Connaissances, attitudes et pratiques des professionnels de santé en santé mentale dans les pays en développement

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Myanmar: Emprowering health workers and leveraging digital technology to improve access to mental health care in Hilaing Thar Yar toxnship

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Knowledge, attitudes and practices in mental health of health professionals at the end of their curriculum in Burkina Faso: A pilot study

International audienceAim: To study the knowledge, attitudes and practices regarding mental health amongst health professionals at the end of their curriculum in Burkina Faso.Design: A descriptive and cross-sectional study was adopted.Methods: A simple random sampling was used to select 420 health students in Burkina Faso. Self-administered questionnaires on sociodemographic profile, knowledge, attitudes and practices about mental health were distributed.Results: The response rate to the questionnaires was 93%. Our study sample included 391 students amongst whom 35% (138/391) were nurse students, 32% (125/391) medical students, 26% (100/391) midwife students and 7% (28/391) were pharmacy students. A quarter of our sample had completed an internship in psychiatry.Medical students’ average knowledge, attitudes and practices in mental health were significantly higher than that of other students. Medical students had more time dedicated to mental health lectures and more opportunities for a mental health internship, unlike nurse students

Availability cost of antiepileptic and psychotropic drugs after community-based interventions in madagascar

International audienceBackground: In Madagascar, prevalence of epilepsy is 27.3/1000 and the lifetime prevalence of mental disorders 34.0. From 2013 to 2018, interventions were carried out by the MoH to train GPs on these diseases and raise awareness among the population.Objectives: The objective was to compare the availability and cost of drugs between intervention and control areas in 8 regions of Madagascar.Methods: Data were collected from all types of points of sale (POS) for medicines (public and private). All psychotropic and antiepileptic drugs were included. The study received ethical approval from the Madagascar MoH.Results: 218 POS (82.5%) agreed to be investigated. Regarding the overall availability of AEDs, there was no significant difference between intervention and control areas (95.9% vs 94.4% of POS stocking at least one AED). There were however differences for carbamazepine (79.7% vs 53.4%) and sodium valproate (27.0% vs 11.8%) with these being available in a greater number of POS in the intervention areas (p <0.05). Phenobarbital was the most commonly stocked AED in both areas (90.5% and 88.9% p=0.7). Phenytoin was not available in any supply chain. Among psychotropic drugs, anxiolytics (89.0%) were the most frequently available overall, followed by neuroleptics (21.6%) and tricyclic antidepressants (15.6%). There were significantly more outlets in the intervention areas having tricyclic antidepressants (27.0%) and mood stabilizers (4.1%). The price of AEDs and psychotropic drugs were lower in the intervention areas, except for injectable neuroleptics.Conclusions: These results suggest greater availability and lower prices for antiepileptic and psychotropic drugs in the intervention areas. As both availability and cost of drugs can affect access to treatment, this provides a relevant focus for the national epilepsy and mental health st

Etude évaluative de la rémanence des initiatives en faveur de la prévention primaire et secondaire pour l'épilepsie et la santé mentale à Madagascar

International audienceA Madagascar, des initiatives pour la prise en charge de l’épilepsie et de la santé mentale (campagnes de sensibilisation, formations, etc.) ont été réalisées entre 2013 et 2018 dans 5 des 22 régions. Notre objectif principal était d’évaluer l’efficacité de ces initiatives à moyen terme (2 à 5 ans plus tard)

Health Literacy in LMICs: what is the evidence for NCDs ?

