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1.
Int J Ment Health Syst ; 14: 66, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32817758

RESUMEN

Background: There are substantial gaps in our knowledge regarding the aetiology of mental, neurological and substance use disorders in sub-Saharan Africa, and the cost-effectiveness and scalability of interventions to reduce the burden of these conditions on the continent. To address these gaps, international investment has focussed on building research capacity, including funding doctoral students in African countries, to support development of high quality, contextually relevant interventions. Absent, however, is an understanding of how capacity building feeds into research careers. Methods: Within a broader mental health research capacity-building initiative (African Mental Health Research Initiative), we conducted 52 qualitative interviews with early-career researchers, policymakers, academics, and service users from four African countries (Ethiopia, Malawi, South Africa, and Zimbabwe) and with international funders of mental health research. The interview guide focused on the research context, planning, and priorities and how respondents perceive research careers and funding. Thematic analysis was applied to the transcribed interviews. Results: Five components of a research career emerged: (i) research positions; (ii) research skills; (iii) funding; (iv) research commitment from African countries; and (v) advocacy. All stakeholders wanted more high-impact African researchers, but few saw a clear, replicable track for developing their careers within universities or their Ministries of Health in their African countries. This stemmed, in part, from the lack of support for infrastructure that enables high-quality research: grants administration, mentorship, university leadership, research culture, and open communication between policymakers and researchers. Conclusions: This study highlights the importance of developing research infrastructure alongside capacity-building efforts. International funders should invest in grant management at African universities which would place them at the centre of research initiatives. African universities should prioritise the creation of a research culture by developing and promoting well-defined research tracks for both clinicians and academics, investing in grant management, and raising the profile of research within their institutions.

3.
Ann Glob Health ; 86(1): 40, 2020 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-32322538

RESUMEN

Background: Career development skills are widely advocated as part of research capacity building and strengthening efforts. However, there is a gap in knowledge on their acceptability in low- and middle-income countries. Objective: This study aimed to examine how a group of 16 early-career researchers in sub-Saharan Africa experienced a career development skills course and how they perceived the utility of the course. Methods: Sixteen early-career researchers registered at universities in Ethiopia, Zimbabwe, Malawi, and South Africa took part in the year-long Academic Competencies Series (ACES) course. ACES comprised ten modules covering mentoring skills, work-life balance, career strategy, teamwork, presentation skills, teaching, academic writing, engaging policy makers, grant-writing, and digital media. ACES was delivered through face-to-face workshops and via webinar as part of a broader mental health research capacity-building programme. In-depth interviews following a topic guide were conducted with participants. Interviews were recorded and transcribed verbatim. Data were analysed using Thematic Analysis. Findings: All ACES participants were interviewed (9 male, 7 female). Participants were PhD students (14) and post-docs (2). The main themes identified throughout the course were 1) Growth, in both personal and professional life; 2) Application of training, often in innovative ways but with notable constraints and obstacles; and 3) Connection with colleagues, where researchers learnt from each other and from experts, building confidence in their new skills. Participants described how face-to-face contact enhanced the perceived quality of their learning experience. Barriers included logistical obstacles to applying training, such as limited resources and being at an early career stage. Conclusions: We found that research career development skills training was highly acceptable for early-career researchers in four African countries, and was perceived as having facilitated their personal and professional growth. Our findings suggest that courses like ACES can be applied successfully and innovatively in low-income settings.

4.
Artículo en Inglés | MEDLINE | ID: mdl-32346483

RESUMEN

Mental, neurological and substance use (MNS) disorders are a leading, but neglected, cause of morbidity and mortality in sub-Saharan Africa. The treatment gap for MNS is vast with only 10% of people with MNS disorders in low-income countries accessing evidence-based treatments. Reasons for this include low awareness of the burden of MNS disorders and limited evidence to support development, adaptation and implementation of effective and feasible treatments. The overall goal of the African Mental Health Research Initiative (AMARI) is to build an African-led network of MNS researchers in Ethiopia, Malawi, South Africa and Zimbabwe, who are equipped to lead high quality mental health research programs that meet the needs of their countries, and to establish a sustainable career pipeline for these researchers with an emphasis on integrating MNS research into existing programs such as HIV/AIDS. This paper describes the process leading to the development of AMARI's objectives through a theory of change workshop, successes and challenges that have been faced by the consortium in the last 4 years, and the future role that AMARI could play in further building MNS research capacity by brining on board more institutions from low- and middle-income countries with an emphasis on developing an evidence-based training curriculum and a research-driven care service.

