Prevalence of substance use among rural high school students in Limpopo Province, South Africa

This study documents the prevalence rates for use of cigarette, alcohol, methylated spirit, cannabis, mandrax and cannabis together, glue or thinners among rural high school students in Mankweng, Limpopo Province, South Africa. A multistage sampling procedure produced a sample of 1600 students in grades 9 and 11 who completed a self-administered questionnaire. The prevalence rates for previous mouth (recent) use of alcohol, cigarettes, cannabis glue and spirits were 6.4%, 10.5%, 1.4%, 1.2% and 0,8% respectively. For all substances, males had higher prevalence rates than females. Developing alcohol and drug programme for high school students that are more gender specific may improve the effectiveness of intervention efforts at high schools. KEY WORDS: substance use, rural high school students, South Afric

A situational analysis of child and adolescent mental health services in Ghana, Uganda, South Africa and Zambia

Objective: Approximately one in five children and adolescents (CA) suffer from mental disorders. This paper reports on the findings of a situational analysis of CA mental health policy and services in Ghana, Uganda, South Africa and Zambia. The findings are part of a 5 year study, the Mental Health and Poverty Project, which aims to provide new knowledge regarding multi-sectoral approaches to breaking the cycle of poverty and mental ill-health in Africa. Method: The World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2 was used to collect quantitative information on mental health resources. Mental health policies and legislation were analysed using the WHO Policy and Plan, and Legislation Checklists. Qualitative data were collected through focus groups and interviews. Results: Child and adolescent mental health (CAMH) - related legislation, policies, services, programmes and human resources are scarce. Stigma and low priority given to mental health contribute to low investment in CAMH. Lack of attention to the impoverishing impact of mental disorders on CA and their families contribute to the burden. Conclusion: Scaling up child and adolescent mental health services (CAMHS) needs to include anti-stigma initiatives, and a greater investment in CAMH. Clear policy directions, priorities and targets should be set in country-level CAMH policies and plans. CAMHS should be intersectoral and include consideration of the poverty- mental health link. The roles of available mental health specialists should be expanded to include training and support of practitioners in all sectors. Interventions at community level are needed to engage youth, parents and local organizations to promote CAMH.Key words: Mental health; Policy; Legislation; Children and adolescent

Predicting referral practices of traditional healers of their patients with a mental illness: An application of the Theory of Planned Behaviour

Objective: Although many studies indicate that traditional healers are willing to collaborate with Western practitioners in South Africa, none focus specifically on mental health care, and none use a theory of health behaviour to explain their findings. The present study applies the Theory of Planned Behaviour (TPB) to predict traditional healer referral practices of patients with a mental illness.Method: One hundred traditional healers were first interviewed to assess the TPB variables and were contacted again 5 months later to measure self-reported behaviour.Results: Herbalists were less likely than other types of healers to referpatients with a mental illness to Western health professionals. From the TPB application, the following cognitive variables were found to predict intentions: attitudes (ß = 0.612, p< 0.01); perceived behavioural control (ß = 0.355, p< 0.01); and past behaviour (ß = 0.704, p< 0.01). Subjective norms and knowledge of mental illness did not predict intentions. Finally, past behaviour (ß = 0.297, p = 0.040) and intentions to refer patients (ß = 0.758, p< 0.01) predicted greater self-reported behaviour.Conclusion: The TPB may be a useful theoretical model for predicting the referral practices of traditional healers. The empirical data here may be useful for future work designing interventions to provide traditional healers with the information and skills they require to appropriately refer patients with mental illness.Keywords: Medicine, African traditional; Referral and Consultation; Decision Analyses; South Afric

Explanatory models of mental disorders and treatment practices among traditional healers in Mpumulanga, South Africa

