Factors Influencing Relapse Among Patients with Schizophrenia in Muhimbili National Hospital: The Perspectives of Patients and their Caregivers

Relapse in patients with schizophrenia is a major challenge for mental health service providers in Tanzania and other countries. Approximately 10% of patients with schizophrenia are re-admitted due to relapse at Muhimbili National Hospital (MNH) Psychiatric Unit each month. Relapse brings about negative effects and it results in a huge burden to patients, their families and mental health sector and country economy as well. So far no study has been done to address relapse in Tanzania. That is why there is a need to find out as to why individuals with schizophrenia experience relapse. This study aimed to explore perspectives on factors influencing relapse to patients with schizophrenia and their caregivers attended at Muhimbili National Hospital Psychiatric Out-patient Department, Dar es Salaam, Tanzania. Methodology A qualitative study was conducted, involving in-depth interviews of 7 schizophrenic out-patients and their 7 caregivers at MNH Psychiatric Out-patient Department in Dar es Salaam, Tanzania. Purposive sampling procedure was used to select participants for the study. Audio recorded in-depth interviews in Swahili language were conducted with all participants in the study. The recorded information was transcribed to text in computer files and analyzed by using NVivo 9 computer assisted qualitative data analysis software. Findings Personal and environmental factors for relapse were the main themes that emerged from this study. Patients and their caregivers perceived non adherence to antipsychotic medication as a leading factor to relapse. Other factors included poor family support, stressful life events and substance use. Family support, adherence to antipsychotic medication, employment and religion were viewed as protectors of relapse. Participants suggested strengthening mental health psychoeducation sessions and community home visits conducted by mental health nurses to help reduce relapse. Other suggestions included strengthening of nurse-patient therapeutic relationship in provision of mental health care. It is important for mental health nurses to strengthen their therapeutic relationships with patients and their caregivers. Regular individual psychoeducation sessions and community based interventions would help reduce relapse and mental health service ix costs. Further larger studies with more diverse sample of people with schizophrenia and their caregivers are necessary to understand the issue of relapse in patients with schizophrenia

Structural and Functional Alterations in Betel-Quid Chewers: A Systematic Review of Neuroimaging Findings

Background: A number of neuroimaging studies have investigated structural, metabolic, and functional connectivity changes in betel quid (BQ) chewers. We present a systematic review of neuroimaging studies with emphasis on key brain systems affected by BQ chewing to bring a better understanding on the neuro mechanisms involved in BQD.Methods: All BQ neuroimaging studies were identified by searching PubMed, EMBASE, and Google scholar for English articles published until March 2018 using the key words: Betel-quid, resting state, functional MRI, structural MRI, diffusion tensor imaging (DTI), and betel quid dependence basing on the PRISMA criteria. We also sought unpublished studies, and the rest were obtained from reference lists of the retrieved articles. All neuroimaging studies investigating brain structural, and functional alterations related to BQ chewing and BQ dependence were included. Our systematic review registration number is CRD42018092669.Results: A review of 12 studies showed that several systems in the brain of BQ chewers exhibited structural, metabolic, and functional alterations. BQ chewing was associated with alterations in the reward [areas in the midbrain, and prefrontal cortex (PFC)], impulsivity (anterior cingulate cortex, PFC) and cognitive (PFC, the default mode, frontotemporal, frontoparietal, occipital/temporal, occipital/parietal, temporal/limbic networks, hippocampal/hypothalamus, and the cerebellum) systems in the brain. BQ duration and severity of betel quid dependence were associated with majority of alterations in BQ chewers.Conclusion: Betel quid chewing is associated with brain alterations in structure, metabolism and function in the cognitive, reward, and impulsivity circuits which are greatly influenced by duration and severity of betel quid dependence

Prevalence and factors associated with late antenatal care visit among pregnant women in Lushoto, Tanzania

Background: Adequate utilization of antenatal health care services is associated with improved maternal and neonatal health outcomes. The World Health Organization recommends pregnant women to attend antenatal care services as early as in the first trimester. However, many women due to various reasons fail to meet the recommendations. The objective of this study was to determine the prevalence and factors associated with late antenatal booking among pregnant women in Lushoto district of north-eastern Tanzania.Methods: This hospital based cross sectional study involved pregnant women and was conducted in August-September 2015. A standardized questionnaire was used to obtain participants demographic characteristics and obstetrics history. Data analysis was done using (SPSS) and relationship between outcome variables and exposure variable was done using Chi-square test. Multivariate logistic regression was used to measure the association.Results: A total of 240 participants were involved in the study.  Out of these, 169 (70.4%) participants booked late for antenatal care (ANC) services. Delayed booking was mainly associated with not being married (AOR=3.08; 95%CI 1.149-8.275; P value=0.025) and unemployment (AOR=4.28; 95% CI 2.11-8.679; p-value=0.000)Conclusion:  Late first antenatal clinic visit was high in Lushoto, and was highly associated with unmarried and unemployment status. Therefore, provision of continuous health education and community sensitization on the importance of timely seeking ANC services should be strengthened

