Conforming to the international classification of diseases: A critique on health information reporting system in Ethiopia

Abstract: Even though updating the health information system of a nation and conforming to international standards is essential for health development, it appears that very little attention is being paid to brace up the gap between the international disease taxonomy and that of Ethiopia. With the intention of appraising the existing local state of affairs with regard to the adoption of a national nosology of diseases, a review of current classification methods of diseases in Ethiopia was done and was compared with recent international developments. The World Health Organization (WHO) that took over the responsibility of revisions of the International Classification of Diseases (ICD) in 1946 with the 6th edition has recently come up with the 10th edition which is adopted world wide. Ethiopia is one of the users of the ICD system but, in disparity with the current changes, it still employs the intermediate list of ICD-6 that was supposed to be compatible with the then developing countries’ health manpower. The conditions that dictated the use of WHO’s intermediate list of causes of morbidity and mortality in the 1950’s are no longer compelling. Our review has made us realise that the persistent use of the outdated classification makes our health information system different from the rest of the world. Putting ICD-10, the latest revision, in place, is highly recommended. [Ethiop. J. Health Dev. 1999;13(3):281-283

Global mental health and schizophrenia

Purpose of review The aim was to synthesize recent evidence on schizophrenia illness experience and outcomes and models of care in low and middle-income countries (LMICs). Recent findings There is a plurality of explanatory models for psychosis and increasing evidence that context influences experiences of stigma. People with schizophrenia in LMICs are vulnerable to food insecurity, violence and physical health problems, in addition to unmet needs for mental healthcare. Family support may help to improve outcomes if present, but caregivers may be overwhelmed by the challenges faced. Despite efforts to increase availability, evidence-based care remains inaccessible to many people with schizophrenia. Non-randomized evaluations in South Africa and Mexico indicate that psychosocial support groups for people with schizophrenia and caregivers may be acceptable and useful. Randomized controlled trials in Pakistan and China show that culturally adapted cognitive-behavioural therapy can reduce symptom severity. There is emerging evidence that alternative medicine, such as Tai Chi, may be beneficial, but to date most studies are of low quality. The challenges of biomedical-traditional provider collaborations have been highlighted. Evaluations of integrated mental healthcare in primary care are underway and promise to provide vital information about how to scale-up quality care. Summary Acceptable and effective responses to schizophrenia in LMICs should be cognisant of both cultural context and universal concerns. Efforts to enhance the quality of family support should be central to models of care

A descriptive analysis of depression and pain complaints among patients with cancer in a low income country

This study highlights the clinical significance of both depression and pain complaints in patients with cancer in a low income country. Exploration of the impact of depressive disorders on quality of life and outcome of cancer is an important area for further research in low income countries

Burnout among primary healthcare workers during implementation of integrated mental healthcare in rural Ethiopia: a cohort study

Background The short-term course of burnout in healthcare workers in low- and middle-income countries has undergone limited evaluation. The aim of this study was to assess the short-term outcome of burnout symptoms in the context of implementation of a new mental health programme in a rural African district. Methods We followed up 145 primary healthcare workers (HCWs) working in 66 rural primary healthcare (PHC) facilities in Southern Ethiopia, where a new integrated mental health service was being implemented. Burnout was assessed at baseline, i.e. when the new service was being introduced, and after 6 months. Data were collected through self-administered questionnaires, including the Maslach Burnout Inventory (MBI) and instruments measuring professional satisfaction and psychosocial factors. Generalised estimating equations (GEE) were used to assess the association between change in the core dimension of burnout (emotional exhaustion) and relevant work-related and psychosocial factors. Results A total of 136 (93.8%) of HCWs completed and returned their questionnaires at 6 months. There was a non-significant reduction in the burnout level between the two time points. In GEE regression models, high depression symptom scores (adjusted mean difference (aMD) 0.56, 95% CI 0.29, 0.83, p < 0.01), experiencing two or more stressful life events (aMD 1.37, 95% CI 0.06, 2.14, p < 0.01), being a community health extension worker vs. facility-based HCW (aMD 5.80, 95% CI 3.21, 8.38, p < 0.01), perceived job insecurity (aMD 0.73, 95% CI 0.08, 1.38, p = 0.03) and older age (aMD 0.36, 95% CI 0.09, 0.63, p = 0.01) were significantly associated with higher levels of emotional exhaustion longitudinally. Conclusion In the short-term, there was no significant change in the level of burnout in the context of adding mental healthcare to the workload of HCWs. However, longer term and larger scale studies are required to substantiate this. This evidence can serve as baseline information for an intervention development to enhance wellbeing and reduce burnout

COVID-19: Initial synthesis of the epidemiology, pathogenesis, diagnosis, treatment, and public health control approaches

