Mubarek Abera

Perceived challenges and opportunities arising from integration of mental health into primary care: a cross-sectional survey of primary health care workers in south-west Ethiopia

BackgroundThe WHO’s mental health Gap Action Programme seeks to narrow the treatment gap for mental disorders by advocating integration of mental health into primary health care (PHC). This study aimed to assess the challenges and opportunities of this approach from the perspective of PHC workers in a sub-Saharan African country.MethodsA facility-based cross-sectional survey of 151 PHC workers was conducted from 1st to 30th November 2011 in Jimma zone, south-west Ethiopia. A structured questionnaire was used to ask about past training and mental health experience, knowledge and attitudes towards mental disorders and provision of mental health care in PHC. Semi-structured interviews were carried out with 12 heads of health facilities for more in-depth understanding.ResultsAlmost all PHC workers (96.0%) reported that mental health care was important in Ethiopia and the majority (66.9%) expressed interest in actually delivering mental health care. Higher levels of general health training (degree vs. diploma) and pre-service clinical exposure to mental health care were associated with more favourable attitudes. Knowledge about mental disorder diagnoses, symptoms and treatments was low. Almost half (45.0%) of PHC workers reported that supernatural factors were important causes of mental disorders. Health system and structural issues, such as poor medication supply, lack of rooms, time constraints, absence of specialist supervision and lack of treatment guidelines, were identified as challenges. Almost all PHC workers (96.7%) reported a need for more training, including a clinical attachment, in order to be able to deliver mental health care competently.ConclusionsDespite acceptability to PHC workers, the feasibility of integrating mental health into PHC in this sub-Saharan African setting is limited by important gaps in PHC worker knowledge and expectations regarding mental health care, coupled with health system constraints. In addition to clinically-based refresher mental health training, expansion of the specialist mental health workforce may be needed to support integration in practice.

The development of a model of training in child psychiatry for non-physician clinicians in Ethiopia

BackgroundThe lack of trained mental health professionals has been an important barrier to establishing mental health services in low income countries. The purpose of this paper is to describe the development and implementation of child psychiatry training within a graduate program in mental health for non-physician clinicians in Ethiopia.MethodsThe existing needs for competent practitioners in child psychiatry were identified through discussions with psychiatrists working in Ethiopia as well as with relevant departments within the Federal Ministry of Health Ethiopia (FMOHE). As part of a curriculum for a two year Master of Science (MSC) in Mental Health program for non-physician clinicians, child psychiatry training was designed and implemented by Jimma University with the involvement of experts from Addis Ababa University (AAU), Ethiopia, and Ludwig-Maximillian’s University, (LMU), Germany. Graduates gave feedback after completing the course. The World Health Organization’s (WHO) Mental Health Gap Action Program (mhGAP) intervention guide (IG) adapted for Ethiopian context was used as the main training material.ResultsA two-week child psychiatry course and a four week child psychiatry clinical internship were successfully implemented during the first and the second years of the MSC program respectively. During the two week psychiatry course, trainees learned to observe the behavior and to assess the mental status of children at different ages who had a variety of mental health conditions. Assessment of the trainees’ clinical skills was done by the instructors at the end of the child psychiatry course as well as during the subsequent four week clinical internship. The trainees generally rated the course to be ‘very good’ to ‘excellent’. Many of the graduates have become faculty at the various universities in Ethiopia.ConclusionChild psychiatry training for non-physician mental health specialist trainees was developed and successfully implemented through collaboration with other universities. The model of institutional collaboration in training mental health professionals in the context of limited resources provides a useful guide for other low income countries where there is scarcity of psychiatrists.

Co-morbidity of depression and epilepsy in Jimma University specialized hospital, Southwest Ethiopia

BACKGROUND Depression is a serious and frequent co-morbid illness among people with epilepsy (PWE) and the risk for depression in PWE is higher than the general population. However, depression among PWE is often under diagnosed and treated by physicians other than psychiatrists in resource-limited settings like Ethiopia. OBJECTIVE This study aimed at assessing the prevalence and factors associated with depression and its implication for treatment among PWE in Southwest Ethiopia. MATERIALS AND METHODS A hospital-based cross-sectional study design was facilitated among 300 adult subjects diagnosed with epilepsy at the Jimma University Specialized Hospital (JUSH) from August to October 2012. Depression was assessed using the Beck Depression Inventory-II (BDI-II) scale which was found to have Cronbachs Alpha of 0.82 for this study. RESULTS A total of 300 adult subjects with epilepsy were interviewed making a response rate of 100%. The prevalence of depressive disorder among patient with epilepsy was 49.3%. Of these, 39.9%, 38.5%, and 21.6% of the patient were found to have mild, moderate, and severe depression, respectively. Epilepsy-related perceived stigma, high seizure frequency, and low educational status were found to be independent predictors of depression among subjects with epilepsy. CONCLUSION In this study, depression was found to be highly prevalent. Early recognition and treatment of depression through routine screening and assessment of PWE should become an essential part of diagnosis and treatment protocol.

