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Abstract
This paper explores the ways in which mental health workers think through the ethics of working with traditional and faith healers in Ghana. Despite reforms along the lines advocated by global mental health, including rights-based legislation and the expansion of community-based mental health care, such healers remain popular resources for treatment and mechanical restraint and other forms of coercion commonplace. As recommended in global mental health policy, mental health workers are urged to form collaborations with healers to prevent human rights abuses and promote psychiatric alternatives for treatment. However, precisely how such collaborations might be established is seldom described. This paper draws on ethnographic research to investigate how mental health workers approach working with healers and the moral imagination which informs their relationship. Through an analysis of trainee mental health workers' encounters with a Prophet and his patients, the paper reveals how mental health workers attempt to negotiate the tensions between their professional duty of care, their Christian faith, and the authority of healers. I argue that, rather than enforcing legal prohibitions, mental health workers seek to avoid confrontation and manouver within existing hierarchies, thereby preserving sentiments of obligation and reciprocity within a shared moral landscape and established forms of sociality.
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Musyimi CW, Mutiso VN, Loeffen L, Krumeich A, Ndetei DM. Exploring mental health practice among Traditional health practitioners: a qualitative study in rural Kenya. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:334. [PMID: 30547778 PMCID: PMC6295025 DOI: 10.1186/s12906-018-2393-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/28/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Involvement of traditional health practitioners (THPs) in the form of collaboration with the formal health care system is suggested to improve the pathways to mental health care in Kenya, yet understanding of the current traditional practice and THPs' perspectives is lacking. The aim of this study was to explore the views of THPs with respect to their mental health practice. METHODS This study qualitatively explored the views of THPs, using four focus group discussions (FDGs) each consisting of 8-10 traditional and faith healers, resulting in a total of 36 participants. Thematic content analysis using a grounded theory approach was performed using QSR NVivo 10. Emerging topics were identified and examined by re-reading the transcripts several times and constantly re-sorting the material. RESULTS Four themes that reflect THPs' mental health practice perspectives emerged as follows: 1) Categorization of mental illness; 2) Diagnostics in traditional mental health practice; 3) Treatments and challenges in current traditional mental health practice; and 4) Solutions to improve traditional mental health practice. CONCLUSIONS These themes provide insight into the perspectives of Kenyan traditional and faith healers on their mental health practice, in an attempt to offer a meaningful contribution to the debate on collaboration between informal and formal health care providers in improving mental health services in Kenya. Furthermore, the presented challenges and solutions can inform policy makers in their task to improve and scale up mental health services in resource-poor areas in Kenya. Addressing these issues would be a first step towards understanding the solid foundation of traditional medicine that is necessary before collaboration can be successfully attempted. Further research is also recommended to assess patients' needs and explore potential forms of collaboration, in order to achieve sustainable improvement in the mental health care pathways for patients.
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Affiliation(s)
- Christine W. Musyimi
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
- Vrije Universiteit, 1081 HV Amsterdam, Netherlands
| | - Victoria N. Mutiso
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
| | - Lianne Loeffen
- Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - Anja Krumeich
- Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - David M. Ndetei
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
- University of Nairobi, P. O. Box 30197 00100, Nairobi, Kenya
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Gloria O, Osafo J, Goldmann E, Parikh NS, Nonvignon J, Kretchy IMA. The experiences of providing caregiving for patients with schizophrenia in the Ghanaian context. Arch Psychiatr Nurs 2018; 32:815-822. [PMID: 30454622 DOI: 10.1016/j.apnu.2018.06.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/23/2018] [Accepted: 06/02/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Odue Gloria
- Department of Psychology, School of Social Science, University of Ghana, Ghana
| | - Joseph Osafo
- Department of Psychology, School of Social Science, University of Ghana, Ghana; Centre for Suicide and Violence Research, Ghana.
| | - Emily Goldmann
- Department of Epidemiology, College of Global Public Health, New York University, United States.
| | - Nina S Parikh
- College of Global Public Health, New York University, United States.
| | - Justice Nonvignon
- Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Ghana.
| | - Irene M A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana.
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Badu E, O’Brien AP, Mitchell R. An integrative review of potential enablers and barriers to accessing mental health services in Ghana. Health Res Policy Syst 2018; 16:110. [PMID: 30445980 PMCID: PMC6240297 DOI: 10.1186/s12961-018-0382-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/14/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The importance of accessible mental health treatment is a global concern, particularly when one in five people will experience a mental health problem in their lifespan. This is no less important in Ghana; however, no studies have yet attempted to appraise and synthesise the potential enablers and barriers to accessing services in Ghana. The aim of this integrative review is therefore to identify and synthesise existing evidence on the barriers and enablers to accessing mental health services in Ghana. METHODS A search of the published literature was conducted using Medline, EMBASE, PsycINFO, CINAHL (EBSCO), Web of Science, and Scopus electronic databases. The search was limited to papers published in English and within 2000-2018. Using pre-defined inclusion and exclusion criteria, two reviewers independently screened the titles and abstracts of the retrieved papers. A data extraction form and a Critical Appraisal Checklist were used to extract and appraise data, respectively. The integrative review incorporates both qualitative and quantitative data into a single synthesis. RESULTS Out of 42 papers that met the inclusion criteria, 50% used qualitative methods, 33.3% used mixed methods and 16.7% used quantitative methods alone. The potential barriers in accessing mental health services were attitudinal, knowledge about services, treatment cost, transportation and geographical proximity, as well as perceived efficacy of medication. Similarly, the health systems factors contributing to barriers were low priority, limited funding sources, irregular medicine supply, limited services for marginalised groups and poor state of psychiatric facilities, together with poor management of mental health cadres. The potential enablers for service users involved increased decentralisation and integration, task-shifting and existing support services. CONCLUSION The existing evidence on mental health in Ghana is skewed towards weaknesses in the systems and stigma, with rationally little, or no, evidence or emphasis on the effectiveness, or quality of mental health services. These attributes largely neglect the provision of psychiatric services for marginalised mental health service user groups, including children, adolescents, people with disabilities and the elderly.
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Affiliation(s)
- Eric Badu
- Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW Australia
| | - Anthony Paul O’Brien
- Faculty Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Newcastle, 2308 NSW Australia
| | - Rebecca Mitchell
- Health Services Research Centre, Faculty of Business and Economics, The University of Newcastle, Newcastle, NSW Australia
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Kpobi L, Swartz L. Implications of healing power and positioning for collaboration between formal mental health services and traditional/alternative medicine: the case of Ghana. Glob Health Action 2018. [PMID: 29529937 PMCID: PMC5912442 DOI: 10.1080/16549716.2018.1445333] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Many current debates about global mental health have increasingly called for collaboration between biomedical and traditional medical health systems. Despite these calls, not much has been written about the variables that would influence such collaboration. To a large extent, collaboration dialogues have considered biomedicine on the one hand, and a wide range of traditional and faith-based treatments on the other hand. However, this dualistic bifurcation does not reflect the plurality of healing systems in operation in many contexts, and the diverse investments that different non-biomedical healing approaches may have in their own power to heal. OBJECTIVE We set out to explore the diversity of different healers' perceptions of power, and the relationship between that power and the perceived power of biomedical approaches. METHODS Through a qualitative design, and using the case of medical pluralism in urban Ghana as an example, we conducted interviews among different categories of traditional and alternative medicine (TAM) practitioners living and/or working in the Greater Accra Region of Ghana. RESULTS Through thematic analyses, differences in the notions about collaboration between the different categories of healers were identified. Their perceptions of whether collaboration would be beneficial seemed, from this study, to co-occur with their perceptions of their own power. CONCLUSIONS We suggest that an important way to move debates forward about collaboration amongst different sectors is to examine the notions of power and positioning of different categories of TAM healers in relation to biomedicine, and the attendant implications of those notions for integrative mental healthcare.
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Affiliation(s)
- Lily Kpobi
- a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
| | - Leslie Swartz
- a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
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Barriers to Timely Presentation of Patients with Surgical Conditions at Tamale Teaching Hospital in Northern Ghana. World J Surg 2018; 43:346-352. [DOI: 10.1007/s00268-018-4800-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kpobi LNA, Swartz L. 'The threads in his mind have torn': conceptualization and treatment of mental disorders by neo-prophetic Christian healers in Accra, Ghana. Int J Ment Health Syst 2018; 12:40. [PMID: 30061921 PMCID: PMC6056911 DOI: 10.1186/s13033-018-0222-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many low- and middle-income countries, faith healing is used alongside biomedical treatment for many health problems including mental disorders. Further, Christianity in Africa has seen much transformation in recent decades with the growth of charismatic or neo-prophetic churches whose doctrines include healing, miracles and prophecies. As such, many charismatic pastors have been engaged in faith healing for many years. Such faith healers form a significant portion of the mental health workforce in these countries, partly due to the limited number of biomedically trained professionals. In this study, we sought to examine the beliefs of charismatic/neo-Pentecostal faith healers about mental disorders, as well as to examine the treatments that they employed to treat such disorders. METHODS We interviewed neo-prophetic pastors who undertook faith healing, and examined their work relating to mental disorders. Ten pastors from eight churches in the Greater Accra Region of Ghana were interviewed using semi-structured interviews. RESULTS The data suggest that the pastors' conceptualization of mental illness was generally limited to psychotic disorders. Their beliefs about causation were predominantly supernatural in nature although they acknowledged that drug misuse and road traffic accidents were also potential causes. The pastors' expectations of healing also showed different perceptions of illness chronicity. Their diagnostic and treatment methods revolved around using prayer, prayer aids such as oils and holy water, as well as spiritual counselling for patients and their caregivers. However, they were not opposed to referring patients to hospitals when deemed necessary. CONCLUSION We discuss the above results with emphasis on their implications for collaboration between biomedical and alternative healing systems in Ghana. In particular, we advocate a mutual understanding of illness perspectives between biomedical practitioners and faith healers as an important component for integrating different health systems in Ghana.