Introduction: The coronavirus disease (abbreviated COVID-19) pandemic caused by SARS-CoV-2 has devastated the world in the space of just a few months. Since it was first reported in December 31, 2019 in the Hubei province of China, at the time of writing, over 2 million people have been infected, with over 127,598 deaths in 202 countries and territories. Records of global distribution show a steady increase, although the USA is leading in its distribution, with Italy reporting close to 20,000 deaths. The purpose of this rapid review is to synthesize available evidence on the epidemiology, pathogenesis, diagnosis and public health control measures to inform policy, programs and research on COVID-19. Methods: A rapid review method was employed using PubMed and Google Scholar search engines. Journal articles, reports and government documents were included in our search, which is focused on the disease epidemiology, advancements in diagnostics, treatment and vaccines, public health control measures, and psychosocial interventions for health care providers. The contents of the identified articles were examined and abstracted by a team of investigators. The concepts represented by the individual reviews were collated to give a complete picture of COVID-19 based on the evidence we have so far. The search period spanned December 30, 2019 to April 15, 2020. Findings: The severity of the disease and its fast spread, three times faster than the flu, has challenged the health systems of almost every country in the world. Although, for now, the case burden remains low in Africa, the impact of COVID-19 is anticipated to be severe if it becomes widespread. Efforts to curb the pandemic, involving prevention, disease surveillance, contact tracing, clinical management and the development of new treatments and diagnostics, is ongoing across the globe. While writing this review, more than 73 vaccines are at the exploratory or preclinical stage, while two are in phase I clinical trialsYet, non-pharmaceutical interventions are critical to stopping the spread of the virus. Africa, in particular, should put extra effort into making preventive public health measures work, because health systems in the continent are too weak to withstand the effect of the pandemic should it hit hard, and the economic implications of extreme control measures following a delayed response would be severe. On the bright side, the lessons drawn from this pandemic are likely to improve the preparedness and response to similar future outbreaks and pandemics. [Ethiop. J. Health Dev. 2020; 34(2):129-140] Key words: Coronavirus, COVID-19, pandemic, SARS-CoV-

Psychometric properties of screening questionnaires to detect depression in primary healthcare setting in rural Ethiopia

Background: Much of the research about the validity of depression screening questionnaires is on criterion validity. Evidence is scarce on the concurrent, convergent and construct validity of these measures, particularly from low-income countries. This study aimed to evaluate the psychometric properties of depression screening questionnaires in primary healthcare (PHC) in rural Ethiopia. Methods: A facility-based cross-sectional study was conducted with 587 participants recruited from patients attending three PHC facilities and two ‘Holy water sites’ (places where religious treatment is being provided). The psychometric properties of five mental health screening questionnaires were evaluated: the nine item Patient Health Questionnaire (PHQ-9), the two item version of PHQ-9 (PHQ-2), a version of PHQ-9 with two added items of irritability and noise intolerance (PHQ-11), the Patient Health Questionnaire-15 (PHQ-15), and the World Health Organization-Five Well-being Index (WHO-5). Clinical diagnosis of depression was ascertained by psychiatrists. We analyzed data using exploratory factor analysis, Spearman’s rank order correlation coefficient (Rho), the Mann Whitney test of the equality of medians, univariate logistic regression and Cronbach’s alpha. Results: PHQ-9, PHQ-11 and WHO-5 were found to be unidimensional, with items in each scale highly loading onto one factor (factor loadings ranging from 0.64 to 0.87). The items of each instrument were internally consistent, with Cronbach’s alpha ranging from 0.72 (PHQ-2) to 0.89 (PHQ-11). Scores for all screening scales were moderately or highly correlated with each other (Rho = 0.58 to 0.98) and moderately correlated with anxiety and disability scores. Median scores of all screening scales were significantly higher in those diagnosed with depression. The association of items measuring emotional and cognitive symptoms with the diagnosis of depression was stronger than the association with items measuring somatic symptoms. Irritability and noise intolerance had higher association with depression diagnosis than PHQ-9 items. Conclusion: Emotional and cognitive symptoms are more useful than somatic symptoms to predict the diagnosis of depression in the PHC context in Ethiopia. Future research should focus on testing the unidimensionality of PHQ-9, PHQ-11 and WHO-5 using confirmatory factor analysis; establishing the criterion validity of PHQ-11 and WHO-5; and on assessing test-retest reliability of all the measures

Ethiopian medicinal plants used for their anti-inflammatory, wound healing or anti-infective activities: protocol for systematic literature review and meta-analysis

Objectives Medicinal plants are used globally as alternative medicines in the management of a range of disease conditions and are widely accepted across differing societies. Ethiopia hosts a large number of plant species (>7000 higher plant species), of which around 12% are thought to be endemic, making it a rich source of plant extracts potentially useful for human health. The aim of this review is to evaluate Ethiopian medicinal plants for their anti-inflammatory, wound healing, antifungal or antibacterial activities. Methods and analysis The guidance of the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) statement will be used. This review will consider all controlled studies of anti-inflammatory and wound healing properties (both in vivo and in vitro) and in vitro anti-infective properties of medicinal plants found in Ethiopia. Data sources will be EMBASE, PubMed/Medline, Scopus and Google Scholar. Guidance documents on good in vitro methods and checklists for reporting in vitro studies will be used for quality assessment of in vitro studies. The risk of bias tool for animal intervention studies (the SYRCLE RoB tool) will be used to assess the validity of studies. The main outcomes will be percent inhibition of inflammation, time of epithelisation and tissue tensile strength in wounds and microbial growth inhibition. Ethics and dissemination The findings of this systematic review will be disseminated by publishing in a peer-reviewed journal and via conference presentations. Ethical clearance was obtained from the Brighton and Sussex Medical School, Research Governance & Ethics Committee (RGEC) and Addis Ababa University, College of Health Science, Institutional Review Board

Experience of traumatic events in people with severe mental illness in a low-income country:a qualitative study

BACKGROUND: This study describes the trauma experiences of people with severe mental illness (SMI) in Ethiopia and presents a model of how SMI and trauma exposure interact to reduce functioning and quality of life in this setting.METHODS: A total of 53 participants living and working in a rural district in southern Ethiopia were interviewed: 18 people living with SMI, 21 caregivers, and 14 primary health care providers.RESULTS: Many participants reported that exposure to traumatic and stressful events led to SMI, exacerbated SMI symptoms, and increased caregiver stress and distress. In addition, SMI symptoms and caregiver desperation, stress or stigma were also reported to increase the possibility of trauma exposure.CONCLUSIONS: Results suggest it is incumbent upon health professionals and the broader health community to view trauma exposure (broadly defined) as a public health problem that affects all, particularly individuals with SMI