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Kidia K, Machando D, Dzoro V, Chibanda D, Abas M, Manda E, Mutengerere A, Nyandoro T, Chawarika M, Majichi D, van Dijk JH, Jack H. Rural Friendship Bench: A qualitative study in Zaka district, Zimbabwe. Soc Sci Med 2024; 348:116791. [PMID: 38522147 DOI: 10.1016/j.socscimed.2024.116791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/07/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND We piloted the Friendship Bench-an evidence-based, urban-area task sharing intervention for common mental disorders-in rural Zimbabwe. The intervention combines problem solving therapy with income generating activities. This study sought to understand the intervention's implementation in terms of acceptability, feasibility, and sustainability as well as local attitudes towards mental wellbeing in rural Zimbabwe. METHODS Using four separate semi-structured interview guides, we conducted in-depth interviews (N = 32) with patients (n = 9), village health workers (n = 12), nurses (n = 6), and community leaders (n = 5). We analyzed our data using thematic analysis with a diverse coding team using an integrative deductive-inductive approach. RESULTS Five themes emerged: 1) explanatory models for mental illness, 2) clinical workflow and emphasis on documentation, 3) positive feedback about the Friendship Bench, 4) accessibility, and 5) feasibility. CONCLUSION In its current format, our intervention was acceptable but neither feasible nor sustainable. Sociocultural context is critical in the development of rural task sharing interventions for mental health. We thus recommend a robust pilot and adaptation phase when scaling task sharing interventions in rural sub-Saharan Africa to elevate community voices, leverage existing social structures, and embed interventions as deeply into communities as possible.
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Affiliation(s)
- K Kidia
- Kushinga, Harare, Zimbabwe; Division of Global Health Equity, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | - D Chibanda
- Friendship Bench, Harare, Zimbabwe; London School of Hygiene and Tropical Medicine, London, UK
| | - M Abas
- King's College London, London, UK
| | - E Manda
- Friendship Bench, Harare, Zimbabwe
| | | | | | | | - D Majichi
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - H Jack
- University of Washington, Seattle, WA, USA
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Zamudio-Haas S, Mahaka I, Chapwanya G, Dunbar MS, Lightfoot M. "I am still human and worth a life:" a qualitative study of the impacts of a community based, peer-led, treatment support model for young adults living with HIV in Zimbabwe. Front Public Health 2024; 12:1367584. [PMID: 38721533 PMCID: PMC11078516 DOI: 10.3389/fpubh.2024.1367584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/01/2024] [Indexed: 05/15/2024] Open
Abstract
Background A persistent treatment gap remains between children and adults living with HIV. The Zvandiri program, developed by Africaid, is one of the few models of differentiated service delivery for children, adolescents, and youth that has been shown to improve outcomes along the HIV care continuum, employing Community Adolescent Treatment Supporters (CATS) to offer peer counseling and patient navigation. Our qualitative study provides an in-depth analysis of the feelings and experiences Zimbabwean youth had following an HIV diagnosis, and the ways that CATS facilitated linkage and retention in care. Methods We conducted in-depth interviews in Shona with adolescents and young adults who were recently diagnosed with HIV in Zimbabwe. Interviews were audio-recorded, transcribed, and then translated to English. Interviews were coded in Dedoose using a structured a priori codebook. We wrote semi-structured summary memos for each interview. We co-conducted thematic analysis, guided by interpretive phenomenology with a team of Zimbabwean and American experienced qualitative researchers and community partners. We co-developed memos to elaborate and understand key themes across interviews. Results Most of our interview participants recounted an immediate sense of loss upon testing HIV positive and a fear that "there was no hope for the future." CATS played a pivotal role for youth, providing emotional, educational, and logistical support to facilitate treatment initiation, adherence, and persistence in care. The CATS program supported youth through multiple approaches: group sessions, individual meetings, and via text or phone. While CATS offered counseling and comfort to participants, they emphasized the long-term importance of identifying at least one other person in participants' lives who could know their status and support them around HIV. Conclusion Our findings delineate some of the key concerns that face youth after receiving an HIV diagnosis and the ways that a community-based adherence peer navigation program supported participants to navigate both their feelings and the health care system. Results can inform practice at community-based agencies that are implementing or considering peer youth navigation programs and garner support for policy to fund interventions for youth.
