Efficacy and cost-effectiveness of task-shared care for people with severe mental disorders in Ethiopia (TaSCS): a single-blind, randomised, controlled, phase 3 non-inferiority trial.

BACKGROUND: There have been no trials of task-shared care (TSC) using WHO's mental health Gap Action Programme for people with severe mental disorders (psychosis or affective disorder) in low-income or middle-income countries. We aimed to evaluate the efficacy and cost-effectiveness of TSC compared with enhanced specialist mental health care in rural Ethiopia. METHODS: In this single-blind, phase 3, randomised, controlled, non-inferiority trial, participants had a confirmed diagnosis of a severe mental disorder, recruited from either the community or a local outpatient psychiatric clinic. The intervention was TSC, delivered by supervised, non-physician primary health care workers trained in the mental health Gap Action Programme and working with community health workers. The active comparison group was outpatient psychiatric nurse care augmented with community lay workers (PSY). Our primary endpoint was whether TSC would be non-inferior to PSY at 12 months for the primary outcome of clinical symptom severity using the Brief Psychiatric Rating Scale, Expanded version (BPRS-E; non-inferiority margin of 6 points). Randomisation was stratified by health facility using random permuted blocks. Independent clinicians allocated groups using sealed envelopes with concealment and outcome assessors and investigators were masked. We analysed the primary outcome in the modified intention-to-treat group and safety in the per-protocol group. This trial is registered with ClinicalTrials.gov, number NCT02308956. FINDINGS: We recruited participants between March 13, 2015 and May 21, 2016. We randomly assigned 329 participants (111 female and 218 male) who were aged 25-72 years and were predominantly of Gurage (198 [60%]), Silte (58 [18%]), and Mareko (53 [16%]) ethnicity. Five participants were found to be ineligible after randomisation, giving a modified intention-to-treat sample of 324. Of these, 12-month assessments were completed in 155 (98%) of 158 in the TSC group and in 158 (95%) of 166 in the PSY group. For the primary outcome, there was no evidence of inferiority of TSC compared with PSY. The mean BPRS-E score was 27·7 (SD 4·7) for TSC and 27·8 (SD 4·6) for PSY, with an adjusted mean difference of 0·06 (90% CI -0·80 to 0·89). Per-protocol analyses (n=291) were similar. There were 47 serious adverse events (18 in the TSC group, 29 in the PSY group), affecting 28 participants. These included 17 episodes of perpetrated violence and seven episodes of violent victimisation leading to injury, ten suicide attempts, six hospital admissions for physical health conditions, four psychiatric admissions, and three deaths (one in the TSC group, two in the PSY group). The incremental cost-effectiveness ratio for TSC indicated lower cost of -US$299·82 (95% CI -454·95 to -144·69) per unit increase in BPRS-E scores from a health care sector perspective at 12 months. INTERPRETATION: WHO's mental health Gap Action Programme for people with severe mental disorders is as cost-effective as existing specialist models of care and can be implemented effectively and safely by supervised non-specialists in resource-poor settings. FUNDING: US National Institute of Mental Health.

COVID -19 vaccine hesitancy and determinants in Ethiopia: A national pilot survey.

Introduction: Despite major advances in Corona Virus Disease 2019 (COVID-19) vaccine development, vaccine hesitancy threatens the progress made to curb the disease. We aimed to assess the level of COVID-19 vaccine hesitancy and the underlying determinants in Ethiopia. Methods: A pilot mobile phone survey of adults in Ethiopia with mobile phones selected randomly. Results: The pilot survey included 614 participants who were predominantly male (71.7%), and married (68.2%) with a median age of 34 years (interquartile range [IQR] = 14.0). Overall, 150 (24.4%) participants reported to have been vaccinated; either the first [57 (38%)], second [19 (12.7%)], or both [74 (49.3%)] doses. About one in six participants (16.3%; n=100) reported vaccine hesitancy, with a significant difference by employment status, with self-employed more likely to show hesitancy [adjusted odds ratio (AOR) 1.85, 95% CI (1.05-3.27)], and region. Major drivers of hesitancy were lack of interest [n=30 (30%)], fear of side-effects [n=24 (24%)], and lack of trust in the vaccine [n=13 (13%)]. Having chronic disease conditions in the family had no association with hesitancy (p > 0.05). Conclusion: While representativeness of the sample is an issue, the findings show a relatively low rate of COVID-19 vaccine hesitancy among the Ethiopian population. The major drivers of hesitancy, lack of interest, fear of side-effects, and lack of trust in the vaccine, may be reversed by disseminating accurate and timely information using credible sources across communities.

