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Sargent J. Experiences in global mental health. Am J Orthopsychiatry 2024:2024-70762-001. [PMID: 38573688 DOI: 10.1037/ort0000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Participating in Global Mental Health program development and education and training efforts is rewarding and exciting work. The author describes several global experiences he has engaged in over the past 30 years, which has focused on teaching and encouraging family therapy and mental health care that support human rights and promote human development as innovated and promoted by the Global Alliance for Behavioral Health, formerly the American Orthopsychiatric Association. The author learned through participation that merely presenting mental health information and treatment approaches through lecture presentation was not adequate to help professionals and advocates in low- and middle-income countries to build sustainable mental health care systems in their home regions. The author engaged in several collaborative program development efforts with local professionals at their invitation. These programs, consisting of multiyear partnerships based on the needs and culture of the home region, will be described in the article. The programs, based on relationships between local professionals and a U.S. team of experts in child mental health care, had long-term positive effects and were highly rewarding. The basis for these programs was an invitation by local professionals, followed by collaboration in setting the agenda for the U.S. professionals' visits, an on-going relationship in which local professionals trusted that the visitors want and need to understand the local cultural environment, and improvements that will be most helpful and sustainable. In this process, the author learned about the cultures he worked in and was a part of extremely meaningful and enlightening relationships and experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- John Sargent
- Department of Psychiatry and Pediatrics, Tufts University School of Medicine
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Smith JA, Powell CA, Chang SM, Ganga E, Tanyanyiwa H, Walker SP. A cluster randomised controlled trial of an early childhood parenting programme delivered through early childhood education centres in rural Zimbabwe. Child Care Health Dev 2024; 50:e13189. [PMID: 37882173 DOI: 10.1111/cch.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/05/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Early childhood is a critical period for child development. Effective approaches to support families in low-resource settings in the use of responsive and stimulating parenting are needed. AIM The aim of this study was to examine the effects of the Reach Up early childhood parenting programme on children's development, parenting attitudes and practices, when delivered through early childhood development (ECD) centres in Zimbabwe. METHODS A cluster randomised controlled trial was conducted in Sanyati, a rural district in Zimbabwe. Twenty-four of 51 available centres were randomised to intervention (n = 12) or control (n = 12) groups. Sixteen mothers with a child aged 12-30 months were recruited from each centre's catchment area (n = 189 intervention; n = 193 control). The intervention comprised two home visits per month delivered by centre teaching assistants over a period of 27 months. Primary outcomes were child Developmental Quotient (DQ), Language, Eye and Hand coordination, Performance and Practical Reasoning subscale scores assessed at follow-up. Secondary outcomes were mothers' attitudes about child development, parenting practices and maternal depressive symptoms all measured at baseline and follow-up. Intention to treat analyses was conducted using mixed-effects regression models with the standard error adjusted for cluster and inverse proportionality weights to adjust for attrition. Significance was set at P < 0.05. RESULTS A total of 285 (74.6%) of 382 children enrolled were tested, with 97 children lost to follow-up. The intervention improved the children's DQ by 3.55 points (95% CI 0.82 to 6.28), Eye and Hand by 3.58 (95% CI 0.59 to 6.56) and Practical Reasoning by 4.19 (95% CI 0.96 to 7.42). No significant improvements to Performance or Language scores, parenting attitudes, parenting practices and depressive symptoms were identified. CONCLUSIONS A home visiting intervention delivered by ECD teaching assistants promoted children's development. This suggests that outreach from preschools may be an effective platform for delivery of parenting interventions.