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Affiliation(s)
- Sophia Zamudio-Haas
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | | | | | - Marguerita Lightfoot
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Bosakova L, Dankulincova Veselska Z, Filakovska Bobakova D. How to improve the system of care for adolescents with emotional and behavioural problems from the perspective of care providers: a concept mapping approach. Health Res Policy Syst 2024; 22:9. [PMID: 38225655 PMCID: PMC10789000 DOI: 10.1186/s12961-023-01096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Emotional and behavioural problems (EBP) are the most common mental health issues during adolescence, and their incidence has increased in recent years. The system of care for adolescents with EBP is known to have several problems, making the provision of care less than optimal, and attention needs to be given to potential improvements. We, therefore, aimed to examine what needs to be done to improve the system of care for adolescents with EBP and to assess the urgency and feasibility of the proposed measures from the perspective of care providers. METHODS We used Concept mapping, a participatory mixed-method research, based on qualitative data collection and quantitative data analysis. A total of 33 stakeholders from 17 institutions participated in our study, including psychologists, pedagogues for children with special needs, teachers, educational counsellors, social workers and child psychiatrists. RESULTS Respondents identified 43 ideas for improving of the system of care for adolescents with EBP grouped into 5 clusters related to increasing the competencies of care providers, changes at schools and school systems, support for existing services, transparency of the care system in institutions and public administration, and the adjustment of legislative conditions. The most urgent and feasible proposals were related to the support of awareness-raising activities on the topic of EBP, the creation of effective screening tools for the identification of EBP in adolescents, strengthening the role of parents in the process of care, comprehensive work with the family, creation of multidisciplinary support teams and intersectoral cooperation. CONCLUSIONS Measures which are more accessible and responsive to the pitfalls of the care system, together with those strengthening the role of families and schools, have greater potential for improvements which are in favour of adolescents with EBP. Care providers should be invited more often and much more involved in the discussion and the co-creation of measures to improve the system of care for adolescents with EBP.
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Affiliation(s)
- Lucia Bosakova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University in Kosice, Tr. SNP 1, Kosice, 040 01, Slovakia.
- Olomouc University Society and Health Institute (OUSHI), Palacky University in Olomouc, Univerzitni 22, Olomouc, 771 11, Czech Republic.
| | - Zuzana Dankulincova Veselska
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University in Kosice, Tr. SNP 1, Kosice, 040 01, Slovakia
| | - Daniela Filakovska Bobakova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University in Kosice, Tr. SNP 1, Kosice, 040 01, Slovakia
- Olomouc University Society and Health Institute (OUSHI), Palacky University in Olomouc, Univerzitni 22, Olomouc, 771 11, Czech Republic
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Mwamuka R, Kaiyo-Utete M, Mawoyo C, Mangezi W. The prevalence and associated characteristics of Bipolar Disorder diagnosis among admitted patients at three tertiary psychiatric hospitals in Zimbabwe: A cross sectional study. PLoS One 2024; 19:e0290560. [PMID: 38166016 PMCID: PMC10760812 DOI: 10.1371/journal.pone.0290560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/09/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Bipolar Affective Disorder (BD) is a serious condition that affects more than 1% of the world's population. If not treated can cause disability, yet its prevalence in Zimbabwe is not known. This study explores the burden of Bipolar Disorder and its associated factors in Zimbabwe. METHODS A cross sectional study with a sample of 272 participants was carried out at three tertiary hospitals in Zimbabwe. Data was collected using an interviewer administered questionnaire and the Mini International Neuropsychiatric Interview (M.I.N.I). The study shows the prevalence and factors associated with Bipolar Disorder at tertiary psychiatric hospitals. Data analysis was done using STATA S/E 13.0 for data management. RESULTS The prevalence of BD in the sample was 39.3%. Factors associated with BD were, being formally employed (AOR = 3.69, 95%CI: 1.55-8.79), a history of defaulting medications (AOR = 1.90, 95%CI: 1.02-3.57) and a reported previous diagnosis of BD (AOR = 5.66, 95%CI: 2.72-11.8). CONCLUSIONS The prevalence of BD among admitted participants in tertiary psychiatric hospitals in Zimbabwe is high. It is comparable to that from African studies done in clinical settings. There is need for in-service training for clinicians to be more vigilant in diagnosing BD.