Body composition at birth and height at 2 years: a prospective cohort study among children in Jimma, Ethiopia

BACKGROUNDLow birth weight is associated with childhood stunting, but equivalent associations for birth body composition (BC) remain unknown. The aim of this study was to assess associations between birth BC and height-for-age z-score (HAZ) at 2 years of age.METHODSIn a prospective cohort study, fat mass (FM) and fat-free mass (FFM) were measured using air-displacement plethysmography within 48 h of birth. Linear regression models were applied to study the relationship between BC at birth and HAZ at 24 ±3 months.RESULTSA total of 268 children with height assessment at 2 years were included. Mean±SD HAZ at 2 years of age was −1.2±1.2, with 25.8% classified as stunted (HAZ <−2SD). FFM at birth was positively associated with HAZ at 2 years, independent of length at birth. When adjusted for potential confounders, HAZ at 2 years was 0.73 higher for each additional kg FFM at birth (β=0.73, 95% CI: 0.08, 1.38). FM was not associated with HAZ at 2 years in any model.CONCLUSIONThe FFM component of birth weight, independent of length at birth, explained variability in HAZ at 2 years. Further studies are required to explore how changes in early infant BC are associated with linear growth.

Relation between body composition at birth and child development at 2 years of age: a prospective cohort study among Ethiopian children

Background/Objectives:Birth weight (BW), independent of socioeconomic status, has been identified as a predictor for childhood cognitive development. However, it is not known whether this relation is related to low BW per se or particularly related to a deficit in fat mass (FM) or fat-free mass (FFM) at birth. This study therefore aimed at investigating the relation between body composition at birth and child development at 2 years of age.Subjects/Methods:An Ethiopian birth cohort was followed up at 2 years. Body composition was measured within 48 h of birth using infant air-displacement plethysmography. Child development was assessed at 2 years of age using Denver developmental screening test. Associations between body composition at birth and development at 2 years of age were tested using linear regression analysis.Results:FFM but not FM at birth was positively associated with higher global developmental score at 2 years of age (β=2.48, 95% confidence interval (CI) 0.17; 4.79) adjusted for neonatal, postnatal and parental characteristics. This association was attributable to the association with the language developmental domain (β=1.61, 95 CI 0.33; 2.90).Conclusions:Among Ethiopian children, FFM at birth but not FM predicted better global and language development at 2 years of age. Higher FFM at birth might have exerted a positive effect on the growth and differentiation of the brain and neuronal circuits for better development. This study therefore highlights the need to improve mothers nutritional status during pregnancy in ways that stimulate fetal FFM growth.

Body Composition during Early Infancy and Mental Health Outcomes at 5 Years of Age: A Prospective Cohort Study of Ethiopian Children

Objective To examine the relationship between body composition—specifically fat mass (FM) and fat‐free mass (FFM)—in early infancy, and mental health outcomes in early childhood. Study design In the Infant Anthropometry and Body Composition birth cohort study from Ethiopia, body composition was measured at birth and 1.5, 2.5, 3.5, 4.5, and 6 months of age. Mental health was assessed at 5 years of age using the approved Amharic version of the Strengths and Difficulties Questionnaire (SDQ), a parent report scale covering 4 different domains providing a total difficulties score. The associations of FM or FFM at birth as well as during early infancy, with SDQ score at 5 years of age were examined using multiple linear regression analyses. Results At 5 years of age, the mean ± SD for SDQ score was 10.4 ± 5.8. FM at birth was positively and FFM negatively associated with SDQ score. For each kg increase in FM at birth, the SDQ score at 5 years was 5.7 points higher (&bgr; = 5.7; 95% CI, 1.4‐10.0). In contrast, for each kilogram increase in FFM at birth, the SDQ score was 3.9 points lower (&bgr; = ‐3.9; 95% CI, ‐7.0 to ‐0.8). Neither FM nor FFM accretion rate during early infancy were associated with SDQ score at 5 years of age. Conclusions Fetal rather than infant body composition was associated with SDQ score at 5 years of age. Greater FFM accretion during fetal life may have contributed to more optimal neurobehavioral development during early life. However, the potential mechanisms underlying the observed associations need further investigation.

Body Composition Growth Patterns in Early Infancy: A Latent Class Trajectory Analysis of the Ethiopian iABC Birth Cohort: Body Composition Growth Patterns in Early Infancy

The objective of this study was to identify subgroups with distinct fat and fat‐free growth patterns in the first 6 months of life and describe predictors of these different patterns.

