Attitude of mental healthcare providers toward tele-psychiatry services and associated factors at public referral hospitals in Addis Ababa city, Ethiopia

INTRODUCTION

Health systems around the world are struggling with the massive numbers of people with mental disorders who require professional care. The treatment gap for mental disorders is high all over the world, with between 76 and 85% of people in low- and middle-income countries with severe mental disorders receiving no treatment for their mental health conditions. Tele-psychiatry is used as an alternative solution to the problem of limited mental health services and effective Tele-psychiatry service use may be achievable if mental health providers have a good attitude towards it.

OBJECTIVE

To assess the attitude of mental healthcare providers toward Tele-psychiatry services and associated factors at public referral hospitals in Addis Ababa city, Ethiopia, 2022.

METHOD

A Multicenter institution-based cross-sectional study was conducted among 413 mental health professionals working in public referral hospitals in Addis Ababa city, from May 04 to June 10, 2022. Data were collected by using a structured and self-administered questionnaire prepared by reviewing previous related studies. Epi Data version 3.1 and Stata version 14 were used for data entry and analysis respectively. Bivariate and multivariable logistic regression analyses were used to identify factors associated with attitudes toward Tele-psychiatry services. A statistical significance was declared at p-value < 0.05.

RESULT

A total of 413 Participants were enrolled with a response rate of 91.8%. The majority of respondents 230 (55.69%) were male and the mean age of participants was 29 years (SD + 5.02). In this study the majority (49%) of mental health care professionals had a poor attitude toward Tele-psychiatry. Having electronic health technology experience [AOR 16.79; 95% CI (4.26, 29.3)], lack of training in telemedicine applications [(AOR 0.1; 95% CI (0.01, 0.41)], a good computer uses for daily work activities [AOR 3.65; 95% CI (1.14, 11.60)], availability of e-Health technology awareness program [AOR 0.16; 95% CI (0.03, 0.90)], having a positive perception about the importance of e-Health technologies[AOR 0.041; 95% CI (0.01, 0.29)] and having good knowledge of Tele-psychiatry services [AOR 6.89; 95% CI (1.8, 12.0)] were significantly associated with attitude towards Tele-psychiatry services.

CONCLUSION

This study found that mental healthcare providers at a public referral hospital in Addis Ababa city generally had poor attitudes regarding Tele-psychiatry services. Considering the significant factors will improve the attitude to use tele-psychiatry services in Ethiopia.

The prevalence of common mental disorders among healthcare professionals during the COVID-19 pandemic at a tertiary Hospital in Addis Ababa, Ethiopia

Background

Coronavirus disease 2019 (COVID-19) has resulted in unprecedented morbidity, mortality, and health system crisis leading to a significant psychological destress on healthcare workers (HCWs). The study aimed to determine the prevalence of symptoms of common mental disorders among HCWs during the COVID-19 pandemic at St. Paul's Hospital, Ethiopia.

Methods

A self-administered cross-sectional study was conducted to collect socio-demographic information and symptoms of mental disorders using validated measurement tools. Accordingly, PHQ-9, GAD-7, ISI, and IES-R were used to assess the presence of symptoms of depression, anxiety, insomnia, and distress, respectively. Chi-square test, non-parametric, and logistic regression analysis were used to detect risk factors for common mental disorders.

Results

A total of 420 healthcare workers participated in the survey. The prevalence of symptoms of depression, anxiety, insomnia, and psychological distress was 20.2%, 21.9%, 12.4%, and 15.5% respectively. Frontline HCWs had higher scores of mental health symptoms than non-frontline healthcare workers. Binary logistic regression analysis showed that being married was associated with a high level of depression. Furthermore, working in a frontline position was an independent risk factor associated with a high-level of symptoms of depression, anxiety, and psychological distress.

Limitations

It is a single-center cross-sectional study and the findings may not be nationally representative or reveal causality.

Conclusions

A significant proportion of healthcare workers are suffering from symptoms of mental disorders. Frontline HCWs were at a greater risk of severe symptoms. Therefore, psychological interventions should be implemented to support health professionals, especially frontline workers.

Lipid-based nutrient supplements do not affect efavirenz but lower plasma nevirapine concentrations in Ethiopian adult HIV patients

OBJECTIVES

Lipid-based nutrient supplements (LNSs) are increasingly used in HIV programmes in resource-limited settings. However, the possible effects of LNSs on the plasma concentrations of antiretroviral drugs have not been assessed. Here, we aimed to assess the effects of LNSs on plasma efavirenz and nevirapine trough concentrations in Ethiopian adult HIV-infected patients.

METHODS

The effects of LNSs were studied in adults initiating antiretroviral therapy (ART) in a randomized trial. Patients with body mass index (BMI) > 17 kg/m(2) (n = 282) received daily supplementation of an LNS containing whey (LNS/w), an LNS containing soy (LNS/s) or no LNS. Trough plasma concentrations of efavirenz and nevirapine were measured at 1 and 2 months. Genotyping for 516 G>T and 983 T>C polymorphisms of the cytochrome P450 (CYP) 2B6 locus was performed. Multilevel linear mixed-effects models were used to assess the associations between LNS and plasma efavirenz and nevirapine concentrations.

