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Miskeen E. Utilization of Antenatal Care Services Within the Context of COVID-19, Security Challenges, and an Unstable Healthcare System at Primary Health Care Centers. Int J Womens Health 2024; 16:737-747. [PMID: 38686390 PMCID: PMC11057666 DOI: 10.2147/ijwh.s435894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/25/2023] [Indexed: 05/02/2024] Open
Abstract
Background Utilizing antenatal care (ANC) is vital for maternal and neonatal well-being, especially in low-resource settings with healthcare challenges. Identifying factors impacting antenatal care this context, t of current situation in Sudan is crucial for developing strategies to improve maternal care. This study explores ANC utilization amidst COVID-19, security issues, and healthcare instability in primary health care centers in a resource-constrained environment, aiming to enhance maternal care access and quality. Methods This is a mixed-methods study. Quantitative data were collected through a retrospective analysis of ANC attendance records before and during the pandemic. Demographic variables were analyzed for their association with ANC utilization. In-depth interviews were conducted to collect qualitative data from pregnant women and healthcare providers. These interviews focused on capturing the experiences, perceptions, and obstacles associated with antenatal care services during the pandemic and within the healthcare system challenges. Results Preliminary quantitative analysis revealed a significant decline in ANC utilization during the pandemic. Fear of COVID-19 infection, disrupted transportation, and resource constraints have emerged as significant barriers to ANC attendance. The qualitative findings highlighted the impact of security challenges on healthcare access and the adaptation strategies employed, including mobile ANC clinics and telehealth consultations. Conclusion This study illuminates the intricate landscape of ANC utilization in the face of a pandemic, security instability, and healthcare system vulnerability. Policymakers and stakeholders should collaborate to strengthen healthcare systems and ensure the continued provision of essential maternal health services during challenging times.
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Affiliation(s)
- Elhadi Miskeen
- Department of Obstetrics and Gynaecology, College of Medicine, University of Bisha, Bisha, Saudi Arabia
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Pauley A, Thatcher EC, Sarafian JT, Zadey S, Shayo F, Mmbaga BT, Sakita F, Boshe J, Vissoci JRN, Staton CA. Alcohol use among emergency medicine department patients in Tanzania: A comparative analysis of injury versus non-injury patients. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001900. [PMID: 37910469 PMCID: PMC10619788 DOI: 10.1371/journal.pgph.0001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/19/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Alcohol is a leading behavioral risk factor for death and disability worldwide. Tanzania has few trained personnel and resources for treating unhealthy alcohol use. In Emergency Medicine Departments (EMDs), alcohol is a well-known risk factor for injury patients. At Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania, 30% of EMD injury patients (IP) test positive for alcohol upon arrival to the ED. While the IP population is prime for EMD-based interventions, there is limited data on if non-injury patients (NIP) have similar alcohol use behavior and potentially benefit from screening and intervention as well. METHODS This was a secondary analysis of a systematic random sampling of adult (≥18 years old), KiSwahili speaking, KCMC EMD patients surveyed between October 2021 and May 2022. When medically stable and clinically sober, participants provided informed consent. Information on demographics (sex, age, years of education, type of employment, income, marital status, tribe, and religion), injury status, self-reported alcohol use, and Alcohol Use Disorder (AUD) Identification Test (AUDIT) scores were collected. Descriptive statistics were analyzed in RStudio using frequencies and proportions. RESULTS Of the 376 patients enrolled, 59 (15.7%) presented with an injury. The IP and NIP groups did not differ in any demographics except sex, an expected difference as females were intentionally oversampled in the original study design. The mean [SD] AUDIT score (IP: 5.8 [6.6]; NIP: 3.9 [6.1]), drinks per week, and proportion of AUDIT ≥8 was higher for IP (IP:37%; NIP: 21%). However, alcohol preferences, drinking quantity, weekly expenditure on alcohol, perceptions of unhealthy alcohol use, attempts and reasons to quit, and treatment seeking were comparable between IPs and NIPs. CONCLUSION Our data suggests 37% of injury and 20% of non-injury patients screen positive for harmful or hazardous drinking in our setting. An EMD-based alcohol treatment and referral process could be beneficial to reduce this growing behavioral risk factor in non-injury as well as injury populations.
