1
|
Laurenzi CA, du Toit S, Mawoyo T, Luitel NP, Jordans MJ, Pradhan I, van der Westhuizen C, Melendez-Torres G, Hawkins J, Moore G, Evans R, Lund C, Ross DA, Lai J, Servili C, Tomlinson M, Skeen S. Development of a school-based programme for mental health promotion and prevention among adolescents in Nepal and South Africa. SSM - MENTAL HEALTH 2024; 5:100289. [PMID: 38910844 PMCID: PMC11188151 DOI: 10.1016/j.ssmmh.2023.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 06/25/2024] Open
Abstract
Introduction Adolescence is a critical time for mental health promotion and prevention and establishing healthy behaviours. Implementing universal, school-based psychosocial interventions can improve short- and long-term health trajectories for adolescents. While these interventions may offer important opportunities for fostering skills and relationships, few school-based interventions have been developed for and tested in low- and middle-income countries (LMICs) where adolescent mental health needs may be significant and under-served. This manuscript details the development of a multi-component, universal school-based intervention, Health Action in ScHools for a Thriving Adolescent Generation (HASHTAG), for adolescents aged 12-15 years in Nepal and South Africa. Methods and results We describe HASHTAG's development over four phases, combining methods and results as each phase was iteratively conducted between 2018 and 2021. Phase 1 included a systematic review and components analysis, building from WHO guidelines for adolescent mental health. Seven components were strongly supported by the evidence: emotional regulation, stress management, mindfulness, problem-solving, interpersonal skills, assertiveness training, and alcohol and drug education. Phase 2 encompassed site selection, theory of change development, and formative research engagements; research teams in each site engaged adolescents and key adult stakeholders to identify priorities for intervention. Stakeholders voiced preferences for external facilitators and key content and delivery for intervention sessions. These findings informed Phase 3, a draft manual of HASHTAG, including a whole-school component, called Thriving Environment in Schools, and a classroom-based, six-session component, Thrive Together. In Phase 4, participants engaged in consultative workshops to review and contextualise content by country, preparing HASHTAG for implementation in a feasibility trial. Minor adaptations were made in Nepal, including using school nurses and adjusting take-home materials; both country's workshops identified practical considerations for implementing activities. Conclusions HASHTAG was designed around core evidence-based components to increase translatability across LMICs, while enabling country-specific tailoring to enhance feasibility. Future research will test whether this multi-component, whole-school approach can improve adolescent mental health.
Collapse
Affiliation(s)
- Christina A. Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Stefani du Toit
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Tatenda Mawoyo
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Nagendra P. Luitel
- Research Department, Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | - Mark J.D. Jordans
- Research Department, Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Indira Pradhan
- Research Department, Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | - Claire van der Westhuizen
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
| | - G.J. Melendez-Torres
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- University of Exeter, Exeter, United Kingdom
| | - Jemma Hawkins
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), Cardiff University, Cardiff, Wales, United Kingdom
| | - Graham Moore
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), Cardiff University, Cardiff, Wales, United Kingdom
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, Wales, United Kingdom
| | - Rhiannon Evans
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), Cardiff University, Cardiff, Wales, United Kingdom
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - David A. Ross
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, Northern Ireland, United Kingdom
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
2
|
Wong AKH, Paton M, Dalbahadur P, Williams AM, Semakula F, Sweeney C, Smith M, Parsons IT. Occupational health screening during Gurkha Central Selection: a retrospective cohort study. BMJ Mil Health 2024; 170:212-215. [PMID: 38777366 DOI: 10.1136/military-2022-002158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The selection process to the British Army's Brigade of Gurkhas is rigorous, demanding and competitive. The ethos of recruitment to the Gurkhas is grounded in an overarching tenant: that selection is free, fair and transparent. The aim of this study was to retrospectively review reasons for potential recruits (PRs) to be deemed medically unsuitable or deferred suitability on medical grounds for selection to the Brigade of Gurkhas. METHODS A retrospective review was conducted by extracted data from published post-exercise reports for the past four years to ascertain numbers of PRs deemed medically fit, medically unsuitable or deferred suitability on medical grounds. The International Classification of Disease version 11 (ICD-11) codes were retrospectively assigned to code medical reasons for non-progression. Rates of medical non-progression were compared by year. RESULTS A total of 3154 PRs were analysed between 2018 and 2021. There was no significant difference between PRs deemed medically fit and those deemed medically suitable or deferred on medical grounds over the study period (p=0.351). There was a significant difference in the ratio of PRs deferred on medical grounds and those deemed medically unsuitable over the study period (p<0.05). CONCLUSION Selection to the Gurkhas is extremely competitive. These data demonstrate that, overall, reasons for medical deferral or unsuitability have remained constant despite the impact of a global pandemic. These data reinforce the central tenant of Gurkha selection; that it continues to be free, fair, and transparent.