RESULTS

In patients with BMI > 17 kg/m(2), nevirapine concentrations were lower in the LNS/w and LNS/s groups by a median of -2.3 μg/mL [interquartile range (IQR) -3.9; -0.9 μg/mL; P = 0.002] and -2.1 μg/mL (IQR -3.9; -0.9 μg/mL; P = 0.01), respectively, compared with the group not receiving supplements. There were no differences between groups with respect to efavirenz plasma concentrations. The CYP2B6 516 G>T polymorphism was associated with a 5 μg/mL higher plasma efavirenz concentration compared with the wild type (P < 0.0001), while it was not associated with plasma nevirapine concentrations.

CONCLUSIONS

Intake of an LNS was associated with lower plasma nevirapine trough concentrations, indicating possible drug-LNS interactions. The clinical relevance of such reductions in nevirapine exposure is not clear. Plasma efavirenz concentration was not affected by the LNS.

Overexpression of malate dehydrogenase in transgenic alfalfa enhances organic acid synthesis and confers tolerance to aluminum

Al toxicity is a severe impediment to production of many crops in acid soil. Toxicity can be reduced through lime application to raise soil pH, however this amendment does not remedy subsoil acidity, and liming may not always be practical or cost-effective. Addition of organic acids to plant nutrient solutions alleviates phytotoxic Al effects, presumably by chelating Al and rendering it less toxic. In an effort to increase organic acid secretion and thereby enhance Al tolerance in alfalfa (Medicago sativa), we produced transgenic plants using nodule-enhanced forms of malate dehydrogenase and phosphoenolpyruvate carboxylase cDNAs under the control of the constitutive cauliflower mosaic virus 35S promoter. We report that a 1.6-fold increase in malate dehydrogenase enzyme specific activity in root tips of selected transgenic alfalfa led to a 4.2-fold increase in root concentration as well as a 7.1-fold increase in root exudation of citrate, oxalate, malate, succinate, and acetate compared with untransformed control alfalfa plants. Overexpression of phosphoenolpyruvate carboxylase enzyme specific activity in transgenic alfalfa did not result in increased root exudation of organic acids. The degree of Al tolerance by transformed plants in hydroponic solutions and in naturally acid soil corresponded with their patterns of organic acid exudation and supports the concept that enhancing organic acid synthesis in plants may be an effective strategy to cope with soil acidity and Al toxicity.

Overexpression of malate dehydrogenase in transgenic alfalfa enhances organic acid synthesis and confers tolerance to aluminum

Al toxicity is a severe impediment to production of many crops in acid soil. Toxicity can be reduced through lime application to raise soil pH, however this amendment does not remedy subsoil acidity, and liming may not always be practical or cost-effective. Addition of organic acids to plant nutrient solutions alleviates phytotoxic Al effects, presumably by chelating Al and rendering it less toxic. In an effort to increase organic acid secretion and thereby enhance Al tolerance in alfalfa (Medicago sativa), we produced transgenic plants using nodule-enhanced forms of malate dehydrogenase and phosphoenolpyruvate carboxylase cDNAs under the control of the constitutive cauliflower mosaic virus 35S promoter. We report that a 1.6-fold increase in malate dehydrogenase enzyme specific activity in root tips of selected transgenic alfalfa led to a 4.2-fold increase in root concentration as well as a 7.1-fold increase in root exudation of citrate, oxalate, malate, succinate, and acetate compared with untransformed control alfalfa plants. Overexpression of phosphoenolpyruvate carboxylase enzyme specific activity in transgenic alfalfa did not result in increased root exudation of organic acids. The degree of Al tolerance by transformed plants in hydroponic solutions and in naturally acid soil corresponded with their patterns of organic acid exudation and supports the concept that enhancing organic acid synthesis in plants may be an effective strategy to cope with soil acidity and Al toxicity.

Group-specific differentiation of Rhizobium from clover species by PCR amplification of 23S rDNA sequences

Two 20-bp primers that provide group-specific detection of Rhizobium spp. by polymerase chain reaction (PCR) have been used to differentiate strains that belong to different effectiveness groups within the Rhizobium-Trifolium cross-inoculation group. The target for DNA amplification was a 370-bp fragment of the 23S rDNA region. Analysis of additional root-nodule forming, as well as root-associated bacterial species by PCR-primer assay revealed that variability within this 20-bp segment of the 23S rDNA region may be widespread and provide an effective identification tool. Our data suggest that strains of Rhizobium isolated from the perennial clover Trifolium semipilosum may be phylogenetically more closely related to Rhizobium etli.

Comparison of partial 23S rDNA sequences from Rhizobium species

A hypervariable region of Rhizobium 23S rDNA was amplified by polymerase chain reaction and phylogenetic relationships of several strains were determined by comparing nucleotide sequences of the amplified product. Variation in the 23S rDNA nucleotide sequences was consistent with phylogenetic relationships determined by host nodulation specificity and (or) 16S rDNA sequence analysis. Six strains representing three Rhizobium species (R. leguminosarum bv. trifolii, R. meliloti, and R. etli), and two strains each of Bradyrhizobium and Agrobacterium were clustered into five rDNA groups. Unique features identified by secondary structure analysis of the 23S rRNA sequenced region were consistent with the hypothesis that 23S rDNA could be used to design species- or strain-specific Rhizobium probes.