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Affiliation(s)
- Alena Pauley
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Emily C. Thatcher
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Joshua T. Sarafian
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Siddhesh Zadey
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Frida Shayo
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Francis Sakita
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
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Sanga SS, Tarimo EAM, Ambikile JS. Factors influencing career preference in mental health among nursing students and intern nurses in Dar es Salaam, Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002108. [PMID: 37450439 PMCID: PMC10348593 DOI: 10.1371/journal.pgph.0002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/03/2023] [Indexed: 07/18/2023]
Abstract
Worldwide, the prevalence of mental health, neurological, and substance use (MNS) disorders has been on the rise and remains a significant leading cause of disease burden. Sub-Saharan Africa (SSA) shares a fair burden of MNS with depressive disorders being the most prevalent in this region. A huge treatment gap for MNS exists, with lack of appropriate human resources and expertise for service delivery being one of the key barriers. Pre-service and in-service training plays a vital role in developing human resource for mental health. However, low or lack of career interests in mental health has been documented among students. A cross-sectional study was conducted between April and May 2021 to determine factors influencing career preference in mental health among nursing students and intern nurses at Muhimbili University of Health and Allied Sciences (MUHAS) and Muhimbili National Hospital (MNH) respectively in Dar es Salaam, Tanzania. Sixty-eight (68) nursing students at MUHAS who had covered the mental health nursing course and 83 intern nurses who had rotated at the MNH Psychiatry and Mental Health department participated in the study using consecutive sampling. A pre-tested structured self-administered questionnaire was used to collect data, followed by analysis with version 25 of the Statistical Package for the Social Sciences. The Chi-square test and logistic regression were performed to determine factors associated with career preference. One third (33.1%; n = 50) of participants had career preference in mental health nursing. Living with a person with mental illness (adjusted odds ratio [AOR]: 4.350; 95% CI: 1.958, 9.664; p <0.001), awareness of possible career advancement in mental health (AOR: 16.193; 95% CI: 2.022, 129.653; p = 0.009), awareness of possible income generation in mental health career (AOR: 6.783; 95% CI: 2.295, 20.047; p = 0.001), and satisfaction with psychiatric working environment (AOR: 6.753; 95% CI: 2.900, 15.726; p <0.001), were significantly associated with career preference in mental health. Low mental health career preference among university nursing students and intern nurses jeopardizes the future of the mental health nursing profession and may complicate the already existing shortage of human resource for mental health. The higher learning institutions, health facilities, and the Ministry of Health may need to take deliberate actions to ensure that interest to pursue a career in mental health is built among students and interns. Further research is needed to provide more insight into how the psychiatric working environment affects career preference in mental health.
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Affiliation(s)
- Sofia Samson Sanga
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Edith A. M. Tarimo
- Department of Nursing Management, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Joel Seme Ambikile
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Stieglitz LM, Adams LB, Bärnighausen T, Berghöfer A, Kazonda P, Killewo J, Leyna GH, Lohmann J, Rohr JK, Kohler S. Depressive symptoms and their association with age, chronic conditions and health status among middle-aged and elderly people in peri-urban Tanzania. Glob Ment Health (Camb) 2023; 10:e27. [PMID: 37854410 PMCID: PMC10579685 DOI: 10.1017/gmh.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 10/20/2023] Open
Abstract
Background Depression is a global mental health challenge. We assessed the prevalence of depressive symptoms and their association with age, chronic conditions, and health status among middle-aged and elderly people in peri-urban Dar es Salaam, Tanzania. Methods Depressive symptoms were measured in 2,220 adults aged over 40 years from two wards of Dar es Salaam using the ten-item version of the Center of Epidemiologic Studies Depression Scale (CES-D-10) and a cut-off score of 10 or higher. The associations of depressive symptoms with age, 13 common chronic conditions, multimorbidity, self-rated health and any limitation in six activities of daily living were examined in univariable and multivariable logistic regressions. Results The estimated prevalence of depressive symptoms was 30.7% (95% CI 28.5-32.9). In univariable regressions, belonging to age groups 45-49 years (OR 1.35 [95% CI 1.04-1.75]) and over 70 years (OR 2.35 [95% CI 1.66-3.33]), chronic conditions, including ischemic heart disease (OR 3.43 [95% CI 2.64-4.46]), tuberculosis (OR 2.42 [95% CI 1.64-3.57]), signs of cognitive problems (OR 1.90 [95% CI 1.35-2.67]), stroke (OR 1.56 [95% CI 1.05-2.32]) and anemia (OR 1.32 [95% CI 1.01-1.71]) and limitations in activities of daily living (OR 1.35 [95% CI 1.07-1.70]) increased the odds of depressive symptoms. Reporting good or very good health was associated with lower odds of depressive symptoms (OR 0.48 [95% CI 0.35-0.66]). Ischemic heart disease and tuberculosis remained independent predictors of depressive symptoms in multivariable regressions. Conclusion Depressive symptoms affected almost one in three people aged over 40 years. Their prevalence differed across age groups and was moderated by chronic conditions, health status and socioeconomic factors.
