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Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 1  |  Page : 143-148
Knowledge of depression in the elderly among primary health care workers in Kubau, Nigeria


1 Jahun General Hospital, Jahun, Jigawa State, Nigeria
2 Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3 Department of Community Medicine, Kaduna State University, Kaduna, Kaduna State, Nigeria

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Date of Web Publication5-May-2017
 

   Abstract 

Background: Depression has been shown to be prevalent in the elderly; however, it is underdiagnosed and hence undertreated. Data on elderly depression in Caucasians are few and showed a high prevalence of major depression with few at primary health care level especially in Nigerians and rural Africans. This study assessed the knowledge of primary health care workers on depression in the elderly in Kubau, Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out in June 2012, which elicited sociodemographic characteristics of the respondents and knowledge of depression using a semi-structured interviewer-administered questionnaire. The collected data were cleaned and entered into statistical package software for social sciences version 16 and the results presented as tables and charts with statistical significance set at P value less than 0.05. Results: Most of the respondents were community health extension workers (67.8%), with 46% having work experience in the range of 5–10 years. About half (55.9%) of the Community health extension workers have heard of depression while only 55% of the total respondents knew the definition of depression in medical terms. Only 12.6% of the health workers knew that old age was a risk factor for depression. Conclusion: The study revealed a poor knowledge of depression in the elderly among healthcare workers at primary healthcare level with the majority of Community health extension workers mostly implicated. Hence, the need for proper training in mental health and awareness campaigns in communities.

Keywords: Knowledge, depression, primary healthcare, Kubau, Nigeria

How to cite this article:
Andrew K, Igboanusi CJ, Joshua IA, Yakubu M. Knowledge of depression in the elderly among primary health care workers in Kubau, Nigeria. Ann Trop Med Public Health 2017;10:143-8

How to cite this URL:
Andrew K, Igboanusi CJ, Joshua IA, Yakubu M. Knowledge of depression in the elderly among primary health care workers in Kubau, Nigeria. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 21];10:143-8. Available from: http://www.atmph.org/text.asp?2017/10/1/143/196820

   Introduction Top


Mood disorders are neuropsychiatric syndromes characterized by pathological disturbance of mood. Mood is defined as a sustained subjective feeling of a person about his/her inner state (emotion) over a time period.[1] Affect is outward manifestation of emotion at a particular point in time.[1] Major depressive disorder, or as it is often called, “major depression,” is characterized by the presence of one or more depressive episodes during the patient's lifetime.[1] It has been described as mood disorder that presents with at least two weeks history of low mood, low energy, and loss of interest in pleasurable activities.[2]

Geriatric depression is mostly not recognized by clinicians and often depressive symptoms are attributed to the aging process. Also elderly persons emphasize somatic symptoms and underreport depressed mood. Geriatric depression often occurs in the context of medical or neurological brain diseases whose symptoms are similar to the symptoms of depression.[13] In some cases, the overlap of symptomatology is such that depression can only be diagnosed after successful treatment with antidepressant medications.

The diagnosis of depressive disorder may be difficult in patients who have dementing disorders. Unreliable reports by the patients and fluctuation of depressive symptomatology over time may interfere with diagnosis because the examiner may see the patients during a well period.[3] However, caregiver reports can be helpful in such cases because caregivers observe the patients for long periods.[3]

Primary health care (PHC) is about providing essential health care, which is universally accessible to individuals and families in the community and provided as close as possible to where people live and work. It refers to care that is based on the needs of the population.[4] Integrating specialized health services – such as mental health services – into PHC is one of World Health Organization's (WHO's) most fundamental health care recommendations[5] with advantages including reduced stigma to people with mental health issues, improved access to care especially for the elderly, and human rights protection with better outcomes of care.

Knowledge among general practitioners about mental disorders may vary from country to country and depends on the amount and quality of training received both at undergraduate and postgraduate levels.[6] There is need to document this knowledge among Primary Healthcare workers in Nigeria. This study assessed the knowledge of depression in the elderly among primary health care workers in Kubau, Nigeria.


