Open Journal of Psychiatry, 2012, 2, 292-300 OJPsych
http://dx.doi.org/10.4236/ojpsych.2012.24041 Published Online October 2012 (http://www.SciRP.org/journal/ojpsych/)
Ethnic density and prevalence of psychiatric morbidity
among patients with hiv infection in Sokoto, Nigeria—A
control study
Mufutau A. Yunusa*, Ayodele Obembe
Department of Psychiatry, Usmanu Danfodiyo University, Sokoto, Nigeria
Received 4 September 2012; revised 2 October 2012; accepted 10 October 2012
ABSTRACT
Background: Previous studies among people living
with HIV infection suggested that prevalence of psy-
chiatric morbidity was high. In addition, among non-
HIV infected patients, ethnic density influence the
prevalence. The present study was aimed to deter-
mine the prevalence and effects of ethnic density on
psychiatric morbidity among these patients in Sokoto,
Nigeria. Methods: This prospective cross-sectional
study was conducted among patients who had been
diagnosed with HIV infection in a teaching hospital in
Sokoto. Questionnaire relating to sociodemographic
variables and psychiatric morbidity were adminis-
tered to the patients. Data obtained were analyzed
using SPSS version 16.0 while test for significance
was set at P < 0.05. Result: The mean age of the pa-
tient was 32 ± 9 years (range = 12 - 63), male being
older than the female. Of the patients, 71% were
married while and about two third were of Islamic
religion. Twenty seven percent had no formal educa-
tion and were mainly Hausa/Fulani ethnicity. Seven
percent of the patients had definite depression while
8% had definite anxiety. When the subjects were di-
chotomized to Hausa/Fulani and others, they were
similar with regard to age and gender (χ2 = 4.43; P =
0.49 and χ2 = 0.22; P = 0.64 respectively). Across the
ethnicity (Hausa/Fulani and others), the subjects dif-
fer significantly with regard to religion (χ2 = 0.68; P =
0.00), marital status (χ2 = 15.05; P = 0.00), education
(χ2 = 30.56; P = 0.00) and employment status (χ2 =
9.81; P = 0.01). The Hausa/Fulani ethnic group had
less psychiatric morbidity. In addition, marital status
had significant pathoplastic effect on depression
across ethnicity (χ2 = 0.42; P = 0.02). Conclusion:
Ethnic density was associated with decrease preva-
lence of common mental disorder among patients
with HIV infection. Environmental manipulation may
play a role in the management of this patient.
Keywords: Ethnicity; HIV; Morbidity; Prevalence;
Psychiatric
1. INTRODUCTION
The prevalence of anxiety and depression among HIV
patients is high, however varied [1-3]. In one report,
nearly half of the patients with HIV infection were re-
ported to have psychiatric morbidity [4]. However in
another study a smaller percentage was reported [5]. A
prevalence of 22% to 32% [6,7] which was 2 to 3 times
higher than the prevalence of psychiatric disorders in
general community population has also been reported.
However in a longitudinal study of Maj et al. [5], lower
prevalence of 9% of major depression and 2% of anxiety
disorder were reported after 6-months follow up [8]. In
south west Nigeria, prevalence of depression among pa-
tients with HIV infection was 59.1% [9].
The effects of psychiatric morbidity on HIV infection
underscored the need to study psychiatric morbidity c l osel y
among the patients and identify the predisposing factors.
Depression and anxiety disorder were reported to speed
progression of the disease [10,11]. In addition, depres-
sion has negative effect on course and outcome of HIV
infection [12] and substantially impact on quality of life
of patients while anxiety has negative consequence on
social role and mental functioning [13].
Ethnic density is one factor that had been reported to
influence distribution of psychiatric morbidity and in
particular beneficial pathoplastic effects on psychiatric
morbidity. It is defined as the relative size of a given
ethnic group in a multi ethnic neighbourhood [14]. In
one report Rabkin [14] reported on the hazards of ethnic
minority status on psychiatric hospitalization. They
showed that the ethnic density had protective association
on suicide and self harm as well as on psychosis [15]. In
a large community study in England and Wales [16],
5167 ethnic minority and 2867 white were studied.
The protective effects of ethnic density on psychiatric
*Corresponding a uthor.

M. A. Yunusa, A. Obembe / Open Journal of Psychiatry 2 (2012) 292-300 293
morbidity were also observed.
