Physical health policies and metabolic screening in mental health care systems of sub-Saharan African countries: a systematic review

Mental distress and associated factors among undergraduate students: evidence from a cross-sectional study at the University of Dodoma, Tanzania

Mental distress is a common health problem facing university students worldwide. It manifests with varying levels of depression, anxiety, and somatic symptoms such as headache, backache, sleeping problems, and fatigue. University students are a high-risk group for mental distress than the general population. This study aimed to assess knowledge, the prevalence of mental distress, and its associated factors among undergraduate students. A cross-sectional study was conducted among undergraduate students at the University of Dodoma in Tanzania. Data were collected using pre-tested and self-administered questionnaires. Bivariate and multivariable logistic regression models were used to identify factors associated with mental distress. A total of 224 undergraduate students gave a complete response, of which the majority were aware of the common symptoms of mental distress. Self-reported mental distress experience was reported among 116/224 (51.8%) students. Multivariable logistic analysis showed that only alcohol consumption (aPR = 1.61, 95% CI 1.22-2.11, p = 0.001) was independently associated with mental distress among students. The findings of this study revealed that undergraduate students had adequate knowledge of the symptoms of mental distress. Our results show that the prevalence of self-reported mental distress was moderately high among undergraduate students. Furthermore, the study indicates a significant association between alcohol consumption and self-reported mental distress among these students. These results suggest that interventions aimed at reducing alcohol consumption may be beneficial in mitigating mental health issues among undergraduate students in Tanzania.

Evaluation and Treatment of Obesity and Its Comorbidities: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity

The goal of the 8th edition of the Clinical Practice Guidelines for Obesity is to help primary care physician provide safe, effective care to patients with obesity by offering evidence-based recommendations to improve the quality of treatment. The Committee for Clinical Practice Guidelines comprised individuals with multidisciplinary expertise in obesity management. A steering board of seven experts oversaw the entire project. Recommendations were developed as the answers to key questions formulated in patient/problem, intervention, comparison, outcomes (PICO) format. Guidelines underwent multi-level review and cross-checking and received endorsement from relevant scientific societies. This edition of the guidelines includes criteria for diagnosing obesity, abdominal obesity, and metabolic syndrome; evaluation of obesity and its complications; weight loss goals; and treatment options such as diet, exercise, behavioral therapy, pharmacotherapy, and bariatric and metabolic surgery for Korean people with obesity. Compared to the previous edition of the guidelines, the current edition includes five new topics to keep up with the constantly evolving field of obesity: diagnosis of obesity, obesity in women, obesity in patients with mental illness, weight maintenance after weight loss, and the use of information and communication technology-based interventions for obesity treatment. This edition of the guidelines features has improved organization, more clearly linking key questions in PICO format to recommendations and key references. We are confident that these new Clinical Practice Guidelines for Obesity will be a valuable resource for all healthcare professionals as they describe the most current and evidence-based treatment options for obesity in a well-organized format.

Physical activity and physical fitness in community patients with alcohol use disorders versus matched healthy controls: cross-sectional data from Uganda

In order to develop adequate public health interventions, there is a need to explore whether people with an alcohol use disorder (AUD) not requiring inpatient treatment do have compromised physical health and are consequently a population at risk. We cross-sectionally compared physical fitness and physical activity levels in community patients with an AUD with healthy matched controls in Uganda. Fifty community patients (42 men, median age=32.0 years, interquartile range=10.7 years) and 50 age-, gender- and body mass index-matched controls performed a 6-minute walk test (6MWT), and completed the Simple Physical Activity Questionnaire (SIMPAQ). Differences between groups were assessed with a t-test or Mann Whitney U test when appropriate. Community patients with AUD have significantly lower 6MWT [median=480.0 (interquartile range=109) versus 802.5 (121.2) m, P<0.001], SIMPAQ walking [0 (30.0) min/day versus 35.0 (17.4) min/day, P<0.001], SIMPAQ exercise [0 (1.5) min/day versus 0 (2.5) min/day, P<0.001], and SIMPAQ incidental physical activity [30.0 (50.0) min/day versus 300.0 (315.0) min/day, P<0.001]. A reduced physical fitness and physical inactivity should be considered and assessed in early interventions targeting community patients with AUDs. If left untreated, both might also emerge as important modifiable risk factors for somatic co-morbidity in this population-at-risk.

The Health Improvement Profile for people with severe mental illness: Feasibility of a secondary analysis to make international comparisons

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates. No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: It appears feasible to use the HIP to profile and compare physical health-related risks in people with SMI across different international settings. The HIP tool identified significant differences in areas of risk across the four countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The HIP could be used to identify unique clusters of health promotion needs in different countries. Use of HIP health checks may support implementation of individualized interventions. ABSTRACT: Introduction To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi-national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources.

Physical activity, physical fitness and quality of life in outpatients with major depressive disorder versus matched healthy controls: Data from a low-income country

BACKGROUND

There is an urgent need to increase awareness that people with major depressive disorder (MDD) in low-income countries do also have a compromised physical health. We compared physical fitness and physical activity levels in outpatients with MDD with healthy matched controls in Uganda and explored whether the variance in quality of life (QoL) can be explained by the variance in physical fitness and physical activity levels.