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Affiliation(s)
- Rukudzo Mwamuka
- Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Malinda Kaiyo-Utete
- Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Chido Mawoyo
- Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Walter Mangezi
- Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Neill R, Shawar YR, Ashraf L, Das P, Champagne SN, Kautsar H, Zia N, Michlig GJ, Bachani AM. Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework. Int J Equity Health 2023; 22:91. [PMID: 37198596 DOI: 10.1186/s12939-023-01896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. METHODS We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. RESULTS The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. CONCLUSIONS This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.
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Affiliation(s)
- Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Yusra Ribhi Shawar
- Department of International Health, Johns Hopkins University Blomberg School of Public Health, Baltimore, MD, USA
- Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC, USA
| | - Lamisa Ashraf
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Priyanka Das
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Sarah N Champagne
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Georgia J Michlig
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
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Understanding the nature of substance use in Zimbabwe: State of the art and ways forward: A scoping review protocol. PLoS One 2023; 18:e0272240. [PMID: 36893211 PMCID: PMC9997907 DOI: 10.1371/journal.pone.0272240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
Reports of substance use in Zimbabwe paint a concerning picture of escalating prevalence of use, with over half of people admitted to inpatient mental health units reportedly experiencing a substance induced disorder. The country has gone through decades of significant political and socio-economical challenges, which are undoubtedly linked to the observed increases in substances use. Nevertheless, despite the resource constraints to adequately address substance use, the government has shown a renewed resolve to provide a comprehensive approach to address substance use in the country. However, there is a lack of clarity of the nature and extent of substance use and substance use disorders (SUDs), which in part is due to a lack of a national monitoring system for substance use in the country. Moreover, reports of a substance use crisis in Zimbabwe are predominantly based on anecdotal evidence, limiting the ability to gain an accurate picture of the situation. Therefore, a scoping review of the primary empirical evidence of substance use and SUDs is proposed in order to develop an adequately informed understanding of the nature of substance use and SUDs in Zimbabwe. Furthermore, the review will embed an assessment of the response to substance use, together with an analysis of the policy landscape on substance use in Zimbabwe. The PRISMA-ScR checklist will be utilised for the write up. The results of the scoping review will be essential for identifying the current state of knowledge around substance use, and identify gaps in knowledge and policy that would be a catalyst for further work to enhance knowledge and develop solutions situated within the local context. Thus the present work presents a timely effort that capitalises on current efforts by the government to address substance use in the country.
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African Immigrant Health: The Health Promotion Beliefs of Zimbabwean Immigrants in the United States. J Immigr Minor Health 2021; 24:1261-1268. [PMID: 34855044 DOI: 10.1007/s10903-021-01318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
To examine the health beliefs that can influence engagement in cardiovascular disease (CVD) risk reduction health promotion activities among Zimbabwe-born immigrants in the US. Focus group interviews with 37 New England-based Zimbabwean immigrants in the US conducted between January and April 2019. Focus groups were led by study investigators who were members of the Zimbabwean community. Interviews were audio-recorded and transcribed. Data were analyzed using framework analysis. Five themes emerged: (1) negative attitudes toward ill health, (2) mistrust toward western medicine, (3) stigma and taboo toward ill health, (4) a negative change in eating habits and (5) negative attitudes toward physical exercise. The participants' attitudes and beliefs may interfere with their engagement in health promotion activities aimed at reducing the burden of CVD risk in this population. Understanding these beliefs paves the way for development of culturally congruent health promotion interventions in Zimbabwean and other African immigrant populations.