T his st udy wa s aimed at determin ing the influen ce of eth-
nic density on prevalence of anxiety and depression among
Hausa/Fulani ethnic group with HIV infection in Sokoto.
2. METHODS
2.1. Study Design and Location
This was part of a large study. Detail on methodology
was reported in earlier report [17]. This cross sectional
study was carried out among patients who were dia-
gnosed of HIV infection at the VCT [voluntary coun-
seling and testing] centre of Usmanu Danfodiyo Univer-
sity Teaching Hospital, Sokoto, North Western Nigeria.
The study included 167 consecutive adult patients who
were attending their routine clinic. Both symptomatic and
non symptomatic patients were included.
2.2. Data Collection
Variables relating to socio demographic profile and substance
use were obtained throu gh the use of questionnaire designed
by the authors while psychiatric morbidity was assessed using
Hospital Anxiety and Depression Scale (HADS) [18].
2.3. Sociodemographic Questionnaire
Sociodemographic questionnaire was designed by the
authors to enquire about basic epidemiological variables
including age, sex, occupation and religion.
2.4. Hospital Anxiety and Depression Scale
This 14-item questionnaire was developed by Zigmond
and Snaith [18] to determine the presence of anxiety
and depression among patients with medical conditions.
Using Likert scoring scale, score range is 0 - 21 for
each of the condition. While patients with score of 0 - 7
are considered as non cases, those that scored 8 - 10 and
11 and above were considered as borderline and definite
cases for anxiety or depression respectively. It has been
validated and used in previous studies in Nigeria.
Abiodun [19] reported from a Nigerian community that
the sensitivity for the anxiety subscale ranged from
85.0% in the medical and surgical wards to 92.9% in
the ante-natal clinic, while sensitivity for the depression
sub-scale ranged from 89.5% in the community sample
to 92.1% in the gynaecology clinic. The specificity for
the anxiety sub-scale ranged from 86.5% in the gynae-
colog y clinic to 90.6% in the community sample, while
specificity for the depression sub-scale ranged from
86.6% in the medical and surgical wards to 91.1% in
the ante-natal clinic and community sample. Misclassi-
fication rates ranged from 9.9% in the community sam-
ple to 13.2% in the medical and surgical wards. Rela-
tive operating characteristics (ROC) analyses showed
the HADS and the GHQ 12 to be quite similar in ability
to discriminate between cases and non cases. Fatoye et
al. [20] used HADS in the study of prevalence of anxi-
ety and depression in patients with epilepsy in a Nige-
rian community. A study had shown that depression
subscale is useful to determine the presence of clinical
depression than beck depression inventory (Jose, et al.)
[21].
2.5. Analysis
For the purpose of analysis anxiety and depressive symp-
toms was made for any patients that cross the threshold
of 7 on HADS in the scoring thereby comprising of bor-
derline and definite anxiety and depression, while those
with definite anxiety and depression were treated sepa-
rately in other analysis. In addition age of onset of illness
was calculated hypothetically by subtracting age at time of
the study from the period since the illness was diagnosed.
Data was analyzed descriptively using SPSS for win-
dows version 16.0. Cases with missing data for the
HADS were excluded.
3. RESULT
A total of one hundred and sixty seven consecutive adult
patients were recruited for the study. Of these patients, 8
(4.8%) did not fill HADS questionnaire completely to be
incorporated into the analysis giving response rate of
95.2%. Eighty six (55.8%) of them were Hausa/Fulani
ethnic group while 68 (44.2%) others included Yoruba,
Igbo among others (Figure 1). The mean age of the pa-
tients was 34.52 ± 8.93. One hundred and fourteen
(71 .7 %) w er e mar r i ed , 25 (15.7%) were widowed, 8 (5%)
were divorced and 11 (8.9%) were never married. Also,
ninety seven (61%) were Muslims and 60 (37.7%) were
Christians. About a quarter of the patients had no formal
education while about 30% had post secondary educa-
tion. Of the subjects, fifteen (9.5%) were found to have
borderline depression while 12 (7.6%) had definite de-
pression. In addition, 10 (6.3%) were found to have
anxiety while 14 (8.8%) had definite anxiety (Tables 1
and 2). Mean score for the patients on HADS—anxiety,
subscale was 3.62 ± 4.03 and HADS (depression) was
4.33 ± 3.81. The mean HADS score for anxiety and de-
pression among patients who had definite anxiety and
depression were 13.00 ± 2.63 and 13.17 ± 2.76 respec-
tively. Table 3 showed the sociodemographic of the
Hausa/Fulani ethnic group against the other ethnic group.
