5 research outputs found
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
Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) protocol
Malawi has a population of around 20 million people and is one of the world's most economically deprived nations. Severe mental illness (largely comprising psychoses and severe mood disorders) is managed by a very small number of staff in four tertiary facilities, aided by clinical officers and nurses in general hospitals and clinics. Given these constraints, psychosis is largely undetected and untreated, with a median duration of untreated psychosis (DUP) of around six years. Our aim is to work with people with lived experience (PWLE), caregivers, local communities and health leaders to develop acceptable and sustainable psychosis detection and management systems to increase psychosis awareness, reduce DUP, and to improve the health and lives of people with psychosis in Malawi. We will use the UK Medical Research Council guidance for developing and evaluating complex interventions, including qualitative work to explore diverse perspectives around psychosis detection, management, and outcomes, augmented by co-design with PWLE, and underpinned by a Theory of Change. Planned deliverables include a readily usable management blueprint encompassing education and community supports, with an integrated care pathway that includes Primary Health Centre clinics and District Mental Health Teams. PWLE and caregivers will be closely involved throughout to ensure that the interventions are shaped by the communities concerned. The effect of the interventions will be assessed with a quasi-experimental sequential implementation in three regions, in terms of DUP reduction, symptom remission, functional recovery and PWLE / caregiver impact, with quality of life as the primary outcome. As the study team is focused on long-term impact, we recognise the importance of having embedded, robust evaluation of the programme as a whole. We will therefore evaluate implementation processes and outcomes, and cost-effectiveness, to demonstrate the value of this approach to the Ministry of Health, and to encourage longer-term adoption across Malawi.</p
Epidemiology and bacterial colonization of burn injuries in Blantyre
Forty-nine patients from the Burns Unit at the QECH had swabs taken
from various sites in order to determine the bacterial profile and
antibiotic susceptibilities in burn wounds colonized by bacteria. The
mean age was 16 years (range 1-70 years); 27 (55 %) of the study
population were female and 22 (45%) were male. Twenty-four (49%)
patients were epileptic. Open fire (41%) was the most common cause of
burn injuries among epileptics while hot water burns (29%) were
commonest among non-epileptics. Burn injury and percentage total burn
surface area (% TBSA) injuries decreased with age, and the upper and
lower limbs, trunk, head and neck were the most commonly affected
sites. Staphylococcus aureus was the commonest isolate (23%),
followed by Proteus mirabilis (22.7%), Streptococci spp (15.9%),
Pseudomonas aeruginosa (4.5%) and 3.4% for Escherichia coli ,
Salmonella and Klebsiella spp. There was a significant trend of
bacterial growth with increasing % TBSA (p<0.001). Bacterial growth
was significantly more common in more recent burns of less than 20 days
compared to burns of longer duration (OR 4.1 [95% CI 1.58-10.99]).
Broad-spectrum antibiotics are required as first-line therapy for
burns-related sepsis but there is need for surveillance of antibiotic
susceptibility to help determine appropriate therapy
Postpartum psychosis: a public involvement perspective across three continents
Postpartum psychosis is a psychiatric emergency that is currently not represented in diagnostic systems, to the detriment of people with lived experience. Engaging with stakeholders offers an important avenue to improve clinical practice and make research more impactful, by providing perspectives based on first-hand, expert experience. There is a paucity of reports on stakeholders’ engagement in psychiatry. Activities have thus far been limited to Western countries and there are few reports on postpartum psychosis. We report the results of public involvement activities (in the form of discussion groups) with key stakeholders in India, Malawi and the UK. These discussions centred around the clinical picture of postpartum psychosis and the terminologies used to describe these episodes. Seven major areas were highlighted: how postpartum psychosis is handled within services, common symptoms and characteristics, impact of episode, barriers to care, non-medical approaches, terminology and research areas of interest. According to the discussions, postpartum psychosis presents similarly across countries, although there are differences in access to services, approaches to mental health and terminologies used within and across countries. With this understanding comes the foundation for cross-cultural assessment, service improvement and a stakeholder-informed research agenda