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Affiliation(s)
- Laura-Marie Stieglitz
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Leslie B Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Anne Berghöfer
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Germana H Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julia Lohmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia K Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Heuschen C, de Mol W, Mwombeki I, Nyundo A, Scholte W. Views of biomedical practitioners and traditional healers on concerted mental health care provision in Tanzania: A study protocol for a qualitative explorative study. Eur J Integr Med 2023. [DOI: 10.1016/j.eujim.2023.102236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Ambikile JS, Iseselo MK. Challenges to the provision of home care and support for people with severe mental illness: Experiences and perspectives of patients, caregivers, and healthcare providers in Dar es Salaam, Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001518. [PMID: 36963044 PMCID: PMC10021743 DOI: 10.1371/journal.pgph.0001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/02/2023] [Indexed: 06/18/2023]
Abstract
A balance between hospital-based and community-based services is needed to effectively provide mental health services for people with mental illness. As an essential part of community mental health services, home-based care plays an important role in meeting patients' needs, and should, therefore, be appropriately provided. To achieve this, there is a need to understand the challenges faced and take relevant actions to address them. This study aimed to explore challenges to home care and support for people with mental illness in Temeke district, Dar es Salaam. We used a descriptive qualitative study approach to explore challenges to home care and support for people with mental illness among patients, their caregivers, and healthcare providers. The purposeful sampling method was used to recruit participants at Temeke hospital, data was collected using in-depth interviews and focus group discussions, and analysis was performed using a content analysis framework. Four main themes highlighting challenges encountered in the provision of home care and support for individuals with mental illness were revealed. They include poor understanding of mental illness, abandonment of patients' care responsibilities, disputes over preferred treatment, and lack of outreach services for mental health. Participants also provided suggestions to improve home care and support for people with mental illness. Home care for people with mental illness is affected by poor knowledge of the mental illness, social stigma, and lack of outreach visits. There is a need for the provision of health education regarding mental illness, stigma reduction programs, and funding and prioritization for outreach home visits to improve home care and support for people with mental illness. Further research is needed to determine the magnitude of these challenges and factors that can facilitate the provision of support in similar settings.
