Substance-related disorders treatment service in a general hospital in Ethiopia: Experience, challenges and opportunities

According to the latest global burden of diseases report, substance related disorders (SRDs) remain important risk factors for disability and premature mortality. The subSaharan Africa region has a long history of substance use, but this was mainly limited to alcohol, tobacco, cannabis, and khat. Recently, use of hard drugs such as cocaine and heroin is on the rise. This paper highlights the current status of SRDs in Ethiopia. Alcohol, khat and tobacco are the three substances commonly misused in Ethiopia. Evidence based interventons for SRDs for low and middle-income countries (LMICs) and the challenges of setng up SRD service, and applicaton of these interventons in Ethiopia, a country of more than 100 million people and the second largest in Africa afer Nigeria with rising SRDs, is presented. It also highlights the successes, opportunites and innovatve approaches undertaken. A descriptve summary of cases seen in the SRD treatment center, and outcomes of detoxifcaton is also presented. Lessons learnt in this process have the potental to inform other similar services in LMICs.Keywords: Alcohol, Drugs, Ethiopia, Low and Middle Income, Services, Substance, subSaharan Afric

Substance use among university students in Ethiopia: A systematic review and meta-analysis

AbstractBackground: Problems arising from psychoactive substance use are among the major health and social challenges facing humanity across the globe. Young people in higher learning institutions are a particularly vulnerable group in terms of substance use, and Ethiopia is no exception. In fact, the problem is believed to be on the rise, and has become a source of concern for various stakeholders.Aim: To review the prevalence of substance use among university students in Ethiopia using reports from different institutions published over a 10-year period.Methods: Search of the literature on substance use reported from 2007 to 2017. Web resources searched included Pub Med, Psych INFO, AJOL and other relevant databases using various search terms, including: substance, alcohol, khat, tobacco, drugs, substance AND college, university, higher learning institution AND Ethiopia. The search strategy was organized using the Preferred Reporting Items for Systematic Reviews and Meta-Analysesmethod. A systematic review and meta-analysis was conducted.Results: The search yielded a total of 97 articles. Ninety-four were retrieved based on the title review, of which nine were included for full-text review. A further two were retrieved after reviewing the references used in the nine articles, and a further five were retrieved from a search of gray literature. A total of 16 articles were included in the review. Almost all studies reviewed reported a high level of substance use among university students in Ethiopia. Alcohol, tobacco and khat were the substances most commonly used by the university students. The current prevalence for drinking alcohol was 26.65% (CI: 25.73-27.56, range: 9.3%-54.9%); for smoking tobacco it was 6.83% (CI: 6.29-7.37, range: 1.8%-51.1%); and for khat chewing it was13.13% (CI: 12.53-13.72, range: 2.3%-62%). Although the prevalence of these substances was reported to be high, only few of the studies reviewed looked at the reasons for use which were very diverse, and the adverse consequences on the students, such as the impact on students’ academic performance, rates of absenteeism, and cumulative grade point averages.Conclusion and recommendation: The studies showed that students in Ethiopian higher learning institutions reported high levels of substance use, especially alcohol, tobacco and khat. Adverse impacts on students’ academic performance were observed. This finding warrants the attention of policy makers to design preventive, counseling and rehabilitative programs for these students. Further well-systematized studies that look at diverse problems associated with substance use are recommended. [Ethiop. J. Health Dev. 2018;32(4):265-277]Key words: Substance, alcohol, khat, tobacco, university students, Ethiopi

INSECTICIDES SOLD IN THE STREETS OF ADDIS ABABA FOR DOMESTIC USE AND THE POSSIBLE PUBLIC HEALTH HAZARD ASSOCIATED WITH THE PRACTICE

ABSTRACTChemical analyses were performed to identify the insecticides sold in the streets of Addis Ababa by peddlers. Parat"'ion, a very toxic substance, and malathion, were identified in a number of the unlabelled liquid samples, while packages of powder bearing the lable "DDT" were confirmed to contain thu insecticide. Thu study assesses the possible hazards resulting from street vendors selling insecticides and living advice on their use and concludes that the practice u hazardous to the public

"I cry every day and night, I have my son tied in chains": physical restraint of people with schizophrenia in community settings in Ethiopia.

