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The scope of ECT practice in South Africa

By Janine Benson-Martin

Abstract

Includes abstract.Includes bibliographical references.Electroconvulsive therapy (ECT) involves the administration of an electrical current to the brain in order to produce a tonic-clonic seizure which is deemed therapeutic. It is an effective and safe procedure for the treatment of severe mental illnesses such as major depression, mania and schizophrenia. Currently little is known about the characteristics of ECT practice in South Africa. This study aims to determine current electroconvulsive therapy (ECT) practice and to compare it with reported ECT practice internationally. This is a retrospective, descriptive study, to determine the characteristics of ECT practice in South Africa; data was collected using a self-report questionnaire. The study population consisted of doctors and nurses who practiced ECT in any 12 month period between 2011 and 2012. Both private and state facilities were included in the study. Initially contact was made with hospital mental health facilities to ascertain whether an ECT machine was present on site. Once formal approval was obtained from the appropriate designated bodies, questionnaires were sent to clinical staff involved in ECT at active sites. The 36-item questionnaire covered relevant questions on: utilization rates, equipment, staffing, practice and monitoring parameters, and indications for use. Forty two institutions had an ECT machine on site, of which thirteen institutions reported non-use. Questionnaires were sent to the 29 active ECT sites. Facilities responding to the questionnaire amounted to 83% (n=24), but of these, 21 units responded to the ECT utilization questions. ECT is performed as a modified procedure in six provinces by psychiatrists, registrars, medical officers and general practitioners. In-and outpatient ECT is offered in 79% (n=19) of hospitals. The number of persons treated with ECT/10 000 population per year (ppy) is 0.22 while the number of ECT procedures/10 000 ppy is 1.19. More patients in the private sector receive ECT as a treatment modality than in the public sector (U = 22, p = 0.045). ECT is performed in a minor theatre/operating room in 79% of units, while the rest is performed in a treatment room. All but one unit had a separate recovery room. Informed consent or assent was used in all institutions. Pre-ECT work-up most commonly involved a physical examination (95.5%, n = 21) and basic blood work investigations (87%, n=20). Bilateral, unilateral and bifrontal electrode placements are used, while various dosage- determination and monitoring methods are employed. The vast majority of patients (89.22%, n=869) receiving ECT are between the ages of 18 and 59. The most common indication for ECT is depression (84.77%, n=796). The utilization rate in South Africa is similar to that of countries like Bulgaria, Poland and India, but less than that of some high-income countries. Even though ECT practices in South Africa generally follow international guidelines, standardisation of practice is still recommended

Topics: Public Mental Health
Publisher: Centre for Public Mental Health
Year: 2013
OAI identifier: oai:open.uct.ac.za:11427/2793

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