5.
Lancet Glob Health ; 8(2): e264-e275, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31924539

RESUMEN

BACKGROUND: Adolescents living with HIV face challenges to their wellbeing and antiretroviral therapy adherence and have poor treatment outcomes. We aimed to evaluate a peer-led differentiated service delivery intervention on HIV clinical and psychosocial outcomes among adolescents with HIV in Zimbabwe. METHODS: 16 public primary care facilities (clusters) in two rural districts in Zimbabwe (Bindura and Shamva) were randomly assigned (1:1) to provide enhanced HIV care support (the Zvandiri intervention group) or standard HIV care (the control group) to adolescents (aged 13-19 years) with HIV. Eligible clinics had at least 20 adolescents in pre-ART or ART registers and were geographically separated by at least 10 km to minimise contamination. Adolescents were eligible for inclusion if they were living with HIV, registered for HIV care at one of the trial clinics, and either starting or already on ART. Exclusion criteria were being too physically unwell to attend clinic (bedridden), psychotic, or unable to give informed assent or consent. Adolescents with HIV at all clinics received adherence support through adult counsellors. At intervention clinics, adolescents with HIV were assigned a community adolescent treatment supporter, attended a monthly support group, and received text messages, calls, home visits, and clinic-based counselling. Implementation intensity was differentiated according to each adolescent's HIV vulnerability, which was reassessed every 3 months. Caregivers were invited to a support group. The primary outcome was the proportion of adolescents who had died or had a viral load of at least 1000 copies per µL after 96 weeks. In-depth qualitative data were collected and analysed thematically. The trial is registered with Pan African Clinical Trial Registry, number PACTR201609001767322. FINDINGS: Between Aug 15, 2016, and March 31, 2017, 500 adolescents with HIV were enrolled, of whom four were excluded after group assignment owing to testing HIV negative. Of the remaining 496 adolescents, 212 were recruited at Zvandiri intervention sites and 284 at control sites. At enrolment, the median age was 15 years (IQR 14-17), 52% of adolescents were female, 81% were orphans, and 47% had a viral load of at least 1000 copies per µL. 479 (97%) had primary outcome data at endline, including 28 who died. At 96 weeks, 52 (25%) of 209 adolescents in the Zvandiri intervention group and 97 (36%) of 270 adolescents in the control group had an HIV viral load of at least 1000 copies per µL or had died (adjusted prevalence ratio 0·58, 95% CI 0·36-0·94; p=0·03). Qualitative data suggested that the multiple intervention components acted synergistically to improve the relational context in which adolescents with HIV live, supporting their improved adherence. No adverse events were judged to be related to study procedures. Severe adverse events were 28 deaths (17 in the Zvandiri intervention group, 11 in the control group) and 57 admissions to hospital (20 in the Zvandiri intervention group, 37 in the control group). INTERPRETATION: Peer-supported community-based differentiated service delivery can substantially improve HIV virological suppression in adolescents with HIV and should be scaled up to reduce their high rates of morbidity and mortality. FUNDING: Positive Action for Adolescents Program, ViiV Healthcare.


Asunto(s)
Conducta del Adolescente/psicología , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Carga Viral/estadística & datos numéricos , Adolescente , Análisis por Conglomerados , Femenino , Humanos , Masculino , Resultado del Tratamiento , Adulto Joven , Zimbabwe/epidemiología
7.
AIDS Behav ; 23(12): 3471-3481, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31444714

RESUMEN

Determination of HIV prevalence among people with mental illness is necessary for developing integrated services for HIV and mental illness. This study determined HIV prevalence and uptake of HIV care among outpatients of psychiatric hospitals in Harare, Zimbabwe. HIV status was determined using open testing of 270 randomly selected consenting adult outpatients. HIV prevalence was 14.4% and the risk of acquiring HIV was similar to the general population of adults in Zimbabwe. Females were six times more likely to have HIV infection than males. Although a relatively high proportion of patients had been tested for HIV in the past (77.2%), fewer were recently tested (27.8%). Access to HIV care was high (94%) amongst patients previously diagnosed to be HIV positive. Tertiary mental health services should offer similar HIV care packages as other points of care and there is need for interventions that reduce the risk of HIV in women with mental disorders.


