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Suicide Prevention in Nigeria: How to Manage low mood and Depression

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‘Very often when people say “I am tired of life” or “There is no point in living”, they are brushed off, or are given examples of other persons who have been in worse difficulties. Neither of these responses helps the suicidal person’. -WHO

The causative issues for low mood and depression are quite common all over the world, but there are other issues I have identified peculiar to the Nigerian environment. In this article I would be discussing the common causes of low mood and depression prevalent in our society.

The rate of Depression, suicidal ideation and drug addiction is on the increase in Nigeria at the moment, this seems to be a ‘chain reaction’ triggered by a host of other factors which include, poverty, unemployment, harmful cultural practices , ‘social media factors ‘and  untreated mental health illness  ;schizophrenia, bipolar disorder,etc.

Social Media pressures;

When we were growing up, there was no social media, I call it the good old days, for social activities we spent more time outdoors, and we made use of indoor and outdoor sport facilities.

I grew up in a university environment where I didn’t have to belong to an elite sports club to make use of a gym, basketball court or lawn tennis court. I had the privilege of having a gym where we contributed only a token, although the gym was filled with males doing body building, it was a bit difficult for me to use the gym sometimes as I could be the only female in the gym and felt outnumbered, but I didn’t let that deter me, because I understood the benefits of physical exercise to my wellbeing, and overall health.

Social media has its own advantages and disadvantages, and it could be addictive as well; these days’ young people are influenced by it and so engrossed in having approval through ‘followership’, likes etc they tend to neglect what matters most which is their mental health and wellbeing. Some people have gone into depression when their friends do not like their posts.

The human body was created to function in harmony, when any part is suffering, it affects our productivity. For some of the suicide cases that have occurred recently, the victims made a post about it on social media before the act or while doing the act.

For us to understand how to deal with low mood and depression, we need to know the trigger factors and causes to enable us seek help in good time .Knowing the root cause is essential to identifying ways to solve the problem.

Common causes of low mood and depression:

1-            Bereavement

2-            Lack of self-worth and feeling of inadequacy

3-            Relationship break down like divorce, seperation etc

4-            Poverty- Unemployment

5-            Minor illness and Major diseases

6-            Natural disasters

7-            Tribal Conflicts /Wars

8-            Poor grades or exam failure

9-            Toxic work place

10-          Hectic lifestyle

11-          Excessive overworking

12-          Domestic Violence

13-          Sexual Abuse

14-          Social Media addiction

15-          Lack of sleep

16-          Underlying mental health illness

17-          Infertility

18-          Prescribed Medication

19-          Drug addiction /Abuse

20-          Issues with finding a life partner/Late marriage

How do we maintain our mental health?

There are several ways we could maintain our emotional health and help reduce low mood and depression

According to the WHO, Depression is a common mental disorder, characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks.

In addition, people with depression normally have several of the following: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.

Depression is treatable, with talking therapies or antidepressant medication or a combination of these. Depression is the most common diagnosis in completed suicide. Everyone feels

Depressed, sad, lonely and unstable from time to time, but usually those feelings pass. However,

When the feelings are persistent and disrupt a person’s usual normal life, they cease to be

Depressive feelings and the condition becomes a depressive illness.

Some of the common symptoms of depression are:

  • feeling sad during most of the day, every day;
  • losing interest in usual activities;
  • losing weight (when not dieting) or gaining weight;
  • sleeping too much or too little or waking too early;
  • feeling tired and weak all the time;
  • feeling worthless, guilty or hopeless;
  • feeling irritable and restless all the time;
  • having difficulty in concentrating, making decisions or remembering things;
  • having repeated thoughts of death and suicide.

Life stressors

The majority of those who commit suicide have experienced a number of stressful life events in the three months prior to suicide, such as:

  • Interpersonal problems – e.g. quarrels with spouses, family, friends, lovers;
  • Rejection – e.g. separation from family and friends;
  • Loss events – e.g. financial loss, bereavement;
  • Work and financial problems – e.g. job loss, retirement, financial difficulties;
  • Changes in society – e.g. rapid political and economic changes;
  • Various other stressors such as shame and the threat of being found guilty.

To understand what leads people to committing suicide, we need to understand the state of mind of a suicidal person.

THE STATE OF MIND OF SUICIDAL PERSONS

Three features in particular are characteristic of the state of mind of suicidal patients:

Ambivalence:

Most people have mixed feelings about committing suicide. The wish to live and the wish to die wage a see-saw battle in the suicidal individual. There is an urge to get away from the pain of living and an undercurrent of the desire to live. Many suicidal persons do not really want to die – it is just that they are unhappy with life. If support is given and the wish to live is increased, the suicidal risk is decreased.

