A novel theatre-based behaviour change approach for influencing community uptake of schistosomiasis control measures

Background: Appropriate behaviour change with regard to safe water contact practices will facilitate the elimination of schistosomiasis as a public health concern. Various approaches to effecting this change have been trialled in the field but with limited sustainable outcomes. Our case study assessed the effectiveness of a novel theatre-based behaviour change technique (BCT), in combination with cohort awareness raising and capacity training intervention workshops. Methodology: Our study was carried out in Mwanza, Tanzania and Kemise, Ethiopia. We adapted the Risk, Attitude, Norms, Ability, and Self-regulation (RANAS) framework and four phases using a mixed methods approach. Participatory project phase engagement an11 qualitative formative data were used to guide the design of an acceptable, holistic intervention. Initial baseline (BL) data was collected using quantitative questionnaire surveys with 804 participants in Tanzania and 617 in Ethiopia, followed by the theatre-based BCT and capacity training intervention workshops. Post-intervention (PI) survey was carried out after six months, with a participant return rate of 65% in Tanzania and 60% in Ethiopia. Results: The intervention achieved a significant improvement in the knowledge of schistosomiasis transmission being associated with poorly managed sanitation and risky water contact. Participants in Tanzania increased their uptake of preventive chemotherapy (Male: BL:56%; PI:73%, Female: BL:43%; PI:50%). There was a significant increase in the selection of sanitation (Tanzania: BL:13%; PI:21%, Ethiopia: BL:63%; PI:90%), safe water and avoiding/minimising contact with infested waters as prevention methods in Tanzania and Ethiopia. Some of the participants in Tanzania followed on from the study by building their own latrines. Conclusions: This study showed substantial positive behaviour changes in schistosomiasis control can be achieved using theatre-based BCT intervention and disease awareness training. With appropriate sensitisation, education and stakeholder engagement approaches, community members were more open to minimising risk-associated contact with contaminated water sources and were mobilised to implement preventive measures

Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions: the Programme for Improving Mental Health Care (PRIME) cohort protocol

Background: The Programme for Improving Mental Health Care (PRIME) sought to implement mental health care plans (MHCP) for four priority mental disorders (depression, alcohol use disorder, psychosis and epilepsy) into routine primary care in five low- and middle-income country districts. The impact of the MHCPs on disability was evaluated through establishment of priority disorder treatment cohorts. This paper describes the methodology of these PRIME cohorts. Methods: One cohort for each disorder was recruited across some or all five districts: Sodo (Ethiopia), Sehore (India) , Chitwan (Nepal), Dr. Kenneth Kaunda (South Africa) and Kamuli (Uganda), comprising 17 treatment cohorts in total (N = 2182). Participants were adults residing in the districts who were eligible to receive mental health treatment according to primary health care staff, trained by PRIME facilitators as per the district MHCP. Patients who screened positive for depression or AUD and who were not given a diagnosis by their clinicians (N = 709) were also recruited into comparison cohorts in Ethiopia, India, Nepal and South Africa. Caregivers of patients with epilepsy or psychosis were also recruited (N = 953), together with or on behalf of the person with a mental disorder, depending on the district. The target sample size was 200 (depression and AUD), or 150 (psychosis and epilepsy) patients initiating treatment in each recruiting district. Data collection activities were conducted by PRIME research teams. Participants completed follow-up assessments after 3 months (AUD and depression) or 6 months (psychosis and epilepsy), and after 12 months. Primary outcomes were impaired functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and symptom severity, assessed using the Patient Health Questionnaire (depression), the Alcohol Use Disorder Identification Test (AUD), and number of seizures (epilepsy). Discussion: Cohort recruitment was a function of the clinical detection rate by primary health care staff, and did not meet all planned targets. The cross-country methodology reflected the pragmatic nature of the PRIME cohorts: while the heterogeneity in methods of recruitment was a consequence of differences in health systems and MHCPs, the use of the WHODAS as primary outcome measure will allow for comparison of functioning recovery across sites and disorders

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1·14 billion (95% uncertainty interval 1·13–1·16) individuals were current smokers, who consumed 7·41 trillion (7·11–7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5–28·5] reduction) and females (37·7% [35·4–39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98–1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16–8·20) deaths and 200 million (185–214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3–21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Funding Bloomberg Philanthropies and the Bill & Melinda Gates Foundation

