Publications
The list below includes publications authored or co-authored by researchers supported by ASSET.
2020 |
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Keynejad, Roxanne C; Hanlon, Charlotte; Howard, Louise M The Lancet Psychiatry, 7 (2), pp. 173–190, 2020, ISSN: 22150374.
@article{Keynejad2020,
title = {Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis}, author = {Roxanne C Keynejad and Charlotte Hanlon and Louise M Howard}, url = {http://dx.doi.org/10.1016/S2215-0366(19)30510-3}, doi = {10.1016/S2215-0366(19)30510-3}, issn = {22150374}, year = {2020}, date = {2020-01-01}, journal = {The Lancet Psychiatry}, volume = {7}, number = {2}, pages = {173--190}, publisher = {The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license}, abstract = {Background: Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs). Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611. Findings: Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0textperiodcentered31, 95% CI 0textperiodcentered04 to 0textperiodcentered57}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background: Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs). Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611. Findings: Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0textperiodcentered31, 95% CI 0textperiodcentered04 to 0textperiodcentered57
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Lund, Crick; Schneider, Marguerite; Garman, Emily C; Davies, Thandi; Munodawafa, Memory; Honikman, Simone; Bhana, Arvin; Bass, Judith; Bolton, Paul; Dewey, Michael; Joska, John; Kagee, Ashraf; Myer, Landon; Petersen, Inge; Prince, Martin; Stein, Dan J; Tabana, Hanani; Thornicroft, Graham; Tomlinson, Mark; Hanlon, Charlotte; Alem, Atalay; Susser, Ezra Behaviour Research and Therapy, 130 (August 2019), pp. 103466, 2020, ISSN: 1873622X.
@article{Lund2020,
title = {Task-sharing of psychological treatment for antenatal depression in Khayelitsha, South Africa: Effects on antenatal and postnatal outcomes in an individual randomised controlled trial}, author = {Crick Lund and Marguerite Schneider and Emily C Garman and Thandi Davies and Memory Munodawafa and Simone Honikman and Arvin Bhana and Judith Bass and Paul Bolton and Michael Dewey and John Joska and Ashraf Kagee and Landon Myer and Inge Petersen and Martin Prince and Dan J Stein and Hanani Tabana and Graham Thornicroft and Mark Tomlinson and Charlotte Hanlon and Atalay Alem and Ezra Susser}, url = {https://doi.org/10.1016/j.brat.2019.103466}, doi = {10.1016/j.brat.2019.103466}, issn = {1873622X}, year = {2020}, date = {2020-01-01}, journal = {Behaviour Research and Therapy}, volume = {130}, number = {August 2019}, pages = {103466}, publisher = {Elsevier}, abstract = {The study's objective was to determine the effectiveness of a task-sharing psychological treatment for perinatal depression using non-specialist community health workers. A double-blind individual randomised controlled trial was conducted in two antenatal clinics in the peri-urban settlement of Khayelitsha, Cape Town. Adult pregnant women who scored 13 or above on the Edinburgh Postnatal Depression rating Scale (EPDS) were randomised into the intervention arm (structured six-session psychological treatment) or the control arm (routine antenatal health care and three monthly phone calls). The primary outcome was response on the Hamilton Depression Rating Scale (HDRS) at three months postpartum (minimum 40% score reduction from baseline) among participants who did not experience pregnancy or infant loss (modified intention-to-treat population) (registered on Clinical Trials: NCT01977326). Of 2187 eligible women approached, 425 (19.4%) screened positive on the EPDS and were randomised; 384 were included in the modified intention-to-treat analysis (control: n = 200; intervention: n = 184). There were no significant differences in response on the HDRS at three months postpartum between the intervention and control arm. A task-sharing psychological treatment was not effective in treating depression among women living in Khayelitsha, South Africa. The findings give cause for reflection on the strategy of task-sharing in low-resource settings.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
The study's objective was to determine the effectiveness of a task-sharing psychological treatment for perinatal depression using non-specialist community health workers. A double-blind individual randomised controlled trial was conducted in two antenatal clinics in the peri-urban settlement of Khayelitsha, Cape Town. Adult pregnant women who scored 13 or above on the Edinburgh Postnatal Depression rating Scale (EPDS) were randomised into the intervention arm (structured six-session psychological treatment) or the control arm (routine antenatal health care and three monthly phone calls). The primary outcome was response on the Hamilton Depression Rating Scale (HDRS) at three months postpartum (minimum 40% score reduction from baseline) among participants who did not experience pregnancy or infant loss (modified intention-to-treat population) (registered on Clinical Trials: NCT01977326). Of 2187 eligible women approached, 425 (19.4%) screened positive on the EPDS and were randomised; 384 were included in the modified intention-to-treat analysis (control: n = 200; intervention: n = 184). There were no significant differences in response on the HDRS at three months postpartum between the intervention and control arm. A task-sharing psychological treatment was not effective in treating depression among women living in Khayelitsha, South Africa. The findings give cause for reflection on the strategy of task-sharing in low-resource settings.
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Janse Van Rensburg, André ; Dube, Audry; Curran, Robyn; Ambaw, Fentie; Murdoch, Jamie; Bachmann, Max; Petersen, Inge; Fairall, Lara Infectious Diseases of Poverty, 9 (1), 2020, ISSN: 20499957.
@article{JanseVanRensburg2020,
title = {Comorbidities between tuberculosis and common mental disorders: A scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries}, author = {André {Janse Van Rensburg} and Audry Dube and Robyn Curran and Fentie Ambaw and Jamie Murdoch and Max Bachmann and Inge Petersen and Lara Fairall}, doi = {10.1186/s40249-019-0619-4}, issn = {20499957}, year = {2020}, date = {2020-01-01}, journal = {Infectious Diseases of Poverty}, volume = {9}, number = {1}, publisher = {Infectious Diseases of Poverty}, abstract = {Background: There is increasing evidence that the substantial global burden of disease for tuberculosis unfolds in concert with dimensions of common mental disorders. Person-centred care holds much promise to ameliorate these comorbidities in low-to-middle income countries (LMICs) and emerging economies. Towards this end, this paper aims to review 1) the nature and extent of tuberculosis and common mental disorder comorbidity and 2) person-centred tuberculosis care in low-to-middle income countries and emerging economies. Main text: A scoping review of 100 articles was conducted of English-language studies published from 2000 to 2019 in peer-reviewed and grey literature, using established guidelines, for each of the study objectives. Four broad tuberculosis/mental disorder comorbidities were described in the literature, namely alcohol use and tuberculosis, depression and tuberculosis, anxiety and tuberculosis, and general mental health and tuberculosis. Rates of comorbidity varied widely across countries for depression, anxiety, alcohol use and general mental health. Alcohol use and tuberculosis were significantly related, especially in the context of poverty. The initial tuberculosis diagnostic episode had substantial socio-psychological effects on service users. While men tended to report higher rates of alcohol use and treatment default, women in general had worse mental health outcomes. Older age and a history of mental illness were also associated with pronounced tuberculosis and mental disorder comorbidity. Person-centred tuberculosis care interventions were almost absent, with only one study from Nepal identified. Conclusions: There is an emerging body of evidence describing the nature and extent of tuberculosis and mental disorders comorbidity in low-to-middle income countries. Despite the potential of person-centred interventions, evidence is limited. This review highlights a pronounced need to address psychosocial comorbidities with tuberculosis in LMICs, where models of person-centred tuberculosis care in routine care platforms may yield promising outcomes.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background: There is increasing evidence that the substantial global burden of disease for tuberculosis unfolds in concert with dimensions of common mental disorders. Person-centred care holds much promise to ameliorate these comorbidities in low-to-middle income countries (LMICs) and emerging economies. Towards this end, this paper aims to review 1) the nature and extent of tuberculosis and common mental disorder comorbidity and 2) person-centred tuberculosis care in low-to-middle income countries and emerging economies. Main text: A scoping review of 100 articles was conducted of English-language studies published from 2000 to 2019 in peer-reviewed and grey literature, using established guidelines, for each of the study objectives. Four broad tuberculosis/mental disorder comorbidities were described in the literature, namely alcohol use and tuberculosis, depression and tuberculosis, anxiety and tuberculosis, and general mental health and tuberculosis. Rates of comorbidity varied widely across countries for depression, anxiety, alcohol use and general mental health. Alcohol use and tuberculosis were significantly related, especially in the context of poverty. The initial tuberculosis diagnostic episode had substantial socio-psychological effects on service users. While men tended to report higher rates of alcohol use and treatment default, women in general had worse mental health outcomes. Older age and a history of mental illness were also associated with pronounced tuberculosis and mental disorder comorbidity. Person-centred tuberculosis care interventions were almost absent, with only one study from Nepal identified. Conclusions: There is an emerging body of evidence describing the nature and extent of tuberculosis and mental disorders comorbidity in low-to-middle income countries. Despite the potential of person-centred interventions, evidence is limited. This review highlights a pronounced need to address psychosocial comorbidities with tuberculosis in LMICs, where models of person-centred tuberculosis care in routine care platforms may yield promising outcomes.
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Keynejad, Roxanne C; Hanlon, Charlotte; Howard, Louise M The Lancet Psychiatry, 7 (2), pp. 173–190, 2020, ISSN: 22150374.
@article{Keynejad2020b,
title = {Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis}, author = {Roxanne C Keynejad and Charlotte Hanlon and Louise M Howard}, url = {http://dx.doi.org/10.1016/S2215-0366(19)30510-3}, doi = {10.1016/S2215-0366(19)30510-3}, issn = {22150374}, year = {2020}, date = {2020-01-01}, journal = {The Lancet Psychiatry}, volume = {7}, number = {2}, pages = {173--190}, publisher = {The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license}, abstract = {Background: Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs). Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611. Findings: Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0textperiodcentered31, 95% CI 0textperiodcentered04 to 0textperiodcentered57}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background: Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs). Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611. Findings: Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0textperiodcentered31, 95% CI 0textperiodcentered04 to 0textperiodcentered57
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Whitaker, J; Nepogodiev, D; Leather, A; Davies, J Assessing barriers to quality trauma care in low and middle-income countries: A Delphi study Journal Article Injury, 51 (2), pp. 278–285, 2020, ISSN: 18790267.
