Publications (12)31.46 Total impact
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Article: Strain and its correlates among carers of people with dementia in low-income and middle-income countries. A 10/66 Dementia Research Group population-based survey.
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ABSTRACT: In a multi-site population-based study in several middle-income countries, we aimed to investigate relative contributions of care arrangements and characteristics of carers and care recipients to strain among carers of people with dementia. Based on previous research, hypotheses focused on carer sex, care inputs, behavioural and psychological symptoms (BPSD) and socioeconomic status, together with potential buffering effects of informal support and employing paid carers. In population-based catchment area surveys in 11 sites in Latin America, India and China, we analysed data collected from people with dementia and care needs, and their carers. Carer strain was assessed with the Zarit Burden Interview. With 673 care recipient/carer dyads interviewed (99% of those eligible), mean Zarit Burden Interview scores ranged between 17.1 and 27.9 by site. Women carers reported more strain than men. The most substantial correlates of carer strain were primary stressors BPSD, dementia severity, needs for care and time spent caring. Socioeconomic status was not associated with carer strain. Those cutting back on work experienced higher strain. There was tentative evidence for a protective effect of having additional informal or paid support. Our findings underline the global impact of caring for a person with dementia and support the need for scaling up carer support, education and training. That giving up work to care was prevalent and associated with substantial increased strain emphasizes the economic impact of caring on the household. Carer benefits, disability benefits for people with dementia and respite care should all be considered.International Journal of Geriatric Psychiatry 03/2012; 27(7):670-82. · 2.42 Impact Factor -
Article: Equity in the delivery of community healthcare to older people: findings from 10/66 Dementia Research Group cross-sectional surveys in Latin America, China, India and Nigeria.
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ABSTRACT: To describe patterns of recent health service utilisation, and consequent out-of-pocket expenses among older people in countries with low and middle incomes, and to assess the equity with which services are accessed and delivered. 17,944 people aged 65 years and over were assessed in one-phase population-based cross-sectional surveys in geographically-defined catchment areas in nine countries - urban and rural sites in China, India, Mexico and Peru, urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and a rural site in Nigeria. The main outcome was use of community health care services in the past 3 months. Independent associations were estimated with indicators of need (dementia, depression, physical impairments), predisposing factors (age, sex, and education), and enabling factors (household assets, pension receipt and health insurance) using Poisson regression to generate prevalence ratios and fixed effects meta-analysis to combine them. The proportion using healthcare services varied from 6% to 82% among sites. Number of physical impairments (pooled prevalence ratio 1.37, 95% CI 1.26-1.49) and ICD-10 depressive episode (pooled PR 1.21, 95% CI 1.07-1.38) were associated with service use, but dementia was inversely associated (pooled PR 0.93, 95% CI 0.90-0.97). Other correlates were female sex, higher education, more household assets, receiving a pension, and health insurance. Standardisation for age, sex, physical impairments, depression and dementia did not explain variation in service use. There was a strong borderline significant ecological correlation between the proportion of consultations requiring out-of-pocket costs and the prevalence of health service use (r = -0.50, p = 0.09). While there was little evidence of ageism, inequity was apparent in the independent enabling effects of education and health insurance cover, the latter particularly in sites where out-of-pocket expenses were common, and private health insurance an important component of healthcare financing. Variation in service use among sites was most plausibly accounted for by stark differences in the extent of out-of-pocket expenses, and the ability of older people and their families to afford them. Health systems that finance medical services through out-of-pocket payments risk excluding the poorest older people, those without a secure regular income, and the uninsured.BMC Health Services Research 06/2011; 11:153. · 1.66 Impact Factor -
Article: Emotional distress, physical illness and functional impairment in community dwelling older adults in South Eastern Nigeria--a report from the 1066 group.
International Journal of Geriatric Psychiatry 05/2011; 26(5):545-6. · 2.42 Impact Factor -
Article: The relationship of comorbidity of mental and substance use disorders with suicidal behaviors in the Nigerian Survey of Mental Health and Wellbeing.
