Sorcery and witchcraft beliefs on the front line of public health response in Papua New Guinea and beyond.

Problem: Many communities refer to sorcery or witchcraft to explain misfortunes such as sickness, death and disability. The effects of these beliefs on public health service delivery have long been overlooked. Beliefs in sorcery and witchcraft are significant challenges for health-care workers to understand to deliver better health outcomes and avoid inadvertently triggering accusations of witchcraft that may lead to violence. Context: This paper examines the impacts of accusations of sorcery and related violence on the provision of health care in Papua New Guinea. Action: The discussion focuses on a workshop held in Papua New Guinea in September 2022 with health extension officers on the topic of health-care delivery and sorcery accusations. Lessons learned: The workshop confirmed the challenges that beliefs in sorcery and witchcraft present for health extension officers and suggested several strategies that could be used to navigate them. It identified several possible future measures that those on the front line of community health-care delivery considered most important in responding to the issue. These included educating health-care workers on how to effectively address sorcery beliefs when delivering health care and developing communication techniques on the causes of death and sickness that avoid triggering sorcery accusations. Discussion: This paper reviews the findings of the workshop in the broader context of the effects of beliefs in witchcraft on public health delivery globally. Because of the close connections between sorcery beliefs and health, equipping health-care workers and field epidemiologists with strategies to address these beliefs effectively is critical to delivering better health care, facilitating timely response to public health events, and helping to prevent violence related to sorcery accusations. This need exists in all countries where sorcery beliefs related to health, illness, disability and death are prevalent.

Witchcraft beliefs around the world: An exploratory analysis.

This paper presents a new global dataset on contemporary witchcraft beliefs and investigates their correlates. Witchcraft beliefs cut across socio-demographic groups but are less widespread among the more educated and economically secure. Country-level variation in the prevalence of witchcraft beliefs is systematically linked to a number of cultural, institutional, psychological, and socioeconomic characteristics. Consistent with their hypothesized function of maintaining order and cohesion in the absence of effective governance mechanisms, witchcraft beliefs are more widespread in countries with weak institutions and correlate positively with conformist culture and in-group bias. Among the documented potential costs of witchcraft beliefs are disrupted social relations, high levels of anxiety, pessimistic worldview, lack of entrepreneurial culture and innovative activity.

Plantas que curan y descolonialidad. prácticas cotidianas comunitarias de las mujeres, en Montes de Maria / Plantas que curam e decolonialidade. práticas cotidianas comunitárias das mulheres, em Montes de Maria / Plants that cure and decoloniality: practices of everyday life communitary of women, in Montes de Maria

RESUMEN. El artículo parte de las reflexiones de la investigación de Doctorado Grupalidad curadora. Descolonialidad de saberes-prácticas campesinas y afroindígenas en Montes de María (Caribe colombiano); interesada, desde una perspectiva descolonial, por aquellos saberes para curar que fueron excluidos por la ciencia moderna y colonial, silenciando el potencial que entraña la comunidad. Nos centramos en las prácticas cotidianas como curar con plantas que utilizan las mujeres campesinas en las comunidades San Francisco, Medellín y Villa Colombia (Ovejas-Sucre). Las herramientas y técnicas fueron el mapeo de saberes y prácticas comunitarias, entrevistas colectivas, observaciones y recorridos comunitarios por las veredas y las huertas; también el diario de campo, como herramienta de apoyo para el registro y la descripción. El método de análisis cualitativo de la información, privilegió el punto de vista de la experiencia de las mujeres. Los aportes descoloniales orientaron nuestras reflexiones y el análisis del material de campo sobre los saberes y prácticas de cura. En el conocimiento silenciado que reside en las prácticas cotidianas de las mujeres campesinas estarían las claves para curar los dolores de la guerra en los territorios colombianos; lo que justifica una reflexión y un aprendizaje para la academia, en particular, para la Psicología Comunitaria.