The effectiveness of counseling, material support and/or nutritional supplementation on improving adherence to anti-retroviral therapy and clinical outcomes among HIV patients: a systematic review of quantitative evidence protocol

Matiwos Soboka, Garumma Tolu Feyiss

Evaluierung eines Programms Master of Science in Integrated Clinical and Community Health (MSc ICCMH) in Äthiopien

Introduction: The shortage of trained manpower in the field of mental health remains a significant obstacle to the treatment of people with mental illnesses in low and middle-income countries. In 2010, a new Master of Science in Integrated Clinical and Community Mental Health (MSc ICCMH) program for non-physician clinicians was established at Jimma University to address this shortage in Ethiopia. This study aimed to assess the competency, satisfaction, and involvement level of graduates of the program.Methods: A cross-sectional study was conducted among the graduates of the program. Data were collected with a semi-structured, self-administered questionnaire that was developed for the study. Responses were recorded on a Likert scale to assess graduates' competency and satisfaction level. The quantitative data were summarized by descriptive statistics, including means, standard deviations, and frequencies. Qualitative data were transcribed and analyzed thematically.Result: Until June 2015, 32 trainees had graduated from the MSc ICCMH program; 87.5% (n=28) of these graduates participated in the study. Almost all (96.4%, n=27) graduates were working in public institutions. The majority (75%, n=21) were directly engaged in the clinical care of patients. Also, two-thirds of the graduates (67.9%, n=19) were involved in mental health research. All of the graduates felt confident in conducting psychiatric assessments of adults and identifying and managing common mental disorders (100%, n=28). Similarly, 100% (n=28) of the graduates reported that they felt confident in identifying and managing severe mental illnesses.Conclusions: The outcome of the program is a considerable workforce of skilled mental health professionals. The majority of graduates were retained within the public mental health service. Brain drain does not appear to be a challenge among non-physician mental health specialists. The findings on the self-perceived competencies mirror the amount of clinical exposure during the training. With a minimal revision of the curriculum, the level of satisfaction and competencies can be enhanced.Einführung: Der Mangel an ausgebildeten Arbeitskräften im Bereich der psychischen Gesundheit bleibt ein wesentliches Hindernis für die Behandlung von Menschen mit psychischen Erkrankungen in Ländern mit niedrigem und mittlerem Einkommen. Im Jahr 2010 wurde an der Jimma University das neue Programm Master of Science in Integrated Clinical and Community Mental Health (MSc ICCMH) für nicht-ärztliches Personal ins Leben gerufen, um diesem Mangel in Äthiopien entgegenzuwirken. In der vorliegenden Studie wurden die Kompetenz, die Zufriedenheit und das Engagement der Absolventen bewertet.Methoden: Unter den Absolventen des Programms wurde eine Querschnittsstudie durchgeführt. Die Daten wurden mit einem teilstrukturierten, selbstverwalteten Fragebogen erhoben, der für die Studie entwickelt wurde. Die Antworten wurden auf einer Likert-Skala erfasst, um die Kompetenz und die Zufriedenheit der Absolventen zu bewerten. Die quantitativen Daten wurden durch deskriptive Statistiken zusammengefasst, einschließlich Mittelwerte, Standardabweichungen und Häufigkeiten. Qualitative Daten wurden transkribiert und thematisch analysiert.Ergebnis: Bis Juni 2015 hatten 32 Studenten das MSc-ICCMH-Programm absolviert und 87,5% (n=28) dieser Absolventen nahmen an der Studie teil. Fast alle (96,4%, n=27) Absolventen arbeiteten in öffentlichen Einrichtungen. Die Mehrheit (75%, n=21) war in der klinischen Versorgung von Patienten tätig; zwei Drittel der Absolventen (67,9%, n=19) waren auch in psychiatrische Forschungsprojekte involviert. Alle Absolventen waren zuversichtlich, psychiatrische Untersuchungen von Erwachsenen durchführen, psychische Störungen identifizieren und behandeln zu können (100%, n=28). Ähnlich berichteten 100% (n=28) der Absolventen, dass sie sich zuversichtlich fühlten, schwere psychische Erkrankungen erkennen und behandeln zu können.Schlussfolgerungen: Im Rahmen des Programms konnte eine beträchtliche Anzahl von qualifizierten Mitarbeitern im Bereich der psychischen Gesundheit ausgebildet werden. Die Mehrheit der Absolventen waren im öffentlichen Dienst für psychische Gesundheit beschäftigt. Das Problem der Fachkräfte-Abwanderung scheint sich im Bereich nicht-ärztliches Fachpersonal für psychische Gesundheit nicht zu stellen. Die Studienergebnisse zu den selbst wahrgenommenen Kompetenzen spiegeln die Schwerpunktsetzung auf die klinische Expertise während des Trainings wider. Mit einer minimalen Überarbeitung des Lehrplans können die Zufriedenheit und die Kompetenzen gesteigert werden

