drug treatment information system in nigeria: data...

March 2016

This project is funded by the European Union

Response to Drugs and Related Organised Crime in Nigeria(FED/2012/306-744) (NGAV16)

Nigerian Epidemiological Network on Drug Use (NENDU)

Drug treatment information system in Nigeria: data analysis of 2015 data

Dominique Lopez

Table of contents

Nigerian Epidemiological Network on Drug Use (NENDU)...................................................1

1. Introduction and background..........................................................................................4First step towards the implementation of a drug treatment information system..................................4Objectives of this report.................................................................................................................................................... 5Participating treatment facilities................................................................................................................................. 5

2. Reporting assessment.....................................................................................................72.1. Excel sheet reporting form......................................................................................................................................72.2. Reporting from treatment facility........................................................................................................................9

2.2.1 Federal Neuro-Psychiatric Hospital Kaduna.............................................................................................102.2.2. Federal Neuro-Psychiatric Hospital Maiduguri.......................................................................................102.2.3. National Hospital Abuja.................................................................................................................................... 112.2.4. Federal Neuro-Psychiatric Hospital Enugu...............................................................................................112.2.5. Federal Neuro-Psychiatric Hospital Benin................................................................................................122.2.6. Quintessential Health Care Center (QHC), Jos..........................................................................................132.2.7. Jos University Teaching Hospital, JUTH....................................................................................................... 152.2.8. Federal Neuro-Psychiatric Hospital Yaba..................................................................................................162.2.9. Federal Neuro-Psychiatric Hospital Aro.....................................................................................................172.2.10. University of Port Harcourt Teaching Hospital (UPTH)...................................................................182.2.11. Aminu Kano Teaching Hospital (AKTH), Kano.....................................................................................19

3. Data analysis.................................................................................................................203.1. Data analysis per treatment facility..................................................................................................................20

3.1.1. Federal Neuro-Psychiatric Hospital Kaduna............................................................................................203.1.2. Federal Neuro-Psychiatric Hospital Maiduguri.......................................................................................213.1.3. National Hospital Abuja.................................................................................................................................... 223.1.4. Federal Neuro-Psychiactric Hospital Enugu.............................................................................................233.1.5. Federal Neuro-Psychiatric Hospital Benin................................................................................................243.1.6. Quintessential Health Care Center (QHC), Jos..........................................................................................253.1.7. Jos University Teaching Hospital, JUTH....................................................................................................... 263.1.8. Federal Neuropsychiatric Hospital Yaba....................................................................................................273.1.9. Federal Neuropsychiatric Hospital Aro.......................................................................................................283.1.10. University of Port Harcourt Teaching Hospital (UPTH)...................................................................283.1.11. Aminu Kano Teaching Hospital (AKTH), Kano.....................................................................................29

3.2. Treatment data and treated people in Nigeria, January to December 2015...................................303.2.1 Patients and type of treatment........................................................................................................................ 313.2.2 Profile of patients admitted for treatment.................................................................................................323.2.3 Drug use of patients admitted into treatment..........................................................................................343.2.4 Injecting..................................................................................................................................................................... 383.2.5 Drug use and injecting of primary drug.......................................................................................................383.2.6 Other information collected.............................................................................................................................. 39

4. Conclusions and recommendations...............................................................................414.1. Recommendations pertaining to reporting and reporting tool............................................................41

Reporting tool..................................................................................................................................................................... 41Reporting and treatment facilities............................................................................................................................ 41

4.2. Conclusions regarding the data analysis........................................................................................................41Analysis per treatment facility.................................................................................................................................... 41Aggregated analysis: treatment demand in Nigeria.........................................................................................42

4.2. Recommendations for policy makers and practitioners.........................................................................44

Annexes............................................................................................................................45NENDU Questionnaire (version of May 2015).....................................................................................................45List of acronyms.................................................................................................................................................................47List of Tables and Figures..............................................................................................................................................47Bibliography........................................................................................................................................................................ 48Feedback received from treatment facilities on data issues..........................................................................48

Kaduna.................................................................................................................................................................................. 48Additional Cross tabulations (analysis of all data from treatment facilities).........................................51List of participating centres and focal points ……………………………………………………….52

Drug treatment information system in Nigeria: data analysis of 2015 data3

1. Introduction and background

To support Nigeria in fighting drug production, trafficking and use, and in curbing related organised crime, UNODC with funding from the European Union is implementing a large-scale project aiming at, among others objectives, “improving the routine data collection and case reporting by statutory and CSO treatment providers” mainly through an activity to “design and implement routine reporting system, possibly through the creation of a national drug observatory”.

First step towards the implementation of a drug treatment information systemExperts from the Medical Research Council of South Africa and representatives from Federal Ministry of Health (FMOH), National Drug Law Enforcement Agency (NDLEA), treatment centers and Economic Community of West African States (ECOWAS) who met during a workshop held in January 2015 came to the conclusion that it was now time to address the issue of building a drug treatment information system and also to design a national drug-related data collection system in line with global best practice. It was agreed that the system would to be called Nigerian Epidemiological Network on Drug Use (NENDU). The meeting focused on discussions on treatment demand. Some of the findings are outlined below:

On the average, it was found that most of the 11 drug treatment centres represented at the meeting already had a semblance of data collection measures in place as a general patient registration process but not specific data for treatment and very little collation or analysis of the data gathered. It was also found that there was no standardised data collection form used by the 11 centres- each had its own registration form.

Consequently: Draft data collection format was developed collecting drug treatment information

from patients at the drug treatment centres (adapted from the WENDU and SACENDU formats)

Participants resolved to commence the immediate collection and collation of data using the form adapted from the WENDU format. Centres who were able to collect data dating back to 1 January 2015 also resolved to include them.

Participants also resolved to tag the drug treatment information system in Nigeria – Nigerian Epidemiological Network for Drug Use (NENDU).

On the modality for sending data it was agreed that each model treatment centre will receive a scanner for this purpose, they are then to scan and email the forms to the UNODC Project Officer as well as the FMOH Focal Point. They may also make use of excel spreadsheet to enter data which will then be emailed to aforementioned contacts. Option of courier of actual copies of the forms to UNODC. In essence, centres are to adopt the modality for submission of data that is most convenient for them.

The project is currently a pilot project, but the fact that there is an adopted and harmonized form for data collection and that the participating treatment facilities are sending regularly their data are already positive outcomes that need to be emphasized.

Objectives of this reportThe aim of this report is to carry out analysis of the 2015 data collected from the 11 treatment facilities and develop the first NENDU report for 2015. Through such a report, stakeholders, members of the network, policy makers and the general population, will be informed about the current developments of the drug treatment system in Nigeria,. This report included the coverage and actual usage of the structures and also helps to better understand the profile of persons who are entering treatment in Nigeria. This document is the first concrete step towards the publication of an annual report on drug treatment.

Following two consecutive missions in Nigeria in June 2015, some recommendations regarding the implementation and development of a drug treatment information system were presented and endorsed by Nigerian experts (Lopez 2015). Among these recommendations, it was agreed to have a mid-term review of the treatment data collection pilot study in order to evaluate the performance of the system as well as the flaws so the latter can be rectified without impeding too much the system. This review was to include the following elements:

1. assess data entry2. assess data quality3. assess processes (within the structures for data collection and of the system itself

for data reporting)4. assess outcomes5. review the NENDU form.

The additional aim of this report is to partially cover these recommendations by reviewing the data submitted by the 11 treatment facilities to FMOH and UNODC.

This report is organized in 2 parts, the first section looks at the reporting itself: use and practically of the excel sheet used by the treatment facilities for the data reporting, data submitted to UNODC so far and recommendations for improvement of the system and reporting in place. It is important to note that the points 1 to 4 of the mid-term review are included in this document (assess data entry, assess data quality, assess processes, assess outcomes). The review of the NENDU form will be organized at a later point. The second part of the report provides an insight on the data submitted and a preliminary picture of treatment data in Nigeria based on data reported by treatment facilities.

Participating treatment facilitiesIn the pilot phase of the treatment data collection system in Nigeria, 11 treatment facilities were identified to be developed into model drug treatment centres by FMOH and UNODC. These 11 centres have agreed to participate. The Figure 1 shows the locations of the treatment Centres that are providing NENDU data. Most of them are named according to the town they are located in with the exception of Quintessential Health Care Center (QHC). QHC is also peculiar as it is the only independent facility, while the others are government run. Of the 11 centres

Six of them are psychiatric hospital: Maiduguri- Federal Neuro-Psychiactric Hospital, Maiduguri; Kaduna - Federal Neuro-Psychiactric Hospital; Benin - Federal Neuro-Psychiactric Hospital, Benin; Enugu- Federal Neuro-Psychiactric


Hospital, Enugu; Aro - Federal Neuro-Psychiactric Hospital, Aro; Yaba - Federal Neuro-Psychiactric Hospital, Yaba

Three are teaching hospital: Kano - Aminu Kano Teaching Hospital (AKTH); UPTH - University Teaching Hospital, Port Harcourt; JUTH - Jos University Teaching Hospital, Jos

One is a General hospital: National Hospital Abuja One independent centre: Quintessential Health Care Center (QHC)

Figure 1: Map of Model Treatment facilities providing NENDU Data

The treatment facilities have heterogeneous capacity to admit clients in drug treatment. The number of beds allocated to drug treatment per structure is summarized in the Table 1. The number of inpatients admitted in each structure will be correlated with the total number of beds available to patients in need for drug treatment.

Table 1: Number of beds allocated to drug treatment, 11 treatment facilities of NENDU, 2013

No Treatment facility Number of

beds1 FNPH Aro 642 FNPH Yaba 803 FNPH Benin 104 UPTH, Port Harcourt* (secluded beds in a general ward) 125 FNPH Enugu 146 FNPH Kaduna 337 AKTH Kano 248 QHC Jos 40

9 JUTH* (The drug unit is located in Vom Christian Hospital and the staff are from JUTH) 30

10 National Hospital Abuja (not part of a separate drug unit) 411 FNPH Maiduguri 24

TOTAL 335Note: Data from Report of the Assessment of Drug Dependence Treatment and Care Facilities in the Six Geo-Political Zones of Nigeria including the Federal Capital Territory (FCT); 2013; Dr. Taiwo Adamson. * Personal communication from Facility (15 March 2016)

2. Reporting assessmentIn terms of reporting, there are mainly two issues that needed to be looked at, the reporting tool (excel sheet) and the way the treatment facilities are using this tool.

The excel reporting tool was first introduced in February 2015 and amended later on in May 2015. The immediate consequence is that not all the treatment facilities are using the correct template (amended version of May 2015) which has a direct impact on the quality of the data reported. Furthermore, the May 2015 template, when in used, is not always filled in in an appropriate manner. The details of the flaws in the reporting tool and reported data are detailed in the following sections.

2.1. Excel sheet reporting formThe excel sheet currently used by the treatment facilities (latest version with attached guide of May 2015) is quite simple and could easily be improved in order to facilitate the reporting as well the data analysis of the information reported.

1. The use of dropdown lists would allow coherent and harmonized use of answers for each question

2. The introduction of an additional column (entry columns) in case the item “other” is chosen, would also allow to specify and to clarify the necessary answers.

3. Clear definitions on the terms used (drug used, primary drug, problematic drug declared by the patient) would also improve the reporting from the structures.