Collapse
Affiliation(s)
| | - M Paton
- Medical Regiment, Brecon, UK
| | | | | | - F Semakula
- Spines and Upper Quadrant Department, Defence Medical Rehabilitations Centre, Loughborough, UK
| | | | - M Smith
- Defence Primary Healthcare Pirbright, Pirbright, UK
| | - I T Parsons
- Leeds Beckett University, Leeds, UK
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| |
Collapse
|
3
|
Pacini A, Shrestha P. Editorial Perspective: Adapting western psychological interventions for children and adolescents in LMICs: lessons from Nepal. J Child Psychol Psychiatry 2024; 65:116-119. [PMID: 37606149 DOI: 10.1111/jcpp.13885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/23/2023]
Abstract
Nepal is a low-middle income country which is considered to be a collectivist culture and has a significant mental health treatment gap for young people. The dominant approach in the global mental health literature has been to import western treatments with varying degrees of cultural adaptation. We argue that this approach is at best cost-ineffective, and at worst harmful, particularly where young people receive interventions outside of their community. The existing literature suggests that the type of intervention delivered, is of less importance than the situating of it within a young person's community, and that leveraging existing cultural resources for resilience within a community, may ultimately be of more benefit than the translating and delivering western ones.
Collapse
Affiliation(s)
- Adele Pacini
- Division of Psychiatry, University College London, London, UK
| | - Prithvi Shrestha
- School of Languages and Applied Linguistics, The Open University, Milton Keynes, UK
| |
Collapse
|
4
|
Stoll V, Edwin N, Dahal K, Barnes JA, Pfautsch M, Maharjan L, Blavo C. Health Issues Among Nepalese Youth: A Literature Review. Cureus 2023; 15:e45108. [PMID: 37842493 PMCID: PMC10569343 DOI: 10.7759/cureus.45108] [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: 07/30/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Nepal is one of the world's least-developed countries. Nepalese children are often vulnerable to a lack of resources which leads to suboptimal levels of health in turn. This review article aims to identify health issues and inequities faced by school-aged children greater than five years old in Nepal. A comprehensive search of the literature was conducted in PubMed and Global Health databases to gather relevant studies. Inclusion and exclusion criteria were applied to select appropriate articles, and 35 full-length articles were reviewed in-depth. The literature supports the association between inadequate resource distribution among Nepalese children and poorer health outcomes compared to youth in developed countries. The key health issues of Nepalese youth identified in the literature consist of diarrheal illness, stunted growth, dental caries, visual impairment, poor mental health, and low health literacy. This review article aims to identify key health issues affecting Nepalese youth as well as propose interventions that can lead to an enhanced quality of life in this population.
Collapse
Affiliation(s)
- Veenah Stoll
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Naomi Edwin
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Kripa Dahal
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - John A Barnes
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Miranda Pfautsch
- Department of Global Health, International Health Initiatives, Inc., Clearwater, USA
| | - Lahana Maharjan
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, NPL
| | - Cyril Blavo
- Department of Public Health, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| |
Collapse
|
5
|
Adhikari S, Ma J, Shakya S, Brøndbo PH, Handegård BH, Javo AC. Self-reported emotional and behavioral problems among school-going adolescents in Nepal-A cross-sectional study. PLoS One 2023; 18:e0287305. [PMID: 37352299 PMCID: PMC10289424 DOI: 10.1371/journal.pone.0287305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/03/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Studies on self-reported emotional and behavioral problems (EBPs) among adolescents are still sparse in many low- and middle-income countries. In Nepal, no such studies have been performed on a larger scale, and little is known about self-reported EBPs in the adolescent population. METHODS This cross-sectional, school-based study on EBPs included 1904 adolescents aged 11-18 years, enrolled in government and private schools located in 16 districts in Nepal. The Nepali version of the Youth Self Report form was used to assess self-reported EBPs, and the Teacher Report Form was used to assess academic performance. Analysis of variance (ANOVA) was used for gender comparisons on adolescents' EBPs and on academic competence. Multiple regression analysis was done to explore correlates of self-reported EBPs. RESULTS The overall prevalence of self-reported EBPs was 14.2%; 15.6% in boys and 12.9% in girls. The mean Total Problems score was 39.27 (standard deviation = 24.16); no gender differences were observed. Boys scored higher on Externalizing Problems and girls scored higher on Internalizing Problems. The effect sizes for gender comparisons were small with Hedges' g ranging from -0.29 to 0.28. Physical illness and negative/traumatic life events were positively correlated with self-reported EBPs, whereas academic performance was negatively correlated. However, the effect sizes were small (η2 < 0.02). CONCLUSION This study helps to narrow the knowledge gap on the prevalence, magnitude, and types of self-reported EBPs in Nepali adolescents. It demonstrated an association between self-reported EBPs and academic performance and linked self-reported EBPs to other factors such as negative/traumatic life events and physical illness. The findings might assist health authorities in the planning of mental health services and may also provide valuable background information to clinicians dealing with adolescent mental health problems.