Asunto(s)
Infecciones por VIH/epidemiología , Trastornos Mentales/epidemiología , Adolescente , Adulto , Anciano , Prestación de Atención de Salud , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Hospitales Psiquiátricos , Humanos , Masculino , Trastornos Mentales/terapia , Persona de Mediana Edad , Servicio Ambulatorio en Hospital , Prevalencia , Asunción de Riesgos , Esquizofrenia/epidemiología , Conducta Sexual/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adulto Joven , Zimbabwe/epidemiología
8.
BMC Pregnancy Childbirth ; 19(1): 53, 2019 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-30704428

RESUMEN

BACKGROUND: Depression is a common psychiatric disorder that is highly prevalent among people living with HIV (PLWH). Depression is linked to poor adherence to anti-retroviral medication while in the peri-natal period may affect birth outcomes. Intimate partner violence (IPV) has been linked to depression. Little is known about the factors associated with depression in HIV positive pregnant women in Zimbabwe. METHODS: We carried out a cross-sectional study in 4 busy primary care clinics offering antenatal services during the months of June through to September in 2016. Simple random sampling was used to screen HIV positive pregnant women while they waited to be attended to at each clinic. Eligible women who gave written informed consent were screened using a locally validated screening tool-the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: A total of 198(85%) participants were recruited out of 234 that were approached. The mean age of participants was 26.6(SD 4.5), of these, 176 (88.9%) had secondary education or more. A total of 78 (39.4%) (95% CI 32.5-46.3) met criteria for antenatal depression according to the local version of the EPDS. Factors associated with antenatal depression after multivariate analysis were intimate partner violence (IPV) [OR 3.2 (95% CI 1.5-6.7)] and previous history of depression OR 4.1 (95% CI 2.0-8.0)]. CONCLUSION: The prevalence of antenatal depression among HIV positive pregnant women in primary care clinics is high. Factors associated with antenatal depression in pregnant HIV positive women are IPV and previous history of depression. There is need for routine screening for depression during the antenatal period and interventions targeting depression in this population should include components to address IPV.


Asunto(s)
Depresión/epidemiología , Infecciones por VIH/psicología , VIH , Complicaciones Infecciosas del Embarazo/psicología , Mujeres Embarazadas/psicología , Adulto , Estudios Transversales , Depresión/virología , Femenino , Infecciones por VIH/virología , Humanos , Violencia de Pareja/psicología , Violencia de Pareja/estadística & datos numéricos , Análisis Multivariante , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Diagnóstico Prenatal , Prevalencia , Atención Primaria de Salud/estadística & datos numéricos , Escalas de Valoración Psiquiátrica , Adulto Joven , Zimbabwe/epidemiología
9.
AAS Open Res ; 2: 1, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-32382699

RESUMEN

Biobanks and human genomics applications are key for understanding health, disease and heredity in Africa and globally. Growing interest in these technologies calls for strengthening relevant legal, ethical and policy systems to address knowledge disparities and ensure protection of society, while supporting advancement of science. In Zimbabwe there is limited understanding of ethical, legal, and societal issues (ELSI) for biobanking and genomics. The Genomics Inheritance Law Ethics and Society (GILES) initiative was established in 2015 to explore the current status and gaps in the ethical and legal frameworks, knowledge among various stakeholders, and to establish capacity for addressing ELSI of biobanking and genomics as applied in biomedical and population research, and healthcare. A multi-methods approach was applied including document reviews, focus group discussions and in-depth interviews among health and research professionals, and community members in six provinces comprising urban, peri-urban and rural areas. Emerging findings indicates a need for updating guidelines and policies for addressing ELSI in biobanking and genomics research in Zimbabwe. Emerging terminologies such as biobanking and genomics lack clarity suggesting a need for increased awareness and educational tools for health professionals, research scientists and community members. Common concerns relating to consent processes, sample and data use and sharing, particularly where there is trans-national flow of biospecimens and data, call for nationally tailored ELSI frameworks aligned to regional and international initiatives. This paper describes the strategy undertaken for the development and implementation of the GILES project and discusses the importance of such an initiative for characterisation of ELSI of human biobanking and genomics in Zimbabwe and Africa. Conducting this explorative study among a wide range of stakeholders over a countrywide geographical regions, established one of the most comprehensive studies for ELSI of human biobanking and genomics in Africa.