   Materials and Methods Top


Study area

Kubau local government area is one of the 23 local government areas of Kaduna State, Nigeria, located in the northern part of the state. Its headquarters is located at Anchau and it has a population of 282,045 at the 2006 census. It is a rural settlement with mostly Hausa and Fulani populations who are mainly farmers, traders, nomadic cattle herders, and civil servants. Ecologically, it occupies the transition zone between the northern guinea and sudan savannah. The area is characterized by alternating dry and wet season with an average rainfall of 81 mm. The mean annual temperature also varies between 34 and 28°C. There are many road networks in the Local Government area that connect the area with other towns within and outside Kaduna state, and they are motorable all-year round.[7],[8]

The health facilities in the local government area are mainly government owned with few privately run primary care facilities. The major facility being the General Hospital, Pambegua with about ten primary health care centers located in major towns within reach of the people in the immediate area and also those in the remote areas who can get access to them.

The general hospital has three medical officers and occasionally doctors on the mandatory one-year national youth service, sixteen registered nurses, and seven community health extension workers. It serves both as a primary care center and as a referral center for secondary care from the primary health care centers both within and outside the local government area; and the total number of health professionals who are directly involved in patient care in Kubau local government area are 91.

Study design

The survey was a cross-sectional descriptive study carried out in June 2012.

Study population

The study population comprised of health care professionals working in primary health care facilities in Kubau local government area of Kaduna state, Nigeria. The inclusion criteria included all health care professionals working in the local government and are directly involved in patient care and have consented to participate in the research. Those that did not consent to participate in the research were excluded.

Sample size determination

The sample size was calculated using the formula:

n = {Z2p q/ d2}[9]

Where: n = minimum sample size

Z = the value of normal curve corresponding to the level of confidence 95% = standard deviation of 1.96

P = prevalence of depression in elderly from a previous study = 42% = 0.42.[10]

Q = 1-p = 1-0.42=0.58, d=a precision level at 5% was used = 0.05. Therefore, n=(1.962 x 0.42 x 0.58) ÷ 0.052, n = 0.936 ÷0.0025, n=374.4.

n = calculated sample size = 374

N = study population = total number of health care professionals in Kubau Local Government area = 91, this was obtained from a list of all the healthcare professionals directly involved in patient care from the Primary Health care department of the Kubau local government.

As calculated sample size is greater than study population, nf = n/[1 + n/N], nf = 374/[1 + 374/91]

nf = 73.3, approximately, 73. Adjusting for nonresponse, ns = n × expected non-response rate, where expected non-response rate = 10%, then ns = 73 × 10/100 = 7.3, approximately, 7.

Therefore n = 73 + 7 = 80. However, 87 health workers participated in the study.

Sampling technique

The whole population of healthcare professionals directly involved in patient care in the primary health care facilities in Kubau local government, Nigeria was sampled, using a list obtained from the PHC department of the Local Government area. The list contained the names of the health care professionals and addresses of their respective Primary Health care facilities and a total of ten PHCs were involved in the study.

Instruments for data collection

A semi-structured, open and closed-ended interviewer-administered questionnaire was administered to the health workers at their respective primary health care facilities. The questionnaire consisted of three sections: section 1 was on sociodemographic characteristics, section 2 was on knowledge of depression while section 3 was on attitudes towards depression. Eighty-seven questionnaires were administered as four people did not respond.

The questionnaire was pre-tested among health workers at the Primary Health Care center Ikara, Nigeria, then fine-tuned.

Data analysis

The data were cleaned, sorted, coded, and analysis was done using the statistical package software for social sciences version 16.0. The results were presented as frequency tables and charts. The knowledge was scored as follows: those who answered three correct questions were scored with a good knowledge, those who answered two questions correctly were scored with fair knowledge, whereas those who answered only one question correctly were scored with poor knowledge.

Ethical considerations

Approval for this study was sought and obtained from the Head of Department, Community Medicine Ahmadu Bello University, Zaria. Consent was also sought from the Director of the Primary Health Care in Kubau local government, the Chief Medical Director of General Hospital Pambeguwa and from the In-Charges of all Primary health care facilities. In addition, informed consents were obtained from the respondents and assurance was given that the information obtained was solely for research purposes and they were also assured of strict confidentiality.