Objective:  Key Words: Explanatory models; Traditional healers; Mental illness; South AfricaIn many traditional belief systems in Africa, including South Africa, mental health problems may be attributed to the influence of ancestors or to bewitchment. Traditional healers are viewed as having the expertise to address these causes. However, there is limited information on their explanatory models and consequent treatment practices. The present study examines traditional healers’ explanatory models (EMs) and treatment practices for psychotic and non-psychotic mental illnesses. Method: 4 focus group discussions (8 healers in each group) and 18 in-depth interviews were conducted. Four vignettes were presented (schizophrenia, depression, panic and somatization) and traditional healers’ views on the nature of the problem, cause, consequence, treatment and patient expectations were elicited. Results: Traditional healers held multiple explanatory models for psychotic and non-psychotic disorders. Psychotic illnesses appear to be the main exemplar of mental illness and were treated with traditional medicine, while nonpsychotic illnesses were not viewed as a mental illness at all. Additionally, traditional healers do not only use herbs and substances solely from “traditional” sources but rather have incorporated into their treatment practices modern ingredients that are potentially toxic. Conclusion: Interventions aimed at increasing the mental health literacy of traditional healers are essential. In addition, investigations of the effectiveness of traditional healer treatment for psychiatric disorders should be conducted

The neurobiology of HIV dementia: implications for practice in South Africa

In this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation. The blood brain barrier continues to limit penetration of anti-retroviral drugs into the cerebrospinal fluid. Individuals with active neuro-inflammation appear to respond well to HAART. In some cases low grade neuro-degeneration persists with consequent clinical deterioration. In South Africa, the emergence of a sub-epidemic of HIV-D is being driven by various factors, including the incomplete coverage of HAART to all who need it, the late stage presentation of people living with HIV/AIDS (PLWHA) and a co-occurring methamphetamine epidemic. Differences in viral subtype do not appear to confer protection against HIV-D. Implications for PLWHA who are at risk for HIV-D in South Africa are explored, with a view to providing suggestions for improving practice and research into this area.Key words: Dementia; HIV; HAART; South Afric

Methamphetamine use and sexual risk behaviour in Cape Town, South Africa: A review of data from 8 studies conducted between 2004 and 2007

Objective: Community studies and studies of admissions to drug treatment centers indicate a dramatic increase in the prevalence of methamphetamine use in Cape Town since 2003. There has also been a substantial increase over this time period in the prevalence of HIV infection among women attending public antenatal clinics in the Western Cape province. This study aimed to review research conducted in Cape Town on the link between methamphetamine use and sexual risk behaviour. Method: A review of published research conducted in Cape Town between 2004 and 2007 was undertaken using PubMed, EBSCOhost and Science Direct. Results: Eight studies were identified, both quantitative and qualitative, and focusing on diverse populations, such as learners in school, out of school youth, adults in the community, men who have sex with men and sex workers. The total sample across the studies was 8153. Across multiple studies methamphetamine was fairly consistently associated with early vaginal sex, condom use during sex, having casual sex and other HIV risk behaviours. For some sub-groups the direction of the relationship was in an unexpected direction. Conclusion: The consistency of the findings across studies highlights the increased risk for contracting HIV among methamphetamine users, and reinforces the importance of interventions addressing both methamphetamine use and unsafe sexual behaviour among young people and other sectors of the population. The need for further research is also considered, particularly research that will explain some of the racial differences that were found.Keywords: Methamphetamine; Sexual behaviour; HIV; South Afric

Risk-taking behaviour of Cape Peninsula high school students

Objectives. To ascertain whether the notion of a syndrome of adolescent risk behaviour (which includes problem drinking, marijuana use, having experienced sexual intercourse, 'general deviance' and cigarette smoking) is valid for this setting; and to investigate whether suicidal behaviour and behaviour that exposes the adolescent to injury should be included in this syndrome. Design. Cross-sectional survey utilising a self-completed questionnaire; for both sexes, relationships between behaviours were documented as odds ratios. Setting. High schools in the Cape Peninsula, South Africa. Subjects. 7 340 students from 16 schools in the three major ed ucation departments. Outcome measures. Participation in the following behaviours: alcohol bingeing, cannabis smoking, sexual intercourse, knife-carrying at school, cigarette smoking, attempting suicide, failure to use a seat belt, and walking home at night from beyond the neighbourhood. Results. All the odds ratios were greater than 1. There were statisticaHy significant odds ratios between all the pairs of risk behaviours included in the 'original' syndrome of risk behaviour except for cigarette smoking and having had sexual intercourse in the case of girls. There were statistically significant relationships between all these risk behaviours, suicidal behaviour, and behaviours that exposed the adolescent to risk of physical injury, except for failure to use a seat belt and: (I) suicidal behaviour for both sexes; and (iI) walking home alone at night and having had sexual intercourse in the case of gins. Conclusion. The notion of a syndrome of adolescent risk behaviour is valid for this population, and both suicidal behaviour and behaviour that exposes the adolescent to injury should be included in this syndrome.S Afr Med J 1996; 86; 1090-1093