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Affiliation(s)
- Lily N. A. Kpobi
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Kpobi L, Swartz L. Ghanaian traditional and faith healers' explanatory models of intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:43-50. [PMID: 29993171 DOI: 10.1111/jar.12500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of traditional/alternative medicine for health care in Africa has been examined for various conditions. However, there is limited research about traditional/alternative health care for intellectual disability. The present authors explored the explanatory models (EMs) of intellectual disability held by traditional/faith healers in Ghana. METHODS Using a case vignette, the present authors conducted semi-structured interviews with 36 traditional/faith healers in Accra, Ghana. Using the EMs of illness framework as a guide, participants were asked questions to examine their beliefs about the nature, causes, course and recommended treatment of intellectual disability. RESULTS The healers' causal explanations included maternal negligence during pregnancy and spiritual factors. They also believed that intellectual disability was a congenital, lifelong condition which could not be cured. CONCLUSIONS Unlike other conditions which traditional healers claimed to cure, participants admitted that intellectual disability was not curable. The present authors suggest that the findings highlight opportunities that exist for collaboration between biomedicine and traditional medicine.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Kpobi L, Swartz L. 'That is how the real mad people behave': Beliefs about and treatment of mental disorders by traditional medicine-men in Accra, Ghana. Int J Soc Psychiatry 2018. [PMID: 29529921 DOI: 10.1177/0020764018763705] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditional healing methods are considered central to mental health care in low-income countries such as Ghana, because they are perceived to be more easily accessible, more affordable and generally ascribe similar causal beliefs to those of the patients. However, not much is known about the work of traditional healers largely because their methods are shrouded in mysticism and secrecy. There is a need to understand the ideology and beliefs of traditional healers surrounding mental disorders, including knowledge about their practices in mental health care. AIMS In this article, we discuss the causal beliefs and treatment methods of traditional medicine-men from Accra, Ghana. We also describe their diagnostic and treatment methods for mental disorders. METHODS Eight medicine-men, indigenous to the Greater Accra Region, were interviewed through individual semi-structured interviews. The data were analysed through thematic analysis. RESULTS The medicine-men's beliefs about mental illness were dominated by supernatural ideas. Mental illness was also seen as a form of punishment or resulting from envy, and there was a strong reliance on spiritual direction from the gods for diagnosis and treatment. CONCLUSION These themes are discussed with emphasis on their potential implications for patients, as well as for collaborative efforts.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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van der Watt ASJ, van de Water T, Nortje G, Oladeji BD, Seedat S, Gureje O. The perceived effectiveness of traditional and faith healing in the treatment of mental illness: a systematic review of qualitative studies. Soc Psychiatry Psychiatr Epidemiol 2018; 53:555-566. [PMID: 29696304 DOI: 10.1007/s00127-018-1519-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/13/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE This work complements a quantitative review by Nortje et al. (Lancet Psychiatry 3(2):154-170, 2016) by exploring the qualitative literature in regard to the perceived effectiveness of traditional and faith healing of mental disorders. METHOD Qualitative studies focusing specifically on traditional and/or faith healing practices for mental illness were retrieved from eight databases. Data were extracted into basic coding sheets to facilitate the assessment of the quality of eligible papers using the COREQ. RESULTS Sixteen articles met the inclusion criteria. Despite methodological limitations, there was evidence from the papers that stakeholders perceived traditional and/or faith healing to be effective in treating mental illness, especially when used in combination with biomedical treatment. CONCLUSION Patients will continue to seek treatment from traditional and/or faith healers for mental illness if they perceive it to be effective regardless of alternative biomedical evidence. This provides opportunities for collaboration to address resource scarcity in low to middle income countries.
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Affiliation(s)
- A S J van der Watt
- Department of Psychiatry, Stellenbosch University, Francie van Zijl Drive, Tygerberg, South Africa.
| | - T van de Water
- Department of Psychiatry, Stellenbosch University, Francie van Zijl Drive, Tygerberg, South Africa
| | - G Nortje
- Department of Psychiatry, Stellenbosch University, Francie van Zijl Drive, Tygerberg, South Africa
| | - B D Oladeji
- Department of Psychiatry, University of Ibadan, Ibadan, 900001, Oyo State, Nigeria
| | - S Seedat
- Department of Psychiatry, Stellenbosch University, Francie van Zijl Drive, Tygerberg, South Africa
| | - O Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, 900001, Oyo State, Nigeria
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Ebrahimi H, Seyedfatemi N, Namdar Areshtanab H, Ranjbar F, Thornicroft G, Whitehead B, Rahmani F. Barriers to Family Caregivers' Coping With Patients With Severe Mental Illness in Iran. QUALITATIVE HEALTH RESEARCH 2018; 28:987-1001. [PMID: 29478404 DOI: 10.1177/1049732318758644] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers' experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers' ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient's isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.
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Affiliation(s)
- Hossein Ebrahimi
- 1 Department of Psychiatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naeimeh Seyedfatemi
- 2 Nursing Care Research Center. Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Namdar Areshtanab
- 1 Department of Psychiatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ranjbar
- 3 Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Farnaz Rahmani
- 1 Department of Psychiatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Akol A, Moland KM, Babirye JN, Engebretsen IMS. "We are like co-wives": Traditional healers' views on collaborating with the formal Child and Adolescent Mental Health System in Uganda. BMC Health Serv Res 2018; 18:258. [PMID: 29631632 PMCID: PMC5892042 DOI: 10.1186/s12913-018-3063-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/27/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early identification and management of mental illness in childhood and adolescence helps to avert debilitating mental illness in adulthood but the attention given to Child and Adolescent Mental Health (CAMH) has until recently been low. Traditional healers are often consulted by patients with mental illness and in Uganda, up to 60% of patients attending traditional healers have moderate to severe mental illness. Poor access to CAMH care in Uganda creates a treatment gap that could be met through enhanced collaboration between traditional healers and biomedical health systems. The aim of this study was to explore traditional healers' views on their collaboration with biomedical health systems so as to inform the implementation of strategies to improve access to CAMH services in Uganda. METHODS In-depth interviews with 20 purposively selected traditional healers were conducted in November 2015. A semi-structured interview guide was used to explore: 1) The experiences of traditional healers with mental ill-health in children and adolescents; 2) their willingness to collaborate with the formal health system; and 3) their perception of clinicians' willingness to collaborate with them. Interviews were conducted in local languages and tape recorded. Data were analysed using thematic analysis. RESULTS Traditional healers described several experiences managing children and adolescents with mental illness, which they ascribed to spiritual and physical causes. The spiritual explanations were a consequence of unhappy ancestral spirits, modern religions and witchcraft, while physical causes mentioned included substance abuse and fevers. No traditional healer had received a patient referred to them from a medical clinic although all had referred patients to clinics for non-mental health reasons. Traditional healers expressed distrust in biomedical health systems and believed their treatments were superior to medical therapies in alleviating mental suffering. They expressed willingness to collaborate with biomedical providers. However, traditional healers believe clinicians disregard them and would not be willing to collaborate with them. CONCLUSION Potential for collaboration between traditional healers and biomedical health systems for improving access to CAMH services in Uganda exists, but is undermined by mutual mistrust and competition between traditional healers and clinicians.
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Affiliation(s)
- Angela Akol
- Center for International Health, University of Bergen, Bergen, Norway
- Makerere University School of Public Health, Kampala, Uganda
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Atinga RA, Yarney L, Gavu NM. Factors influencing long-term medication non-adherence among diabetes and hypertensive patients in Ghana: A qualitative investigation. PLoS One 2018; 13:e0193995. [PMID: 29590156 PMCID: PMC5874015 DOI: 10.1371/journal.pone.0193995] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/22/2018] [Indexed: 12/17/2022] Open
Abstract
Background Evidence remains limited on why diabetes and hypertensive patients admitted to long-term drug therapy miss doses or discontinue medication taking. We examined this phenomenon from the perspective of diabetes and hypertension patients at a Ghanaian teaching hospital. Methods Between July and December 2015, we conducted a qualitative study targeting caregivers and their patients with chronic diabetes and hypertensive on re-admission at the Korle Bu Teaching Hospital due to non-adherence to prescribed medication. Participants were sampled purposefully and taking through in-depth interviews using an interview guide. Notes and audio recordings of interviews were transcribed, managed and coded for themes guided by the thematic network analysis recommended by Attride-Stirling. Results Non-adherence was the result of perceptions that the medications are not effective for managing the conditions. Patients with these perceptions rejected the medications and turned to herbal medicines and spiritual healing as therapeutic alternatives, because of their easy accessibility, perceived efficacy and affordability. Other factors identified to influence non-adherence included polypharmacy practice; tight work schedules; social norms; poor prescription instruction by health providers; and knowledge and experience of medication. Conclusion Findings suggests the need for health providers to adopt therapeutic approaches that take into account patients’ beliefs, values and norms in administering medications. Sensitisation of patients and caregivers during admission on the implication of non-adherence, as well as interventions that monitor and provide feedback mechanisms on patients’ medication taking behaviour holds promise for maximising diabetes and hypertensive medication adherence.