Some other problems have been identified:4. Reporting dates: dates are reported in different formats, creating some confusion

on the month the client should be reported. It is hence important to define a fixed format to report the different dates (date and date of admission. Proposed format: dd/mm/yy).

5. Client code: does NENDU need to introduce a common patient code for among the treatment facilities? At the moment each facility report a different patient code, either created specifically for NENDU or the one used in their structure.

a. In case it is decided to follow the EMCDDA treatment demand indicator guidelines, an unique identifier based on an algorithm will be necessary to include in the form to control double-counting and count the number of treatment episodes received by patients during the calendar year

6. Question 5. The detail on involuntary admission (diversion, correctional) is rarely informed, and sometimes misinformed (informed while the admission declared is voluntary). Are the 2 reply items enough and reflecting the situation? Are more modalities needed?


7. Question 11: level of education is quite high among people admitted for treatment. One feedback made by treatment facility was that available responses were merging tertiary institution with graduation from tertiary institution (some tertiary/graduate clients) in the same group may be responsible for the high preponderance of clients in that group. It could be that most of the clients have attempted tertiary education but not necessarily completed it.

a. We consider revising the possible answers of this question by splitting level of tertiary and completed tertiary as it is done for primary and secondary level.

8. Questions 15, 16, 17, 18: there is a need to introduce mandatory specification of the name of the drug for some categories of drugs reported (categories 5 up to 10).

a. Especially since according to the data reported most of opiates use is in fact prescription drugs misused (codeine, tramadol, pentazocine) and not heroin.

b. Having more details on drugs used would also allow to identify and pick up more quickly changes in drug use among patients entering treatment (overall or within each treatment facility)

c. In some rare cases drug have been declared twice9. Question 20: seems that this questions is not always well reported by the

treatment facilities. Some clarification on the form/guidelines are needed to ensure that the drugs declared in this questions are not drugs which has been already declared in question 15, 16, 17 or 18.

10. Question 21: need to ensure that the substance most problematic declared in this question is according to the assessment done by the patient.

a. Relevance of adding 1 category item: when all substances declared are problematic to the patient.

b. In a few cases, the problematic drug declared as not been declared as a drug used by the patient

c. In 1/3 of the cases the problematic drug is not the first drug declared11. Question 22. Number of times in treatment is not always informed when the

patient has been treated previously.a. In some cases the number of treatments received by the patient is higher

than 5 (and up to 18 declared)12. Question 24. When informed, only 1 disease is declared while this question is

supposed to be multi-choice. Also category “other” should be added. It is also not possible to differentiate between a patient not having other disease and the answer unknown.

13. Question 25. Some facilities reported “Yes” without specifying the timeframe of the testing (in the past 12 months, not in the past 12 months).

Derived from these comments and assessment, there is a clearly a need to revise the questionnaire and develop and improve guidelines for the coding in the excel tool. For example, while reporting employment status, the item “other” is chosen but most of the time not specified so there is no way of double checking that the answer is correct, some other times, the item “other” is chosen and details indicate jobs like self employed, farming, trader and in this case the correct answer should be ‘regular employment’. For some categories of answers like the question 15 on most frequent drug used, it would

also be good to have some details on the substances used (e.g.: categories opiates, other stimulants, sedative-hypnotics, hallucinogens, organic solvent and “others”).There is also a need to develop and improve definitions and terms used especially when it comes to drug used, treatment and previous treatment (e.g.: some patients declared having been treated more than 15 times in their lifetime).

It is important to note that the review of the form has been done considering only the practicalities of filling up the excel sheet, adding clarifications to some items and consequently decrease the burden of data cleaning before starting analysis of the data reported especially when reporting is done without standardized and harmonised answers (use of capital letters or not, full reply or only short one, detail of the drug attached to the number itself, etc…). The NENDU form and the related excel sheet form has not been reviewed taking into consideration the compatibility with EMCDDA treatment demand indicator, this task will be done in the framework of another work assignment. Hence, even if some amendments have to be made to the tool to improve the reporting, it might be wise to wait for the further assessment of the tool itself before introducing a new reporting format among the treatment facilities.A new version of the reporting tool is being submitted with this report. However, the excel sheet could be further improved with the introduction of conditionality (i.e.: column ‘specify’ only possible to filled in if answer ‘other’ has been selected, etc…), formatting of dates and multiple choice dropdown list (feasibility of the latter in excel need to be explored).

2.2. Reporting from treatment facilityThe aim of this section is to pinpoint for each structure the problems identified in their respective reporting. This exercise was done in order to improve the quality of the reporting among the treatment facilities, as well as raise awareness among them of the importance of following up guidelines.It is first important to state that timeless of reporting was not assessed by the consultant. Reporting is organized on a monthly basis and is summarised in the Table 2.


Table 2: Monthly reporting by the 11 treatment facilities (at the date of 09/03/2016)

FNPH Kadun

a

FNPH Maidu

guri

National hospital Abuja

FNPH Enugu

FNPH Benin

QHC, Jos

JUTH Kano FNPH Yaba

UPTH FNPH Aro

Jan-15 1 1 1

Feb-15 1 1 1 1 1 1 1 1 1 1

Mar-15 1 1 1 1 1 1 1 1 1 1 1Apr-15 1 1 1 1 1 1 1 1 1 1 1May-15 1 1 1 1 1 1 1 1 1 1 1Jun-15 1 1 1 1 1 1 1 1 1 1

Jul-15 1 1 1 1 1 1 1 1 1 1

Aug-15 1 1 1 1 1 1 1 1 1 1

Sep-15 1 1 1 1 1 1 1 1 1 1

Oct-15 1 1 1 1 1 1 1 1 1 1 1Nov-15 1 1 1 1 1 1 1 1 1 1 1Dec-15 1 1 1 1 1 1 1 1 1 1 1Total 11 11 11 11 11 12 12 11 8 11 10Data feedback received

YES (partia

lly)

YES YES YES (partia

lly)

YES YES(partially)

YES YES YES YES YES(partia

lly)

2.2.1 Federal Neuro-Psychiatric Hospital KadunaAll months were submitted (February to December 2015).Need to clarify coding and pay attention to:

Very high level of education for all patients, it is a bias from the patients entering in treatment in this structure or misreporting from patient/structure?

Very high level of HIV testing, is it a bias from the structure? Coding of question 21 (most problematic drug) need to be confirmed if it is

assessment done by the practitioner/clinician or by the patient. Need to verify variable age for some patients.

Data corrections were made by the facility and feedback was also shared on the questions raised during the first data feedback (February to September). Reply from the treatment facility on data issues is attached in annex. The second data feedback (October to December) was unfortunately less comprehensive with only minor corrections made.

2.2.2. Federal Neuro-Psychiatric Hospital MaiduguriAll months were submitted (February to December 2015).Need to clarify coding and pay attention to:

Some patients declared having been in treatment previously more than 10 times, up to 25 times. What is the definition used by the structure to report a treatment, does the structure rather report interventions rather than treatment?

How come more than half the patients admitted in the structure are tramadol misusers?

Coding of question 20 (other drugs) is a repeat of drugs already declared in questions 15, 16, 17 or 18. So obviously reporting for this question has not been assimilated properly, need some clarification from the structure.

Coding of question 21 (most problematic drug) need to be confirmed if it is assessment done by the practitioner/clinician or by the patient.

Need to verify variable age and age at first use declared for some patients. Need to verify date of admission declared for some patients (based on months

reported).Data corrections were made by the facility (January to December except for question 20 from February to September), but no feedback on the questions raised was received. The following data submission (months from October to December) took into consideration the feedback given by the consultant and required less corrections.The coding of the questions 5 and 20 are still not in line with the data requirements.

2.2.3. National Hospital AbujaMonths from February to December 2015 were submitted.Need to clarify coding and pay attention to:

Type of treatment center was declared “general hospital” and then switched to “other: tertiary”, which one should be kept?

Use of correct template (February to July submitted with updated template but August submitted with first template)

Question 3: Need to verify date of admission declared for some patients (based on months reported)

Question 5: need to inform type of involuntary admission (diversion or correctional services)

Question 8: Need to verify variable age declared for some patients. Question 15, 16, 17, 18 (d): Need to integrate (if still possible) age at 1 st use

(primary to forth drug declared) for some patients Question 18: Need to verify name of drug declared. Question 19: Need to choose 1 main source of drug for primary drug declared (it

is not a multiple choice answer but single choice answer) Question 21: on problematic drug: when NIL specified, does this means that the

patient didn’t want to answer or didn’t know what to answer or declared that no drug was problematic to him/her.


Data corrections were made by the facility and feedback was also shared on the questions raised during the first data feedback (February to August 2015). The following data submission (months from September to December) took into consideration the feedback given by the consultant and required less corrections. Nonetheless the reporting is still done on the initial template and not the revised one.

2.2.4. Federal Neuro-Psychiatric Hospital EnuguAll months were submitted (February to December 2015).Need to clarify coding and pay attention to:

Use the correct template, the template used for the reporting is the initial template (used only for 2 months) and not the latest. In the latest version of the template was introduced an additional column to declare the number of previous treatment(s) received by the patients.



Question 5: need to inform type of involuntary admission (diversion or correctional services)

Question 19: Need to choose 1 main source of drug for primary drug declared (it is not a multiple choice answer but single choice answer)


Question 22b: please inform number of previous treatment for patient previously treated (if possible)

Check route of administration for some drugs declared (not coherent with drug declared or simply not declared).

Data corrections were made by the facility (except for month of September), but no feedback on the questions raised was received. Following submission (October to December) required no corrections as initial data feedback was taken into consideration by the treatment facility.

2.2.5. Federal Neuro-Psychiatric Hospital BeninAll months were submitted (February to December 2015).Need to clarify coding and pay attention to:


Question 4: Need to inform type admission (voluntary or involuntary) for some patients

Question 5: Need to inform type of involuntary admission (diversion or correctional services) for some patients admitted

Question 8: Need to verify age declared or year of birth for some patients Question 10b and 10c: missing data please inform if possible Question 10b: please specify answer when reply ‘other’ has been reported. Check

coherence of some patient declaration: 1 patient declaring living alone but been married.

Question 15, 16, 17, 18: please specify the drug for some categories reported if possible

Question 17b: please check misreporting of route (‘alcohol’ declared). Question 15d and 18d: please inform age at first use if possible for missing

patients. Check route of administration for some drugs declared (not coherent with drug

declared or simply not declared), in this case please specify the drug for more clarity or correct if misreported: other stimulants smoked (Crystal Ice?), cannabis swallow (cake/oil form?), opiates swallow (tramadol? Or other opioids analgesic medicine). And specify other route when category ‘other’ has been reported.


Coding of question 21 (most problematic drug) need to be confirmed if it is assessment done by the practitioner/clinician or by the patient

Question 21: on problematic drug: when no answer reported, does this means that the patient didn’t want to answer or didn’t know what to answer or declared

that no drug was problematic to him/her. Or that answer to this question is not available.

Question 22: please inform previous treatment for some patient. Please also check/correct as patients declared with no previous treatment have number of previous treatment allocated.

Question 22: Some patients declared having been in treatment previously more than 5 times, up to 8 times. What is the definition used by the structure to report a treatment, does the structure rather report interventions rather than treatment?

Data corrections were made by the facility, but no feedback on the questions raised was received during the first data feedback (February to August). The following data submission (months from September to December) took into consideration the feedback given by the consultant and required less corrections.