@article{Whitaker2020,
title = {Assessing barriers to quality trauma care in low and middle-income countries: A Delphi study}, author = {J Whitaker and D Nepogodiev and A Leather and J Davies}, url = {https://doi.org/10.1016/j.injury.2019.12.035}, doi = {10.1016/j.injury.2019.12.035}, issn = {18790267}, year = {2020}, date = {2020-01-01}, journal = {Injury}, volume = {51}, number = {2}, pages = {278--285}, publisher = {Elsevier Ltd}, abstract = {Background: Most deaths from injury occur in Low and Middle Income Countries (LMICs) with one third potentially avoidable with better health system access. This study aimed to establish consensus on the most important barriers, within a Three Delays framework, to accessing injury care in LMICs that should be considered when evaluating a health system. Methods: A three round electronic Delphi study was conducted with experts in LMIC health systems or injury care. In round one, participants proposed important barriers. These were synthesized into a three delays framework. In round 2 participants scored four components for each barrier. Components measured whether barriers were feasible to assess, likely to delay care for a significant proportion of injured persons, likely to cause avoidable death or disability, and potentially readily changed to improve care. In round 3 participants re-scored each barrier following review of feedback from round 2. Consensus was defined for each component as ≥70% agreement or disagreement. Results: There were 37 eligible responses in round 1, 30 in round 2, and 27 in round 3, with 21 countries represented in all rounds. Of the twenty conceptual barriers identified, consensus was reached on all four components for 11 barriers. This included 2 barriers to seeking care, 5 barriers to reaching care and 4 barriers to receiving care. The ability to modify a barrier most frequently failed to achieve consensus. Conclusion: 11 barriers were agreed to be feasible to assess, delay care for many, cause avoidable death or disability, and be readily modifiable. We recommend these barriers are considered in assessments of LMIC trauma systems.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background: Most deaths from injury occur in Low and Middle Income Countries (LMICs) with one third potentially avoidable with better health system access. This study aimed to establish consensus on the most important barriers, within a Three Delays framework, to accessing injury care in LMICs that should be considered when evaluating a health system. Methods: A three round electronic Delphi study was conducted with experts in LMIC health systems or injury care. In round one, participants proposed important barriers. These were synthesized into a three delays framework. In round 2 participants scored four components for each barrier. Components measured whether barriers were feasible to assess, likely to delay care for a significant proportion of injured persons, likely to cause avoidable death or disability, and potentially readily changed to improve care. In round 3 participants re-scored each barrier following review of feedback from round 2. Consensus was defined for each component as ≥70% agreement or disagreement. Results: There were 37 eligible responses in round 1, 30 in round 2, and 27 in round 3, with 21 countries represented in all rounds. Of the twenty conceptual barriers identified, consensus was reached on all four components for 11 barriers. This included 2 barriers to seeking care, 5 barriers to reaching care and 4 barriers to receiving care. The ability to modify a barrier most frequently failed to achieve consensus. Conclusion: 11 barriers were agreed to be feasible to assess, delay care for many, cause avoidable death or disability, and be readily modifiable. We recommend these barriers are considered in assessments of LMIC trauma systems.
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White, Michelle C; Daya, Leonid; Brice Karel, Fabo Kwemi ; White, Graham; Abid, Sonia; Fitzgerald, Aoife; Mballa, Alain Etoundi G; Sevdalis, Nick; Leather, Andrew J M Using the knowledge to action framework to describe a nationwide implementation of the WHO surgical safety checklist in Cameroon Journal Article Anesthesia and Analgesia, 130 (5), pp. 1425–1434, 2020, ISSN: 15267598.
@article{White2020,
title = {Using the knowledge to action framework to describe a nationwide implementation of the WHO surgical safety checklist in Cameroon}, author = {Michelle C White and Leonid Daya and Fabo Kwemi {Brice Karel} and Graham White and Sonia Abid and Aoife Fitzgerald and Alain Etoundi G Mballa and Nick Sevdalis and Andrew J M Leather}, doi = {10.1213/ANE.0000000000004586}, issn = {15267598}, year = {2020}, date = {2020-01-01}, journal = {Anesthesia and Analgesia}, volume = {130}, number = {5}, pages = {1425--1434}, abstract = {BACKGROUND: Surgical safety has advanced rapidly with evidence of improved patient outcomes through structural and process interventions. However, knowledge of how to apply these interventions successfully and sustainably at scale is often lacking. The 2019 Global Ministerial Patient Safety Summit called for a focus on implementation strategies to maintain momentum in patient safety improvements, especially in low- and middle-income settings. This study uses an implementation framework, knowledge to action, to examine a model of nationwide World Health Organization (WHO) Surgical Safety Checklist implementation in Cameroon. Cameroon is a lower-middle-income country, and based on data from high- and low-income countries, we hypothesized that more than 50% of participants would be using the checklist (penetration) in the correct manner (fidelity) 4 months postintervention. METHODS: A collaboration of 3 stakeholders (Ministry of Health, academic institution, and nongovernmental organization) used a prospective observational design. Based on knowledge to action, there were 3 phases to the study implementation: problem identification (lack of routine checklist use in Cameroonian hospitals), multifaceted implementation strategy (3-day multidisciplinary training course, coaching, facilitated leadership engagement, and support networks), and outcome evaluation 4 months postintervention. Validated implementation outcomes were assessed. Primary outcomes were checklist use (penetration) and fidelity; secondary outcomes were perioperative teams' reactions, learning and behavior change; and tertiary outcomes were perioperative teams' acceptability of the checklist. RESULTS: Three hundred and fifty-one operating room staff members from 25 hospitals received training. Median time to evaluation was 4.5 months (interquartile range [IQR]: 4.5–5.5, range 3–7); checklist use (penetration) increased from 20% (95% confidence interval [CI], 16–25) to 56% (95% CI, 49–63); fidelity for adherence to 6 basic safety processes was high: verification of patient identification was 91% (95% CI, 87–95); risk assessment for difficult intubation was 79% (95% CI, 73–85): risk assessment for blood loss was 88% (95% CI, 83–93) use of pulse oximetry was 93% (95% CI, 90–97); antibiotic administration was 95% (95% CI, 91–98); surgical counting was 89% (95% CI, 84–93); and fidelity for nontechnical skills measured by the WHO Behaviorally Anchored Rating Scale was 4.5 of 7 (95% CI, 3.5–5.4). Median scores for all secondary outcomes were 10/10, and 7 acceptability measures were consistently more than 70%. CONCLUSIONS: This study shows that a multifaceted implementation strategy is associated with successful checklist implementation in a lower-middle-income country such as Cameroon, and suggests that a theoretical framework can be used to practically drive nationwide scale-up of checklist use.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
BACKGROUND: Surgical safety has advanced rapidly with evidence of improved patient outcomes through structural and process interventions. However, knowledge of how to apply these interventions successfully and sustainably at scale is often lacking. The 2019 Global Ministerial Patient Safety Summit called for a focus on implementation strategies to maintain momentum in patient safety improvements, especially in low- and middle-income settings. This study uses an implementation framework, knowledge to action, to examine a model of nationwide World Health Organization (WHO) Surgical Safety Checklist implementation in Cameroon. Cameroon is a lower-middle-income country, and based on data from high- and low-income countries, we hypothesized that more than 50% of participants would be using the checklist (penetration) in the correct manner (fidelity) 4 months postintervention. METHODS: A collaboration of 3 stakeholders (Ministry of Health, academic institution, and nongovernmental organization) used a prospective observational design. Based on knowledge to action, there were 3 phases to the study implementation: problem identification (lack of routine checklist use in Cameroonian hospitals), multifaceted implementation strategy (3-day multidisciplinary training course, coaching, facilitated leadership engagement, and support networks), and outcome evaluation 4 months postintervention. Validated implementation outcomes were assessed. Primary outcomes were checklist use (penetration) and fidelity; secondary outcomes were perioperative teams' reactions, learning and behavior change; and tertiary outcomes were perioperative teams' acceptability of the checklist. RESULTS: Three hundred and fifty-one operating room staff members from 25 hospitals received training. Median time to evaluation was 4.5 months (interquartile range [IQR]: 4.5–5.5, range 3–7); checklist use (penetration) increased from 20% (95% confidence interval [CI], 16–25) to 56% (95% CI, 49–63); fidelity for adherence to 6 basic safety processes was high: verification of patient identification was 91% (95% CI, 87–95); risk assessment for difficult intubation was 79% (95% CI, 73–85): risk assessment for blood loss was 88% (95% CI, 83–93) use of pulse oximetry was 93% (95% CI, 90–97); antibiotic administration was 95% (95% CI, 91–98); surgical counting was 89% (95% CI, 84–93); and fidelity for nontechnical skills measured by the WHO Behaviorally Anchored Rating Scale was 4.5 of 7 (95% CI, 3.5–5.4). Median scores for all secondary outcomes were 10/10, and 7 acceptability measures were consistently more than 70%. CONCLUSIONS: This study shows that a multifaceted implementation strategy is associated with successful checklist implementation in a lower-middle-income country such as Cameroon, and suggests that a theoretical framework can be used to practically drive nationwide scale-up of checklist use.
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Frissa, Souci; Dessalegn, Bazghina-werq Semo The mental health impact of the COVID-19 pandemic: Implications for sub-Saharan Africa. Journal Article 19 , 2020.
@article{Frissa2020,
title = {The mental health impact of the COVID-19 pandemic: Implications for sub-Saharan Africa.}, author = {Souci Frissa and Bazghina-werq Semo Dessalegn}, doi = {10.31219/osf.io/yq9kn}, year = {2020}, date = {2020-01-01}, volume = {19}, abstract = {The COVID-19 pandemic is leading to mental health problems due to disease experience, physical distancing, stigma and discrimination, and job losses in many of the settings hardest hit by the pandemic. Health care workers, patients with COVID-19 and other illnesses, children, women, youth, and the elderly are experiencing post-traumatic stress disorders, anxiety, depression, and suicidal ideation. Virtual mental health services have been established in many settings and social media is being used to impart mental health education and communication resources. Mental health services across countries hardest hit by the COVID-19 pandemic need to be scaled up further and coordinated better to ensure equity and efficiency.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
The COVID-19 pandemic is leading to mental health problems due to disease experience, physical distancing, stigma and discrimination, and job losses in many of the settings hardest hit by the pandemic. Health care workers, patients with COVID-19 and other illnesses, children, women, youth, and the elderly are experiencing post-traumatic stress disorders, anxiety, depression, and suicidal ideation. Virtual mental health services have been established in many settings and social media is being used to impart mental health education and communication resources. Mental health services across countries hardest hit by the COVID-19 pandemic need to be scaled up further and coordinated better to ensure equity and efficiency.
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Bitew, Tesera; Keynejad, Roxanne; Honikman, Simone; Sorsdahl, Katherine; Myers, Bronwyn; Fekadu, Abebaw; Hanlon, Charlotte Stakeholder perspectives on antenatal depression and the potential for psychological intervention in rural Ethiopia: a qualitative study Journal Article BMC pregnancy and childbirth, 20 (1), pp. 371, 2020, ISSN: 14712393.