10.
AIDS Behav ; 22(1): 86-101, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28063075

RESUMEN

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire-4.7 points in PST-AD arm vs. control, adjusted p value = 0.01). Results inform and justify a future randomised controlled trial of task-shifted PST-AD.


Asunto(s)
Depresión/etiología , Depresión/terapia , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Cumplimiento de la Medicación/psicología , Aceptación de la Atención de Salud/psicología , Solución de Problemas , Adulto , Terapia Cognitivo-Conductual , Estudios de Factibilidad , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Admisión y Programación de Personal , Evaluación de Programas y Proyectos de Salud , Zimbabwe/epidemiología
11.
Trials ; 18(1): 478, 2017 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-29052529

RESUMEN

BACKGROUND: World Health Organization (WHO) adolescent HIV-testing and treatment guidelines recommend community-based interventions to support antiretroviral therapy (ART) adherence and retention in care, while acknowledging that the evidence to support this recommendation is weak. This cluster randomized controlled trial aims to evaluate the effectiveness and cost-effectiveness of a psychosocial, community-based intervention on HIV-related and psychosocial outcomes. METHODS/DESIGN: We are conducting the trial in two districts. Sixteen clinics were randomized to either enhanced ART-adherence support or standard of care. Eligible individuals (HIV-positive adolescents aged 13-19 years and eligible for ART) in both arms receive ART and adherence support provided by adult counselors and nursing staff. Adolescents in the intervention arm additionally attend a monthly support group, are allocated to a designated community adolescent treatment supporter, and followed up through a short message service (SMS) and calls plus home visits. The type and frequency of contact is determined by whether the adolescent is "stable" or in need of enhanced support. Stable adolescents receive a monthly home visit plus a weekly, individualized SMS. An additional home visit is conducted if participants miss a scheduled clinic appointment or support-group meeting. Participants in need of further, enhanced, support receive bi-weekly home visits, weekly phone calls and daily SMS. Caregivers of adolescents in the intervention arm attend a caregiver support group. Trial outcomes are assessed through a clinical, behavioral and psychological assessment conducted at baseline and after 48 and 96 weeks. The primary outcome is the proportion who have died or have virological failure (viral load ≥1000 copies/ml) at 96 weeks. Secondary outcomes include virological failure at 48 weeks, retention in care (proportion of missed visits) and psychosocial outcomes at both time points. Statistical analyses will be conducted and reported in line with CONSORT guidelines for cluster randomized trials, including a flowchart. DISCUSSION: This study provides a unique opportunity to generate evidence of the impact of the on-going Zvandiri program, for adolescents living with HIV, on virological failure and psychosocial outcomes as delivered in a real-world setting. If found to reduce rates of treatment failure, this would strengthen support for further scale-up across Zimbabwe and likely the region more widely. TRIAL REGISTRATION: Pan African Clinical Trial Registry database, registration number PACTR201609001767322 (the Zvandiri trial). Retrospectively registered on 5 September 2016.


Asunto(s)
Servicios de Salud del Adolescente/organización & administración , Fármacos Anti-VIH/uso terapéutico , Servicios de Salud Comunitaria/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación , Adolescente , Conducta del Adolescente , Fármacos Anti-VIH/efectos adversos , Citas y Horarios , Protocolos Clínicos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Visita Domiciliaria , Humanos , Masculino , Visita a Consultorio Médico , Grupo de Atención al Paciente/organización & administración , Sistemas Recordatorios , Proyectos de Investigación , Apoyo Social , Teléfono , Factores de Tiempo , Resultado del Tratamiento , Carga Viral , Adulto Joven , Zimbabwe
12.
Lancet Psychiatry ; 4(11): 876-886, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28625876

RESUMEN

There has been little external analysis of Zimbabwe's mental health system. We did a systems analysis to identify bottlenecks and opportunities for mental health service improvement in Zimbabwe and to generate cost-effective, policy-relevant solutions. We combined in-depth interviews with a range of key stakeholders in health and mental health, analysis of mental health laws and policies, and publicly available data about mental health. Five themes are key to mental health service delivery in Zimbabwe: policy and law; financing and resources; criminal justice; workforce, training, and research; and beliefs about mental illness. We identified human resources, rehabilitation facilities, psychotropic medication, and community mental health as funding priorities. Moreover, we found that researchers should prioritise measuring the economic impact of mental health and exploring substance use, forensic care, and mental health integration. Our study highlights forensic services as a central component of the mental health system, which has been a neglected concept. We also describe a tailored process for mental health systems that is transferable to other low-income settings and that garners political will, builds capacity, and raises the profile of mental health.


