Development of a psycho-social intervention for reducing psychological distress among parents of children with intellectual disabilities in Malawi

BACKGROUND:The burden of intellectual disabilities in low and middle income countries (LMIC) is high and is associated with parental psychological distress. There are few services for children and parents in most developing countries and few interventions have been created that target the psychological issues among parents of such children. This study aimed to develop a contextualized intervention to provide psychological support for parents of children with intellectual disabilities in an African setting. METHODS:Six steps were adopted from the Medical Research Council framework for designing complex interventions. This include: literature review of similar interventions and models, qualitative studies to gain insights of lived experiences of parents of such children, a consensus process with an expert panel of professionals working with children with disabilities and piloting and pre-testing the draft intervention for its acceptability and practicability in this settings. RESULTS:21 intervention modules were found from a systematic search of the literature which were listed for possible use in our intervention along with four themes from our qualitative studies. An expert panel formed consensus on the eight most pertinent and relevant modules for our setting. This formed the intervention; "Titukulane." This intervention was piloted and found to have high acceptability and practicability when contextualized in the field. CONCLUSION:The use of a systematic framework for designing a complex intervention for supporting the mental health of parents of children with disabilities enables good acceptability and practicability for future use in low resource settings

EXPLORATION OF ADOPTION OF HEALTH LIFESTYLE FOR SECONDARY PREVENTION OF NON COMMUNICABLE DISEASES (STROKE, DIABETES AND HYPERTENSION) AMONG CLIENTS AT MZUZU CENTRAL HOSPITAL MALAWI, 2013

Background: Noncommunicable diseases (NCDs) kill more than 36million people each year. Nearly 80% of NCD death (29 million) occurs inlow and middle income countries (WHO, 2010). In Malawi, NCDs accountfor at least 12% of total Disability Adjusted Life Years (WHO 2010) .Objective: The main objective was to explore adoption of healthy lifestylefor secondary prevention of stroke, diabetes and hypertension among clientsreceiving treatment at Mzuzu Central Hospital. Methods: A cross sectionalanalytical study design was used. Sixty three participants aged 18 years andabove were selected using a purposive sampling technique, who had all, ortwo or one of the following NCDs; stroke, diabetes or hypertension, andreceiving treatment at Mzuzu Central Hospital participated in the study. Aninterviewer administered questionnaires was used to collect data. Findings:The majority were females (74.6%; 47/63), and the median age of theparticipants was 60 years (Q1=51; Q3=65). Although most participantsfailed to define stroke, diabetes and hypertension (88.9%), failed to mentionthe recommended healthy lifestyle (65.1%) as regards its prevention and alsofailed to mention complications of NCDs (85.7%), the majority (85.7%)indicated to have received health education on NCDs. Furthermore, thefindings revealed that 71.4% did not perceive to be at risk of developingcomplications from their diagnosed condition despite the given healtheducation. Participant consumed fewer servings of fruits and vegetables per day, and did not practice healthy lifestyle in general. Conclusion: Healtheducation need to comprehensively cover interventions for prevention ofNCDs. Besides that, reinforcement of acquired knowledge on NCDs amongclient should be emphasized so as to increase the chances to adopt andpractice healthy lifestyle

FACTORS ASSOCIATED WITH DEVELOPMENT OF TYPHOID FEVER AT KAZIWIZIWI COAL MINING AREA IN RUMPHI DISTRICT, MALAWI: A Retrospective Case Control Study

Introduction: Kaziwiziwi is a coal mine situated in the eastern and mountainous area, 60km from Rumphi Boma in Malawi. The mine has a population of about 350 workers. Outbreak of typhoid occurred from 21st May to 15th June, 2012, at the mining area. Therefore the investigation of the outbreak was instituted to establish risk factors associated with the development of typhoid. Methodology: An unmatched 1:1 case-control study design was used to establish the relationships between the risk factors and the development of typhoid. Anyone who suffered from typhoid in the month of May and June 2012 and living within the area was regarded as a case. A control was any participant who had the same characteristics like the cases except for the contraction of typhoid during the same period, in the area. An interviewer administered questionnaire was used to collect data. Results: A total of 50 cases and 50 controls consented to participate in the study. Risk factors such as use of untreated water from a nearby river, drinking locally prepared thobwa (sweet mild beer) and not having a facility for hand washing after toilet use were associated with contracting typhoid with OR [2.7(95%CI 1.2, 6.3) p=0.0176], [OR, 1.8(95% CI 0.8, 3.96)p=0.1127] and [OR, 2.6(CI 1.1,6.1) p=0.0236] respectively. Discussion and Conclusion: Like some previous studies, use of water from the river and not washing hands after using toilet were the main risk factors associated with contracting typhoid. The water from the river needs to be treated before use and health education campaigns with targeted health promotion messaging should be conducted in the area to avoid recurrence of the outbreak

FACTORS ASSOCIATED WITH DEVELOPMENT OF TYPHOID FEVER AT KAZIWIZIWI COAL MINING AREA IN RUMPHI DISTRICT, MALAWI: A Retrospective Case Control Study