2.2.6. Quintessential Health Care Center (QHC), JosAll months were submitted (February to December 2015). Month of January 2015 was also submitted.Need to clarify coding and pay attention to:

Use the correct template, the template used for the reporting is the initial template (used only for 2 months) and not the latest. In the latest version of the template was introduced an additional column to declare the number of previous treatment(s) received by the patients.

Do not use 0 as coding, if the reply is not known or not applicable, leave the cell blank.

Date and date admitted for treatment: please use the same formatting for reporting dates: dd/mm/yy.

Question 5 type of admission: please use the correct coding for this question:o If admission voluntary = 1o If admission is involuntary=2o Please explicit use of 0 for the coding of this variableo If no information available please leave cell blank

Question 5b: Need to inform type of involuntary admission (diversion or correctional services) for patients admitted on an involuntary basis only (question 5: answer =1). Please use the correct coding for this question:

o If type of involuntary admission is diversion =1o If type of involuntary admission is correctional services =2o Please explicit use of 0 for the coding of this variableo If no information available please leave cell blank

Question 9: report only year of birth, full date of birth not necessary. Question 8 and 9: check coherence between age and year of birth reported Question 10:

o All patients have reported living in stable accommodation, please check that is it coherent with the patient profile

o Area of residence: please use the appropriate coding from 1 to 3 (coding with 4 and 5 found).

Urban=1 Semi-urban=2


Rural=3 Question 15, 16, 17, 18:

o Do not use 0 as coding, if answer is not known or not applicable, leave the cell blank

o drug name “snoff” was used, please avoid as much as possible street names, and clarify what type of drug “snoff” is.

o drug name “methadol” was used, please clarify what type of drug “methadol” is : methadone?

o drug name “diazephine” was used, please clarify what type of drug “diazephine” is: benzodiazepine?

o Pay attention while filling up the excel sheet, for the month of January, route of administration, frequency and age at first use are the same declared for the first drug, and the second drug, even though first and second drugs are not the same (seems to be a copy and paste for the 3 variables for the January month). Please correct as necessary and leave the cell blank when there is no information to be reported or when the information is missing.

o Please pay attention while filling up the excel sheet, question 17 and 18 have route of administration, frequency and age at first use informed while no drug has been declared, and this information is a repeat of the information reported for the second drug declared. Please correct as necessary and leave the cell blank when there is no information to be reported or when the information is missing.

o Check route of administration for some drugs declared (not coherent with drug declared or simply not declared), in this case please specify the drug for more clarity or correct if misreported: alcohol smoked, cannabis swallow (cake/oil form?) and snorted, cocaine swallowed, glue swallowed (rather, ‘other’=inhaled?), heroin smoked (quite rare and in this case this is inhalation of the solid rather than properly smoking), methadone smoked, codeine smoked.

o Check coherence for age declared and age at first use declared for some drugs and correct accordingly.

o Check route of administration and specify other route when category ‘other route of administration’ has been reported.

Coding of question 20 (other drugs used)o This variable should be reported only if 4 different other substances have

been reported previously in questions 15, 16, 17 and 18. It is not the case at the moment, as some drugs were reported in the column “other drugs” for some patients who had only 1 or 2 most frequently drugs declared. Please correct and amend as necessary.

o Drug name “cot” was used, please avoid as much as possible street names, and clarify what type of drug “cot” is.

o Please explicit use of 0 for the coding of this variableo If no information available please leave cell blank

Coding of question 21 (most problematic drug) need to be confirmed if it is assessment done by the practioner/clinician or by the patient.

o when no answer is reported, does this means that the patient didn’t want to answer or didn’t know what to answer or declared that no drug was problematic to him/her. Or that answer to this question is not available.

Question 22: Use the correct template and the correct coding for this question. If treated or not previously by the following coding:

o Any previous treatment for drug dependence, Yes = 1o Any previous treatment for drug dependence, No = 2o Right now coding reported seems to be 0= not treated before and 1 and

above= treated before and number indicating the number of times treated before.

Question 22b: Inform number of previous treatment for patient previously treated (if possible)

Question 22: Some patients declared having been in treatment previously up to 8 times. What is the definition used by the structure to report a treatment, does the structure rather report interventions rather than treatment?

Data corrections were made by the facility (February to September month), but no feedback on the questions raised was received. The following data submission (months from September to December) took into consideration the feedback given by the consultant and required less corrections, unfortunately no correction was received for the last batch of data (October to December).

2.2.7. Jos University Teaching Hospital, JUTHAll months were submitted (February to December 2015). Month of January 2015 was also submitted but not integrated in the analysis.Need to clarify coding and pay attention to:

Use the template in an appropriate manner: a codebook has been developed, asking to report data using numbers instead of wording the answer. Words can nonetheless be used to specify an answer when needed.

Date and date admitted for treatment: use the same formatting for reporting dates: dd/mm/yy. Check and correct dates and dates of admission for some patients.

Coding of question 11 (education): Use the correct coding for this question at the moment there is no distinction between some secondary school and having completed secondary level, it should be coded:

o Never completed primary school=1o Primary level =2o Some secondary school=3o Completed secondary school =4o Some tertiary/graduate level=5

Question 15: information on 1st drug use missing for some patients (as well as route of administration, age at first use and frequency), please inform if possible

Question 15, 16, 17,18: Provide as much information as possible these questions, they are essential for the monitoring of drug treatment

o Complete if possible missing information for age at first use of some patients (for primary, secondary, 3rd and forth drug use)

o Name of drugs: Confirm that “rephnol” is rohypnol


Confirm that “tramol” is tramadolo Route of administration: no patient admitted for treatment in the

structure declare injection. Is injection underreported by the patient and by the structure. Please provide explanation.


Coding of question 21 (most problematic drug) need to be confirmed if it is assessment done by the practioner/clinician or by the patient.

Question 22 and 22b: most of these 2 questions are blank. Is the information available at the level of the facility? If yes why it is not reported? If no, why these questions are not asked to the patient?

o Provide as much information as possible if previous treatment (Yes/No)o P Provide as much information as possible number of previous treatment

if applicable Coding of question 24: No treatment for other disease declared for any patients.

Is it misreported by the patients, or not taken into consideration/asked by the structure? Please provide explanation.

Coding of question 25: Use the correct coding for this question at the moment the question is coded in Yes/No where it should be coded:

o HIV tested Yes in the past 12 months =1o HIV tested Yes but not in the past 12 months =2o HIV tested No=3o HIV tested declined to answer =4

Data corrections were made by the facility (January to September 2015). The following data submission (months from October to December) took into consideration the feedback given by the consultant and required almost no correction or re-coding.

2.2.8. Federal Neuro-Psychiatric Hospital YabaThe following months were submitted: February to May 2015 and October to December 2015. The hospital was on strike from June 2015 to October 2015.Need to clarify coding and pay attention to:


Date and date admitted for treatment: Use the same formatting for reporting dates: dd/mm/yy. Check and correct dates and dates of admission for some patients.

Question 8 and 9: Check coherence between age and year of birth reported for some patients

Please specify drug when coding is 10 (Others) (question 15, 16, 17, 18) Coding of question 21 (most problematic drug) need to be confirmed if it is

assessment done by the practitioner/clinician or by the patient. Please check route of administration for some drugs: sedative-hypnotic being

smoked? Hallucinogens being smoked (Salvia?) Question 22: Some patients declared having been in treatment previously up to

10 times. What is the definition used by the structure to report a treatment, does the structure rather report interventions rather than treatment?

Question 23, Specify when the answer is “others” Question 24: all patients admitted are declared receiving also treatment for

mental health problems…. Is it a specificity of the facility to admit patients with mental health problems?

Very high level of HIV testing, is it a bias from the structure or from the reporting (information coming from the patients)? Are patients tested mandatorily in the structure once admitted?

Data corrections were made by the facility (February to May 2015). The following data submission (months from October to December) took into consideration the feedback given by the consultant and required less work on data correction or re-coding.

2.2.9. Federal Neuro-Psychiatric Hospital AroThe following months were submitted: March to December 2015.Need to clarify coding and pay attention to:


o Please report all the data for the same patient on a single sheet. Date and date admitted for treatment: please use the same formatting for

reporting dates: dd/mm/yy. Please check and correct dates and dates of admission for some patients.

Question 8 and 9: Check coherence between age and year of birth reported for some patients

Question 10b: Check coherence of response for 2 patients: declared living with spouse but marital status is “single (never married)”.

Question 15, 16, 17,18: Inform as much as possible these questions, they are essential for the monitoring of drug treatment

o Complete missing information for route of administration, frequency, age at first use of some patients (for primary, secondary, 3rd and forth drug use)

o Name of drugs: Please confirm what is “crackevian” : crack cocaine? Please confirm what is “Peutaudan” : pentanone? (solvent) Please confirm what is “Adhesives”: glue and solvent? Please confirm what is “Toaredol” Please confirm what is “Polyprol” (also declared twice for the same

patient) Please confirm what is “Fluritrapanol” Please confirm what is “Pawpaw Leaf”: Khat? Please confirm what is “Feunilagrapan” Please confirm what is “Flunilrippai” Please confirm what is “pharmacy”: substances must be named by

the name and not where you find themo Check coherence of route of administration and drug declared for some

patients: cannabis route of administation. Declared swallow; heroin declared swallowed; alcohol declared smoked;


Please also inform as much as possible route of administration for each drug declared

o Check age at first use for some patients higher than actual age Question 19: Need to choose 1 main source of drug for primary drug declared (it

is not a multiple choice answer but single choice answer). Also the answer “Self” can’t be accepted, please provide other answer if possible.

Question 22 and 22b: Use the correct template: for each person treated previously, number of times in treatment should be informed.

o Inform as much as possible if previous treatment (Yes/No)o Iinform as much as possible number of previous treatment if applicable


No Data corrections were made by the facility (February to December 2015). Consequently, the submissions received after the first data feedback didn’t take into consideration the data feedback especially on the use of the correct template (the monthly data submitted is split up for each patient on 3 different excel sheets, no appropriate use of the coding, etc…).

2.2.10. University of Port Harcourt Teaching Hospital (UPTH)The following months were submitted: February to December 2015.Need to clarify coding and pay attention to:

Use the appropriate template: the most recent template has a column to report the number of previous treatment.

Specify answer when answer “other” is chosen (question 10b, question 12 on employment, question 15, 16, 17, 18, 20, 21).

Date and date admitted for treatment: Use the same formatting for reporting dates: dd/mm/yy. Please check and correct dates and dates of admission for some patients.

Question 4: Check, type of center mainly coded in 7, but twice coded in 4. Type of center should remain the same for all records.

Question 5: type of admission (diversion or correctional) has to be informed only when the type of admission is involuntary. Please check answers for some patients and amend as necessary.

Question 6: inform current treatment received by the patient (inpatient or outpatient). If not possible to inform, please indicate why.

Question 9: report only year of birth and not exact date of birth Question 8 and 9: check coherence between age and year of birth reported for

some patients. Question 10b: check coherence of response for 1 patient: declared living with

spouse but marital status is “single (never married)”. Check coherence of route of administration and drug declared for some patients:

alcohol declared smoked; solvent/glue swallow. Question 19: Need to choose 1 main source of drug for primary drug declared (it

is not a multiple choice answer but single choice answer). Question 22 and 22b: use the correct template: for each person treated

previously, number of times in treatment should be informed. o inform as much as possible number of previous treatment if applicable


Very high level of HIV testing, is it a bias from the structure or from the reporting (information coming from the patients)? Are patients tested mandatorily in the structure once admitted?