Impulsivity:

Suicide is also an impulsive act. Like any other impulse, the impulse to commit suicide is transient and lasts for a few minutes or hours. It is usually triggered by negative day-to-day events. By defusing such crises and by playing for time, the health worker can help to reduce the suicide wish.

Rigidity:

When people are suicidal, their thinking, feelings and actions are constricted. They constantly think about suicide and are unable to perceive other ways out of the problem. They think drastically. A majority of suicidal people communicate their suicidal thoughts and intentions. They often send out signals and make statements about “wanting to die”, “feeling useless”, and so on. All those pleas for help must not be ignored. Whatever the problems, the feelings and thoughts of the suicidal person tend to be the same all round the world.

HOW TO REACH OUT TO THE SUICIDAL PERSON

Very often when people say “I am tired of life” or “There is no point in living”, they are brushed off, or are given examples of other persons who have been in worse difficulties. Neither of these responses helps the suicidal person. The initial contact with the suicidal person is very important. Often the contact occurs in a busy clinic, home or public place where it may be difficult to have a private conversation.

  • Feelings Thoughts
  • Sad, depressed “I wish I were dead”
  • Lonely “I can’t do anything”
  • Helpless “I can’t take it anymore”
  • Hopeless “I am a loser and a burden”
  • Worthless “Others will be happier without me”

 

  1. The first step is to find a suitable place where a quiet conversation can be held in reasonable privacy.
  2. The next step is to allocate the necessary time. Suicidal persons usually need more time to unburden themselves and one must be mentally prepared to give them time.
  3. The most important task is then to listen to them effectively. “To reach out and listen is itself a major step in reducing the level of suicidal despair”.

The aim is to bridge the gap created by mistrust, despair and loss of hope and give the

person the hope that things could change for the better.

How to communicate

  • Listen attentively, be calm.
  • Understand the person’s feelings (empathize).
  • Give non-verbal messages of acceptance and respect.
  • Express respect for the person’s opinions and values.
  • Talk honestly and genuinely.
  • Show your concern, care and warmth.
  • Focus on the person’s feelings.

How not to communicate

  • Interrupt too often.
  • Become shocked or emotional.
  • Convey that you are busy.
  • Be patronizing.
  • Make intrusive or unclear remarks.
  • Ask loaded questions.

A calm, open, caring, accepting and non-judgemental approach is required to facilitate communication.

Also Read Mentoring The Girl Child: Interview With Ebella Whajah Ellis, A Girl Child Advocate

HOW TO MANAGE A SUICIDAL PERSON

Low risk

The person has had some suicidal thoughts, such as “I can’t go on”, “I wish I were dead”, but has not made any plans.

Action needed

  • Offer emotional support.
  • Work through the suicidal feelings. The more openly person talks of loss, isolation and worthlessness, the less his or her emotional turmoil becomes. When the emotional turmoil subsides, the person is likely to be reflective. This process of reflection is crucial, as nobody except that individual can revoke the decision to die and make a decision to live.
  • Focus on the person’s positive strengths by getting him or her to talk of how earlier problems have been resolved without resorting to suicide.
  • Refer the person to a mental health professional or a doctor.
  • Meet at regular intervals and maintain ongoing contact. All these questions must be asked with care, concern and compassion

Medium risk

The person has suicidal thoughts and plans, but has no plans to commit suicide immediately.

Action needed

  • Offer emotional support, work through the person’s suicidal feelings and focus on positive strengths. In addition, continue with the steps below.
  • Use the ambivalence. The health worker should focus on the ambivalence felt by the suicidal person so that gradually the wish to live is strengthened.
  • Explore alternatives to suicide. The health worker should try to explore the various alternatives to suicide even though they may not be ideal solutions, in the hope that the person will consider at least one of them.
  • Make a contract. Extract a promise from the suicidal person that he or she will not commit suicide without contacting the health care staff; for a specific period.
  • Refer the person to a psychiatrist, counsellor or doctor, and make an appointment as soon as possible.
  • Contact the family, friends and colleagues, and enlist their support.

High risk

The person has a definite plan, has the means to do it, and plans to do it immediately.

Action needed

  • Stay with the person. Never leave the person alone.
  • Gently talk to the person and remove the pills, knife, gun, insecticide, etc. (distance the

means of suicide).

  • Make a contract.
  • Contact a mental health professional or doctor immediately and arrange for an ambulance and hospitalization.
  • Inform the family and enlist its support.