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Affiliation(s)
- Roger A. Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
- * E-mail:
| | - Lily Yarney
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Krah E, de Kruijf J, Ragno L. Integrating Traditional Healers into the Health Care System: Challenges and Opportunities in Rural Northern Ghana. J Community Health 2018; 43:157-163. [PMID: 28681282 PMCID: PMC5767209 DOI: 10.1007/s10900-017-0398-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Traditional medicine is widespread in Ghana, with 80% of Ghanaians relying on its methods for primary health care. This paper argues that integrating traditional and biomedical health systems expands the reach and improves outcomes of community health care. Moving beyond literature, it stresses the importance of trust-relationships between healers and biomedical staff. Insights are based on qualitative research conducted in Ghana's Northern Region (2013-2014). Five challenges to integration emerged out of the data: a lack of understanding of traditional medicine, discrimination, high turnover of biomedical staff, declining interest in healing as a profession, and equipment scarcity. Besides challenges, opportunities for integration exist, including the extensive infrastructure of traditional medicine, openness to collaboration, and grassroots initiatives. Contemplating challenges and opportunities this paper provides recommendations for integration, including: identify/select healers, promote best practices, institute appropriate forms of appreciation/recognition of healers, provide aid and equipment, use communication campaigns to promote integration and steer attitudinal change towards healers among biomedical staff. Most crucial, we argue successful implementation of these recommendations depends on a concerted investment in relationships between healers and biomedical staff.
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Affiliation(s)
- Eva Krah
- University of Dundee, Dundee, UK.
- Department of Cultural Anthropology, Utrecht University, Padualaan 14, 3584 CH, Utrecht, the Netherlands.
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Ofori-Atta A, Attafuah J, Jack H, Baning F, Rosenheck R. Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial. Br J Psychiatry 2018; 212:34-41. [PMID: 29433613 DOI: 10.1192/bjp.2017.12] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Care of people with serious mental illness in prayer camps in low-income countries generates human rights concerns and ethical challenges for outcome researchers. Aims To ethically evaluate joining traditional faith healing with psychiatric care including medications (Clinical trials.gov identifier NCT02593734). METHOD Residents of a Ghana prayer camp were randomly assigned to receive either indicated medication for schizophrenia or mood disorders along with usual prayer camp activities (prayers, chain restraints and fasting) (n = 71); or the prayer camp activities alone (n = 68). Masked psychologists assessed Brief Psychiatric Rating Scale (BPRS) outcomes at 2, 4 and 6 weeks. Researchers discouraged use of chaining, but chaining decisions remained under the control of prayer camp staff. RESULTS Total BPRS symptoms were significantly lower in the experimental group (P = 0.003, effect size -0.48). There was no significant difference in days in chains. CONCLUSIONS Joining psychiatric and prayer camp care brought symptom benefits but, in the short-run, did not significantly reduce days spent in chains. Declaration of interest None.
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Affiliation(s)
- A Ofori-Atta
- Department of Psychiatry,University of Ghana,School of Medicine and Dentistry,Accra,Ghana
| | | | - H Jack
- Harvard Medical School,Boston,Massachusetts,USA, andInstitute of Psychiatry, Psychology, and Neuroscience,King's College London,UK
| | - F Baning
- Ghana Health Service,Accra,Ghana
| | - R Rosenheck
- Department of Psychiatry,Yale University,New Haven,Connecticut,USA
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Musyimi CW, Mutiso VN, Ndetei DM, Unanue I, Desai D, Patel SG, Musau AM, Henderson DC, Nandoya ES, Bunders J. Mental health treatment in Kenya: task-sharing challenges and opportunities among informal health providers. Int J Ment Health Syst 2017; 11:45. [PMID: 28775764 PMCID: PMC5540195 DOI: 10.1186/s13033-017-0152-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background The study was conducted to explore challenges faced by trained informal health providers referring individuals with suspected mental disorders for treatment, and potential opportunities to counter these challenges. Methods The study used a qualitative focus group approach. It involved community health workers, traditional and faith healers from Makueni County in Kenya. Ten Focus Group Discussions were conducted in the local language, recorded and transcribed verbatim and translated. Using a thematic analysis approach, data were entered into NVivo 7 for analysis and coding. Results Results demonstrate that during the initial intake phase, challenges included patients’ mistrust of informal health providers and cultural misunderstanding and stigma related to mental illness. Between initial intake and treatment, challenges related to resource barriers, resistance to treatment and limitations of the referral system. Treatment infrastructure issues were reported during the treatment phase. Various suggestions for solving these challenges were made at each phase. Conclusions These findings illustrate the commitment of informal health providers who have limited training to a task-sharing model under difficult situations to increase patients’ access to mental health services and quality care. With the identified opportunities, the expansion of this type of research has promising implications for rural communities.
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Affiliation(s)
- Christine W Musyimi
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya.,Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
| | - Victoria N Mutiso
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - David M Ndetei
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya.,University of Nairobi, P.O Box 30197, Nairobi, 00100 Kenya
| | - Isabel Unanue
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Dhru Desai
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Sita G Patel
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Abednego M Musau
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - David C Henderson
- Boston University School of Medicine, 72 E. Concord St, Boston, MA 02118 USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Erick S Nandoya
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - Joske Bunders
- Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
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Opare-Henaku A, Utsey SO. Culturally prescribed beliefs about mental illness among the Akan of Ghana. Transcult Psychiatry 2017; 54:502-522. [PMID: 28612682 DOI: 10.1177/1363461517708120] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mental illness is a culturally laden phenomenon, and different cultures have unique ways of constructing mental illness. In this study, conceptions of mental illness were explored among 30 participants of Akan descent in Ghana through individual and group interviews. Participants demonstrated a wide range of knowledge on mental illness indicating that poor self-care, deficits in social functioning, and disordered behaviors are the cardinal features of mental illness. The data revealed that Akan cultural beliefs influenced notions of etiology of mental illness and care of the mentally ill. While participants recognized the role of multiple factors such as genetics, substance abuse, daily hassles (for example, concerns about basic needs such as food, clothing, and shelter), and trauma in the cause of mental illness, the predominant belief was that mental illness is a retributive and/or a spiritual illness. This belief encourages pluralistic health-seeking behaviors: use of hospitals, prayer camps, herbalists, and traditional healers. The implications of these findings for public health education on mental illness, and clinical training and practice are discussed.
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68
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Musyimi CW, Mutiso VN, Nayak SS, Ndetei DM, Henderson DC, Bunders J. Quality of life of depressed and suicidal patients seeking services from traditional and faith healers in rural Kenya. Health Qual Life Outcomes 2017; 15:95. [PMID: 28482849 PMCID: PMC5422872 DOI: 10.1186/s12955-017-0657-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background In rural Kenya, traditional and faith healers provide an alternative pathway to health care, including mental health care. However, not much is known about the characteristics of the populations they serve. The purpose of this study was to determine the relationship between depression, suicidal ideation, and socio-demographic variables with Quality of Life (QoL) indicators in a sample seeking mental health services from traditional and faith healers in rural Kenya. Understanding QoL in this sample can help develop mental health policy and training to improve the well-being of this population. Method This was a cross-sectional epidemiological survey (n = 443) conducted over a period of 3 months among adult patients seeking care from traditional and faith healers in rural Kenya. Data were collected using the Beck Depression Inventory II (BDI-II), Beck Scale for Suicide Ideation (BSS) and WHO Quality of Life Survey- BREF (WHOQOL-BREF), and analyzed using correlation analyses, parametric tests, and regression analyses. Results Increasing levels of depression were associated with lower QoL among patients seeking care from traditional and faith healers. BSS scores were significantly negatively correlated with overall, physical, psychological, and environmental QoL, p < .05. There was a statistically significant difference between mean scores for overall QoL between depressed (M = 2.35, SD = 0.76) and non-depressed participants (M = 3.03, SD = 0.67), t(441) = 8.899, p < .001. Overall life satisfaction for depressed participants (M = 2.23, SD = 0.69) was significantly lower than non-depressed participants. Regression analyses indicated that depression, suicidal ideation, and being married predicted lower overall QoL controlling for other variables. Post hoc tests and subgroup analysis by gender revealed significant differences for females only. Depression, and older age predicted lower life satisfaction whereas being self-employed predicted higher life satisfaction, when controlling for other variables. Conclusion This study sheds light on correlates of QoL in depressed and non-depressed patients in rural Kenya. Evidence suggests that traditional and faith healers treat patients with a variety of QoL issues. Further research should focus on understanding how these issues tie into QoL, and how these healers can target these to improve care.
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Affiliation(s)
- Christine W Musyimi
- Africa Mental Health Foundation, Nairobi, Kenya.,Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - David M Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya. .,University of Nairobi, Nairobi, Kenya.
| | - David C Henderson
- Boston University School of Medicine, Boston, USA.,Harvard Medical School, Boston, USA
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Ae-Ngibise KA, Adiibokah E, Nettey OEA, Nyame S, Doku VCK, Asante KP, Owusu-Agyei S. "Making the Mentally Ill Count", lessons from a Health and Demographic Surveillance System for people with mental and neurological disorders in the Kintampo districts of Ghana. Int J Ment Health Syst 2017; 11:22. [PMID: 28293283 PMCID: PMC5348759 DOI: 10.1186/s13033-017-0130-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 03/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Persons with mental and neurological disorders (PMNDs) are among the most marginalised groups in developing countries, as they are socially excluded and overlooked in most developmental efforts. Due to high levels of stigma and other operational difficulties, PMNDs are often marginalised in routine enumeration exercises. Health and Demographic Surveillance System is an important public health research platform especially in countries that lacks reliable data systems, as it registers and monitor basic demographic and health events such as births, deaths and migration in a geographically defined population. This information is essential for policy development and resource distribution and service delivery. We aim to document the reasons for not counting PMNDs in our communities and demonstrate the usefulness of the Kintampo Health and Demographic Surveillance Systems (KHDSS) platform in counting PMNDs over time. We also documented strategies in providing vital information that helps in establishing the rights of PMNDs. Methods As a longitudinal study, psychiatric case register was established. Both quantitative and qualitative data collection techniques were used to solicit responses from stakeholders regarding the non-consideration of PMNDs as part of household membership in the study area. PMNDs were identified using the KHDSS and followed every 6 months. The “targeted” (actively searching for PMNDs) and “service provision” (providing medical treatment for PMNDs) approaches were adopted to enhance the identification of PMNDs. Results Stigma was the main reason cited for the non-counting of PMNDs in the area. Following a “targeted” and “service provision” approach, the number of PMNDs enrolled into the psychiatric case register went up to 68% in 2010; as against the previous levels of 49 and 54% in 2005 and 2008 respectively. The study highlights the intrinsic value of such an approach for social inclusion of PMNDs. Conclusions Stigma against PMNDs was report in this study. We provided evidence that the KHDSS platform is useful for identification of PMNDs for service provision. The paper highlights evidence for policy formulation and implementation.