Data corrections were made by the facility (January to August 2015). The following data submission (months from September to December) took into consideration the feedback given by the consultant and required almost no correction or re-coding. Unfortunately, no answer to the questions raised by the consultant were provided.

2.2.11. Aminu Kano Teaching Hospital (AKTH), KanoThe following months were submitted: February to December 2015.Need to clarify coding and pay attention to:


Date and date admitted for treatment: Check and correct dates and dates of admission for some patients (excel file).

Question 5: type of admission (diversion or correctional) has to be informed when the type of admission is involuntary. So far no information has been reported. Indicate the reason and complete if possible (excel file).

Question 5: the proportion of people admitted on an involuntary basis is very high, does the facility have an explanation for it?

Question 9: Report only year of birth and not exact date of birth (excel file). Question 8 and 9: check coherence between age and year of birth reported for

some patients (excel file). Question 19: Need to choose 1 main source of drug for primary drug declared (it

is not a multiple choice answer but single choice answer). Coding of question 21 (most problematic drug) need to be confirmed if it is

assessment done by the practitioner/clinician or by the patient. Question 22: Some patients declared having been in treatment previously up to 7

times. What is the definition used by the structure to report a treatment, does the structure rather report interventions rather than treatment?

Coding of question 25: Use the correct coding for this question at the moment the question is coded in Yes/No where it should be coded:

o HIV tested Yes in the past 12 months =1o HIV tested Yes but not in the past 12 months =2o HIV tested No=3o HIV tested declined to answer =4

Data corrections were made by the facility (January to August 2015). The following data submission (months from September to December) took into consideration the feedback given by the consultant and required almost no correction or re-coding.


3. Data analysis

The data analysis is divided in two parts. The first part looks at the data per treatment facility (using a similar template), the second part analyses the overall data submitted by the treatment facilities during the period considered providing an overview of patients entering treatment and their profile.

3.1. Data analysis per treatment facilityNote: The current NENDU form considers the 4 most frequent drugs used and their route of administration. It is not clear if the 1st most frequently used drug is also the drug at the origin of the treatment and creating most problems to the patient. Hence in the sections below, the term primary drug is used only when related to the Question 20 (“Usual source of primary drug” as phrased in the reporting form).

3.1.1. Federal Neuro-Psychiatric Hospital KadunaNote: analysis relies on data submitted from February to December 2015.

From February to December 2015, the structure has admitted 62 patients. The total number of patients entering treatment per month during varies from 3 to 9 during the period considered.Most of the patients have been referred to the structure by family and friends (72%) and all presented themselves on a voluntary basis. Among the 62 patients, 60 were admitted as inpatients, 2 were admitted as outpatients. 84% of these patients are male and all are living in a stable accommodation and of Nigerian nationality. All patients have at least completed secondary level. 26% of the patients have a regular job, 31% are still student and the rest are unemployed (34%) and a minority (9%) has declared another type of employment.

32% of the patients declared an opiate as the first drug most used, the second most frequent category of drug is ‘other’, due mainly to nicotine dependence (Figure 2). It is important to note that the opiates declared are opioids analgesic prescription medicines, likely to be misused (codeine, tramadol, pentazocine). The mean age of patients admitted for treatment is 30,4 years old while the mean age at first use for the first drug most used is 21 years old.

92% of the patients also declared a second drug used, and a bit less than half (47%) up to 4 drugs used. A bit less than half of the patients have been previously treated (43%).Among the patients seen, only 6 declared have injected the substance they are using (almost 10% of all patients who entered treatment during the period).The usual sources of the primary drug are street dealers (51%) and friends (30%).The majority of patients have been tested for HIV in their lifetime (81%).

Figure 2: First drug most used by patients admitted for treatment in FNPH Kaduna, 2015

Alcohol

Cannab

is

Cocain

e

crack

coca

ine

opiates

sedati

ve-hypnotic

sOth

erTotal

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

3.1.2. Federal Neuro-Psychiatric Hospital MaiduguriNote: analysis relies on data submitted from February to December 2015.

From February to December 2015, the structure has admitted 259 patients.The total number of patients entering treatment per month during varies from 9 to 50 during the period considered.Most of the patients have been referred to the structure by family and friends (94%) and 62% presented themselves on a voluntary basis. Among the patients, 57 (22%) were admitted as inpatients, the rest were admitted as outpatients (78%). 96% of these patients are male, almost all (98%) declared living in a stable accommodation and are of Nigerian nationality. Level of education varies: 41% have never completed primary school, 8% have a primary level, 34% have a secondary level and 17% have some tertiary or graduate level. 58% of the patients seen in this structure are unemployed, 17% have a regular employment and almost 20% have another type of employment status (without being specified).

68% of the patients declared an opiate as the first drug most used, the second most frequent category of drug is cannabis (27%) (Figure 3). It is important to note that the opiates declared are opioids analgesic prescription medicines, likely to be misused (essentially tramadol, 1 mention of pentazocine and 1 mention of codeine). The mean age of patients admitted for treatment is 28,8 years old while the mean age at first use for the first drug most used is 21.6 years old.

57% of the patients also declared a second drug used, and a bit less than 10% up to 4 drugs used. More than half of the patients have been previously treated (67%).Among the patients seen, only 1 declared injecting (pentazocine).The usual source of the primary drug is principally street dealers (63%), followed by friends (34%).The majority of patients have not been tested for HIV in their lifetime (70%), 25.5% refused to answer the question and finally only 10 patients declared having been ever tested for HIV (4.6% of patients admitted during the period).

Figure 3: First drug most used by patients admitted for treatment in FNPH Maiduguri, 2015


Alcohol Cannabis Opiates Sedative-hypnotics Other0

10

20

30

40

50

60

70

80

3.1.3. National Hospital AbujaNote: analysis relies on data submitted from February to December 2015.

From February to December 2015, the structure has admitted 23 patients. The total number of patients entering treatment per month during varies from 1 to 5 during the period considered.Patients have been referred to the structure by family and friends (39%), doctor/nurse (39.1%) or themselves (13%) and all presented themselves on a voluntary basis. Among the 23 patients, 52% were admitted as inpatients (12 cases), 48% were admitted as outpatients (11 cases). 78% of these patients are male and all are living in a stable accommodation and of Nigerian nationality. Level of education is high as all patients have at least completed secondary level and 83% have some tertiary or graduate level. 30% of the patients have a regular job, 35% are still student and the rest are unemployed (35%).

30% of the patients declared alcohol as the first drug most used, the other most frequent category is opiates (mainly pentazocine, 30%) (Figure 4). The mean age of patients admitted for treatment is 27,4 years old while the mean age at first use for the first drug most used is 21.4 years old.

74% of the patients also declared a second drug used, and a 26% up to 4 drugs used. Only 26% of the patients have been previously treated.Among the patients seen and admitted for treatment, 4 declared have injected the substance they are using (opiates and benzodiazepines).The usual sources of the primary drug are street dealers.56% of the patients have been tested for HIV in their lifetime, around 34% have never been tested, other patients declined to answer.

Figure 4: First drug most used by patients admitted for treatment in National Hospital Abuja, 2015

Alcohol Cannabis opiates sedative-hypnotics Other0

5

10

15

20

25

30

35

3.1.4. Federal Neuro-Psychiactric Hospital EnuguNote: analysis relies on data submitted from February to December 2015.

From February to December 2015, the structure has admitted 70 patients.The total number of patients entering treatment per month during varies from 1 to 13 during the period considered.Most of the patients have been referred to the structure by family and friends (94%) and approximately half of them presented themselves on a voluntary basis (51%). Among the patients, all were admitted as inpatients. 98% of these patients are male (only 1 women out of the 70 patients), almost all (96%) declared living in a stable accommodation and are of Nigerian nationality. Level of education is quite high: 9% have never completed primary school, 10% have a primary level, 50% have a secondary level (completed or not) and 31% have some tertiary or graduate level. More than one third of the patients seen in this structure have a regular employment (37%) and 34% are unemployed.

63% of the patients declared cannabis as the first drug most used, the second most frequent category of drug is alcohol (19%) (Figure 5). The mean age of patients admitted for treatment is 30 years old while the mean age at first use for the first drug most used is 23 years old.

61% of the patients also declared a second drug used, and approximately 13% up to 4 drugs used. More than half of the patients have been previously treated (57%).Among the patients seen 13% declared injecting the substances they are using (cocaine, crack cocaine, opiates, benzodiazepines).The usual source of the primary drug is principally street dealers (73%), followed by friends (17%).A bit more than half of the patients have been tested for HIV in their lifetime (57%), 12% refused to answer the question and finally 31% of the patients declared never been tested for HIV.

Figure 5: First drug most used by patients admitted for treatment in FNPH Enugu, 2015


Alcohol

Cannab

is

Cocain

e

crac

k coca

ine

opiates

sedati

ve-hypnotic

s

solv

ents

/glu

e

Other

0

10

20

30

40

50

60

70

3.1.5. Federal Neuro-Psychiatric Hospital BeninNote: analysis relies on data submitted from February to December 2015.

From February to September 2015, the structure has admitted 61 patients.The total number of patients entering treatment per month during varies from 3 to 7 during the period considered.Most of the patients have been referred to the structure by family and friends and 51% presented themselves on a voluntary basis. All the patients were admitted as inpatients. 98% of these patients are male, almost all (93%) declared living in a stable accommodation and are of Nigerian nationality. Level of education is quite high: 1.6% have never completed primary school, 3.3% have a primary degree, 15% have a secondary level, 23% have completed a secondary level and 57% have some tertiary or graduate level. Only 13% of the patients seen in this structure have a regular employment and 75% declared themselves as unemployed.

59% of the patients declared cannabis as the first drug most used, the second most frequent category of drug is alcohol (21%) (Figure 6). The mean age of patients admitted for treatment is 31,3 years old while the mean age at first use for the first drug most used is 19,2 years old.

Figure 6: First drug most used by patients admitted for treatment in FHNP Benin, 2015

Alcohol Cannabis Cocaine Opiates Other0

10

20

30

40

50

60

70

62% of the patients also declared a second drug used, and approximately 7% up to 4 drugs used. Less than half of the patients have been previously treated (33%).Among the patients admitted only 4.5% (2 patients) declared injecting the substances they are using (opiates, cocaine).

The usual source of the primary drug is principally street dealers (79%), followed by friends (18%).81% of the patients have been tested for HIV in their lifetime (66% in the last 12 months) and 16% of the patients declared never been tested for HIV.

3.1.6. Quintessential Health Care Center (QHC), JosNote: analysis relies on data submitted from January to December 2015.

From January to December 2015, the structure has admitted 136 patients.The total number of patients entering treatment per month during varies from 5 to 25 during the period considered.Most of the patients have been referred to the structure by family and friends (74%) and 70% presented themselves on a voluntary basis. Most of the patients were admitted as inpatients (73%). 90% of these patients are male, all declared living in a stable accommodation and all except two are of Nigerian nationality (foreign nationality mentioned is German and Ghanaian). Level of education is quite high: 3.7% have never completed primary school, 2.9% have a primary degree, 2.9% have a secondary level, 35.3% have completed a secondary level and 51.1% have some tertiary or graduate level. 28% of the patients seen in this structure have a regular employment and 60% declared themselves as unemployed.