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ABSTRACT: Mental and substance use disorders are often associated with an elevated risk for suicidal behaviors. The role of the co-occurrence of multiple disorders in this association is still unclear. The Nigerian Survey of Mental Health and Wellbeing is a community survey of mental and substance use disorders as well as of suicidal outcomes. Face-to-face assessment was conducted using the World Health Organization's Composite International Diagnostic Interview, version 3. A total of 6,752 adults, aged 18 years and over, were interviewed. Persons with lifetime suicide attempt were more likely than those without attempt to have experienced lifetime DSM-IV disorders. Lifetime attempters were also more likely to have comorbid conditions. Compared with only 0.4% of persons with no history of lifetime attempts, over 11% of persons with lifetime attempt had three or more co-occurring disorders. Multivariate analysis controlling for the effects of comorbid conditions suggests that while mood disorder is independently associated with suicidal outcomes, comorbidity partly explains the association of anxiety disorders and almost fully accounts for the association of substance use disorders with suicidal outcomes. Comorbidity is an important factor in the association of mental and substance use disorders with suicidal behavior.Social Psychiatry 02/2010; 46(3):173-80. · 2.05 Impact Factor -
Article: The epidemiology of dependence in older people in Nigeria: prevalence, determinants, informal care, and health service utilization. A 10/66 dementia research group cross-sectional survey.
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ABSTRACT: To describe the prevalence and determinants of dependence in older Nigerians and associations with informal care and health service utilization. A single-phase cross-sectional catchment area survey. Dunukofia, a rural community in southeastern Nigeria. One thousand two hundred thirty-eight adults aged 65 and older, for whom full data were available on 914. The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, cognitive impairment, physical impairments, and self-reported diagnoses. The interviewer rated dependence as not needing care, needing some care, or needing much care. The prevalence of dependence and the independent contribution of underlying health conditions were estimated. Sources of income, care arrangements, caregiver strain, and health service use are described according to level of dependence. The prevalence of dependence was 24.3% (95% confidence interval=22.1-26.5%), with a concentration in participants aged 80 and older. Only 1% of participants received a pension, and fewer than 7% had paid work. Those who were dependent were less likely than others to receive income from their family. Cognitive impairment, physical impairments, stroke, and depression were each independently associated with dependence. Depression made the largest contribution. Dependence was strongly associated with health service use (particularly private doctor and traditional healer services) and with high levels of out-of-pocket expenditure. In Nigeria, dependence is an important outcome given rapid demographic aging and increases in chronic disease prevalence in all developing regions. Enhancing the social protection of dependent older adults should be a policy priority. Cognitive and mental disorders are important contributors to disability and dependence; more attention should be given to their prevention, detection, and treatment.Journal of the American Geriatrics Society 09/2009; 57(9):1620-7. · 3.74 Impact Factor -
Article: Depression in adult Nigerians: results from the Nigerian Survey of Mental Health and Well-being.
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ABSTRACT: Community-based studies of the rates and profile of depression among Africans are still sparse. As part of the World Mental Health Surveys initiative, a clustered multi-stage sampling of households in 21 of Nigeria's 36 states (representing 57% of the national population) was implemented to select adults aged 18 years and over (N=6752) for face-to-face interviews using the Composite International Diagnostic Interview (CIDI 3.0). Diagnosis of major depressive episode (MDE) was based on the criteria of the Diagnostic and Statistical Manual, 4th edition. Lifetime and 12-month estimates of MDE were 3.1% (standard error 0.3) and 1.1% (s.e. 0.1), receptively. Increasing age was associated with higher estimates of positive responses to stem (screen) questions for depression and of lifetime disorders among stem-positive respondents. The mean age of onset was about 29.2 years. The median (inter quartile range, IQR) duration of an episode among lifetime cases was 1.0 (2.0-2.4) year and the median (IQR) number of lifetime episodes was 1.5 (2.0-2.8). MDE was highly comorbid with anxiety disorders, musculoskeletal conditions, chronic pain and ulcer. The odds ratio of lifetime suicide attempt among persons with lifetime MDE was 11.6 (95% confidence interval, 3.9-34.9). Over 25% of 12-month cases were rated as severely disabled in the performance of usual roles. Only 16.9% (s.e. 5.0) of 12-month cases had received any treatment. All data were based on self-reports. MDE, defined according to DSM-IV, is a risk factor for mental and physical comorbidity as well as disability in Nigerians. Age-related telescoping or denial may partly explain the low rates in this young population.Journal of affective disorders 06/2009; 120(1-3):158-64. · 3.76 Impact Factor -
Article: Ageing and dementia in low and middle income countries-Using research to engage with public and policy makers.
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ABSTRACT: While two thirds of the 24 million people with dementia worldwide live in low and middle income countries, very little research has been conducted to support policy making in these regions. Among the non-communicable diseases, dementia (in common with other chronic NCDs linked more to long-term disability than to mortality) has been relatively under-prioritized. International agreements, plans and policy guidelines have called for an end to ageist discrimination and a focus upon reducing disadvantage arising from poverty and the consequences of ill health. Social protection, access to good quality age-appropriate healthcare and addressing the problem of disability are all key issues. However, as yet, little progress has been made in addressing these concerns. In this review we outline the current international policy agenda for older individuals, and its specific relevance to those with dementia and other disabling non-communicable diseases. We consider the potential for epidemiological research to raise awareness, refine the policy agenda, and promote action, using the example of the dissemination strategy developed by the 10/66 Dementia Research Group.International Review of Psychiatry 09/2008; 20(4):332-43. · 1.80 Impact Factor -
Article: A descriptive epidemiology of substance use and substance use disorders in Nigeria during the early 21st century.