International audienceHealth literacy is defined as a person's ability to access, understand, appraise and apply health information in order to make sound health decisions. It has emerged as a key déterminant of health outcomes, more particularly in noncommunicable diseases. Low health literacy has been associated with lower use of health care services and poorer health outcomes, including increased morbidity and mortality. During the second meeting of the EMAC-AOC Group (Epidemiology of Chronic Diseases - Central & Western Africa) health literacy and noncommunicable diseases in Low- and Middle-lncome Countries were discussed to explore options for interventional studies in sub-Saharan Africa on noncommunicable diseases prévention and control. We reviewed how health literacy is defined, how it is associated with health outcomes and health inequities, and what instruments are available to assess it. Several published studies, systematic reviews, especially in Low- and Middle-lncome Countries, as well as national and international recommendations were discussed to explore potential approaches to improve health literacy in a study evaluating interventions for the prévention and control of noncommunicable diseases in Africa

Associations of mental disorders and neurotropic parasitic diseases: a meta-analysis in developing and emerging countries

International audienceBackground: Although they are declining worldwide, neurotropic parasitic diseases are still common in developingand emerging countries. The aim of this study was to estimate the pooled prevalence and pooled associationmeasures of comorbidities between mental disorders (anxiety, depression, bipolar disorder, and schizophrenia) andneurotropic parasitic diseases (malaria, cysticercosis, toxoplasmosis, human African trypanosomiasis, Chagas disease,and human toxocariasis) in developing and emerging countries.Methods: As the first meta-analysis on this topic, this study was performed in accordance with PRISMA guidelines.The protocol was registered in PROSPERO (N°CRD42017056521). The Medline, Embase, Lilacs, and Institute ofEpidemiology and Tropical Neurology databases were used to search for articles without any restriction in languageor date. We evaluated the quality of studies independently by two investigators using the Downs and Blackassessment grid and pooled estimates using the random-effects method from CMA (Comprehensive Meta Analysis)Version 3.0.Results: In total, 18 studies published between 1997 and 2016 met our inclusion criteria. We found that theprevalence of anxiety and depression in people suffering from Chagas disease and/or neurocysticercosis was 44.9%(95% CI, 34.4–55.9). In 16 pooled studies that included 1782 people with mental disorders and 1776 controls,toxoplasmosis and/or toxocariasis were associated with increased risk of schizophrenia and/or bipolar disorders(odds ratio = 2.3; 95% CI, 1.7–3.2). Finally, toxocariasis and/or toxoplasmosis were associated with an increased risk ofthe onset of schizophrenia (odds ratio = 2.4; 95% CI, 1.7–3.4).Conclusion: Our pooled estimates show that the associations between diseases studied are relatively high indeveloping and emerging countries. This meta-analysis supports the hypothesis that toxoplasmosis could be thecause of schizophrenia. These findings could prove useful to researchers who want to further explore andunderstand the associations studied

Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: a meta-analysis

International audienceBACKGROUND:As the data on the association of mental disorders and chronic physical diseases in developing and emerging countries is heterogeneous, this study aims to produce the first meta-analysis of these comorbidities.METHODOLOGY:The meta-analysis protocol was registered in PROSPERO (N°CRD42017056521) and was performed in accordance with PRISMA guidelines. Initially, an article search was conducted on Medline, Embase, Lilacs and the Institut d'Epidémiologie et de Neurologie Tropicale database [Institute of Epidemiology and Tropical Neurology], as well as manually, with no restriction on language or date focusing on mental disorders, chronic diseases and neurotropic diseases. Two independent investigators assessed the quality of the studies which met the inclusion criteria using the Downs and Black assessment grid. The pooled estimates were calculated out using a random-effects method with CMA software Version 3.0. A meta-regression was then performed, and the significance level was set at 0.05.RESULTS:Of the 2604 articles identified, 40 articles involving 21,747 subjects met the inclusion criteria for co-morbidities between mental disorders and chronic physical diseases. Thirty-one articles were included in the meta-analysis of prevalence studies and 9 articles in that of the analytical studies. The pooled prevalence of mental disorders in patients with chronic physical diseases was 36.6% (95% CI, 31.4-42.1) and the pooled odds ratio was 3.1 (95% CI, 1.7-5.2). There was heterogeneity in all the estimates and in some cases, this was explained by the quality of the studies.CONCLUSION:Some estimates regarding the prevalence of mental disorders in people with chronic physical diseases living in developing and emerging countries were similar to those in developed countries. Mental disorders are a burden in these countries. In order to respond effectively and efficiently to the morbidity and mortality associated with them, mental health care could be integrated with physical care

L’épilepsie à Madagascar : quelle rémanence des initiatives passées ?

