Browsing by Subject "primary healthcare"

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    Open Access
    Child and Adolescent Mental Health Services in Khartoum State, Sudan: A desktop situational analysis
    (2022) Abdalhai, Khalid Abdallah; de Vries, Petrus J; Mokitimi, Stella
    Background Sudan is a Northeast African country, with 61.7% of its population under 24 years. Data concerning child and adolescent mental health (CAMH) is limited in low-income countries. With a large youth population and significant cultural and linguistic diversity, Sudan has contributed minimal data to global CAMH research. Objectives This study aimed to perform a desktop situational analysis of CAMH services in Khartoum state, Sudan. Methods In chapter 1, we performed a literature review of peer-reviewed publications on PubMed and Google scholar and identified relevant articles through search terms relevant to the focus of the study. In chapter 2, we performed a desktop situational analysis of the national capital of Sudan, Khartoum state, in the calendar years 2019 and 2020. The study used the World Health Organization Assessment Instrument for Mental Health Systems version 2.2 adapted for CAMH. The study covered the six WHO-AIMS domains: 1) policy and legislation, 2) CAMH services, 3) CAMH in primary health care, 4) human resources for CAMH, 5) public education, and 6) monitoring and research. Data sources were identified, and relevant information and documents were reviewed. The data were described in tables and figures using the WHO-AIMS version 2.2 template. Ethical approval was obtained from the Human Research Ethics Committee at the Faculty of Health Sciences, University of Cape Town. Results The desktop situational analysis found no available policy legislation specific to CAMH in Khartoum and no separate budget for CAMH. There was no supervising body for CAMH services in Khartoum. Three mental health tertiary hospitals were found to provide services for children and adolescents with mental health problems, all together with adult mental health services. Essential medicines were available in all facilities, except methylphenidate (a stimulant medication used for ADHD), available only in 3 central pharmacies. At the primary care level, there were limited data about training offered to primary healthcare providers and about the process of referral to specialized CAMH services. A School Mental Health Program (SMHP) existed, which provided services for school-aged children and helped in the early identification and management of CAMH problems. The workforce was small and variable across all levels of care. There was no formal public health awareness campaign identified in Khartoum during the study period and little evidence of formal intersectoral collaboration on CAMHS. A health information system existed in Khartoum, but no CAMH-specific items were reported. No national studies in CAMH were identified. Conclusion This situational analysis represented the first systematic collation of data and information about CAMH services in one of the Sudan states. Findings highlighted some areas of strength, but also many gaps in CAMH services and systems. We acknowledge the need to complement the desktop analysis with in-depth data collection with stakeholders across multiple levels, but hope that this will serve as a first step towards strengthening CAMH services in Khartoum and beyond.
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    Open Access
    Task sharing for the care of severe mental disorders in a low-income country (TaSCS): study protocol for a randomised, controlled, non-inferiority trial
    (BioMed Central, 2016-02-11) Hanlon, Charlotte; Alem, Atalay; Medhin, Girmay; Shibre, Teshome; Ejigu, Dawit A; Negussie, Hanna; Dewey, Michael; Wissow, Lawrence; Prince, Martin; Susser, Ezra; Lund, Crick; Fekadu, Abebaw
    Background: Task sharing mental health care through integration into primary health care (PHC) is advocated as a means of narrowing the treatment gap for mental disorders in low-income countries. However, the effectiveness, acceptability, feasibility and sustainability of this service model for people with a severe mental disorder (SMD) have not been evaluated in a low-income country. Methods/Design: A randomised, controlled, non-inferiority trial will be carried out in a predominantly rural area of Ethiopia. A sample of 324 people with SMD (diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder) with an ongoing need for mental health care will be recruited from 1) participants in a population-based cohort study and 2) people attending a psychiatric nurse-led out-patient clinic. The intervention is a task-sharing model of locally delivered mental health care for people with SMD integrated into PHC delivered over 18 months. Participants in the active control arm will receive the established and effective model of specialist mental health care delivered by psychiatric nurses at an out-patient clinic within a centrally located general hospital. The hypothesis is that people with SMD who receive mental health care integrated into PHC will have a non-inferior clinical outcome, defined as a mean symptom score on the Brief Psychiatric Rating Scale, expanded version, of no more than six points higher, compared to participants who receive the psychiatric nurse-led service, after 12 months. The primary outcome is change in symptom severity. Secondary outcomes are functional status, relapse, service use costs, service satisfaction, drop-out and medication adherence, nutritional status, physical health care, quality of care, medication side effects, stigma, adverse events and cost-effectiveness. Sustainability and costeffectiveness will be further evaluated at 18 months. Randomisation will be stratified by health centre catchment area using random permuted blocks. The outcome assessors and investigators will be masked to allocation status. Discussion: Evidence about the effectiveness of task sharing mental health care for people with SMD in a rural, low-income African country will inform the World Health Organisation’s mental health Gap Action Programme to scale-up mental health care globally.