HUMAN IMMUNODEFICIENCY VIRUS (HIV), HEPATITIS B VIRUS (HBV), HEPATITIS C VIRUS (HCV) AND SYPHILIS INFECTIONS AMONG PEOPLE WITH PSYCHIATRIC DISORDERS AT THE ANKAFUL PSYCHIATRIC HOSPITAL, GHANA

ABSTRACT
Background: People with psychiatric disorders are at increased risk to HIV, Hepatitis B C and Syphilis infections as compared to general population. Many risk behaviours have been identified in studies from both developed and developing countries. The psychiatric population is usually neglected in terms of prevention and control programs as compared to the general population.
Aim: This research is the first of its kind in Ghana and seeks to determine the prevalence of HIV, HBV, HCV and Syphilis infections, its related risk behaviours among people with psychiatric disorders at the Ankaful psychiatric hospital.
Methodology: This is a cross-sectional study of the Ankaful psychiatric hospital with a total of 200 in-patients and out-patients surveyed. Participants (male/female) who were included in the study were clinically stable and above 18 years old. Questionnaire was administered on socio-demographic characteristics, psychiatric disorders, knowledge, attitude and substance use/abuse risk related practices for HIV, HBV, HCV and Syphilis infections. Serologic test was done for HIV, HBV, HCV and Syphilis after interview.
Results: The results revealed that, 55% (n=110) were male whilst 45% (n=90) were female. The mean age was 35.60 and most participants were in the age group 20-39 years i.e. 64.5% (n=129) as compared to 4.5% (n=9) for the age group of less than 20 years and above 60 years respectively.

Conclusion: The overall prevalence of HIV (5.0%), HBV (9.5%), HCV (2.0%) and Syphilis (13.5%) were recorded. Multiple infections to HBV+Syphilis (0.5%), HBV+HIV (1.0%) HBV+Syphilis (0.5%) and HIV+HBV+Syphilis (0.5%) respectively.


CHAPTER 1
1.0 INTRODUCTION
Psychiatric patients are at risk of being infected with Human immunodeficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Syphilis infections since they lack knowledge about contraception and may make poorer decisions regarding sexual behavior (Sikkema, 2007). Relationships between people with psychiatric disorders and HIV, HBV, HCV and Syphilis infections may exist because patients with complex and varied social and sexual interactions may experience higher needs for both types of services. Alternatively, people with psychiatric disorders may exhibit less conscious control over their sexual interactions because of feelings of worthlessness, restlessness, boredom or anxiety (Carey et al., 2001).

A research conducted by the World Health Organization (WHO) on updates of the AIDS epidemic revealed that, about 33million HIV persons are chronically infected (WHO, 2007), 170 million with HCV (WHO, 2002), 350 million with HBV (WHO, 2004) and also 12 million people acquire Syphilis infections each year (WHO, 2001). Majority of the people affected are found in the developing countries. HIV, HBV, HCV and Syphilis infections are the most prevalent STIs which have similar transmission routes, mostly through unprotected sex, needle/razor sharing, blood transfusion, and offering of drugs, shelter or food in exchange for sex which is of public health concern.

A research conducted by the WHO in 2001 to determine the prevalence and incidences of some selected curable sexually transmitted infections found out that, about 450 million people suffered from psychiatric or behavioural disorders, making it the fourth (4th) leading cause of disability in the world. Due to neuropsychiatric disorders, the WHO estimated an increase between 10.5% to 14.7% from 1990 to 2020 and also ranked major depression second after ischemic heart disease which is anticipated to be higher in developing countries.

Over the past two decades, a lot of articles have reported increased rate of STIs including HIV and AIDS, Hepatitis B and C virus, and Syphilis infection among people with psychiatric disorders (Hughes et al., 2015). Comparable estimate of HIV infections in the overall US adult’s non-psychiatric and the psychiatric population is approximately 0.3% to 0.4% (NCHS, 2009). Relative to the general population, research has shown that women with psychiatric disorders appear to be at higher risk (estimated infection rate of 5% vs. 0.17%) for sexually transmitted infections (Marks, Senterfitt & Janssen, 2005)

Published studies has shown that, people with psychiatric disorders appears to be at increased risk of HIV, HBV, HCV and Syphilis infections and these people may indulged in risky sexual practices such as having multiple sexual partners, inconsistent condom use, same sex sexual activity and sex in exchange for money or drugs (Sikkema, 2007).These risk factors coupled with poverty and neglect among people with severe mental illness raises the concern that this population is at risk HIV, HBV, HCV and Syphilis infections.

In 2001, one hundred and eighty heads of states and government representatives declared commitment on HIV and AIDS acknowledging that, the epidemic constitutes a Global emergency and one of the most formidable challenges to human life and dignity in the first ever special session of the United Nations General assembly. In addressing this emergency, which sub-Sahara Africa is the worst affected region in the world (Fitzpatrick et al., 2004), there needs to be an urgent analysis of the situation in all spheres of the human population especially the most at risk groups which includes people with psychiatric disorders.

A research conducted by World Health Organization(WHO) in the early 1990s validated a panel of neurological, neuropsychiatric and psychological measures across five geographical areas (Thailand, Zaire, Germany, Kenya and Brazil) with participants of varied risk behaviors and stages of HIV diseases (including seronegative participants) (Maj et al., 1994) . In all sites and across risk behaviors, they found a higher rate of depressing symptoms (affective and somatic) in symptomatic HIV-positive participants than in seronegative participants (Maj et al., 1994) as well as higher rate of cognitive impairment. Evidence was found in some sites that low educational status among asymptomatic HIV positive participants was associated with impaired neuropsychological performance compared to seronegative participants (Maj et al., 1994) concluding the fact that there is actually a relationship between HIV, HBV, HCV and Syphilis infections and psychiatric disorders.

A case control study conducted in London found out that Black Africans were nearly three times likely to be referred for mental health assistance than the general population of patients (Malanda et al., 2001) and were more likely to be suffering from STIs including HIV and AIDS at the time of referral indicating that racial lines (i.e. Black Africans ) stand the chance to be the hardest hit in terms of mental illness and HIV, HBV, HCV and Syphilis infections.

There are no publish data on HIV, HBV, HCV and Syphilis infections among psychiatric patients in Ghana to address risk because of the relationship between psychiatric disorders and HIV, HBV, HCV and Syphilis infections is an important research focus with implication for preventive programs.

Despite the growing epidemic in sub-Sahara Africa, almost all the research on mental health aspects of HIV, HBV HCV and Syphilis infections has been done in Europe, America and Southern Africa, much more studies have not been done in West Africa and none can be said about Ghana to effectively address the concerns. This research therefore seeks to determine the prevalence of HIV, HBV, HCV and Syphilis infections and its risk related practices among people with psychiatric disorders.

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Item Type: Ghanaian Postgraduate Material  |  Attribute: 79 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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