@article{Bitew2020,
title = {Stakeholder perspectives on antenatal depression and the potential for psychological intervention in rural Ethiopia: a qualitative study}, author = {Tesera Bitew and Roxanne Keynejad and Simone Honikman and Katherine Sorsdahl and Bronwyn Myers and Abebaw Fekadu and Charlotte Hanlon}, doi = {10.1186/s12884-020-03069-6}, issn = {14712393}, year = {2020}, date = {2020-01-01}, journal = {BMC pregnancy and childbirth}, volume = {20}, number = {1}, pages = {371}, publisher = {BMC Pregnancy and Childbirth}, abstract = {BACKGROUND: Psychological interventions for antenatal depression are an integral part of evidence-based care but need to be contextualised for respective sociocultural settings. In this study, we aimed to understand women and healthcare workers' (HCWs) perspectives of antenatal depression, their treatment preferences and potential acceptability and feasibility of psychological interventions in the rural Ethiopian context. METHODS: In-depth interviews were conducted with women who had previously scored above the locally validated cut-off (five or more) on the Patient Health Questionnaire during pregnancy (n = 8), primary healthcare workers (HCWs; nurses, midwives and health officers) (n = 8) and community-based health extension workers (n = 7). Translated interview transcripts were analysed using thematic analysis. RESULTS: Women expressed their distress largely through somatic complaints, such as a headache and feeling weak. Facility and community-based HCWs suspected antenatal depression when women reported reduced appetite, sleep problems, difficulty bonding with the baby, or if they refused to breast-feed or were poorly engaged with antenatal care. Both women and HCWs perceived depression as a reaction ("thinking too much") to social adversities such as poverty, marital conflict, perinatal complications and losses. Depressive symptoms and social adversities were often attributed to spiritual causes. Women awaited God's will in isolation at home or talked to neighbours as coping mechanisms. HCWs' motivation to provide help, the availability of integrated primary mental health care and a culture among women of seeking advice were potential facilitators for acceptability of a psychological intervention. Fears of being seen publicly during pregnancy, domestic and farm workload and staff shortages in primary healthcare were potential barriers to acceptability of the intervention. Antenatal care providers such as midwives were considered best placed to deliver interventions, given their close interaction with women during pregnancy. CONCLUSIONS: Women and HCWs in rural Ethiopia linked depressive symptoms in pregnancy with social adversities, suggesting that interventions which help women cope with real-world difficulties may be acceptable. Intervention design should accommodate the identified facilitators and barriers to implementation.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
BACKGROUND: Psychological interventions for antenatal depression are an integral part of evidence-based care but need to be contextualised for respective sociocultural settings. In this study, we aimed to understand women and healthcare workers' (HCWs) perspectives of antenatal depression, their treatment preferences and potential acceptability and feasibility of psychological interventions in the rural Ethiopian context. METHODS: In-depth interviews were conducted with women who had previously scored above the locally validated cut-off (five or more) on the Patient Health Questionnaire during pregnancy (n = 8), primary healthcare workers (HCWs; nurses, midwives and health officers) (n = 8) and community-based health extension workers (n = 7). Translated interview transcripts were analysed using thematic analysis. RESULTS: Women expressed their distress largely through somatic complaints, such as a headache and feeling weak. Facility and community-based HCWs suspected antenatal depression when women reported reduced appetite, sleep problems, difficulty bonding with the baby, or if they refused to breast-feed or were poorly engaged with antenatal care. Both women and HCWs perceived depression as a reaction ("thinking too much") to social adversities such as poverty, marital conflict, perinatal complications and losses. Depressive symptoms and social adversities were often attributed to spiritual causes. Women awaited God's will in isolation at home or talked to neighbours as coping mechanisms. HCWs' motivation to provide help, the availability of integrated primary mental health care and a culture among women of seeking advice were potential facilitators for acceptability of a psychological intervention. Fears of being seen publicly during pregnancy, domestic and farm workload and staff shortages in primary healthcare were potential barriers to acceptability of the intervention. Antenatal care providers such as midwives were considered best placed to deliver interventions, given their close interaction with women during pregnancy. CONCLUSIONS: Women and HCWs in rural Ethiopia linked depressive symptoms in pregnancy with social adversities, suggesting that interventions which help women cope with real-world difficulties may be acceptable. Intervention design should accommodate the identified facilitators and barriers to implementation.
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Brima, Nataliya; Davies, Justine; Leather, Andrew Jm BMJ open, 10 (5), pp. e036615, 2020, ISSN: 20446055.
@article{Brima2020,
title = {Improving quality of surgical and anaesthesia care at hospital level in sub-Saharan Africa: a systematic review protocol of health system strengthening interventions}, author = {Nataliya Brima and Justine Davies and Andrew Jm Leather}, doi = {10.1136/bmjopen-2019-036615}, issn = {20446055}, year = {2020}, date = {2020-01-01}, journal = {BMJ open}, volume = {10}, number = {5}, pages = {e036615}, abstract = {INTRODUCTION: Over 5 billion people in the world do not have access to safe, affordable surgical and anaesthesia care when needed. In order to improve health outcomes in patients with surgical conditions, both access to care and the quality of care need to be improved. A recent commission on high-quality health systems highlighted that poor-quality care is now a bigger barrier than non-utilisation of the health system for reducing mortality. AIM: To carry out a systematic review to provide an evidence-based summary of hospital-based interventions associated with improved quality of surgical and anaesthesia care in sub-Saharan African countries (SSACs). METHODS AND ANALYSIS: Three search strings (1) surgery and anaesthesia, (2) quality improvement hospital-based interventions and (3) SSACs will be combined. The following databases EMBASE, Global Health, MEDLINE, CINAHL, Web of Science and Scopus will be searched. Further relevant studies will be identified from national and international health organisations and publications and reference lists of all selected full-text articles. The review will include all type of original articles in English published between 2008 and 2019. Article screening, data extraction and assessment of methodological quality will be done by two reviewers independently and any disputes will be resolved by a third reviewer or team consensus. Three types of outcomes will be collected including clinical, process and implementation outcomes. The primary outcome will be mortality. Secondary outcomes will include other clinical outcomes (major and minor complications), as well as process and implementation outcomes. Descriptive statistics and outcomes will be summarised and discussed. For the primary outcome, the methodological rigour will be assessed. ETHICS AND DISSEMINATION: The results will be published in a peer reviewed open access journal and presented at national and international conferences. As this is a review of secondary data no formal ethical approval is required. PROSPERO REGISTRATION NUMBER: .}, keywords = {}, pubstate = {published}, tppubtype = {article} }
INTRODUCTION: Over 5 billion people in the world do not have access to safe, affordable surgical and anaesthesia care when needed. In order to improve health outcomes in patients with surgical conditions, both access to care and the quality of care need to be improved. A recent commission on high-quality health systems highlighted that poor-quality care is now a bigger barrier than non-utilisation of the health system for reducing mortality. AIM: To carry out a systematic review to provide an evidence-based summary of hospital-based interventions associated with improved quality of surgical and anaesthesia care in sub-Saharan African countries (SSACs). METHODS AND ANALYSIS: Three search strings (1) surgery and anaesthesia, (2) quality improvement hospital-based interventions and (3) SSACs will be combined. The following databases EMBASE, Global Health, MEDLINE, CINAHL, Web of Science and Scopus will be searched. Further relevant studies will be identified from national and international health organisations and publications and reference lists of all selected full-text articles. The review will include all type of original articles in English published between 2008 and 2019. Article screening, data extraction and assessment of methodological quality will be done by two reviewers independently and any disputes will be resolved by a third reviewer or team consensus. Three types of outcomes will be collected including clinical, process and implementation outcomes. The primary outcome will be mortality. Secondary outcomes will include other clinical outcomes (major and minor complications), as well as process and implementation outcomes. Descriptive statistics and outcomes will be summarised and discussed. For the primary outcome, the methodological rigour will be assessed. ETHICS AND DISSEMINATION: The results will be published in a peer reviewed open access journal and presented at national and international conferences. As this is a review of secondary data no formal ethical approval is required. PROSPERO REGISTRATION NUMBER: .
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Abraham, Teklu; Teferra, Solomon; Yilma, Tesfaye; Hanlon, Charlotte; Abraham, Teklu; Teferra, Solomon; Yilma, Tesfaye; Hanlon, Charlotte Treatment Gap for Co-Morbid Depression in Medical Outpatients with Hypertension: A Cross-Sectional Hospital-Based Study Journal Article 58 (2), pp. 105–114, 2020.
@article{Abraham2020,
title = {Treatment Gap for Co-Morbid Depression in Medical Outpatients with Hypertension: A Cross-Sectional Hospital-Based Study}, author = {Teklu Abraham and Solomon Teferra and Tesfaye Yilma and Charlotte Hanlon and Teklu Abraham and Solomon Teferra and Tesfaye Yilma and Charlotte Hanlon}, year = {2020}, date = {2020-01-01}, volume = {58}, number = {2}, pages = {105--114}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
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Robbins, Tanya; Shennan, Andrew; Sandall, Jane Modified early obstetric warning scores: A promising tool but more evidence and standardization is required Journal Article Acta Obstetricia et Gynecologica Scandinavica, 98 (1), pp. 7–10, 2019, ISSN: 16000412.
@article{Robbins2019,
title = {Modified early obstetric warning scores: A promising tool but more evidence and standardization is required}, author = {Tanya Robbins and Andrew Shennan and Jane Sandall}, doi = {10.1111/aogs.13448}, issn = {16000412}, year = {2019}, date = {2019-01-01}, journal = {Acta Obstetricia et Gynecologica Scandinavica}, volume = {98}, number = {1}, pages = {7--10}, abstract = {Early warning systems involve the routine monitoring and recording of vital signs or clinical observations on specifically designed charts with linked escalation protocols. Meeting criteria for abnormal physiological parameters triggers a color-coded or weighted scoring system aimed to guide the frequency of monitoring, need for, and urgency of clinical review. Color-coded systems trigger a clinical response when one or more abnormal observation is recorded in the red zone or two or more mildly abnormal parameters in the amber zone. The principle of maternity-specific early warning systems to structure surveillance for hospitalized women is intuitive. The widespread use and policy support, including recommendations following confidential enquiries and from the National Health Service Litigation Authority, is not, however, currently backed up by a strong evidence base. Research is required to develop predictive models and validate evidence-based maternity-specific early warning systems in the general maternity population.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Early warning systems involve the routine monitoring and recording of vital signs or clinical observations on specifically designed charts with linked escalation protocols. Meeting criteria for abnormal physiological parameters triggers a color-coded or weighted scoring system aimed to guide the frequency of monitoring, need for, and urgency of clinical review. Color-coded systems trigger a clinical response when one or more abnormal observation is recorded in the red zone or two or more mildly abnormal parameters in the amber zone. The principle of maternity-specific early warning systems to structure surveillance for hospitalized women is intuitive. The widespread use and policy support, including recommendations following confidential enquiries and from the National Health Service Litigation Authority, is not, however, currently backed up by a strong evidence base. Research is required to develop predictive models and validate evidence-based maternity-specific early warning systems in the general maternity population.
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Bitew, Tesera; Hanlon, Charlotte; Medhin, Girmay; Fekadu, Abebaw Antenatal predictors of incident and persistent postnatal depressive symptoms in rural Ethiopia: A population-based prospective study Journal Article Reproductive Health, 16 (1), pp. 1–9, 2019, ISSN: 17424755.
@article{Bitew2019,
title = {Antenatal predictors of incident and persistent postnatal depressive symptoms in rural Ethiopia: A population-based prospective study}, author = {Tesera Bitew and Charlotte Hanlon and Girmay Medhin and Abebaw Fekadu}, doi = {10.1186/s12978-019-0690-0}, issn = {17424755}, year = {2019}, date = {2019-01-01}, journal = {Reproductive Health}, volume = {16}, number = {1}, pages = {1--9}, publisher = {Reproductive Health}, abstract = {Background: There have been few studies to examine antenatal predictors of incident postnatal depression, particularly in low- and middle-income countries (LMICs). The aim of this study was to investigate antenatal predictors of incident and persistent maternal depression in a rural Ethiopian community in order to inform development of antenatal interventions. Method: A population-based prospective study was conducted in Sodo district, south central Ethiopia. A locally validated version of the Patient Health Questionnaire (PHQ-9) was used to assess antenatal (second and third trimesters) and postnatal (4-12 weeks after childbirth) depressive symptoms, with a PHQ-9 cut-off of five or more indicating high depressive symptoms. Poisson regression with robust standard errors was used to identify independent predictors of persistence and incidence of postnatal depressive symptoms from a range of antenatal, clinical and psychosocial risk factors. Result: Out of 1311 women recruited antenatally, 1240 (356 with and 884 without antenatal depressive symptoms) were followed up in the postnatal period. Among 356 women with antenatal depressive symptoms, the elevated symptoms persisted into postnatal period in 138 women (38.8%). Out of 884 women without antenatal depressive symptoms, 136 (15.4%) experienced incident elevated depressive symptoms postnatally. The prevalence of high postnatal depressive symptoms in the follow-up sample was 274 (22.1%). Higher intimate partner violence scores in pregnancy were significantly associated with greater risk of incident depressive symptoms [adjusted Risk Ratio (aRR) = 1.06, 95% CI: 1.00, 1.12]. Each 1-point increment in baseline PHQ-9 score predicted an increased risk of incidence of postnatal depressive symptoms (aRR = 1.29, 95% CI: 1.15, 1.45). There was no association between self-reported pregnancy complications, medical conditions or experience of threatening life events with either incidence or persistence of depressive symptoms. Conclusion: Psychological and social interventions to address intimate partner violence during pregnancy may be the most important priorities, able to address both incident and persistent depression.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background: There have been few studies to examine antenatal predictors of incident postnatal depression, particularly in low- and middle-income countries (LMICs). The aim of this study was to investigate antenatal predictors of incident and persistent maternal depression in a rural Ethiopian community in order to inform development of antenatal interventions. Method: A population-based prospective study was conducted in Sodo district, south central Ethiopia. A locally validated version of the Patient Health Questionnaire (PHQ-9) was used to assess antenatal (second and third trimesters) and postnatal (4-12 weeks after childbirth) depressive symptoms, with a PHQ-9 cut-off of five or more indicating high depressive symptoms. Poisson regression with robust standard errors was used to identify independent predictors of persistence and incidence of postnatal depressive symptoms from a range of antenatal, clinical and psychosocial risk factors. Result: Out of 1311 women recruited antenatally, 1240 (356 with and 884 without antenatal depressive symptoms) were followed up in the postnatal period. Among 356 women with antenatal depressive symptoms, the elevated symptoms persisted into postnatal period in 138 women (38.8%). Out of 884 women without antenatal depressive symptoms, 136 (15.4%) experienced incident elevated depressive symptoms postnatally. The prevalence of high postnatal depressive symptoms in the follow-up sample was 274 (22.1%). Higher intimate partner violence scores in pregnancy were significantly associated with greater risk of incident depressive symptoms [adjusted Risk Ratio (aRR) = 1.06, 95% CI: 1.00, 1.12]. Each 1-point increment in baseline PHQ-9 score predicted an increased risk of incidence of postnatal depressive symptoms (aRR = 1.29, 95% CI: 1.15, 1.45). There was no association between self-reported pregnancy complications, medical conditions or experience of threatening life events with either incidence or persistence of depressive symptoms. Conclusion: Psychological and social interventions to address intimate partner violence during pregnancy may be the most important priorities, able to address both incident and persistent depression.