Collapse
Affiliation(s)
- Sirjana Adhikari
- Department of Psychology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
- Child & Adolescent Psychiatry Unit, Kanti Children’s Hospital, Kathmandu, Nepal
| | - Jasmine Ma
- Child & Adolescent Psychiatry Unit, Kanti Children’s Hospital, Kathmandu, Nepal
| | - Suraj Shakya
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Per Håkan Brøndbo
- Department of Psychology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Youth Mental Health and Child Welfare—North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Cecilie Javo
- Sami National Competence Center for Mental Health (SANKS), Sami Klinihkka, Finnmark Hospital Trust, Karasjok, Norway
| |
Collapse
|
6
|
Dhungel S, Mahat B, Limbu P, Thapa S, Awasthi JR, Thapaliya S, Jha MK, Kunwar AJ. Advantage of neuroeducation in managing mass psychogenic illness among rural school children in Nepal. IBRO Neurosci Rep 2023; 14:435-440. [PMID: 37388487 PMCID: PMC10300494 DOI: 10.1016/j.ibneur.2023.05.003] [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: 07/21/2022] [Accepted: 05/07/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Mass psychogenic illness (MPI), also known as mass hysteria (MH), is a mental health disorder that frequently occurs in Nepal. It primarily affects female students in government high schools and occurs during the course of the school day over a few days without corresponding organic causes. Purpose of the study This study set out to evaluate and give neuroeducation with the goal of preventing and/or managing MPI after documenting the existing state of knowledge regarding MPI. Materials and methods A total of 234 female students in grades 6 through 10 who attended MH-affected schools (SMH, n = 119) and schools without a mass hysteria history (SNOMH, n = 114) participated in this mass hysteria awareness study. Participants received written pre- and posttests formatted as questionnaires before and after receiving neuroeducation by watching a drama, viewing a human brain-spinal cord model demonstration, and attending an instructive lecture on the human neurological system, stress, and mass hysteria. Results Our neuroeducation awareness study on mass hysteria was found to be effective among all of the participants from both SMH and SNOMH. The results indicated that the aforementioned neuroeducation tools are more effective in improving knowledge about mental stress differently in different grades of SMH and SNOMH students. The basic understanding of the human neurological system was not improved by the neuroeducation tool, according to our findings. Conclusion Our study suggests that using day-structured neuroeducational tools might be an efficient way to treat mass psychogenic illness in Nepal.
Collapse
Affiliation(s)
- Sunil Dhungel
- College of Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Bhandarkhal, Kathmandu, Nepal
- Neuroscience Society of Nepal, Gwarko, Lalitpur, Nepal
| | - Barun Mahat
- College of Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Bhandarkhal, Kathmandu, Nepal
- Neuroscience Society of Nepal, Gwarko, Lalitpur, Nepal
| | - Prakash Limbu
- College of Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Bhandarkhal, Kathmandu, Nepal
- Neuroscience Society of Nepal, Gwarko, Lalitpur, Nepal
| | - Sandeep Thapa
- Kathmandu Center for Genomics and Research Laboratory, Gwarko, Lalitpur, Nepal
- Neuroscience Society of Nepal, Gwarko, Lalitpur, Nepal
| | - Janak Raj Awasthi
- Gandaki Medical College and Teaching Hospital, Pokhara, Kaski, Nepal
| | - Sabin Thapaliya
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Mukesh Kumar Jha
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
- Neuroscience Society of Nepal, Gwarko, Lalitpur, Nepal
| | - Ajaya Jang Kunwar
- College of Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Bhandarkhal, Kathmandu, Nepal
- Kathmandu Center for Genomics and Research Laboratory, Gwarko, Lalitpur, Nepal
- Neuroscience Society of Nepal, Gwarko, Lalitpur, Nepal
| |
Collapse
|
7
|
Quasi-experimental study to assess the effectiveness of mental health programme on promoting mental health characteristics among adolescents in Coimbatore, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
8
|
Ma J, Mahat P, Brøndbo PH, Handegård BH, Kvernmo S, Javo AC. Teacher reports of emotional and behavioral problems in Nepali schoolchildren: to what extent do they agree with parent reports? BMC Psychiatry 2022; 22:584. [PMID: 36056334 PMCID: PMC9440565 DOI: 10.1186/s12888-022-04215-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Teacher reports of child emotional and behavioral problems (EBPs) are sparse in many low- and middle-income countries, especially when compared to reports from parents. Cross-informant information is pivotal to clinicians when dealing with mentally ill children. In this study from Nepal, we examined teacher reports of child EBPs, the agreement between teacher and parent reports, and how this agreement varied by type of EBP and child gender. METHODS This cross-sectional, observational study included 3808 schoolchildren aged 6-18 years from 16 districts of Nepal. Teacher and parent reports of EBPs were measured by the Nepali versions of the Teacher Report Form (TRF) and the Child Behavior Checklist (CBCL), respectively. Linear mixed model analysis was used for group comparisons and intraclass correlations. Agreement between TRF and CBCL scale scores were analyzed using Pearson's correlation coefficient. RESULTS The prevalence of EBPs according to teacher reports was 15.4%, whereas the previous parent reported prevalence was 19.1%. Also, the mean TRF score was significantly lower than mean CBCL score for the 90 common items. Mean TRF scores for Total Problems, Externalizing Problems, and Internalizing Problems were 26.9 (standard deviation, SD 24.5), 6.1 (SD 7.2), and 7.9 (SD 7.3), respectively. Consistent with parent reports, mean TRF scores for Total Problems and Externalizing Problems were higher among boys than girls, whereas no significant gender differences were found for Internalizing Problems. Teacher-parent agreement was moderate (r = .38), and slightly higher for Externalizing Problems than for Internalizing Problems (r = .37 versus r = .34). Moderate to low correlations were found for all syndrome scales, with coefficients ranging from r = .26 (Social Problems) to r = .37 (Attention Problems). The effect of child gender on the teacher-parent agreement was significant for Internalizing Problems only, with a higher agreement for girls than for boys. CONCLUSION Nepali teachers reported fewer child EBPs than parents. Teacher-parent agreement was moderate and varied by type of EBP and child gender. Our findings underscore the importance of obtaining information on child EBPs from both parents and teachers when evaluating and treating children in low- and middle-income countries like Nepal.
