Study area and period
The study was conducted from Jun 21 to July 5, 2016 at Jimma University Specialized Hospital (JUSH), Psychiatric clinic to assess the prevalence of TD and associated factors. Jimma University Specialized Hospital is one of the Hospitals in Ethiopia which is found in Jimma city, located 345 km southwest of Addis Ababa. It is a referral center for the southwestern part of Ethiopia, and currently, the only teaching and referral hospital in the southwestern part of the country. Jimma University Specialized Hospital Psychiatric clinic gives both inpatient and outpatient service for psychiatric patients mostly coming from Jimma area as well as patients referred from other health institutions in the southwestern region of the country. Even if majority of the patients come from Jimma area, the hospital give service for patients come from up to 300 km radius from Jimma town in the southwest part of Ethiopia. Generally, it gives services for more than 30 million populations, which served a huge bulk of the community next to Paulos Hospital in Addis Ababa Ethiopia concerning Psychiatry health facility
Study design
Source population
All psychiatric patients on first-generation antipsychotics at Jimma University Specialized Hospital, Psychiatric clinic
Study population
All Psychiatric patients on first-generation antipsychotics who were attending follow up at Jimma University Specialized Hospital, Psychiatric clinic outpatient department (OPD) during the study period and fulfill the inclusion criteria.
Inclusion Criteria
All psychiatric patients’ age above or equal to18 years and who were on first-generation anti-psychotic drugs treatment at least for 6 months.
Exclusion criteria
Psychiatric patients whose abnormal involuntary movements were induced by other reasons like infections and seizure were excluded;
Sample size determination and Sampling technique
Using single population proportion formula and taking the prevalence of antipsychotic induced movement disorders (Tardive Dyskinesia) from the study conducted at Amanuel mental specialized hospital, Addis Ababa, Ethiopia [1] which was 11%, with 95% confidence level and marginal error of 5% the final sample size was 151 individuals. Simple random sampling technique was used to select the study participants. From a total of 912 psychiatric patients who were taking first-generation antipsychotics and on follow-up at Jimma University specialized hospital, psychiatric clinic, we collected their card number from card room and we selected the total study participants (151 individuals) using simple random sampling technique by lottery method.
Study Variables
Dependent variable:
The presence of Tardive Dyskinesia (yes/no)
Independent Variables:
The independent variables included in this study were: Age, Sex, Religion, Ethnicity, Occupational status, Educational status, Current Alcohol use, Current Khat use, Current smoking Cigarette, Current Caffeine use, Diagnosis, Duration of psychiatric disorder, Drug used and Duration of treatment.
Data collection method and tools
Data were collected by four (4) experienced psychiatric nurses using interviewer administered structured questionnaire and research criteria suggested by Schooler and Kane. The questionnaire used was Abnormal Involuntary Movement Scale (AIMS) which is a rating scale designed in the 1970s to measure involuntary movements known as tardive dyskinesia (TD) [10]. The AIMS test has a total of twelve items rating involuntary movements of various areas of the patient's body. These items are rated on a five-point scale of severity from 0–4. The scale is rated from 0 (none), 1 (minimal), 2 (mild), 3 (moderate), 4 (severe) and the entire test performed within ten (10) minutes for each patient. For the diagnosis of Tardive dyskinesia (TD), research criteria suggested by Schooler and Kane [11] were used and they are as follows:1. At least 3 months of total exposure to ant-dopaminergic medicinal products, 2. Exclusion of other reasons for involuntary movements, and 3. A minimum global rating of “mild”(i.e. 2 or more on AIMS) was used.
Before data collection time the data collectors were trained by principal investigators on the objectives of the study and how to identify Tardive Dyskinesia in accordance with Abnormal Involuntary Movement Scale (AIMS) for Tardive dyskinesia.
Data Analysis and Processing
The Data were analyzed using SPSS software program version 20. In order to determine association between TD and independent variables, we employed Logistic regression analysis. Characteristics of study population were described by descriptive statistics. Odds ratio with 95% confidence interval was calculated to assess the association and statistical significance. Those variables which were found to be significant in the bivariate analysis with a p-value <0.05 were retained for further multivariate logistic regression analysis to control for potential confounders and to predict independent factors associated with TD.
Data Quality Assurance
To maintain the quality of the data, data collectors were trained on how to approach respondents, how to collect and fill all the necessary data and on different variables which are used in the study. Meanwhile, the data collectors were supervised by the principal investigator and One week before the actual survey pretest was carried out among patients with similar socio-demographic characteristic and using similar rating scale which was, Abnormal Involuntary Movement Scale (AIMS) for Tardive dyskinesia. The pretest was conducted at Jimma University Specialized Hospital, psychiatric clinic on 5% of the total sample size and necessary modification was done before being applied on the study subject. Also, the result of pre-test was not included in the final result of the study. Concerning inter rater reliability of data collectors, only 4 experienced psychiatric nurses collected the data under close supervision of the principal investigator.
Operational definitions
Tardive dyskinesia (TD): In this study TD is defined as patients who scored a minimum global rating of “mild”(i.e. 2 or more on AIMS)[11].
Current alcohol, Khat, cigarettes and caffeine use: Defined as the proportion of individuals who used these substances at least once during the last 1 month preceding the study [12].
Ethical clearance
Ethical clearance was obtained from the Research Ethical Review Board of Jimma University, institute of health, and the study was performed according to the declaration of Helsinki. The respondents were informed about their right to refuse or agree to participate in the study and written informed consent was obtained from every participant before the start of the data collection.