Transforming access to care for serious mental disorders in slums (the TRANSFORM Project) : rationale, design and protocol

This paper introduces the TRANSFORM project, which aims to improve access to mental health services for people with serious and enduring mental disorders (SMDs – psychotic disorders and severe mood disorders, often with co-occurring substance misuse) living in urban slums in Dhaka (Bangladesh) and Ibadan (Nigeria). People living in slum communities have high rates of SMDs, limited access to mental health services and conditions of chronic hardship. Help is commonly sought from faith-based and traditional healers, but people with SMDs require medical treatment, support and follow-up. This multicentre, international mental health mixed-methods research project will (a) conduct community-based ethnographic assessment using participatory methods to explore community understandings of SMDs and help-seeking; (b) explore the role of traditional and faith-based healing for SMDs, from the perspectives of people with SMDs, caregivers, community members, healers, community health workers (CHWs) and health professionals; (c) co-design, with CHWs and healers, training packages for screening, early detection and referral to mental health services; and (d) implement and evaluate the training packages for clinical and cost-effectiveness in improving access to treatment for those with SMDs. TRANSFORM will develop and test a sustainable intervention that can be integrated into existing clinical care and inform priorities for healthcare providers and policy makers

A protocol for a controlled, pre-post intervention study to change attitudes toward child marriage in Southwestern Nigeria using targeted radio programming.

BackgroundChild marriage hinders progress toward population health and development goals. Cost effective interventions that address the root causes of child marriage are needed to speed progress toward ending the practice. Nigeria is home to the largest number of married girls in Africa and many of these girls are members of the Hausa ethnic group, making efforts to tackle this issue particularly urgent among this population.MethodsRadio programs have the potential to inform large numbers of people about the harms of child marriage and change their support for the practice at low cost. We will develop a series of radio programs that address gender inequitable attitudes that motivate child marriage among Hausa communities in Ibadan, Nigeria. The content of the series will be based on input from the Hausa community. A baseline survey that measures knowledge of and support for child marriage will be conducted among randomly selected samples of Hausa adults in two cities: Ibadan, which will serve as the intervention site, and Akure, the control site. The radio programs will then air on Hausa-language stations in Ibadan over a three-month period, with the aim of informing persons of the potential harms of child marriage and reducing their support for the practice. A follow-up survey with the same individuals surveyed at baseline will be conducted in both cities. We will measure the impact of this intervention by comparing changes in these outcomes over time in the intervention site (Ibadan) with changes in the same outcomes in the control site (Akure).ConclusionThis study will investigate whether a series of targeted radio programs can reduce support for child marriage. The intervention is readily scalable and cost-effective and, if it effectively shifts attitudes toward child marriage, could represent a promising way of addressing child marriage in Nigeria

Health workers’ attitude towards children and adolescents with mental illness in a teaching hospital in north-central Nigeria

Objective: Public stigma against mental illness is well studied. However, there is a dearth of research into health workers’ attitude towards children and adolescents with mental illness, especially in lowand middle income countries such Nigeria.Methods: A cross-sectional study was conducted among 395 health workers in a Teaching Hospital in North-Central Nigeria. Participants were selected by random sampling from clinical and non-clinical departments. Participants completed questionnaires to assess stigma, knowledge, personal contact, previous training, and exposure to religious teaching on child and adolescent mental illness (CAMI).Results: The response rate was 90%. Many health workers (42%) indicated that affected children should not play with other children, 38% would feel ashamed if a child in their family had mental illness, 42% would be concerned if their child sat with an affected child, and 27% would be afraid to speak to a child or adolescent with mental illness. Independent predictors of negative attitudes were: poor knowledge, exposure to religious teaching that affected children are possessed or dangerous, and being from a non-medical professional group.Conclusion: CAMI is stigmatised by health workers in this specialist Hospital in Nigeria. Urgent intervention is required to avoid adverse impact on affected children