Browsing by Author "Mall, Sumaya"

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    Attitudes of health care professionals in South Africa to the use of traditional medicine by their patients on antiretroviral treatment: a research note
    (Taylor & Francis, 2005) Mall, Sumaya
    This research note explores the attitudes and approaches of health care professionals working in antiretroviral (ARV) roll out sites in South Africa to patients taking traditional medicine. It shows that health professionals are concerned about the possibility of traditional healers undermining an ARV roll out programme through providing untested substances that could interact adversely with ARV drugs. Furthermore, traditional healers could even discourage patients from adhering to their ARV regimens. The research note also explores the opinion of the health workers towards possible collaboration between medical professionals and traditional healers. Many health care professionals were willing to collaborate with traditional healers but on their (the health care professionals) own terrain. Health care professionals would prefer to be solely in charge of the drug regimen with trained traditional healers supporting such a biomedical intervention. They would prefer traditional healers to concentrate solely on spiritual treatments as rituals.
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    Attitudes of HIV positive patients in South Africa to African traditional healers and their practices
    (2008) Mall, Sumaya
    This study explores the use of African traditional healers by people using Antiretroviral (ARV) treatment in South Africa. It focuses on the insights and? opinions of two different populations: HIV positive patients attending ARV services and lay healthcare workers (patient advocates and ARV counsellors) providing counselling services parallel to ARV treatment. A semi-structured questionnaire was used to explore the attitudes of patients to African traditional healers and their practices. This was complemented by in depth interviews with patients who reported use of traditional healing systems in the past year. The responses show that the majority of respondents had never accessed a traditional healing service. Only two patients were found to be actively crossing between ARV treatment facilities and traditional healing services at the time of their interview. The study also included two focus group discussions with lay health workers (i.e. ARV counsellors and patient advocates) at two ARV sites. On the whole it showed that lay health workers support an ARV roll out process that effectively underplays the role of traditional healers and therefore actively discourages their patients from using traditional healing services while taking ARV treatment.
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    Demand and access to mental health services: a qualitative formative study in Nepal
    (BioMed Central Ltd, 2014) Brenman, Natassia; Luitel, Nagendra; Mall, Sumaya; Jordans, Mark
    BACKGROUND: Nepal is experiencing a significant 'treatment gap' in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. METHODS: This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. RESULTS: As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. CONCLUSIONS: This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME's integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting.
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    The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers
    (BioMed Central, 2015-03-04) Cooper, Diane; Mantell, Joanne E; Moodley, Jennifer; Mall, Sumaya
    Background: Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South Africa’s prominence as a global leader in HIV treatment. In 2011, the Southern African HIV Clinicians Society published safer conception guidelines for people living with HIV (PLWH) and in 2013, the South African government published contraceptive guidelines highlighting the importance of SRH and fertility planning services for people living with HIV. Addressing unintended pregnancies, safer conception and maternal health issues is crucial for improving PLWH’s SRH and combatting the global HIV epidemic. This paper explores South African policymakers’ perspectives on public sector SRH-HIV policy integration, with a special focus on the need for national and regional policies on safer conception for PLWH and contraceptive guidelines implementation. Methods: It draws on 42 in-depth interviews with national, provincial and civil society policymakers conducted between 2008–2009 and 2011–2012, as the number of people on ART escalated. Interviews focused on three key domains: opinions on PLWH’s childbearing; the status of SRH-HIV integration policies and services; and thoughts and suggestions on SRH-HIV integration within the restructuring of South African primary care services. Data were coded and analysed according to themes. Results: Participants supported SRH-HIV integrated policy and services. However, integration challenges identified included a lack of policy and guidelines, inadequately trained providers, vertical programming, provider work overload, and a weak health system. Participants acknowledged that SRH-HIV integration policies, particularly for safer conception, contraception and cervical cancer, had been neglected. Policymakers supported public sector adoption of safer conception policy and services. Participants interviewed after expanded ART were more positive about safer conception policies for PLWH than participants interviewed earlier. Conclusion: The past decade’s HIV policy changes have increased opportunities for SRH–HIV integration. The findings provide important insights for international, regional and national SRH-HIV policy and service integration initiatives.