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Langmia IM, Just KS, Yamoune S, Brockmöller J, Masimirembwa C, Stingl JC. CYP2B6 Functional Variability in Drug Metabolism and Exposure Across Populations-Implication for Drug Safety, Dosing, and Individualized Therapy. Front Genet 2021; 12:692234. [PMID: 34322158 PMCID: PMC8313315 DOI: 10.3389/fgene.2021.692234] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
Adverse drug reactions (ADRs) are one of the major causes of morbidity and mortality worldwide. It is well-known that individual genetic make-up is one of the causative factors of ADRs. Approximately 14 million single nucleotide polymorphisms (SNPs) are distributed throughout the entire human genome and every patient has a distinct genetic make-up which influences their response to drug therapy. Cytochrome P450 2B6 (CYP2B6) is involved in the metabolism of antiretroviral, antimalarial, anticancer, and antidepressant drugs. These drug classes are commonly in use worldwide and face specific population variability in side effects and dosing. Parts of this variability may be caused by single nucleotide polymorphisms (SNPs) in the CYP2B6 gene that are associated with altered protein expression and catalytic function. Population variability in the CYP2B6 gene leads to changes in drug metabolism which may result in adverse drug reactions or therapeutic failure. So far more than 30 non-synonymous variants in CYP2B6 gene have been reported. The occurrence of these variants show intra and interpopulation variability, thus affecting drug efficacy at individual and population level. Differences in disease conditions and affordability of drug therapy further explain why some individuals or populations are more exposed to CYP2B6 pharmacogenomics associated ADRs than others. Variabilities in drug efficacy associated with the pharmacogenomics of CYP2B6 have been reported in various populations. The aim of this review is to highlight reports from various ethnicities that emphasize on the relationship between CYP2B6 pharmacogenomics variability and the occurrence of adverse drug reactions. In vitro and in vivo studies evaluating the catalytic activity of CYP2B6 variants using various substrates will also be discussed. While implementation of pharmacogenomic testing for personalized drug therapy has made big progress, less data on pharmacogenetics of drug safety has been gained in terms of CYP2B6 substrates. Therefore, reviewing the existing evidence on population variability in CYP2B6 and ADR risk profiles suggests that, in addition to other factors, the knowledge on pharmacogenomics of CYP2B6 in patient treatment may be useful for the development of personalized medicine with regards to genotype-based prescription.
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Affiliation(s)
- Immaculate M. Langmia
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Katja S. Just
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Sabrina Yamoune
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jürgen Brockmöller
- Department of Clinical Pharmacology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Collen Masimirembwa
- African Institute of Biomedical Science and Technology (AiBST), Harare, Zimbabwe
| | - Julia C. Stingl
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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Molebatsi K, Musindo O, Ntlantsana V, Wambua GN. Mental Health and Psychosocial Support During COVID-19: A Review of Health Guidelines in Sub-Saharan Africa. Front Psychiatry 2021; 12:571342. [PMID: 34093251 PMCID: PMC8172960 DOI: 10.3389/fpsyt.2021.571342] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/22/2021] [Indexed: 01/02/2023] Open
Abstract
The COVID-19 pandemic brought in its wake an unforeseen mental health crisis. The World Health Organization published a guideline as a way of supporting mental health and psychosocial well-being of different groups during this pandemic. The impact of the pandemic has pushed governments to put measures in place to curb not only the physical health of individuals but their mental health and psychosocial well-being as well. The aim of our paper was to review mental health guidelines of some Sub Saharan African (SSA) countries: (i) to assess their appropriateness for the immediate mental health needs at this time, (ii) to form as a basis for ongoing reflection as the current pandemic evolves. Guidelines were retrieved openly from internet search and some were requested from mental health practitioners in various SSA countries. The authors designed a semi structured questionnaire, as a self-interview guide to gain insight on the experience of COVID-19 from experts in the mental health sector in the various countries. While we used a document analysis approach to analyze the data, we made use of the Mental Health Preparedness and Action Framework to discuss our findings. We received health or mental health guidelines from 10 SSA countries. Cameroon, Kenya, South Africa, Tanzania, and Uganda all had mental health guidelines or mental health component in their health guidelines. Our experts highlight that the mental health needs of the people are of concern during this pandemic but have not been given priority. They go further to suggest that the mental health needs are slightly different during this time and requiring a different approach especially considering the measures taken to curb the spread of disease. We conclude that despite the provision of Mental Health and Psychosocial Support guidelines, gaps still exist making them inadequate to meet the mental health needs of their communities.