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Affiliation(s)
- Joel Seme Ambikile
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Masunga K. Iseselo
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Asmare Y, Ali A, Belachew A. Magnitude and associated factors of depression among people with hypertension in Addis Ababa, Ethiopia: a hospital based cross-sectional study. BMC Psychiatry 2022; 22:327. [PMID: 35538447 PMCID: PMC9086661 DOI: 10.1186/s12888-022-03972-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The burden of depression is higher among people with chronic illnesses like hypertension and this comorbid condition leads to poor adherence to treatment and failure of compliance to lifestyle modifications, which in turn, increases risk of cardiovascular complications and mortalities. Low income countries, Ethiopia included, suffer from paucity of information describing the burden of hypertension comorbid with depression, which demands studies to narrow this knowledge gap, such as this one. METHODS Institution based cross-sectional study was conducted in three randomly selected public hospitals in Addis Ababa. Through a systematic random sampling method, a total of 416 known hypertensive patients with follow up in hypertension clinics with in the study period enrolled in the study. Data were collected through structured questionnaire administered by trained interviewer, which latter cleaned, edited and entered in to epi-data version 3.1. Descriptive and bi-variable and binary logistic regression analysis were done using the statistical software, SPSS version 25. Depression was assessed through Hospital Anxiety and Depression Scale (HADs). RESULTS The prevalence of depression among hypertensive patients was found to be 37.8% [95% CI (33.4%-42.5%)]. The binary logistic regression model revealed that, female sex [AOR = 5.37, 95% CI (3.089-9.35)], being married [AOR = 0.25, 95% CI (0.08-0.78)], presence of chronic comorbid illnesses [AOR = 3.03, 95% CI (1.78-5.16)], uncontrolled blood pressure [AOR = 2.80, 95% CI (1.65-4.75)], duration of hypertension of 5-10 years [AOR = 3.17, 95% CI (1.61-6.23)] and more than 10 years [AOR = 5.81, 95% CI (2.90-11.65)], family history of depression [AOR = 4.53, 95% CI (2.37-8.66)] and current alcohol consumption [AOR = 1.77, 95% CI (1.02-3.07)] were significantly associated with depression among hypertensive patients. CONCLUSION High proportion of depression was observed among hypertensive patients, and socio-demographic, clinical and behavioral characteristics were found to significantly influence the likelihood of occurrence. Health care providers should consider mental health status of hypertensive patients, and counsel for these factors.
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Affiliation(s)
- Yonatan Asmare
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Ahmed Ali
- grid.7123.70000 0001 1250 5688School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayele Belachew
- grid.7123.70000 0001 1250 5688School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Anxiety and Depression among Hypertensive Adults in Tertiary Care Hospitals of Nepal. PSYCHIATRY JOURNAL 2022; 2022:1098625. [PMID: 35310013 PMCID: PMC8933064 DOI: 10.1155/2022/1098625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/20/2022] [Accepted: 02/22/2022] [Indexed: 12/28/2022]
Abstract
Introduction Cooccurrence of hypertension and depression/anxiety increases the chance of cardiovascular mortality and morbidity. Therefore, this study is aimed at assessing the prevalence of anxiety and depression and their association with hypertension among hypertensive adults in a tertiary care hospital in Kathmandu, Nepal. Methods A descriptive cross-sectional study was conducted using a semistructured self-administered questionnaire based on Hamilton Anxiety and Hamilton Depression Rating Scale. The data was entered in EPI Data and analyzed using descriptive and inferential statistics in SPSS version 22. P value < 0.05 was considered statistically significant. Results A total of 260 individuals participated in the study, with a mean age of 42.6 years. About 46% of patients did not have any symptoms of depressed mood, and 73 (28.1%) of the participants experienced feelings of depressed mood only on questioning. Similarly, (151) 58.1% did not have feelings of guilt, and 48 (18.5%) participants who had the feeling of guilt had let people down. Among 260 respondents, most participants ((102) 39.2%) had mild symptoms of anxious mood, followed by (86) 33.1% participants with moderate symptoms. Only (4) 1.5% of participants had severe symptoms. Similarly, the majority of participants ((114) 43.8%) had a mild form of mental and emotional strain, followed by (72) 27.7% with moderate mental and emotional strain while (43) 16.5% had no mental and emotional strain. The occupation and marital status of the hypertensive individual was associated with anxiety and depression (P = ≤0.01). Conclusion In conclusion, anxiety and depression were common among patients with hypertension. Anxiety and depression were linked to some of the patients' sociodemographic and clinical features. This study demonstrates that treating hypertension alone is not enough to improve patients' quality of life; mental illness screening among chronically ill individuals is also required.