REFERRING A SUICIDAL PERSON

Refer when the person has:

  • Psychiatric illness;
  • A history of previous suicide attempt;
  • A family history of suicide, alcoholism or mental illness;
  • Physical ill-health;
  • No social support.

If we can identify the level of risk of suicide an individual has, we will be better placed to manage the suicidal thoughts before they get carried out.

Established mental health illnesses need to be managed medically, sometimes with pharmacological or non pharmacological therapy.

Non- pharmacological therapy includes- Cognitive behavioural therapy, befriending services, yoga/exercise, talking therapy etc.

Pharmacological therapy incudes the uses of medication like anti-depressants, mood stabilisers, anxiolytics, prescribed by a qualified medical/healthcare professional. Such medication also have side effects so adequate management is needed and if when considering stopping, the dose is tapered of gradually to prevent withdrawal symptoms which could make the patient’s condition worse at the end of the day.

 

Reference:

Preventing Suicide –A resource for Primary Health care workers

Mental and Behavioural Disorders

Department of Mental Health. World Health Organization

Geneva2000

 

For primary care workers who would like to develop toolkit on projects or suicide prevention, Please access full resource guide from WHO form the link below

PREVENTING SUICIDE A RESOURCE FOR PRIMARY HEALTH CARE WORKERS

 

Article Curated by

Adaku Efuribe

UN SDG Advocate/Good health & Wellbeing coach

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Health

Live A Full Life With Sickle Cell Disease

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Kunle Tometi a Pharmacist, Entrepreneur and Public Health Advocate.

The World Sickle Cell Day is a United Nation’s recognized day to raise awareness about sickle cell disease (SCD) at a national and international level. On 22nd December 2008, the UN General Assembly adopted a resolution that recognizes sickle cell disease as a public health issue and “one of the world’s foremost genetic diseases.” The resolution calls for UN member states to raise awareness about sickle cell on June 19th of each year.

In this article, I would be creating awareness on sickle cell disease, the causes, symptoms, treatment and prevention.

What is sickle cell disease (SCD)

Sickle cell anemia (sickle cell disease) is a disorder of the blood caused by inherited abnormal hemoglobin (the oxygen-carrying protein within the red blood cells). The abnormal hemoglobin causes distorted (sickled) red blood cells.

Occurrence

SCD is more common in certain ethnic groups, including:

  • People of African descent,
  • Including African-Americans (among whom 1 in 12 carries a sickle cell gene)
  • Hispanic-Americans from Central and South America
  • People of Middle Eastern, Asian, Indian, and Mediterranean descent
  • Approximately 2000 infants are born annually with the disease
  • SCD affects approximately 200,000 Americans annually
  • 1 in 365 African Americans
  • 1 in 13 African Americans have the traits (carrying only 1 of the gene, S)

(CDC August 2017, Mayo Clinic)

Economics of SCD

10 years ago; Medical expenditure for children with SCD averaged $12,000 yearly for those with Medicaid and $15,000 yearly for those with commercial insurance.

There were also 113,000 hospitalizations costing over $500,000 paid by Medicare and Medicaid of which 75% of the visits were in adults and each with at least 3 Emergency Room visits per year. Children with SCD miss a minimum of 18 days per school year

Total healthcare costs nowadays for SCD is estimated at $2billion per year.

According to (David A.N et al 2018), ‘In Nigeria, the prevalence of SCD is 20–30/1000 live births. The burden of the disease has reached a level where it contributes 9–16% to under-five mortality in many West African countries. Hemoglobinopathies alone represent a health burden comparable to that of communicable and other major diseases’

Causes of SCD

Healthy red blood cells are round, and they move freely through small blood vessels to carry oxygen to all parts of the body. In SCD, the red blood cells become hard and sticky and look like a C-shaped called a “sickle” and they are not able to carry enough oxygen. When they travel through small blood vessels, they get stuck and clog the blood flow.

The sites most often affected by clogging or stacking of sickle cells are found in the lungs, liver, muscle, bone, spleen, eyes, and kidneys and other parts and tissues of the body: explains why patients complain of a lot of pain in these areas as the symptom of the disease.

Patients also have immunity suppression which leads to infections by bacteria, and viruses.

