Provision of mental health services in resource-poor settings: a randomised trial comparing counselling with routine medical treatment in North Afghanistan (Mazar-e-Sharif)

<p>Abstract</p> <p>Background</p> <p>Psychosocial stress caused by war, ongoing conflict, lack of security, and restricted access to resources promotes mental suffering and diseases in many resource-poor countries. In an exemplary setting, the present study compares the efficacy of psychosocial counselling with routine pharmacological treatment in a randomised trial in Mazar-e-Sharif (Afghanistan).</p> <p>Methods</p> <p>Help seeking Afghan women (N = 61), who were diagnosed with mental health symptoms by local physicians either received routine medical treatment<b/>(treatment as usual) or psychosocial counselling (5-8 sessions) following a specifically developed manualised treatment protocol. Primary outcome measures were symptoms of depression and anxiety assessed before treatment and at follow-up using the Hopkins Symptom Checklist and the Mini-International Neuropsychiatric Interview. Secondary outcome measures were psychosocial stressors and coping mechanisms.</p> <p>Results</p> <p>At 3-month follow-up, psychosocial counselling patients showed high improvements with respect to the severity of symptoms of depression and anxiety. In addition, they reported a reduction of psychosocial stressors and showed an enhancement of coping strategies. At the same time, the severity of symptoms, the quantity of psychosocial stressors and coping mechanisms did not improve in patients receiving routine medical treatment.</p> <p>Conclusion</p> <p>These results indicate that psychosocial counselling can be an effective treatment for mental illnesses even for those living in ongoing unsafe environments.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01155687">NCT01155687</a></p

Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan

BACKGROUND: Afghanistan lacks suitable specialized mental healthcare services despite high prevalence of severe mental health disorders which are aggravated by the conflict and numerous daily stressors. Recent studies have shown that Afghans with mental illness are not only deprived of care but are vulnerable in many other ways. Innovative participatory approaches to the design of mental healthcare policies and programs are needed in such challenging context. METHODS: We employed community based system dynamics to examine interactions between multiple factors and actors to examine the problem of persistently low service utilization for people with mental illness. Group model building sessions, designed based on a series of scripts and led by three facilitators, took place with NGO staff members in Mazar-I-Sharif in July 2014 and in Kabul in February 2015. RESULTS: We identified major feedback loops that constitute a hypothesis of how system components interact to generate a persistently low rate of service utilization by people with mental illness. In particular, we found that the interaction of the combined burdens of poverty and cost of treatment interact with cultural and social stigmatizing beliefs, in the context of limited clinical or other treatment support, to perpetuate low access to care for people with mental disorders. These findings indicate that the introduction of mental healthcare services alone will not be sufficient to meaningfully improve the condition of individuals with mental illness if community stigma and poverty are not addressed concurrently. CONCLUSIONS: Our model highlights important factors that prevent persons with mental illness from accessing services. Our study demonstrates that group model building methods using community based system dynamics can provide an effective tool to elicit a common vision on a complex problem and identify shared potential strategies for intervention in a development and global health context. Its strength and originality is the leadership role played by the actors embedded within the system in describing the complex problem and suggesting interventions

Artemisia spp. essential oils against the disease-carrying blowfly Calliphora vomitoria

Background: Synanthropic flies play a considerable role in the transmission of pathogenic and non-pathogenic microorganisms. In this work, the essential oil (EO) of two aromatic plants, Artemisia annua and A. dracunculus, were evaluated for their abilities to control the blowfly Calliphora vomitoria. A. annua and A. dracunculus EOs were extracted, analysed and tested in laboratory bioassays. Besides, the physiology of EOs toxicity and the EOs antibacterial and antifungal properties were evaluated. Results: Both Artemisia EOs were able to deter C. vomitoria oviposition on fresh beef meat. At 0.05 μL cm-2 A. dracunculus EO completely inhibited C. vomitoria oviposition. Toxicity tests, by contact, showed LD50 of 0.49 and 0.79 μL EO per fly for A. dracunculus and A. annua, respectively. By fumigation, LC50 values were 49.54 and 88.09 μL L-1 air for A. dracunculus and A. annua, respectively. EOs AChE inhibition in C. vomitoria (IC50 = 202.6 and 472.4 mg L-1, respectively for A. dracunculus and A. annua) indicated that insect neural sites are targeted by the EOs toxicity. Finally, the antibacterial and antifungal activities of the two Artemisia EOs may assist in the reduction of transmission of microbial infections/contaminations. Conclusions: Results suggest that Artemisia EOs could be of use in the control of C. vomitoria, a common vector of pathogenic microorganisms and agent of human and animal cutaneous myiasis. The prevention of pathogenic and parasitic infections is a priority for human and animal health. The Artemisia EOs could represent an eco-friendly, low-cost alternative to synthetic repellents and insecticides to fight synanthropic disease-carrying blowflies

The Evaluation of the Antibacterial and Antioxidant Activity of Tarragon (Artemisia dracunculus L.) Essential Oil and Its Chemical Composition

Background: Food born pathogenic bacteria are the most important agents of infections in humans, and food spoilage also results in economic losses in food industry. Objectives: The aim of this study was the evaluation of chemical components, total phenolic content, antioxidant and antibacterial activities of Artemisia dracunculus essential oil. Materials and Methods: The essential oil of Tarragon was analyzed by gas chromatography-flame ionization detector (GC-FID) and gas chromatography/mass spectrometry (GC-MS). The antioxidant activity and total phenolic content were evaluated by bleaching of β-carotene and folin ciocalteu methods, respectively. The antibacterial effect of the essential oil was inspected on seven Gram- positive and negative bacteria using the microdilution method. Results: A total of 19 compounds were identified by GC-FID and GC-MS. The main compounds were methyl chavicol (84.83), trans-ocimene (3.86), z-β-ocimene (3.42), limonene (1.79) and α-pinene (0.57). Total phenols were 10.16 ± 0.08 mg/g Gallic acid equivalent. The essential oil showed good antioxidant activity in bleaching of β-carotene method (50 ± 1.63). The minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) for essential oil ranged between 3.8 to 250 mg/mL, respectively. Conclusions: The essential oil of Tarragon might be replaced by synthetic antioxidant and preservatives in food industry. © 2013, Ahvaz Jundishapur University of Medical Sciences; Published by Kowsar Corp