Schizophrenia: illness impact on family members in a traditional society – rural Ethiopia

Background: Studies have consistently shown that both the subjective and objective dimensions of burden among family members of schizophrenia patients and other psychiatric disorders are prevalent. However, as most of these reports were from western societies, we lack information on the subject in developing countries. Method: The study was conducted within the framework of the ongoing epidemiological study of course and outcome of schizophrenia and bipolar disorders in a rural population of 15–49 years of age. Three hundred and one cases of schizophrenia and their close relatives participated in the study. Results: Family burden is a common problem of relatives of cases with schizophrenia. Financial difficulty is the most frequently endorsed problem among the family burden domains (74.4 %). Relatives of female cases suffered significantly higher social burden (Z = 2.103; p = 0.036). Work (Z = 2.180; p = 0.029) and financial (Z = 2.088; p = 0.037) burdens affected female relatives more often than males. Disorganised symptoms were the most important factors affecting the family members in all family burden domains. Prayer was found to be the most frequently used coping strategy in work burden (adj. OR = 1.99; 95 % CI = 1.08–3.67; p = 0.026). Conclusion: Negative impact of schizophrenia on family members is substantial even in traditional societies such as those in Ethiopia where family network is strong and important. The scarce existing services in the developing countries should include family interventions and support at least in the form of educating the family members about the nature of schizophrenia illness and dealing with its stigma and family burden. Received: 15 January 2002 / Accepted: 29 July 2002 Correspondence to Gunnar Kullgren, MD, PhD     

Onset and clinical course of schizophrenia in Butajira-Ethiopia

Abstract. Background: There are reports on favourable course and outcome of schizophrenia in lowincome countries. The aim of the present study was to examine onset and clinical course of the illness in a community-based sample in rural Ethiopia based on crosssectional information. Method: A two-stage survey was carried out in Butajira-Ethiopia, a predominantly rural district. Altogether 68,378 individuals aged 15–49 years were CIDI-interviewed, of whom 2,159 were identified as cases according to the CIDI interview with regard to psychotic or affective disorders. Key informants identified another group of 719 individuals as being probable cases and a total of 2,285 individuals were SCAN-interviewed. The present paper reports on cases with schizophrenia. Results: There were 321 cases of schizophrenia giving an estimated lifetime prevalence of 4.7/1,000). Of the cases,83.2% (N = 267) were males. Mean age of first onset of psychotic symptoms for males was 23.8 (sd 8.6) compared to 21.0 (sd 7.8) for females (P = 0.037; 95 %CI 0.16–5.47). Over 80% had negative symptoms and over 67% reported continuous course of the illness. Less than 10% had a history of previous treatment with neuroleptic medication. About 7% were vagrants, 9 % had a history of assaultive behaviour,and 3.8% had attempted suicide. The male to female ratio was nearly 5:1. Conclusion: This large community-based study differs from most previous studies in terms of higher male to female ratio, earlier age of onset in females and the predominance of negative symptoms.     

Burden of disease analysis in rural Ethiopia

We describe the design and results of a study conducted to determine the magnitude and healthy years of life lost due to morbidity and mortality for major causes in rural Ethiopia. The design included a cross-sectional household survey to determine the magnitude and causes of morbidity and a retrospective longitudinal study to determine the magnitude and causes of mortality. The study was conducted between June 1 and July 12, 1998, within the Butajira Rural Health Project (BRHP) setting. The source population were all people residing in the district and the study population were the sample of households for the BRHP which are the inhabitants of nine rural and one urban Kebeles (villages) in Butajira area, which is located about 130 Kms south of Addis Ababa. The sample was previously selected randomly using probabilities proportional to size, constituting 10% of the total district population (approximately 32,000) and has been under continuous demographic surveillance since 1987. All individuals who were sick two weeks preceding the survey and all those who deceased in the two years prior to the survey were included in the present analysis. The Disability-Adjusted Life Years (DALYs) lost was used as a measure of the burden of disease from the analyzed data. According to the results, prevalence of morbidity within the preceding two weeks was 13.8% (95% CI = 12.8-14.8). In addition, there were 875 deaths during the preceding two years making an annual mortality rate of 13.5 per 1,000 populations (95% CI = 13.13-13.87). The total burden of disease in terms of DALYs lost calculated from these data was 59,125 per 100,000 populations (95% CI = 58,591-59,659). Communicable, maternal, perinatal and nutritional problems contributed to 72% of the total DALYs lost; non-communicable diseases contributed to 24% of the DALYs lost while the proportion of DALYs lost due to injuries was only 4%. The results were similar to previous estimates for countries in Sub-Saharan Africa.     

Use of psychiatric rating instruments in Ethiopia

It is quite fascinating to see the increasing use of psychiatric rating instruments in Ethiopia in the last 3 decades, almost parallel with the growing interest world-wide. A review of those instruments used in Ethiopia was made to evaluate their applicability and quality, and to recommend ways of ensuring standard use. In this paper, the effect of culture and translation are discussed and practical ways of using the instruments in field situation, and culturally sensitive and applicable ways of translation are endorsed. Their use in general medical settings, is also stressed.     

Preliminary results of natural radioactivity measurements in the southern part of Ethiopia

The paper presents the first results of natural radioactivity measurements in the Southern part of Ethiopia (Bale Zone-Oromiya Regional State). The preliminary results indicate that radiation levels in the mining areas of Kallido Mountain are elevated compared with those in the town of Negele Borena (background area). Both external gamma radiation and alpha surface contamination levels are significantly elevated above local background levels.     

