A review of the incidence of nonprescription psychoactive substance use/misuse in Nigeria

Convergent Validity of Self-Administered Addiction Severity Index in a Sample of Nigerian Patients in a Residential Treatment Facility

BACKGROUND

Substance use disorders present with multiple drug-related problems that need to be evaluated with a view to planning and administering holistic interventions that could potentially improve addiction treatment outcomes. Many valid instruments are available for assessing the problems that occur in addiction but most of them require some training and they take a lot of time to administer. This study validates a shorter self-administered version of the Addiction severity Index (ASI) against the Clinician-administered ASI with a view to cutting the time needed to administer the instrument.

METHODS

The study recruited 142 patients in a residential treatment center. Correlation coefficient and t-test were used to assess for the convergence of the two version.

RESULTS

The correlation coefficients ranged from 0.52 to 0.97 for the different domain of the ASI with higher endorsement of problems in the self-administered than clinician administered version in most domains.

CONCLUSION

The self-administered ASI is a valid alternative to the clinician-administered ASI and it saves valuable time especially in resource-constrained settings.

Psychoactive substance use among outpatients with severe mental illness: A comparative study

Background

Despite several studies on the prevalence and pattern of substance use in Nigeria, there is little information on substance use in patients diagnosed with serious mental illness (SMI) such as schizophrenia and bipolar affective disorder (BD).

Aim

The aim of the study was to compare the pattern of psychoactive substance use among outpatients with BD and schizophrenia.

Setting

The study was conducted in a neuropsychiatric hospital in Nigeria.

Methods

Seventy five consecutive patients with a MINI-PLUS diagnosis of BD were compared with an equal number of patients obtained by systematic random sampling with a MINI-PLUS diagnosis of schizophrenia.

Results

The respondents with schizophrenia were aged 18–59 years (37.2 ± 9.99) and were predominantly young adult (49, 65.3%), men (46, 61.3%), who were never married (38, 50.7%). Overall, lifetime drug use prevalence was 52%, while for current use, overall prevalence was 21.3%. Participants with BD were aged 18–63 years (36.7 ± 10.29) and were predominantly young adult (53, 70.7%), women (44, 58.7%), who were married (32, 42.7%), with tertiary education (31, 41.3%). Overall, lifetime drug use prevalence was 46.7%, while current overall prevalence was 17.3%. These rates (lifetime and current) for both diagnostic groups are higher than what was reported by the World Health Organization in the global status report of 2014 (0% – 16%). The statistically significant difference between the two diagnostic groups was related to their sociodemographic and clinical variables and psychoactive substance use.

Conclusion

Psychoactive substance use remains a burden in the care of patients diagnosed with schizophrenia and BD. Future policies should incorporate routine screening for substance use at the outpatient department with a view to stemming the tide of this menace.

Alcohol consumption as a barrier to prior HIV testing in a population-based study in rural Uganda

Early receipt of HIV care and ART is essential for improving treatment outcomes, but is dependent first upon HIV testing. Heavy alcohol consumption is common in sub-Saharan Africa, a barrier to ART adherence, and a potential barrier to HIV care. We conducted a population-based study of 2,516 adults in southwestern Uganda from November-December 2007, and estimated the relative risk of having never been tested for HIV using sex-stratified Poisson models. More men (63.9 %) than women (56.9 %) had never been tested. In multivariable analysis, compared to women who had not consumed alcohol for at least 5 years, women who were current heavy drinkers and women who last drank alcohol 1-5 years prior, were more likely to have never been tested. Alcohol use was not associated with prior HIV testing among men. HIV testing strategies may thus need to specifically target women who drink alcohol.

Phosphatidylethanol (PEth) as a biomarker of alcohol consumption in HIV-positive patients in sub-Saharan Africa

BACKGROUND

Alcohol is heavily consumed in sub-Saharan Africa and affects HIV transmission and treatment and is difficult to measure. Our goal was to examine the test characteristics of a direct metabolite of alcohol consumption, phosphatidylethanol (PEth).