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Affiliation(s)
- Keneilwe Molebatsi
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Psychiatry, Nelson Mandela School of Clinical Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Otsetswe Musindo
- Selibe Phikwe Government Hospital, Ministry of Health and Wellness, Selibe Phikwe, Botswana
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Vuyokazi Ntlantsana
- Department of Psychiatry, Nelson Mandela School of Clinical Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Grace Nduku Wambua
- Department of Psychiatry, Nelson Mandela School of Clinical Medicine, University of Kwa-Zulu Natal, Durban, South Africa
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Chidarikire S, Cross M, Skinner I, Cleary M. Ethnographic Insights into the Quality of Life and Experiences of People Living with Schizophrenia in Harare, Zimbabwe. Issues Ment Health Nurs 2021; 42:65-78. [PMID: 32633167 DOI: 10.1080/01612840.2020.1770385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Schizophrenia is a complex and severe mental disorder affecting more than 20 million people worldwide. This study used focused ethnography to explore the everyday lives of 18 people living with schizophrenia in Zimbabwe and its impact on their quality of life (QOL). Data were collected using semi-structured interviews, observational fieldwork, and the short form of the World Health Organization QOL-BREF questionnaire. Those aged 20-40 years experienced poorer QOL than older people. Family dislocation, living with stigma and discrimination, cost of medications and limited and variable access to treatment and support disrupted participants' ability to enjoy life and function socially.
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Affiliation(s)
| | - Merylin Cross
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Isabelle Skinner
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - Michelle Cleary
- School of Nursing, University of Tasmania, Sydney, New South Wales, Australia
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Jack HE, Myers B, Regenauer KS, Magidson JF. Mutual Capacity Building to Reduce the Behavioral Health Treatment Gap Globally. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:497-500. [PMID: 31823100 PMCID: PMC7253395 DOI: 10.1007/s10488-019-00999-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Use of lay health workers for the treatment of common mental disorders is an expanding, yet still underutilized, opportunity for closing the behavioral health treatment gap globally. In this commentary, we describe how "mutual capacity building," an equal exchange of ideas between low and middle-income countries (LMICs) and high-income countries (HICs) to promote shared learning, could promote the development and scale-up of therapies using lay health workers. We propose ways that task sharing models for behavioral health can inform and be supported by bidirectional learning across HICs and LMICs.
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Affiliation(s)
- Helen E. Jack
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow, 7505 South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
| | - Kristen S. Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD 20742 USA
| | - Jessica F. Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD 20742 USA
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Dube-Mawerewere V, Ncube-Sibanda SP. Service Provider Perspectives on Female Forensic Mental Health Services in Zimbabwe: An Interpretative Phenomenological Analysis. JOURNAL OF FORENSIC NURSING 2020; 16:47-54. [PMID: 31834077 DOI: 10.1097/jfn.0000000000000258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Service providers' perspectives on female forensic mental health services have not been explored in Zimbabwe. This study examined how health service providers in forensic mental health in Zimbabwe understand and interpret rehabilitation of female forensic psychiatric patients. METHODS An interpretive phenomenological study was completed. Service provider participants were selected via purposive sampling from two main Special Institutions. Data were collected using audio-recorded semistructured interviews and subjected to interpretive phenomenological analysis. FINDINGS Two master themes evolved from interview data: (a) conflicting legal documents of care and management of female forensic psychiatric patients; and (b) the forensic mental health system's processes, procedures, and resources impacting female forensic psychiatric rehabilitation. DISCUSSION Findings of the study call for the need to balance between public safety interests and fulfilling clinical rehabilitation objectives.