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Adams DJ, Ndanzi T, Rweyunga AP, George J, Mhando L, Ngocho JS, Mboya IB. Depression and associated factors among geriatric population in Moshi district council, Northern Tanzania. Aging Ment Health 2021; 25:1035-1041. [PMID: 32252543 DOI: 10.1080/13607863.2020.1745147] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression in the elderly population has been identified as a significant public health problem associated with adverse outcomes such as decreased quality of life, cognitive decline, and increased rates of suicide. We aimed to determine the prevalence and factors associated with depressive symptoms among geriatric population in Moshi district council, northern Tanzania. METHODS This community-based cross-sectional study was conducted in Moshi rural district, northern Tanzania, between June and July 2019. A multi-stage sampling technique was used to recruit 304 elders aged 60 or more years. We used geriatric depression scale (GDS-15) to assess depression. Generalized linear model with Poisson family and log link function was used to estimate prevalence ratio (PR) and the corresponding 95% confidence intervals for factors associated with geriatric depressive symptoms. RESULTS A total of 304 participants were enrolled, the median age (interquartile range) 67 (62-75.5 years), and about half (51%) were females. The prevalence of geriatric depressive symptoms was 44.4%. Elders with a self-reported history of cognitive impairment had higher prevalence of depressive symptoms (PR = 1.66, 95%CI 1.16, 2.38) while elders with intermediate (PR = 0.56, 95%CI 0.38, 0.82) and strong social support (PR = 0.27, 95%CI 0.17, 0.44) were less likely to have depressive symptoms compared to those with no available social support. CONCLUSIONS Nearly one in every two elders had geriatric depressive symptoms. Depressive symptoms were associated with self-reported history of cognitive impairment and availability of social support. We recommend community screening, awareness creation, and social support interventions for early identification and management of depressive symptoms in this population.
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Affiliation(s)
- Diana J Adams
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Tunu Ndanzi
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Aminatha P Rweyunga
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Johnston George
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Lisbeth Mhando
- Department of Behavioral and Social Sciences, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - James S Ngocho
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Innocent B Mboya
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,School of Mathematics, Statistics & Computer Science, University of KwaZulu Natal, Pietermaritzburg, South Africa
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The Effect of Tai Chi Chuan on Emotional Health: Potential Mechanisms and Prefrontal Cortex Hypothesis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5549006. [PMID: 34007290 PMCID: PMC8110391 DOI: 10.1155/2021/5549006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/25/2021] [Accepted: 04/22/2021] [Indexed: 12/31/2022]
Abstract
Deep involvement in the negative mood over long periods of time likely results in emotional disturbances/disorders and poor mental health. Tai Chi Chuan (TCC) is regarded as a typical mind-body practice combining aerobic exercise and meditation to prevent and treat negative mood. Although there are an increasing number of TCC studies examining anxiety, depression, and mental stress, the mechanisms underlying these negative emotions are not fully understood. This review study examined TCC studies related to emotional health from both clinical patients and healthy individuals. Next, several potential mechanisms from physiological, psychological, and neurological perspectives were evaluated based on direct and indirect research evidence. We reviewed recent functional magnetic resonance imaging studies, which demonstrated changes in brain anatomy and function, mainly in the prefrontal cortex, following TCC practice. Finally, the effects of TCC on emotion/mental health is depicted with a prefrontal cortex hypothesis that proposed “an immune system of the mind” indicating the role of the prefrontal cortex as a flexible hub in regulating an individual's mental health. The prefrontal cortex is likely a key biomarker among the multiple complex neural correlates to help an individual manage negative emotions/mental health. Future research is needed to examine TCC effects on mental health by examining the relationship between the executive control system (mainly prefrontal cortex) and limbic network (including amygdala, insula, and hippocampal gyrus).