Prevalence and Associated Factors of Depression among Prisoners in Jimma Town Prison, South West Ethiopia

Background Mental disorder is one of the greatest challenges that current and future generations will face. Currently among all people suffering from depression, 85% of them live in low- and middle-income countries. Previous studies reported the global burden/prevalence of depression to be five to ten times higher among prisoners than the general population. However, the prevalence of depression among prisoners in our study area is not known. Objective This study therefore aimed to assess the prevalence and associated factors of depression among prisoners in Jimma town in 2017. Method A cross-sectional study design was employed on 332 prisoners selected by systematic random sampling method. Data was collected by a face to face interview using Beck Depression Inventory (BDI-II) scale. Data analysis was done using SPSS version 20. Result The study revealed that 41.9% (n = 139) of participants among prisoners had depression. Having family history of mental illness (AOR = 6.05, 95% CI = 2.6, 13.8), having chronic physical illness (AOR = 2.87, 95% CI = 1.29, 6.41), having history of previous incarceration (AOR = 3.26, 95% CI = 1.02, 10.64), lack of job in the prison (AOR = 4.96, 95% CI = 2.09, 11.8), lifetime alcohol use (AOR = 3.61, 95% CI = 1.8, 7.26), thinking life to be a difficult one after release from prison (AOR = 2.07, 95% CI = 1.2, 3.6), having age between 21 and 25 years (AOR = 2.04, 95% CI = 1.06, 3.89), and having poor social support (AOR = 2.2, 95% CI = 1.27, 3.82) had significant association with depression in the fully adjusted final regression model. Conclusion This study has shown that the prevalence of depression among prisoners was very high. Having family history of mental illness, having chronic physical illness, having previous incarceration, lack of job in prison, lifetime alcohol use, thinking life to be difficult one after release from prison, having age between 21 and 25 years old, and having poor social support were found to have an impact on the prevalence of depression.

Body composition during early infancy and its relation with body composition at 4 years of age in Jimma, an Ethiopian prospective cohort study

Background/ObjectivesLow and high birth weight and rapid weight gain during infancy are associated with childhood obesity. Associations of birth and infancy body composition (BC) growth with childhood BC remain unknown in low-income countries. We aimed to investigate the associations of fat mass (FM) and fat-free mass (FFM) at birth and its accretion during early infancy with FM and FFM at the age of 4 years.MethodsIn the infant Anthropometry and Body Composition (iABC) cohort, BC was assessed at six consecutive time points from birth to 6 months and at 4 years of age by air displacement plethysmography. Multiple linear regression models were used to determine the association between FM and FFM at birth and their accretion rates during infancy and FM index (FMI) and FFM index (FFMI) at 4 years in 314 children.ResultsOne kilogram higher FFM at birth was associated with a 1.07 kg/m2 higher FFMI (95% CI 0.60, 1.55) at 4 years while a one SD increment in FFM accretion rate from 0 to 6 months was associated with a 0.24 kg/m2 increment in FFMI (95% CI 0.11, 0.36) and with a 0.20 kg/m2 higher FMI at 4 years (β = 0.20; 95% CI 0.04, 0.37). FFM at birth did not predict FMI at 4 years. FM at birth was associated with 1.17 kg/m2 higher FMI at 4 years (95% CI 0.13, 2.22) whereas FM accretion from 0 to 4 months was associated with an increase in FMI of 0.30 kg/m2 (95% CI 0.12, 0.47). FM at birth did not predict FFMI at 4 years, and neither did FM accretion from 0 to 4 months.ConclusionsA higher FFM in early infancy predicted higher FFMI at 4 years while a higher FM accretion during early infancy predicted higher FMI at 4 years. Follow-up studies are merited to explore associations of childhood BC with cardio-metabolic risk later in life.

Suicidal Behavior and Associated Factors among Prisoners in Jimma Town Correctional Institution South, West Ethiopia, 2017

Introduction: Suicidal behavior is the act of intentionally causing ones own death. Being in correctional institution is continues to be associated with an under-recognized risk for suicidal behavior. The increased risk of suicidal behavior in correctional institution is because of several factors including prison related, psychiatric disorders and substance use related factors are believed to be associated.Objective: To assess the prevalence and associated factors of suicidal behavior among prisoners in Jimma town correctional institution; South West Ethiopia 2017.Methods: An Institutional based cross-sectional study design was employing among 336 prisoners in Jimma town correctional institution in 2017. Systematic random sampling technique was used. A structured pretested SBQ-R questioner was used and the data was collected with face to face interview. Data was entered in to Epi-data version 3.1, and then exported in to SPSS version 21.0 statistical package for analysis. Bivariate and multivariate logistic regressions were carried to examine the association between independent and dependent variables. Adjusted odds ratio at a p-value<0.05 with 95% CI was declared statistically significant.Results: The overall prevalence of suicidal behaviors was found to be 23.2%. Age group between 25-34 years (AOR=2.47,95% CI: 1.307,4. 655), being unemployed (AOR=2.13, 95% CI: 1.175,3.849), current comorbid depression (AOR=2.13, 95%CI: 1.203,3.762), current poor level of social support (AOR=2.95, 95% CI:1.107,7.882) and history of previous incarceration (AOR=3.04, 95% CI: 1.247,7.418), were associated with suicidal behavior among prisoners in Jimma town correctional institution.Conclusion and recommendations: In this study suicidal behavior was found to be high among prisoners. Therefore attention should be given to prisoners through prison health services in early screening and treatment particularly for those who are on younger age group, unemployed, prisoners with co morbid depressive disorders, having poor social support and previous incarceration.