RESUMO. O artigo parte das reflexões de pesquisa de doutorado Grupalidade Curadora. Descolonialidade dos saberes-práticas camponesas e afroindígenas em Montes de Maria (Caribe colombiano), interessada, a partir de uma perspectiva descolonial, esses saberes para curar que foram excluídos pela ciência moderna e colonial, silenciando o potencial envolvido na comunidade. Focalizamos as práticas cotidianas como curar com plantas usadas pelas mulheres camponesas nas comunidades San Francisco, Medellín e Villa Colombia (Ovejas-Sucre). As ferramentas e técnicas eram mapeamento de saberes e práticas comunitárias, entrevistas coletivas, observações e visitas comunitárias pelos caminhos e hortas; também o diário de campo, como ferramenta de apoio ao registro e descrição. O método de análise qualitativa da informação privilegiou o ponto de vista e a experiência das mulheres. Aportes descoloniais orientaram nossas reflexões e a análise do material de campo sobre os saberes e práticas de cura. No conhecimento silenciado que reside nas práticas cotidianas, haveria as chaves para curar as dores da guerra nos territórios colombianos; o que justifica uma reflexão e um aprendizado para a academia, em especial, para a Psicologia Comunitária.

ABSTRACT. This article originates from the PhD research Groupality curator: Decoloniality of peasant and afro-indigenous knowledge/practices in Montes de Maria (Colombian Caribbean); from a decolonial perspective, it is interested on the knowledge of cure that were excluded by modern/colonial science. Ando as a consequence, it has silenced the potential of the community. The central point of our study are the practices of everyday life related to cure with medicinal plants that are employed by peasant women in the communities of San Francisco, Medellin and Villa Colombia (Ovejas-Sucre). The tools and techniques we used were mapping community knowledge and practices, collective interviews, observations, trips along the countryside roads and vegetable gardens, and, finally, a field diary—as support tool for registration and description. The method of qualitative analysis of information privileges the point of view and experience of woman. The decolonial contributions enabled us to direct our reflections and analyses of the field material toward knowledge and practices of cura. In the silenced knowledge that resides in the practices of everyday life of peasant women would be the keys to heal the pains of war in the Colombian territories; which justifies a reflection and learning for the academy, in particular, for Community Psychology.

Knowledge, attitude and traditional practices towards epilepsy among relatives of PWE (patients with epilepsy) in Marrakesh, Morocco.

Epilepsy remains one of the most common neurological diseases in the world but seems to be widely misunderstood, especially in low-income countries. Patients with epilepsy (PWE) can face considerable stigma in society, and there have been various studies that evaluate the knowledge and attitude of the population towards epilepsy. However, there was no study of this kind in Morocco. PURPOSE: Our aim was thus to assess knowledge, attitudes, and traditional practices specifically among relatives and caregivers of PWE in our community, in order to better evaluate their educational needs. METHODS: This cross-sectional and descriptive study was carried out over a year long period in the outpatient neurology clinic of the Mohammed 6 University Hospital, a tertiary referral center in Marrakesh, Morocco. The respondents were relatives of PWE (usually parents and siblings) or spouses who attended the outpatient clinic alongside them. The interviews were carried out by the same investigator at the outpatient clinic during patient's visits, face-to-face using Moroccan Arabic or Darija, with an 18-item questionnaire. RESULTS: Responses of 100 participants were analyzed. The mean age was 40 years old and 5 months. Sixty-six percent of the respondents were women, 50% of rural origin and 76 % lived in an urban area. Forty-one percent were illiterate, and 74% were of low income. Only 65% of the participants knew the Arabic term for epilepsy. For 48%, epilepsy was linked with witchcraft or demonic possession. Seventy-five percent of the respondents had at least one prior consultation to a traditional healer. Only 5% in our study knew the first-aid basics to apply in case of a seizure. CONCLUSION: Despite having a relative with epilepsy, our participants' knowledge was very poor. The level of education and income seem to be the two major contributing factors. Cultural beliefs and superstition are very pervasive, and the majority of our sample had already used traditional healing and alternative medicine. Our study highlights the need for a more global intervention in Morocco encompassing healthcare policies, awareness campaigns, and educational reforms.

Public perception and attitude towards people living with epilepsy in Nigeria.