   Results Top


In [Table 1] most of the PHC workers were within age bracket of 30–39 years with mean age of 35.7 years, about 60% men, 67.8% were community health extension workers (CHEW), and 40.2% had working experience of 6–10 years.
Table 1: Sociodemographic characteristics of health care professionals working in Primary health care in Kubau Nigeria, 2012

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In [Table 2] about half (55.9 %) of community health extension workers have heard of depression, 90.9 % of community health officers, and 100% of nurses have heard of depression.
Table 2: Distribution of health workers that participated in the study and their various health facilities

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In [Table 3] About half (55.9 %) of community health extension workers have heard of depression, 90.9 % of community health officers and 100 % of nurses have heard of depression. It shows low knowledge base for factors associated with depression, with old age having a value of 12.6 %.
Table 3: Knowledge of depression among the medical cadres in Kubau, Nigeria (n = 87)

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   Discussion Top


Majority of the health workers were within the age bracket of 30–39 years and there were more males than female respondents, which could be due to poor enrolment of the girl child into tertiary institutions. The majority of the respondents were Community Health extension workers, with few registered nurses and Community health officers among others. Majority of the respondents had an average working experience of 6–10 years, meaning they are experienced staff [Table 1].

Pambegua PHC had the highest number of respondents [Table 2] that could be as the result of the large population of the inhabitants under the area. It was also observed that all the nurses had heard of depression, 90.9% of the Community health officers (CHO) and 75% of the midwives have heard of depression, whereas only half of the Community health extension workers (CHEW) have heard of depression [Table 3]. The majority of the health care professionals in Kubau Local government area Primary health care centers had a fair knowledge of depression [Figure 1]. A similar study in Benin City reported that general practitioners there had a limited knowledge about depression.[11] The low knowledge base found among the CHEWs, which may be due to limited training in mental health and psychiatry compared with CHOs. Community health extension workers also form the bulk of the health care professionals in the local government PHCs, hence, they see more patients than the nurses and CHOs put together [Table 4]; this implies that many cases of depression may be overlooked especially in the elderly whom most times present with a myriad of problems. There was a statistically significant relationship between the years of practice and their knowledge of depression (X2 = 31.54 df = 23 P = 0.05).{Table 4}
Figure 1: Knowledge score for depression among health care professionals in Kubau, Nigeria Less than a third (29.9%) of the respondents had a good knowledge of depression, while a little above one-third of the respondents had a poor knowledge (34.5%)

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Literature was the main source of information on depression, and very few obtained theirs from workshops/seminars or colleagues this may be as a result of infrequent workshops for the health professionals in Kubau local government PHCs [Figure 2]. Half of the health care professionals knew the correct definition/meaning of depression in clinical terms [Figure 3], despite depression being a component of the mental health section of the 'standing orders' for Community Health Extension Workers issued by the Primary Health Care Department of the Federal Ministry of Health in Nigeria.
Figure 2: Source of information about depression among health professionals in Kubau, Nigeria Among the various sources of information about depression, literature accounted for the most common source with a percentage of 82.6%

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Figure 3: The perception of what depression is among health professionals in Kubau, Nigeria.
KEY A = A clinical condition characterized by feeling of low energy and mood with loss of interest in pleasurable activities.
B = Severe medical condition characterized by extremely elevated mood, energy, unusual thought patterns and sometimes psychosis.
C = Mental disorder characterized by abnormalities in the perception or expression of reality.
It is a degenerative disease of the brain with prominent cognitive and behavioral impairment that is sufficiently severe to interfere significantly with social and occupational function
E = Others.


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The respondents had a poor knowledge of the factors associated with depression with only 12.6% of the respondents agreeing that old age was a risk factor for depression, whereas 14.9% responded positively to brain abnormalities as a risk factor [Figure 4]. A study among UK general practitioners showed strong disagreement with the notion that depression was due to ageing[6] a similar study among primary health care workers in Tanzania, most of the respondents believed biochemical abnormalities in the brain were the main problem of depressed patients.[12]
Figure 4: Knowledge factors associated with depression among primary health care professionals in Kubau, Nigeria

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A study in China showed that the primary care setting was the most ideal for management of late life depression, as most chronic diseases of the elderly are managed there and depression also been a chronic disease would benefit too, however, there was the need for integrating mental health into the Primary Health Care Programme after more research.[13]

In Kenya and Tanzania, the attitudes of primary health care workers toward depression was recently surveyed and showed that although they held high levels of knowledge, they perceived working with depressed patients as difficult.[12],[14] A high prevalence of mental disorders (and in particular depression) was found in the General facilities in Kenya, which go undiagnosed, specifically where there is lack of adequate numbers of psychiatrist.[15]


   Conclusion Top


Depression is common in general practice and especially in primary health care settings. The study found a poor knowledge among Community Health Extension Workers compared with other medical workers in Kubau, Nigeria.

