Sitting with others: mental health self-help groups in northern Ghana

BACKGROUND: Over the past four decades, there has been increasing interest in Self-Help Groups, by mental health services users and caregivers, alike. Research in high-income countries suggests that participation in SHGs is associated with decreased use of inpatient facilities, improved social functioning among service users, and decreased caregiver burden. The formation of SHGs has become an important component of mental health programmes operated by non-governmental organisations (NGOs) in low-income countries. However, there has been relatively little research examining the benefits of SHGs in this context. METHODS: Qualitative research with 18 SHGs, five local non-governmental organisations, community mental health nurses, administrators in Ghana Health Services, and discussions with BasicNeeds staff. RESULTS: SHGs have the potential to serve as key components of community mental health programmes in low-resource settings. The strongest evidence concerns how SHGs provide a range of supports, e.g., social, financial, and practical, to service users and caregivers. The groups also appear to foster greater acceptance of service users by their families and by communities at large. Membership in SHGs appears to be associated with more consistent treatment and better outcomes for those who are ill. DISCUSSION: This study highlights the need for longitudinal qualitative and quantitative evaluations of the effect of SHGs on clinical, social and economic outcomes of service users and their carers. CONCLUSIONS: The organisation of SHGs appears to be associated with positive outcomes for service users and caregivers. However, there is a need to better understand how SHGs operate and the challenges they face

Perspectives of different stakeholders about mental health care services provided by traditional healers in Ghana and the possibility of the integration of traditional medicine into mental health care

Thesis (MPhil)--Stellenbosch University, 2016.ENGLISH ABSTRACT: There is recognition that despite technological advancement and increase in expenditure in formal health care services, the popularity of traditional healing services has remained very high. This is demonstrated by the high utilisation of services of traditional healers, especially for the management of mental illnesses. This study undertook to explore perspectives of different stakeholders about mental health care services provided by traditional healers and the possibility of integrating traditional medicine into formal community mental health care in northern Ghana. It was a qualitative study where field data was collected using Key Informant Interviews and Focus Group Discussions with a range of stakeholders, made up of traditional healers, mental health service users and their primary carers formal community mental health workers, made up of mental health nurses and general health nurses, as well as district, regional and national level health policy officials and legislator. Analysis of the data was done using the thematic analysis framework of Braun and Clarke (2006). The findings of the study supported the high utilisation of traditional healing services in the treatment of mental illnesses and epilepsy. On the whole, views of stakeholders were that integration of traditional healers and their services into formal community mental health treatment services would enhance mental health services, scale up mental health care and reduce the mental health treatment gap in Ghana. On how such integration might work within the formal health system of Ghana. The finding clearly indicate that integration of services of traditional healers does not amount to their locating in public health facilities such as hospitals and clinics, with offices or working spaces to operate from. Traditional healers wold continue to be in their places of operation. Opportunities to bring about such inclusion of traditional healing services into formal community mental health care was that the study established that both traditional healers and community mental health workers being agreeable to working together. Also current national level efforts and the global momentum for increased attention to mental health has included mobilising all available resources to optimise mental health care service provision among the population, especially in low income settings. Ghana’s Mental Health Act, 2012 (Act 846) and association of traditional healers in mental health were other opportunities to take advantage of to maximise the services of traditional healers in community mental health care service provision. Challenges to the effective integration of traditional healing services into formal community mental health care included the different approaches and nosological perspectives of traditional healing and formal community mental health services, low literacy and numeracy levels of traditional healers, funding constraints and inadequate political commitment, as well as concerns with misuse of knowledge and attributions of the contribution of formal and traditional healing services to treatment and recovery of service users. It is recommended that a referral process be in place and traditional healers so identified to be treating mental illnesses of epilepsy located within proximity of community mental health service facility are engaged, through regular meetings and supportive visits, are encouraged to refer people who come to them with mental health care needs to the Community Psychiatric Units for treatment. They can be assured to have the patients to administer their prayers. The regular meetings between traditional healers and formal mental health practitioners should help diffuse the mutual suspicion between and among the two categories of health care practitioners. Guidelines detailing when to refer and minimum standards can be collectively agreed upon and regularly reviewed to ensure compliance. A system of monitoring and supervision of practices and activities of traditional healers should be in place to prevent excesses. The Mental Health Act, 2012 (Act 846) provides for such monitoring and supervision for compliance through the Visiting Committees and Mental Health Tribunals.AFRIKAANSE OPSOMMING: Geen opsomming beskikbaa

Contribution of Mental Health Service User Groups to Mental Health Services and Policy in Ghana : The Case of Mental Health Society of Ghana