Symptoms of SCD includes;

  • Excessive fatigue, irritability from anemia
  • Jaundice (yellowing of eyes and skin), may also include retina damage
  • Swelling and pain in hands, and feet, Pain in chest, back arms and legs, also damage of hip
  • Frequent infections,
  • Pain and problems in the spleen, (Nausea, vomiting, diarrhea)
  • Delayed growth
  • Stroke (20–30% of children stroke, 23% in African Americans)
  • Genitalia (priapism, a constant erection, in which severe episodes may lead to impotency)

Treatment of Sickle Cell Anemia

Treatment of SCD pain or crisis is done in the following manner:

Rehydration: with IV fluids, helps Red blood cells return to normal shape

Also Read: The ELMA Group of Foundations Commits ZAR 2 Billion to COVID-19 Response in Africa

Drugs:

  • Antibiotics: used to treat underlying infections. In some cases antibiotic prophylaxis, penicillins are recommended.
  • Pain medications to treat acute pain
  • Hydroxyurea: helps increase production of red blood cells

Immunization: Pneumococcal and Meningococcal vaccines have drastically reduced the rate of infections in SCD

Blood transfusion: improves oxygen and nutrients needed

Supplemental oxygen by mask makes breathing easier and improves oxygen levels in the blood

Bone marrow transplant: for severe complications and matching donors.

Prevention

  • Genetic counselling and testing (better before marriage and at pregnancy) can help prevent the likelihood of passing gene to your child
  • Preventing infections can be achieved by practising simple hand washing techniques at every opportunity. Hand sanitiser gels and wipes are also available and affordable
  • Immunisation is very important and one must assure shots and records are current to cut down on the rate of common infections.
  • Re-hydration with fluids at all times is essential.
  • Avoid staying in places with low concentration of oxygen, e.g. unpressurised air planes, or high altitudes

For more information about SCD, please speak to your Pharmacist or Doctor.

Article by Kunle Tometi a Pharmacist, Entrepreneur and Public Health Advocate.

Ref:

  • https://en.wikipedia.org/wiki/Sickle_cell_disease.
  • Mayo clinic https://www.gstatic.com/healthricherkp/pdf/sickle-cell-anemia.pdf
  • CDC https://www.cdc.gov/ncbddd/sicklecell/data.html
  • Sickle cell Disease: Public health agenda & Social, Economic and Health implications by CDR Althea M Grant, PhD September 2012
  • www.score_international.org/resources/conference_presentations
  • Overview of the management & prognosis of sickle cell disease, Joseph Palermo, D.O.
  • Economic impact of sickle cell Hospitalization. R Singh, Ryan Jordan and Charin Hanlon
  • www.bloodjournal.org/content/124/21/5971
  • Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria

Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria.

BAO Magazine

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Health

Adaku Efuribe: COVID-19 treatment and the dangers of drug misuse in Nigeria

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Adaku Efuribe (Image credit: Adaku Efuribe)

Drug misuse is defined as the use of a substance for a purpose not consistent with legal or medical guidelines (WHO, 2006). It has a negative impact on health or functioning and may take the form of drug dependence, or be part of a wider spectrum of problematic or harmful behaviour (Department of Health, 2006).

At the moment there seems to be an increased risk of self-medication and drug misuse especially in countries where prescription only medicines could be bought without prescription. For instance, countries like Nigeria where some patent medicines dealers who are meant to sell GSL medicines end up dispensing pharmacy only medicines and prescription only medicines.

As soon as a new drug for managing COVID-19 is announced by mainstream media, people run off to the shops to buy these drugs, even people who have not tested positive for the coronavirus, indulge in self-medication in a bid to prevent contracting the virus.

I am worried about the recent announcement for Dexamethasone as a new drug for treating COVID 19. Information reaching me shows, following hours of announcing this drug by the media, some Nigerian resident has started trooping to their pharmacy, ‘chemist’ and illegal drug dealers to buy dexamethasone tablets.

Dexamethasone is a corticosteroid, it has high glucocorticoid activity, and it should not be used without the guidance of a clinician. According to the Electronic Medicines Compendium (EMC), depending on the dose and duration of therapy, adrenocortical insufficiency caused by glucocorticoid therapy can continue for several months and in individual cases more than a year after cessation of therapy.

Also Read: Lockdown Bozza: Developed to simplify the lockdown regulations in South Africa

Through immunosuppression, treatment with Dexamethasone can lead to an increased risk of bacterial, viral, parasitic, opportunistic and fungal infections. It can mask the symptoms of an existing or developing infection, thereby making a diagnosis more difficult. Latent infections, like tuberculosis or hepatitis B, can be reactivated.

Dexamethasone also has some side effects; the following side effects are common (occurring in greater than 30%) for patients taking dexamethasone:

· Increased appetite.

· Irritability.

