Drug policies' sensitivity towards women, pregnancy, and motherhood: a content analysis of national policy and programs from nine countries and their adherence to international guidelines.

BACKGROUND AND OBJECTIVES: Substance use in women is associated with unique psycho-social and physical vulnerabilities and poses complex challenges during pregnancy and motherhood. Gender-sensitive drug policy which considers the needs of women and their children could address these concerns. The objectives of this study were: (1) to systematically explore national-level drug policies' sensitivity and responsiveness to women, pregnant women, and children; and (2) to examine the adherence of drug policies with international guidelines for gender sensitivity in drug policy. METHODS: The research team was diverse professional backgrounds and nine countries. A summative content analysis of national drug policy documents, action plans, and strategies was performed. Specific documents focusing on women, pregnancy, and children were analysed. Specific themes and how frequently they appeared in the documents were identified. This quantification was an attempt to explore usage indicating the relative focus of the policies. A thematic map was developed to understand how national-level drug policies conceive and address specific concerns related to women who use drugs. We adapted the UNODC checklist for gender mainstreaming to assess policies' adherence to international guidelines. RESULTS: Twenty published documents from nine countries were reviewed. The common themes that emerged for women, pregnancy, and children were needs assessment, prevention, treatment, training, supply reduction, and collaboration and coordination. Custody of children was a unique theme for pregnant women. Specific psycho-social concerns and social reintegration were special themes for women, whereas legislation, harm reduction, research, and resource allocation were children-specific additional themes. For women-specific content analysis, special issues/concerns in women with drug misuse, need assessment, and prevention were the three most frequent themes; for the children-specific policies, prevention, training, and treatment comprised the three most occurring themes. For pregnant women/pregnancy, prevention, treatment, and child custody were the highest occurring themes. According to ratings of the countries' policies, there is limited adherence to international guidelines which ensure activities are in sync with the specific needs of women, pregnant women and their children. CONCLUSION: Our analysis should help policymakers revise, update and adapt national policies to ensure they are gender-responsive and address the needs of women, pregnant women and their children.

Changes in rates of psychiatric beds and prison populations in sub-Saharan Africa from 1990 to 2020.

Background: Psychiatric bed numbers (general, forensic, and residential) and prison populations have been considered indicators of institutionalization. The present study aimed to assess changes of those indicators across sub-Saharan Africa (SSA) from 1990 to 2020. Methods: We retrospectively obtained data on psychiatric bed numbers and prison populations from 46 countries in SSA between 1990 and 2020. Mean and median rates, as well as percentage changes between first and last data points were calculated for all of SSA and for groups of countries based on income levels. Results: Primary data were retrieved from 17 out of 48 countries. Data from secondary sources were used for 29 countries. From two countries, data were unavailable. The median rate of psychiatric beds decreased from 3.0 to 2.2 per 100 000 population (median percentage change = -16.1%) between 1990 and 2020. Beds in forensic and residential facilities were nonexistent in most countries of SSA in 2020, and no trend for building those capacities was detected. The median prison population rate also decreased from 77.8 to 71.0 per 100 000 population (-7.8%). There were lower rates of psychiatric beds and prison populations in low-income and lower-middle income countries compared with upper-middle income countries. Conclusions: SSA countries showed, on average, a reduction of psychiatric bed rates from already very low levels, which may correspond to a crisis in acute psychiatric care. Psychiatric bed rates were, on average, about one twenty-fifth of countries in the Organization for Economic Co-operation and Development (OECD), while prison population rates were similar. The heterogeneity of trends among SSA countries over the last three decades indicates that developments in the region may not have been based on coordinated policies and reflects unique circumstances faced by the individual countries.

Changes in retrospectively recalled alcohol use pre, during and post alcohol sales prohibition during COVID pandemic in Botswana.

BACKGROUND: The COVID-19 pandemic has seen the implementation of unprecedented legislation and policy, including drug control measures which in some countries, like Botswana, included a temporary full alcohol sales ban. However, the association of such absolute prohibition of alcohol sales on population drinking, including hazardous drinking, during the COVID-19 period has not yet been determined. This study investigated changes in retrospectively recalled alcohol use and hazardous drinking pre (prior 5th August 2020), during (5th August to 3rd September 2020) and post (after 4th September) the second alcohol sales ban in Botswana. Predictors of hazardous drinking across the three time points were also investigated. METHODS: An online cross-sectional study involving a convenience sample of 1318 adults with a past 12 months drinking history in Botswana was conducted in October 2020 following a month long alcohol sales prohibition. Participants completed a modified Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alongside demographic questions. Participants were expected to retrospectively recall their alcohol use pre, during and post the second alcohol sales ban. RESULTS: The prevalence of alcohol use among participants with a past 12 months drinking history was 91.7% (95%CI= 90.1-93.1) before the second ban, 62.3% (95%CI= 59.7-64.9) during the second ban, and 90.4% (95%CI= 88.7-91.8) after the ban.. Hazardous drinking temporarily decreased by 30% during the second alcohol sales ban, and rose to the pre-ban levels of about 60% after the ban. Significant predictors of hazardous drinking at any of the three time points (pre, during and post the second ban) were being male (AOR ranging from 1.50 to 2.13 for all time points), earning between P3000-P6000 (AOR= 1.69 prior sales ban), being a student (AOR=0.56 during the sales ban), and being employed (AOR= 1.45 post the sales ban). CONCLUSION: The alcohol sales ban was associated with short-lived changes in alcohol consumption and hazardous drinking thereby likely contributed in providing the anticipated and much needed temporary relief to the health system sought by COVID-19 pandemic measures.

Psychiatric epidemiological survey of university students in Botswana: rationale and methods of the Youth Mental Health Study (YMHS).

BACKGROUND: While the burden of disease attributable to mental disorders in low/middle-income countries (LMICs) is lower than high-income countries, there is recognition that the dearth of evidence from the LMICs may underestimate the actual prevalence and burden associated with mental disorders. Such is likely the case for Botswana where there has been no nationally representative data on the prevalence of symptoms of mental disorders or even a subgroup estimation of mental disorders in the country. Thus, the Youth Mental Health Study (YMHS) aims to estimate the prevalence and identify predictors of symptoms of mental disorders among university students in Botswana to add to the evidence and contribute to the country's health service planning. METHODS: The YMHS is a cross-sectional study of youth (18-29 years) attending six large universities (accounting for nearly half of the tertiary student population) in Botswana. A stratified sampling procedure with proportionate allocation and selection is used to select a representative sample of 1308 participants. An online survey comprising of a battery of reliable and validated self-report measures of symptoms of mental disorders is used. A developmental psychopathology framework is used in identifying the risk factors of mental disorders. Participant recruitment will span over 4 months beginning in February 2020. ETHICS AND DISSEMINATION: The study has received ethics approval from the University of Botswana Institutional Review Board, and the Ministry of Health and Wellness. Participants will be provided with feedback of their own results. Aggregated findings will be disseminated to stakeholders in the tertiary education and health sector in Botswana, and through peer-reviewed journals, conference presentations and the media.

Mental health legislation in Botswana.

The Mental Disorders Act of 1969 is the primary legislation relating to mental health in Botswana. Despite the country not being a signatory to the United Nations Convention on the Rights of Persons with Disabilities, its Act has a self-rated score of four out of five on compliance to human rights covenants. However, it can be argued that the Act does not adequately espouse a human rights- and patient-centred approach to legislation. It is hoped that ongoing efforts to revise the Act will address the limitations discussed in this article.