METHODS

Persons infected with HIV were recruited from a large HIV clinic in southwestern Uganda. We conducted surveys and breath alcohol concentration (BRAC) testing at 21 daily home or drinking establishment visits, and blood was collected on day 21 (n = 77). PEth in whole blood was compared with prior 7-, 14-, and 21-day alcohol consumption.

RESULTS

(i) The receiver operator characteristic area under the curve (ROC-AUC) was highest for PEth versus any consumption over the prior 21 days (0.92; 95% confidence interval [CI]: 0.86 to 0.97). The sensitivity for any detectable PEth was 88.0% (95% CI: 76.0 to 95.6) and the specificity was 88.5% (95% CI: 69.8 to 97.6). (ii) The ROC-AUC of PEth versus any 21-day alcohol consumption did not vary with age, body mass index, CD4 cell count, hepatitis B virus infection, and antiretroviral therapy status, but was higher for men compared with women (p = 0.03). (iii) PEth measurements were correlated with several measures of alcohol consumption, including number of drinking days in the prior 21 days (Spearman r = 0.74, p < 0.001) and BRAC (r = 0.75, p < 0.001).

CONCLUSIONS

The data add support to the body of evidence for PEth as a useful marker of alcohol consumption with high ROC-AUC, sensitivity, and specificity. Future studies should further address the period and level of alcohol consumption for which PEth is detectable.

Epidemiology of psychoactive drug use amongst adolescents in metropolitan Lagos, Nigeria

The study was conducted in response to the lack of epidemiological data in recent time on the use of psychoactive substances by adolescents in metropolitan Lagos-a city unique for its socio-economic profile. We considered some methodological issues omitted in several previous studies. A total of 4,286 school pupils (mean age 15.2) were anonymously administered a Self-Report Questionnaire to ascertain a range of key drug use factors in lifetime and 1-year periods. The rate of use of most of the 14 substances investigated was much higher than reported in any other study on comparable population sample. We found that 61.8 and 32.1% of respondents have used one or more substances in their lifetime and in the past 1 year, respectively. High lifetime rates of use were found for common stimulants: coffee, kolanut, and prescription drugs (barbiturates and minor tranquilisers). The rate of use of proscribed addictive substances, cannabis, heroin, and cocaine, ranged between 4.0 and 4.8%. Missing data and non-response rates were few; however, social acquiescence, under and over reporting, could be mitigant to estimation of rates and patterns of use. We advocate properly articulated school-based educative programmes that can facilitate drug demand reduction.

Secondhand smoke exposure, awareness, and prevention among African-born women

BACKGROUND

Little research exists on exposure to the health risks of secondhand smoke among women and children in African immigrant communities.

PURPOSE

This exploratory study aims to understand the prevalence of secondhand smoke exposure; assess levels of awareness of the dangers of secondhand smoke; and identify strategies for building increased awareness of these issues in African immigrant communities in Minnesota.

METHODS

Key informant interviews with ten African women community leaders, focus groups with 29 female African youth, and surveys of 223 African women were conducted between August 2008 and March 2009. The focus groups and key informant interviews were in English, and the surveys were in English, French, Oromo, and Somali.

RESULTS

Over one quarter of African women reported daily exposure to cigarette smoke, and one in ten women reported daily exposure to smoke from shisha (fruit-flavored tobacco smoked in a hookah or waterpipe). Many respondents had general awareness of the health impacts of tobacco smoke, but some were unsure. The majority felt that increased awareness was badly needed in their communities. Awareness of the health impacts of shisha smoking was particularly low. Strategies for increasing awareness include: using media and visual images, attending large gatherings, and appealing to community members' priorities, including protecting their children.

CONCLUSIONS

Exposure to secondhand smoke among women and children in African immigrant communities in Minnesota is substantial. Awareness about the health impacts of secondhand smoke exposure in these communities needs to be increased. Disseminating visual information at existing community gatherings or appealing to individual priorities may be the best approaches to increase awareness and motivate change.