Efficacy and Safety of Selective Laser Trabeculoplasty among Ethiopian Glaucoma Patients

Background. Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering intraocular pressure (IOP). Purpose. To determine the efficacy and safety of SLT among Ethiopian patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), and ocular hypertension (OHT). Method. A prospective, nonrandomized interventional study was conducted at Menelik II Hospital, Ethiopia. Patients on antiglaucoma medication with uncontrolled IOP and those patients treated for the first time with 360 degrees of SLT were included. Success was defined as an IOP lowering of > 20% from baseline without repeat treatment. Result. A total of 95 eyes of 61 patients with a diagnosis of OAG and OHT were enrolled. The diagnosis was POAG in 55 (57.9%) eyes, PXG in 22 (23.2%) eyes, and OHT in 18 (18.9%) eyes. Seventy (73.7%) eyes were on medications, and 25 (26.3%) eyes were treated with laser as primary therapy. The mean (SD) baseline IOP and medication were 24.3 ± 2.5 mmHg and 1.29 ± 1.01, respectively. The one-year mean (SD) IOP reduction was 6.7 ± 4.2 mmHg and medication reduction was 0.26 ± 1.34. The overall IOP reduction at 12 months was 27.6%, and the success rate was 60%. The mean IOP (SD) reduction for patients who were treated for the first time with laser and on antiglaucoma medication was 6.5 ± 3.1 mmHg and 6.8 ± 2.8 mmHg, respectively. Post-SLT, patients experienced transient ocular pain, brow ache, headache, and/or blurring of vision in 31.6%, anterior chamber reaction in 36.8%, and IOP spike ≥ 6 mmHg in 11.6%. Conclusion. SLT is an effective and safe treatment modality for OHT, POAG, and PXG among Ethiopian patients either as a first-line treatment or as an adjunct to topical glaucoma treatment

A novel theatre-based behaviour change approach for influencing community uptake of schistosomiasis control measures

Background: Appropriate behaviour change with regard to safe water contact practices will facilitate the elimination of schistosomiasis as a public health concern. Various approaches to effecting this change have been trialled in the field but with limited sustainable outcomes. Our case study assessed the effectiveness of a novel theatre-based behaviour change technique (BCT), in combination with cohort awareness raising and capacity training intervention workshops. Methodology: Our study was carried out in Mwanza, Tanzania and Kemise, Ethiopia. We adapted the Risk, Attitude, Norms, Ability, and Self-regulation (RANAS) framework and four phases using a mixed methods approach. Participatory project phase engagement an11 qualitative formative data were used to guide the design of an acceptable, holistic intervention. Initial baseline (BL) data was collected using quantitative questionnaire surveys with 804 participants in Tanzania and 617 in Ethiopia, followed by the theatre-based BCT and capacity training intervention workshops. Post-intervention (PI) survey was carried out after six months, with a participant return rate of 65% in Tanzania and 60% in Ethiopia. Results: The intervention achieved a significant improvement in the knowledge of schistosomiasis transmission being associated with poorly managed sanitation and risky water contact. Participants in Tanzania increased their uptake of preventive chemotherapy (Male: BL:56%; PI:73%, Female: BL:43%; PI:50%). There was a significant increase in the selection of sanitation (Tanzania: BL:13%; PI:21%, Ethiopia: BL:63%; PI:90%), safe water and avoiding/minimising contact with infested waters as prevention methods in Tanzania and Ethiopia. Some of the participants in Tanzania followed on from the study by building their own latrines. Conclusions: This study showed substantial positive behaviour changes in schistosomiasis control can be achieved using theatre-based BCT intervention and disease awareness training. With appropriate sensitisation, education and stakeholder engagement approaches, community members were more open to minimising risk-associated contact with contaminated water sources and were mobilised to implement preventive measures