Collapse
Affiliation(s)
- Jasmine Ma
- Faculty of Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare -North, UiT The Arctic University of Norway, Tromsø, Norway. .,Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal.
| | | | - Per Håkan Brøndbo
- grid.10919.300000000122595234Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn H. Handegård
- grid.10919.300000000122595234Faculty of Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare -North, UiT The Arctic University of Norway, Tromsø, Norway
| | - Siv Kvernmo
- grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Cecilie Javo
- Sami National Competence Center for Mental Health (SANKS), Finnmark Hospital Trust, Sami Klinihkka, Karasjok, Norway
| |
Collapse
|
9
|
Maharjan S, Rana M, Neupane B, Rijal S, Shakya S, Pradhan PM, Ojha SP, Gautam K, Singh R. Psychometric properties of Nepalese preschool anxiety scale among preschool children: A cross-sectional study. Health Sci Rep 2022; 5:e808. [PMID: 36090623 PMCID: PMC9440761 DOI: 10.1002/hsr2.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background The Preschool Anxiety Scale (PAS)-Parent version scale is a 28-item measure designed to assess anxiety symptoms in preschoolers aged 3-6 years. The aim of this study was to assess the psychometric properties of the Nepali translated version of the PAS-Parent version. Methods A descriptive cross-sectional design was used to collect data from 680 mothers among seven conveniently selected schools in Kathmandu. Results The difference in PAS-Parent version scores across age groups was found to be statistically significant. In confirmatory factor analysis, 28 items showed a poor fit of the five-factor original model for the data. However, removing three items (25 item version) through the five-factor model indicated a better fit. Internal consistency measured by Cronbach's α for the PAS-Parent version scale was of good range (0.87). Cronbach's α of the subscales: generalized anxiety (0.63), social phobia (0.67), physical injury fears (0.75), and separation anxiety (0.63) were in fair range; while it was in poor range for the obsessive-compulsive subscale (0.567). Conclusion Nepali version of the PAS demonstrated fair psychometric properties, supporting its utility in screening and assessing a broad range of anxiety symptoms in Nepalese preschoolers.
Collapse
Affiliation(s)
| | - Mita Rana
- Transcultural Psychosocial Organization NepalKathmanduNepal
- Department of Psychiatry and Mental Health, Institute of MedicineTribhuvan UniversityKathmanduNepal
| | - Bidusha Neupane
- School of Health ServiceOld Dominion UniversityNorfolkVirginiaUSA
| | - Sujan Rijal
- Health Economics Policy and ManagementUniversity of OsloOsloNorway
| | - Suraj Shakya
- Department of Psychiatry and Mental Health, Institute of MedicineTribhuvan UniversityKathmanduNepal
| | - Pramesh Man Pradhan
- Department of Psychiatry and Mental Health, Institute of MedicineTribhuvan UniversityKathmanduNepal
| | - Saroj Prasad Ojha
- Department of Psychiatry and Mental Health, Institute of MedicineTribhuvan UniversityKathmanduNepal
| | - Kamal Gautam
- Transcultural Psychosocial Organization NepalKathmanduNepal
| | - Rakesh Singh
- Transcultural Psychosocial Organization NepalKathmanduNepal
| |
Collapse
|
10
|
Miller FA, Marphatia AA, Wells JC, Cortina-Borja M, Manandhar DS, Saville NM. Associations between early marriage and preterm delivery: Evidence from lowland Nepal. Am J Hum Biol 2021; 34:e23709. [PMID: 34862821 DOI: 10.1002/ajhb.23709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Preterm delivery (<37 weeks gestation) is the largest cause of child mortality worldwide. Marriage and pregnancy during adolescence have been associated with an increased risk of preterm delivery. We investigate independent associations of age at marriage and age at first pregnancy with preterm delivery in a cohort of women from rural lowland Nepal. METHODS We analyzed data from 17 974 women in the Low Birth Weight South Asia Trial. Logistic regression models tested associations of age at marriage and age at first pregnancy with preterm delivery, for primigravida (n = 6 243) and multigravida (n = 11 731) women. Models were adjusted for maternal education, maternal caste, and household asset score. RESULTS Ninety percent of participants had married at <18 years and 58% had their first pregnancy at <18 years. 20% of participants delivered preterm. Primigravida participants married at ≤14 years had higher odds of preterm delivery than those married ≥18 years, when adjusting for study design (adjusted odds ratio (aOR) 1.45, 95% CI: 1.15-1.83), confounders (aOR 1.28: 1.01-1.62) and confounders + age at pregnancy (aOR 1.29: 1.00-1.68). Associations were insignificant for multigravida women. No significant associations were observed between age at first pregnancy and preterm delivery. DISCUSSION In this population, early marriage, rather than pregnancy, is a risk factor for preterm delivery. We hypothesize that psychological stress, a driver of preterm delivery which is increased among those marrying young, rather than physiological immaturity, drives this association. Further research into the psychological consequences of child marriage in Nepal is needed.