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Affiliation(s)
| | | | | | - Solomon Nyame
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Victor Christian Korley Doku
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
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70
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Hickey JE, Pryjmachuk S, Waterman H. Exploring personal recovery in mental illness through an Arabic sociocultural lens. J Psychiatr Ment Health Nurs 2017; 24:163-170. [PMID: 27859968 DOI: 10.1111/jpm.12342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 12/01/2022]
Affiliation(s)
- J E Hickey
- University of Calgary Qatar, Doha, Qatar.,University of Manchester, Manchester, UK
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71
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Sørensen CW, Bæk O, Kallestrup P, Carlsson J. Integrating mental health in primary healthcare in low-income countries: changing the future for people with mental disorders. Nord J Psychiatry 2017; 71:151-157. [PMID: 27774828 DOI: 10.1080/08039488.2016.1245784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Untreated mental disorders are a huge challenge for healthcare systems worldwide. Treatment possibilities are particularly scarce in low-income countries (LICs). WHO estimates that up to 85% of all people with a mental disorder in LICs do not have access to evidence-based treatment. AIMS This paper seeks to explore the rationale behind the WHO recommendations for improving mental health services in LICs. At the core of these recommendations is an integration of mental health services into existing primary healthcare. This article presents available research supporting this approach. Furthermore, it highlights challenges needing special attention and opportunities demanding additional research to guide a comprehensive restructuring of a healthcare system. METHODS A literature review of WHO documents and searches on PubMed for relevant supporting literature. RESULTS Research from LICs that investigate mental health interventions is scarce. The evidence that does exist favours integration into primary healthcare. There is evidence that collaborative- and stepped-care interventions can provide viable treatment options for patients. CONCLUSION Integration of mental health services into primary healthcare seems like a viable solution to ensure that treatment becomes more available, even though the evidence is limited. Locally conducted research is needed to guide the development of sustainable evidence-based mental health treatment, involving relevant healthcare providers, with optimal task-sharing and possibilities for referral of complex cases. Furthermore, to achieve this, comprehensive political will and investments are necessary pre-requisites.
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Affiliation(s)
- Carina Winkler Sørensen
- a The Mental Health Services of the Capital Region of Denmark , Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup , Copenhagen , Denmark.,b Center for Global Health, Department of Public Health , University of Aarhus (GloHAU) , Aarhus , Denmark
| | - Ole Bæk
- a The Mental Health Services of the Capital Region of Denmark , Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup , Copenhagen , Denmark.,b Center for Global Health, Department of Public Health , University of Aarhus (GloHAU) , Aarhus , Denmark.,c Department of Infectious Diseases , Hvidovre Hospital , Hvidovre, Copenhagen , Denmark
| | - Per Kallestrup
- b Center for Global Health, Department of Public Health , University of Aarhus (GloHAU) , Aarhus , Denmark
| | - Jessica Carlsson
- a The Mental Health Services of the Capital Region of Denmark , Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup , Copenhagen , Denmark
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72
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Asamoah MK. Leveraging the Deliverance Phenomenon: Penteco/Charismatic Vista. JOURNAL OF RELIGION AND HEALTH 2016; 55:1642-1664. [PMID: 26912091 DOI: 10.1007/s10943-016-0209-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article reflects on the deliverance concept within Classical Pentecostalism and Neo-Pentecostalism against historical and contemporary considerations. The research design combined ethnography and case study. Participant observation and in-depth interviews were used for data collection. Findings include: overstretched demonic mentality; the notion that the Penteco/Charismatic believer cannot be possessed but could be harassed by demons; and dehumanizing situations inherent in deliverance practice. It is recommended that sanity, care and collaboration be established amongst deliverance practitioners, psychologists, psychiatrists, professional counsellors as well as other business experts to ensure a holistic deliverance practice and also to enhance the dignity and value of the deliverance ministry in Ghana and Africa at large.
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73
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Arias D, Taylor L, Ofori-Atta A, Bradley EH. Prayer Camps and Biomedical Care in Ghana: Is Collaboration in Mental Health Care Possible? PLoS One 2016; 11:e0162305. [PMID: 27618551 PMCID: PMC5019394 DOI: 10.1371/journal.pone.0162305] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/19/2016] [Indexed: 12/03/2022] Open
Abstract
Background Experts have suggested that intersectoral partnerships between prayer camps and biomedical care providers may be an effective strategy to address the overwhelming shortage of mental health care workers in Africa and other low-income settings. Nevertheless, previous studies have not explored whether the prayer camp and biomedical staff beliefs and practices provide sufficient common ground to enable cooperative relationships. Therefore, we sought to examine the beliefs and practices of prayer camp staff and the perspective of biomedical care providers, with the goal of characterizing interest in—and potential for—intersectoral partnership between prayer camp staff and biomedical care providers. Methods We conducted 50 open-ended, semi-structured interviews with prophets and staff at nine Christian prayer camps in Ghana, and with staff within Ghana’s three public psychiatric hospitals. We used the purposive sampling method to recruit participants and the constant comparative method for qualitative data analysis. Results Prayer camp staff expressed interest in collaboration with biomedical mental health care providers, particularly if partnerships could provide technical support introducing medications in the prayer camp and address key shortcomings in their infrastructure and hygienic conditions. Nevertheless, challenges for collaboration were apparent as prayer camp staff expressed strong beliefs in a spiritual rather than biomedical explanatory model for mental illness, frequently used fasting and chained restraints in the course of treatment, and endorsed only short-term use of medication to treat mental illness—expressing concerns that long-term medication regimens masked underlying spiritual causes of illness. Biomedical providers were skeptical about the spiritual interpretations of mental illness held by faith healers, and were concerned by the use of chains, fasting, and the lack of adequate living facilities for patients in prayer camps; many, however, expressed interest in engaging with prayer camps to expand access to clinical care for patients residing in the camps. Conclusions The findings demonstrate that biomedical care providers are interested in engaging with prayer camps. Key areas where partnerships may best improve conditions for patients at prayer camps include collaborating on creating safe and secure physical spaces and delivering medication for mental illness to patients living in prayer camps. However, while prayer camp staff are willing to engage biomedical knowledge, deeply held beliefs and routine practices of faith and biomedical healers are difficult to reconcile Additional discussion is needed to find the common ground on which the scarce resources for mental health care in Ghana can collaborate most effectively.
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Affiliation(s)
- Daniel Arias
- Yale College, Yale University, New Haven, Connecticut, United States of America
| | - Lauren Taylor
- Harvard Divinity School, Cambridge, Massachusetts, United States of America
| | | | - Elizabeth H. Bradley
- Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
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74
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Hickey JE, Pryjmachuk S, Waterman H. Mental illness research in the Gulf Cooperation Council: a scoping review. Health Res Policy Syst 2016; 14:59. [PMID: 27492156 PMCID: PMC4972953 DOI: 10.1186/s12961-016-0123-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 06/24/2016] [Indexed: 11/26/2022] Open
Abstract
Rapid growth and development in recent decades has seen mental health and mental illness emerge as priority health concerns for the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). As a result, mental health services in the region are being redefined and expanded. However, there is a paucity of local research to guide ongoing service development. Local research is important because service users’ experience of mental illness and mental health services are linked to their sociocultural context. In order for service development to be most effective, there is a need for increased understanding of the people who use these services. This article aims to review and synthesize mental health research from the Gulf Cooperation Council. It also seeks to identify gaps in the literature and suggest directions for future research. A scoping framework was used to conduct this review. To identify studies, database searches were undertaken, regional journals were hand-searched, and reference lists of included articles were examined. Empirical studies undertaken in the Gulf Cooperation Council that reported mental health service users’ experience of mental illness were included. Framework analysis was used to synthesize results. Fifty-five studies met inclusion criteria and the following themes were identified: service preferences, illness (symptomology, perceived cause, impact), and recovery (traditional healing, family support, religion). Gaps included contradictory findings related to the supportive role of the Arabic extended family and religion, under-representation of women in study samples, and limited attention on illness management outside of the hospital setting. From this review, it is clear that the sociocultural context in the region is linked to service users’ experience of mental illness. Future research that aims to fill the identified gaps and develop and test culturally appropriate interventions will aid practice and policy development in the region.