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Semrau M, Alem A, Ayuso-Mateos JL, Chisholm D, Gureje O, Hanlon C, Jordans M, Kigozi F, Lund C, Petersen I, Shidhaye R, Thornicroft G. Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme. BJPsych Open 2019; 5:e73. [PMID: 31530325 PMCID: PMC6700480 DOI: 10.1192/bjo.2018.90] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a large treatment gap for mental, neurological or substance use (MNS) disorders. The 'Emerging mental health systems in low- and middle-income countries (LMICs)' (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems. AIMS To provide a set of proposed recommendations for mental health system strengthening in LMICs. METHOD The Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012-2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening. RESULTS The proposed recommendations align closely with the World Health Organization's key health system strengthening 'building blocks' of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald. CONCLUSIONS These recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders. DECLARATION OF INTEREST None.
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Affiliation(s)
- Maya Semrau
- Research Fellow in Implementation Research, Centre for Global Health Research, Brighton and Sussex Medical School; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Atalay Alem
- Professor, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Jose L. Ayuso-Mateos
- Chairman and Director, Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid; and Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Dan Chisholm
- Programme Manager for Mental Health, Regional Office for Europe, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
| | - Oye Gureje
- Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa
| | - Charlotte Hanlon
- Reader in Global Mental Health, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Adjunct Associate Professor, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Mark Jordans
- Reader, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Fred Kigozi
- Senior Consultant Psychiatrist and Researcher, Butabika National Referral and Teaching Hospital, Uganda
| | - Crick Lund
- Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Professor of Global Mental Health and Development, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Inge Petersen
- Research Professor and Director, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Rahul Shidhaye
- Clinical Psychiatrist, Public Health Foundation of India; and CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands
| | - Graham Thornicroft
- Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Psychiatry, King's College London, UK
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14
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Lovett A, Kwon HR, Kidia K, Machando D, Crooks M, Fricchione G, Thornicroft G, Jack HE. Mental health of people detained within the justice system in Africa: systematic review and meta-analysis. Int J Ment Health Syst 2019; 13:31. [PMID: 31080500 PMCID: PMC6501291 DOI: 10.1186/s13033-019-0273-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/15/2019] [Indexed: 01/17/2023] Open
Abstract
Worldwide, people with mental disorders are detained within the justice system at higher rates than the general population and often suffer human rights abuses. This review sought to understand the state of knowledge on the mental health of people detained in the justice system in Africa, including epidemiology, conditions of detention, and interventions. We included all primary research studies examining mental disorders or mental health policy related to detention within the justice system in Africa. 80 met inclusion criteria. 67% were prevalence studies and meta-analysis of these studies revealed pooled prevalence as follows: substance use 38% (95% CI 26-50%), mood disorders 22% (95% CI 16-28%), and psychotic disorders 33% (95% CI 28-37%). There were only three studies of interventions. Studies examined prisons (46%), forensic hospital settings (37%), youth institutions (13%), or the health system (4%). In 36% of studies, the majority of participants had not been convicted of a crime. Given the high heterogeneity in subpopulations identified in this review, future research should examine context and population-specific interventions for people with mental disorders.
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Affiliation(s)
- Aish Lovett
- Harvard College, 28 Fernald Drive, Cambridge, MA 02138 USA
| | - Hye Rim Kwon
- Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB UK
| | - Khameer Kidia
- Kushinga, 8 Collina Close, Borrowdale, Harare, Zimbabwe
- Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Debra Machando
- Kushinga, 8 Collina Close, Borrowdale, Harare, Zimbabwe
- Department of Psychiatry, University of Zimbabwe, 630 Churchill Avenue, Harare, Zimbabwe
| | - Megan Crooks
- The Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, BT16 1RH UK
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, UK
| | - Helen E. Jack
- Kushinga, 8 Collina Close, Borrowdale, Harare, Zimbabwe
- Centre for Global Mental Health, Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, UK
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195 USA
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15
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Kajawu L, Chiweshe M, Mapara J. Community Perceptions of Indigenous Healers and Mental Disorders in Zimbabwe. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojpsych.2019.93015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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