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Goldstein L, Smith AM, Romagnoli D, Katergi E. The effect of Transcendental Meditation on self-esteem, self-efficacy, and gratitude, for increasing empowerment of female youth in Uganda. Health Care Women Int 2024:1-34. [PMID: 38980139 DOI: 10.1080/07399332.2024.2358789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 05/20/2024] [Indexed: 07/10/2024]
Abstract
This longitudinal study with female youth in the slums of Kampala, Uganda (n = 130), explored the impact of the Transcendental Meditation® (TM®) technique on self-esteem, the primary outcome measure, and self-efficacy, gratitude, hope, tiredness, and resilience as secondary outcomes. Quality-of-life behaviors were also assessed, including excessive alcohol use. After baseline testing participants learned TM over five consecutive days. Participants practiced TM at home for 20 min twice a day and attended two follow-up sessions. Post-testing occurred at five months. Significant improvements in self-esteem (p < .001), self-efficacy (p < .001), gratitude (p < .001), and tiredness (p = .05) were found. A decrease in excessive alcohol use was also observed (p = .02). At eight months a short answer questionnaire showed improved physical health, decreased stress and anxiety levels, and improved relationships in the family and community. Our findings have important implications for enhancing the well-being and empowerment of these vulnerable female youth.
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Affiliation(s)
- Leslee Goldstein
- Center for Social Emotional Health and Consciousness, Maharishi International University, Fairfield, Iowa, USA
| | | | - Daniela Romagnoli
- University Workforce Education and Development, College of Education, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Elissa Katergi
- School of Psychology, University of Ottawa, Ottawa, Canada
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Skar AMS, Engebretsen IMS, Braathu N, Aber H, Bækkelund H, Kühl MJ, Mukisa M, Nalugya JS, Skokauskas N, Skylstad V, Wentzel-Larsen T, Babirye JN. Study protocol for a stepped-wedge implementation study investigating the intersectoral collaboration of implementering the TREAT INTERACT intervention for primary school teachers and the mhGAP for health care workers for child mental health promotion in Uganda. Trials 2024; 25:465. [PMID: 38982328 PMCID: PMC11234609 DOI: 10.1186/s13063-024-08312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Mental and neuropsychological disorders make up approximately 14% of the total health burden globally, with 80% of the affected living in low- and middle-income countries (LMICs) of whom 90% cannot access mental health services. The main objective of the TREAT INTERACT study is to adapt, implement, and evaluate the impact of a novel, intersectoral approach to prevent, identify, refer, and treat mental health problems in children through a user centred task-sharing implementation of the TREAT INTERACT intervention, inspired by the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for primary school staff in Mbale, Uganda. Health care personell will be trained in the mhGAP-IG. METHODS This is a pragmatic mixed-methods hybrid Type II implementation-effectiveness study utilizing a co-design approach. The main study utilize a stepped-wedged trial design with six starting sequences, randomizing three schools to the intervention at each interval, while the remaining act as "controls". Other designs include a nested prospective cohort study, case control studies, cross-sectional studies, and qualitative research. Main participants' outcomes include teachers' mental health literacy, stigma, and violence towards the school children. Implementation outcomes include detection, reach, sustainability, and service delivery. Child and caregiver outcomes include mental health, mental health literacy, and help-seeking behaviour. DISCUSSION Based on the results, we will develop sustainable and scalable implementation advice on mental health promotion and draft implementation guidelines in line with current WHO guidelines. This project will generate new knowledge on the structure, organization, delivery, and costs of mental health services in a LMIC setting, as well as new knowledge on the implementation and delivery of new health services. TRIAL REGISTRATION ClinicalTrials, NCT06275672, 28.12.2023, retrospectively registered.
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Affiliation(s)
- Ane-Marthe Solheim Skar
- Norwegian Center for Violence and Traumatic Stress Studies, Gullhaugveien 1, Oslo, 0484, Norway.