Asunto(s)
Política de Salud , Fuerza Laboral en Salud , Legislación Médica , Servicios de Salud Mental , Salud Mental , Rehabilitación Psiquiátrica , Servicios Comunitarios de Salud Mental/economía , Psiquiatría Forense/economía , Psiquiatría Forense/legislación & jurisprudencia , Conocimientos, Actitudes y Práctica en Salud , Política de Salud/economía , Política de Salud/legislación & jurisprudencia , Fuerza Laboral en Salud/economía , Derechos Humanos , Humanos , Salud Mental/economía , Salud Mental/legislación & jurisprudencia , Servicios de Salud Mental/economía , Servicios de Salud Mental/legislación & jurisprudencia , Rehabilitación Psiquiátrica/economía , Participación de los Interesados , Análisis de Sistemas , Zimbabwe
13.
PLoS One ; 11(9): e0161860, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27607240

RESUMEN

INTRODUCTION: Few people with mental disorders in low and middle-income countries (LMICs) receive treatment, in part because mental disorders are highly stigmatized and do not enjoy priority and resources commensurate with their burden on society. Advocacy has been proposed as a means of building political will and community support for mental health and reducing stigma, but few studies have explored the practice and promise of advocacy in LMICs. METHODS: We conducted 30 semi-structured interviews with leaders in health and mental health in Zimbabwe to explore key stakeholder perceptions on the challenges and opportunities of the country's mental health system. We coded the transcripts using the constant comparative method, informed by principles of grounded theory. Few interview questions directly concerned advocacy, yet in our analysis, advocacy emerged as a prominent, cross-cutting theme across participants and interview questions. RESULTS: Two thirds of the respondents discussed advocacy, often in depth, returning to the concept throughout the interview and emphasizing their belief in advocacy's importance. Participants described six distinct components of advocacy: the advocates, to whom they advocate ("targets"), what they advocate for ("asks"), how advocates reach their targets ("access"), how they make their asks ("arguments"), and the results of their advocacy ("outcomes"). DISCUSSION: Despite their perception that mental health is widely misunderstood and under-appreciated in Zimbabwe, respondents expressed optimism that strategically speaking out can reduce stigma and increase access to care. Key issues included navigating hierarchies, empowering service users to advocate, and integrating mental health with other health initiatives. Understanding stakeholder perceptions sets the stage for targeted development of mental health advocacy in Zimbabwe and other LMICs.


Asunto(s)
Defensa del Consumidor , Mercadotecnía , Salud Mental , Accesibilidad a los Servicios de Salud , Humanos , Servicios de Salud Mental , Zimbabwe
14.
Lancet Psychiatry ; 3(1): 65-76, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26772066

RESUMEN

Commitment to building mental health treatment capacity in Africa is increasing but little agreement exists on strategies to train health workers on mental health or evaluation of training efforts. We systematically reviewed published literature on interventions to train health-care workers in Africa on mental health. 37 studies met our inclusion criteria. Training outcomes focused on changes in knowledge and attitude, with few studies evaluating skill and practice and only two studies measuring clinical outcomes. Quality of study methodology was generally not high, with scarce follow-up data and use of control cohorts. Existing studies provide examples of many training and evaluation strategies, but evidence to draw conclusions about the efficacy of different training techniques is inadequate. Key knowledge gaps include development and testing of innovative educational strategies; development of standardised, competency-based learning objectives and outcome measures; and training that facilitates implementation of integrated mental health systems. African institutions need to be empowered to do research in these areas to encourage the development of best practices for the continent.