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Affiliation(s)
- Jason E Hickey
- University of Calgary Qatar, P.O. Box 23133, Doha, Qatar. .,University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom.
| | - Steven Pryjmachuk
- University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom
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Vaughn RL, Smith LM, Bernstein CA, Hansen H, Ofori-Atta A, Ohene S. Expanding the Pipeline: The New York University School of Medicine-University of Ghana School of Medicine and Dentistry Psychiatric Education Initiative. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2016; 45:154-159. [PMID: 29118456 PMCID: PMC5673107 DOI: 10.1080/00207411.2016.1167490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As many low- and middle-income countries (LAMICs), Ghana is affected by a severe shortage of mental health specialists: there are 11 practicing psychiatrists for a population of 25 million. The pipeline for Ghanaian psychiatrists remains restricted for the foreseeable future given the low expressed interest in the field by junior medical trainees. The few senior psychiatric specialists are overextended with clinical and professional duties leaving them with minimal time to teach and mentor trainees. This limits opportunities for mentorship, modeling, teaching, and curricular development, leaving trainees with little exposure to psychiatric practice, and therefore, little motivation to enter a highly stigmatized and underresourced field. To support the training of Ghanaian medical students in psychiatry, the New York University School of Medicine-University of Ghana School of Medicine and Dentistry (NYUSOM-UGSMD) Psychiatric Education Initiative, and the NYU Global Mental Health Elective were formed (1) to provide educational support to medical students and residents at UGSMD and (2) to provide a sustainable international experience for NYUSOM residents with a strong interest in leadership in global mental health and underserved populations.
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Affiliation(s)
| | | | | | - Helena Hansen
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Angela Ofori-Atta
- Department of Psychiatry, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Sammy Ohene
- Department of Psychiatry, University of Ghana School of Medicine and Dentistry, Accra, Ghana
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Whyle EB, Olivier J. Models of public-private engagement for health services delivery and financing in Southern Africa: a systematic review. Health Policy Plan 2016; 31:1515-1529. [PMID: 27296061 DOI: 10.1093/heapol/czw075] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/12/2022] Open
Abstract
In low- and middle-income countries (LMICs), the private sector-including international donors, non-governmental organizations, for-profit providers and traditional healers-plays a significant role in health financing and delivery. The use of the private sector in furthering public health goals is increasingly common. By working with the private sector through public -: private engagement (PPE), states can harness private sector resources to further public health goals. PPE initiatives can take a variety of forms and understanding of these models is limited. This paper presents the results of a Campbell systematic literature review conducted to establish the types and the prevalence of PPE projects for health service delivery and financing in Southern Africa. PPE initiatives identified through the review were categorized according to a PPE typology. The review reveals that the full range of PPE models, eight distinct models, are utilized in the Southern African context. The distribution of the available evidence-including significant gaps in the literature-is discussed, and key considerations for researchers, implementers, and current and potential PPE partners are presented. It was found that the literature is disproportionately representative of PPE initiatives located in South Africa, and of those that involve for-profit partners and international donors. A significant gap in the literature identified through the study is the scarcity of information regarding the relationship between international donors and national governments. This information is key to strengthening these partnerships, improving partnership outcomes and capacitating recipient countries. The need for research that disaggregates PPE models and investigates PPE functioning in context is demonstrated.
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Affiliation(s)
- Eleanor Beth Whyle
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jill Olivier
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Shields L, Chauhan A, Bakre R, Hamlai M, Lynch D, Bunders J. How can mental health and faith-based practitioners work together? A case study of collaborative mental health in Gujarat, India. Transcult Psychiatry 2016; 53:368-91. [PMID: 27199281 DOI: 10.1177/1363461516649835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the knowledge that people with mental illness often seek care from multiple healing systems, there is limited collaboration between these systems. Greater collaboration with existing community resources could narrow the treatment gap and reduce fragmentation by encouraging more integrated care. This paper explores the origins, use, and outcomes of a collaborative programme between faith-based and allopathic mental health practitioners in India. We conducted 16 interviews with key stakeholders and examined demographic and clinical characteristics of the user population. Consistent with previous research, we found that collaboration is challenging and requires trust, rapport-building, and open dialogue. The collaboration reached a sizeable population, was reviewed favourably by key stakeholders-particularly on health improvement and livelihood restoration-and perhaps most importantly, views the client holistically, allowing for both belief systems to play a shared role in care and recovery. Results support the idea that, despite differing practices, collaboration between faith-based and allopathic mental health practitioners can be achieved and can benefit clients with otherwise limited access to mental health care.
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Affiliation(s)
- Laura Shields
- Trimbos Institute/Netherlands Institute for Mental Health and Addiction, the Netherlands
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78
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Owusu-Ansah FE, Tagbor H, Togbe MA. Access to health in city slum dwellers: The case of Sodom and Gomorrah in Accra, Ghana. Afr J Prim Health Care Fam Med 2016; 8:e1-7. [PMID: 27247151 PMCID: PMC4827165 DOI: 10.4102/phcfm.v8i1.822] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 11/17/2022] Open
Abstract
Background Rapid rural-urban migration of people to cities is a reality around the globe that has increased city slum dwellers. Sodom and Gomorrah is a city slum located in the heart of Accra, Ghana. Like other slums, it lacks basic amenities necessary for dwellers’ quality of life. This study describes residents’ access to health and factors associated with the use of healthcare facilities. Methods Questionnaires were administered in systematically selected shacks across the entire slum. Data on demographic characteristics, existent health facilities and number of users, health-insured residents and knowledge of common diseases were collected. Results Majority of the residents were from the northern parts of Ghana, relative to the south and a few of them come from other parts of West Africa. Seventy-one percent of residents had never visited a health facility in the last 5 years. When necessary, they access health care from drug stores (61.1%) or hospitals (33.1%). Residents’ age, educational status, income, health knowledge and membership of National Health Insurance Scheme were significantly (p < 0.05) associated with the use of healthcare facilities. Younger residents and those without National Health Insurance Scheme membership, formal education, no knowledge of common illnesses and regular income were significantly less likely to use a healthcare facility. For most residents, neither distance (73.2%) nor transportation to health facilities was a problem (74.1%). Conclusion Conditions of profound environmental hazards, overcrowding, poor-quality housing and lack of health care in Sodom and Gomorrah pose grave threats to the health of the inhabitants. Multisectoral interventions and resource mobilisation championed by the Ministry of Local Government and Rural Development are needed to alter the trend.
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Affiliation(s)
- Frances E Owusu-Ansah
- Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology.
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79
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Wilson A, Somhlaba NZ. The position of Ghana on the progressive map of positive mental health: A critical perspective. Glob Public Health 2016; 12:579-588. [PMID: 26999029 DOI: 10.1080/17441692.2016.1161816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
According to the World Health Organisation (WHO), mental health is a state of well-being and not just the absence of diseases. With this definition, there has been a surge of mental health research, albeit still predominantly in Western countries, which is reflected in contemporary theories on positive mental health that include 'flourishing mental health', 'salutogenesis', and 'fortigenesis'. However, in low- and middle-income countries (LMICs), mental health research is slowly receiving scholarly attention. The aim of this paper was twofold: Firstly, to highlight progress that had been made in some LMICs, giving consideration to research across different settings and populations as a basis to argue for more research on positive mental health in the Ghanaian context. Secondly, to present a critical perspective on the current mental health research trends in Ghana, thus discussing important recommendations for future research.
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Affiliation(s)
- Angelina Wilson
- a Department of Psychology , University of Stellenbosch , Stellenbosch , South Africa
| | - Nceba Z Somhlaba
- a Department of Psychology , University of Stellenbosch , Stellenbosch , South Africa
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Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries. Psychiatr Q 2016; 87:63-73. [PMID: 25939823 DOI: 10.1007/s11126-015-9363-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.
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Nortje G, Oladeji B, Gureje O, Seedat S. Effectiveness of traditional healers in treating mental disorders: a systematic review. Lancet Psychiatry 2016; 3:154-70. [PMID: 26851329 DOI: 10.1016/s2215-0366(15)00515-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
Traditional healers form a major part of the mental health workforce worldwide. Despite this, little systematic examination has been done of their effectiveness in treating mental illness or alleviating psychological distress. In this Review, we aim to fill this gap, with a focus on quantitative outcomes. We searched four databases and reference lists for papers that explicitly measured the effectiveness of traditional healers on mental illness and psychological distress. Eligible papers were assessed for quality, and outcomes and other details were extracted with the use of a standardised template. 32 eligible papers from 20 countries were included. The published literature on this topic is heterogeneous and studies are generally of poor quality, although some findings emerge more consistently. Some evidence suggests that traditional healers can provide an effective psychosocial intervention. Their interventions might help to relieve distress and improve mild symptoms in common mental disorders such as depression and anxiety. However, little evidence exists to suggest that they change the course of severe mental illnesses such as bipolar and psychotic disorders. Nevertheless, qualitative changes that are captured poorly by conventional rating scales might be as important as the quantitative changes reviewed here. We conclude by outlining the challenges involved in assessing the effectiveness of traditional healers.