Approximately 35% of the patients declared alcohol as the first drug most used, the second most frequent category of drug is opiates (21%), followed by cannabis (18%) (Figure 7). In the category “other”, Cigarette and Khat are the psychoactive substances concerned. The mean age of patients admitted for treatment is 30,1 years old while the mean age at first use for the first drug most used is 19.6 years old.

Figure 7: First drug most used by patients admitted for treatment in QHC, 2015

Alcohol

Cannabis

Cocaine

crack co

c...opiat

es

sedati

ve-hy...

hallucin

o...Other

0

5

10

15

20

25

30

35

40

82% of the patients also declared a second drug used, and approximately 32% up to 4 drugs used. A bit more than half of the patients have been previously treated (54%).Among the patients admitted six declared injecting (4.4% of all patients admitted for treatment during the period): they are all and only injecting pentazocine.


The usual source of the primary drug is principally street dealers (90%), followed by friends (7%).67% of the patients have been tested for HIV in their lifetime (33% in the last 12 months, 34% before that) and 14% of the patients declared never been tested for HIV (19% declined to answer).

3.1.7. Jos University Teaching Hospital, JUTHNote: analysis relies on data submitted from November 2014 to December 2015.

From November 2014 to December 2015, the structure has admitted 56 patients.The total number of patients entering treatment per month during varies from 1 to 16 during the period considered.Most of the patients have been referred to the structure by family and friends (89%) and all presented themselves on a voluntary basis. All patients were admitted as inpatients. 88% of these patients are male, all declared living in a stable accommodation and all are of Nigerian nationality. Level of education is quite high as all have completed primary school, 37% have a some secondary level, 3,6% have completed secondary and 60% have some tertiary or graduate level. 30% of the patients seen in this structure have a regular employment and 68% declared themselves as unemployed.

48% of the patients declared alcohol as the first drug most used, the second most frequent category of drug is cannabis (27%), followed by opiates (14.5%) (Figure 8). The mean age of patients admitted for treatment is 31 years old while the mean age at first use for the first drug most used is 19 years old.

Figure 8: First drug most used by patients admitted for treatment in JUTH, 2015

Alcohol Cannabis Opiates Other0

10

20

30

40

50

60

84% of the patients also declared a second drug used, and approximately 23% up to 4 drugs used. Less than one third of the patients have been previously treated (29%).Among the patients admitted one only declared injecting (pentazocine).The usual source of the primary drug is principally street dealers (94%).60% of the patients have been tested for HIV in their lifetime, the rest of the patients (40%) declared never been tested for HIV.

3.1.8. Federal Neuropsychiatric Hospital YabaNote: analysis relies on data submitted from January to May 2015 and October to December 2015.

From January to December 2015, the structure has admitted 107 patients.The total number of patients entering treatment per month during varies from 1 to 35 during the period considered.Most of the patients have been referred to the structure by family and friends (99%). 48% of the patients presented themselves on a voluntary basis, the remaining patients were admitted on an involuntary basis. All patients except one were admitted as inpatients. 96% of these patients are male, patients are usually living in a stable accommodation (97%) and all are of Nigerian nationality. Level of education is quite high as only 14.0% of the patients have some secondary school level of less. 57% of the patients seen in this structure have a regular employment, 31% declared themselves as unemployed, 12% are pupil/students.

64.5% of the patients declared cannabis as the first drug most used, the second most frequent category of drug is alcohol (19%), followed by the category “others” (Figure 9). The mean age of patients admitted for treatment is 33 years old while the mean age at first use for the first drug most used is 20,9 years old.

Figure 9: First drug most used by patients admitted for treatment in FNPH Yaba, 2015

Alcohol Cannabis Cocaine other stimulant opiates sedative-hypnotics Other0

10

20

30

40

50

60

70

70% of the patients also declared a second drug used, and approximately 10% up to 4 drugs used. Approximately half the patients have been previously treated (52%).Among the patients admitted two declared injecting (injection of opiates).The usual source of the primary drug is principally street dealers (91%). All patients admitted also have mental health problems associated with their drug addiction.90% of the patients have been tested for HIV in their lifetime, the rest of the patients (10%) declared never been tested for HIV.

3.1.9. Federal Neuropsychiatric Hospital AroNote: analysis relies on data submitted from March to December 2015.


From March to December 2015, the structure has admitted 157 patients.The total number of patients entering treatment per month during varies from 3 to 33 during the period considered.Most of the patients have been referred to the structure by family and friends (81%) and 98.7% presented themselves on a voluntary basis. All patients were admitted as inpatients. 94% of these patients are male, patients are usually living in a stable accommodation (94.3%) and all except one are of Nigerian nationality (foreign nationality mentioned is American). Level of education is quite high: 1.3% have never completed primary school, 1.9% have a primary degree, 10.8% have a secondary level, 15.3% have completed a secondary level and 69.4% have some tertiary or graduate level. 17% of the patients seen in this structure have a regular employment and more than 60% (62%) declared themselves as unemployed.

57% of the patients declared cannabis as the first drug most used, the second most frequent category of drug is alcohol (19%), followed by “others” (essentially cigarettes) (Figure 10). The mean age of patients admitted for treatment is 30,7 years old while the mean age at first use for the first drug most used is 19,5 years old.

Figure 10: First drug most used by patients admitted for treatment in FNPH Aro, 2015

Alcohol Cannabis Cocaine crack cocaine opiates Other0

10

20

30

40

50

60

86% of the patients also declared a second drug used, and approximately 28% up to 4 drugs used. A bit more than a third of the patients have been previously treated (35%).Among the patients admitted 6 declared injecting (3.8% of the total of patients admitted during the period) and mainly injecting opiates.The usual source of the primary drug is principally street dealers (80%).60% of the patients have been tested for HIV in their lifetime, while 39% declared never been tested for HIV, the rest declined to answer to this question.

3.1.10. University of Port Harcourt Teaching Hospital (UPTH)Note: analysis relies on data submitted from February to December 2015.

From February to December 2015, the structure has admitted 51 patients.The total number of patients entering treatment per month during varies from 2 to 9 during the period considered.Most of the patients have been referred to the structure by family and friends (88.5%) but also by school (1 case) or doctor/nurse (3 cases, 6%) and all patients presented

themselves on a voluntary basis. 67% of the patients were admitted as inpatients, the rest are outpatient. 88% of these patients are male, all are living in a stable accommodation and are of Nigerian nationality. Level of education is quite high: 2.0% have a primary degree, 3.9% have a secondary level, 47.1% have completed a secondary level and 44.1% have some tertiary or graduate level. Only 16% of the patients seen in this structure have a regular employment, 43% are students, 25.5% declared themselves as unemployed, the rest are in the category “other” (without more precision).

Almost 50% of the patients declared cannabis as the first drug most used, the second most frequent category of drug is alcohol (25%), followed by other stimulants (12%) and opiates (8%) (Figure 11). The mean age of patients admitted for treatment is 30,3 years old while the mean age at first use for the first drug most used is 18 years old.

Figure 11: First drug most used by patients admitted for treatment in UPTH, 2015

Alcohol

Cannabis

Cocaine

other stim

u...opiat

es

sedati

ve-hy...

hallucin

o...

0

10

20

30

40

50

60

70% of the patients also declared a second drug used, and approximately 20% up to 4 drugs used. Approximately one third of the patients have been previously treated (35%).Among the patients admitted, two declared injecting (3,9% of all patients, injection of opiates without more precision on the opiates injected).The usual source of the primary drug is principally street dealers (90%).78% of the patients have been tested for HIV during the last 12 months and 14% declared never been tested for HIV.

3.1.11. Aminu Kano Teaching Hospital (AKTH), KanoNote: analysis relies on data submitted from February to December 2015.

From February to December 2015, the structure has admitted 72 patients.The total number of patients entering treatment per month during varies from 13 to 3 during the period considered.Most of the patients have been referred to the structure by family and friends (94%) although a large majority of them presented themselves on an involuntary basis (73.1%). All patients were admitted as inpatients. 85% of these patients are male, all are


of Nigerian nationality. Living conditions are principally in a stable accommodation (75%). Level of education is quite high: 4% have a primary degree or less, 3% have a secondary level, 17% have completed a secondary level and 76% have some tertiary or graduate level. Only 22% of the patients seen in this structure have a regular employment, 32% are students, 36% declared themselves as unemployed, the rest (7%) are in the category “other”.

39% of the patients declared tobacco as the first drug most used (category “other”), the second most frequent category of drug are opiates (36%), followed by cannabis (17%) (Figure 12). The mean age of patients admitted for treatment is 29,1 years old while the mean age at first use for the first drug most used is 20 years old.

Figure 12: First drug most used by patients admitted for treatment in AKTH, 2015

Alcohol

Cannab

is

Cocain

e

crac

k coc..

.

other

stim

u...

opiates

sedati

ve-hy...

Other

0

5

10

15

20

25

30

35

40

45

87.5% of the patients also declared a second drug used, and approximately 32% up to 4 drugs used. A bit more than a third of the patients have been previously treated (39%).Among the patients admitted, 13 declared injecting (18% of all patients, injection of opiates, benzodiazepines, promethazine and ketamine). 85% have mental health problems associated to their substance use.The usual source of the primary drug is principally street dealers (89%).49% of the patients have been tested for HIV in their lifetime, the rest of the patients declared never been tested for HIV.

3.2. Treatment data and treated people in Nigeria, January to December 2015The analysis is based on the data reported by the 11 treatment facilities between January (for those who were able to provide the information) and December 2015. It is already important to note that this preliminary analysis presents a partial view of the treatment data in Nigeria since only 11 treatment facilities are currently part of the reporting and that not all the 11 facilities submitted data during the period (see Table 2).Furthermore, as data checking was done at a late point after submission of data and at several occasions (January to August data in October 2015, September data in November 2015, October to December data in February 2016), it was difficult to receive from facilities all needed corrections of the data submitted. Hence some data have been only partially corrected (see Table 2).

3.2.1 Patients and type of treatmentBetween January and December 2015, 1044 patients entered for treatment in Nigeria in the 11 treatment centers currently part of the NENDU reporting system. The flow of patients admitted during the calendar year for treatment is summarized in the Figure 13.

Figure 13: Number of patients entering treatment in Nigeria, January to December 2015

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC0

20

40

60

80

100

120

140

160

The source of referral for these patients remains mainly friends and family (87.3%), in some limited case the patient himself/herself (6.9%) or a doctor/nurse (3.6%). A large majority of the patients have been presenting themselves at the treatment facilities on a voluntary basis (70.3%). The proportion of type of admission varies among treatment facilities (Figure 14), AKTH Kano being the facility who receive the most patients on an involuntary basis. This will remain an area of concern for policy makers and practitioners as it would be essential to examine ways to increase voluntary admission; possibly through counseling and closer involvement of families.

When patients are entering treatment on an involuntary basis, and when the information has been entered, 53% of the patients were sent after diversion, while the rest (46.8%) were sent from correctional services.

74% of all the patients entering treatment in 2015 were admitted as inpatients. Only a few treatment facilities have the capacity to have outpatient patients, and fewer the ability to monitor the actual number of admission of outpatients patients into treatment. This again is an area for consideration of the hospital and for policy makers as outpatient treatment could enhance treatment access for indigent drug users.