Asunto(s)
Personal de Salud/educación , Salud Mental/educación , África , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
15.
BMC Med Educ ; 15: 23, 2015 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-25889733

RESUMEN

BACKGROUND: The use of simulated patients to teach in psychiatry has not been reported from low-income countries. This is the first study using simulation teaching in psychiatry in Africa. The aim of this study was to introduce a novel method of psychiatric teaching to medical students at the University of Zimbabwe and assess its feasibility and preliminary effectiveness. We selected depression to simulate because students in Zimbabwe are most likely to see cases of psychoses during their ward-based clinical exposure. METHODS: Zimbabwean psychiatrists adapted scenarios on depression and suicide based on ones used in London. Zimbabwean post-graduate trainee psychiatrists were invited to carry out the teaching and psychiatric nursing staff were recruited and trained in one hour to play the simulated patients (SPs). All students undertaking their psychiatry placement (n = 30) were allocated into groups for a short didactic lecture on assessing for clinical depression and then rotated around 3 scenarios in groups of 4-5 and asked to interview a simulated patient with signs of depression. Students received feedback from peers, SPs and facilitators. Students completed the Confidence in Assessing and Managing Depression (CAM-D) questionnaire before and after the simulation session and provided written free-text feedback. RESULTS: Post-graduate trainers, together with one consultant, facilitated the simulated teaching after three hours training. Student confidence scores increased from mean 15.90 to 20.05 (95% CI = 2.58- 5.71) t (20) = 5.52, (p > 0.0001) following the simulation teaching session. Free-text feedback was positive overall with students commenting that it was "helpful", "enjoyable" and "boosted confidence". CONCLUSIONS: In Zimbabwe, simulation teaching was acceptable and could be adapted with minimal effort by local psychiatrists and implemented by post-graduate trainees and one consultant, Students found it helpful and enjoyable and their confidence increased after the teaching. It offers students a broader exposure to psychiatric conditions than they receive during clinical attachment to the inpatient wards. Involving psychiatry trainees and nursing staff may be a sustainable approach in a setting with small number of consultants and limited funds to pay for professional actors.


Asunto(s)
Educación de Pregrado en Medicina , Simulación de Paciente , Aprendizaje Basado en Problemas/organización & administración , Psiquiatría/educación , Adulto , Competencia Clínica , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Estudios de Factibilidad , Femenino , Retroalimentación Formativa , Humanos , Masculino , Autoeficacia , Adulto Joven , Zimbabwe
17.
Int Rev Psychiatry ; 26(4): 453-9, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25137111

RESUMEN

Despite the need to improve the quantity and quality of psychiatry training in sub-Saharan Africa (SSA), very little is known about the experiences of psychiatric trainees in the region. This is the first study examining psychiatric trainees in a low-income country in SSA. It was carried out as part of the needs assessment for a unique Medical Education Partnership Initiative (MEPI) programme to find African solutions for medical shortages in Africa. We approached all doctors who had trained in post-graduate psychiatry in Zimbabwe in 2010 and conducted in-depth qualitative interviews with all except one (n = 6). We analysed the data using constant comparison and thematic analysis. Trainees described the apprenticeship model as the programme's primary strength, through providing clinical exposure and role models. Programme weaknesses included shortages in information sources, trainee salaries, trainers, public health education, and in the mental health service. Most respondents were, however, eager to continue practising psychiatry in Zimbabwe, motivated by family ties, national commitment and helping vulnerable, stigmatized individuals. Respondents called for sub-speciality training and for infrastructure and training to do research. Resources need to be made available for psychiatric trainees in more SSA settings to develop public health competencies. However, investment in psychiatry training programmes must balance service provision with trainees' educational needs. Directing investment towards needs identified by trainees may be a cost-effective, context-sensitive way to increase retention and learning outcomes.