With regard to age and gender, the two groups were
similar (χ2 = 4.43; P = 0.49) and (χ2 = 0.22; P = 0.64).
The groups differed significantly across religion (χ2 =
0.68; P = 0.00) and marital status with more of the
Hausa/Fulani ethnic group being widow (χ2 = 15.05; P =
0.00). In addition more of the Hausa ethnic group had no

M. A. Yunusa, A. Obembe / Open Journal of Psychiatry 2 (2012) 292-300 294
tribe
Figure 1. Ethnicity.
Table 1. Sociodemographic characteristics and prevalence of
psychiatric morbidity. Table 2. Sociodemographic characteristics and prevalence of psychiatric morbidity (cont’d).
Characteristics Number %
AGE
<20 2 1.3
20 - 29 47 29.9
30 - 39 66 42.0
40 - 49 33 21.0
50 - 59 8 5.1
60 - 60+ 1 0.6
Total 157 100.0
Gender
Male 48 30.2
Female 111 69.8
Total 159 100.0
Religion
Islam 97 61.8
Christianity 60 38.2
Total 157 100.0
Marital status
Never married 11 6.9
Married 114 71.7
Separated 1 0.6
Divorced 8 5.0
Widow 25 15.7
Total 159 100.0
Education
No formal education 44 27.8
Primary 19 12.0
Secondary 47 29.7
Post secondary 48 30.4
Total 158 99.9
Number %
Tribe
Hausa / Fulani 86 55.8
Others 68 44.2
Total 154 100.0
Depression
Normal 130 82.3
Borderline 15 9.5
Definite 12 7.6
Total 158 99.4
Anxiety
Normal 134 84.3
Borderline 10 6.3
Definite 14 8.8
Total 158 99.4
formal education compared to the other ethnic group (χ2 =
30.56; P = 0.00) and similarly, more of the Hausa ethnic
group were unemployed (χ2 = 9.81; P = 0.01). As shown
in Table 4, prevalence of definite depression and anxiety
disorder were higher than that of the Hausa/Fulani ethnic
group.
In Table 5, sociodemographic characteristics of the
subjects were cross tabulated against psychiatric morbid-
dity. Subjects who were of age group 20 - 29 years were
mor e as s oci a t ed with borderline psychiatric morbidity and
those who were divorced. In addition, sociodemo-graphic
characteristics of each of the 2 groups (Hausa/Fulani and
others) were examined for the distribution of psychiatric
morbidity (Tables 6 and 7). Across both groups, being

M. A. Yunusa, A. Obembe / Open Journal of Psychiatry 2 (2012) 292-300 295
Table 3. Sociodemographic characteristics across ethnicity of patients.
Characteristics Hausa/Fulani No. (%) Others No. (%) χ2 P-value
Age
<20 1 (1.2) 1 (1.5) 4.43 0.49
20 - 29 22 (25.9) 24 (35.8)
30 - 39 36 (42.4) 28 (41.8)
40 - 49 21 (24.7) 11 ( 1 6.4)
50 - 59 5 (5.9) 2 (3.0)
60 - 60+ 0 (0.0) 1 (1.5)
Total 85 (100) 67 (100)
Gender
Male 27 (31.4) 19 (27.1) 0.22 0.64
Female 59 (68.6) 49 (72.1)
Total 86 (100.0) 68 (100.0)
Religion
Islam 77 (91.7) 17 (25.0) 0.68 0.00
Christianity 7 (8.3) 51 (75.0)
Total 84 (100.0) 68 (100.0)
Marital status
Never married 2 (2.3) 9 (13.2) 15.05 0.00
Married 57 (66.3) 52 (76.5)
Separated 1 (1.2) 0 (0.0)
Divorced 7 (8.1) 1 (1.5)
Widow 19 (22.1) 6 (8.8)
Total 86 (100.0) 68 (100.0)
Education
No formal education 39 (45.9) 4 (5.9) 30.56 0.00
Primary 9 (10.6) 10 (14.7)
Secondary 17 (20.0) 28 (41.2)
Tertiary 20 (23.5) 26 (38.3)
Total 85 (100.0) 68 (100.0)
Employment status
Employed 31 (36.9) 40 (62.5) 9.81 0.01
Unemploy e d 49 (58.3) 23 (35.9)
Table 4. Distribution of psychiatric morbidity and ethnicity.