Figure 14: Proportion of voluntary and involuntary admissions among the 11 treatment facilities, Nigeria, 2015


FNPH Kaduna

FNPH Maiduguri

National Hospital Abuja

FNPH ENUGU

FNPH Benin

QHC

JUTH

FNPH Aro

UPTH

FNPH Yaba

AKTH Kano

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

voluntary involuntary

Figure 15: Proportion of patients admitted as inpatient or outpatient among the 11 treatment facilities, Nigeria, 2015

FNPH KadunaFNPH Maiduguri

National Hospital AbujaFNPH ENUGU

FNPH BeninQHC

JUTHFNPH Aro

UPTHFNPH YabaAKTH Kano

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

inpatient outpatient

3.2.2 Profile of patients admitted for treatmentAmong the 1044 patients admitted for treatment, 92% are male. All treatment facilities have admitted at least a female in treatment during the period. National Hospital Abuja has admitted proportionally more women than all the other treatment facilities. This points to significantly lower number of female drug users accessing treatment services, which could be due to various reasons, such as treatment facilities across Nigeria are far less equipped to admit women in their drug treatment services, higher stigma associated with drug use among women, lack of child care facilities and lower drug use behavior among women in general.

The mean age of clients accessing treatment is 30 years old, the majority of patients are under 34 years old, and the repartition among the age categories are not significantly

different between male and female (Table 3). The mean age at first used declared for the substance the most frequently used is 20,5 years old.

Table 3: Sex and age of patients admitted for treatment, Nigeria, 2015

Age categoriesSex

TotalMale Female

15 to 24 years old 29.2% 31.2% 29.4%25 to 34 years old 44.5% 50.6% 44.9%35 to 44 years old 18.0% 7.8% 17.3%45 years old or more 8.3% 10.4% 8.4%Total 965 77 1042% within Sex of the patient 100.0% 100.0% 100.0%Mean age 30,3 28,9 30,2Mean age at first use* 20,5 21 20,5

* Computed for the first most frequent drug used

The majority of the patients are living in a stable accommodation (96% of all the patients), with their parents (74% of all the patients) and their marital status is single (78.2%). The marital status of the patients is highly linked to whom he/she is living with (Table 4). The young age of the patients also explain the high proportion of them being single.

Table 4: Marital status of patients and living with whom, Nigeria, 2015

Living with whomMarital Status

TotalSingle never married Married Divorced/separated Widowed

Alone 9.8% 2.80% 29.70% 55.6% 9.70%With parents or family/relatives 87.2% 33.7% 62.2% 33.3% 76.5%with spouse/partner 0.0% 61.9% 0.0% 0.0% 10.8%with friends 1.8% 1.7% 0.0% 0.0% 1.7%with children and no spouse 0.0% 0.0% 5.4% 11.1% 0.3%other 1.1% 0.0% 2.7% 0.0% 1.0%Total 813 181 37 9 1040% within Marital status 100.0% 100.0% 100.0% 100.0% 100.0%

The area of residence of the patients varies according to the treatment center they have been admitted, FNPH Enugu receiving the highest proportion of people living in rural areas followed by the FNPH of Benin, the FNPH of Maiduguri and JUTH (Figure 16).


Figure 16: Area of residence of the patients according to the treatment facility, Nigeria, 2015

FNPH Kaduna

FNPH Maiduguri


FNPH ENUGU

FNPH Benin

QHC

JUTH

FNPH Aro

UPTH

FNPH Yaba

AKTH Kano

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

urban semi urban rural

The level of education of the patients is high. This could be due to the design of the variable items in the reporting form or is linked to the socio-economic status of the patients as drug treatment in Nigeria is not free. Nonetheless, 50% of the patients have a tertiary or graduate level (highest level which could be declared), and only 11.8% have never completed primary level. The level of education is not statistically different between the male and female patients admitted.Only 26.4% of the patients declared having a regular employment, 15.4% are students or pupils, 51% are unemployed and the rest are falling into the category other (without any more information specified).

3.2.3 Drug use of patients admitted into treatmentThe current NENDU form considers the 4 most frequent drugs used and their route of administration. It is not clear if the 1st most frequently used drug is also the drug at the origin of the treatment and creating most problems to the patient (see section 3.2.5).

The age at first use of the first most used drug is 20,5 years. There is no difference between male and female at age of initiation. The drug declared the most frequently by the patients entering treatment are cannabis (36.2%), followed by opiates (28.3%) and alcohol (17,1%) (Figure 17). Among the different substances declared as “others”, 79% are cigarettes/tobacco.

Figure 17: Most frequently first drug declared by patients entering treatment (%), Nigeria, 2015

Alcohol

Cannab

is

Cocain

e

crac

k coca

ine

other

stim

ulant

opiate

s

sedat

ive-

hypnotics

hallu

cinoge

ns

solv

ents

/glu

e

Other

0

5

10

15

20

25

30

35

40

Excluding alcohol and tobacco from the first drug most used, the picture of the illicit drugs declared is slightly different, cannabis amounting for a bit less than half of the entry for treatment, followed by opiates (Figure 18). The opiates concerned by the entry into treatment are mainly prescription medicines: tramadol (71% of opiates as 1st most frequently used substance and specified), codeine (15,1%) and pentazocine (9,9%). Heroin and morphine are representing only 3.3% of the opiates declared.The type of first drug declared by the patients entering treatment varies considerably among the treatment facilities (Figure 19).

Figure 18: Most frequently first drug declared by patients entering treatment (%) excluding alcohol and tobacco, Nigeria, 2015

Cannab

is

Cocain

e

crac

k coca

ine

other

stim

ulant

opiates

sedati

ve-hypnotic

s

hallucin

ogens

solv

ents/

glue

Other

exclu

ding T

obacco

0

10

20

30

40

50

60


Figure 19: Most frequently first drug declared by patients entering treatment excluding alcohol and tobacco by treatment facility, Nigeria, 2015

FNPH Kaduna

FNPH Maiduguri


FNPH ENUGU

FNPH Benin

QHC

JUTH

FNPH Aro

UPTH

FNPH Yaba

AKTH Kano

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Cannabis Cocaine crack cocaineother stimulant opiates sedative-hypnoticshallucinogens solvents/glue Other excluding Tobacco

Among the first drug most frequently used, there are some differences between male and female. Male are declaring using more cannabis, alcohol than female. On the other hand, female entering treatment are more prone to declare using opiates, crack cocaine and sedatives (Figure 20).The drugs used also depend on the age of the patient admitted (Figure 21). Patients aged more than 35 years old declared using more alcohol and tobacco, while the younger patients used relatively more illicit drugs.

Figure 20: Most frequently first drug declared by patients entering treatment (%) by sex, Nigeria, 2015

Alcohol

Cannab

is

Cocain

e

crac

k coca

ine

other

stim

ulant

opiate

s

sedat

ive-

hypnotics

hallu

cinoge

ns

solv

ents

/glu

e

Other

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Male Female

Figure 21: Most frequently first drug declared by patient entering treatment by age groups, Nigeria, 2015

Alcohol

Cannab

is

Cocain

e

crac

k coca

ine

other

stim

ulant

opiate

s

sedat

ive-

hypnotics

hallu

cinoge

ns

solv

ents

/glu

e

Other

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

15 to 34 years old 35 years old or more

Polydrug use is widespread. Only 15.7% of the patients admitted declared using 1 psychoactive substance only, using 2 substances or more is more of the normality: 28.4% of the patients admitted declared using 2 substances, 27.2% 3 substances and 28.6% 4 substances and more.The Figure 22 provides an overview of the total number of psychoactive substances used according to the first most frequent drug used declared by the patient.

Figure 22: Number of substances used declared by first most frequent used drug, Nigeria, 2015

Alcohol

Cannabis

Cocaine & Crack

opiates

sedative-hypnotics

Other drugs

Tobacco

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

1 substance 2 substances 3 substances 4 and more substances

Note: the category “other drugs” contains: other stimulants, hallucinogens, solvent/glue and other drugs declared (without tobacco).

Looking at the most frequent drug combinations (first and second drug most frequently used declared) for patients who have declared using more than 1 psychoactive substance, the patients who have declared alcohol as their most frequent substance used usually consume as well cannabis (27%) and tobacco (57%) (Table 5). Patients using cannabis the most frequently declared alcohol, opiates and tobacco use while more than one third of patients declaring cocaine and crack also use cannabis. Patients who are using opiates as first frequent drug are associating them mostly with cannabis and sedatives-hypnotics. More than half of the patients declaring tobacco as most frequently used drug, declare using cannabis (second most frequently drug), fewer proportion use


alcohol (26.4% patients declaring tobacco as most frequently used drug and also declaring using a second drug), and even lower opiates (10.3%) (Table 5).

Table 5: Most frequent drug combinations (1st and 2nd most frequent drug declared) (%), Nigeria, 2015

Second most used drug declared

First most used drug declared

Alcohol CannabisCocaine and crack Opiates Tobacco

Alcohol ------------- 31.1 20.8 2.2 26.4Cannabis 27 -------------- 37.5 38.5 56.3Cocaine 3.3 1.4 ---------- 3.9Crack cocaine 0.3 ----------- 1.1Other stimulant 2.5 8 0.6Opiates 6.6 25.2 12.5 6.7 10.3Sedative-hypnotics 1.6 4.2 16.7 27.4 3.4Hallucinogens 0.8Solvents/glue 1.7 0.6Other 57.4 27.6 12.5 20.1 2.3Total 100% 100% 100% 100% 100%

3.2.4 InjectingInjecting is a risky behavior among the patients who have entered treatment in Nigeria in 2015: 5% of all the patients have declared injecting a drug. The proportion of men injecting is higher than the female, younger patients also tend to inject more than the ones aged more than 35 years old. Injecting is also a more urban behavior. The most frequent drugs injected are opiates (70%), sedatives-hypnotics (benzodiazepines, 15%) and cocaine (6%).

Among the people injecting, 42% have been tested for HIV in the last 12 months, 35% have been tested but not in the last 12 months and 21% have never been tested (2% declined to answer).

3.2.5 Drug use and injecting of primary drugFor patients having declared the first most frequent substance used the same than the problematic drug, it is possible to define this substance as their primary drug.In this case, it is assumed that the problematic drug is the substance leading to treatment. 774 patients have a matching first most frequent drug and problematic drug declared. The rest of the analysis in this section is based on this selected sample.The picture of the drug problem among patients change slightly while considering the primary drug rather than the first most frequent drug declared: cannabis and opiates are more prevalent, while the licit substances are less recurrent.

Figure 23: Primary versus first most frequent drug declared, Nigeria, 2015

Alcohol

Cannab

is

Cocaine

crack

coca

ine

other sti

mulant

opiates

sedati

ve-hypnotic

s

hallucin

ogenes

solven

ts/glu

eOther

0

5

10

15

20

25

30

35

40

45

First most frequently drug declared Primary drug

Among the primary drug patients, 4.4% are injecting the primary drug, but the practice of injecting is higher when secondary drugs are considered (5.4%).Patients are returning quite often into treatment, this is the case of a bit less than half of the primary drug patients (46.8%). The primary drug at the origin of the treatment varies based on if the patient is treated for the first time or entering treatment for a new time: primary users of opiates and cocaine tend to re-enter treatment more often (Figure 24).

Figure 24: Share of primary drug declared by new or old patients entering treatment, Nigeria, 2015

Alcohol

Cannab

is

Cocain

e

crac

k coca

ine

other

stim

ulant

opiate

s

sedat

ive-

hypnotics

solv

ents

/glu

e

Other

0.05.0

10.015.020.025.030.035.040.045.0

Previously treated Never treated

3.2.6 Other information collectedApproximately half of the patients who have started a treatment in 2015 have been treated previously (49.2%). For those treated before, the average is 3 treatments and median equals to 2 treatments. However, since there is no clear definition of treatment and treatment episode, the accuracy of the number of treatment reported is questionable.