Introduction: Kaziwiziwi is a coal mine situated in the eastern and mountainous area, 60km from Rumphi Boma in Malawi. The mine has a population of about 350 workers. Outbreak of typhoid occurred from 21st May to 15th June, 2012, at the mining area. Therefore the investigation of the outbreak was instituted to establish risk factors associated with the development of typhoid. Methodology: An unmatched 1:1 case-control study design was used to establish the relationships between the risk factors and the development of typhoid. Anyone who suffered from typhoid in the month of May and June 2012 and living within the area was regarded as a case. A control was any participant who had the same characteristics like the cases except for the contraction of typhoid during the same period, in the area. An interviewer administered questionnaire was used to collect data. Results: A total of 50 cases and 50 controls consented to participate in the study. Risk factors such as use of untreated water from a nearby river, drinking locally prepared thobwa (sweet mild beer) and not having a facility for hand washing after toilet use were associated with contracting typhoid with OR [2.7(95%CI 1.2, 6.3) p=0.0176], [OR, 1.8(95% CI 0.8, 3.96)p=0.1127] and [OR, 2.6(CI 1.1,6.1) p=0.0236] respectively. Discussion and Conclusion: Like some previous studies, use of water from the river and not washing hands after using toilet were the main risk factors associated with contracting typhoid. The water from the river needs to be treated before use and health education campaigns with targeted health promotion messaging should be conducted in the area to avoid recurrence of the outbreak

Pathways to care for psychosis in Malawi

People with psychosis in Malawi have very limited access to timely assessment and evidence-based care, leading to a long duration of untreated psychosis and persistent disability. Most people with psychosis in the country consult traditional or religious healers. Stigmatising attitudes are common and services have limited capacity, particularly in rural areas. This paper, focusing on pathways to care for psychosis in Malawi, is based on the Wellcome Trust Psychosis Flagship Report on the Landscape of Mental Health Services for Psychosis in Malawi. Its purpose is to inform Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE), a longitudinal study that aims to build on existing services to develop sustainable psychosis detection systems and management pathways to promote recovery

A support programme for caregivers of children with disabilities in Ghana: Understanding the impact on the wellbeing of caregivers

Background: Four fifths of the estimated 150 million children with disability in the world live in resource poor settings where the role of the family is crucial in ensuring that these children survive and thrive. Despite their critical role, evidence is lacking on how to provide optimal support to these families. This study explores the impact of a participatory training programme for caregivers delivered through a local support group, with a focus on understanding caregiver wellbeing. Methods: A qualitative longitudinal study was conducted to investigate the impact of a training programme, “getting to know cerebral palsy,” with caregivers on their wellbeing. Eighteen caregivers, from four districts, were interviewed up to three times over 14 months, to assess impact and the reasons for any changes. Results: Low levels of knowledge, high levels of stigma, physical and emotional exhaustion, and often difficult family relationships with social exclusion of the child and caregiver were common themes at the outset. Caregivers struggled to combine their caring and economic activities. This was exacerbated by the common absence of the father. Two months after completion of the training, their reported wellbeing had improved. The reasons for this were an improved understanding about their child's condition, positive attitudinal change towards their child, feelings of hope, and through the group support, a profound realisation that they are “not on their own.” While relationships within the family remained complex in many cases, the support group offered an important and alternative social support network. Conclusions: This study illustrates the many benefits of a relatively simple caregiver intervention, which has the potential to offer a mechanism to provide sustainable social support for caregivers and children with cerebral palsy. Any future programme needs to also address more structural issues, including stigma and discrimination, and strengthen approaches to family engagement

Early intervention for children with developmental disabilities in low and middle-income countries - the case for action

In the last two decades, the global community has made significant progress in saving the lives of children <5 y of age. However, these advances are failing to help all children to thrive, especially children with disabilities. Most early child development research has focussed on the impact of biological and psychosocial factors on the developing brain and the effect of early intervention on child development. Yet studies typically exclude children with disabilities, so relatively little is known about which interventions are effective for this high-risk group. In this article we provide an overview of child development and developmental disabilities. We describe family-centred care interventions that aim to provide optimal stimulation for development in a safe, stable and nurturing environment. We make the case for improving opportunities for children with developmental disabilities to achieve their full potential and thrive, including through inclusive early childhood development intervention. Finally, we call for the global research community to adopt a systematic approach for better evidence for and implementation of early interventions for children with developmental disabilities in low-resource settings

Prevalence of psychological distress among parents of children with intellectual disabilities in Malawi

Abstract Background Children with intellectual disabilities are common and are increasing in number as more children survive globally. In stark contrast to the 1–3% prevalence of intellectual disability in children globally (reported by WHO), studies from Malawi provide alarmingly high rates (26%). We know that the prevalence of psychological distress is as high as 50% in parents of children with intellectual disabilities in Europe and the US. No such studies have yet been conducted in Africa. This study is aimed at determining the prevalence and risk factors for psychological distress among parents of intellectually disabled children in Malawi. Methods This quantitative cross-sectional study was conducted in January and February 2015. One hundred and seventy mothers and fathers of children with intellectual disabilities as diagnosed by psychiatric clinical officers were randomly sampled from two selected child disability clinics. The Self-Reporting Questionnaire (SRQ) was used “as measure for psychological distress and questions on socio-demographic variables were administered to all consenting participants.” Data was coded, cleaned and analyzed using STATA. Results 70/170 (41.2%) of parents of children with intellectual disabilities reported psychological distress. Univariate and multivariate analysis showed that area of residence (P < 0.05), low socio-economic status (P < 0.05), knowledge of the disability of one’s child (P < 0.05), low confidence in managing the disabled child (P < 0.05), increased perceived burden of care (P = 0.05), and having no sources for psychological support (P < 0.05) significantly predicted psychological distress among the parents for children with disabilities. Conclusion There is huge burden of psychological distress among parents of intellectually disabled children in Malawi. Psychosocial interventions are urgently needed to support parents of children with intellectual disability in Malawi

Influence de la cohésion familiale et de l’alexithymie parentale sur le contrôle glycémique

n/