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    The impact of African traditional healers on Antiretroviral (ARV) treatment in South Africa
    (2007) Mall, Sumaya; London, Leslie; Nattrass, Nicoli
    There are few studies on the impact of African traditional healing on HIV/AIDS care and treatment in South Africa. There is a need for concrete data on the subject as many people across the African continent are thought to be accessing these kinds of healing services. This study which consists of three inter-related sub studies, investigated the impact of African traditional healers on Antiretroviral (ARV) treatment in South Africa. Each of the sub studies focused on the insights and opinions of three different populations, i.e. health care workers, traditional healers (who were affiliated with HIV/AIDS care services) and HIV positive patients. The first of the sub studies used in- depth interviews to explore the attitudes and approaches often health care professionals (nurses, doctors, ARV counsellors and a pharmacy assistant) working in ARV roll out sites in South Africa to their patients taking traditional medicine and accessing traditional healing paradigms. The sub study also probed their opinions of collaborating with traditional healers to strengthen ARV care. Furthermore, this sub study included two focus group discussions with lay health workers at two ARV sites (i.e. ARV counsellors and patient advocates). On the whole the study showed that health care professionals are concerned about the possibility of traditional healers undermining an ARV roll out programme. These perceptions are based on concerns that traditional healers may provide untested substances to HIV positive patients that could interact adversely with ARV drugs. They also believed that traditional healers could discourage patients from adhering to their ARV regimen. However, despite these concerns, most of the health care professionals were willing to collaborate with traditional healers but the partnership would have to be formed on the basis of the principles of the biomedical paradigm of healing. Health care professionals preferred to be solely in charge of the ARV drug regimen with (biomedically) trained traditional healers supporting them. They preferred traditional healers to concentrate solely on symbolic rituals. The focus groups with the ARV counsellors and patient advocates show that these lay health workers support an ARV roll out process that effectively underplays the role of traditional healers and therefore actively discourage their patients from using traditional healing services while taking ARV treatment. The second sub study complements the first and used in-depth interviews to explore the attitudes and approaches of five female traditional healers (working in HIV/AIDS organizations in the Western Cape) towards the use of ARV treatment by their clients. This study also explored their attitudes towards a partnership with the formal public health sector with regard to HIV/ AIDS care. The sub study showed that traditional healers are concerned about the wellbeing of HIV positive people. All of the traditional healers who were recruited into this study were in favour of a partnership with health care workers as long as such a partnership is based on mutual collaboration and respect. The third sub study was a study of HIV positive patients attending health facilities that provide ARV care. A semi structured questionnaire was adapted from instruments used in previous studies and was complemented by in depth interviews with patients who reported use of traditional healing systems in the past year. This sub study explored the attitudes of the respondents towards African traditional healers and their practices. The responses of the patients show that the majority of respondents have never accessed a traditional healing service. Some of the patients recruited in the study said they had accessed a traditional healing service before they had begun ARV treatment or before they were recruited into this study. They expressed the reasons for their choice. Only two patients were found to be actively crossing between ARV treatment facilities and traditional healing services at the time of their interview. A public health and human rights analysis suggests means of incorporating a traditional healer in ARV care, whereby an ARV treatment policy can respect cultural rights of patients and traditional healers while simultaneously improving ARV treatment infrastructure. Limitations encountered in the study such as location of the research sites, nature of the respondents and the ways in which the questions were worded to the respondents were addressed through efforts by the researcher. The study concludes that a partnership between traditional healers and the formal public health sector is feasible but must incorporate respect for cultural rights.