· Difficulty sleeping (insomnia)

· Swelling in your ankles and feet (fluid retention)

· Heartburn.

· Muscle weakness.

· Impaired wound healing.

· Increased blood sugar levels

If only the media companies understood the fact that prescription only medicines could be bought without prescription in some countries, they would thread carefully and choose appropriate wording when announcing potential drugs for COVID-19 treatment.

It’s the duty of the Ministry of health and drug regulatory bodies of those countries where prescription medication could be bought in the market like sweets to continue to create awareness, educate the general public on the dangers of self-medication, drug misuse and drug abuse. They must not relent in their efforts of managing drug distribution/regulation.

My advice to people living in countries where you could buy prescription only medicines without prescription is this:

Do not run off to buy the latest drug announced for COVID-19 treatment.

This drug is a corticosteroid and should only be taken if prescribed by a clinician.

Please do not indulge in medication misuse and abuse. It could lead to adverse effects or even death

Author: Adaku Efuribe is a Clinical Pharmacist & Global consultant in Medicines Management

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Health

Sickle Cell Disease Educational Resources Initiative(SERI)- Our Story

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Sickle Cell Disease Educational Resources Initiative(SERI)

Every year, nearly 300,000 children are born worldwide with this most painful disease and many of them will not survive beyond their fifth birthday. Discovered more than a century ago, Sickle Cell Disease (SCD) is an inherited genetic disease that is transmitted when both parents who carry hemoglobin S transmit it to their child.

SCD comes with many complications such as high blood pressure, kidney failure, kidney stones, growth delay, bone necrosis, stroke, retinopathy and increased risk of infection and sepsis. Treatment options include medications to manage the symptoms and blood transfusions to replace the sickled cells. A stem cell also known as bone marrow transplant might cure the disease. However, this procedure usually involves patients to have a matched donor, such as a sibling, who doesn’t have sickle cell anemia.

Both Agnes Nsofwa and Biba Tinga(Founders of The Sickle Cell Disease Educational Resources Initiative) gave birth to children with SCD type SS. Like all caregivers of children with a chronic illness, they had to face many challenges while managing their children’s health. Agnes, has a little girl who received a bone marrow transplant and was cured from SCD a year ago; She left a career in Business, trained to become a Registered Nurse in order to better understand the disease and care for her daughter. She fought hard for over 10 years to get her cured. Today her little girl is Sickle Cell free, but Agnes is still advocating for others who are still affected by SCD.

Agnes Nsofwa, Co-Founder at SERI

Biba has a young adult son living with SCD, but he is not a candidate for a bone marrow transplant to get cured. He will have to keep fighting every day of his life to stay healthy. As a treatment, he regularly receives Red Blood Cell exchanges or apheresis which allows him to avoid the terrible pain crisis. Their journey which started in Niger continues in Canada.

When they met for the first time in January 2020 in Amsterdam, they quickly realized they had been fighting the same battle. They have both been engaged in their respective communities, advocating on behalf of other families dealing with the same condition. Their combined years of experiences has taught them the need to unite. Because when life becomes a struggle, you engage with family. And sometimes family is someone who shares your life journey. After a short discussion, they knew they were going to join forces against this common cause and become friends.

Agnes had started the project translating sickle cell materials into her native language of Bemba from Zambia since 2018, in order to help others to better understand and care for their children since. When she shared this idea with Biba, she instantly agreed to come on board because she had also been sharing information in her native languages of Zarma and Hausa with parents of affected children.

Biba Tinga, Co-Founder at SERI

Together they want parents, to have access to information so that they can make the best decisions to care for their children. To do this, they created SERI, Sickle Cell Disease Educational Resources Initiative, a platform of educational and informative resources on sickle cell disease in various languages.

As they present it, “we created SERI because without education we could not have looked after our children properly. We want all mothers to have what we did not have. SERI is more than a platform; it is also a movement for awareness and education. Whether you speak Bemba, Tonga, Hausa, English, French, Yoruba, Arabic, Hindi, Twi, Spanish or any other language, SERI will offer the information in the language you understand.

SCD requires long continuous care. When the parents or the patient does not understand the basic information, the consequences could be fatal. SERI will also provide audio recorded version in the local languages to ensure that those who cannot read and write can listen and still receive the education that will empower them to better care for themselves.

Also Read: Lockdown Bozza: Developed to simplify the lockdown regulations in South Africa

SERI will also share the stories and the experiences of those who are fighting SCD because their stories matter.

The stories will tell our journeys, the stories will say who we are. We are SERI!”

Visit: Sickle Cell Disease Educational Resources Initiative(SERI)

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