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Thornicroft, Graham; Ahuja, Shalini; Barber, Sarah; Chisholm, Daniel; Collins, Pamela Y; Docrat, Sumaiyah; Fairall, Lara; Lempp, Heidi; Niaz, Unaiza; Ngo, Vicky; Patel, Vikram; Petersen, Inge; Prince, Martin; Semrau, Maya; Unützer, Jürgen; Yueqin, Huang; Zhang, Shuo Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries Journal Article The Lancet Psychiatry, 6 (2), pp. 174–186, 2019, ISSN: 22150374.
@article{Thornicroft2019,
title = {Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries}, author = {Graham Thornicroft and Shalini Ahuja and Sarah Barber and Daniel Chisholm and Pamela Y Collins and Sumaiyah Docrat and Lara Fairall and Heidi Lempp and Unaiza Niaz and Vicky Ngo and Vikram Patel and Inge Petersen and Martin Prince and Maya Semrau and Jürgen Unützer and Huang Yueqin and Shuo Zhang}, doi = {10.1016/S2215-0366(18)30298-0}, issn = {22150374}, year = {2019}, date = {2019-01-01}, journal = {The Lancet Psychiatry}, volume = {6}, number = {2}, pages = {174--186}, abstract = {Integrated care is defined as health services that are managed and delivered such that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services, coordinated across the different levels and sites of care within and beyond the health sector and, according to their needs, throughout the life course. In this Review, we describe the most relevant concepts and models of integrated care for people with chronic (or recurring) mental illness and comorbid physical health conditions, provide a conceptual overview and a narrative review of the strength of the evidence base for these models in high-income countries and in low-income and middle-income countries, and identify opportunities to test the feasibility and effects of such integrated care models. We discuss the rationale for integrating care for people with mental disorders into chronic care; the models of integrated care; the evidence of the effects of integrating care in high-income countries and in low-income and middle-income countries; the key organisational challenges to implementing integrated chronic care in low-income and middle-income countries; and the practical steps to realising a vision of integrated care in the future.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Integrated care is defined as health services that are managed and delivered such that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services, coordinated across the different levels and sites of care within and beyond the health sector and, according to their needs, throughout the life course. In this Review, we describe the most relevant concepts and models of integrated care for people with chronic (or recurring) mental illness and comorbid physical health conditions, provide a conceptual overview and a narrative review of the strength of the evidence base for these models in high-income countries and in low-income and middle-income countries, and identify opportunities to test the feasibility and effects of such integrated care models. We discuss the rationale for integrating care for people with mental disorders into chronic care; the models of integrated care; the evidence of the effects of integrating care in high-income countries and in low-income and middle-income countries; the key organisational challenges to implementing integrated chronic care in low-income and middle-income countries; and the practical steps to realising a vision of integrated care in the future.
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White, M C; Randall, K; Capo-Chichi, N F E; Sodogas, F; Quenum, S; Wright, K; Close, K L; Russ, S; Sevdalis, N; Leather, A J M Implementation and evaluation of nationwide scale-up of the surgical safety checklist Journal Article British Journal of Surgery, 106 (2), pp. e91–e102, 2019, ISSN: 13652168.
@article{White2019,
title = {Implementation and evaluation of nationwide scale-up of the surgical safety checklist}, author = {M C White and K Randall and N F E Capo-Chichi and F Sodogas and S Quenum and K Wright and K L Close and S Russ and N Sevdalis and A J M Leather}, doi = {10.1002/bjs.11034}, issn = {13652168}, year = {2019}, date = {2019-01-01}, journal = {British Journal of Surgery}, volume = {106}, number = {2}, pages = {e91--e102}, abstract = {Background: The WHO Surgical Safety Checklist improves surgical outcomes, but evidence and theoretical frameworks for successful implementation in low-income countries remain lacking. Based on previous research in Madagascar, a nationwide checklist implementation in Benin was designed and evaluated longitudinally. Methods: This study had a longitudinal embedded mixed-methods design. The well validated Consolidated Framework for Implementation Research (CFIR) was used to structure the approach and evaluate the implementation. Thirty-six hospitals received 3-day multidisciplinary training and 4-month follow-up. Seventeen hospitals were sampled purposively for evaluation at 12–18 months. The primary outcome was sustainability of checklist use at 12–18 months measured by questionnaire. Secondary outcomes were CFIR-derived implementation outcomes, measured using the WHO Behaviourally Anchored Rating Scale (WHOBARS), safety questionnaires and focus groups. Results: At 12–18 months, 86⋅0 per cent of participants (86 of 100) reported checklist use compared with 31⋅1 per cent (169 of 543) before training and 88⋅8 per cent (158 of 178) at 4 months. There was high-fidelity use (median WHOBARS score 5⋅0 of 7; use of basic safety processes ranged from 85⋅0 to 99⋅0 per cent), and high penetration shown by a significant improvement in hospital safety culture (adapted Human Factors Attitude Questionnaire scores of 76⋅7, 81⋅1 and 82⋅2 per cent before, and at 4 and 12–18 months after training respectively; P textless 0⋅001). Acceptability, adoption, appropriateness and feasibility scored 9⋅6–9⋅8 of 10. This approach incorporated 31 of 36 CFIR implementation constructs successfully. Conclusion: This study shows successfully sustained nationwide checklist implementation using a validated implementation framework.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background: The WHO Surgical Safety Checklist improves surgical outcomes, but evidence and theoretical frameworks for successful implementation in low-income countries remain lacking. Based on previous research in Madagascar, a nationwide checklist implementation in Benin was designed and evaluated longitudinally. Methods: This study had a longitudinal embedded mixed-methods design. The well validated Consolidated Framework for Implementation Research (CFIR) was used to structure the approach and evaluate the implementation. Thirty-six hospitals received 3-day multidisciplinary training and 4-month follow-up. Seventeen hospitals were sampled purposively for evaluation at 12–18 months. The primary outcome was sustainability of checklist use at 12–18 months measured by questionnaire. Secondary outcomes were CFIR-derived implementation outcomes, measured using the WHO Behaviourally Anchored Rating Scale (WHOBARS), safety questionnaires and focus groups. Results: At 12–18 months, 86⋅0 per cent of participants (86 of 100) reported checklist use compared with 31⋅1 per cent (169 of 543) before training and 88⋅8 per cent (158 of 178) at 4 months. There was high-fidelity use (median WHOBARS score 5⋅0 of 7; use of basic safety processes ranged from 85⋅0 to 99⋅0 per cent), and high penetration shown by a significant improvement in hospital safety culture (adapted Human Factors Attitude Questionnaire scores of 76⋅7, 81⋅1 and 82⋅2 per cent before, and at 4 and 12–18 months after training respectively; P textless 0⋅001). Acceptability, adoption, appropriateness and feasibility scored 9⋅6–9⋅8 of 10. This approach incorporated 31 of 36 CFIR implementation constructs successfully. Conclusion: This study shows successfully sustained nationwide checklist implementation using a validated implementation framework.
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Evans-Lacko, Sara; Hanlon, Charlotte; Alem, Atalay; Ayuso-Mateos, Jose Luis; Chisholm, Dan; Gureje, Oye; Jordans, Mark; Kigozi, Fred; Lempp, Heidi; Lund, Crick; Petersen, Inge; Shidhaye, Rahul; Thornicroft, Graham; Semrau, Maya BJPsych Open, 5 (5), pp. 1–10, 2019, ISSN: 2056-4724.
@article{Evans-Lacko2019,
title = {Evaluation of capacity-building strategies for mental health system strengthening in low- and middle-income countries for service users and caregivers, policymakers and planners, and researchers}, author = {Sara Evans-Lacko and Charlotte Hanlon and Atalay Alem and Jose Luis Ayuso-Mateos and Dan Chisholm and Oye Gureje and Mark Jordans and Fred Kigozi and Heidi Lempp and Crick Lund and Inge Petersen and Rahul Shidhaye and Graham Thornicroft and Maya Semrau}, doi = {10.1192/bjo.2019.14}, issn = {2056-4724}, year = {2019}, date = {2019-01-01}, journal = {BJPsych Open}, volume = {5}, number = {5}, pages = {1--10}, abstract = {BACKGROUND: Strengthening of mental health systems in low- and middle-income countries (LMICs) requires the involvement of appropriately skilled and committed individuals from a range of stakeholder groups. Currently, few evidence-based capacity-building activities and materials are available to enable and sustain comprehensive improvements. AIMS: Within the Emerald project, the goal of this study was to evaluate capacity-building activities for three target groups: (a) service users with mental health conditions and their caregivers; (b) policymakers and planners; and (c) mental health researchers. METHOD: We developed and tailored three short courses (between 1 and 5 days long). We then implemented and evaluated these short courses on 24 different occasions. We assessed satisfaction among 527 course participants as well as pre-post changes in knowledge in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, Uganda). Changes in research capacity of partner Emerald institutions was also assessed through monitoring of academic outputs of participating researchers and students and via anonymous surveys. RESULTS: Short courses were associated with high levels of satisfaction and led to improvements in knowledge across target groups. In relation to institutional capacity building, all partner institutions reported improvements in research capacity for most aspects of mental health system strengthening and global mental health, and many of these positive changes were attributed to the Emerald programme. In terms of outputs, eight PhD students submitted a total of 10 papers relating to their PhD work (range 0-4) and were involved in 14 grant applications, of which 43% (n = 6) were successful. CONCLUSIONS: The Emerald project has shown that building capacity of key stakeholders in mental health system strengthening is possible. However, the starting point and appropriate strategies for this may vary across different countries, depending on the local context, needs and resources. DECLARATION OF INTEREST: S.E.L. received consulting fees from Lundbeck.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
BACKGROUND: Strengthening of mental health systems in low- and middle-income countries (LMICs) requires the involvement of appropriately skilled and committed individuals from a range of stakeholder groups. Currently, few evidence-based capacity-building activities and materials are available to enable and sustain comprehensive improvements. AIMS: Within the Emerald project, the goal of this study was to evaluate capacity-building activities for three target groups: (a) service users with mental health conditions and their caregivers; (b) policymakers and planners; and (c) mental health researchers. METHOD: We developed and tailored three short courses (between 1 and 5 days long). We then implemented and evaluated these short courses on 24 different occasions. We assessed satisfaction among 527 course participants as well as pre-post changes in knowledge in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, Uganda). Changes in research capacity of partner Emerald institutions was also assessed through monitoring of academic outputs of participating researchers and students and via anonymous surveys. RESULTS: Short courses were associated with high levels of satisfaction and led to improvements in knowledge across target groups. In relation to institutional capacity building, all partner institutions reported improvements in research capacity for most aspects of mental health system strengthening and global mental health, and many of these positive changes were attributed to the Emerald programme. In terms of outputs, eight PhD students submitted a total of 10 papers relating to their PhD work (range 0-4) and were involved in 14 grant applications, of which 43% (n = 6) were successful. CONCLUSIONS: The Emerald project has shown that building capacity of key stakeholders in mental health system strengthening is possible. However, the starting point and appropriate strategies for this may vary across different countries, depending on the local context, needs and resources. DECLARATION OF INTEREST: S.E.L. received consulting fees from Lundbeck.