Recommendations

The following recommendations are made:

  • The Kubau Local Government Primary health care department should organize workshops and seminars on mental health and especially depression for the workers directly involved in patient care.
  • The Kubau Local Government Primary health care department should incorporate mental health care into its primary health care program.
  • The training of community health extension workers and other health professionals should involve mental health postings and not just the traditional classroom 'lectures' on mental disorders.
  • The Kubau Local government area Primary health care department should organize awareness campaigns in the local government to educate the populace on the problems of the elderly and especially depression and how to approach the elderly depressed in the society.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
David M, Jefferson J. Handbook of medical psychiatry. 2nd ed. Philadelphia (PA): Elssevier Mosby Inc. 2004; ch 74:134-39.  Back to cited text no. 1
    
2.
Gonzalez M, Roderick S. Kaplan review of psychiatry for USMLE. 7th ed. Florida (FL): Kaplan Inc. 2005; ch 5:pp 21-28.  Back to cited text no. 2
    
3.
George SA. Kaplans Textbook of Psychiatry. 7th ed. Philadelphia (PA): Lippincott Williams and Wilkins Publishers. 2005;ch 51: pp 283-89.  Back to cited text no. 3
    
4.
WHO Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978. 1978; url:http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf. [Last accessed on 2012 June 10].  Back to cited text no. 4
    
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WHO The world health report 2001. Mental health: new understanding, new hope. Genva; world health organization. 2001: 1-169. http://www.who.int/whr/2001/en/whr_en.pdf. [Last accessed on 2012 Jun 8].   Back to cited text no. 5
    
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Haddad M, Menchetti M, Walters P, Norton J, Tylee A, Mann A. et al. Clinicians' attitudes to depression in Europe: a pooled analysis of depression attitude questionnaire findings. Fam Pract Sept 2011:30.  Back to cited text no. 6
    
7.
Nigerian National Population Commission, 2006 National population Census.http://www.population.gov.ng/kaduna_PDF_rev.[Last accessed on 2012 Jun 8].  Back to cited text no. 7
    
8.
Kubau weather. www.worldweatheronline/kubau-online-weather-averages/kaduna/NG.aspx. [Last accessed on 2015 March 10].  Back to cited text no. 8
    
9.
Singha P. Introductory text on Biostatistics. 3rd ed. Kaduna: Dabco investment limited. 2002;4: pp 205.  Back to cited text no. 9
    
10.
Djemes JK. Prevalence and predictors of depression in populations of the elderly. Acta psychiatrica scandinavica 2006;133:375-87.  Back to cited text no. 10
    
11.
James BO, Jenkins R, Lawani AO, Omoaregba JO. Depression in primary care: the knowledge, attitudes and practices of general practitioners in Benin City, Nigeria. S Afr Fam Pract 2012;54:55-60.  Back to cited text no. 11
    
12.
Mbatia M, Shah A, Jenkins R. knowledge, attitude and practice pertaining to depression among primary health care workers in Tanzania. Int J Mental Health Sys 2009;3:1752-4488.  Back to cited text no. 12
    
13.
Shulin C, Conwell Y, Xu B, Chiu H, Tu X, Ma Y. et al. Depression care management for late life depression in Chinas primary care: protocol for randomized controlled trial. Trials 2011;12:121-4.  Back to cited text no. 13
    
14.
Jenkins R, Kiima D, Okonji M, Njenga F, Kingora J, Lock S. et al. Attitudes to depression among community health workers in Kenya. Epid Psy Soc 2009;18:352-56.  Back to cited text no. 14
    
15.
Ndetei DM, Khasakhala LI, Mutiso V, Mbwayo AW. Knowledge, attitudes and practice of mental illness among staff in general medical facilities in Kenya: Practice and policy implications. Afr J Psychiatry 2011;14:225-35.  Back to cited text no. 15
    

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Correspondence Address:
Dr. Kashini Andrew
Jahun General Hospital, Jahun, Jigawa State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196820

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