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Muhorakeye O, Biracyaza E. Exploring Barriers to Mental Health Services Utilization at Kabutare District Hospital of Rwanda: Perspectives From Patients. Front Psychol 2021; 12:638377. [PMID: 33828506 PMCID: PMC8019821 DOI: 10.3389/fpsyg.2021.638377] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Barriers to mental health interventions globally remain a health concern; however, these are more prominent in low- and middle-income countries (LMICs). The barriers to accessibility include stigmatization, financial strain, acceptability, poor awareness, and sociocultural and religious influences. Exploring the barriers to the utilization of mental health services might contribute to mitigating them. Hence, this research aims to investigate these barriers to mental health service utilization in depth at the Kabutare District Hospital of the Southern Province of Rwanda. The qualitative approach was adopted with a cross-sectional study design. The participants were patients with mental illnesses seeking mental health services at the hospital. Ten interviews were conducted in the local language, recorded, and transcribed verbatim and translated by the researchers. Thematic analysis was applied to analyze the data collected. The results revealed that the most common barriers are fear of stigmatization, lack of awareness of mental health services, sociocultural scarcity, scarcity of financial support, and lack of geographical accessibility, which limit the patients to utilize mental health services. Furthermore, it was revealed that rural gossip networks and social visibility within the communities compounded the stigma and social exclusion for patients with mental health conditions. Stigmatization should be reduced among the community members for increasing their empathy. Then, the awareness of mental disorders needs to be improved. Further research in Rwanda on the factors associated with low compliance to mental health services with greater focus on the community level is recommended.
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Affiliation(s)
- Oliviette Muhorakeye
- Department of Clinical Psychology, School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Emmanuel Biracyaza
- Department of Community Health, School of Public Health, University of Rwanda, Butare, Rwanda.,Sociotherapy Programme, Prison Fellowship Rwanda (PFR), Member of Prison Fellowship International, Kigali, Rwanda
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Essien B, Asamoah MK. Reviewing the Common Barriers to the Mental Healthcare Delivery in Africa. JOURNAL OF RELIGION AND HEALTH 2020; 59:2531-2555. [PMID: 32691189 DOI: 10.1007/s10943-020-01059-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current paper sought to thematically present common challenges associated with mental healthcare services in Africa. We largely limited our search for literature materials to studies published from 2003 to 2019 in African countries from which the findings showed that there are common challenges confronting mental healthcare services in Africa. The challenges include: inadequate mental healthcare facilities, funding constraints, shortage of professional healthcare workers, inadequate training and development scheme for mental health workers and weak mental healthcare policies. Implications for policy and practice are disclosed and recommendations are stated to trigger actions to remedy the situation. This information is beneficial for researchers, policymakers, mental healthcare providers and community members who are interested in mental healthcare issues. It was concluded that in order for Africa to enjoy successful mental healthcare service, critical and enduring attention must focus on sound and enforceable government policy on mental healthcare service, provision of adequate and regular funding, availability of adequate mental healthcare facilities, provision of training and development facilities for the mental health professionals and collaboration of mental healthcare providers.
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Carbonell Á, Navarro-Pérez JJ, Mestre MV. Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1366-1379. [PMID: 32115797 DOI: 10.1111/hsc.12968] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
The aim of this systematic integrative review is to analyse the challenges and barriers found in mental healthcare systems and the impact they have on the family. Searches were made of the Web of Science, Scopus, Medline and Cochrane databases using terms relating to mental health, family care and healthcare systems. We included and critically evaluated studies published in English between 2015 and 2019 that directly or indirectly analysed public mental health policies and the consequences they have for the family. We analysed our findings following the inductive content analysis approach. A total of 32 articles that met quality indicators were identified. Very closely related structural, cultural, economic and healthcare barriers were found that contribute to the treatment gap in mental health. The family covers the care systems' deficiencies and weaknesses, and this leads to overload and a diminishing quality of life for caregivers. It is acknowledged that people with mental illness and their families should be able to participate in the development of policies and thus contribute to strengthening mental healthcare systems worldwide.
