Community-based rehabilitation for people with psychosocial disabilities in low- and middle-income countries: a systematic review of the grey literature.

BACKGROUND: Community based rehabilitation (CBR) aims to promote the inclusion and participation of people with disabilities, particularly in low- and middle-income countries (LMICs). Yet people with psychosocial disabilities are often excluded from CBR programmes. The restrictive inclusion criteria used by previous reviews make it difficult to identify promising examples that could otherwise help to inform the uptake of CBR for people with psychosocial disabilities. We aim to address this gap using gold standard methods for the review and synthesis of grey literature on CBR for people with psychosocial disabilities in LMICs. METHODS: Our search strategy was developed in consultation with an expert advisory group and covered seven grey literature databases, two customised Google Advanced searches, 34 targeted websites and four key reports. A single reviewer screened the search results and extracted relevant data using a standardised format based on the World Health Organisation's CBR matrix. The included programmes were then checked by a second reviewer with experience in CBR to ensure they met the review's criteria. A narrative synthesis with summative content analysis was performed to synthesise the findings. RESULTS: The 23 CBR programmes identified for inclusion spanned 19 countries and were mostly located in either rural areas or urban areas where a large proportion of the population was living in poverty. 13 were classified as livelihood programmes, eight as empowerment programmes, seven as social programmes, seven as health programmes and four as education programmes. Only two addressed all five of these components. 12 of the included programmes reported challenges to implementation, with stigma and lack of resources emerging as two of the most prominent themes. CONCLUSION: This grey literature review identified several CBR programmes and synthesised key learning that would have otherwise been missed by a more traditional review of the published literature. However, as evaluation by implementing organisations is not always conducted to a high standard, the quality of this evidence is generally poor. A flexible monitoring and evaluation framework for CBR programmes could help to reduce heterogeneity in terms of the quality and content of reporting

Two are Better Than One but Three is Best: Fast-Tracking the Attainment of the Sustainable Development Goals (SDGs) Among In-School Adolescents in Nigeria

Background: With 60% of Africa’s population under the age of 25 years, investing in youth will accelerate progress towards achieving the Sustainable Development Goals (SDGs). The United Nations concept of ‘Development Accelerators’ is operationalized by examining factors associated with multiple SDGs among adolescents in Nigeria. Methodology: Through data collected on the health of 1800 adolescents in Southwest Nigeria (Ibadan), ten SDG targets were identified. Accelerator protective factors that could lead to the attainment of two or more SDG targets were identified. Associations were assessed using multivariable logistic regression adjusting for sociodemographic covariates and multiple testing. Cumulative effects were tested by marginal effects modelling. Results: Participants’ mean age was 15.02 years (SD = 2.27). Family (parenting support), environmental (no survival work and food security) and school (safe schools) related factors emerged as development accelerators. For seven of the identified SDG-aligned targets, a combination of two or more accelerator factors showed cumulative positive associations, suggesting accelerator synergies with a combination of three accelerators showing the greatest increase. For instance, perceiving the school environment as safe, being food secure and having optimal mental health was associated with an 67% chance of not using psychoactive substances. While with safe school alone it was 39% (29%-51%), with food security alone it was 42% (31%-54%) and with optimal mental health alone it was 54% (42%-66%). Conclusion: Several development accelerators related to family, environmental and school factors can have additive effects on the attainment of the SDGs amongst adolescents in Nigeria. This has practical and policy utility in the fastest growing economy in Africa

Two are Better Than One but Three is Best: Fast-Tracking the Attainment of the Sustainable Development Goals (SDGs) Among In-School Adolescents in Nigeria

Abstract Background With 60% of Africa’s population under the age of 25 years, investing in youth will accelerate progress towards achieving the Sustainable Development Goals (SDGs). The United Nations concept of ‘Development Accelerators’ is operationalized by examining factors associated with multiple SDGs among adolescents in Nigeria. Methodology Through data collected on the health of 1800 adolescents in Southwest Nigeria (Ibadan), ten SDG targets were identified. Accelerator protective factors that could lead to the attainment of two or more SDG targets were identified. Associations were assessed using multivariable logistic regression adjusting for sociodemographic covariates and multiple testing. Cumulative effects were tested by marginal effects modelling. Results Participants’ mean age was 15.02 years (SD = 2.27). Family (parenting support), environmental (no survival work and food security) and school (safe schools) related factors emerged as development accelerators. For seven of the identified SDG-aligned targets, a combination of two or more accelerator factors showed cumulative positive associations, suggesting accelerator synergies with a combination of three accelerators showing the greatest increase. For instance, perceiving the school environment as safe, being food secure and having optimal mental health was associated with an 67% chance of not using psychoactive substances. While with safe school alone it was 39% (29%-51%), with food security alone it was 42% (31%-54%) and with optimal mental health alone it was 54% (42%-66%). Conclusion Several development accelerators related to family, environmental and school factors can have additive effects on the attainment of the SDGs amongst adolescents in Nigeria. This has practical and policy utility in the fastest growing economy in Africa. </jats:sec

Interventions for adolescents and adults with psychosis in Africa: a systematic review and narrative synthesis.

BACKGROUND: The Global Burden of Disease attributable to psychotic disorders in African countries is high and has increased sharply in recent years. Yet, there is a scarcity of evidence on effective, appropriate and acceptable interventions for schizophrenia and other psychotic disorders on the continent. METHODS: We carried out a systematic review and narrative synthesis of peer-reviewed literature evaluating the impact of non-pharmacological interventions for adolescents and adults (10–65 years) in African countries. Two reviewers independently double-screened all articles and performed data extraction and quality appraisal using standardized tools. RESULTS: Of the 8529 unique texts returned by our search, 12 studies were identified for inclusion, from seven countries: Egypt, Ethiopia, Ghana, Kenya, Nigeria, South Africa and Sudan. They evaluated a range of interventions with one or more clinical, psychological or psychosocial, education or awareness or traditional or faith-based components, and were delivered by either mental health specialists or non-specialist health workers. Ten of the 12 included studies reported significant, positive effects on a range of outcomes (including functioning, symptoms and stigma). Nearly half of the interventions were based out of health facilities. Based on quality appraisals, confidence in these studies' findings is only rated low to medium. CONCLUSION: Further research is needed to develop and evaluate interventions that meet the diverse needs of people with psychosis, within and beyond the health sector