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ABSTRACT: Several studies have examined the use of psychoactive substances among selected groups in Nigeria. Here, we extend the description to include the features of substance dependence. A stratified multi-stage random sampling of households was used to select respondents in 21 of Nigeria's 36 states (representing 57% of the national population). In-person interviews with 6752 adults were conducted using the World Health Organization Composite International Diagnostic Interview, Version 3. Lifetime history and recent (past year) use, as well as features of dependence on, alcohol, tobacco, cannabis, sedatives, stimulants, and other drugs were assessed. Alcohol was the most commonly used substance, with 56% (95% confidence interval, CI=54, 58%) ever users and 14% (95% CI=13, 15%) recent (past year) users. Roughly 3% were recent smokers (3%, 95% CI=2.6, 4.2%). Next most common were sedatives, 4% (95% CI=2.3, 4.5%), and cannabis smokers, 0.4% (95% CI=0.1, 0.6%). Males were more likely than females to be users of every drug group investigated, with male preponderance being particularly marked for cannabis. Prevalence of both alcohol and tobacco use was highest among middle aged adults. Moslems were much less likely to use alcohol than persons of other faiths, but no such association was found for tobacco, non-prescription drug use, or illegal drug use. Features of abuse and dependence were more common at the population level for alcohol; but among users, these features were just as likely to be experienced by alcohol users as they were by other drug users. Alcohol is the most commonly used psychoactive drug in Nigeria. Features associated with drug dependence and abuse are less prevalent but may require attention by public health authorities.Drug and Alcohol Dependence 12/2007; 91(1):1-9. · 3.38 Impact Factor -
Article: Comorbidity and impact of chronic spinal pain in Nigeria.
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ABSTRACT: A cross-sectional survey of households selected using multistage stratified sampling. This paper investigates the prevalence of chronic spinal pain, its profile of comorbidity, and its impact on role disability in Nigeria. Study was conducted in 21 states representing 57% of the national population. A probability sample (n = 2143) was interviewed. Self-reports of chronic spinal pain, other pain conditions, as well as comorbid medical conditions were obtained. Composite International Diagnostic Interview, version 3, was used to evaluate mood, anxiety, and substance use disorders. Functional role impairment was assessed with questions about days out of role. Chronic spinal pain was present in 16.4% (95% confidence interval, 14.5%-18.5%) of the sample. Prevalence increased with age of respondents, with 1 in 3 persons 60 years of age and older reporting chronic spinal pain. Persons with chronic spinal pain were at elevated risk to have chronic pain at other anatomic sites, to have a range of medical comorbidities, and to have mood and substance use disorders. Even though about one third of the decrement in functional role performance associated with chronic pain condition was attributable to demographics and comorbid conditions, chronic spinal pain was independently associated with significant role impairment. Chronic spinal pain is a common problem in the Nigerian community, and persons 60 years of age and older may be at particularly elevated risk. Chronic spinal pain is associated with increased probability of comorbid physical and mental disorders. These comorbid conditions partly but do not fully explain the disability associated with chronic spinal pain, which therefore constitutes a substantial health burden on the society.Spine 09/2007; 32(17):E495-500. · 2.08 Impact Factor -
Article: The profile and risks of suicidal behaviours in the Nigerian Survey of Mental Health and Well-Being.
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ABSTRACT: Suicide is a leading cause of death worldwide but information about it is sparse in Sub-Saharan Africa. Suicide-related behaviours can provide an insight into the extent of this compelling consequence of mental illness. Face-to-face interviews were conducted with a representative sample of persons aged 18 years and over (n=6752) in 21 of Nigeria's 36 states (representing about 57% of the national population). Suicide-related outcomes, mental disorders, as well as history of childhood adversities were assessed using the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Lifetime prevalence estimates of suicide ideation, plan and attempts were 3.2% [95% confidence interval (CI) 1.4-6.5], 1.0% (95% CI 0.4-7.5) and 0.7% (95% CI 0.5-1.0) respectively. Almost two of every three ideators who made a plan went on to make an attempt. The highest risks for transition from ideation to plan and from plan to attempt were in the first year of having ideation or plan respectively. Mental disorders, especially mood disorders, were significant correlates of suicide-related outcomes. Childhood adversities of long separation from biological parents, being raised in a household with much conflict, being physically abused, or being brought up by a woman who had suffered from depression, anxiety disorder, or who had attempted suicide were risk factors for lifetime suicide attempt. History of childhood adversities and of lifetime mental disorders identify persons at high-risk for suicide-related outcomes. Preventive measures are best delivered within the first year of suicide ideation being expressed.Psychological Medicine 07/2007; 37(6):821-30. · 6.16 Impact Factor -
Article: The protocols for the 10/66 dementia research group population-based research programme.