- Global Health Cluster, Division for Health Services, the Norwegian Institute of Public Health, Oslo, Norway.
| | - Ingunn Marie S Engebretsen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Nora Braathu
- Norwegian Center for Violence and Traumatic Stress Studies, Gullhaugveien 1, Oslo, 0484, Norway
| | - Harriet Aber
- School of Public Health, Makerere University College of Health Sciences, MakSPH, Kampala, Uganda
| | - Harald Bækkelund
- Norwegian Center for Violence and Traumatic Stress Studies, Gullhaugveien 1, Oslo, 0484, Norway
| | - Melf-Jakob Kühl
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Marjorie Mukisa
- School of Public Health, Makerere University College of Health Sciences, MakSPH, Kampala, Uganda
| | - Joyce Sserunjogi Nalugya
- School of Public Health, Makerere University College of Health Sciences, MakSPH, Kampala, Uganda
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vilde Skylstad
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Tore Wentzel-Larsen
- Norwegian Center for Violence and Traumatic Stress Studies, Gullhaugveien 1, Oslo, 0484, Norway
| | - Juliet Ndimwibo Babirye
- School of Public Health, Makerere University College of Health Sciences, MakSPH, Kampala, Uganda
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Abdalhai KA, Mokitimi S, de Vries PJ. Child and adolescent mental health services in Khartoum State, Sudan: a desktop situational analysis. Child Adolesc Psychiatry Ment Health 2024; 18:21. [PMID: 38310302 PMCID: PMC10838434 DOI: 10.1186/s13034-024-00707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/11/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Sudan is a Northeast African country, with 61.7% of its population under 24 years. With a large youth population and significant cultural and linguistic diversity, Sudan, like most low-income countries, has contributed minimal data to global child and adolescent mental health (CAMH) research. This study aimed to perform the first ever situational analysis of CAMH services and systems in Khartoum State, Sudan. METHODS The study focused on Khartoum state and covered the calendar years 2019 and 2020. Using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) version 2.2 adapted for CAMH, the study focused on the publically available data sources. Findings were described and presented in tables and figures using the WHO-AIMS template. RESULTS The situational analysis found no CAMH-specific policies, no separate budget for CAMH, and no supervising body for CAMH services in Khartoum. Three tertiary mental health hospitals provided CAMH services, all combined with adult mental health services. Essential medicines were available in all facilities, except methylphenidate available only in 3 central pharmacies. There was no free access to essential psychotropic drugs for children and adolescents except in emergency settings. Data about training to primary healthcare providers and the process of referral to specialized services were limited. A school mental health programme existed which provided early identification and management of CAMH problems in schools. The workforce was small and variable across all levels of care. No formal public health awareness campaigns and little evidence of formal intersectoral collaboration on CAMH were identified. A health information system existed, but no CAMH-specific items were reported. Among a handful of publications on CAMH, no national studies on CAMH were identified. CONCLUSIONS This situational analysis represented the first systematic collation of data and information about CAMH in Sudan. Findings highlighted some areas of strength, but also many gaps in CAMH services and systems. We acknowledge the need to complement the desktop analysis with in-depth data collection with stakeholders across multiple levels, but hope that this will serve as a first step towards strengthening CAMH services in Sudan and other low-income countries.
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Affiliation(s)
- Khalid A Abdalhai
- Department of Psychiatry, Faculty of Medicine, International University of Africa, Khartoum, Sudan.
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Stella Mokitimi
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Petrus J de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Aber-Odonga H, Nuwaha F, Kisaakye E, Engebretsen IMS, Babirye JN. Health facility readiness to screen, diagnose and manage substance use disorders in Mbale district, Uganda. Subst Abuse Treat Prev Policy 2023; 18:63. [PMID: 37925411 PMCID: PMC10625191 DOI: 10.1186/s13011-023-00570-x] [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: 07/25/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Substance use disorders (SUD) pose a significant public health problem in Uganda. Studies indicate that integrating mental health services into Primary Health Care can play a crucial role in alleviating the impact of SUD. However, despite ongoing efforts to integrate these services in Uganda, there is a lack of evidence regarding the preparedness of health facilities to effectively screen and manage SUD. Therefore, this study aimed to assess the readiness of health facilities at all levels of the health system in Mbale, Uganda, to carry out screening, diagnosis, and management of SUD. METHODS A health facility-based cross-sectional study was carried out among all the 54 facilities in Mbale district. A composite variable adapted from the WHO Service Availability and Readiness Assessment manual (2015) with 14 tracer indicators were used to measure readiness. A cut-off threshold of having at least half the criteria fulfilled (higher than the cutoff of 7) was classified as having met the readiness criteria. Descriptive analyses were performed to describe readiness scores across various facility characteristics and a linear regression model was used to identify the predictors of readiness. RESULTS Among all health facilities assessed, only 35% met the readiness criteria for managing Substance Use Disorders (SUD). Out of the 54 facilities, 42 (77.8%) had guidelines in place for managing SUD, but less than half, 26 (48%), reported following these guidelines. Only 8 out of 54 (14.5%) facilities had staff who had received training in the diagnosis and management of SUD within the past two years. Diagnostic tests for SUD, specifically the Uri stick, were available in the majority of facilities, (46/54, 83.6%). A higher number of clinical officers working at the health centres was associated with higher readiness scores (score coefficient 4.0,95% CI 1.5-6.5). CONCLUSIONS In this setting, a low level of health facility readiness to provide screening, diagnosis, and management for substance use disorders was found. To improve health facility readiness for delivery of care for substance use disorders, a frequent inventory of human resources in terms of numbers, skills, and other resources are required in this resource-limited setting.