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Petersen, Inge; van Rensburg, André; Kigozi, Fred; Semrau, Maya; Hanlon, Charlotte; Abdulmalik, Jibril; Kola, Lola; Fekadu, Abebaw; Gureje, Oye; Gurung, Dristy; Jordans, Mark; Mntambo, Ntokozo; Mugisha, James; Muke, Shital; Petrus, Ruwayda; Shidhaye, Rahul; Ssebunnya, Joshua; Tekola, Bethlehem; Upadhaya, Nawaraj; Patel, Vikram; Lund, Crick; Thornicroft, Graham Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform Journal Article BJPsych Open, 5 (5), pp. 1–8, 2019, ISSN: 2056-4724.
@article{Petersen2019,
title = {Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform}, author = {Inge Petersen and André van Rensburg and Fred Kigozi and Maya Semrau and Charlotte Hanlon and Jibril Abdulmalik and Lola Kola and Abebaw Fekadu and Oye Gureje and Dristy Gurung and Mark Jordans and Ntokozo Mntambo and James Mugisha and Shital Muke and Ruwayda Petrus and Rahul Shidhaye and Joshua Ssebunnya and Bethlehem Tekola and Nawaraj Upadhaya and Vikram Patel and Crick Lund and Graham Thornicroft}, doi = {10.1192/bjo.2019.7}, issn = {2056-4724}, year = {2019}, date = {2019-01-01}, journal = {BJPsych Open}, volume = {5}, number = {5}, pages = {1--8}, abstract = {BACKGROUND: There is a global drive to improve access to mental healthcare by scaling up integrated mental health into primary healthcare (PHC) systems in low- and middle-income countries (LMICs)., AIMS: To investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs., METHOD: Semi-structured interviews were conducted with 121 managers and service providers. Transcribed interviews were analysed using framework analysis guided by the Consolidated Framework for Implementation Research and World Health Organization basic building blocks., RESULTS: Ensuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and task-sharing were identified as aiding integration efforts. The latter includes (a) strengthening governance to include technical support for integration efforts as well as multisectoral collaborations; (b) ring-fencing mental health budgets at district level; (c) a critical mass of mental health specialists to support task-sharing; (d) including key mental health indicators in the health information system; (e) psychotropic medication included on free essential drug lists and (f) enabling collaborative and community- oriented PHC-service delivery platforms and continuous quality improvement to aid service delivery challenges in implementation., CONCLUSIONS: Scaling up integrated mental healthcare in PHC in LMICs is more complex than training general healthcare providers. Leveraging existing health system processes that are synergistic with chronic care services and strengthening healthcare system building blocks to provide a more enabling context for integration are important., DECLARATION OF INTEREST: None.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
BACKGROUND: There is a global drive to improve access to mental healthcare by scaling up integrated mental health into primary healthcare (PHC) systems in low- and middle-income countries (LMICs)., AIMS: To investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs., METHOD: Semi-structured interviews were conducted with 121 managers and service providers. Transcribed interviews were analysed using framework analysis guided by the Consolidated Framework for Implementation Research and World Health Organization basic building blocks., RESULTS: Ensuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and task-sharing were identified as aiding integration efforts. The latter includes (a) strengthening governance to include technical support for integration efforts as well as multisectoral collaborations; (b) ring-fencing mental health budgets at district level; (c) a critical mass of mental health specialists to support task-sharing; (d) including key mental health indicators in the health information system; (e) psychotropic medication included on free essential drug lists and (f) enabling collaborative and community- oriented PHC-service delivery platforms and continuous quality improvement to aid service delivery challenges in implementation., CONCLUSIONS: Scaling up integrated mental healthcare in PHC in LMICs is more complex than training general healthcare providers. Leveraging existing health system processes that are synergistic with chronic care services and strengthening healthcare system building blocks to provide a more enabling context for integration are important., DECLARATION OF INTEREST: None.
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Chisholm, Dan; Docrat, Sumaiyah; Abdulmalik, Jibril; Alem, Atalay; Gureje, Oye; Gurung, Dristy; Hanlon, Charlotte; Jordans, Mark J D; Kangere, Sheila; Kigozi, Fred; Mugisha, James; Muke, Shital; Olayiwola, Saheed; Shidhaye, Rahul; Thornicroft, Graham; Lund, Crick Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project Journal Article BJPsych Open, 5 (5), pp. 1–9, 2019, ISSN: 2056-4724.
@article{Chisholm2019,
title = {Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project}, author = {Dan Chisholm and Sumaiyah Docrat and Jibril Abdulmalik and Atalay Alem and Oye Gureje and Dristy Gurung and Charlotte Hanlon and Mark J D Jordans and Sheila Kangere and Fred Kigozi and James Mugisha and Shital Muke and Saheed Olayiwola and Rahul Shidhaye and Graham Thornicroft and Crick Lund}, doi = {10.1192/bjo.2019.24}, issn = {2056-4724}, year = {2019}, date = {2019-01-01}, journal = {BJPsych Open}, volume = {5}, number = {5}, pages = {1--9}, abstract = {Background}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background
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Lund, Crick; Docrat, Sumaiyah; Abdulmalik, Jibril; Alem, Atalay; Fekadu, Abebaw; Gureje, Oye; Gurung, Dristy; Hailemariam, Damen; Hailemichael, Yohannes; Hanlon, Charlotte; Jordans, Mark J D; Kizza, Dorothy; Nanda, Sharmishtha; Olayiwola, Saheed; Shidhaye, Rahul; Upadhaya, Nawaraj; Thornicroft, Graham; Chisholm, Dan BJPsych Open, 5 (3), pp. 1–11, 2019, ISSN: 2056-4724.
@article{Lund2019,
title = {Household economic costs associated with mental, neurological and substance use disorders: a cross-sectional survey in six low- and middle-income countries}, author = {Crick Lund and Sumaiyah Docrat and Jibril Abdulmalik and Atalay Alem and Abebaw Fekadu and Oye Gureje and Dristy Gurung and Damen Hailemariam and Yohannes Hailemichael and Charlotte Hanlon and Mark J D Jordans and Dorothy Kizza and Sharmishtha Nanda and Saheed Olayiwola and Rahul Shidhaye and Nawaraj Upadhaya and Graham Thornicroft and Dan Chisholm}, doi = {10.1192/bjo.2019.20}, issn = {2056-4724}, year = {2019}, date = {2019-01-01}, journal = {BJPsych Open}, volume = {5}, number = {3}, pages = {1--11}, abstract = {BackgroundLittle is known about the household economic costs associated with mental, neurological and substance use (MNS) disorders in low- and middle-income countries.AimsTo assess the association between MNS disorders and household education, consumption, production, assets and financial coping strategies in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.MethodWe conducted an exploratory cross-sectional household survey in one district in each country, comparing the economic circumstances of households with an MNS disorder (alcohol-use disorder, depression, epilepsy or psychosis) (n = 2339) and control households (n = 1982).ResultsDespite some heterogeneity between MNS disorder groups and countries, households with a member with an MNS disorder had generally lower levels of adult education; lower housing standards, total household income, effective income and non-health consumption; less asset-based wealth; higher healthcare expenditure; and greater use of deleterious financial coping strategies.ConclusionsHouseholds living with a member who has an MNS disorder constitute an economically vulnerable group who are susceptible to chronic poverty and intergenerational poverty transmission.Declaration of interestD.C. is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
BackgroundLittle is known about the household economic costs associated with mental, neurological and substance use (MNS) disorders in low- and middle-income countries.AimsTo assess the association between MNS disorders and household education, consumption, production, assets and financial coping strategies in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.MethodWe conducted an exploratory cross-sectional household survey in one district in each country, comparing the economic circumstances of households with an MNS disorder (alcohol-use disorder, depression, epilepsy or psychosis) (n = 2339) and control households (n = 1982).ResultsDespite some heterogeneity between MNS disorder groups and countries, households with a member with an MNS disorder had generally lower levels of adult education; lower housing standards, total household income, effective income and non-health consumption; less asset-based wealth; higher healthcare expenditure; and greater use of deleterious financial coping strategies.ConclusionsHouseholds living with a member who has an MNS disorder constitute an economically vulnerable group who are susceptible to chronic poverty and intergenerational poverty transmission.Declaration of interestD.C. is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.
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Semrau, Maya; Alem, Atalay; Ayuso-Mateos, Jose L; Chisholm, Dan; Gureje, Oye; Hanlon, Charlotte; Jordans, Mark; Kigozi, Fred; Lund, Crick; Petersen, Inge; Shidhaye, Rahul; Thornicroft, Graham Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme Journal Article BJPsych Open, 5 (5), pp. 1–5, 2019, ISSN: 2056-4724.
@article{Semrau2019,
title = {Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme}, author = {Maya Semrau and Atalay Alem and Jose L Ayuso-Mateos and Dan Chisholm and Oye Gureje and Charlotte Hanlon and Mark Jordans and Fred Kigozi and Crick Lund and Inge Petersen and Rahul Shidhaye and Graham Thornicroft}, doi = {10.1192/bjo.2018.90}, issn = {2056-4724}, year = {2019}, date = {2019-01-01}, journal = {BJPsych Open}, volume = {5}, number = {5}, pages = {1--5}, abstract = {BACKGROUND: There is a large treatment gap for mental, neurological or substance use (MNS) disorders. The 'Emerging mental health systems in low- and middle-income countries (LMICs)' (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems. AIMS: To provide a set of proposed recommendations for mental health system strengthening in LMICs. METHOD: The Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012-2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening. RESULTS: The proposed recommendations align closely with the World Health Organization's key health system strengthening 'building blocks' of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald. CONCLUSIONS: These recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders. DECLARATION OF INTEREST: None.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
BACKGROUND: There is a large treatment gap for mental, neurological or substance use (MNS) disorders. The 'Emerging mental health systems in low- and middle-income countries (LMICs)' (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems. AIMS: To provide a set of proposed recommendations for mental health system strengthening in LMICs. METHOD: The Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012-2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening. RESULTS: The proposed recommendations align closely with the World Health Organization's key health system strengthening 'building blocks' of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald. CONCLUSIONS: These recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders. DECLARATION OF INTEREST: None.