Mental Health Stigma: What is being done to raise awareness and reduce stigma in South Africa?

Objective: Stigma plays a major role in the persistent suffering, disability and economic loss associated with mental illnesses. There is an urgent need to find effective strategies to increase awareness about mental illnesses and reduce stigma and discrimination. This study surveys the existing anti-stigma programmes in South Africa. Method: The World Health Organization’s Assessment Instrument for Mental Health Systems Version 2.2 and semi-structured interviews were used to collect data on mental health education programmes in South Africa. Results: Numerous anti-stigma campaigns are in place in both government and non-government organizations across the country. All nine provinces have had public campaigns between 2000 and 2005, targeting various groups such as the general public, youth, different ethnic groups, health care professionals, teachers and politicians. Some schools are setting up education and prevention programmes and various forms of media and art are being utilized to educate and discourage stigma and discrimination. Mental health care users are increasingly getting involved through media and talks in a wide range of settings. Yet very few of such activities are systematically evaluated for the effectiveness and very few are being published in peer-review journals or in reports where experiences and lessons can be shared and potentially applied elsewhere. Conclusion: A pool of evidence for anti-stigma and awareness-raising strategies currently exists that could potentially make a scientific contribution and inform policy in South Africa as well as in other countries.Key words: Mental Health; Stigma; South Africa; Mental Health Promotio

The prevalence of mental disorders among children, adolescents and adults in the Western Cape, South Africa

Objective: To provide estimates of the prevalence of selected mental disorders in the Western Cape, based on the consensus achieved by a working group established for this purpose. Method: An expert working group was established to provide technical expertise for the project. Potential risk factors likely to influence local prevalence rates were identified. Annual prevalence rates for adults and for children and adolescents were derived by consensus, informed by a systematic literature review. Prevalence rates were derived for individual disorders and adjusted for comorbidity. Results: The overall prevalence was 25.0% for adults and 17.0% for children and adolescents. Conclusion: Prevalence rates of child, adolescent and adult mental disorders were derived in a short period of time and with the use of minimal resources. Although of unknown validity, they are useful for policy development and for planning service utilisation estimates, resource costing and targets for service development for local mental health needs. This in the absence of an existing methodologically sound national prevalence study. We recommend that policy and programme developers draw on the expertise of local academics and clinicians to promote research-informed planning and policy development in the public sector. South African Psychiatry Review Vol. 9(3) 2006: 157-16

Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana

Objective: This paper aims to explore the options available for developing community-based care and improving the quality of care in psychiatric hospitals in Ghana. Method: Semi-structured interviews (SSIs) and focus group discussions (FGDs) were conducted with a cross-section of stakeholders including health professionals, researchers, policy makers, politicians, users and carers. The SSIs and FGDs were recorded digitally and transcribed verbatim. Apriori and emergent themes were coded and analysed with NVivo version 7.0, using a framework analysis. Results: Psychiatric hospitals in Ghana have a mean bed occupancy rate of 155%. Most respondents were of the view that the state psychiatric hospitals were very congested, substantially compromising quality of care. They also noted that the community psychiatric system was lacking human and material resources. Suggestions for addressing these difficulties included committing adequate resources to community psychiatric services, usingpsychiatric hospitals only as referral facilities, relapse prevention programmes, strengthening psychosocial services, adopting more precise diagnoses and the development of a policy on long-stay patients. Conclusion: There is an urgent need to build a credible system of community-based care and improve the quality of care in psychiatric hospitals in Ghana.Key words: Psychiatric hospital; Community psychiatry; Psychosocial services; Low and middle-income countries; Ghan