Collapse
Affiliation(s)
- Faith A Miller
- Institute for Global Health (IGH), University College London (UCL), London, UK
| | - Akanksha A Marphatia
- Department of Geography, University of Cambridge, Cambridge, UK.,Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Jonathan C Wells
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | | | - Naomi M Saville
- Institute for Global Health (IGH), University College London (UCL), London, UK
| |
Collapse
|
11
|
Wang J, Aaron A, Baidya A, Chan C, Wetzler E, Savage K, Joseph M, Kang Y. Gender differences in psychosocial status of adolescents during COVID-19: a six-country cross-sectional survey in Asia Pacific. BMC Public Health 2021; 21:2009. [PMID: 34736426 PMCID: PMC8568363 DOI: 10.1186/s12889-021-12098-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND School closures and family economic instability caused by the COVID-19 lockdown measures have threatened the mental health and academic progress of adolescents. Through secondary data analysis of World Vision Asia Pacific Region's COVID-19 response-assessments in May-June 2020, this study examined whether adolescents' study, physical, and leisure activities, psychosocial status, and sources of COVID-19 information differed by gender. METHODS The assessments used cross-sectional surveys of adolescents in poor communities served by World Vision (n = 5552 males and n = 6680 females) aged 10-18 years old in six countries. The study households of adolescents were selected either by random sampling or non-probability convenience sampling and assessed using telephone or in-person interviews. Multivariate logistic regression analyses examined the relationship between gender and psychosocial status; daily activities (e.g., play, study); and sources of information about COVID-19. RESULTS Participation in remote education was low (range: 0.5-20.7% across countries), with gender difference found only in Vietnam. Compared to males, female adolescents were less likely to play physically with a range of AOR: 0.36-0.55 (n = 5 countries) or play video games with a range of AOR: 0.55-0.72 (n = 2 countries). Female adolescents were more likely to feel isolated or stressed (India, AOR = 1.13, 95%CI:1.00, 1.26); feel unsafe (the Philippines, AOR = 2.22, 95%CI:1.14, 4.33; Vietnam, AOR = 1.31, 95%CI:1.03, 1.47); be concerned about education (India, AOR = 1.24, 95%CI:1.09, 1.41; Myanmar, AOR = 1.59, 95%CI:1.05, 2.40); or be concerned about household income (India, AOR = 1.13, 95%CI:1.00, 1.28; Vietnam, AOR = 1.31, 95%CI:1.09, 1.58). Female adolescents were also less likely to obtain COVID-19 related information through internet/social media (Bangladesh, AOR = 0.51, 95%CI:0.41, 0.64; India, AOR = 0.84, 95%CI:0.73, 0.96; and Myanmar, AOR = 0.65, 95%CI:0.43, 0.97) and mobile call or short message (India, AOR = 0.88, 95%CI:0.80, 0.98) but more likely to get the information from friends (Vietnam, AOR = 1.18, 95%CI:1.02, 1.36) and family (Bangladesh, AOR = 1.44, 95% CI:1.21, 1.70; India, AOR = 1.29, 95% CI:1.15, 1.45). CONCLUSIONS An understanding of gender differences in the impacts of COVID-19 on adolescents' schooling, physical, and mental health can inform adolescent protection interventions. Psychosocial support during response and recovery phases needs to pay special attention to gender differences, since female adolescents' psychosocial status is at higher risk when facing the challenges of this pandemic.
Collapse
Affiliation(s)
- Jun Wang
- Johns Hopkins School of Education, Baltimore, MD, USA
| | - Alec Aaron
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anurima Baidya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christabel Chan
- World Vision Asia Pacific Regional Office, Singapore, Republic of Singapore
| | | | | | | | - Yunhee Kang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
12
|
Jayawardena HKH, Gamage GP. Exploring challenges in mental health service provisions for school-going adolescents in Sri Lanka. SCHOOL PSYCHOLOGY INTERNATIONAL 2021. [DOI: 10.1177/01430343211043062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schools provide an ideal setting for early, accessible intervention according to research conducted in developed countries for adolescents experiencing adverse mental health (MH). Many schools in South Asia, however, lack structured and standardized school counselling services. Research indicates that where services do exist, students are reluctant to access them due to perceived high risks and low benefits in MH help seeking. This paper explores the challenges experienced in MH provision from the perspective of school counsellors. A qualitative approach was chosen, and three main themes emerged from the data using the thematic analysis: negative perceptions of MH and counselling, the unwillingness to invest in MH services, and the challenges inherent in the system itself. The findings reveal cultural implications behind these challenges and suggest grassroots level initiatives that can be implemented within schools to reduce the barriers to service provision without the need for legislative changes at a national level.