Mental wellbeing during the time of COVID-19 pandemic: A national pilot survey in Ethiopia.

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic substantially disrupts population health and wellbeing globally, while little is known about the effect on mental wellbeing in developing countries. This study aimed to assess the impact of COVID-19 on mental wellbeing of individuals and households in Ethiopia. Methods: A cross-sectional, national pilot survey was conducted through phone interviews from September to November 2021. Mental wellbeing and disability were assessed using a questionnaire adapted from the 5-item World Health Organization Wellbeing Index (WHO-5), the Oslo Social Support Scale (OSSS-3), and the WHO Disability Assessment Scale (WHODAS 2.0). Results: A total of 614 adults completed the pilot survey. The mean age was 36 years (standard deviation 11) and 71.7% were male. Mental wellbeing was poor in 218 (35.5%) participants. The most important predictors for poor mental wellbeing were rural residence (Adjusted Odds Ratio [AOR] 1.89; 95% CI 1.14, 3.14; p=0.012), perceived COVID-19 risk (AOR 1.75; 95% CI 1.18, 2.60; p=0.005), household stress (AOR 2.09; 95% CI 1.31, 3.34; p=0.002), experience of symptom of COVID-19 in the household (AOR 2.14; 95% CI 1.13, 4.04; p=0.019), and poor social support (AOR 2.43; 95% CI 1.51, 3.91; p<0.001). Conclusion: The study provides evidence that COVID-19 had a significant adverse impact on the mental wellbeing of individuals and households in Ethiopia. Further studies are needed to understand in detail the implications of the pandemic and interventions needed to keep mental wellbing of citizens.

Adherence to COVID -19 protective practices in Ethiopia: Use and predictors of face mask-wearing.

Introduction: The Ethiopian Ministry of Health strongly recommends that anyone, regardless of vaccination status, wears a standard face mask consistently when in public. This study aimed to assess the self-reported use and predictors of wearing face masks in the general population in Ethiopia. Methods: This was a population-based cross-sectional study using a telephone survey. Adults living in Ethiopia were randomly selected from the Ethio Telecom list of mobile phone numbers and interviewed about their mask-wearing practice and individual and household-level factors that could impact on the use of face masking. Multivariable logistic regression was used to measure associations. Results: A total of 614 participants were interviewed from September to November 2021. The prevalence of self-reported face mask use when in public was 81.1%. Living outside Addis Ababa, including Oromia [adjusted odds ratio [(AOR) 0.30, 95% confidence interval (CI) (0.14, 0.63)], Amhara [AOR 0.11, 95% CI (0.05, 0.23)], and Southern Nations, Nationalities and People's Region [AOR 0.31, 95% CI (0.12-0.79)] and being divorced or widowed [AOR 0.18, 95% CI (0.06, 0.62)] were found to be inversely associated with face mask use. Female gender [AOR 1.91, 95% CI (1.02, 3.58)] and older age [age ≥ 50, AOR 2.96, 95% CI (1.09-7.97)] were positively associated with the use of face masks. Attending social events [AOR 0.51, 95% CI (0.31-0.82)], was negatively associated with the use of face masks. Conclusion: Self-reported use of face masks was relatively high nationally, but inconsistent among different regions and demographics. The findings imply that policies and messaging campaigns may need to focus on specific populations and behaviors in this ongoing pandemic.