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    Improving adherence in mental health service users with severe mental illness in South Africa: a pilot randomized controlled trial of a treatment partner and text message intervention vs. treatment as usual
    (BioMed Central, 2017-11-09) Sibeko, Goodman; Sibeko, Goodman; Mall, Sumaya; Williams-Ashman, Peter; Thornicroft, Graham; Susser, Ezra S; Lund, Crick; Stein, Dan J; Milligan, Peter D
    Objectives: Medication non-adherence is a significant problem in treatment of severe mental disorders and is associated with poor clinical outcomes and increased demand on services. Task-shifting interventions incorporating mobile health may improve adherence in mental health service users in low- and middle-income countries. Seventy-seven participants were recruited from a psychiatric hospital in Cape Town, with 42 randomized to receive the intervention and 35 to treatment as usual. Intervention pairs underwent treatment-partner contracting and psychoeducation, and received monthly text message reminders of clinic appointments. Primary outcomes were intervention acceptability and feasibility. Secondary outcome for efficacy were adherence to clinic visit; relapse; quality of life; symptomatic relief and medication adherence. Results: Treatment partner and psychoeducation components were acceptable and feasible. The text message component was acceptable but not feasible in its current form. Efficacy outcomes favoured the intervention but did not reach statistical significance. A treatment-partner intervention is acceptable and feasible in a low- and middle-income setting. Work is needed to ensure that additional components of such interventions are tailored to the local context. Appropriately powered efficacy studies are needed. Trial Registration PACTR PACTR201610001830190, Registered 21 October 2016 (Retrospectively registered)
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    Maternal mental health in primary care in five low- and middle-income countries: a situational analysis
    (BioMed Central, 2016-02-16) Baron, Emily C; Hanlon, Charlotte; Mall, Sumaya; Honikman, Simone; Breuer, Erica; Kathree, Tasneem; Luitel, Nagendra P; Nakku, Juliet; Lund, Crick; Medhin, Girmay; Patel, Vikram; Petersen, Inge; Shrivastava, Sanjay; Tomlinson, Mark
    Background: The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care. Methods: The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness. Results: Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3–50 %) and alcohol consumption during pregnancy (5–51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community. Conclusions: It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services.
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    Parents' perspectives and experiences of having a child with hereditary hearing loss
    (2016) Ross, Sinead Amber; Wonkam, Ambroise; Laing, Nakita; Mall, Sumaya
    Congenital hearing loss (HL) occurs in 1-2 per 1000 newborns globally. Of all the congenital diseases that occur worldwide, HL remains the most disabling, with the highest rate for age-standardised disability life years and is a significant public health concern particularly in the developing world. In South Africa, 6 in 1000 newborns, have disabling HL. Genetic aetiology accounts for half of the cases of prelingual HL and of these 70% are nonsyndromic. There is ongoing research into the genetic basis of HL in the South African setting as at present, genetic testing for HL is largely uninformative in most African populations. Previous studies have examined the psychosocial challenges experienced by parents related to their child's HL, but in South Africa there have been no studies investigating the hereditary aspects of HL and how they may be related to the experiences of parents. Furthermore, the understanding and comprehension of genetics concepts is unknown in this population and needs to be explored before appropriate genetic counselling may be provided to parents of children with hereditary HL. Therefore, the aim of this research was to examine the perspectives, experiences and understanding of parents, whose children are deaf, potentially due to a nonsyndromic genetic aetiology, in a selected setting in Cape Town. Eleven participants were recruited through the clinical genetics service at Red Cross War Memorial Children's Hospital and the Dominican School for Deaf Children in Cape Town. Semi-structured interviews were conducted, and the transcripts analysed using the framework approach for data analysis. Through this approach, five themes were identified relating to the experience of parenting a deaf child, parents' understanding of the cause of their child's HL and the way that their child's difference or normalcy is perceived. Most parents were unable to identify the cause of their child's HL unless there were previous cases of HL in the family, but almost all were interested in pursuing genetic testing to assist them in finding answers. The time from the diagnosis had been an emotional and confusing time for many of the participants, who found means to cope and adapt to their child's HL through faith and support systems. Each of the participants had a unique experience with regards to their child's HL, some needing to make sacrifices and overcome practical challenges in order to provide for their child. Participants both rejected shame and pity with regards to their child's HL and embraced that their child was different, part of the Deaf world, but that this difference does not define them. This research could influence the genetics services provided for this population. It is imperative to understand the experiences and comprehension of this population so that improvements can be made to provide appropriate services.