RESUMO: Este estudo procurou documentar a perspectiva (s) dos utentes de saúde mental e das associações de prestadores de cuidados sobre a prestação, o papel e a contribuição de serviços de saúde mental da comunidade tal como foram percebidos por um número de informadores-chave, incluindo os utentes do serviço mentais e os próprios prestadores de cuidados. O caso específico da Sociedade Saúde Mental do Gana (MEHSOG) foi o foco deste estudo. O modelo foi o de um estudo de caso, utilizando discussões de grupo e entrevistas com informadores-chave como instrumentos de recolha de dados. Estas ferramentas de colheita de dados foram complementadas por observações dos participantes e pela revisão de documentos da MEHSOG e dos vários grupos de apoio da comunidade de auto-ajuda que compõem a associação nacional. O estudo revelou que os utentes dos serviços de saúde mental e seus prestadores de cuidados constituem um importante grupo de partes interessadas na prestação de serviços de saúde mental da comunidade e no desenvolvimento de políticas que tenham em conta as necessidades e os direitos das pessoas com doença mental ou epilepsia. O envolvimento da MEHSOG promove a mobilização de membros e famílias relacionadas com a doença mental de beneficiar de serviços de tratamento bem organizados com um impacto significativo na melhoria da saúde e da participação dos utentes dos serviços e seus prestadores de cuidados primários em processos de tomada de decisão da família e na comunidade processos de desenvolvimento. Os utentes dos serviços por beneficiarem de tratamento, e os prestadores de cuidados primários, por se tornarem mais livres e menos sobrecarregados com a responsabilidade de cuidar, podem passar a envolver-se mais em atividades que melhoramo seu estado, o de suas famílias e das comunidades. A advocacia dos membros da MEHSOG para conseguir que a “Mental Health Bill” se transforme numa Lei foi também um desenvolvimento significativo resultante da participação ativa dos utentes do serviço em chamar a atenção para uma nova e inclusiva legislação de saúde mental para o Gana. Entre os fatores e oportunidades que permitiram aos utentes dos serviços de saúde mental e aos prestadores de cuidados primários de pessoas com doença mental apoiar activamente a prestação de serviços de saúde mental comunitária e o desenvolvimento de políticas conta-se a contribuição da sociedade civil do Gana, particularmente o movimento da deficiência, e os esforços anteriores de ONGs em saúde mental e dos profissionais de saúde mental para ter uma nova lei em saúde mental. Observámos um certo número de desafios e barreiras que actuam de forma a limitar a influência dos utentes dos serviços de saúde mental na provisão da saúde mental comunitária e no desenvolvimento de políticas. Entre elas o estigma social contra a doença mental e pessoas com doença mental ou epilepsia e seus cuidadores primaries é um factor chave. O estigma tem alterado a percepção e as análises do público em geral, especialmente dos profissionais de saúde e das autoridades políticas afetando a priorização dos problemas de saúde mental nas políticas e programas. Outro desafio foi a deficiente infra-estrutura disponível para apoiar serviços de saúde mentais que assegurem aos utentes permanecerem em bom estado de saúde e bem-estar para serem advogados de si próprios. A recomendação do presente estudo é que os movimentos de utentes dos serviços de saúde mental são importantes e que eles precisam de ser apoiados e encorajados a desempenhar o seu papel como pessoas com experiência vivida para contribuir para a organização e prestação de serviços de saúde mental, bem como para a implementação, monitorização e avaliação de políticas e programas. ------------------------------------ ABSTRACT: This study sought to document the perspective(s) of mental health users and care-givers associations in community mental health service provision and their role and contribution as it was perceived by a number of key informants including the mental service users and care-givers themselves. The specific case of the Mental Health Society of Ghana (MEHSOG) was the focus of this study. A case study approach was used to with Focus Group Discussions and Key Informants Interviews being the data collection tools that were used. These data collection tools were complemented by participant observations and review of documents of the MEHSOG and the various community self-help peer support groups that make up the national association. The study revealed that mental health service users and their care-givers constitute an important stakeholder group in community mental health service provision and development of policies that factor in the needs and rights of persons with mental illness or epilepsy. MEHSOG’s involvement in mobilising members and education families to come forward with the relations with mental illness to benefit from treatment services were well made a significant impact in improving the health and participation of service users and their primary carers in family decision-making processes and in community development processes. Service users, on benefiting from treatment, and primary care-givers, on becoming freer and less burdened with the responsibility of care, move on to engage in secure livelihoods activities, which enhanced their status in their families and communities. The advocacy MEHSOG members undertook in getting the mental health Bill become Law was also noted as significant development that was realised as a result of active involvement of service users in calling for a new and inclusive mental health legislation for Ghana. Enabling factors and opportunities that enabled mental health service users and primary care-givers of people with mental illness to actively support community mental health service provision and policy development is with the vibrant civil society presence in Ghana, particularly the disability movement, and earlier efforts by NGOs in mental health in Ghana long-side mental health professionals to have a new law in mental health. A number of challenges were also noted which were found to limit the extent to which mental health service users can be influential in community mental health service provision and policy development. Key among them was the social stigma against mental illness and people with mental illness or epilepsy and their primary carers. Stigma has affected perceptions, analyses of the general public, especially health practitioners and policy authorities that it has affected their prioritisation of mental health issues in policies and programmes. Another challenge was the poor infrastructure available to support enhanced mental health care services that ensure mental health service users remain in a good state of health and wellbeing to advocate for themselves. The recommendation from the study is that mental health service user movements are important and need to be supported and encouraged to play their role as persons with lived experience to inform organisation and provision of mental health services as well as design and implementation, monitoring and evaluation of policies and programes