OBJECTIVE: This study aimed to assess the community knowledge, awareness, and attitude towards people living with epilepsy (PLWE) in Lagos, Nigeria. This was to provide background information for formulating evidence-based campaign and intervention to reduce stigma and improve health-related quality of life amongst PLWE and their families. METHODS: Adult respondents (n = 1614) selected via multistage probability sampling completed a set of questionnaires. A case vignette was used to depict epilepsy. The respondents' knowledge of, familiarity with, perceived cause, and preferred treatment option for epilepsy were assessed. Their attitude towards people's attitude was measured with Attitudes and Beliefs about Living with Epilepsy (ABLE) scale. RESULTS: While a total of 1258 (67.6%) could correctly name the illness as epilepsy, only 945 (58.5%) had witnessed an epileptic seizure episode before. The most endorsed causes of epilepsy were brain injury/infection (75.8%), evil spirit/witchcraft (73.0%), God's will (70.0%), and infection by contact (64.9%). Only 67.6% believe that epilepsy is treatable, and 42.5% preferred treatment by spiritualist. Generally, there was a positive attitude to PLWE; however, there were serious risk and safety concerns. The factors associated with negative attitude towards PLWE include male gender (adjusted odds ratio [AOR]: 2.44, 95% confidence interval [CI]: 1.98-3.00), lower educational status (AOR: 1.69, 95% CI: 1.32-2.16), poor knowledge of epilepsy (AOR: 1.74, 95% CI: 1.36-2.22), poor familiarity with epilepsy (AOR: 1.65, 95% CI: 1.14-2.42), and endorsement of supernatural causes of epilepsy (AOR: 1.59, 95% CI: 1.28-1.97). SIGNIFICANCE: Closing the treatment gap for epilepsy in Nigeria and other sub-Saharan Africa countries will involve steps to change the misconception of the Nigerian populace as regards the causes of epilepsy and help seeking pathway. There is need for nationwide educational programs for epilepsy that consider cognitive and affective processes and also involve all the major stakeholders like primary care workers, community leaders, and spiritual and traditional leaders.

Contemporary views on dementia as witchcraft in sub-Saharan Africa: A systematic literature review.

AIM: To explore the impact of cultural beliefs of dementia as witchcraft in sub-Saharan Africa. BACKGROUND: The population of sub-Saharan Africa is ageing, which increases the number of those at risk of dementia. Mental health and physical diseases that affect behaviour have often been associated with witchcraft. Accusations of witchcraft leave individuals vulnerable and at risk. METHOD: A systematic review, which followed the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and completed a PRISMA checklist. CINAHL, PsycINFO, Web of Knowledge, PubMed and Science Direct databases were searched for relevant studies published from their inception to 31 May 2019 by applying appropriate Medical Subject Headings. Data analysis adhered to Thomas and Harding's thematic synthesis. RESULTS: The review identified limited literature on this topic, with only five papers meeting the inclusion and exclusion criteria. Studies explored health provision, and knowledge and beliefs of dementia in Tanzania and South Africa. Three themes emerged as follows: (a) poor knowledge of dementia, including the belief of dementia as witchcraft; (b) challenges of supporting a family member with dementia in the community; and (c) health-seeking behaviours of and for people with dementia. CONCLUSION: There remains a need for dementia awareness and education across sub-Saharan Africa communities, including faith and traditional healers, and healthcare professionals to support pluralistic healthcare provision. Nurses are the best-placed healthcare professionals to support these initiatives and the development and implementation of low-resource nonpharmacological interventions to support people with dementia and their families living in the community. RELEVANCE TO CLINICAL PRACTICE: Nurses working in sub-Saharan Africa and those caring for patients from sub-Saharan Africa can only provide person-centred care and support for a person with dementia and their family if they understand their cultural beliefs, one of which may include witchcraft.

Aged women, witchcraft, and social relations among the Igbo in South-Eastern Nigeria.

Belief in the existence of witchcraft has remained a social phenomenon in Igbo society, especially with aged women who are often labeled witches. This study is exploratory and explains the implication of labeling an aged woman a witch and social relations in Igbo society in South-Eastern Nigeria. Twenty interviews were conducted with aged women who are victims of the witchcraft label and their relatives using qualitative methods of data collection, key informant interviews, and in-depth interviews. Data collected were analyzed using ethnographic content analysis. Findings reveal different social views attached to witchcraft and how it relates to aged women.

The role of traditional and faith healers in the treatment of dementia in Tanzania and the potential for collaboration with allopathic healthcare services.