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    Perceptions of health-related quality of life among adults living with sickle cell disease in Cape Town, South Africa
    (2018) Ingram, Clair; Wonkam, Ambroise; Laing, Nakita; Mall, Sumaya
    Sickle cell disease (SCD) is a chronic, heritable blood disorder with affected individuals suffering from debilitating health issues and requiring frequent hospitalisation. SCD is highly prevalent in areas of the world where malaria is endemic and specifically in Sub-Saharan African (SSA) region from where a number of migrants flee to South Africa. This has resulted in increased numbers of SCD patients in the South African healthcare system requiring holistic treatment and care, and ultimately improvement of their health-related quality of life (HRQL). There is limited empirical information on issues related to HRQL in SCD in Africa, with none available on adults living with SCD in South Africa. For this reason, this study was carried out with the aim of qualitatively exploring the perceptions of HRQL in adult SCD patients at Groote Schuur Hospital in Cape Town. Participants were selected from Groote Schuur Hospital, a tertiary referral hospital in Cape Town, South Africa using a purposive sampling method. Participants were asked about how their condition affected physical and psychological functioning, effects of their health on relationships and social issues such as education and employment opportunities as well as discrimination. Perceptions of access to and satisfaction with healthcare, coping strategies and independent living skills were also explored. The data collected for this study were analysed using the framework approach and thematic content analyses methods. Results suggest that participants believed their functioning was affected by the constant and unpredictable nature of SCD clinical events, and this was seen to have social, financial and psychological implications. Environmental factors such as weather, activity and psychological state had significant impact on participants' health, with pain being a common complication of the condition often making coping with the condition difficult. Participants also experienced health-related discrimination and stigma in personal and social relationships and within the workplace often with negative emotional consequences. Both the positive and negative experiences with healthcare were also described. Participants found ways to cope with their condition but it appeared that SCD had more of a negative overall impact on various domains of HRQL for participants. Insights in to the impact of SCD on adult patients is important to allow for healthcare professionals to better understand patient needs and to implement more effective coping and self-management strategies appropriate for their patients. It also allows for genetic counselling services to be better tailored to addressing the concerns and needs of patients to provide better educational and psychosocial support.
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    Process evaluations of task sharing interventions for perinatal depression in low and middle income countries (LMIC): a systematic review and qualitative meta-synthesis
    (BioMed Central, 2018-03-23) Munodawafa, Memory; Mall, Sumaya; Lund, Crick; Schneider, Marguerite
    Background Perinatal depression is common in low and middle income countries (LAMICs). Task sharing interventions have been implemented to treat perinatal depression in these settings, as a way of dealing with staff shortages. Task sharing allows lay health workers to provide services for less complex cases while being trained and supervised by specialists. Randomized controlled trials suggest that these interventions can be effective but there is limited qualitative information exploring barriers and facilitators to their implementation. This systematic review aims to systematically review current qualitative evidence of process evaluations of task sharing interventions for perinatal depression in LAMICs in relation to the United Kingdom (UK) Medical Research Council (MRC) framework for conducting process evaluations. Methods We searched Medline/ PubMed, PsycINFO, Scopus, Cochrane Library and Web of science for studies from LAMICS using search terms under the broad categories of: (a) “maternal depression’” (b) “intervention” (c) “lay counsellor” OR “community health worker” OR “non-specialist” and (d) “LAMICs”. Abstracts were independently reviewed for inclusion by two authors. Full text articles were screened and data for included articles were extracted using a standard data extraction sheet. Qualitative synthesis of qualitative evidence was conducted. Results 8420 articles were identified from initial searches. Of these, 26 full text articles were screened for eligibility with only three studies meeting the inclusion criteria. Main findings revealed that participants identified the following crucial factors: contextual factors included physical location, accessibility and cultural norms. Implementation factors included acceptability of the intervention and characteristics of the personnel. Mechanisms included counsellor factors such as motivating and facilitating trust; intervention factors such as use of stories and visual aids, and understandability of the content; and participant factors such as shared experience, meeting learning needs, and meeting expectations. Conclusions While task sharing has been suggested as an effective way of filling the treatment gap for perinatal depression, there is a paucity of qualitative research exploring barriers and facilitators to implementing these interventions. Qualitative process evaluations are crucial for the development of culturally relevant interventions.