Acute and chronic effects of betel quid chewing on brain functional connectivity

Background: The active alkaloid in Betel quid is arecoline. Consumption of betel quid is associated with both acute effects and longer-term addictive effects. Despite growing evidence that betel quid use is linked with altered brain function and connectivity, the neurobiology of this psychoactive substance in initial acute chewing, and long-term dependence, is not clear. Methods: In this observational study, functional magnetic resonance imaging in a resting-state was performed in 24 male betel quid-dependent chewers and 28 male controls prior to and promptly after betel quid chewing. Network-based statistics were employed to determine significant differences in functional connectivity between brain networks for both acute effects and in long-term betel users versus controls. A support vector machine was employed for pattern classification analysis. Results: Before chewing betel quid, higher functional connectivity in betel quid-dependent chewers than in controls was found between the temporal, parietal and frontal brain regions (right medial orbitofrontal cortex, right lateral orbital frontal cortex, right angular gyrus, bilateral inferior temporal gyrus, superior parietal gyrus, and right medial superior frontal gyrus). In controls, the effect of betel quid chewing was significantly increased functional connectivity between the subcortical regions (caudate, putamen, pallidum, and thalamus), and the visual cortex (superior occipital gyrus and right middle occipital gyrus). Conclusion: These findings show that individuals who chronically use betel quid have higher functional connectivity than controls of the orbitofrontal cortex, and inferior temporal and angular gyri. Acute effects of betel quid are to increase the functional connectivity of some visual cortical areas (which may relate to the acute symptoms) and the basal ganglia and thalamus

“Experiences with disclosure of HIV-positive status to the infected child”: Perspectives of healthcare providers in Dar es Salaam, Tanzania

Abstract Background The specific age to which an HIV infected child can be disclosed to is stipulated to begin between ages 4 and 6 years. It has also been documented that before disclosure of HIV positive status to the infected child. Health care providers should consider children’s cognitive-developmental ability. However, observation and situation analysis show that, health care providers still feel uncomfortable disclosing the HIV positive status to the infected child. The aim of the study was to explore healthcare providers’ experiences in disclosure of HIV-positive status to the infected child. Methods A qualitative study involving 20 health care providers who attend HIV-positive children was conducted in September, 2014 in Dar es Salaam, Tanzania. Participants were selected from ten HIV care and treatment clinics (CTC) by purposive sampling. An interview guide, translated into participants’ national language (Kiswahili) was used during in-depth interviews. Sampling followed the principle of data saturation. The interviews focused on perspectives of health-care providers regarding their experience with paediatric HIV disclosure. Data from in-depth interviews were transcribed into text; data analysis followed qualitative content analysis. Results The results show how complex the process of disclosure to children living with HIV can be to healthcare providers. Confusion was noted among healthcare providers about their role and responsibility in the process of disclosing to the HIV infected child. This was reported to be largely due to unclear guidelines and lack of standardized training in paediatric HIV disclosure. Furthermore, healthcare providers were concerned about parental hesitancy to disclose early to the child due to lack of disclosure skills and fear of stigma. In order to improve the disclosure process in HIV infected children, healthcare providers recommended further standardized training on paediatric HIV disclosure with more emphasis on practical skills and inclusion of disclosure content that is age appropriate for children with HIV. Discussion The disclosure process was found to be a complex process. Perspectives regarding disclosure in children infected with HIV varied among healthcare providers in terms of their role in the process, clear national guidelines and appropriate standardized training for paediatric disclosure. Consistent with other studies, healthcare providers reported difficulties during disclosure because parents /guardians largely fear blame, social stigma, child's negative emotional reaction when disclosed to and have concerns about the child being too young and immature to understand the HIV condition. Conclusions In order to prevent inconsistencies during the disclosure process, it is important to have in place clear guidelines and standardized paediatric HIV disclosure training for healthcare providers. This would help improve their skills in paediatric disclosure, leading to positive health outcomes for children infected with HIV