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

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

Older persons’ perceptions about advanced directives and end of life issues in a geriatric care setting in Southwestern Nigeria

Introduction: advanced directives enable the planning of care and support services independent of the older person’s ability to make the decision. There is a paucity of information regarding the views and preferences regarding advanced directives and other end of life issues among older persons in low and middle-income countries such as Nigeria. The study aimed to explore the knowledge, attitude and belief of older persons regarding decision making surrounding end of life and advance directives. Methods: data were collected through focus group discussions at a monthly social gathering of outpatients in a geriatric center in Oyo State, Nigeria. Discussions were audiotaped, transcribed and analyzed manually using a thematic approach. Results: respondents’ knowledge about the end of life care and advanced directives as prescribed in high income settings were sparse and did not include choices about treatment options or any medical directives. The predominant perceptions among the participants bordered mainly on the arrangements for place of death, burial and property sharing. Participants listed in order of preference the major decision makers in the advanced directive process mainly, the oldest male child, religious leaders and legal practitioners. Conclusion: our findings imply the need for improving knowledge and awareness about the benefits of advanced directives among older persons with a focus on opportunities for their active participation

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