International audienceIntroduction Des initiatives pour la prise en charge del’épilepsie (campagnes de sensibilisation, formations, etc.) ontété menées dans 5 des 22 régions de Madagascar entre 2013 et2018. Notre objectif principal était d’évaluer l’efficacité à longterme de ces initiatives (soit 2 à 5 ans plus tard). Les objec-tifs spécifiques étaient (i) d’évaluer les effets et les bénéficesdes interventions auprès de la population générale et des per-sonnes souffrant d’épilepsie, et (ii) d’évaluer les bénéfices desinterventions auprès des prestataires de soins.Méthodes Il s’agit d’une étude quasi expérimentale (zonesd’intervention vs zones contrôle) composée de 5 enquêtes(i) Connaissances–Attitudes–Pratiques (CAP) populationgénérale, (ii) outils pour les scolaires, (iii) médecins général-istes CAP, (iv) diagnostics et conformité des prescriptions, et(v) les consultations à différents niveaux du système de santé.Résultats Les scores CAP de la population générale et dupersonnel soignant étaient significativement plus élevés dansla zone d’intervention. La bande dessinée était un outiltrès efficace et didactique pour sensibiliser et informer lesenfants. Les consultations étaient plus fréquentes dans leszones d’intervention notamment dans les centres de santéde base. La conformité des diagnostics et des prescriptions(avec les recommandations OMS) était plus élevée dans la zoned’intervention, mais tout de même classé comme « moyenne »après audit par des spécialistes. Une différence significative aété retrouvée avec une meilleure concordance en zone con-trôle (80 %) par rapport en zone d’intervention (56 %).Conclusion Les connaissances sur l’épilepsie en populationgénérale étaient insuffisantes, et l’éducation du public estainsi recommandée pour corriger des idées fausses. La bandedessinée destinée aux écoliers a été efficace pour améliorer lesCAP des élèves d’écoles publiques. La formation des médecinsgénéralistes a été efficace à court terme, mais à long terme,les CAP sont de nouveau très insuffisantes. Les interventionsdoivent être soutenues et continues jusqu’à ce que le diagnos-tic et la prise en charge des épileptiques soient acqui

Scaling Up Interventions for Better Access to Mental Health and Epilepsy Care: A Forum with Impact

International audiencePsychiatric and neurological disorders are now considered among the first contributors to the globalburden of disease. In low‑ and middle‑income countries (LMICs), insufficient specialized humanresources, inadequate training of primary care workers, traditional beliefs, stigmatization, anddiscrimination are the most common barriers to access to care. Availability and cost of medicinesare also common problems. Although in many cases effective treatments exist, 76%–85% of patientswith mental disorders or epilepsy living in LMICs are not treated. Over the last 8 years, throughthe Interactive Meetings Promoting Access to Care and Treatment (IMPACT) forum, the Instituteof Epidemiology and Tropical Neurology UMR 1094 INSERM, the World Association of Social Psychiatry, and Sanofi Global Health Programs have convened every year a group of approximately forty people from about twenty countries (not only from Africa, Asia, and Latin America, but also from Europe), and from various backgrounds (public, private, associative, and academic sectors), who are all involved in developing access to care for people living with mental disorders or epilepsy in LMICs. The meeting held in Versailles, France, on September 13 and 14, 2018, focused on “Scaling Up Interventions for Better Access to Mental Health and Epilepsy Care.” Through didactic presentations based on the World Health ganization‑ExpandNet “Nine steps for developing a scaling‑up strategy” guide, as well as case studies and workshops around three pilot projectsimplemented in Cambodia, Guatemala, and Madagascar, this forum provided participants with an opportunity to gain in knowledge and understanding of scaling‑up theories and to apply these to practical cases