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Affiliation(s)
- Joanne A Smith
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Christine A Powell
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Susan M Chang
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Emily Ganga
- Robert Mugabe School of Education and Culture, Great Zimbabwe University, Masvingo, Zimbabwe
| | | | - Susan P Walker
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
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Onwujekwe O, Orjiakor C, Ogbozor P, Agu I, Agwu P, Wright T, Balabanova D, Kohler J. Examining corruption risks in the procurement and distribution of COVID-19 vaccines in select states in Nigeria. J Pharm Policy Pract 2023; 16:141. [PMID: 37957711 PMCID: PMC10641993 DOI: 10.1186/s40545-023-00649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Public health emergencies raise significant concerns about corruption and accountability; however, these concerns can manifest in different ways across diverse locations. For instance, more developed countries with a stronger rule of law may experience more corruption in vaccine procurement, whereas developing countries may experience more corruption at the point of distribution and delivery to end users. This research focuses on corruption concerns in Nigeria, specifically examining the procurement and distribution of COVID-19 vaccines. METHODS This paper utilizes a scoping review and a qualitative research approach. Key informants (n = 40) involved in the procurement and distribution of COVID-19 vaccines across two states in Nigeria were interviewed. Findings from the scoping review were summarized, and collected data were inductively coded and analysed in themes, revealing clear examples of implementation irregularities and corruption in the country's COVID-19 vaccination processes. RESULTS Vaccination programme budgeting processes were unclear, and payment irregularities were frequently observed, resulting in vaccinators soliciting informal payments while in the field. Recruitment and engagement of vaccination personnel was opaque, while target vaccination rates incentivized data falsification during periods of vaccine hesitancy. Accountability mechanisms, such as health worker supervision, vaccination data review, and additional technical support provided by donors were implemented but not effective at preventing corruption among frontline workers. CONCLUSIONS Future accountability measures should be evidence-driven based on findings from this research. Personnel recruitment, contracting, budgeting, and remuneration should focus on transparency and accountability.
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Affiliation(s)
- Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu, Nigeria
| | - Charles Orjiakor
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
- Department of Psychology, University of Toronto, Scarborough, Canada
| | - Pamela Ogbozor
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Psychology, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Ifunanya Agu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Prince Agwu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Social Work, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Tom Wright
- Transparency International Global Health Programme, Transparency International, London, UK
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Jillian Kohler
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
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Scheibe A, Shelly S, Gerardy T, von Homeyer Z, Schneider A, Padayachee K, Naidoo SB, Mtshweni K, Matau A, Hausler H, Marks M. Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa. Addict Sci Clin Pract 2020; 15:13. [PMID: 32085807 PMCID: PMC7035721 DOI: 10.1186/s13722-020-00186-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. METHODS We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. RESULTS The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). CONCLUSIONS Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.
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Affiliation(s)
- Andrew Scheibe
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
| | - Shaun Shelly
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Tara Gerardy
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Zara von Homeyer
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Andrea Schneider
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | | | | | - Klaas Mtshweni
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Ayanda Matau
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Harry Hausler
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Monique Marks
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
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Abrahams N, Mathews S, Lombard C, Martin LJ, Jewkes R. Sexual homicides in South Africa: A national cross-sectional epidemiological study of adult women and children. PLoS One 2017; 12:e0186432. [PMID: 29040329 PMCID: PMC5645125 DOI: 10.1371/journal.pone.0186432] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
METHODS We conducted a retrospective national mortuary based study to identify all adult female homicides (18 years and older) and all child homicides (boys and girls < 18 years) in 2009 in a randomly selected, proportionate sample of mortuaries. Victim, perpetrator and crime data were collected in three processes: from the mortuary register, the autopsy report and from police with the identification of sexual homicides validated across the data collection processes. FINDINGS Among the 2670 (95% CI: 2311-2979) adult women killed in 2009, 494 (95% CI: 406-574) were identified as sexual homicides which was 19.8% (95% CI: 17.6-22.0) of all adult female homicides and among 1277 (95% CI: 1091-1462) children killed in SA, sexual homicides were found in 104 (95% CI: 77-132) of the child homicides which was 8.7% (95% CI: 10.9-11.2%) of these murders. Strangulation was the most common cause of death for both children and adult females. A distinct age and sex pattern was found among children with only 1% boy child death identified as a sexual homicide and 92% of all the child sexual homicides were among girls. Strangulation was the most common manner of death among children (35.5%) and perpetrators were seldom strangers. However, no difference in the proportion of convictions between the sexual homicides and non-sexual homicides were found for both adult females and children. CONCLUSION Rape homicide is not a rare event in South Africa, with one in five female homicides and nearly one in ten child homicides identified with an associated sexual crime. These high prevalences are amongst the highest levels reported in the literature with our study among the few reporting on the epidemiology of child sexual homicide. Reducing mortality is an important policy goal for South Africa and for the rest of the world and the prevention of female and child homicide is an important part of attaining this goal.
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Affiliation(s)
- Naeemah Abrahams
- Gender & Health Research Unit, South African Medical Research Council, Cape Town & Pretoria, South Africa
- * E-mail:
| | - Shanaaz Mathews
- Children’s Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carl Lombard
- Biostatics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lorna J. Martin
- Forensic Pathology Services, Western Cape/ Forensic Medicine & Toxicology, University of Cape Town, Cape Town, South Africa
| | - Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Cape Town & Pretoria, South Africa
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