Collapse
Affiliation(s)
| | - Gayani P. Gamage
- Department of Counselling and Psychology, The Open University of Sri Lanka, Sri Lanka
| |
Collapse
|
13
|
Ma J, Mahat P, Brøndbo PH, Handegård BH, Kvernmo S, Javo AC. Parent reports of children's emotional and behavioral problems in a low- and middle- income country (LMIC): An epidemiological study of Nepali schoolchildren. PLoS One 2021; 16:e0255596. [PMID: 34343215 PMCID: PMC8330921 DOI: 10.1371/journal.pone.0255596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/19/2021] [Indexed: 01/09/2023] Open
Abstract
Background As epidemiological data on child mental health in low- and middle-income countries are limited, a large-scale survey was undertaken to estimate the prevalence and amount of child emotional and behavioral problems (EBP) in Nepal as reported by the parents. Methods 3820 schoolchildren aged 6–18 years were selected from 16 districts of the three geographical regions of Nepal, including rural, semi-urban and urban areas. We used the Nepali version of the Child Behavior Checklist (CBCL)/6-18 years as screening instrument. Comparisons of child problems between genders and between the seven largest castes and ethnic groups were carried out by analysis of variance. Prevalence was computed based on American norms. Results Adjusted prevalence of Total Problems was 18.3% (boys: 19.1%; girls:17.6%). The prevalence of internalizing problems was higher than externalizing problems. The mean scores of Total, Externalizing, and Internalizing problems were 29.7 (SD 25.6), 7.7 (SD 8.0), and 9.1 (SD 8.1), respectively. The Khas Kaami (Dalit) group scored the highest, and the indigenous Tharu group scored the lowest on all scales. In the Mountains and Middle Hills regions, problem scores were higher in the rural areas, whereas in the Tarai region, they were higher in the urban areas. Conclusion The prevalence and magnitude of emotional and behavioral problems in Nepali children were found to be high compared to findings in meta-analyses worldwide. Problem scores varied according to gender, castes /ethnic groups, and living areas. Our findings highlight the need for a stronger focus on child mental problems in a low-and middle-income country like Nepal.
Collapse
Affiliation(s)
- Jasmine Ma
- Regional Centre for Child and Youth Mental Health and Child Welfare -North, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Child & Adolescent Psychiatry Clinic, Kanti Children’s Hospital, Kathmandu, Nepal
- * E-mail:
| | | | - Per Håkan Brøndbo
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn H. Handegård
- Regional Centre for Child and Youth Mental Health and Child Welfare -North, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Siv Kvernmo
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Cecilie Javo
- Regional Centre for Child and Youth Mental Health and Child Welfare -North, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Sami National Competence Center for Mental Health, Sami Klinihkka, Finnmark Hospital Trust, Karasjok, Norway
| |
Collapse
|
14
|
Dhonju G, Kunwar AR, Karki U, Devkota N, Bista I, Sah R. Identification and Management of COVID-19 Related Child and Adolescent Mental Health Problems: A Multi-Tier Intervention Model. Front Public Health 2021; 8:590002. [PMID: 33614565 PMCID: PMC7891176 DOI: 10.3389/fpubh.2020.590002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/07/2020] [Indexed: 12/02/2022] Open
Abstract
Nepal is a low and medium-income country (LMIC), situated in South-east Asia, with a population of 29 million, of which, 40–50% are children and adolescents. The Coronavirus Disease 2019 (COVID-19) pandemic has affected the lives of people around the world, including Nepal. The child and adolescent mental health (CAMH) needs and services in Nepal have a significant gap. CAMH in Nepal suffers from lack of specialized training in this field as well as scarcity of human resources and services. There is only one full-time child and adolescent psychiatry (CAP) out-patient clinic in the country. Some recent activities have focused on CAMH in Nepal but the COVID-19 pandemic has produced new challenges. Access to mental health services for children and adolescents (C&A) across Nepal has been adversely affected. Factors such as closure of schools, confinement at home, lockdown, transportation problems, uncertainty, loss of usual routine and fear of infection have affected the mental health of C&A. This has highlighted a need to build capacity of available local human resources, enhance community support, teach measures of coping with stress and improve CAMH service delivery by strengthening the referral system, but these have to be addressed overcoming problems of travel restrictions and limited resources. To address these needs, online platform can be a suitable approach. With this view, a multi-tier CAMH intervention model was developed, which utilizes online platform for training mental health professionals across Nepal, who would then facilitate sessions for C&A, teachers, parents and caregivers; and link them to CAMH services locally, and remotely through teleconsultation. This started as a pilot from June 2020 and will continue till end of February 2021, with the aim to reach 40,000 C&A, parents, teachers and caregivers. As of Nov 2020, this model has been used to successfully conduct 1,415 sessions, with 28,597 population reached. Among them, 16,571 are C&A and 12,026 are parents, teachers and caregivers, across all 7 provinces of Nepal. In this paper, the multi-tier intervention to address the COVID-19 related CAMH problems has been discussed as a feasible framework for resource limited settings and LMICs like Nepal.
Collapse
Affiliation(s)
- Gunjan Dhonju
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Arun Raj Kunwar
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Utkarsh Karki
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Narmada Devkota
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Isha Bista
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Rampukar Sah
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| |
Collapse
|
15
|
Bhattarai D, Shrestha N, Paudel S. Prevalence and factors associated with depression among higher secondary school adolescents of Pokhara Metropolitan, Nepal: a cross-sectional study. BMJ Open 2020; 10:e044042. [PMID: 33384401 PMCID: PMC7780534 DOI: 10.1136/bmjopen-2020-044042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study examined the prevalence and factors associated with depression among adolescents attending higher secondary schools in the Pokhara Metropolitan City of Nepal. DESIGN A cross-sectional study design was adopted. SETTING Four randomly selected higher secondary schools of Pokhara Metropolitan, Nepal. PARTICIPANTS 312 randomly sampled higher secondary school students. METHODS The Center for Epidemiologic Studies Depression Scale was used to assess the level of depression among students. The data collected through a self-administered questionnaire were analysed using descriptive statistical methods such as frequency and percentage. χ2 test and unadjusted OR (UOR) were calculated to assess the statistical relationship between depression and various variables at 95% CI, with level of significance at p<0.05. RESULTS The study found a high prevalence of depression among high school students, with more than two-fifths (44.2%) of students having depression. Furthermore, almost a quarter (25.3%) of the students were noted to have mild depression and 18.9% of the students expressed major depression. Students who had low perceived social support (UOR: 3.604; 95% CI 2.088 to 6.220), did not share their problems with anyone (UOR: 1.931; 95% CI 1.228 to 3.038) and had low self-esteem (UOR: 5.282; 95% CI 2.994 to 9.319) were at higher odds of being depressed. CONCLUSION A high prevalence of depression was observed among high school students. It was also observed that students' level of perceived social support, self-esteem and help-seeking behaviour are somehow related to their mental well-being. Hence, improving social support and self-esteem may alleviate depression and mental distress among these adolescents.