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Jordans, Mark; Chisholm, Dan; Semrau, Maya; Gurung, Dristy; Abdulmalik, Jibril; Ahuja, Shalini; Mugisha, James; Mntambo, Ntokozo; Kigozi, Fred; Petersen, Inge; Shidhaye, Rahul; Upadhaya, Nawaraj; Lund, Crick; Thornicroft, Graham; Gureje, Oye BJPsych Open, 5 (5), pp. 1–7, 2019, ISSN: 2056-4724.
@article{Jordans2019,
title = {Evaluation of performance and perceived utility of mental healthcare indicators in routine health information systems in five low- and middle-income countries}, author = {Mark Jordans and Dan Chisholm and Maya Semrau and Dristy Gurung and Jibril Abdulmalik and Shalini Ahuja and James Mugisha and Ntokozo Mntambo and Fred Kigozi and Inge Petersen and Rahul Shidhaye and Nawaraj Upadhaya and Crick Lund and Graham Thornicroft and Oye Gureje}, doi = {10.1192/bjo.2019.22}, issn = {2056-4724}, year = {2019}, date = {2019-01-01}, journal = {BJPsych Open}, volume = {5}, number = {5}, pages = {1--7}, abstract = {Background: In most low- and middle-income countries (LMIC), routine mental health information is unavailable or unreliable, making monitoring of mental healthcare coverage difficult. This study aims to evaluate a new set of mental health indicators introduced in primary healthcare settings in five LMIC.; Method: A survey was conducted among primary healthcare workers (n = 272) to assess the acceptability and feasibility of eight new indicators monitoring mental healthcare needs, utilisation, quality and payments. Also, primary health facility case records (n = 583) were reviewed by trained research assistants to assess the level of completion (yes/no) for each of the indicators and subsequently the level of correctness of completion (correct/incorrect - with incorrect defined as illogical, missing or illegible information) of the indicators used by health workers. Assessments were conducted within 1 month of the introduction of the indicators, as well as 6-9 months afterwards.; Results: Across both time points and across all indicators, 78% of the measurements of indicators were complete. Among the best performing indicators (diagnosis, severity and treatment), this was significantly higher. With regards to correctness, 87% of all completed indicators were correctly completed. There was a trend towards improvement over time. Health workers' perceptions on feasibility and utility, across sites and over time, indicated a positive attitude in 81% of all measurements.; Conclusion: This study demonstrates high levels of performance and perceived utility for a set of indicators that could ultimately be used to monitor coverage of mental healthcare in primary healthcare settings in LMIC. We recommend that these indicators are incorporated into existing health information systems and adopted within the World Health Organization Mental Health Gap Action Programme implementation strategy.; Declaration of Interest: None.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background: In most low- and middle-income countries (LMIC), routine mental health information is unavailable or unreliable, making monitoring of mental healthcare coverage difficult. This study aims to evaluate a new set of mental health indicators introduced in primary healthcare settings in five LMIC.; Method: A survey was conducted among primary healthcare workers (n = 272) to assess the acceptability and feasibility of eight new indicators monitoring mental healthcare needs, utilisation, quality and payments. Also, primary health facility case records (n = 583) were reviewed by trained research assistants to assess the level of completion (yes/no) for each of the indicators and subsequently the level of correctness of completion (correct/incorrect - with incorrect defined as illogical, missing or illegible information) of the indicators used by health workers. Assessments were conducted within 1 month of the introduction of the indicators, as well as 6-9 months afterwards.; Results: Across both time points and across all indicators, 78% of the measurements of indicators were complete. Among the best performing indicators (diagnosis, severity and treatment), this was significantly higher. With regards to correctness, 87% of all completed indicators were correctly completed. There was a trend towards improvement over time. Health workers' perceptions on feasibility and utility, across sites and over time, indicated a positive attitude in 81% of all measurements.; Conclusion: This study demonstrates high levels of performance and perceived utility for a set of indicators that could ultimately be used to monitor coverage of mental healthcare in primary healthcare settings in LMIC. We recommend that these indicators are incorporated into existing health information systems and adopted within the World Health Organization Mental Health Gap Action Programme implementation strategy.; Declaration of Interest: None.
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Hanlon, C; Medhin, G; Selamu, M; Birhane, R; Dewey, M; Tirfessa, K; Garman, E; Asher, L; Thornicroft, G; Patel, V; Lund, C; Prince, M; Fekadu, A Epidemiology and Psychiatric Sciences, 2019, ISSN: 20457979.
@article{Hanlon2019,
title = {Impact of integrated district level mental health care on clinical and social outcomes of people with severe mental illness in rural Ethiopia: An intervention cohort study}, author = {C Hanlon and G Medhin and M Selamu and R Birhane and M Dewey and K Tirfessa and E Garman and L Asher and G Thornicroft and V Patel and C Lund and M Prince and A Fekadu}, doi = {10.1017/S2045796019000398}, issn = {20457979}, year = {2019}, date = {2019-01-01}, journal = {Epidemiology and Psychiatric Sciences}, abstract = {AimThere is limited evidence of the safety and impact of task-shared care for people with severe mental illnesses (SMI; psychotic disorders and bipolar disorder) in low-income countries. The aim of this study was to evaluate the safety and impact of a district-level plan for task-shared mental health care on 6 and 12-month clinical and social outcomes of people with SMI in rural southern Ethiopia.MethodsIn the Programme for Improving Mental health carE, we conducted an intervention cohort study. Trained primary healthcare (PHC) workers assessed community referrals, diagnosed SMI and initiated treatment, with independent research diagnostic assessments by psychiatric nurses. Primary outcomes were symptom severity and disability. Secondary outcomes included discrimination and restraint.ResultsAlmost all (94.5%) PHC worker diagnoses of SMI were verified by psychiatric nurses. All prescribing was within recommended dose limits. A total of 245 (81.7%) people with SMI were re-assessed at 12 months. Minimally adequate treatment was received by 29.8%. All clinical and social outcomes improved significantly. The impact on disability (standardised mean difference 0.50; 95% confidence interval (CI) 0.35-0.65) was greater than impact on symptom severity (standardised mean difference 0.28; 95% CI 0.13-0.44). Being restrained in the previous 12 months reduced from 25.3 to 10.6%, and discrimination scores reduced significantly.ConclusionsAn integrated district level mental health care plan employing task-sharing safely addressed the large treatment gap for people with SMI in a rural, low-income country setting. Randomised controlled trials of differing models of task-shared care for people with SMI are warranted.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
AimThere is limited evidence of the safety and impact of task-shared care for people with severe mental illnesses (SMI; psychotic disorders and bipolar disorder) in low-income countries. The aim of this study was to evaluate the safety and impact of a district-level plan for task-shared mental health care on 6 and 12-month clinical and social outcomes of people with SMI in rural southern Ethiopia.MethodsIn the Programme for Improving Mental health carE, we conducted an intervention cohort study. Trained primary healthcare (PHC) workers assessed community referrals, diagnosed SMI and initiated treatment, with independent research diagnostic assessments by psychiatric nurses. Primary outcomes were symptom severity and disability. Secondary outcomes included discrimination and restraint.ResultsAlmost all (94.5%) PHC worker diagnoses of SMI were verified by psychiatric nurses. All prescribing was within recommended dose limits. A total of 245 (81.7%) people with SMI were re-assessed at 12 months. Minimally adequate treatment was received by 29.8%. All clinical and social outcomes improved significantly. The impact on disability (standardised mean difference 0.50; 95% confidence interval (CI) 0.35-0.65) was greater than impact on symptom severity (standardised mean difference 0.28; 95% CI 0.13-0.44). Being restrained in the previous 12 months reduced from 25.3 to 10.6%, and discrimination scores reduced significantly.ConclusionsAn integrated district level mental health care plan employing task-sharing safely addressed the large treatment gap for people with SMI in a rural, low-income country setting. Randomised controlled trials of differing models of task-shared care for people with SMI are warranted.
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Hailemichael, Yohannes; Hanlon, Charlotte; Tirfessa, Kebede; Docrat, Sumaiyah; Alem, Atalay; Medhin, Girmay; Fekadu, Abebaw; Lund, Crick; Chisholm, Dan; Hailemariam, Damen Mental health problems and socioeconomic disadvantage: A controlled household study in rural Ethiopia Journal Article International Journal for Equity in Health, 18 (1), pp. 1–12, 2019, ISSN: 14759276.
@article{Hailemichael2019,
title = {Mental health problems and socioeconomic disadvantage: A controlled household study in rural Ethiopia}, author = {Yohannes Hailemichael and Charlotte Hanlon and Kebede Tirfessa and Sumaiyah Docrat and Atalay Alem and Girmay Medhin and Abebaw Fekadu and Crick Lund and Dan Chisholm and Damen Hailemariam}, doi = {10.1186/s12939-019-1020-4}, issn = {14759276}, year = {2019}, date = {2019-01-01}, journal = {International Journal for Equity in Health}, volume = {18}, number = {1}, pages = {1--12}, publisher = {International Journal for Equity in Health}, abstract = {Background: There is a lack of high quality population-based studies from low- and middle-income countries examining the relative economic status of households with and without a member with a mental health problem. The aim of the study was to explore the socio-economic status of households with a person with severe mental disorder (SMD; psychosis or bipolar disorder) or depression compared to households without an affected person. Methods: A population-based, comparative, cross-sectional household survey was conducted in Sodo district, south Ethiopia, between January and November 2015. Two samples were recruited, each with its own comparison group. Sample (1): households of 290 community-ascertained persons with a clinician-confirmed diagnosis of SMD and a comparison group of 289 households without a person with SMD. Sample (2): households of 128 people who attended the primary health care centre and who were identified by primary care staff as having a probable diagnosis of depressive disorder; and comparison households of 129 patients who attended for other reasons and who did not receive a diagnosis of depression. Household socioeconomic status (household income, consumption and asset-based wealth) was assessed using a contextualized version of theWorld Health Organization (WHO) Study on global Ageing and adult health (SAGE) questionnaire. Each disorder group (SMD and depression) was further divided into higher and lower disability groups on the basis of median score on the WHO Disability Assessment Schedule. Results: Households of a person with SMD who had higher disability were more likely to have a poorer living standard (no toilet facility; p textless 0.001). Having a reliable source of regular income was significantly lower in households of a person with SMD (p = 0.008) or depression (p = 0.046) with higher disability than the comparison group. Households of persons with SMD with higher disability earned less (p = 0.005) and owned significantly fewer assets (p textless 0.001) than households without SMD. Households including persons with depression who had higher disability had lower income (p = 0.042) and reduced consumption (p = 0.048). Conclusions: Households with a member who had either SMD or depression were socioeconomically disadvantaged compared to the general population. Moreover, higher disability was associated with worse socio-economic disadvantage. Prospective studies are needed to determine the direction of association. This study indicates a need to consider households of people with SMD or depression as a vulnerable group requiring economic support alongside access to evidence-based mental healthcare.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background: There is a lack of high quality population-based studies from low- and middle-income countries examining the relative economic status of households with and without a member with a mental health problem. The aim of the study was to explore the socio-economic status of households with a person with severe mental disorder (SMD; psychosis or bipolar disorder) or depression compared to households without an affected person. Methods: A population-based, comparative, cross-sectional household survey was conducted in Sodo district, south Ethiopia, between January and November 2015. Two samples were recruited, each with its own comparison group. Sample (1): households of 290 community-ascertained persons with a clinician-confirmed diagnosis of SMD and a comparison group of 289 households without a person with SMD. Sample (2): households of 128 people who attended the primary health care centre and who were identified by primary care staff as having a probable diagnosis of depressive disorder; and comparison households of 129 patients who attended for other reasons and who did not receive a diagnosis of depression. Household socioeconomic status (household income, consumption and asset-based wealth) was assessed using a contextualized version of theWorld Health Organization (WHO) Study on global Ageing and adult health (SAGE) questionnaire. Each disorder group (SMD and depression) was further divided into higher and lower disability groups on the basis of median score on the WHO Disability Assessment Schedule. Results: Households of a person with SMD who had higher disability were more likely to have a poorer living standard (no toilet facility; p textless 0.001). Having a reliable source of regular income was significantly lower in households of a person with SMD (p = 0.008) or depression (p = 0.046) with higher disability than the comparison group. Households of persons with SMD with higher disability earned less (p = 0.005) and owned significantly fewer assets (p textless 0.001) than households without SMD. Households including persons with depression who had higher disability had lower income (p = 0.042) and reduced consumption (p = 0.048). Conclusions: Households with a member who had either SMD or depression were socioeconomically disadvantaged compared to the general population. Moreover, higher disability was associated with worse socio-economic disadvantage. Prospective studies are needed to determine the direction of association. This study indicates a need to consider households of people with SMD or depression as a vulnerable group requiring economic support alongside access to evidence-based mental healthcare.