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Affiliation(s)
- Harriet Aber-Odonga
- School of Public Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda.
| | - Fred Nuwaha
- School of Public Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Esther Kisaakye
- School of Public Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Ingunn Marie S Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, 7804, Norway
| | - Juliet Ndimwibo Babirye
- School of Public Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
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Ma H, Zhu F, Zhai H, Ma Y, Liu Y, Wang S, Xu Y. Prevalence of psychological distress among people living with HIV/AIDS: a systematic review and meta-analysis. AIDS Care 2023; 35:153-164. [PMID: 35642250 DOI: 10.1080/09540121.2022.2080802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although people living with HIV/AIDS (PLWHA) are known to be vulnerable to psychological distress (PD), little is known about the prevalence of PD among PLWHA. A systematic literature search of several databases was conducted from inception to August 2021 focusing on studies reporting on PD symptoms among PLWHA. The overall prevalence estimates were pooled using a random-effects meta-analysis. Differences according to study-level characteristics were examined using stratified meta-analysis. We pooled and analyzed data from 15 studies comprising 5593 PLWHA. The prevalence rate of PD among PLWHA was 43.7% (95% Confidence Interval: 29.9-57.5%). Subgroup analyses by gender, country, CD4 count, employment status and ever attended school found no statistically significant differences in the prevalence of PD. Heterogeneity in the prevalence of PD among PLWHA was partially explained by the assessment tool. Further large-scale studies of high quality are warranted to identify risk factors of PD in PLWHA in their respective socio-cultural contexts.
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Affiliation(s)
- Haiqi Ma
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Fu Zhu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Huimin Zhai
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Yue Ma
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Yiting Liu
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Shangjie Wang
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Ying Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
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Shaligram D, Skokauskas N, Aragones E, Azeem MW, Bala A, Bernstein B, Cama S, Canessa L, Silva FD, Engelhard C, Garrido G, Guerrero APS, Hunt J, Jadhav M, Martin SL, Miliauskas C, Nalugya J, Nazeer A, Ong SH, Robertson P, Sassi R, Seker A, Watkins M, Leventhal B. International perspective on integrated care models in child and adult mental health. Int Rev Psychiatry 2022; 34:101-117. [PMID: 35699101 DOI: 10.1080/09540261.2022.2059346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability.
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Affiliation(s)
| | | | - Enric Aragones
- Institut de Recerca en Atencio Primaria Jordi Gol, Spain
| | | | | | | | - Shireen Cama
- Cambridge Health Alliance/Harvard Medical School, USA
| | - Laura Canessa
- Facultad de Medicina, Universidad de la República, Uruguay
| | | | | | | | | | - Jeffrey Hunt
- Brown University Warren Alpert Medical School, USA
| | | | - Sarah L Martin
- Texas Tech University Health Science Center El Paso, Texas, USA
| | | | - Joyce Nalugya
- Makerere University College of Health Sciences, Uganda
| | | | | | - Paul Robertson
- Department of Psychiatry, The University of Melbourne, Australia
| | - Roberto Sassi
- University of British Columbia, BC Children's Hospital, Canada
| | - Asilay Seker
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
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- The University of Texas System, Texas, USA
| | - Michael Watkins
- The University of Texas Health Science Center at Tyler, Texas, USA
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