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Affiliation(s)
- Ángela Carbonell
- Inter-University Research of Local Development (IidL) and Social Work and Social Services Department, University of Valencia, Valencia, Spain
| | - José-Javier Navarro-Pérez
- Inter-University Research of Local Development (IidL) and Social Work and Social Services Department, University of Valencia, Valencia, Spain
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Mulaudzi NP, Mashau NS, Akinsola HA, Murwira TS. Working conditions in a mental health institution: An exploratory study of professional nurses in Limpopo province, South Africa. Curationis 2020; 43:e1-e8. [PMID: 32787431 PMCID: PMC7479419 DOI: 10.4102/curationis.v43i1.2081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Professional nurses are responsible for the provision of care, treatment and rehabilitation of all mental healthcare users (MHCUs) in the institutions for mental healthcare. However, professional nurses find themselves in difficult circumstances under which they must provide quality healthcare services to MHCUs. OBJECTIVES The study explored and described the challenges experienced by the professional nurses working in a mental healthcare institution in Limpopo province of South Africa. METHOD A qualitative approach was used to explore and describe the challenges faced by professional nurses working in a mental healthcare institution. The study was conducted from July 2016 to December 2016. Purposive sampling was used to select participants. Data were obtained through individual in-depth interviews with professional nurses between the ages of 26 and 50 years. Data collection continued until data saturation, which occurred after interviewing 18 participants. Tech's open coding method was used to analyse data in this study. RESULTS Four themes emerged from data analysis, namely: inadequate safety measures, inadequate resources, impact of high workload and shortage of staff. The themes were further sub-divided into sub-themes. CONCLUSION The study revealed several challenges that professional nurses face in mental healthcare institutions which might be a barrier to the provision of quality healthcare. Conducive working environments should be established to enable professional health nurses to provide quality nursing care, thereby promoting the health of MHCUs.
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Affiliation(s)
- Ndivhuwo P Mulaudzi
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou.
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Promoting Recovery in Mental Illness: The Perspectives of Patients, Caregivers, and Community Members in Dar es Salaam, Tanzania. PSYCHIATRY JOURNAL 2020; 2020:3607414. [PMID: 32566637 PMCID: PMC7298341 DOI: 10.1155/2020/3607414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
Background Promoting mental health and care in the community setting leads to the recovery of patients with mental illness. Although recovery in mental health is a complex phenomenon, caregivers and community members have important roles to play in the recovery process for patients with mental illness. Little is documented on how recovery is promoted in the community setting. This study explored the experience of patients, caregivers, and community members on how recovery can be realized in a patient with severe mental illness in Dar es Salaam. Methods We conducted four focus group discussions (FGDs): two with caregivers and the other two with community members. Also, six in-depth interviews were held with patients with mental illness. Participants were purposively selected based on the type of information needed. Both FGD and in-depth interviews were digitally recorded and transcribed. Qualitative content analysis was used to analyze data. Findings. Four themes emerged from this study, which include promoting patients' participation in household activities, improving patients' support system, promoting patients' self-care management, and providing safety and protection among patients with mental illness. However, financial, psychological, and establishing care and support centers and professional supports emerged as subthemes from patients' support system. Conclusion Caregivers and community members are significant stakeholders for promoting recovery for people with mental illness. The current study reveals that patients' involvement in home activities, promoting self-care management, improving patients' support systems, and providing safety and protection are important factors that promote recovery for people with mental illness. Advocating mental health awareness for caregivers and community members will bridge the gap to enhance the recovery for people with mental illness. Further research is needed in this area to explore the health care providers' perspectives on the recovery process of mental illness in the hospital setting.
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Mboya IB, John B, Kibopile ES, Mhando L, George J, Ngocho JS. Factors associated with mental distress among undergraduate students in northern Tanzania. BMC Psychiatry 2020; 20:28. [PMID: 31996200 PMCID: PMC6988278 DOI: 10.1186/s12888-020-2448-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/21/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mental distress is a major public health problem which includes anxiety, depression and somatic symptoms such as sleeping problems, fatigue and headache. University students are consistently reported to have higher levels of mental distress compared to the general population. Although university students with mental distress have significantly impaired cognitive functioning, learning disabilities and poor academic performance, the burden of this problem in Tanzania is unknown. This study aimed to determine prevalence and factors associated with mental distress among undergraduate students in northern Tanzania. METHODS A cross-sectional study was conducted among undergraduate students at Kilimanjaro Christian Medical University College from April-July 2018. Simple random sampling technique using probability proportional to size was used to sample students from their respective classes. Mental distress was screened using the self-reporting questionnaire (SRQ-20). Data was analyzed using Stata version 15.1. Frequencies and percentages were used to summarize categorical variables while mean and standard deviation for numeric variables. Multivariable logistic regression was used to determine factors associated with mental distress adjusted for potential confounders. RESULTS A total of 402 undergraduate students participated in this study, 14% screened positive for mental distress. Residing off-campus (OR = 0.44, 95%CI 0.20-0.96) and perceived availability of social support (OR = 0.22, 95%CI 0.11-0.45) reduced the odds of mental distress while students with family history of mental distress (OR = 2.60, 95%CI 1.04-6.57) and those with decreased grades than anticipated (OR = 3.61, 95%CI 1.91-6.83) had higher likelihood of mental distress. CONCLUSION One in every ten students screened was positive for mental distress. Those who reported a family history of mental illness and lower grades than anticipated had higher response of mental distress. To relieve students from stress and frustrations related to studies and their lives in general, this study recommends awareness creation, counselling to help those with mental health issues, establishment of student drop-in centers for such services and promotion of social and recreational activities at the college.