Collapse
Affiliation(s)
- Deepa Bhattarai
- Faculty of Health Sciences, School of Health and Allied Sciences, Pokhara University, Lekhnath, Kaski, Nepal
| | - Nisha Shrestha
- Pokhara Nursing Campus, Institute of Medicine, Tribhuvan University, Pokhara, Kaski, Nepal
| | - Shishir Paudel
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| |
Collapse
|
16
|
Alenko A, Girma S, Abera M, Workicho A. Children emotional and behavioural problems and its association with maternal depression in Jimma town, southwest Ethiopia. Gen Psychiatr 2020; 33:e100211. [PMID: 32656496 PMCID: PMC7333798 DOI: 10.1136/gpsych-2020-100211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In sub-Saharan countries, one in five children and one in three women experiences emotional and behavioural problems (EBPs) and depression, respectively. While various factors were reported to affect the mental health of children, little is known about the impact of maternal depression on the offspring. Moreover, the magnitude of children's EBPs is barely known in Ethiopia. AIM To determine the magnitude of child EBPs and its association with maternal depression in Jimma town, southwest Ethiopia. METHODS A quantitative cross-sectional study was conducted among 734 mother-child pairs in Jimma town from January to June, 2019. EBP was assessed by using the parent version of Strengths and Difficulties Questionnaire (SDQ) with cut-off score of ≥14. Maternal depression was assessed using Patient Health Questionnaire-9 with a cut-off score of ≥10. Data were entered into Epidata V.3.1 and exported to SPSS V.24 for analysis. Multivariable logistic regression was fitted to identify the strength of association between exposure and outcome variables. RESULTS Of the 734 participants, 146 (19.9%, 95% CI: 16.9% to 22.9%) met EBP criteria based on parent version of SDQ. Maternal depression had significant association with child EBP (adjusted OR=2.38, 95% CI: 1.55 to 3.66). In addition, children aged 7-10 years, family size categories of ≤3 and 4-6, maternal intimate partner violence and maternal khat use had significant association with child EBP. CONCLUSIONS AND RECOMMENDATIONS A significant number of children suffer from EBP in Jimma town. Maternal depression is found to be a predictor of children's EBPs. Thus, there is a need to design and implement an integrated maternal and child mental health programme. The maternal and child health section at the national level should integrate and cascade routine maternal and child mental health screening and intervention modalities down to the family healthcare system.
Collapse
Affiliation(s)
- Arefayne Alenko
- Psychiatry, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Shimelis Girma
- Psychiatry, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Mubarek Abera
- Psychiatry, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Abdulhalik Workicho
- Epidemiology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| |
Collapse
|
17
|
Sharma V, Reina Ortiz M, Sharma N. Risk and Protective Factors for Adolescent and Young Adult Mental Health Within the Context of COVID-19: A Perspective From Nepal. J Adolesc Health 2020; 67:135-137. [PMID: 32444197 PMCID: PMC7237905 DOI: 10.1016/j.jadohealth.2020.04.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Nandita Sharma
- Central Department of Psychology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| |
Collapse
|
18
|
D'Sa S, Foley D, Hannon J, Strashun S, Murphy AM, O'Gorman C. The psychological impact of childhood homelessness-a literature review. Ir J Med Sci 2020; 190:411-417. [PMID: 32488463 DOI: 10.1007/s11845-020-02256-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/09/2020] [Indexed: 11/26/2022]
Abstract
In August 2019, 3848 children in Ireland were faced with emergency homelessness [1]. In recent years, lack of affordable housing, unemployment and shortage of rental properties have been the primary driving factors for the potentially devastating impact of familial homelessness in our society [1]. Our aim was to evaluate current knowledge on the psychological impact of homelessness in children. Using the PRISMA model, we performed a review of the currently available literature on the psychological impact of homelessness on children. This concept was explored under two different categories-'transgenerational' and 'new-onset homelessness'. Hidden homelessness was also explored. Our literature review revealed several psychological morbidities which were unique to children. This includes developmental and learning delays, behavioural difficulties and increased levels of anxiety and depression [66, 77, 40, 81, 42]. This has been demonstrated by poorer performance in school testing and increased levels of aggression. Anxiety in children within this cohort has been shown to peak at time of dispersion from their stable home environment [67]. Our study highlights violence, aggression and poor academic learning outcomes to be just some of the key findings in our review of homelessness in childhood, worldwide. Unfortunately, there has been minimum research to date on paediatric homelessness within the context of the Irish population. We anticipate this review to be the first chapter in a multipart series investigation to evaluate the psychological morbidity of paediatric homelessness within the Irish Society.
