The psychosis treatment gap and its consequences in rural Ethiopia

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dc.contributor.authorFekadu, Abebaw
dc.contributor.authorMedhin, Girmay
dc.contributor.authorLund, Crick
dc.contributor.authorDeSilva, Mary
dc.contributor.authorSelamu, Medhin
dc.contributor.authorAlem, Atalay
dc.contributor.authorAsher, Laura
dc.contributor.authorBirhane, Rahel
dc.contributor.authorPatel, Vikram
dc.contributor.authorHailemariam, Maji
dc.contributor.authorShibre, Teshome
dc.contributor.authorThornicroft, Graham
dc.contributor.authorPrince, Martin
dc.contributor.authorHanlon, Charlotte
dc.date.accessioned2019-12-10T09:01:12Z
dc.date.available2019-12-10T09:01:12Z
dc.date.issued2019-10-29
dc.date.updated2019-11-03T04:19:02Z
dc.description.abstractAbstract Background The “treatment gap” (TG) for mental disorders, widely advocated by the WHO in low-and middle-income countries, is an important indicator of the extent to which a health system fails to meet the care needs of people with mental disorder at the population level. While there is limited research on the TG in these countries, there is even a greater paucity of studies looking at TG beyond a unidimensional understanding. This study explores several dimensions of the TG construct for people with psychosis in Sodo, a rural district in Ethiopia, and its implications for building a more holistic capacity for mental health services. Method The study was a cross-sectional survey of 300 adult participants with psychosis identified through community-based case detection and confirmed through subsequent structured clinical evaluations. The Butajira Treatment Gap Questionnaire (TGQ), a new customised tool with 83 items developed by the Ethiopia research team, was administered to evaluate several TG dimensions (access, adequacy and effectiveness of treatment, and impact/consequence of the treatment gap) across a range of provider types corresponding with the WHO pyramid service framework. Results Lifetime and current access gap for biomedical care were 41.8 and 59.9% respectively while the corresponding figures for faith and traditional healing (FTH) were 15.1 and 45.2%. Of those who had received biomedical care for their current episode, 71.7% did not receive minimally adequate care. Support from the community and non-governmental organisations (NGOs) were negligible. Those with education (Adj. OR: 2.1; 95% CI: 1.2, 3.8) and history of use of FTH (Adj. OR: 3.2; 95% CI: 1.9–5.4) were more likely to use biomedical care. Inadequate biomedical care was associated with increased lifetime risk of adverse experiences, such as history of restraint, homelessness, accidents and assaults. Conclusion This is the first study of its kind. Viewing TG not as a unidimensional, but as a complex, multi-dimensional construct, offers a more realistic and holistic understanding of health beliefs, help-seeking behaviors, and need for care. The reconceptualized multidimensional TG construct could assist mental health services capacity building advocacy and policy efforts and allow community and NGOs play a larger role in supporting mental healthcare.
dc.identifier.apacitationFekadu, A., Medhin, G., Lund, C., DeSilva, M., Selamu, M., Alem, A., ... Hanlon, C. (2019). The psychosis treatment gap and its consequences in rural Ethiopia. http://hdl.handle.net/11427/30674en_ZA
dc.identifier.chicagocitationFekadu, Abebaw, Girmay Medhin, Crick Lund, Mary DeSilva, Medhin Selamu, Atalay Alem, Laura Asher, et al "The psychosis treatment gap and its consequences in rural Ethiopia." (2019) http://hdl.handle.net/11427/30674en_ZA
dc.identifier.citationBMC Psychiatry. 2019 Oct 29;19(1):325
dc.identifier.ris TY - Journal Article AU - Fekadu, Abebaw AU - Medhin, Girmay AU - Lund, Crick AU - DeSilva, Mary AU - Selamu, Medhin AU - Alem, Atalay AU - Asher, Laura AU - Birhane, Rahel AU - Patel, Vikram AU - Hailemariam, Maji AU - Shibre, Teshome AU - Thornicroft, Graham AU - Prince, Martin AU - Hanlon, Charlotte AB - Abstract Background The “treatment gap” (TG) for mental disorders, widely advocated by the WHO in low-and middle-income countries, is an important indicator of the extent to which a health system fails to meet the care needs of people with mental disorder at the population level. While there is limited research on the TG in these countries, there is even a greater paucity of studies looking at TG beyond a unidimensional understanding. This study explores several dimensions of the TG construct for people with psychosis in Sodo, a rural district in Ethiopia, and its implications for building a more holistic capacity for mental health services. Method The study was a cross-sectional survey of 300 adult participants with psychosis identified through community-based case detection and confirmed through subsequent structured clinical evaluations. The Butajira Treatment Gap Questionnaire (TGQ), a new customised tool with 83 items developed by the Ethiopia research team, was administered to evaluate several TG dimensions (access, adequacy and effectiveness of treatment, and impact/consequence of the treatment gap) across a range of provider types corresponding with the WHO pyramid service framework. Results Lifetime and current access gap for biomedical care were 41.8 and 59.9% respectively while the corresponding figures for faith and traditional healing (FTH) were 15.1 and 45.2%. Of those who had received biomedical care for their current episode, 71.7% did not receive minimally adequate care. Support from the community and non-governmental organisations (NGOs) were negligible. Those with education (Adj. OR: 2.1; 95% CI: 1.2, 3.8) and history of use of FTH (Adj. OR: 3.2; 95% CI: 1.9–5.4) were more likely to use biomedical care. Inadequate biomedical care was associated with increased lifetime risk of adverse experiences, such as history of restraint, homelessness, accidents and assaults. Conclusion This is the first study of its kind. Viewing TG not as a unidimensional, but as a complex, multi-dimensional construct, offers a more realistic and holistic understanding of health beliefs, help-seeking behaviors, and need for care. The reconceptualized multidimensional TG construct could assist mental health services capacity building advocacy and policy efforts and allow community and NGOs play a larger role in supporting mental healthcare. DA - 2019-10-29 DB - OpenUCT DP - University of Cape Town KW - Treatment gap KW - The Butajira treatment gap questionnaire KW - Treatment coverage KW - Treatment access KW - Severe mental disorder KW - Low and middle-income country KW - Developing country LK - https://open.uct.ac.za PY - 2019 T1 - The psychosis treatment gap and its consequences in rural Ethiopia TI - The psychosis treatment gap and its consequences in rural Ethiopia UR - http://hdl.handle.net/11427/30674 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12888-019-2281-6
dc.identifier.urihttp://hdl.handle.net/11427/30674
dc.identifier.vancouvercitationFekadu A, Medhin G, Lund C, DeSilva M, Selamu M, Alem A, et al. The psychosis treatment gap and its consequences in rural Ethiopia. 2019; http://hdl.handle.net/11427/30674.en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.subjectTreatment gap
dc.subjectThe Butajira treatment gap questionnaire
dc.subjectTreatment coverage
dc.subjectTreatment access
dc.subjectSevere mental disorder
dc.subjectLow and middle-income country
dc.subjectDeveloping country
dc.titleThe psychosis treatment gap and its consequences in rural Ethiopia
dc.typeJournal Article
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