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Affiliation(s)
- Innocent B. Mboya
- Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College (KCMUCo), P. O. Box 2240, Moshi, Tanzania
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), P. O. Box 2240, Moshi, Tanzania
- Institute of Public Health, Department of Behavioral and Social Sciences, Kilimanjaro Christian Medical University College (KCMUCo), P. O. Box 2240, Moshi, Tanzania
- School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville, 3209 South Africa
| | - Beatrice John
- Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College (KCMUCo), P. O. Box 2240, Moshi, Tanzania
| | - Eneck S. Kibopile
- Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College (KCMUCo), P. O. Box 2240, Moshi, Tanzania
| | - Lisbeth Mhando
- Institute of Public Health, Department of Behavioral and Social Sciences, Kilimanjaro Christian Medical University College (KCMUCo), P. O. Box 2240, Moshi, Tanzania
| | - Johnston George
- Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College (KCMUCo), P. O. Box 2240, Moshi, Tanzania
| | - James S. Ngocho
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), P. O. Box 2240, Moshi, Tanzania
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Anxiety and Depression among Hypertensive Outpatients in Afghanistan: A Cross-Sectional Study in Andkhoy City. Int J Hypertens 2018; 2018:8560835. [PMID: 30155287 PMCID: PMC6093076 DOI: 10.1155/2018/8560835] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/07/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022] Open
Abstract
There is a relationship between mental and physical health. Depression and anxiety are linked with the development of several chronic diseases. The purpose of the present study was to determine the prevalence and factors associated with anxiety and depression among adult hypertensive outpatients in Afghanistan. Methods. Two hundred thirty-four consecutive hypertensive patients from December 2015 to August 2016 were recruited to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, which has scores for classifying the participants having anxiety and depression symptoms. Results. Of the total 234 patients, 81 (34.6%) were males and 153 (65.4%) were females. The mean age was 54.6 ± 12.7 for the hypertensive patients with anxiety and 63.8 ± 15.0 for the hypertensive patients with depression while this figure was 49.5 ± 10.2 for the adult participants in general population in Kabul city (Saeed, 2013). The prevalence of anxiety and depression (42.3% vs. 58.1%) among hypertensive persons is compared with the same mental disorders among Afghan refugees (39.3% vs. 22.1%) in Dalakee Refugee Camp (in Iran) (Hosseini Divkolaye and Burkle, 2017). Of the total participants, 99 had anxiety (42.3%), 136 had depression (58.1%), and 66 had (28.2%) comorbid anxiety-depression. Multivariate analysis was used. For anxiety age, female gender, smoking, diabetes mellitus, and 2 or more chronic diseases had a significant association. For depression, age and diabetes mellitus had a significant association, and for comorbid anxiety, depression, age, diabetes mellitus, and 2 or more chronic diseases had a significant association. Conclusion. This study shows that anxiety and depression are highly prevalent among hypertensive patients in an outpatient clinic in Afghanistan. There was an association between some sociodemographic and clinical characteristics and anxiety and depression. More studies are needed on a national level to inform the development of strategies for the prevention and control of psychological distress among patients with chronic diseases in Afghanistan.
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