Background: Low diagnostic rates are a barrier to improving care for the growing number of people with dementia in sub-Saharan Africa. Many people with dementia are thought to visit traditional healers (THs) and Christian faith healers (FHs) and these groups may have a role in identifying people with dementia. We aimed to explore the practice and attitudes of these healers regarding dementia in rural Tanzania and investigate attitudes of their patients and their patients' carers. Methods: This was a qualitative study conducted in Hai district, Tanzania. Semi-structured interviews were conducted with a convenience sample of THs and FHs and a purposive-stratified sample of people with dementia and their carers. Interview guides were devised which included case vignettes. Transcripts of interviews were subject to thematic analysis. Findings: Eleven THs, 10 FHs, 18 people with dementia and 17 carers were recruited. Three themes emerged: (i) conceptualisation of dementia by healers as a normal part of the ageing process and no recognition of dementia as a specific condition; (ii) people with dementia and carer reasons for seeking help and experiences of treatment and the role of prayers, plants and witchcraft in diagnosis and treatment; (iii) willingness to collaborate with allopathic healthcare services. FHs and people with dementia expressed concerns about any collaboration with THs. Conclusions: Although THs and FHs do not appear to view dementia as a specific disease, they may provide a means of identifying people with dementia in this setting.

Normal grief and its correlates in Lubumbashi, an urban city in the Democratic Republic of Congo.

INTRODUCTION: Grief is a universal experience faced at one time or another by most people during their lives. Response to grief and bereavement losses can lead to psychiatric disorders such as mood disorders, post traumatic responses, insomnia loss of appetite, anxiety, and depression. The aim of our study is to value in our community the physical and psychological complications of a normal grief. METHODS: We conducted a cross-sectional study from March 2012 to September 2012 in Lubumbashi, Democratic Republic of Congo. Two questionnaires, the Hamilton Anxiety Scale and the Beck Depression Inventory scale were used as screening tool. A snow ball sampling method was performed and the questionnaires were administered only to those who consented to participate in the study. RESULTS: A total of 78 subjects were included in the study of which 87.2% were aged between 14-50 years old. The majority of the subjects were female 65.4%, and about a quarter (28%) was unemployed. The main correlates of the grief reported in the present study were being treated as witchcraft or accused to be responsible of a death (68%), being rejected by family and not being allowed to inherit (32%). Being homeless was reported in 26%. The main psychological symptoms reported were psychological distress after 1 year (65%) and related physical health problems after the death (72%). Depression and mild anxiety were the most reported disorders, with respectively 92.3% and 74.4% of the subjects. CONCLUSION: Grief in Lubumbashi is associated with a large number of psychological, social and health problems. Health problems such as gastric is, high blood pressure were often reported. Being accused of witchcraft remains the main social impact. Depression and anxiety were the most psychological problem associated with grief.

Witchcraft and Biopsychosocial Causes of Mental Illness: Attitudes and Beliefs About Mental Illness Among Health Professionals in Five Countries.

This study examines the intercorrelation of measures reflecting beliefs about and attitudes toward people with mental illness in a sample of health professionals (N = 902) from five countries: Brazil, China, Ghana, Nigeria, and the United States, and, more specifically, the association of beliefs in supernatural as contrasted with biopsychosocial causes of mental illness. Factor analysis of a 43-item questionnaire identified four factors favoring a) socializing with people with mental illness; b) normalizing their roles in society; c) belief in supernatural causes of mental illness (e.g., witchcraft, curses); and d) belief in biopsychosocial causes of mental illness. Unexpectedly, a hypothesized negative association between belief in supernatural and biopsychosocial causation of mental illness was not found. Belief in the biopsychosocial causation was weakly associated with less stigmatized attitudes towards socializing and normalized roles.

Leprosy presenting as a non-healing ulcer and associated unusual myth.

A case of a 70 year old lady with borderline tuberculoid leprosy who presented with a chronic ulcer and associated myth has been illustrated. The need for awareness programmes focusing on these types. of myths has been stressed.

[A manner of voicing, the mass hysteria]. / Une manière de s'exprimer, l;hystérie collective.