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Affiliation(s)
- Gareth Nortje
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | | | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Determinants of Psychological Help-Seeking Intentions of University Students in Ghana. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2015. [DOI: 10.1007/s10447-015-9247-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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83
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Weobong B, ten Asbroek AHA, Soremekun S, Gram L, Amenga-Etego S, Danso S, Owusu-Agyei S, Prince M, Kirkwood BR. Association between probable postnatal depression and increased infant mortality and morbidity: findings from the DON population-based cohort study in rural Ghana. BMJ Open 2015; 5:e006509. [PMID: 26316646 PMCID: PMC4554911 DOI: 10.1136/bmjopen-2014-006509] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the impact of probable depression in the immediate postnatal period on subsequent infant mortality and morbidity. DESIGN Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths. SETTING Rural/periurban communities within the Kintampo Health Research Centre study area of the Brong-Ahafo Region of Ghana. PARTICIPANTS 16,560 mothers who had a live singleton birth reported between 24 March 2008 and 11 July 2009, who were screened for probable postnatal depression (pPND) between 4 and 12 weeks post partum (some of whom had also had depression assessed at pregnancy), and whose infants survived to this point. PRIMARY/SECONDARY OUTCOME MEASURES All-cause early infant mortality expressed per 1000 infant-months of follow-up from the time of postnatal assessment to 6 months of age. The secondary outcomes were (1) all-cause infant mortality from the time of postnatal assessment to 12 months of age and (2) reported infant morbidity from the time of the postnatal assessment to 12 months of age. RESULTS 130 infant deaths were recorded and singletons were followed for 67,457.4 infant-months from the time of their mothers' postnatal depression assessment. pPND was associated with an almost threefold increased risk of mortality up to 6 months (adjusted rate ratio (RR), 2.86 (1.58 to 5.19); p=0.001). The RR up to 12 months was 1.88 (1.09 to 3.24; p=0.023). pPND was also associated with increased risk of infant morbidity. CONCLUSIONS There is new evidence for the association between maternal pPND and infant mortality in low-income and middle-income countries. Implementation of the WHO's Mental Health Gap Action Programme (mhGAP) to scale up packages of care integrated with maternal health is encouraged as an important adjunct to child survival efforts.
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Affiliation(s)
- Benedict Weobong
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - Augustinus H A ten Asbroek
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - Seyi Soremekun
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lu Gram
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Samuel Danso
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Prince
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Betty R Kirkwood
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
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Ae-Ngibise KA, Doku VCK, Asante KP, Owusu-Agyei S. The experience of caregivers of people living with serious mental disorders: a study from rural Ghana. Glob Health Action 2015; 8:26957. [PMID: 25967587 PMCID: PMC4429259 DOI: 10.3402/gha.v8.26957] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/07/2015] [Accepted: 04/10/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Families and friends who give care to people with mental disorders (MDs) are affected in a variety of ways and degrees. The interplay of caregiving consequences: poverty, discrimination and stigma, lack of support from others, diminished social relationships, depression, emotional trauma, and poor or interrupted sleep are associated caregiver burden. OBJECTIVE The burden of care on caregivers of people living with MDs was assessed in two districts located in the middle part of Ghana. Coping strategies and available support for caregivers of MDs were also assessed. DESIGN A qualitative study was carried out involving 75 caregivers of participants with MDs registered within the Kintampo Health and Demographic Surveillance Systems. Data were gathered from caregivers about their experiences in providing care for their relations with MDs. RESULTS Caregivers reported various degrees of burden, which included financial, social exclusion, emotional, depression, and inadequate time for other social responsibilities. Responsibilities around caregiving were mostly shared among close relatives but to a varying and limited extent. Religious prayers and the anticipation of cure were the main coping strategies adopted by caregivers, with expectation of new treatments being discovered. CONCLUSIONS Emotional distress, stigma, financial burden, lack of support networks, social exclusion, health impact, and absence of decentralised mental health services were experienced by family caregivers. These findings highlight the need for interventions to support people with MDs and their caregivers. This might include policy development and implementation that will decentralise mental health care provision including psychosocial support for caregivers. This will ameliorate families' financial and emotional burden, facilitate early diagnosis and management, reduce travel time to seek care, and improve the quality of life of family caregivers of persons with MDs.
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Affiliation(s)
| | - Victor Christian Korley Doku
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
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Weobong B, Ten Asbroek AH, Soremekun S, Danso S, Owusu-Agyei S, Prince M, Kirkwood BR. Determinants of postnatal depression in rural ghana: findings from the don population based cohort study. Depress Anxiety 2015; 32:108-19. [PMID: 24272979 DOI: 10.1002/da.22218] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/27/2013] [Accepted: 10/28/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Risk factors for postnatal depression (PND), one of the most pervasive complications of child bearing, are poorly understood in Africa. A recent systematic review of 31 studies found that the strongest predictors are social and economic disadvantage and gender-based factors; only six of these studies were community based, and almost all were in South Asia. METHODS Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for depression during pregnancy and after birth using the Patient Health Questionnaire to ascertain DSM-IV major or minor depression. Information was collected on determinants relating to the mother, birth, and baby, which were examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals. RESULTS Thirteen thousand nine hundred and twenty nine women were screened both during pregnancy and after birth, of whom 13,360 (95.9%) had complete data on potential determinants. Two hundred and fifty five (3.8%, 95% CI: 3.5%, 4.1%) had PND. Antenatal depression (AND) was the strongest determinant accounting for 34.4% of PND cases. Other determinants were season of delivery, peripartum/postpartum complications, newborn ill health, still birth, or neonatal death. Common determinants were observed for onset and persistent depression. CONCLUSIONS Although most AND resolves in this setting, more than a third of women with PND also had AND. Adverse birth- and baby-related outcomes are the other main determinants. We recommend that programs detect and treat depression during pregnancy and provide support to women with adverse birth outcomes.
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Alosaimi FD, Alshehri Y, Alfraih I, Alghamdi A, Aldahash S, Alkhuzayem H, Al-Beeshi H. Psychosocial correlates of using faith healing services in Riyadh, Saudi Arabia: a comparative cross-sectional study. Int J Ment Health Syst 2015; 9:8. [PMID: 25685187 PMCID: PMC4328536 DOI: 10.1186/1752-4458-9-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/24/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In this study, we compared the prevalence of psychiatric disorders and the characteristics of those who either use or do not use faith healers (FHs) services. We also assessed the independent factors of study subjects associated with using FHs. METHODS This cross-sectional study compared those who use FHs (n = 383) with a control group of those who do not use them (i.e., shopping mall visitors, n = 424) using a survey of sociodemographic characteristics and a validated Arabic version of the Mini International Neuropsychiatric Interview (MINI 6.0). RESULTS Participants who ranked higher among FH users included males, people who were either married, divorced, or widowed, those with less education, and those with lower income. They were more likely to report past medical and psychiatric history. Those with diagnosable psychiatric disorders were more likely to visit FHs, especially if the diagnosis was of psychotic and bipolar disorders. The prevalence of psychiatric disorders was higher among FH users, and depressive and anxiety disorders were the most prevalent. CONCLUSIONS The study showed that having past psychiatric history and a current psychiatric disorder are risk factors for using FHs. Also, a high percentage of FH users had a diagnosable psychiatric disorder. Further research should assess how to facilitate their access to the mental health system.
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Affiliation(s)
- Fahad D Alosaimi
- />Department of Psychiatry, King Saud University, P.O. Box 7805, Riyadh, 11472 Kingdom of Saudi Arabia
| | - Youssef Alshehri
- />Department of Psychiatry, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Ibrahim Alfraih
- />Psychiatry Resident, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Ayedh Alghamdi
- />Psychiatry Resident, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Saleh Aldahash
- />Psychiatry Resident, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Haifa Alkhuzayem
- />Psychiatry Resident, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Haneen Al-Beeshi
- />Psychiatry Resident, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
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Osafo J, Agyapong I, Asamoah MK. Exploring the nature of treatment regimen for mentally ill persons by neo-prophetic ministers in Ghana. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/17542863.2014.973428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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88
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Weobong B, ten Asbroek AHA, Soremekun S, Manu AA, Owusu-Agyei S, Prince M, Kirkwood BR. Association of antenatal depression with adverse consequences for the mother and newborn in rural Ghana: findings from the DON population-based cohort study. PLoS One 2014; 9:e116333. [PMID: 25549334 PMCID: PMC4280205 DOI: 10.1371/journal.pone.0116333] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/05/2014] [Indexed: 12/31/2022] Open
Abstract
Background Whilst there is compelling evidence of an almost 2-fold increased risk of still births, and suggestive evidence of increased mortality among offspring of mothers with psychotic disorders, only three studies have addressed the role of antenatal depression (AND) on survival of the baby. We examined these associations in a large cohort of pregnant women in Ghana. Methods A Cohort study nested within 4-weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for AND using the Patient Health Questionnaire (PHQ-9) to ascertain DSM-IV major or minor depression. Outcomes were adverse birth outcomes, maternal/infant morbidity, and uptake of key newborn care practices, examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals. Results 20679 (89.6%) pregnant women completed the PHQ-9. The prevalence of AND was 9.9% (n = 2032) (95% confidence interval 9.4%–10.2%). AND was associated with: prolonged labour (RR 1.25, 95% CI 1.02–1.53); peripartum complications (RR 1.11, 95% CI 1.07–1.15);postpartum complications (RR 1.27, 96% CI 1.21–1.34); non-vaginal delivery (RR 1.19, 95% CI 1.02–1.40); newborn illness (RR 1.52, 95% CI 1.16–1.99); and bed net use during pregnancy (RR 0.93, 95% CI 0.89–0.98), but not neonatal deaths, still births, low birth weight, immediate breast feeding initiation, or exclusive breastfeeding. AND was marginally associated with preterm births (RR 1.32, 95% CI 0.98–1.76). Conclusion This paper has contributed important evidence on the role of antenatal depression as a potential contributor to maternal and infant morbidity. Non-pharmacological treatments anchored on primary care delivery structures are recommended as an immediate step. We further recommend that trials are designed to assess if treating antenatal depression in conjunction with improving the quality of obstetric care results in improved maternal and newborn outcomes.