Collapse
Affiliation(s)
- Saskia D'Sa
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland.
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland.
| | - Deirdre Foley
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland
| | - Jessica Hannon
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland
| | - Sabina Strashun
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
| | - Anne-Marie Murphy
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland
| | - Clodagh O'Gorman
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
| |
Collapse
|
19
|
Karki U, Rai Y, Dhonju G, Sharma E, Jacob P, Kommu JVS, Seshadri SP. Child and adolescent psychiatry training in Nepal: early career psychiatrists' perspective. Child Adolesc Psychiatry Ment Health 2020; 14:13. [PMID: 32280370 PMCID: PMC7137493 DOI: 10.1186/s13034-020-00319-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nepal is a developing low-income country in Southeast Asia. There is a huge burden of child and adolescent mental health (CAMH) in Nepal which has a population of around 29 million and 40-50% of the population comprises of children and adolescents. Child and Adolescent Psychiatry (CAP) has not been formally recognized as a subspecialty in Nepal and there is no standardized curriculum for CAP training. The objectives of the survey were to identify the current status of training, shortfalls and to explore the training experiences of early career psychiatrists (ECPs) in Nepal. METHODS The participants were ECPs in Nepal. An online questionnaire was created consisting of 20 questions including 3 questions requiring an answer indicating a level of agreement scored on a ten-point scale. Questionnaire using google form was e-mailed with the uniform resource locator (URL). Respondents anonymously answered the questions. The survey was open from 01/01/2019 to 01/04/2019. RESULTS Response rate was 83.69%. Around 42% (n = 32) were trainees in Doctor of Medicine (MD) Psychiatry and 58% (n = 45) of respondents had completed their MD Psychiatry. More than half of the ECPs had not received formal training specific to CAP. Seventy percent (n = 54) ECPs reported that their current workplace did not have a specific unit to address psychological problems in children and adolescents. However, 62% (n = 48) of ECPs came across 10 CAP cases per week. On a ten-point scale, mean score of ECPs confidence in diagnosing, management and overall confidence in CAP cases were 5.18 ± 1.56, 4.58 ± 1.59 and 4.67 ± 1.62 respectively. Fifty-four percent (n = 42) of respondents rated their training as limited and 74% (n = 57) of them wanted additional training in CAP. Psychological intervention, psychotherapy and a fellowship course were the additional training most of the ECPs wanted to receive. CONCLUSION Despite significant exposure to CAP patients in daily practice, ECPs self-evaluated their training as inadequate and there is no standardized CAP training program in Nepal for ECPs. The desire of ECPs to receive additional training in CAP is highly encouraging and positive. We advocate for the development and incorporation of CAP training in current psychiatry training to fulfill these unmet training needs in Nepal.
Collapse
Affiliation(s)
- Utkarsh Karki
- grid.416861.c0000 0001 1516 2246Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Yugesh Rai
- Essex Partnership University NHS Trust, Colchester, UK
| | - Gunjan Dhonju
- Child and Adolescent Psychiatry Unit, Kanti Children’s Hospital, Kathmandu, Nepal
| | - Eesha Sharma
- grid.416861.c0000 0001 1516 2246Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Preeti Jacob
- grid.416861.c0000 0001 1516 2246Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - John Vijay Sagar Kommu
- grid.416861.c0000 0001 1516 2246Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Shekhar P. Seshadri
- grid.416861.c0000 0001 1516 2246Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| |
Collapse
|
20
|
Emotional quality-of-life and patient-reported limitation in sports participation in children with uncorrected congenital and acquired heart disease in healthcare-restricted settings in low- and middle-income countries. Cardiol Young 2020; 30:188-196. [PMID: 32019617 PMCID: PMC7332412 DOI: 10.1017/s1047951120000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about emotional quality-of-life in paediatric heart disease in low- and middle-income countries where the prevalence of uncorrected lesions is high. Research on emotional quality-of-life and its predictors in these settings is key to planning interventions. METHODS Ten-year retrospective cross-sectional study of children aged 6-17 years with uncorrected congenital or acquired heart disease in 12 low- and middle-income countries was conducted. Emotional functioning score of the PedsQL TM 4.0 generic core scale and data on patient-reported limitation in sports participation were collected via in-person interview and analysed using regression analyses. RESULTS Ninety-four children reported mean emotional functioning scores of 71.94 (SD 25.32) [95% CI 66.75-77.13] with lower scores independently associated with having a parent with a chronic illness or who had died (p = 0.005), having less than three siblings (p = 0.007), and reporting a subjective limitation in carrying an item equivalent to a 4 lb load (p = 0.021). Patient-reported limitation in sports participation at least "sometimes" was present in 69% and was independently associated with experiencing symptoms at least once a month (p < 0.001). CONCLUSION Some of the factors which were associated with better emotional quality-of-life were similar to those identified in previous studies in patients with corrected defects. Patient-reported limitation in sports participation is common. In addition to corrective surgery and exercise, numerous other interventions which are practicable during surgical missions might improve emotional quality-of-life.
Collapse
|