METHODS

Fifty outpatients (35 men, median age = 29 years, interquartile range = 14 years) and 50 age, gender and body mass index matched controls performed a 6-minute walk test (6MWT), the World Health Organization Quality of Life short-version (WHOQoLBref), Simple Physical Activity Questionnaire (SIMPAQ), and Brief Symptoms Inventory-18 (BSI-18). Differences between groups were assessed with a Mann Whitney U test and backward stepwise multivariable regression analysis was performed to evaluate independent variables explaining the variance in WHOQoLBref scores.

RESULTS

Outpatients with MDD have significantly lower 6MWT, SIMPAQ walking, SIMPAQ incidental physical activity, physical and psychological WHOQoLBref scores, and significantly higher BSI-18 depression and anxiety scores. BSI-18 depression was the only significant independent predictor of the WHQoLBref physical score explaining 39.7% of the variance, while the 6MWT score remained the only significant independent predictor of the WHQoLBref psychological score explaining 31.7% of the variance.

CONCLUSIONS

Our data demonstrate that outpatients with MDD in a low-income country are significantly less physically fit and less physically active than the general population. Lower physical fitness levels are also associated with lower QoL levels.

Adherence to clinical guidelines in integration of mental health services into primary health care in Mbarara, southwestern Uganda: a medical records review

Background

The Ugandan Ministry of Health decentralized mental healthcare to the district level; developed the Uganda Clinical Guidelines (UCG); and trained primary health care (PHC) providers in identification, management, and referral of individuals with common mental disorders. This was intended to promote integration of mental health services into PHC in the country. ‘Common mental disorders’ here refers to mental, neurological and substance use conditions as indicated in the UCG. However, the extent of integration of mental health into general healthcare remains unknown. This study aimed to establish the level of adherence of PHC providers to the UCG in the identification and management of mental disorders.

Methods

This was a prospective medical record review of patient information collected in November and December 2018, and March and April 2019 at two health centers (III and IV) in southwestern Uganda. Data (health facility level; sex and age of the patient; and mental disorder diagnosis, management) was collected using a checklist. Continuous data was analyzed using means and standard deviation while categorical data was analyzed using Chi-square. Multivariable logistic regression analysis was performed to establish predictors of PHC provider adherence to the clinical guidelines on integration of mental health services into PHC. The analysis was conducted at a 95% level of significance.

Results

Of the 6093 records of patients at the study health facilities during the study period, 146 (2.4%) had a mental or neurological disorder diagnosis. The commonly diagnosed disorders were epilepsy 91 (1.5%) and bipolar 25 (0.4%). The most prescribed medications were carbamazepine 65 (44.5%), and phenobarbital 26 (17.8%). The medicines inappropriately prescribed at health center III for a mental diagnosis included chlorpromazine for epilepsy 3 (2.1%) and haloperidol for epilepsy 1 (0.7%). Female gender (aOR: 0.52, 95% CI 0.39–0.69) and age 61+ years (aOR: 3.02, 95% CI 1.40–6.49) were predictors of a mental disorder entry into the HMIS register.

Conclusion

There was a noticeable change of practice by PHC providers in integrating mental health services in routine care as reflected by the rise in the number of mental disorders diagnosed and treated and entered into the modified paper based HMIS registers.

Test-retest reliability and correlates of the Simple Physical Activity Questionnaire in Ugandan out-patients with psychosis

BACKGROUND

In order to facilitate people with psychosis to increase their physical activity (PA) levels, a reliable measurement of these levels is of relevance.

OBJECTIVES

The primary aim of current study was to explore the test-retest of the Simple Physical Activity Questionnaire (SIMPAQ) in Ugandan outpatients with psychosis. A second aim was to explore correlates of the SIMPAQ, including demographic variables and antipsychotic medication dose.

METHODS

Thirty-four women (33.9±8.0 years) and 21 men completed the SIMPAQ twice in a day. The test-retest reliability was assessed using Spearman Rho correlations coefficients. Differences in subgroups were analysed with Mann Whitney U tests.

RESULTS

The SIMPAQ showed a good test-retest reliability with correlates ranging from 0.78 (P<0.001) for structured exercise to 0.96 (P<0.001) for walking. Women, non-smokers and those without HIV/AIDS showed higher incidental PA than men, smokers and those with HIV/AIDS.

CONCLUSION

The SIMPAQ is a reliable tool to assess PA and sedentary levels in Ugandan outpatients with psychosis. Men, smokers and those with HIV/AIDS appear to be at risk for lower incidental PA.

Barriers, attitudes, confidence, and knowledge of nurses regarding metabolic health screening and intervention in people with mental illness: a pilot study from Uganda

Background

People with mental illness are at an increased risk for developing cardio-metabolic disorders. Routine screening following pharmacotherapy is however unacceptably low in sub-Saharan African countries with less than 1% adequately screened. It is unknown whether this is due to a lack of adequate competences.

Objectives

The aim of this pilot study was to assess the barriers, attitudes, confidence, and knowledge of nurses regarding metabolic health, prevention and treatment in Uganda.