CHARACTERISTICS HAUSA/FULANI No. (%)OTHERS NO. (%) χ2 P-Value
Depression
Normal 71 (83.5) 56 (82.4) 1.50 0.68
Borderline 9 (10.6) 6 (8.8)
Definite 5 (5.9) 5 (7.4)
TOTAL 85 (100.0) 68 (100.0)
Anxiety
Normal 74 (86.0) 56 (82.4) 1.89 0.59
Borderline 6 (7.0) 4 (5.9)
Definite 6 (7.0) 7 (10.3)
TOTAL 86 (100.0) 67 (99.6)

M. A. Yunusa, A. Obembe / Open Journal of Psychiatry 2 (2012) 292-300 296
Table 5. Sociodemographic charac teristics and distribution of psychiatric morbidity among the patients.
Depression Anxiety
Normal Borderline Definiteχ2 P-valueNormal Borderline Definite χ2 P-value
Age class (years)
<20 2 (100.0) 0 (0.0) 0 (0.0) 8.25 0.91 0 (0. 0) 2 (100.0) 0 (0.0) 0.37
20 - 29 35 (74.5) 7 (14.9) 4 (8.5) 35 (74.5)4 (8.5) 7 (14.9)
30 - 39 56 (86.2) 3 (4.6) 6 (9.2) 56 (84.8)5 (7.6) 5 (7.6)
40 - 49 28 (84.8) 4 (12.1) 1 (3.0) 31(93.9) 1 (3.0) 1 (3.0)
50 - 59 6 (75.0) 1 (12. 5 ) 1 (12.5) 7 (87.5) 0 (0.0) 1 (12.5)
60 - 60+ 1 (100.0) 0 (0.0) 1 (0.0) 1 (100.0)0 (0.0) 0 (0.0)
Marital status
Never married 7 (63.6) 3 (27.3) 1 (9.6) 18.090.11 7 (63.6) 4 (36.4) 0 ( 0.0) 19.580.08
Married 96 (85.0) 7 (6.2) 9 (8.0) 97 (85.1)5 (4.4) 11 (9.6)
Separated 0 (0.0) 1 (100) 0 (0.0) 0 (0.0) 1 (10 0.0) 0 (0.0)
Divorced 7 (87.5) 0 (-) 1 (12.5) 7 (87.5) 0 (0.0) 1 (12.5)
Widow 20 (80.0) 4 (16.0) 1 (4.0) 22 (88.0)1 (4.0) 2 (8.0)
Tribe
Hausa/ Fulani 7 1 (83.5) 9 (10.6) 5 (5.9) 1.50 0.68 74 (86.0)6 (7.0) 6 (7.0) 1.89 0.59
Others 56 (82.4) 6 (8.8) 5 (7.4) 56 (82.4)4 (5.9) 7 (10.3)
Table 6. Characteristics, prevalence of definite depression among the patients.
Hausa/Fulani ethnic group Other ethnic group
Definite depression χ2 P-value
Definite depression χ2 P-value
Age
<20 0 (0.0)
0.29 0.49 0 (0.0) 0.41 0.55
20 - 29 0 (0.0) 4 (16.7)
30 - 39 4 (11.4) 1 (3.6)
40 - 49 0 (0.0) 0 (0.0)
50 - 59 1 (2 0 .0) 0 (0.0)
60 - 60+
Total
Gender
Male 1 (3.7) 0.11 0.60 0 (0.0) 0.19 0.46
Female 4 (6.9) 5 (10.2)
Total
Religion
Islam 5 (6.6) 0.08 0.8 2 ( 11.8) 0.13 0.76
Christianity 0 (0.0) 3 (5.9)
Total
Marital status
Never married 1 (50.0) 0.42 0.02 0 (0.0) 0.36 0.32
Married 3 (5.4) 4 (7.7)
Separated 0 (0.0) 0 (0.0)
Divorced 1 (14.3)
0 (0.0)
Widow 0 (0.0) 1 (16.7)
Total
Education
No formal education 1 (2.6) 0.33 0.26 1 (25.0) 0.31 0.84
Primary 2 (22.2) 1 (10.0)
Secondary 2 (11.8) 1 (3.6)
Tertiary 0 (0.0) 2 (10.0)
Total

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Table 7. Characteristics, prevalence of anxiety among the patients.