Adherence to highly active antiretroviral therapy and its correlates among HIV infected pediatric patients in Ethiopia

Background  

The introduction of combination antiretroviral therapy (ART) has resulted in striking reductions in HIV-related mortality. Despite increased availability of ART, children remain a neglected population. This may be due to concerns that failure to adhere appears to be related to continued viral replication, treatment failure and the emergence of drug-resistant strains of HIV. This study determines the rates and factors associated with adherence to Antiretroviral (ARV) Drug therapy in HIV-infected children who were receiving Highly Active Antiretroviral Therapy (HAART) in Addis Ababa, Ethiopia in 2008.     

Consistent management of repeated procedural pain with sucrose in preterm neonates: Is it effective and safe for repeated use over time?

OBJECTIVE: Preterm neonates undergo numerous painful procedures in the neonatal intensive care unit (NICU). Sucrose, with and without pacifiers, is effective and safe for relieving pain from single painful events. However, repeated use of sucrose for multiple painful procedures has not been adequately evaluated. The study objectives were to: 1) determine the efficacy and safety of consistent management of repeated procedural pain with sucrose; and 2) explore the impact of consistent pain management on clinical outcomes and neurobiological risk status. METHODS: Sixty-six preterm infants were randomized to receive standard care (positioning and swaddling; n = 21), sterile water plus pacifier (n = 23), or 24% sucrose plus pacifier (n = 22) prior to all painful procedures in the NICU during the first 28 days of life. Also, at a routine heel lance at 7, 14, 21, and 28 days of life, data were collected to determine efficacy and immediate and long-term adverse events. Data on clinical outcomes and neurobiological risk status were collected at 28 days or NICU discharge. RESULTS: There was no intervention by time interaction (P = 0.60). There was a significant main effect of intervention (P = 0.03) between the sucrose plus pacifier group, and the standard care group (P = 0.01), but there was no main effect of time (P = 0.72). No group differences existed for adverse events, clinical outcomes, or neurobiological risk status. DISCUSSION: Consistent management of painful procedures with sucrose plus pacifier was effective and safe for preterm neonates during their stay in the NICU. Further exploration of consistent pain management with sucrose on clinical, developmental, and neurobiological outcomes is required.     

Cluster analysis for identifying sub-groups and selecting potential discriminatory variables in human encephalitis

Background

There is conclusive evidence that human papillomavirus (HPV) infections of the cervix are a necessary cause of cervical cancer. In Italy there are consistent data of HPV prevalence in women aged 25 - 64 years, but there is limited data for younger women. The objective of this on-going 3-year prospective cohort study is to investigate the prevalence, acquisition, clearance and persistence of HPV infections in young Tuscan women and the risk factors correlated with such events.

Methods

One thousand and sixty-six women aged between 18 and 24 years were enrolled and received an initial HPV test. They were asked to return to the clinic over the study period for further tests every 12 months, if their HPV HR result was negative, or every 6 months, if positive. Additionally, women with an HPV positive result were given a cytological examination and if the cytological diagnosis was ASC-US or more severe, only women with HPV HR, were referred for colposcopy.

Results

We present here data for the enrolment phase of the study. At baseline, within the study sample, just under 30% of women were infected by HPV and 19.3% of women were infected with oncogenic types. A relationship was highlighted between HPV infection, number of sexual partners (in particularly in the last 3 years) and the lifetime number of partner's partners. Condom use showed a slight protective effect in univariate analysis but these data were not statistically significant in multivariate analysis. The association between HPV infection and demographic and behavioural variables were tested by crude odds ratio (OR). Multivariate logistic regression was applied to compute the adjusted odds ratios.

Conclusions

The prevalence of oncogenic HPV types was high in young Tuscan women. The 3-year follow-up of this cohort may provide a better understanding of the processes of acquisition, clearance and persistence of infection and the correlated risk factors.     

Clinical course and outcome of schizophrenia in a predominantly treatment-naive cohort in rural Ethiopia

The established view that schizophrenia may have a favorable outcome in developing countries has been recently challenged; however, systematic studies are scarce. In this report, we describe the clinical outcome of schizophrenia among a predominantly treatment-naive cohort in a rural community setting in Ethiopia. The cohort was identified in a 2-stage sampling design using key informants and measurement-based assessment. Follow-up assessments were conducted monthly for a mean duration of 3.4 years (range 1-6 years). After screening 68 378 adults, ages 15-49 years, 321 cases with schizophrenia (82.7% men and 89.6% treatment naive) were identified. During follow-up, about a third (30.8%) of cases were continuously ill while most of the remaining cohort experienced an episodic course. Only 5.7% of the cases enjoyed a near-continuous complete remission. In the final year of follow-up, over half of the cases (54%) were in psychotic episode, while 17.6% were in partial remission and 27.4% were in complete remission for at least the month preceding the follow-up assessment. Living in a household with 3 or more adults, later age of onset, and taking antipsychotic medication for at least 50% of the follow-up period predicted complete remission. Although outcome in this setting appears better than in developed countries, the very low proportion of participants in complete remission supports the recent observation that the outcome of schizophrenia in developing countries may be heterogeneous rather than uniformly favorable. Improving access to treatment may be the logical next step to improve outcome of schizophrenia in this setting.