Mental health care in the city of Lubumbashi, Democratic Republic of the Congo: Analysis of demand, supply and operational response capacity of the health district of Tshamilemba.

BACKGROUND: Integrating mental health care into the primary care system is an important policy option in the Democratic Republic of the Congo (DRC). From the perspective of the integration of mental health care in district health services, this study analyzed the existing demand and supply of mental health care in the health district of Tshamilemba, which is located in Lubumbashi, the second largest city of the DRC. We critically examined the district's operational response capacity to address mental health. METHODS: A multimethod cross-sectional exploratory study was carried out. We conducted a documentary review (including an analysis of the routine health information system) from the health district of Tshamilemba. We further organized a household survey to which 591 residents responded and conducted 5 focus group discussions (FGDs) with 50 key stakeholders (doctors, nurses, managers, community health workers and leaders, health care users). The demand for mental health care was analyzed through the assessment of the burden of mental health problems and care-seeking behaviors. The burden of mental disorders was assessed by calculating a morbidity indicator (proportion of mental health cases) and through a qualitative analysis of the psychosocial consequences as perceived by the participants. Care-seeking behavior was analyzed by calculating health service utilization indicators and more specifically the relative frequency of mental health complaints in primary health care centers, and by analyzing FGDs participants' reports. The mental health care supply available was described by using the qualitative analysis of the declarations of the participants (providers and users of care) to the FGDs and by analyzing the package of care available in the primary health care centers. Finally, the district's operational response capacity was assessed by making an inventory of all available resources and by analyzing qualitative data provided by health providers and managers regarding the district' capacity to address mental health conditions. RESULTS: Analysis of technical documents indicated that the burden of mental health problems is a major public problem in Lubumbashi. However, the proportion of mental health cases among the general patient population seen in the outpatient curative consultations in the Tshamilemba district remains very low, at an estimated 5.3%. The interviews not only pointed to a clear demand for mental health care but also indicated that there is currently hardly any offer of care available in the district. There are no dedicated psychiatric beds, nor is there a psychiatrist or psychologist available. Participants in the FGDs stated that in this context, the main source of care for people remains traditional medicine. CONCLUSION: Our findings show a clear demand for mental health care and a lack of formal mental health care supply in the Tshamilemba district. Moreover, this district lacks adequate operational capacity to meet the mental health needs of the population. Traditional African medicine is currently the main source of mental health care in this health district. Identifying concrete priority mental health actions to address this gap, by making evidence-based mental care available, is therefore of great relevance.

Using Latent Class Analysis to Identify Health Lifestyle Profiles and Their Association with Suicidality among Adolescents in Benin.

Youth suicidality is considerably prevalent in low- and middle-income countries, including Benin. Factors such as psychosocial distress, socio-environmental factors, and health risk behaviors are associated with suicidality. However, little is known about how these factors co-occur in these countries. An analysis of these factors taken together would help to identify the profiles most at risk and better target prevention policies. Our study aimed to identify profiles related to these factors and their association with suicidality among adolescents in Benin. Data from the 2016 Global School-Based Student Health Survey were used, and factors related to lifestyle (tobacco and alcohol consumption and physical activity), physical violence, parental support, and psychological distress were studied. Latent class analysis was used to identify the profiles, and a modified Poisson regression with generalized estimating equations, adjusted for sociodemographic characteristics, was performed to assess the association between these profiles and suicidality. The survey results show that globally, 13.8% of the adolescents (n = 2536) aged 11 to 18 had thought about suicide, 15.6% had planned suicide, and 15.6% had attempted suicide. Four profiles were identified: a low-risk group, one with psychological distress problems, a group with violence problems, and one with alcohol, tobacco, and violence problems. The risk of suicidality, in terms of ideation, planning, or attempting, was higher for adolescents in Profiles 2, 3, and 4 than those in Profile 1 (p < 0.05). Adolescents in Profile 2 were particularly affected by this increased risk (prevalence ratio (PR) for ideation = 1.13, 95% CI = 1.03-1.23; PR for planning = 1.12, 95% CI = 1.04-1.22; PR for attempting = 1.09, 95% CI = 1.01-1.17). This study highlights the typical profiles that may be linked with suicidality among adolescents in Benin. A holistic consideration of these factors could help in planning better preventive measures to reduce suicidality among adolescents in Benin.

[Current challenges in cancer care in Brussels-capital region: A qualitative study]. / Les défis actuels en cancérologie dans la région de Bruxelles-capitale : une étude qualitative.

Cancer is a disease with multidimensional consequences accompanied by new challenges in order to guarantee optimal care involving physical, psychological and social consequences of the disease and his treatments. The objective of this study is to identify the main challenges encountered by different stakeholders around cancer, including patients, in Brussels. This qualitative study was carried out with various stakeholders in the field of oncology. The semi-structured interviews and focus groups were transcribed directly and the data collected was analysed manually. Healthcare professionals and patients face many challenges in the current context of oncology care. Communication difficulties can affect the therapeutic relationship and the sharing of complex information. The increasing complexity of therapeutic strategies complicates interprofessional collaborations and care coordination. In a context of early return home and home hospitalization in particular, continuity in care and collaboration between the different lines of care are crucial. Patients face a variety of challenges, such as managing long-term side effects and post-cancer difficulties, including redefining their social and professional identities. Finally, cancer involves financial toxicity and social inequalities in health are particularly marked. Cancer is a complex disease which management involves a growing number of caretakers. It is also frequently synonymous with disruption in the personal, social and professional life of patients. The emerging themes of this study are closely interconnected and communication seems to occupy a central place. A holistic approach to the individual and inter-professional interactions could guide future prospects for the overall management of this constantly changing field.

Prevalence and determinants of use of complementary and alternative medicine by hypertensive patients attending primary health care facilities in Kinshasa, Democratic Republic of the Congo: a cross-sectional study.

BACKGROUND: In the Democratic Republic of the Congo the control of hypertension is poor, characterized by an increasing number of reported cases of hypertension related complications. Poor control of hypertension is associated with non-adherence to antihypertensive medication. It is well established that the use of complementary and alternative medicine is one of the main factors of non-adherence to antihypertensive medication. The aim of this study is to determine the prevalence and factors associated with the use of complementary and alternative medicine. METHODS: A cross-sectional study was carried out at the Kinshasa Primary Health-care (KPHC) facilities network in November 2014. A structured interview questionnaire was administrated to a total of 280hypertensive patients. Complementary and alternative medicine were defined according to the National Institute of Health classification as a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine. Data were summarized using proportion and mean (with standard deviation). The student's t test and χ2 test were used respectively for mean and proportion comparison. Logistic regression analysis identified determinants of the use of complementary and alternative medicine. RESULTS: The prevalence of use of complementary and alternative medicine was 26.1% (95% CI: 20.7% - 31.8%).Determinants of use of complementary and alternative medicine included misperception about hypertension curability (OR = 2.1; 95%CI: 1.1-3.7) and experience of medication side effects (OR = 2.9; 95%CI: 1.7-5.1). CONCLUSION: The use of CAM for hypertensive patients is a major problem; antihypertensives with fewer side effects must be emphasized. Religious leaders must become involved in the communication for behavioral change activities to improve the quality of life for hypertensive patients.