Methods

Twenty-eight nurses (39% female, 30.9±6.9 years) completed the Metabolic — Barriers, Confidence, Attitudes and Knowledge Questionnaire and the physical activity prescription rate item of the Exercise in Mental Illness Questionnaire.

Results

More than 75% had a positive attitude towards metabolic screening and intervention and more than 50% were confident in providing smoking cessation advice, and physical activity and nutritional counseling. However, 57% stated that their heavy workload prevented them from doing health screening and promotion activities. There was a negative correlation (ρ=-0.54, P=0.003) between the frequency of physical activity prescription and the perception of the inability of patients to change.

Conclusion

The present findings suggest that nurses are generally supportive of metabolic health screening and intervention but their high workload prevents them from implementing metabolic health interventions.

Integrating a brief mental health intervention into primary care services for patients with HIV and diabetes in South Africa: study protocol for a trial-based economic evaluation

INTRODUCTION

Depression and alcohol use disorders are international public health priorities for which there is a substantial treatment gap. Brief mental health interventions delivered by lay health workers in primary care services may reduce this gap. There is limited economic evidence assessing the cost-effectiveness of such interventions in low-income and middle-income countries. This paper describes the proposed economic evaluation of a health systems intervention testing the effectiveness, cost-effectiveness and cost-utility of two task-sharing approaches to integrating services for common mental disorders with HIV and diabetes primary care services.

METHODS AND ANALYSIS

This evaluation will be conducted as part of a three-armed cluster randomised controlled trial of clinical effectiveness. Trial clinical outcome measures will include primary outcomes for risk of depression and alcohol use, and secondary outcomes for risk of chronic disease (HIV and diabetes) treatment failure. The cost-effectiveness analysis will evaluate cost per unit change in Alcohol Use Disorder Identification Test and Centre for Epidemiological Studies scale on Depression scores as well as cost per unit change in HIV RNA viral load and haemoglobin A1c, producing results of provider and patient cost per patient year for each study arm and chronic disease. The cost utility analyses will provide results of cost per quality-adjusted life year gained. Additional analyses relevant for implementation including budget impact analyses will be conducted to inform the development of a business case for scaling up the country's investment in mental health services.

ETHICS AND DISSEMINATION

The Western Cape Department of Health (WCDoH) (WC2016_RP6_9), the South African Medical Research Council (EC 004-2/2015), the University of Cape Town (089/2015) and Oxford University (OxTREC 2-17) provided ethical approval for this study. Results dissemination will include policy briefs, social media, peer-reviewed papers, a policy dialogue workshop and press briefings.

TRIAL REGISTRATION NUMBER

PACTR201610001825405.

Sedentary Behavior and Quality of Life in People with Psychotic Disorders from a Low Income Country: A Study from Uganda

The current study examined the impact of sedentary behaviour (SB) on quality of life (QoL) in people with psychotic disorders. Thirty-six Ugandan women (mean age = 33.9 ± 8.0 years) and 23 men (37.4 ± 11.8 years) with a DSM 5 diagnosis of psychosis completed the World Health Organization Quality of Life-Brief version and Simple Physical Activity Questionnaire (SIMPAQ). Medication use, physical co-morbidities, weight, height, blood pressure and smoking habits were recorded. Multiple regression analyses were undertaken. Variability in SIMPAQ sedentary and walking scores explained 56% of the variability in psychological QoL, while variability in SIMPAQ walking explained 46% of the variability in physical QoL. Health care professionals should not only consider increasing physical activity but also reducing SB to improve QoL in their patients.

Adherence to physical activity recommendations and physical and mental health risk in people with severe mental illness in Uganda

This study investigated cardio-metabolic risk factors among patients with severe mental illness who do or do not meet the recommendations of 150min per week of physical activity. A secondary aim was to assess whether those that do meet the recommendations report lower levels of mental health symptoms. 107 (60♀) Ugandan in- and outpatients (mean age=34.4 ± 9.7 years) with severe mental illness (depression=7, bipolar disorder=55, schizophrenia=45) completed the Physical Activity Vital Sign (PAVS) method and Brief Symptoms Inventory -18. Participants were also screened for abdominal obesity (waist circumference>90cm), overweight (body mass index≥25) and hypertension (systolic pressure≥140mmHg and/or diastolic pressure≥90mmHg).48.6% (n = 52) of patients met the physical activity recommendations as assessed by the PAVS method. 41.1% (n = 44) were overweight, 40.2% (n = 43) had abdominal obesity and 23.4% (n = 25) had hypertension. Those who did not meet the physical activity recommendations were significantly older, had a higher BSI-18 somatisation score, and had a higher risk of overweight [relative risk (RR) = 2.88, 95% confidence interval (CI) = 1.59-4.99], abdominal obesity (RR = 1.82, 95%CI = 1.13-2.93), and hypertension (RR = 2.16, 95%CI = 0.99-4.73). The PAVS is a feasible method of assessing physical activity among patients with severe mental illness in a low resource setting. The PAVS may have clinical utility for physical and mental health risk stratification.