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Prince, Martin; Acosta, Daisy; Guerra, Mariella; Huang, Yueqin; Jacob, K S; Jimenez-Velazquez, Ivonne; Jotheeswaran, A T; Llibre Rodriguez, Juan ; Salas, Aquiles; Sosa, Ana Luisa; Acosta, Isaac; Mayston, Rosie; Liu, Zhaorui; Llibre-Guerra, Jorge; Prina, Matthew A; Valhuerdi, Adolfo Intrinsic capacity as a framework for Integrated Care for Older People (ICOPE); insights from the 10/66 Dementia Research Group cohort studies in Latin America, India and China, pp. 19006403, 2019.
@article{Prince2019,
title = {Intrinsic capacity as a framework for Integrated Care for Older People (ICOPE); insights from the 10/66 Dementia Research Group cohort studies in Latin America, India and China}, author = {Martin Prince and Daisy Acosta and Mariella Guerra and Yueqin Huang and K S Jacob and Ivonne Jimenez-Velazquez and A T Jotheeswaran and Juan {Llibre Rodriguez} and Aquiles Salas and Ana Luisa Sosa and Isaac Acosta and Rosie Mayston and Zhaorui Liu and Jorge Llibre-Guerra and Matthew A Prina and Adolfo Valhuerdi}, doi = {10.1101/19006403}, year = {2019}, date = {2019-01-01}, journal = {Intrinsic capacity as a framework for Integrated Care for Older People (ICOPE); insights from the 10/66 Dementia Research Group cohort studies in Latin America, India and China}, pages = {19006403}, abstract = {Background The World Health Organization has reframed health and healthcare for older people around achieving the goal of healthy ageing. Recent evidence-based guidelines on Integrated Care for Older People focus on maintaining intrinsic capacity, addressing declines in mobility, nutrition, vision and hearing, cognition, mood and continence aiming to prevent or delay the onset of care dependence. The target group (with one or more declines in intrinsic capacity) is broad, and implementation at scale may be challenging in less-resourced settings. Planning can be informed by assessing the prevalence of intrinsic capacity, characterising the target group, and validating the general approach by evaluating risk prediction for incident dependence and mortality. Methods Population-based cohort studies in urban sites in Cuba, Dominican Republic, Puerto Rico, Venezuela, and rural and urban sites in Peru, Mexico, India and China. Sociodemographic, behaviour and lifestyle, health, healthcare utilisation and cost questionnaires, and physical assessments were administered to all participants, with ascertainment of incident dependence, and mortality, three to five years later. Results In the 12 sites in eight countries, 17,031 participants were surveyed at baseline. Intrinsic capacity was least likely to be retained for locomotion (71.2%), vision (71.3%), cognition (73.5%), and mood (74.1%). Only 30% retained full capacity across all domains, varying between one quarter and two-fifths in most sites. The proportion retaining capacity fell sharply with increasing age, and declines affecting multiple domains were more common. Poverty, morbidity (particularly dementia, depression and stroke), and disability were concentrated among those with DIC, although only 10% were frail, and a further 9% had needs for care. Hypertension and lifestyle risk factors for chronic disease, healthcare utilization and costs were more evenly distributed in the general older population. 15,901 participants were included in the mortality cohort (2,602 deaths/ 53,911 person years of follow-up), and 12,965 participants in the dependence cohort (1900 incident cases/ 38,377 person-years). DIC (any decline, and number of domains affected) strongly and independently predicted incident dependence and death. Relative risks were higher for those who were frail, but were also substantially elevated for the much larger sub-groups yet to become frail. Mortality was mainly concentrated in the frail and dependent sub-groups. Conclusions Our findings support the strategy to focus on optimizing intrinsic capacity in pursuit of healthy ageing. Most needs for care arise in those with declines in intrinsic capacity who are yet to become frail. Implementation at scale requires community-based screening and assessment, and a stepped-care approach to intervention. Community healthcare workers roles would need redefinition to engage, train and support them in these tasks. ICOPE could be usefully integrated into community programmes orientated to the detection and case management of chronic diseases including hypertension and diabetes.Competing Interest StatementThe authors have declared no competing interest.Funding StatementFunded by Wellcome Trust (GR066133 Prevalence phase in Cuba; GR080002- Incidence phase in Peru, Mexico, Cuba, Dominican Republic, Venezuela and China and data analysis across all centres) - http://www.wellcome.ac.uk/, World Health Organization (Prevalence phase in Dominican Republic and China) - www.who.int, US Alzheimers Association (IIRG041286 - Prevalence phase in Peru, and Mexico) - http://www.alz.org/research/alzheimers_grants/, FONACIT/ CDCH/ UCV (data collection in Venezuela) - http://www.fonacit.gob.ve/, Puerto Rico Legislature (data collection in Puerto Rico), and the European Research Council (ongoing data collection, and further analyses of existing data - ERC-2013-ADG340755 LIFE2YEARS1066. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Author DeclarationsAll relevant ethical guidelines have been followed and any necessary IRB and/or ethics committee approvals have been obtained.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesAny clinical trials involved have been registered with an ICMJE-approved registry such as ClinicalTrials.gov and the trial ID is included in the manuscript.Not ApplicableI have followed all appropriate research reporting guidelines and uploaded the relevant Equator, ICMJE or other checklist(s) as supplementary files, if applicable.YesThe data underlying this study are restricted, as participants did not consent to sharing their information publicly. Data are freely available from the 10/66 Dementia Research Group public data archive for researchers who meet the criteria for access to confidential data. Information on procedures to apply for access to data is available at https://www.alz.co.uk/ 1066/1066_public_archive_baseline.php, or by contacting Prof Martin Prince at .}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background The World Health Organization has reframed health and healthcare for older people around achieving the goal of healthy ageing. Recent evidence-based guidelines on Integrated Care for Older People focus on maintaining intrinsic capacity, addressing declines in mobility, nutrition, vision and hearing, cognition, mood and continence aiming to prevent or delay the onset of care dependence. The target group (with one or more declines in intrinsic capacity) is broad, and implementation at scale may be challenging in less-resourced settings. Planning can be informed by assessing the prevalence of intrinsic capacity, characterising the target group, and validating the general approach by evaluating risk prediction for incident dependence and mortality. Methods Population-based cohort studies in urban sites in Cuba, Dominican Republic, Puerto Rico, Venezuela, and rural and urban sites in Peru, Mexico, India and China. Sociodemographic, behaviour and lifestyle, health, healthcare utilisation and cost questionnaires, and physical assessments were administered to all participants, with ascertainment of incident dependence, and mortality, three to five years later. Results In the 12 sites in eight countries, 17,031 participants were surveyed at baseline. Intrinsic capacity was least likely to be retained for locomotion (71.2%), vision (71.3%), cognition (73.5%), and mood (74.1%). Only 30% retained full capacity across all domains, varying between one quarter and two-fifths in most sites. The proportion retaining capacity fell sharply with increasing age, and declines affecting multiple domains were more common. Poverty, morbidity (particularly dementia, depression and stroke), and disability were concentrated among those with DIC, although only 10% were frail, and a further 9% had needs for care. Hypertension and lifestyle risk factors for chronic disease, healthcare utilization and costs were more evenly distributed in the general older population. 15,901 participants were included in the mortality cohort (2,602 deaths/ 53,911 person years of follow-up), and 12,965 participants in the dependence cohort (1900 incident cases/ 38,377 person-years). DIC (any decline, and number of domains affected) strongly and independently predicted incident dependence and death. Relative risks were higher for those who were frail, but were also substantially elevated for the much larger sub-groups yet to become frail. Mortality was mainly concentrated in the frail and dependent sub-groups. Conclusions Our findings support the strategy to focus on optimizing intrinsic capacity in pursuit of healthy ageing. Most needs for care arise in those with declines in intrinsic capacity who are yet to become frail. Implementation at scale requires community-based screening and assessment, and a stepped-care approach to intervention. Community healthcare workers roles would need redefinition to engage, train and support them in these tasks. ICOPE could be usefully integrated into community programmes orientated to the detection and case management of chronic diseases including hypertension and diabetes.Competing Interest StatementThe authors have declared no competing interest.Funding StatementFunded by Wellcome Trust (GR066133 Prevalence phase in Cuba; GR080002- Incidence phase in Peru, Mexico, Cuba, Dominican Republic, Venezuela and China and data analysis across all centres) - http://www.wellcome.ac.uk/, World Health Organization (Prevalence phase in Dominican Republic and China) - www.who.int, US Alzheimers Association (IIRG041286 - Prevalence phase in Peru, and Mexico) - http://www.alz.org/research/alzheimers_grants/, FONACIT/ CDCH/ UCV (data collection in Venezuela) - http://www.fonacit.gob.ve/, Puerto Rico Legislature (data collection in Puerto Rico), and the European Research Council (ongoing data collection, and further analyses of existing data - ERC-2013-ADG340755 LIFE2YEARS1066. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Author DeclarationsAll relevant ethical guidelines have been followed and any necessary IRB and/or ethics committee approvals have been obtained.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesAny clinical trials involved have been registered with an ICMJE-approved registry such as ClinicalTrials.gov and the trial ID is included in the manuscript.Not ApplicableI have followed all appropriate research reporting guidelines and uploaded the relevant Equator, ICMJE or other checklist(s) as supplementary files, if applicable.YesThe data underlying this study are restricted, as participants did not consent to sharing their information publicly. Data are freely available from the 10/66 Dementia Research Group public data archive for researchers who meet the criteria for access to confidential data. Information on procedures to apply for access to data is available at https://www.alz.co.uk/ 1066/1066_public_archive_baseline.php, or by contacting Prof Martin Prince at .
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2018 |
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Feyissa, Yibeltal Mekonnen; Hanlon, Charlotte; Emyu, Solomon; Cornick, Ruth Vania; Fairall, Lara; Gebremichael, Daniel; Teka, Telahun; Shiferaw, Solomon; Walelgne, Wubaye; Mamo, Yoseph; Segni, Hailemariam; Ayehu, Temesgen; Wale, Meseret; Eastman, Tracy; Awotiwon, Ajibola; Wattrus, Camilla; Picken, Sandy Claire; Ras, Christy Joy; Anderson, Lauren; Doherty, Tanya; Prince, Martin James; Tegabu, Desalegn Using a mentorship model to localise the Practical Approach to Care Kit (PACK): From South Africa to Ethiopia Journal Article BMJ Global Health, 3 , 2018, ISSN: 20597908.