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Affiliation(s)
- Benedict Weobong
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Seyi Soremekun
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alexander A. Manu
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin Prince
- Health Services and Population Research Department, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Betty R. Kirkwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Paddick SM, Kalaria RN, Mukaetova-Ladinska EB. The prevalence and clinical manifestations of delirium in sub-Saharan Africa: a systematic review with inferences. J Neurol Sci 2014; 348:6-17. [PMID: 25466692 DOI: 10.1016/j.jns.2014.10.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/30/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND In high-income countries with ageing populations, delirium is most prevalent in older adults and in palliative and intensive care settings. The prevalence and aetiology of delirium are likely to differ in low income countries, including sub-Saharan Africa (SSA), due to different population demographics, disease burden and exposure to pathogens. We reviewed published literature relating to the prevalence, clinical features and underlying causes of delirium in SSA and compare this with that published in high-income countries in order to identify knowledge and clinical service gaps, and priorities for further research. METHODS We performed a narrative review by comprehensively searching the following databases: Medline, PsychInfo, Embase and PubMed. Studies published between January 1 1975 and December 31 2013 in all languages, including the terms 'delirium', 'acute brain syndrome', 'organic brain syndrome', or 'acute confusion' originating from SSA were included. In addition, reference lists of included articles and online databases of African medical literature were hand-searched. We also included case series and case reports due to paucity of published studies. RESULTS We identified a total of 46 relevant studies. Delirium was the main focus of only one cross-sectional study, whereas most included delirium in studies on neuropsychiatric conditions. Only two studies reported prevalence in older adults. Most studies reported very low (<2%) delirium prevalence, whereas delirium in psychiatric inpatient and outpatient settings was higher than expected (18.2%-29.9%). Descriptive studies of 'bouffee delirante' from psychiatry settings were often describing delirium. Infection and HIV seropositivity were common associations of delirium throughout these studies. There were no studies of intensive, critical or surgical care settings or of management strategies. CONCLUSIONS We currently know very little about the prevalence, presentation and aetiology of delirium in developing countries. This knowledge gap should be tackled with some urgency, in order to address questions of screening, diagnosis, prevention and management in this setting.
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Affiliation(s)
- S-M Paddick
- Institute for Ageing and Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, UK; Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - R N Kalaria
- Institute for Ageing and Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, UK.
| | - E B Mukaetova-Ladinska
- Institute for Ageing and Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, UK
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Weobong B, Soremekun S, Ten Asbroek AH, Amenga-Etego S, Danso S, Owusu-Agyei S, Prince M, Kirkwood BR. Prevalence and determinants of antenatal depression among pregnant women in a predominantly rural population in Ghana: the DON population-based study. J Affect Disord 2014; 165:1-7. [PMID: 24882170 DOI: 10.1016/j.jad.2014.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/11/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND While depression during pregnancy is one of the strongest risk factors for postnatal depression, it has been comparatively little studied, particularly in sub-Saharan Africa. METHODS Cohort study nested within 4-weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for depression during pregnancy using the Patient Health Questionnaire to ascertain DSM-IV major or minor depression. Information on demographic factors, indicators of social and economic disadvantage, and previous obstetric history were also collected which were examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals. RESULTS 21,135 pregnant women were screened of whom 20,920 (98.9%) had complete data on potential determinants. 2086 (9.9%, 95% CI: 9.5%-10.3%) had AND. Determinants of AND were: maternal age 30+ years (relative risk [RR], 1.16 (1.06-1.27); never married ([RR] 1.34, (1.14-1.58); lower wealth quintile ([RR], 1.30 (1.13-1.50); unplanned pregnancy ([RR], 1.55 (1.43-1.69); previous pregnancy loss ([RR], 1.30 (1.18-1.43). LIMITATIONS We did not assess women for physical health during pregnancy, and lacked information on some potentially relevant psychosocial factors. CONCLUSION Prevalence of antenatal depression, applying clinical criteria, is similar to that seen in high income countries. Factors related to chronic social and economic disadvantage are among the most important co-determinants. Population-level interventions that address these problems among women of reproductive age may be the most effective strategy for reducing the prevalence and impact of depression in pregnancy.
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Affiliation(s)
- Benedict Weobong
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Brong-Ahafo Region, Ghana; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK.
| | - Seyi Soremekun
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
| | | | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Brong-Ahafo Region, Ghana
| | - Samuel Danso
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Brong-Ahafo Region, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Brong-Ahafo Region, Ghana; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
| | - Martin Prince
- Health Services and Population Research Department, Institute of Psychiatry, King׳s College, London
| | - Betty R Kirkwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
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Nakimuli-Mpungu E, Wamala K, Okello J, Alderman S, Odokonyero R, Musisi S, Mojtabai R. Developing a culturally sensitive group support intervention for depression among HIV infected and non-infected Ugandan adults: a qualitative study. J Affect Disord 2014; 163:10-7. [PMID: 24836082 DOI: 10.1016/j.jad.2014.03.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 03/22/2014] [Accepted: 03/24/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression is ranked first among neuropsychiatric diseases that contribute to the burden of disease in low- and middle-income countries. However, access to antidepressants is limited and there is a dearth of locally developed psychotherapeutic interventions targeted to treat depression. AIM We aimed to obtain information on the cultural understanding of depression symptoms, complications and treatment methods used in post-conflict communities in northern Uganda in order to inform the development of an indigenous group support intervention to treat depression. METHODS Focus group discussions (FGDs) were conducted with a total of 110 men and women aged 19-68 years. FDGs took place in a private space, lasted about 2-3h and were conducted in the local language for patients and their caregivers and in English for health workers. Interview transcripts from the FGDs were reviewed for accuracy, translated into English and transcribed. QRS Nvivo 10 qualitative data analysis software was used for coding and thematic analysis. RESULTS Our study revealed community misperceptions about etiology, presentation and treatment of depression. Regardless of HIV status, most FGD participants who were not health workers linked depression symptoms to HIV infection. Although there were concerns about confidentiality of issues disclosed, many FGD participants were supportive of a group support intervention, tailored to their gender and age, that would not only focus on treating depression but also provided them with skills to improve their livelihoods. Simple CBT techniques were deemed culturally appropriate and acceptable. LIMITATION Generalizability of study findings may be limited given that the sample was primarily of Luo ethnicity yet there are different ethnic populations in the region. CONCLUSION Local communities can directly inform intervention content. The participants׳ preferences confirmed the need for a gender-specific intervention for depression that extends beyond medications and empowers them emotionally, socially and economically.
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Affiliation(s)
- Etheldreda Nakimuli-Mpungu
- Makerere University, College of Health Sciences, Kampala, Uganda; Peter C. Alderman Foundation, NewYork, USA.
| | - Kizito Wamala
- African Center for Tortured Victims, Kampala, Uganda
| | - James Okello
- Peter C. Alderman Foundation, NewYork, USA; Gulu University, Department of Psychiatry, Gulu, Uganda
| | | | - Raymond Odokonyero
- Makerere University, College of Health Sciences, Kampala, Uganda; Peter C. Alderman Foundation, NewYork, USA
| | - Seggane Musisi
- Makerere University, College of Health Sciences, Kampala, Uganda; Peter C. Alderman Foundation, NewYork, USA
| | - Ramin Mojtabai
- Johns Hopkins School of Public Health, Department of Mental Health, Baltimore, United States
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Uwakwe R, Otakpor A. Public Mental Health - Using the Mental Health Gap Action Program to Put all Hands to the Pumps. Front Public Health 2014; 2:33. [PMID: 24795874 PMCID: PMC4000990 DOI: 10.3389/fpubh.2014.00033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/31/2014] [Indexed: 11/19/2022] Open
Abstract
Although mental ill health constitutes a huge portion of the Global Burden of Disease (GBD), the majority of people with mental health problems do not receive any treatment, a scenario much worse in developing countries where mental health personnel are in gross short supply. The mhGAP was launched to address this gap, especially by training non-mental health professionals to deliver effective services for selected priority mental health problems. Especially in developing countries, many people with mental health problems consult traditional healers either as a first step in the pathway to biomedical mental health care or as the sole mental health service providers. Bridging the gap between mental health needs and available services in developing countries needs to incorporate traditional healers, who are ubiquitously available, easily accessible, and acceptable to the natives. Even though there are barriers in forging collaborations between traditional and biomedical mental health care providers, with mutual respect, understanding, and adapted training using the mhGAP intervention guide, it should be possible to get some traditional healers to understand the core principles of some priority mental health problems identification, treatment, and referral.
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Affiliation(s)
- Richard Uwakwe
- Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Alex Otakpor
- Department of Mental Health, University of Benin, Benin City, Nigeria
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Help-seeking behaviour, barriers to care and experiences of care among persons with depression in Eastern Cape, South Africa. J Affect Disord 2013; 151:439-448. [PMID: 23890669 DOI: 10.1016/j.jad.2013.06.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little is known about the help-seeking behaviour and barriers to care among people with depression in poor resource settings in Sub-Saharan Africa. METHODS This is a cross-sectional population-based study including 977 persons aged 18-40 living in the Eastern Cape Province in South Africa. The prevalence of depression was investigated with the help of a questionnaire (the Mini International Neuropsychiatric Interview). Several socio-economic variables, statements on help-seeking and perceptions of earlier mental health care were included. Data collection was performed from March to July 2012. RESULTS The prevalence of depression was 31.4%. People aged 18-29 and those with no or low incomes were less likely to seek help. Promotive factors for help-seeking included having social support and tuberculosis comorbidity. Of all people with depression in this sample, 57% did not seek health care at all even though they felt they needed it. Of the variety of barriers identified, those of most significance were related to stigma, lack of knowledge of their own illness and its treatability as well as financial constraints. LIMITATION Recall bias may be present and the people identified with depression were asked if they ever felt so emotionally troubled that they felt they should seek help; however, we do not know if they had depression at the time they referred to. CONCLUSIONS Depression is highly prevalent among young adults in the Eastern Cape Province, South Africa; however, many do not seek help. Health planners should increase mental health literacy in the communities and improve the competence of the health staff.