Hausa/Fulani P-value χ2 Others P-value χ2
Age
<20 0 (0.0) 0.30 0.39 0 (0.0) 0.35 0.87
20 - 29 3 (13.6) 4 (16.7)
30 - 39 1 (2.8) 3 (10.7)
40 - 49 1 (4.8) 0 (0.0)
50 - 59 1 (20.0) 0 (0.0)
60 - 60+
Total
Gender
Male 2 (7.4) 0.87 0.72 1 (5.3) 0.17 0.57
Female 4 (6.8) 6 (12.2)
Total
Religion
Islam 5 (6.5) 2 (11.8) 0.12 0.53
Christianity 1 (14.3) 5 (9.8) 0.16 0.61
Total
Marital status
Never married 0 (0.0) 0.28 0.52 0 (0.0) 0.43 0.08
Married 4 (7.0) 6 (11.5)
Separated 0 (0.0) 0 (0.0)
Divorced 1 (14.3) 0 (0.0)
Widow 1 (5.3) 1 (16.7)
Total
Education
No formal education 1 (2.6)
1 (25.0)
Primary 1 (11.1) 2 (20.0)
Secondary 1 (5.9) 1 (3.6)
Tertiary 2 (10.0) 3 (11.5)
Total
Employment status
Employed 2 (6.5)
0.18 0.56
5 (12.5) 0.18 0.90
Unemployed 4 (8.2) 2 (8.7)
married and having higher education were associated
with lower prevalence of psychiatric morbidity.
4. DISCUSSION
This study set out to determine the prevalence of psy-
chiatric morbidity among patients with HIV infection
who attended outpatient clinic of a tertiary hospital in
Sokoto, Nigeria. In addition, to determine the impact of
ethnic density on prevalence of psychiatric morbidity
among the patients.
The subjects were mainly young and sexually active
age group with about one third being married. More than
two third of the patients were not gainfully employed,
over half of them were married while another one third
were widowed. In this culture, women often remarried
soon after bereavement or divorce. This could be of in-
terest in the study of HIV disease transmission.
Anxiety and depressive symptoms were present in
17.1% and 15.1% of the patients respectively while defi-
nite anxiety and depression were present in 8.8% and
7.5% respectively. We observed that the following were
significantly associated with high prevalence of anxiety
and depression namely: Young age group (<20 years),
female gender, tertiary education, being employed and

M. A. Yunusa, A. Obembe / Open Journal of Psychiatry 2 (2012) 292-300 298
being with the illness for greater than 3 years. Also, de-
pressive symptom was more frequently associated with
age group <20 years, female gender, and being with the
illness for duration more than 5 years. Definite depres-
sion was found to be common among those who were of
young age, female gender, with no formal education.
The prevalence of mood disorder in present study was
consistent with previous studies among HIV infected
patients. Grant et al. [22] reported prevalence of mood
disorders in US population to be 9.21% while that of
anxiety disorder was 11.08%. This was also consistent
with findings in a Kenya [5] and Tanzania [23] study.
However other studies reported higher prevalence. Chan-
dra et al. [24] reported prevalence of 40% of depression
and 36% of anxiety among patients who attended tertiary
centre in India using HADS. In Ethiopia, using Kassler
[25 ] scale prevalence of common mental disorders among
patients with HIV infection was 46.7% which was higher
than findings in our study. The diff er e n ce s may b e a s so c i-
ated to sample size, socioculture and duration of illness.
For instance in their study patients were recruited within
4 - 6 weeks of revelation of HIV status unlike our study
with varied duration of illness from 2 weeks to 9 years. A
previous study in Nigeria reported prevalence of 59.1%
[9]. This difference may be associated with differences
in socioculture and instrument used to assess for psy-
chiatric morbidity. The subjects reported in that study
were mainly of Yoruba ethnic group south west Nigeria
which socioculturally differed from the Northwest Ni-
gerians where the present study took place. In addition
the instrument used had the advantage in discriminating
against physical symptoms associated with chronic phy-
sical illness such as fatigue, which DSM IV they used
could not.