BACKGROUND: A primary rationale for scaling up mental health services in low and middle-income countries is to address human rights violations, including physical restraint in community settings. The voices of those with intimate experiences of restraint, in particular people with mental illness and their families, are rarely heard. The aim of this study was to understand the experiences of, and reasons for, restraint of people with schizophrenia in community settings in rural Ethiopia in order to develop constructive and scalable interventions. METHODS: A qualitative study was conducted, involving 15 in-depth interviews and 5 focus group discussions (n = 35) with a purposive sample of people with schizophrenia, their caregivers, community leaders and primary and community health workers in rural Ethiopia. Thematic analysis was used. RESULTS: Most of the participants with schizophrenia and their caregivers had personal experience of the practice of restraint. The main explanations given for restraint were to protect the individual or the community, and to facilitate transportation to health facilities. These reasons were underpinned by a lack of care options, and the consequent heavy family burden and a sense of powerlessness amongst caregivers. Whilst there was pervasive stigma towards people with schizophrenia, lack of awareness about mental illness was not a primary reason for restraint. All types of participants cited increasing access to treatment as the most effective way to reduce the incidence of restraint. CONCLUSION: Restraint in community settings in rural Ethiopia entails the violation of various human rights, but the underlying human rights issue is one of lack of access to treatment. The scale up of accessible and affordable mental health care may go some way to address the issue of restraint. TRIAL REGISTRATION: Clinicaltrials.gov NCT02160249 Registered 3rd June 2014

Editorial

NCD Risk Factors on the Rise in Ethiopia: A call for Action

The critical needs and challenges for genetic architecture studies in Africa

Human genetic studies have long been vastly Eurocentric, raising a key question about the generalizability of these study findings to other populations. Because humans originated in Africa, these populations retain more genetic diversity, and yet individuals of African descent have been tremendously underrepresented in genetic studies. The diversity in Africa affords ample opportunities to improve fine-mapping resolution for associated loci, discover novel genetic associations with phenotypes, build more generalizable genetic risk prediction models, and better understand the genetic architecture of complex traits and diseases subject to varying environmental pressures. Thus, it is both ethically and scientifically imperative that geneticists globally surmount challenges that have limited progress in African genetic studies to date. Additionally, African investigators need to be meaningfully included, as greater inclusivity and enhanced research capacity afford enormous opportunities to accelerate genomic discoveries that translate more effectively to all populations. We review the advantages, challenges, and examples of genetic architecture studies of complex traits and diseases in Africa. For example, with greater genetic diversity comes greater ancestral heterogeneity; this higher level of understudied diversity can yield novel genetic findings, but some methods that assume homogeneous population structure and work well in European populations may work less well in the presence of greater heterogeneity in African populations. Consequently, we advocate for methodological development that will accelerate studies important for all populations, especially those currently underrepresented in genetics.Peer reviewe

Promoting access to indigenous information in Africa: Challenges and requirements

The United Nations Sustainable Development Goal SDG16.10 advocates for ensuring public access to information, yet knowledge access and sharing are some of the key challenges in many countries, especially in Africa. The African Union Agenda 2063 strongly recommends access to African indigenous, cultural information to promote sustainable development but how might this be achieved? This paper shares findings from a project - NetDiploma - that built an international multi-stakeholder network of experts, professionals and various user communities to mobilize and share knowledge to explore the requirements for promoting access to cultural heritage and government information held in memory institutions, such as archives, for everyone in Africa. It identifies the key enablers and challenges associated with the long-term goal of making African government, indigenous and cultural heritage information accessible online in the form of a Digital Public Library of Africa (DPLAf) and the research and development required to realise this vision

“Like a doctor, like a brother”: achieving competence amongst lay health workers delivering community-based rehabilitation for people with schizophrenia in Ethiopia

BackgroundThere are gaps in our understanding of how non-specialists, such as lay health workers, can achieve core competencies to deliver psychosocial interventions in low- and middle-income countries.MethodsWe conducted a 12-month mixed-methods study alongside the Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE) pilot study. We rated a total of 30 role-plays and 55 clinical encounters of ten community-based rehabilitation (CBR) lay workers using an Ethiopian adaptation of the ENhancing Assessment of Common Therapeutic factors (ENACT) structured observational rating scale. To explore factors influencing competence, six focus group discussions and four in-depth interviews were conducted with 11 CBR workers and two supervisors at three time-points. We conducted a thematic analysis and triangulated the qualitative and quantitative data.Results There were improvements in CBR worker competence throughout the training and 12-month pilot study. Therapeutic alliance competencies (e.g., empathy) saw the earliest improvements. Competencies in personal factors (e.g., substance use) and external factors (e.g., assessing social networks) were initially rated lower, but scores improved during the pilot. Problem-solving and giving advice competencies saw the least improvements overall. Multimodal training, including role-plays, field work and group discussions, contributed to early development of competence. Initial stigma towards CBR participants was reduced through contact. Over time CBR workers occupied dual roles of expert and close friend for the people with schizophrenia in the programme. Competence was sustained through peer supervision, which also supported wellbeing. More intensive specialist supervision was needed. ConclusionIt is possible to equip lay health workers with the core competencies to deliver a psychosocial intervention for people with schizophrenia in a low-income setting. A prolonged period of work experience is needed to develop advanced skills such as problem-solving. A structured intervention with clear protocols, combined with peer supervision to support wellbeing, is recommended for good quality intervention delivery. Repeated ENACT assessments can feasibly and successfully be used to identify areas needing improvement and to guide on-going training and supervision