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ABSTRACT: Latin America, China and India are experiencing unprecedentedly rapid demographic ageing with an increasing number of people with dementia. The 10/66 Dementia Research Group's title refers to the 66% of people with dementia that live in developing countries and the less than one tenth of population-based research carried out in those settings. This paper describes the protocols for the 10/66 population-based and intervention studies that aim to redress this imbalance. Cross-sectional comprehensive one phase surveys have been conducted of all residents aged 65 and over of geographically defined catchment areas in ten low and middle income countries (India, China, Nigeria, Cuba, Dominican Republic, Brazil, Venezuela, Mexico, Peru and Argentina), with a sample size of between 1000 and 3000 (generally 2000). Each of the studies uses the same core minimum data set with cross-culturally validated assessments (dementia diagnosis and subtypes, mental disorders, physical health, anthropometry, demographics, extensive non communicable disease risk factor questionnaires, disability/functioning, health service utilisation, care arrangements and caregiver strain). Nested within the population based studies is a randomised controlled trial of a caregiver intervention for people with dementia and their families (ISRCTN41039907; ISRCTN41062011; ISRCTN95135433; ISRCTN66355402; ISRCTN93378627; ISRCTN94921815). A follow up of 2.5 to 3.5 years will be conducted in 7 countries (China, Cuba, Dominican Republic, Venezuela, Mexico, Peru and Argentina) to assess risk factors for incident dementia, stroke and all cause and cause-specific mortality; verbal autopsy will be used to identify causes of death. The 10/66 DRG baseline population-based studies are nearly complete. The incidence phase will be completed in 2009. All investigators are committed to establish an anonymised file sharing archive with monitored public access. Our aim is to create an evidence base to empower advocacy, raise awareness about dementia, and ensure that the health and social care needs of older people are anticipated and met.BMC Public Health 02/2007; 7:165. · 2.00 Impact Factor -
Article: The protocols for the 10/66 dementia research group population-based research programme
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ABSTRACT: Abstract Background Latin America, China and India are experiencing unprecedentedly rapid demographic ageing with an increasing number of people with dementia. The 10/66 Dementia Research Group's title refers to the 66% of people with dementia that live in developing countries and the less than one tenth of population-based research carried out in those settings. This paper describes the protocols for the 10/66 population-based and intervention studies that aim to redress this imbalance. Methods/design Cross-sectional comprehensive one phase surveys have been conducted of all residents aged 65 and over of geographically defined catchment areas in ten low and middle income countries (India, China, Nigeria, Cuba, Dominican Republic, Brazil, Venezuela, Mexico, Peru and Argentina), with a sample size of between 1000 and 3000 (generally 2000). Each of the studies uses the same core minimum data set with cross-culturally validated assessments (dementia diagnosis and subtypes, mental disorders, physical health, anthropometry, demographics, extensive non communicable disease risk factor questionnaires, disability/functioning, health service utilisation, care arrangements and caregiver strain). Nested within the population based studies is a randomised controlled trial of a caregiver intervention for people with dementia and their families (ISRCTN41039907; ISRCTN41062011; ISRCTN95135433; ISRCTN66355402; ISRCTN93378627; ISRCTN94921815). A follow up of 2.5 to 3.5 years will be conducted in 7 countries (China, Cuba, Dominican Republic, Venezuela, Mexico, Peru and Argentina) to assess risk factors for incident dementia, stroke and all cause and cause-specific mortality; verbal autopsy will be used to identify causes of death. Discussion The 10/66 DRG baseline population-based studies are nearly complete. The incidence phase will be completed in 2009. All investigators are committed to establish an anonymised file sharing archive with monitored public access. Our aim is to create an evidence base to empower advocacy, raise awareness about dementia, and ensure that the health and social care needs of older people are anticipated and met.BMC Public Health. 01/2007;
Top co-authors
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Institutions
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2007–2011
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Nnamdi Azikiwe University, Awka
- Faculty of Medicine
Awka, Anambra State, Nigeria -
King's College London
- Department of Health Service and Population Research
London, ENG, United Kingdom
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