@article{Feyissa2018,
title = {Using a mentorship model to localise the Practical Approach to Care Kit (PACK): From South Africa to Ethiopia}, author = {Yibeltal Mekonnen Feyissa and Charlotte Hanlon and Solomon Emyu and Ruth Vania Cornick and Lara Fairall and Daniel Gebremichael and Telahun Teka and Solomon Shiferaw and Wubaye Walelgne and Yoseph Mamo and Hailemariam Segni and Temesgen Ayehu and Meseret Wale and Tracy Eastman and Ajibola Awotiwon and Camilla Wattrus and Sandy Claire Picken and Christy Joy Ras and Lauren Anderson and Tanya Doherty and Martin James Prince and Desalegn Tegabu}, doi = {10.1136/bmjgh-2018-001108}, issn = {20597908}, year = {2018}, date = {2018-01-01}, journal = {BMJ Global Health}, volume = {3}, abstract = {The Federal Ministry of Health, Ethiopia, recognised the potential of the Practical Approach to Care Kit (PACK) programme to promote integrated, comprehensive and evidence-informed primary care as a means to achieving universal health coverage. Localisation of the PACK guide to become the 'Ethiopian Primary Health Care Clinical Guidelines' (PHCG) was spearheaded by a core team of Ethiopian policy and technical experts, mentored by the Knowledge Translation Unit, University of Cape Town. A research collaboration, ASSET (heAlth Systems StrEngThening in sub-Saharan Africa), has brought together policy-makers from the Ministry of Health and health systems researchers from Ethiopia (Addis Ababa University) and overseas partners for the PACK localisation process, and will develop, implement and evaluate health systems strengthening interventions needed for a successful scale-up of the Ethiopian PHCG. Localisation of PACK for Ethiopia included expanding the guide to include a wider range of infectious diseases and an expanded age range (from 5 to 15 years). Early feedback from front-line primary healthcare (PHC) workers is positive: The guide gives them greater confidence and is easy to understand and use. A training cascade has been initiated, with a view to implementing in 400 PHC facilities in phase 1, followed by scale-up to all 3724 health centres in Ethiopia during 2019. Monitoring and evaluation of the Ministry of Health implementation at scale will be complemented by indepth evaluation by ASSET in demonstration districts. Anticipated challenges include availability of essential medications and laboratory investigations and the need for additional training and supervisory support to deliver care for non-communicable diseases and mental health. The strong leadership from the Ministry of Health of Ethiopia combined with a productive collaboration with health systems research partners can help to ensure that Ethiopian PHCG achieves standardisation of clinical practice at the primary care level and quality healthcare for all.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
The Federal Ministry of Health, Ethiopia, recognised the potential of the Practical Approach to Care Kit (PACK) programme to promote integrated, comprehensive and evidence-informed primary care as a means to achieving universal health coverage. Localisation of the PACK guide to become the 'Ethiopian Primary Health Care Clinical Guidelines' (PHCG) was spearheaded by a core team of Ethiopian policy and technical experts, mentored by the Knowledge Translation Unit, University of Cape Town. A research collaboration, ASSET (heAlth Systems StrEngThening in sub-Saharan Africa), has brought together policy-makers from the Ministry of Health and health systems researchers from Ethiopia (Addis Ababa University) and overseas partners for the PACK localisation process, and will develop, implement and evaluate health systems strengthening interventions needed for a successful scale-up of the Ethiopian PHCG. Localisation of PACK for Ethiopia included expanding the guide to include a wider range of infectious diseases and an expanded age range (from 5 to 15 years). Early feedback from front-line primary healthcare (PHC) workers is positive: The guide gives them greater confidence and is easy to understand and use. A training cascade has been initiated, with a view to implementing in 400 PHC facilities in phase 1, followed by scale-up to all 3724 health centres in Ethiopia during 2019. Monitoring and evaluation of the Ministry of Health implementation at scale will be complemented by indepth evaluation by ASSET in demonstration districts. Anticipated challenges include availability of essential medications and laboratory investigations and the need for additional training and supervisory support to deliver care for non-communicable diseases and mental health. The strong leadership from the Ministry of Health of Ethiopia combined with a productive collaboration with health systems research partners can help to ensure that Ethiopian PHCG achieves standardisation of clinical practice at the primary care level and quality healthcare for all.
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Prince, Martin James Back to the future with PACK Journal Article BMJ Global Health, 3 , pp. 1–2, 2018, ISSN: 20597908.
@article{Prince2018,
title = {Back to the future with PACK}, author = {Martin James Prince}, doi = {10.1136/bmjgh-2018-001231}, issn = {20597908}, year = {2018}, date = {2018-01-01}, journal = {BMJ Global Health}, volume = {3}, pages = {1--2}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
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Prince, Martin “If you can't measure it, you can't manage it” – essential truth, or costly myth? Journal Article World Psychiatry, 17 (1), pp. 1–2, 2018, ISSN: 20515545.
@article{Prince2018a,
title = {“If you can't measure it, you can't manage it” – essential truth, or costly myth?}, author = {Martin Prince}, doi = {10.1002/wps.20477}, issn = {20515545}, year = {2018}, date = {2018-01-01}, journal = {World Psychiatry}, volume = {17}, number = {1}, pages = {1--2}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
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White, Michelle C; Randall, Kirsten; Ravelojaona, Vaonandianina A; Andriamanjato, Hery H; Andean, Vanessa; Callahan, James; Shrime, Mark G; Russ, Stephanie; Leather, Andrew J M; Sevdalis, Nick BMJ Global Health, 3 (6), pp. 1–10, 2018, ISSN: 20597908.
@article{White2018,
title = {Sustainability of using the WHO surgical safety checklist: A mixed-methods longitudinal evaluation following a nationwide blended educational implementation strategy in Madagascar}, author = {Michelle C White and Kirsten Randall and Vaonandianina A Ravelojaona and Hery H Andriamanjato and Vanessa Andean and James Callahan and Mark G Shrime and Stephanie Russ and Andrew J M Leather and Nick Sevdalis}, doi = {10.1136/bmjgh-2018-001104}, issn = {20597908}, year = {2018}, date = {2018-01-01}, journal = {BMJ Global Health}, volume = {3}, number = {6}, pages = {1--10}, abstract = {Background The WHO Surgical Safety Checklist reduces postoperative complications by up to 50% with the biggest gains in low-income and middle-income countries (LMICs). However in LMICs, checklist use is sporadic and widespread implementation has hitherto been unsuccessful. In 2015/2016, we partnered with the Madagascar Ministry of Health to undertake nationwide implementation of the checklist. We report a longitudinal evaluation of checklist use at 12–18 months postimplementation. Methods Hospitals were identified from the original cohort using purposive sampling. Using a concurrent triangulation mixed-methods design, the primary outcome was self-reported checklist use. Secondary outcomes included use of basic safety processes, assessment of team behaviour, predictors of checklist use, impact on individuals and organisational culture and identification of barriers. Data were collected during 1-day hospital visits using validated questionnaires, WHO Behaviourally Adjusted Rating Scale (WHOBARS) assessment tool and focus groups and analysed using descriptive statistics, multivariate linear regression and thematic analysis. results 175 individuals from 14 hospitals participated. 74% reported sustained checklist use after 15 months. Mean WHOBARS scores were high, indicating good team engagement. Sustained checklist use was associated with an improved overall understanding of patient safety but not with WHOBARS, hospital size or surgical volume. 87% reported improved understanding of patient safety and 83% increased job satisfaction. Thematic analysis identified improvements in hospital culture (teamwork and communication, preparation and organisation, trust and confidence) and hospital practice (pulse oximetry, timing of antibiotic prophylaxis, introduction of a surgical count). Lack of time in an emergency and obstructive leadership were the greatest implementation barriers. Conclusion 74% of participants reported sustained checklist use 12–18 months following nationwide implementation in Madagascar, with associated improvements in job satisfaction, culture and compliance with safety procedures. Further work is required to examine this implementation model in other countries.}, keywords = {}, pubstate = {published}, tppubtype = {article} }
Background The WHO Surgical Safety Checklist reduces postoperative complications by up to 50% with the biggest gains in low-income and middle-income countries (LMICs). However in LMICs, checklist use is sporadic and widespread implementation has hitherto been unsuccessful. In 2015/2016, we partnered with the Madagascar Ministry of Health to undertake nationwide implementation of the checklist. We report a longitudinal evaluation of checklist use at 12–18 months postimplementation. Methods Hospitals were identified from the original cohort using purposive sampling. Using a concurrent triangulation mixed-methods design, the primary outcome was self-reported checklist use. Secondary outcomes included use of basic safety processes, assessment of team behaviour, predictors of checklist use, impact on individuals and organisational culture and identification of barriers. Data were collected during 1-day hospital visits using validated questionnaires, WHO Behaviourally Adjusted Rating Scale (WHOBARS) assessment tool and focus groups and analysed using descriptive statistics, multivariate linear regression and thematic analysis. results 175 individuals from 14 hospitals participated. 74% reported sustained checklist use after 15 months. Mean WHOBARS scores were high, indicating good team engagement. Sustained checklist use was associated with an improved overall understanding of patient safety but not with WHOBARS, hospital size or surgical volume. 87% reported improved understanding of patient safety and 83% increased job satisfaction. Thematic analysis identified improvements in hospital culture (teamwork and communication, preparation and organisation, trust and confidence) and hospital practice (pulse oximetry, timing of antibiotic prophylaxis, introduction of a surgical count). Lack of time in an emergency and obstructive leadership were the greatest implementation barriers. Conclusion 74% of participants reported sustained checklist use 12–18 months following nationwide implementation in Madagascar, with associated improvements in job satisfaction, culture and compliance with safety procedures. Further work is required to examine this implementation model in other countries.
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Patel, Vikram; Saxena, Shekhar; Lund, Crick; Thornicroft, Graham; Baingana, Florence; Bolton, Paul; Chisholm, Dan; Collins, Pamela Y; Cooper, Janice L; Eaton, Julian; Herrman, Helen; Herzallah, Mohammad M; Huang, Yueqin; Jordans, Mark J D; Kleinman, Arthur; Medina-Mora, Maria Elena; Morgan, Ellen; Niaz, Unaiza; Omigbodun, Olayinka; Prince, Martin; Rahman, Atif; Saraceno, Benedetto; Sarkar, Bidyut K; De Silva, Mary ; Singh, Ilina; Stein, Dan J; Sunkel, Charlene; UnÜtzer, JÜrgen The Lancet Commission on global mental health and sustainable development Journal Article The Lancet, 392 (10157), pp. 1553–1598, 2018, ISSN: 1474547X.
@article{Patel2018,
title = {The Lancet Commission on global mental health and sustainable development}, author = {Vikram Patel and Shekhar Saxena and Crick Lund and Graham Thornicroft and Florence Baingana and Paul Bolton and Dan Chisholm and Pamela Y Collins and Janice L Cooper and Julian Eaton and Helen Herrman and Mohammad M Herzallah and Yueqin Huang and Mark J D Jordans and Arthur Kleinman and Maria Elena Medina-Mora and Ellen Morgan and Unaiza Niaz and Olayinka Omigbodun and Martin Prince and Atif Rahman and Benedetto Saraceno and Bidyut K Sarkar and Mary {De Silva} and Ilina Singh and Dan J Stein and Charlene Sunkel and JÜrgen UnÜtzer}, doi = {10.1016/S0140-6736(18)31612-X}, issn = {1474547X}, year = {2018}, date = {2018-01-01}, journal = {The Lancet}, volume = {392}, number = {10157}, pages = {1553--1598}, keywords = {}, pubstate = {published}, tppubtype = {article} } |