Half of the patients in treatment are also receiving treatment for some other diseases or drug-related diseases. When the other treatment received have been informed by the treatment facilities, mental health problems are the most frequent co-morbidities.

The cost of treatment is mostly supported by the family and friends (90%) or the patient himself/herself (9%).

Finally, a little over half the patients reported having being tested for HIV: 52.4% have been tested during their lifetime (34.2% during the last 12 months, 16.5% not in the past 12 months and 1.7% respond without giving a timeframe). The rest of the patients were not tested (37.3%) or refused to answer (10.2%). HIV testing among patients is quite heterogeneous among treatment facilities (Figure 25). HIV testing is not a requirement for admission into the treatment however, the fact that the structure is an approved HIV counseling and testing (HCT) centre may be contribute to the ease of HIV testing.

Figure 25: HIV testing among patients in treatment by treatment facility, Nigeria, 2015

FNPH Kaduna

FNPH Maiduguri


FNPH ENUGU

FNPH Benin

QHC

JUTH

FNPH Aro

UPTH

FNPH Yaba

AKTH Kano

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Yes in the past 12 months Yes but not in the past 12 monthsNo Decline to answer

4. Conclusions and recommendations

The treatment demand information system in Nigeria is at this stage still a pilot project. Even if some improvements could be easily introduce to ease up the reporting (see below), it is quite positive and re-assuring to see that all treatment facilities are actually reporting to the Federal Ministry of Health and UNODC, most of them have been able to provide data monthly from February 2015 onwards. Additionally, even if the reporting can be improved, as well as the contextual information behind the reporting (obviously each structure work and attract different kind of profile of clients), the most important data is usually reported well enough to have an overview of profile of clients, drugs used and drug-related harms. Having said that, the form needs to be streamlined and clarified to ensure a better reporting and common understanding of the concepts used and data to be reported.

4.1. Recommendations pertaining to reporting and reporting tool

Reporting tool1. Introduce an improved and more adequate reporting tool with necessary space

for reporting on “other”, details of drugs used, appropriate dates, etc. 2. Improve the current NENDU guidelines with clearer definitions and information

to be reported (drug most used, primary drug, substance problematic to the patient, number of times in treatment, etc…)

3. The current NENDU form considers the 4 most frequent drugs used and their route of administration. It is not clear if the 1st most frequently used drug is also the drug at the origin of the treatment and creating most problems to the patient.

Reporting and treatment facilities1. Better follow up by FMOH, UNODC on a monthly basis: timeliness, reminder and

follow up, checking that appropriate reporting tool is used and in a correct manner

2. Introduce monthly data checking of the data submitted (only having a look at some major mistakes on the excel file should be enough)

3. Introduce a monthly data validation process between FMOH, UNODC and treatment facilities. This will allow to:

a. improve the reporting of the treatment facilities by regularly asking for clarifications/amendments of data submitted

b. have coherent data at the time of the analysis4. Additional training on the NENDU form to ensure that definitions and concepts

are understood and data to be reported clearly identified5. Additional training on the reporting tool for the treatment facilities to ensure that

the tool is filled in an appropriate manner.


4.2. Conclusions regarding the data analysis

Analysis per treatment facilityThe data analysis per treatment facility shows some disparity in terms of activity, type of drugs reported, level of other problems reported (apart from drug use), and variation as well in the level of HIV testing among the structures.The fact that the structures are located in different regions of Nigeria could be a reason for explaining the different type of drug use declared by the patients admitted in the facilities. Unless the type of the facility itself directly influences the type of patients admitted (through direct or indirect recruitment or by referral).

To explain the high level of education, a reason provided by one of the treatment center could be that awareness of the service being provided by the facility may be higher among educated members of the society since previous studies have shown that the level of education of the patients and their sponsor affects treatment seeking behaviour. Also since treatment is not free, it is possible that the socio-economic background of treatment seekers is from among the more affluent strata of society which could also be more educated. Additionally the way the reporting is organized (no difference between having started a tertiary education and having completed it in the answer provided) could also be responsible for the high level of education among patients admitted.

HIV testing is not a requirement for admission into the treatment but some facilities reported high level of testing. Several reasons could justify these figures:

The fact that some facilities are an approved HIV counseling and testing (HCT) centre may be contribute to the ease of HIV testing (Kaduna for example)

Some facilities have also observed that prior exposure to drug treatment may also increase the level of HIV testing among the patients.

Unfortunately, treatment facilities have not replied with the same level of comprehensiveness to the data request that was sent to them in order to correct misreported data or answer question regarding how the reporting is done or questions considered. Consequently, some data interpretations are difficult to make (i.e.: question on problematic drug is answered by the patient or by the practitioner; first drug entered is the most frequently used or more problematic to the patient or simply the first drug declared by the patient).

Aggregated analysis: treatment demand in NigeriaAs mentioned above, the quality of the data impacts on the analysis as some data were not corrected by the treatment facilities. Additionally, the design of the form also doesn’t allow much interpretation with regards to the drugs declared by the patients. Although each patient entering treatment can declare up to 4 psychoactive substances with route of administration, frequency of use and age at first use, the first substance declared (first substance most frequently used) is actually not always the substance leading to treatment and the most problematic to the patient. To illustrate the issue the table below (Table 6) provides an overview of the problematic drug declared based on the 1st

most frequently used substance by the patient.

If we take the first column: 115 are the patients with problematic use of alcohol and who have declared alcohol as the first most frequently drug used (so entered alcohol in question 15 of the form). But 25 patients who have declared alcohol in question 15, have

not an alcohol problem but a cannabis problem…. 4 patients who have declared alcohol in question 15, have not an alcohol problem but an opiate problem.

This is one of the main flaw in the current reporting. The first substance declared in the form, should be the substance creating most problem and leading to treatment (primary drug according to EMCDDA definition)

Table 6: First most frequently drug declared by patients by most problematic drug declared, Nigeria, 2015

Problematic drug declared

1st Most frequently used drug by the patientTotal

Alcohol CannabisCocaine & Crack Opiates

Sedative-hypnotics

Other drugs*

Tobacco

Alcohol 115 14 1 3 0 3 11 147Cannabis 25 298 2 11 2 5 20 363Cocaine & Crack 1 6 22 2 0 5 3 39Opiates 4 31 0 261 6 7 10 319Sedative-hypnotics 3 6 0 9 20 0 5 43Other drugs* 3 3 0 4 2 17 4 33Tobacco 10 4 0 2 0 2 38 56All substances 10 2 0 0 0 0 1 13Total 171 364 25 292 30 39 92 1013* The category “other drugs” contains: other stimulants, hallucinogens, solvent/glue and other drugs declared (without tobacco).

The difference between the problematic drug declared and the most frequently used drug is also illustrated in the figure below (Figure 26). Clearly, in case of alcohol and tobacco, even if the frequency of the intake is more, these substances are not systematically the substances leading to treatment. Based on this figure we can assume that to be able to define the substance leading to treatment, the primary drug according to the EMCCDA guidelines, some work will need to be done in terms of data collection to ensure that the primary drug reported (1st drug declared) is indeed the substance leading to treatment (most problematic drug to the patient) and not the substance used the more often.

The small numbers of female entering treatment has not allowed to do much of sex comparisons.Nonetheless, the data submitted by the treatment facilities during the year 2015 and the relatively good reporting (only a few months missing), allow to have a first overview of the profile of patients entering treatment in Nigeria.

Figure 26: Proportions of patients declaring problematic drug and 1st most frequently used drug (% of the total of the type of drugs declared), Nigeria, 2015


Alcohol

Cannab

is

Cocain

e & C

rack

opiate

s

sedat

ive-

hypnotics

Other

dru

gs

Tobacco

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

problematic drug declared 1st most frequently used drug declared

4.2. Recommendations for policy makers and practitionersBased on the monitoring and analysis of the 2015 NENDU data, it is also possible to draw some preliminary recommendations

Consider expanding community based treatment to increase treatment access to indigent drug users as drug treatment in Nigeria is currently limited to people who can afford it

Consider expanding number of beds per facility for drug users Consider diversifying the drug treatment offer based on the needs of clients Address the issue of voluntary admission to treatment Address the issue of outpatient admission to treatment Consider strategies to reach female drug users Ensure that HIV testing is available to drug users

Annexes

NENDU Questionnaire (version of May 2015)

CLIENT CODE: ___________INTERVIEWER ID:___________ DATE: __________________

A. TREATMENT DEMAND INDICATORS 1. Treatment Centre: ____________________________________________________

2. Type of Centre: 1. Private outpatient 2.Private in-patient 3.General Hospital 4.Psychiatric Hospital 5.Prison unit 6. Therapeutic Community 7.Others: ___________

3. Date admitted for treatment: (Day/Month/Year) ____________________________

4. Source of referral: 1. Self 2.Family/friends 3. Doctor/nurse 4. Social services 5. Workplace 6. School 7. Court/police 8. Others (specify)______________

5. Types of Admission (1) Voluntary (2) Involuntary (i) Diversion (ii) Correctional Services

6. What treatment are you currently receiving? (1) Inpatient (2) Outpatient

B. SOCIO-DEMOGRAPHIC INFORMATION

7. Sex: 1. Male 2. Female

8. Age: ________ years

9. Year of birth: ______________________

10. Living status: (a) Where: 1. Home/stable accommodation 2. Dormitory/institution 3. No stable accommodation (b) With whom: 1. Alone 2. With Parents 3. With spouse/partner 4. With friends 5. With children (no spouse) 6. Other (c) Area of residence: 1. Urban 2. Semi-Urban 3. Rural

11. Highest educational level completed: 1. Never completed primary school 2. Primary level 3. Some secondary school 4. Completed secondary school 5. Some tertiary/graduate

12. Employment status: 1. Regular employment 2. Pupil/student 3. Unemployed 4. Housewife 5. Other (specify)

13. Marital status: 1. Single (never married) 2. Married 3. Divorced/separated 4. Widowed 5. Other


14. Nationality: __________________________________________________________

C. DRUG-RELATED INFORMATION

(a) Current substances by name (write in one per line)

(b) Routes of administration (circle

all relevant codes)

(c) Frequency past month

(circle one code)

(d) Age at 1st use (years)

15 1st most frequently used 1 2 3 4 5 1 2 3 4

16 2nd most frequently used 1 2 3 4 5 1 2 3 4

17 3rd most frequently used 1 2 3 4 5 1 2 3 4

18 4th most frequently used 1 2 3 4 5 1 2 3 4

(a) 1.Alcohol 2. Cannabis 3. Cocaine 4. Crack Cocaine 5. Other stimulants (e.g., amphetamines) 6. Opiates (e.g., heroin) 7. Sedative-hypnotics (barbiturates, benzodiazepines) 8. Hallucinogens 9. Organic solvents/glue 10. Other(b) Route: 1=swallow, 2=smoke, 3=snort/sniff, 4=inject, 5=other(c) Frequency: 1=daily, 2=2-6 days per week, 3=Once per week or less often, 4=not used in past month

