A 20 year retrospective analysis of medicolegal deaths in a tertiary hospital setting in Nigeria

Death registration in Nigeria: a systematic literature review of its performance and challenges

Background

Death registration provides an opportunity for the legal documentation of death of persons. Documentation of deaths has several implications including its use in the recovery of inheritance and insurance benefits. It is also an important input for construction of life tables which are crucial for national planning. However, the registration of deaths is poor in several countries including Nigeria.

Objective

This paper describes the performance of death registration in Nigeria and factors that may affect its performance.

Methods

We conducted a systematic literature review of death registration completeness in Nigeria to identify, characterize issues as well as challenges associated with realizing completeness in death registration.

Results

Only 13.5% of deaths in Nigeria were registered in 2007 which regressed to 10% in 2017. There was no data reported for Nigeria in the World Health Organization database between 2008 and 2017. The country scored less than 0.1 (out of a maximum of 1) on the Vital Statistics Performance Index. There are multiple institutions with parallel constitutional and legal responsibilities for death registration in Nigeria including the National Population Commission, National Identity Management Commission and Local Government Authorities, which may be contributing to its overall poor performance.

Conclusions

We offer proposals to substantially improve death registration completeness in Nigeria including the streamlining and merger of the National Population Commission and the National Identity Management Commission into one commission, the revision of the legal mandate of the new agency to mainly coordination and establishment of standards. We recommend that Local Government authorities maintain the local registries given their proximity to households. This arrangement will be enhanced by increased utilization of information and communications technology in Civil Registration and Vital Statistics processes that ensure records are properly archived.

An Autopsy Study of Pattern and Yearly Trend of Homicide in Warri, Nigeria

Background:

Homicide is a common cause of unnatural death and an index of the level of security of the state. The aim of this study was to analyze all autopsied unnatural homicide cases in Warri, Nigeria from 2003 to 2016 with emphasis on age, sex, regional distribution of injury, and circumstance of death.

Materials and Methods:

Six hundred and seventy-four cases were studied and relevant information extracted from police and autopsy records. These information were analyzed using SPSS 21.

Results:

Unnatural homicide cases accounted for 69.1% of 975 medicolegal deaths autopsied in this region, with a male to female distribution of 14:1. The mean age of the victims was 33.2 years with the highest incidence occurring in the 3^rd decade. Firearms, sharp weapons, blunt weapons, suffocation, and burning were the methods used in 426 (63.2%), 162 (24.0%), 73 (10.8%), 11 (1.7%), and 2 (0.3%) cases, respectively. The chest, the head, and the neck were the most common parts of the body affected representing 275 (40.8%), 162 (24%), and 52 (7.7%) of cases.

Conclusion:

Unnatural death as a result of homicide is very common in the study area and mainly perpetrated using firearms and sharps with young males being the most vulnerable age group. The head, chest, and neck are more commonly affected regions of the body.

The Yoruba version of the Beck Hopelessness Scale: psychometric characteristics and correlates of hopelessness in a sample of Nigerian psychiatric outpatients

BACKGROUND

Previous studies from the developed western countries have repeatedly demonstrated that hopelessness positively correlates with an increased risk of suicide in the context of chronic mental disorders such as schizophrenia and affective disorders. Despite this persistently strong association, the construct of hopelessness in terms of its factorial structure and correlates has not been explored among Nigerian psychiatric outpatients.

OBJECTIVE

The aim of this present study is to examine the psychometric characteristics of the Yoruba language culturally adapted version of the Beck Hopelessness Scale in a cross-sectional sample of psychiatric outpatients in South-western Nigeria.

METHOD

The participants were 327 Nigerian adult outpatients receiving treatment for schizophrenia, bipolar and depressive disorders, consecutively recruited from the outpatient psychiatric clinics of a university teaching hospital in South-western Nigeria. The outpatients were recruited over a one year period. They completed the Yoruba translated version of the Beck Hopelessness Scale (BHS-Y), a sociodemographic and illness-related questionnaire, the Beck Depression Inventory-II (BDI-II). Their level of functioning was assessed with the Global Assessment of Functioning Scale (GAF), psychopathology was evaluated with the Positive and Negative Syndrome Scale (PANSS) and the level of disability measured with the World Health Organization Disability Assessment Schedule (WHODAS-II). Suicidality and confirmation of the diagnoses of schizophrenia, bipolar and depressive disorders were evaluated with the Mini International Neuropsychiatric Interview (MINI). The construct of hopelessness in terms of factorial structure, reliability, validity and correlates was explored. Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation was used to examine the factorial structure of the BHS-Y. Internal consistency was examined with Cronbach's alpha, and the construct validity of the scale was assessed using correlational analyses with the MINI suicidality module, BDI-II, GAF and WHODAS-II domain scores. We also tested the hypothesis that a shortened version of the BHS-Y will possess psychometric properties similar to the 20 item version.

RESULTS

Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation showed that the construct of hopelessness among our outpatients was best explained by a 3 factor model. Reliability of the translated version of the scale was adequate as indicated by a Cronbach's alpha of 0.92. Construct validity was also satisfactory as reflected by the strong correlations with MINI suicidality, Beck Depression Inventory-II and Global Assessment of Functioning scores. The shortened 4 item single factor BHS-Y composed of items 8, 9, 13 and 15 demonstrated psychometric properties similar to those of the full item version.

CONCLUSION

The Beck Hopelessness Scale (Yoruba Version) demonstrated satisfactory reliability and validity and therefore may be useful in measuring the construct of hopelessness and in clinical suicide risk assessments among Nigerian psychiatric outpatients. There is the need for more studies to further explore the psychometric features and correlates of this scale among other Nigerian ethnic groups in addition to other medical patients' populations.