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Asante KP, Agyemang CT, Zandoh C, Saah J, Febir LG, Donlebo CK, Owusu-Agyei S. Community engagement in biomedical research in an African setting: the Kintampo Health Research Centre experience. BMC Health Serv Res 2013; 13:383. [PMID: 24090148 PMCID: PMC4015992 DOI: 10.1186/1472-6963-13-383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 09/30/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Community engagement (CE) is becoming relevant in health research activities; however, models for CE in health research are limited in developing countries. The Kintampo Health Research Centre (KHRC) conducts research to influence health policy locally and also internationally. Since its establishment in 1994 with the mandate of conducting relevant public health studies in the middle part of Ghana, KHRC has embarked on a series of clinical and operational studies involving community members. In these studies, community members have been engaged through community durbars before, during and also after all study implementations. Lessons learnt from these activities suggested the need to embark on further CE processes that could serve as a model for emerging research institutions based in African communities. METHODS Interactive community durbars, workshops, in-depth discussions, focus group discussions and radio interactions were used as the main methods in the CE process. RESULTS Community members outlined areas of research that they perceived as being of interest to them. Though community members expressed continual interest in our traditional areas of research in communicable, maternal, neonatal and child health, they were interested in new areas such as non- communicable diseases such as diabetes and hypertension. Misconceptions about KHRC and its research activities were identified and clarified. This research provided KHRC the opportunity to improve communication guidelines with the community and these are being used in engaging the community at various stages of our research, thus improving on the design and implementation of research. CONCLUSION KHRC has developed a culturally appropriate CE model based on mutual understanding with community members. The experience obtained in the CE process has contributed to building CE capacity in KHRC. Other health research institutions in developing countries could consider the experiences gained.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Charlotte Tawiah Agyemang
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Charles Zandoh
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Jacob Saah
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Lawrence Gyabaa Febir
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Casimir Kabio Donlebo
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
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Sorketti EA, Zainal NZ, Habil MH. The treatment outcome of psychotic disorders by traditional healers in central Sudan. Int J Soc Psychiatry 2013; 59:365-76. [PMID: 22433242 DOI: 10.1177/0020764012437651] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alternative and traditional healing methods are common and popular in Sudan, particularly for treating people with mental disorders, but little information is available about the outcome of theses traditional healing approaches. OBJECTIVES To study the outcome of treating patients with psychotic disorders by traditional healers, and to understand the type of services, interventions procedures and treatments methods used by traditional healers to manage patients with psychotic disorders. METHOD A prospective follow-up quantitative study of a cohort of inpatients with psychotic disorders was carried out from admission until discharge. Subjects were people with psychotic disorders undergoing treatment in traditional healer centres in central Sudan. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose the psychotic disorders and the Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of psychotic symptoms on admission and discharge from the traditional healer centre. RESULTS We interviewed 129 inpatients with psychotic disorders on admission and discharge from the traditional healers centres. There was a significant reduction in the PANSS score (p = .0001) after a mean period of stay of 4.5 months. The mean for the overall PANSS score was 118.36 on admission and 69.36 on discharge. CONCLUSION Although traditional-healing approaches produce a significant improvement in the signs and symptoms of psychotic disorders measured on the PANSS, they need to be further investigated, assessed and studied.
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Affiliation(s)
- Ehab Ali Sorketti
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Abstract
BACKGROUND For too long there have been heated debates between those who believe that mental health care should be largely or solely provided from hospitals and those who adhere to the view that community care should fully replace hospitals. The aim of this study was to propose a conceptual model relevant for mental health service development in low-, medium- and high-resource settings worldwide. Method We conducted a review of the relevant peer-reviewed evidence and a series of surveys including more than 170 individual experts with direct experience of mental health system change worldwide. We integrated data from these multiple sources to develop the balanced care model (BCM), framed in three sequential steps relevant to different resource settings. RESULTS Low-resource settings need to focus on improving the recognition and treatment of people with mental illnesses in primary care. Medium-resource settings in addition can develop 'general adult mental health services', namely (i) out-patient clinics, (ii) community mental health teams (CMHTs), (iii) acute in-patient services, (iv) community residential care and (v) work/occupation. High-resource settings, in addition to primary care and general adult mental health services, can also provide specialized services in these same five categories. CONCLUSIONS The BCM refers both to a balance between hospital and community care and to a balance between all of the service components (e.g. clinical teams) that are present in any system, whether this is in low-, medium- or high-resource settings. The BCM therefore indicates that a comprehensive mental health system includes both community- and hospital-based components of care.
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Affiliation(s)
- G Thornicroft
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK.
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Walstrom P, Operario D, Zlotnick C, Mutimura E, Benekigeri C, Cohen MH. 'I think my future will be better than my past': examining support group influence on the mental health of HIV-infected Rwandan women. Glob Public Health 2012; 8:90-105. [PMID: 22812728 PMCID: PMC5576858 DOI: 10.1080/17441692.2012.699539] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Urgent need exists for improved psychological services among HIV-infected women in post-genocide Rwanda. Psychological problems associated with trauma and sexual violence (i.e., depression, posttraumatic stress disorder [PTSD]) place women at increased risk for sexual risk behaviour, low health-seeking behaviour, delay of antiretroviral therapy (ART) and reduced ART adherence. We explored experiences of HIV-infected Rwandan women attending psychosocial support groups and their narratives about how participation affected their mental health and HIV treatment. Focus group discussions examined participants' reasons for support group attendance, perceived psychological benefit of support groups, influence on ART adherence, and other influences on health behaviors and attitudes. Rwandan women (aged 18-65) were randomly selected from 10 health clinic-facilitated support groups for HIV-infected trauma survivors in Kigali. Results identified positive psychological and physical changes as well as behaviour changes in relationships with men, which participants attributed to support group attendance. Data showed significant improvement in mental health, ART adherence and HIV serostatus disclosure resulting from group attendance. Participants acknowledged limitations of support groups with respect to addressing poverty and hunger. Implementing psychosocial support groups may leverage clinical outcomes and rejuvenate the well-being of HIV-infected women with interpersonal trauma and/or PTSD and depressive symptoms, particularly those from post-conflict countries.
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Affiliation(s)
- Paige Walstrom
- Program in Public Health, Brown University, Providence, RI, USA.
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Read U. "I want the one that will heal me completely so it won't come back again": the limits of antipsychotic medication in rural Ghana. Transcult Psychiatry 2012; 49:438-60. [PMID: 22722982 DOI: 10.1177/1363461512447070] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Campaigns to scale up mental health services in low-income countries emphasise the need to improve access to psychotropic medication as part of effective treatment yet there is little acknowledgement of the limitations of psychotropic drugs as perceived by those who use them. This paper considers responses to treatment with antipsychotics by people with mental illness and their families in rural Ghana, drawing on an anthropological study of family experiences and help seeking for mental illness. Despite a perception among health workers that there was little popular awareness of biomedical treatment for mental disorders, psychiatric services had been used by almost all informants. However, in many cases antipsychotic treatment had been discontinued, even where it had been recognised to have beneficial effects such as controlling aggression or inducing sleep. Unpleasant side effects such as feelings of weakness and prolonged drowsiness conflicted with notions of health as strength and were seen to reduce the ability to work. The reduction of perceptual experiences such as visions was less valued than a return to social functioning. The failure of antipsychotics to achieve a permanent cure also cast doubt on their efficacy and strengthened suspicions of a spiritual illness which would resist medical treatment. These findings suggest that efforts to improve the treatment of mental disorders in low-income countries should take into account the limitations of antipsychotic drugs for those who use them and consider how local resources and concepts of recovery can be used to maximise treatment and support families.
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Affiliation(s)
- Ursula Read
- Department of Anthropology, University College London, 14 Taviton Street, London, UK.
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O’Brien KS, Soliman AS, Annan K, Lartey RN, Awuah B, Merajver SD. Traditional herbalists and cancer management in Kumasi, Ghana. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:573-579. [PMID: 22549472 PMCID: PMC4276030 DOI: 10.1007/s13187-012-0370-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cancer incidence rates are increasing in sub-Saharan Africa where traditional medical practitioners (TMPs) are involved in cancer management. Little is known about the specific role that TMPs play in cancer management in Ghana; we hypothesize that an understanding of the practices of TMPs with regard to cancer patients would help to enhance literacy about cancer amongst TMPs and would contribute to the diagnosis of cancer at earlier stages, by avoiding the detrimental delays while enlisting their help in certain activities that enhance cancer care. To elucidate the nature of the involvement of TMPs in cancer management, we conducted semi-structured interviews with 42 TMPs who practice in Kumasi, Ghana. The interviews elicited information about their knowledge and practices regarding cancer management and interactions with local hospitals. The results showed that TMPs tended to identify cancers as diseases of visible masses, fungating lesions, ulceration, and bleeding reflecting the advanced stages and types of cancers they usually encounter. TMPs identified certain causes of cancer and believed that they can treat and prevent cancer. These results indicate that TMPs are significant health service delivery resources in Ghana for patients potentially affected with cancer. Our work suggests that dedicated efforts to further integrate TMPs into the overall health care system would be beneficial to patients. Future research should examine the role of cancer education and training programs for TMPs to enhance their knowledge, strengthen their ability to complement allopathic practitioners, and increase early detection and treatment efforts through appropriate and timely referrals.
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Affiliation(s)
| | - Amr S. Soliman
- University of Michigan School of Public Health, Ann Arbor, MI, USA. Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Kofi Annan
- Department of Herbal Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard N. Lartey
- Department of Herbal Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Sofia D. Merajver
- University of Michigan School of Public Health, Ann Arbor, MI, USA. University of Michigan Medical School and Center for Global Health, Ann Arbor, MI, USA
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