19. Usual source of primary drug: 1. Friends 2. Street dealers 3. Prescription/pharmacy 4. Other: ______________

20. Other drugs used: (Use list above) _____________________________________

21. Which of these substances is most problematic to you (Please use list in question 15) ____________________

22. Any previous treatment for drug abuse/dependence? 1. Yes 2.No If Yes, Number of times in treatment: __________

23. How will treatment be paid for? 1. Personal income, 2. Family/friends, 3. Employer 4. Insurance, 5. Other

24. Are you currently receiving treatment for any of the following? Please tick all that apply:

1) Cardiovascular disease, (2) Diabetes, (3) Respiratory disease, (4) Mental heal problems, (5) Hypertension (6) Liver Disease, (7) Gastrointestinal tract disease

25. Have you been tested for HIV? 1) Yes – in the past 12 months 2) Yes – but not in the past 12 months 3) No 4) Decline to answer

List of acronyms

AKTH Aminu Kano Teaching Hospital

CSO Civil Society OrganisationECOWAS Economic Community Of West African StatesEMCDDA European Monitoring Center for Drugs and drug addictionFMOH Federal Ministry of HealthFNPH Federal Neuro Psychiatric HospitalJUTH Jos University Teaching HospitalQHC Quintessential Health Care CenterHIV Human immunodeficiency virusNDLEA National Drug Law Enforcement AgencyNENDU Nigerian Epidemiological Network for Drug UseUNODC United Nation Office on drugs and crimeUPTH University Teaching Hospital, Port HarcourtSACENDU South African Community Epidemiology Network on Drug UseWENDU West African Epidemiological Network on Drug Use

List of Tables and Figures

Table 1: Number of beds allocated to drug treatment, 11 treatment facilities of NENDU, 2013................................................................................................................................................................. 6

Table 2: Monthly reporting by the 11 treatment facilities (at the date of 09/03/2016)..10Table 3: Sex and age of patients admitted for treatment, Nigeria, 2015..................................33Table 4: Marital status of patients and living with whom, Nigeria, 2015................................33Table 5: Most frequent drug combinations (1st and 2nd most frequent drug declared)

(%), Nigeria, 2015...................................................................................................................................38Table 6: First most frequently drug declared by patients by most problematic drug

declared, Nigeria, 2015.........................................................................................................................42

Figure 1: Map of Model Treatment facilities providing NENDU Data..........................................6Figure 2: First drug most used by patients admitted for treatment in FNPH Kaduna, 2015

......................................................................................................................................................................... 21Figure 3: First drug most used by patients admitted for treatment in FNPH Maiduguri,

2015.............................................................................................................................................................. 22Figure 4: First drug most used by patients admitted for treatment in National Hospital

Abuja, 2015................................................................................................................................................ 23Figure 5: First drug most used by patients admitted for treatment in FNPH Enugu, 2015

......................................................................................................................................................................... 24Figure 6: First drug most used by patients admitted for treatment in FHNP Benin, 2015

......................................................................................................................................................................... 24Figure 7: First drug most used by patients admitted for treatment in QHC, 2015..............25Figure 8: First drug most used by patients admitted for treatment in JUTH, 2015............26Figure 9: First drug most used by patients admitted for treatment in FNPH Yaba, 201527Figure 10: First drug most used by patients admitted for treatment in FNPH Aro, 201528Figure 11: First drug most used by patients admitted for treatment in UPTH, 2015........29Figure 12: First drug most used by patients admitted for treatment in AKTH, 2015........30


Figure 13: Number of patients entering treatment in Nigeria, January to December 2015......................................................................................................................................................................... 31

Figure 14: Proportion of voluntary and involuntary admissions among the 11 treatment facilities, Nigeria, 2015......................................................................................................................... 32

Figure 15: Proportion of patients admitted as inpatient or outpatient among the 11 treatment facilities, Nigeria, 2015...................................................................................................32

Figure 16: Area of residence of the patients according to the treatment facility, Nigeria, 2015.............................................................................................................................................................. 34

Figure 17: Most frequently first drug declared by patients entering treatment (%), Nigeria, 2015............................................................................................................................................. 35

Figure 18: Most frequently first drug declared by patients entering treatment (%) excluding alcohol and tobacco, Nigeria, 2015............................................................................35

Figure 19: Most frequently first drug declared by patients entering treatment excluding alcohol and tobacco by treatment facility, Nigeria, 2015......................................................36

Figure 20: Most frequently first drug declared by patients entering treatment (%) by sex, Nigeria, 2015............................................................................................................................................. 36

Figure 21: Most frequently first drug declared by patient entering treatment by age groups, Nigeria, 2015............................................................................................................................37

Figure 22: Number of substances used declared by first most frequent used drug, Nigeria, 2015............................................................................................................................................. 37

Figure 23: Primary versus first most frequent drug declared, Nigeria, 2015........................39Figure 24: Share of primary drug declared by new or old patients entering treatment,

Nigeria, 2015............................................................................................................................................. 39

Figure 25: HIV testing among patients in treatment by treatment facility, Nigeria, 2015......................................................................................................................................................................... 40

Figure 26: Proportions of patients declaring problematic drug and 1st most frequently used drug (% of the total of the type of drugs declared), Nigeria, 2015........................43

Bibliography

Lopez, Dominique. 2015. Implementing an Integrated and Comprehensive Drug-Related Monitoring Information System in Nigeria: Report and Recommendations.

Feedback received from treatment facilities on data issues

Kaduna

UNODC NENDU DATAData issues with Kaduna reporting

1. Very high level of education for all patients, is it biased from the patients entering the in treatment in this structure or misreporting from patient/structure?

Answer: This is not due to misreporting from patient/structure. We however make some observations that may be responsible.

i. Coding of Question 11 on the questionnaire, merges attempt at tertiary institution with graduation from tertiary institution (some tertiary/graduate clients) in the same group. This may be responsible for the high preponderance of clients in that group. As most of the clients have attempted tertiary education but not necessarily completed it.

ii. We suspect that awareness of the service being provided by the facility may be higher among educated members of the society since previous studies have shown that the level of education of the clients and their sponsor affects treatment seeking behaviour. This may however stimulate a specific research on the subject matter.

2. Very high level of HIV testing declared by the patients. Is it a bias from the structure, does the structure do HIV testing mandatorily for patients admitted for treatment? or misreporting from patients? or simply a reflection of the reality (since patients have high education.

HIV testing is not a requirement for admission into the treatment facility however, the fact that the Hospital is an approved HIV counselling and testing (HCT) centre may be contribute to the ease of HIV testing. We also observed that being prior exposure to drug treatments may also increase the level of HIV testing among the clients.

3. Coding of question 21 (most problematic drug) need to be confirmed if it assessment done by the practitioner/clinician or by the patient.

The patient always confirms the most problematic drug use.


4. Need to verify variable age for some patients (see excel file enclosed, cells highlighted in red)

Discrepancies in age have been noted and corrected. Please, find below corrected information.

s/n Client Code Year of Birth Age1 May017 1987 282 May020 1982 333 Feb001 1978 374 June030 1986 295 July033 1973 42

5. Coding of year of birth: only year of birth is important, exact date of birth not necessary as currently reported, please avoid such detailed information and report only year of birth.

This correction is noted and will be effected in subsequent Questionnaires, we however note that using the year alone without the month of birth may create ambiguity in age. The standard method that will ensure precision and not subject the data to false inclusions is to at least use the month of the year of birth. An example is, if a client’s year of birth is December 1990, his age can be 24yrs or 25yrs depending on if the year of birth alone was used.

Thank you for your observations, we hope this has answered the raised issues and you will also find our observations worthy of consideration.

Dr. Taiwo Lateef SheikhFocal person for treatment,Federal Neuropsychiatric Hospital, Kaduna.

Additional Cross tabulations (analysis of all data from treatment facilities)

Source of referral

Frequency Percent Valid Percent Cumulative

Percent

Valid

1 .1 .1 .1

self 72 6.9 6.9 7.0

family/friends 911 87.3 87.3 94.3

doctor/nurse 38 3.6 3.6 97.9

social

services

3 .3 .3 98.2

workplace 3 .3 .3 98.5

school 11 1.1 1.1 99.5

court/police 1 .1 .1 99.6

others 4 .4 .4 100.0

Total 1044 100.0 100.0

Type of admission

Frequency Percent Valid Percent Cumulative

Percent

Valid

1 .1 .1 .1

voluntary 734 70.3 70.3 70.4

involuntary 309 29.6 29.6 100.0

Total 1044 100.0 100.0

Type of treatment center * Type of admission Crosstabulation

Count

Type of admission Total

voluntary involuntary

Type of treatment center

general hospital 16 56 72

psychiatric hospital 541 221 762

therapeutic community 103 32 135

others 74 0 74

Total 734 309 1043

Name of treatment center * Sex of the patient CrosstabulationCount

Sex of the patient Total


Male FemaleName of treatment center FNPH Kaduna 52 10 62

FNPH Maiduguri 248 10 258National Hospital Abuja 18 5 23FNPH ENUGU 69 1 70FNPH Benin 60 1 61QHC 122 14 136JUTH 40 6 46FNPH Aro 147 9 156UPTH 45 6 51FNPH Yaba 103 4 107AKTH Kano 61 11 72

Total 965 77104

2

List of participating centresNo Agency Name of participants Email Phone1 Aminu Kano Teaching

Hospital (AKTH)Dr Auwal Sani Salihu [email protected] 8036092822

2 Aminu Kano Teaching Hospital (AKTH)

Ali Bashir [email protected]

3 FNPH Maiduguri Dr. Ibrahim Abdu Wakawa [email protected], [email protected]

08066787941

4 FNPH Maiduguri Nura Abdullahi [email protected] 8080615810

5 FNPH Benin Mr. Adeyelu Adeola [email protected] 08138003806

6 FNPH Benin Dr. Sunday O. Olotu [email protected] 08103604194

7 UPTH Port Harcourt Dr Nkporbu A.Kennedy [email protected] 8036772778

8 UPTH Port Harcourt Prof P.C.Stanley [email protected] 80331087299 UPTH Port Harcourt Dr. C. U. Okeafor

10 FNPH Yaba Ms. Chinyere Okonkwo Chinyere Okonkwo <[email protected]>

8028379354

11 FNPH Yaba Ayodeji Olaniyan Ayodeji Olaniyan <[email protected]>

8184873618

12 FNPH Enugu Dr Unaogu Ngozi [email protected] 08033567143,13 FNPH Enugu Mr Tukur Kabiru [email protected] 8105228282

14 Quintessential Healthcare Centre, Jos

Sunday Goar [email protected] 08130291664

15 Quintessential Healthcare Centre, Jos

Mr Tuna Setmut Tupshak [email protected] 07037728718

16 UTH Jos DR TAIWO OBINDO [email protected], [email protected]

8034520136

17 UTH Jos Bernard Bansan Tunkoyo [email protected] 08039141228

18 FNPH Aro Dr. Amosu SUNDAY [email protected] 0706054843019 FNPH Aro Mr. Jonathan O. OLADEJO [email protected] 08067746467

20 National Hospital, Abuja Dr Olusola Ephraim-Oluwanuga

[email protected] 8033262921

21 National Hospital, Abuja Mr Wada Aliyu [email protected], [email protected]

7033816051

22 FNPH Kaduna Dr T. L. Sheikh [email protected] 803700461123 FNPH Kaduna Jumoke Edun [email protected] 8054432293


mailto:[email protected]

mailto:[email protected]%C2%A0










drug treatment information system in nigeria: data...

Documents