Asunto(s)
Creación de Capacidad/métodos , Psiquiatría , Femenino , Humanos , Masculino , Servicios de Salud Mental , Psiquiatría/educación , Recursos Humanos , Zimbabwe/epidemiología
18.
J Womens Health (Larchmt) ; 19(11): 2071-7, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20849286

RESUMEN

BACKGROUND: Postnatal depression (PND) is a serious public health problem in resource-limited countries. Research is limited on PND affecting HIV-infected women in sub-Saharan Africa. Zimbabwe has one of the highest antenatal HIV infection rates in the world. We determined the prevalence and risk factors of PND among women attending urban primary care clinics in Zimbabwe. METHODS: Using trained peer counselors, a simple random sample of postpartum women (n = 210) attending the 6-week postnatal visit at two urban primary care clinics were screened for PND using the Shona version of the Edinburgh Postnatal Depression Scale (EPDS). All women were subsequently subjected to mental status examination using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression by two psychiatrists who had no knowledge of the EPDS test results. RESULTS: Of the 210 mothers (31 HIV positive, 148 HIV negative, 31 unknown status) enrolled during the postpartum period, 64 (33%) met DSM-IV criteria for depression. The HIV prevalence was 14.8%. Of the 31 HIV-infected mothers, 17(54%) met DSM-IV criteria for depression. Univariate analysis showed that multiparity (prevalent odds ratio [OR] 2.22, 95% confidence intervals [CI] 1.15-4.31), both parents deceased (OR 2.35, 95% CI 1.01-5.45), and having experienced a recent adverse life event (OR 8.34, CI 3.77-19.07) were significantly associated with PND. Multivariate analysis showed that PND was significantly associated with adverse life event (OR 7.04, 95% CI 3.15-15.76), being unemployed (OR 3.12, 95% CI 1.23-7.88), and multiparity (OR 2.50, 95% CI 1.00-6.24). CONCLUSIONS: Our data indicate a high burden of PND among women in Zimbabwe. It is feasible to screen for PND in primary care clinics using peer counselors. Screening for PND and access to mental health interventions should be part of routine antenatal care for all women in Zimbabwe.


Asunto(s)
Depresión Posparto/epidemiología , Infecciones por VIH/psicología , Adolescente , Adulto , Depresión Posparto/complicaciones , Depresión Posparto/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Entrevistas como Asunto , Análisis Multivariante , Paridad , Embarazo , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Zimbabwe/epidemiología
19.
Int Psychiatry ; 7(4): 93-94, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31508055

RESUMEN

Zimbabwe is a landlocked country which has recently emerged from some marked political and socioeconomic challenges. Against this background, mental health has fallen down the priority list, as matters such as food shortages and the AIDS scourge have taken precedence. Zimbabwe is in southern Africa; Zambia and Botswana lie to the north, Namibia to the west, South Africa to the south and Mozambique to the east. Its population is 11.4 million. The capital city is Harare, which has a population of 1.6 million.

20.
Arch Womens Ment Health ; 13(3): 201-6, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19760051

RESUMEN

UNLABELLED: Despite the significant burden of common mental disorders (CMD) among women in sub Saharan Africa, data on postnatal depression (PND) is very limited, especially in settings with a high HIV prevalence. The Edinburgh Postnatal Depression Scale (EPDS), a widely used screening test for PND has been validated in many countries, but not in Zimbabwe. We assessed the validity of the EPDS scale among postpartum women compared with Diagnostic Manual of Mental Disorders (DSM-IV) criteria for major depression. Six trained community counselors administered the Shona version of the EPDS to a random sample of 210 postpartum HIV-infected and uninfected women attending two primary care clinics in Chitungwiza. All women were subsequently subjected to mental status examination using DSM IV criteria for major depression by 2 psychiatrists, who were blinded to the subject's EPDS scores. Data were analyzed using receiver operating characteristic (ROC) curve analysis. Of the 210 postpartum mothers enrolled, 64 (33%) met DSM IV criteria for depression. Using a cut-off score of 11/12 on the Shona version of the EPDS for depression, the sensitivity was 88%, and specificity was 87%, with a positive predictive value of 74%, a negative predictive value of 94%, and an area under the curve of 0.82. Cronbach's alpha coefficient for the whole scale was 0.87. CONCLUSION: The Shona version of the EPDS is a reliable and valid tool to screen for PND among HIV-infected and un-infected women in Zimbabwe. Screening for PND should be integrated into routine antenatal and postnatal care in areas with high HIV prevalence.


Asunto(s)
Depresión Posparto/epidemiología , Depresión Posparto/prevención & control , Infecciones por VIH/epidemiología , Entrevista Psicológica , Tamizaje Masivo , Adulto , Comorbilidad , Estudios Transversales , Femenino , Humanos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Población Urbana , Zimbabwe/epidemiología
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