Hematology of layers chickens vaccinated with fowl cholera vaccine and experimentally inoculated with virulent Pasteurella multocida serotypes in Zaria, Nigeria

Objective: The objective of this study was to evaluate some hematological parameters in commercial layers inoculated with two virulent Pasteurella multocida serotypes. Materials and Methods: A total of 84 twenty-week-old black Harco layers were randomly assigned to seven groups (A, B, C, D, E, F and G) with 12 birds per group. 1mLof live attenuated fowl cholera (FC) vaccine was administered subcutaneously at 24 weeks of age to groups A and B, emulsified inactivated (killed) FC vaccine was administered dosed at 0.5 mL per bird subcutaneously at 24 weeks of age to groups C and D, groups E and F were not vaccinated, while group G served as control. Groups A, C and E were inoculated with P. multocida serotype A:1 and groups B, D and F were inoculated with P. multocida serotype A:3. Using McFarland Standard, each bird received a dose of 0.5 mL (0.1 mL intranasally and 0.4 mL intramuscularly) containing 4.5 x 108 cfu/bird. Results: For PCV (P≤0.2692 and P≤0.7643) and HB (P≤0.2806 and P≤0.7266) on day 2 and 10 post inoculation, there was no significant difference between the vaccinated, non-vaccinated groups and control group G. However, there was a highly significant difference P≤0.05 in the mean concentrations of ALP between the control group G (67.67±1.453 u/l) vaccinated groups A (80.33±4.98 u/l), B (81.33±2.60 u/l), C (75±6.35 u/l), and D (84±5.132 u/l) and unvaccinated groups E (104±1.528 u/l ), and F (78 ±3.512 u/l) post inoculation. Conclusion The PCV significantly decrease P≤0.05 in layers vaccinated and inoculated with P. multocida but increase in unvaccinated layers inoculated P. multocida. The mean serum ALP concentration significantly increase P≤0.05 in unvaccinated layers inoculated with P. multocida when compared to layers vaccinated and inoculated with P. multocida. [J Adv Vet Anim Res 2017; 4(3.000): 234-240

Antibiotic-resistant pathogenic bacterial isolates from patients attending the outpatient department of university of Cape Coast hospital, Ghana: A retrospective study between 2013-2015.

Uropathogenic Escherichia coli (E. coli) is an important urinary tract infection (UTI) that has been associated with both complicated and uncomplicated disease conditions. The global emergence of multiple drug-resistant (MDR) and extended-spectrum β-lactamase (ESBL) is of public health concern as the resistance limits the current treatment options. The objective of this study was to analyze the antibiotic-resistant patterns among the uropathogenic E. coli isolates at the University of Cape Coast (UCC) hospital between 2013 and 2015 as baseline data to understand the current antibiotic resistance situation within UCC and its environs. A retrospective cross-sectional study of bacteria isolates at UCC hospital from January 2013 to December 2015 were analyzed. A standard biochemical and antibiotic susceptibility tests were performed using Kirby-Bauer NCCLs modified disc diffusion technique. The network of interaction between pathogenic isolates and antibiotic resistance was performed using Cytoscape software. Statistical significance was tested using ANOVA and one-sample Wilcoxon test. The overall E. coli prevalence was 15.76% (32/203); females had the highest infection of 17.33% (26/150) compared to male subjects who had 11.32% (6/53) out of all the pathogenic infections. The E. coli prevalence among the age categories were 2/21 (9.52%), 27/154 (17.53%) and 4/21 (19.05%) among ≤20 years, 21-40 years and 41-60 years respectively. The isolated resistant pathogens exhibited different antibiotic resistance patterns. An interaction network of nodes connecting to other nodes indicating positive correlations between the pathogens and antibiotic resistance was established. Escherichia coli, Citrobacter spp, Klebsiella spp among other isolated pathogens formed higher centrality in the network of interaction with antibiotic resistance. The individual E. coli isolates showed a significant difference in the mean ± SD (95% CI) pattern of antibiotic resistance, 2.409±1.205 (1.828-2.990), χ2 = 36.68, p<0.0001. In conclusion, the study reports the interaction of E. coli isolates at UCC hospital and its antibiotic-resistant status between 2013 and 2015. This data forms the baseline information for assessing the current antibiotic status in UCC and its environs