El presupuesto Municipal como herramienta de desarrollo.

The results of this study showed that there was almost parity between the number of females and males. These caregivers were within the age range of 41 – 60 years, and were married. The finding of an almost equal number of male and female participants could be due to the fact that caregiving in patients with disorders of psychoactive drug use commences early and runs a prolonged course hence at different stages either mother or father may have to play a role. This finding differs from some of the reports in literature with a female preponderance in caregiving. This has been explained by the fact that women are generally perceived as carers within the family in many parts of the world. ⁹⁶ Within the family, it is usually the woman in the role as a wife or mother who is most affected by the individual’s substance use problem and has to bear a significant part of the family burden. ⁹⁶ According to reports, majority of informal caregivers were reported to be middle aged females (45-55 years) who were usually married. ⁹⁷ Another study similarly found a mean age of 40.04 years among informal caregivers, 60% of whom were female,⁹⁸ and further reports showed more female than male informal caregivers who were married and provided care for their elderly care recipients.⁹⁹ However there have also been opposing reports. In a study of Arab subjects with schizophrenia, 66.1% of 121 caregivers interviewed were reported to be males.²⁵ Similarly in another study in Nigeria, out of 103 caregivers of patients with cancer, 58% were males and 42% were females. This was due to the culture in those studies which limited the role of women outside the home including bringing patients to the hospital.¹⁰⁰

This study revealed that most of the informal caregivers of the study and control group had secondary and/or tertiary levels of education. This can be explained by the fact that the study took place in Lagos State where education is being offered free up to the secondary level. This has made education more available to everyone in the state.

Majority of the informal caregivers in both groups interviewed resided in the urban area. This could be explained by the fact that the study was carried out in two large hospitals within the metropolis of Lagos which is an urban and commercial centre and former capital of the country. The patients seen in these two hospitals reside mostly in the city hence this result is therefore not surprising.

Most of the subjects in both groups were employed. This is probably due to higher educational attainment as shown above. Currently most women in Nigeria are fairly well educated and this has increased their employment opportunity and earning power. Hence most of the caregivers were gainfully employed. Among the caregivers in the study group, a greater proportion were either professional or semi skilled workers while in the control group the subjects were mostly professional and skilled workers. This could be attributed to the fact that caregivers of patients with disorders of psychoactive drug use are likely to have started providing care quite early and this burden may hamper their ability to reach their full occupational capacity. This is unlike cancer which tends to occur later in life and the caregiver would most likely have attained his or her occupational potential prior to commencing the caregiving role.

A greater proportion of subjects in both groups earned less than 50,000 Naira monthly. This is not surprising in Nigeria where the minimum wage for workers is 18,000 Naira in government establishments. Also proportionally more caregivers in

the study group were earning less than 50,000 monthly which could also point to their occupational classification above.

Majority of the informal caregivers had one form of support or another, either financial or non financial. Financial support was significantly (p=0.016) greater in the control group (40.4%) than in the study group (22.5%) The availability of support could be linked to our extended family system in this part of the world where other family members often partake in the care of a sick individual at one point or the other.

Furthermore this support was more in the control group due to the nature of the illness. Cancer tended to elicit a lot of empathy due to its terminal nature and associated pain. This is unlike disorders of psychoactive drug use which were viewed by the society as being self inflicted with associated unwanted behaviour.

Furthermore patients with cancer may have been employed prior to the onset of the illness and may have some funds of their own to commence initial treatment. Patients with disorders of psychoactive drug use on the other hand are more likely to have lower educational attainment and may not be employed consistently hence they remain the responsibility of the caregiver. This is likely to contribute to burden. A study reported that only 42.2% of the drug users completed elementary education, hence their integration into the labour market was difficult and was compounded by the drug use and its problems.¹⁰¹ It was also observed in the study that although most of the patients with disorders of Psychoactive drug use had one type of occupation or another, their low mean monthly income pointed to the inconsistency of the work and also to evidence that most of them did not have a formal employment contract.¹⁰¹ This is likely to contribute to burden in their caregivers.

More participants in the study group spent 20,000 naira or less monthly in caring for their relative. This compares with 73.0% of subjects in the control group who spent

the same amount. This could be due to the fact that treatment in cancer is complex, as it may involve costs for investigations both serological and radiological, surgical procedures, radiotherapy and chemotherapy. This is unlike treatment in drug use whereby funds are mostly required for purchase of medication and drug rehabilitation.

Parents, siblings and offsprings formed the majority of the participants in the study group compared to the control group and this difference was statistically significant (p< 0.001). This may be due to the fact that drug abuse often starts early in life, probably in the adolescent years when the individual is still under the control of his/her parents and runs a chronic course. Also these patients are less likely to be married hence the responsibility of caregiving is mainly on the parents This finding is in line with an earlier finding in a study on the experience of burden among caregivers of mentally ill patients where most of the caregivers were found to be parents and siblings.¹⁰² Reports also showed that 83.5% of the caregivers of schizophrenic patients were parents, siblings or children.²⁵ On the other hand the participants in the control group in this study were mainly spouses and other relatives (53.9%). This may be attributable to the likelihood of cancer occurring at a relatively older age in life with the patient more likely to be married.

The findings on duration of caregiving show that significantly more participants in the study group had been performing their caregiving role for a longer duration compared to those in the control group. Thirty seven percent of subjects in the study group were still providing care after 5 years. Again this could be explained, as drug abuse is a chronic enduring condition which could last throughout life. Patients with drug abuse problems may never be gainfully employed and remain the responsibilities of their caregiver throughout life. This is unlike cancer which usually occurs later in life and may lead to a cure or death hence caregiving duration is reduced.

6.2 CAREGIVER BURDEN AMONG THE PARTICIPANTS IN BOTH