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    Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries
    (2015-02-12) Brooke-Sumner, Carrie; Petersen, Inge; Asher, Laura; Mall, Sumaya; Egbe, Catherine O; Lund, Crick
    Abstract Background In low and middle income countries there is evidence to suggest effectiveness of community-based psychosocial interventions for schizophrenia. Many psychosocial interventions have however been conceptualized in high income countries and assessing their feasibility and acceptability in low and middle income countries is pertinent and the objective of this review. Methods Six databases were searched using search terms (i) “Schizophrenia”; (ii) “Low and middle income or developing countries” and (iii) “Psychosocial interventions”. Abstracts identified were extracted to an EndNote Database. Two authors independently reviewed abstracts according to defined inclusion and exclusion criteria. Full papers were accessed of studies meeting these criteria, or for which more information was needed to include or exclude them. Data were extracted from included studies using a predesigned data extraction form. Qualitative synthesis of qualitative and quantitative data was conducted. Results 14 037 abstracts were identified through searches. 196 full articles were reviewed with 17 articles meeting the inclusion criteria. Little data emerged on feasibility. Barriers to feasibility were noted including low education levels of participants, unavailability of caregivers, and logistical issues such as difficulty in follow up of participants. Evidence of acceptability was noted in high participation rates and levels of satisfaction with interventions. Conclusions While there is preliminary evidence to suggest acceptability of community-based psychosocial interventions for schizophrenia in low and middle income countries, evidence for overall feasibility is currently lacking. Well-designed intervention studies incorporating specific measures of acceptability and feasibility are needed.
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    The content of delusions in a sample of South African Xhosa people with schizophrenia
    (BioMed Central, 2017-01-24) Campbell, Megan M; Sibeko, Goodman; Mall, Sumaya; Baldinger, Adam; Nagdee, Mohamed; Susser, Ezra; Stein, Dan J
    Background: Although the relationship between cultural beliefs and schizophrenia has received some attention, relatively little work has emerged from African contexts. In this study we draw from a sample of South African Xhosa people with schizophrenia, exploring their cultural beliefs and explanations of illness. The purpose of the article is to examine the relationship between this cultural context and the content of delusions. Methods: A sample comprising 200 Xhosa people with schizophrenia participating in a South African schizophrenia genomics study were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Participant delusions were thematically analyzed for recurring themes. Results: The majority of participants (n = 125 72.5%) believed that others had bewitched them in order to bring about their mental illness, because they were in some way jealous of the participant. This explanation aligns well with the understanding of jealousy-induced witchcraft in Southern African communities and highlights the important role that culture plays in their content of delusions. Conclusions: Improved knowledge of these explanatory frameworks highlights the potential value of culturally sensitive assessment tools and stigma interventions in patient recovery. Furthermore such qualitative analyses contribute towards discussion about aspects of delusional thought that may be more universally stable, and those that may be more culturally variable.
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    The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university
    (BioMed Central, 2018-03-09) Mall, Sumaya; Mortier, Philippe; Taljaard, Lian; Roos, Janine; Stein, Dan J; Lochner, Christine
    Background College students are at risk of depression. This risk may be increased by the experience of childhood adversity and/or recent stressors. This study examined the association between reported experiences of childhood adversity, recent stressors and depression during the last 12 months in a cohort of South African university students. Methods Six hundred and eighty-six first year students at Stellenbosch University in South Africa completed a health-focused e-survey that included items on childhood adversity, recent stressors and mood. Individual and population attributable risk proportions (PARP) between experiences of childhood adversity and 12-month stressful experiences and 12-month depression were estimated using multivariate binomial logistic regression analysis. Results About one in six students reported depression during the last 12 months. Being a victim of bullying and emotional abuse or emotional neglect during childhood were the strongest predictors of depression in the past year at both individual and population level. With regard to recent stressors, a romantic partner being unfaithful, serious ongoing arguments or break-ups with some other close friend or family member and a sexual or gender identity crisis were the strongest predictors of depression. The predictor effect of recent stressors was significantly reduced in the final model that adjusted for the type and number of childhood traumatic experiences. At a population level, academic stress, serious ongoing arguments or break-ups with a close friend or family member, and serious betrayal by someone close were the variables that yielded the highest PARP. Conclusions Our findings suggest a significant relationship between early adversity, recent stressors, and depression here and throughout, consistent with the broader literature on predictors of depression. This study contributes to the limited data on college students’ mental health in low and middle income countries including on the African continent. The findings provide information on the population level effect sizes of trauma as a risk factor for depression, as well as on the relationship between specific recent stressors and depression in college students.