The subjects were predominantly Hausa/Fulani ethnic
group while the remaining subjects comprised of more
than 10 different ethnic groups. We found variations in
sociodemographic characteristics when the Hausa/Fulani
ethnic group was compared with the other groups. The
Hausa/Fulani group was similar to the other ethnic group
with regard to age and gender. However more of the
Hausa/Fulani were less educated and less likely to be
married o r employed .
Also subjects who were ethnic minor ity were found to
have higher psychiatric morbidity than the Hausa/Fulani
ethnic. In addition, age and marital status appeared to
have effects on the prevalence across the ethnicity. This
finding was consistent with previous study on ethnic
density hypothesis which proposed that persons who live
in neighbourhood with a greater proportion of residents
of their own race or ethnicity have better mental health
outcomes and lower levels of depression symptoms than
persons who live in neighbourhood members with few
people of their own race/ethnicity [16]. A review by
Shaw et al. [15] showed consistent finding of the protect-
tion of ethnic density on depression and anxiety. This
protection was also extended to suicide and self harm.
This finding has been supported by other previous stu-
dies. In one study, the smaller the ethnic group, the
higher its hospitalization rate in comparison to both the
rate of other residents in the same area and that of mem-
bers of the same ethnic group living in areas where they
constituted a numerical majority [14]. An extensive study
which analyzed two cross sectional nationally represen-
tative surveys showed that nominally similar measures of
ethnic density perform differently across health outcomes
and measures of experienced ra cis m in the two cou ntr ie s.
In the US, increased Caribbean ethnic density was as-
sociated with improved health including mental health
[26]. Other study which supported our finding was
conducted among millennium group cohort which was a
large prospective study of 18,819 infants and their
18,533 families born in 2000-2002 in the United King-
dom [27]. They found protective effect of ethnic density
for limiting long term illness among Bangladeshi moth-
ers at 5% - 30% density and Pakistani mothers at all
higher densities. However it was unrelated to infant
outcomes.
The Hausa/Fulani ethnic group who w ere of ag e group
30 - 39 years had more definite anxiety than other age
group among the ethnic group. However the other group
who were of age group 30 - 39 years had more definite
anxiety disorder than other age group among same eth-
nicity and among same age group of other ethnic group.
However across gender, female patients reported anxiety
disorder than the male subjects. Marriage appeared to
have significant pathoplastic effects among the Hausa/
Fulani ethnic group.
The mechanism for this protection of ethnic density on
mental health has been related to shared culture, social
networks and social capital [27]. In addition, majority of
the patient being Muslim have attribution hypothesis
which states that everything has been preordained which
may result in attenuation of emotion associated with
chronic illness. Other hypothesis to support reasons why
ethnic minority who were not presently living in own
ethnic group include selective migration, genetic, neuro-
developmental, substance use and psycho social factors
[28]. Migration: Odegaard [29] reported that individuals
who were likely to migrate were due to selective migra-
tion and associated this with poor migration in Norway.
However this was not supported by the findings of Selten
et al. [30] which showed that Surinamese migrants were
more likely than the Dutch had it been all the Surinamese
were brought to Neitherlands. In addition, the in itial neg-
ative symptoms which proceeded schizophrenia would
reduce the likelihood for migration. Genetic: The study
among the black Carribeans suggested that genetic play ed

M. A. Yunusa, A. Obembe / Open Journal of Psychiatry 2 (2012) 292-300 299
little role in the prevalence of psychiatric morbidity and
associated the differences more to environment. Psycho-
social factors such as unfamiliar culture and beliefs, dif-
ferent climate and environment, challenging interactions
with government institutions and new language.
It is imperative to emphasize that the findings in this
study should be interpreted with caution because of some
limitation. For instance, being hospital based it is diffi-
cult to generalize. Also, sample size would appear to be
small. In spite of these limitations, this study supported
the protection role of ethnic density on psychiatric mor-
bidity among patients with HIV infection suggesting that
environmental manipulation could be of benefit in the
management of the patient. Future study which these au-
thors would be eager to carry out, involving larger sam-
ple size from the community is encouraged .
5. ACKNOWLEDGEMENTS
We acknowledge Drs. Gana, G.J., Ango, J.T., and Abdullahi, Z. of the
department community medicine for assisting in the administration of
the questionnaire.
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