INTRODUCTION: Mass hysteria is defined as the epidemic occurrence of a succession of physical symptoms without organic disorder or identifiable illness agents. The hysteria epidemic has been described since the Middle Ages, reported in different cultures and religions and affects different populations throughout the world. Few studies on the subject have been under takenin Madagascar. We aim at describing in this study the clinical and therapeutic aspects of a mass hysteria that has occurred in the South of Madagascar. METHODOLOGY: The study is retrospective and prospective at the same time. It concerns the victims of a mass hysteria that had occurred in a village (Ikalahazo) in the South of Madagascar,from the 6th of April 2009 to the 7th of May 2009. Patients exhibiting clinical symptoms ofconversive behavior and having undergone an assessment in hospital surroundings represent the object of this study. During the study period, 27 cases of young women were reported, 22 ofthem were sent to the University Hospital Center of Fianarantsoa (UHCF), a referring center o fthe region, for a thorough clinical examination. Demographic data, the clinical aspects and thecare and treatment provided are the studied parameters. RESULT: During a land ownership dissension that drags on endlessly in Ikalahazo village, exclusively 27 young women, between 8 and 21 years old, presented atypical symptoms, strangedisorders. A first case appeared on the 6th of April 2009, that is to say a month before alarge manifestation of the crisis. A similar case was observed two years ago, but it was an isolated case. The symptoms, primarily with motive manifestation, extended rapidly but remainedhowever limited, susceptible to the "Mpiandry" (literally "shepherds") advice. As the villagers believed that spiteful spirits were at the origin of the deeds, they appealed to the latter. Facing the symptoms persistence, the Neuropsychiatry Unit employees of the CHUF were sent to the village on the 6th of May 2009. The intense adhesion of villagers to a belief in satanic misdeedscomplicated their somatic assessment, the results of which showed no distinctive features. At the end of the land dissension proceedings that was resolved in favor of the villagers, and after the isolation of the "madwomen" in the Mpiandry's camp, no more pathological cases related to the above occurrence were reported. CONCLUSION: A mass hysteria diagnosis is retained. It is favored and kept up by local dissensions,by the villagers' belief and its large media casting, thanks to the shepherds' presence. It mingles culture, tradition and modern psychiatry. Therefore, care and treatment of the disorder to be appropriate and optimal require the cooperation between these three spheres.

A village possessed by "witches": a mixed-methods case-control study of possession and common mental disorders in rural Nepal.

In Nepal, spirit possession is a common phenomenon occurring both in individuals and in groups. To identify the cultural contexts and psychosocial correlates of spirit possession, we conducted a mixed-method study in a village in central Nepal experiencing a cluster of spirit possession events. The study was carried out in three stages: (1) a pilot study consisting of informal interviews with possessed individuals, observations of the possession spells, and video recording of possession events; (2) a case-control study comparing the prevalence of symptoms of common mental disorders in women who had and had not experienced possession; and (3) a follow-up study with focus group discussions and in-depth interviews with possessed and non-possessed men and women, and key informants. Quantitative results indicated that possessed women reported higher rates of traumatic events and higher levels of symptoms of mental disorder compared to non-possessed women (Anxiety 68 vs. 18 %, Depression 41 vs. 19 %, and PTSD 27 vs. 0 %). However, qualitative interviews with possessed individuals, family members, and traditional healers indicated that they did not associate possession states with mental illness. Spirit possession was viewed as an affliction that provided a unique mode of communication between humans and spirits. As such, it functioned as an idiom of distress that allowed individuals to express suffering related to mental illness, socio-political violence, traumatic events, and the oppression of women. The study results clearly indicate that spirit possession is a multi-dimensional phenomenon that cannot be mapped onto any single psychiatric or psychological diagnostic category or construct. Clinical and public health efforts to address spirit possession must take the socio-cultural context and systemic dynamics into account to avoid creating iatrogenic illness, undermining coping strategies, and exacerbating underlying social problems.

Doctors and vampires in sub-Saharan Africa: ethical challenges in clinical trial research.

Collecting blood samples from individuals recruited into clinical research projects in sub-Saharan Africa can be challenging. Strikingly, one of the reasons for participant reticence is the occurrence of local rumors surrounding "blood stealing" or "blood selling." Such fears can potentially have dire effects on the success of research projects--for example, high dropout rates that would invalidate the trial's results--and have ethical implications related to cultural sensitivity and informed consent. Though commonly considered as a manifestation of the local population's ignorance, these rumors represent a social diagnosis and a logical attempt to make sense of sickness and health. Born from historical antecedents, they reflect implicit contemporary structural inequalities and the social distance between communities and public health institutions. We aim at illustrating the underlying logic governing patients' fear and argue that the management of these beliefs should become an intrinsic component of clinical research.

Experiences of possession and paranormal phenomena among women in the general population: are they related to traumatic stress and dissociation?

This study sought to determine the prevalence of experiences of possession and paranormal phenomena (PNP) in the general population and their possible relations to each other and to traumatic stress and dissociation. The study was conducted on a representative female sample recruited from a town in central eastern Turkey. The Dissociative Disorders Interview Schedule, the posttraumatic stress disorder (PTSD) and borderline personality disorder sections of the Structured Clinical Interviews for DSM-IV Axis-I and Personality Disorders, and the Childhood Abuse and Neglect Questionnaire were administered to 628 women. Of these, 127 (20.2%) women reported at least 1 type of PNP and 13 (2.1%) women reported possession. Women with a dissociative disorder reported all types of possession and PNP (except telepathy) more frequently than those without. Whereas women with a trauma history in childhood and adulthood or PTSD reported possession more frequently than those without, PNP were associated with childhood trauma only. Factor analysis yielded 4 dimensions: possession by and/or contact with nonhuman entities, extrasensory communications, possession by a human entity, and precognition. These factors correlated with number of secondary features of dissociative identity disorder and Schneiderian symptoms. Latent class analysis identified 3 groups. The most traumatized group, with predominantly dissociative and trauma-related disorders, had the highest scores on all factors. Notwithstanding their presence in healthy individuals, possession and PNP were associated with trauma and dissociation in a subgroup of affected participants. Both types of experience seem to be normal human capacities of experiencing that may be involved in response to traumatic stress. Given the small numbers, this study should be considered preliminary.

Children enacting idioms of witchcraft and spirit possession as a response to trauma: therapeutically beneficial, and for whom?

This article examines children's enactment of spirit possession idioms and witchcraft in Africa including the meanings such idioms provide and the local healing resources they mobilize. Idioms of haunting spirits in Northern Uganda and witch-children elsewhere in Africa can be interpreted as manifestations of social crises and mass traumatic stress. On the other hand, such idioms also allow children to articulate, reflect upon, and communicate the complex feelings resulting from their precarious positions within families and communities under duress. With the help of Dow's transactional model of symbolic healing, this article explores obstacles to the effectivity of the rich variety of symbolic healing available for haunting spirits in Uganda and points to the generational gap between children and their families and communities. Elsewhere, witchcraft idioms may act as a healing resource at the group level, but at the expense of the accused child. The idioms of evil spirits and witchcraft speak of these children's navigation of the moral universe of their postconflict communities. Given that children's appraisal of their experiences through these notions may also exacerbate their anxiety, interdisciplinary research examining the microprocesses that lead to children being haunted or accused, including emotional and physiological levels effects, is urgently needed.

Profile of suicide in rural Cameroon: are health systems doing enough?

OBJECTIVES: To describe the characteristics of suicide and assess the capacity of health services at the district level in Cameroon to deliver quality mental health care. METHODS: The study covered the period between 1999 and 2008 and was carried out in Guidiguis health district which had a population of 145 700 inhabitants in 2008. Data collection was based on psychological autopsy methods. To collect data, we used documentary review of medical archives, semi-structured interviews of relatives of suicide completers, a focus group discussion of health committee members and a survey to consulting nurses working at the primary health care level. RESULTS: Forty-seven suicides were recorded from 1999 to 2008: 37 (78.7%) males and 10 (21.3%) females, yielding rates of reported suicides that ranged from 0.89 to 6.54 per 100 000 inhabitants. The most frequently used suicide method was the ingestion of toxic agricultural chemicals (in 76.6% of cases). According to the relatives, the suicides were due to an ongoing chronic illness (31.9%), sexual and marital conflicts (25.5%), witchcraft (14.9%), financial problems (8.5%) or unknown cause (25.5%). In 25 (53.2%) cases, suicide victims exhibited symptoms suggestive of a mental disorder but only six of the suicide committers who presented behavioural symptoms sought health care. Only two of the 15 consulting nurses were able to cite at least three symptoms of depression and were aware that depression can lead to suicide. All of the nurses acknowledged that they had never received any specific training or supervision in mental health care. CONCLUSIONS: Suicides are not a rare event in rural settings in Cameroon. The health district capacity to provide quality mental care is almost insignificant. The integration of minimal mental health care services at the community and primary health care levels should be considered a priority in sub-Saharan Africa.