Browsing by Author "Kola, L."

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A pilot randomized controlled trial of a stepped care intervention package for depression in primary care in Nigeria
(2015) Oladeji, B. D.; Kola, L.; Abiona, T.; Montgomery, A. A.; Araya, R.; Gureje, O.
Background: Depression is common in primary care and is often unrecognized and untreated. Studies are needed to demonstrate the feasibility of implementing evidence-based depression care provided by primary health care workers (PHCWs) in sub-Saharan Africa. We carried out a pilot two-parallel arm cluster randomized controlled trial of a package of care for depression in primary care. Methods: Six primary health care centers (PHCC) in two Local Government Areas of Oyo State, South West Nigeria were randomized into 3 intervention and 3 control clinics. Three PHCWs were selected for training from each of the participating clinics. The PHCWs from the intervention clinics were trained to deliver a manualized multicomponent stepped care intervention package for depression consisting of psychoeducation, activity scheduling, problem solving treatment and medication for severe depression. Providers from the control clinics delivered care as usual, enhanced by a refresher training on depression diagnosis and management. Outcome measures Patient’s Health Questionnaire (PHQ-9), WHO quality of Life instrument (WHOQOL-Bref) and the WHO disability assessment schedule (WHODAS) were administered in the participants’ home at baseline, 3 and 6 months. Results: About 98% of the consecutive attendees to the clinics agreed to have the screening interview. Of those screened, 284 (22.7%) were positive (PHQ-9 score ≥ 8) and 234 gave consent for inclusion in the study: 165 from intervention and 69 from control clinics. The rates of eligible and consenting participants were similar in the control and intervention arms. In all 85.9% (92.8% in intervention and 83% in control) of the participants were successfully administered outcome assessments at 6 months. The PHCWs had little difficulty in delivering the intervention package. At 6 months follow up, depression symptoms had improved in 73.0% from the intervention arm compared to 1.6% control. Compared to the mean scores at baseline, there was improvement in the mean scores on all outcome measures in both arms at six months. Conclusion: The results provide support for the feasibility of conducting a fully-powered randomized study in this setting and suggest that the instruments used may have the potential to detect differences between the arms.
A survey of traditional and faith healers providing mental health care in three sub-Saharan African countries
(Springer Science + Business Media, 2019) Esan, O.B.; Appiah-Poku, J.; Othieno, C.; Kola, L.; Harris, B.; Nortje, G.; Makanjuola, V.; Oladeji, B.; Price, L.; Seedat, S.; Gureje, O.
Background: Traditional and faith healers constitute an important group of complementary and alternative mental health service providers (CAPs) in sub-Sahara Africa. Governments in the region commonly express a desire to integrate them into the public health system. The aim of the study was to describe the profile, practices and distribution of traditional and faith healers in three sub-Saharan African countries in great need for major improvements in their mental health systems namely Ghana, Kenya and Nigeria. Materials and methods: A mapping exercise of CAPs who provide mental health care was conducted in selected catchment areas in the three countries through a combination of desk review of existing registers, engagement activities with community leaders and a snowballing technique. Information was collected on the type of practice, the methods of diagnosis and the forms of treatment using a specially designed proforma. Results: We identified 205 CAPs in Ghana, 406 in Kenya and 82 in Nigeria. Most (> 70%) of the CAPs treat both physical and mental illnesses. CAPs receive training through long years of apprenticeship. They use a combination of herbs, various forms of divination and rituals in the treatment of mental disorders. The use of physical restraints by CAPs to manage patients was relatively uncommon in Kenya (4%) compared to Nigeria (63.4%) and Ghana (21%). CAPs often have between 2- to 10-fold capacity for patient admission compared to conventional mental health facilities. The profile of CAPs in Kenya stands out from those of Ghana and Nigeria in many respects. Conclusion: CAPs are an important group of providers of mental health care in sub-Saharan Africa, but attempts to integrate them into the public health system must address the common use of harmful treatment practices.
Collaboration Between Biomedical and Complementary and Alternative Care Providers: Barriers and Pathways
(SAGE Publishing, 2017) "Van der Watt, A.S.J.; Nortje, G.; Kola, L.; Appiah-Poku, J.; Othieno, C.; Harris, B.; Oladeji, B.D.; Esan, O.B.; Makanjuola, V.; Price, L.N.; Seedat, S.; Gureje, O.
We examined the scope of collaborative care for persons with mental illness as implemented by traditional healers, faith healers, and biomedical care providers. We conducted semistructured focus group discussions in Ghana, Kenya, and Nigeria with traditional healers, faith healers, biomedical care providers, patients, and their caregivers. Transcribed data were thematically analyzed. A barrier to collaboration was distrust, influenced by factionalism, charlatanism, perceptions of superiority, limited roles, and responsibilities. Pathways to better collaboration were education, formal policy recognition and regulation, and acceptance of mutual responsibility. This study provides a novel cross-national insight into the perspectives of collaboration from four stakeholder groups. Collaboration was viewed as a means to reach their own goals, rooted in a deep sense of distrust and superiority. In the absence of openness, understanding, and respect for each other, efficient collaboration remains remote. The strongest foundation for mutual collaboration is a shared sense of responsibility for patient well-being.
Collaborative shared care to improve psychosis outcome (COSIMPO): study protocol for a randomized controlled trial
(BioMed Central, 2017) Gureje, O.; Makanjuola, V.; Kola, L.; Yusuf, B.; Price, L.; Esan, O.B.; Oladeji, B.D.; Appiah-Poku, J.; Haris, B.; Othieno, C.; Seedat, S.
Keywords Background: Psychotic disorders are a group of severe mental disorders that cause considerable disability to sufferers and a high level of burden to families. In many low- and middle-income countries (LMIC), traditional and faith healers are the main providers of care to affected persons. Even though frequently canvassed as desirable for improved care delivery, collaboration between these complementary alternative health providers (CAPs) and conventional health providers has yet to be rigorously tested for feasibility and effectiveness on patient outcomes. Methods/design: COSIMPO is a single-blind, cluster randomized controlled trial (RCT) being conducted in Nigeria and Ghana to compare the effectiveness of a collaborative shared care (CSC) intervention program implemented by CAPs and primary health care providers (PHCPs) with care as usual (CAU) at improving the outcome of patients with psychosis. The study is designed to test the hypotheses that patients receiving CSC will have a better clinical outcome and experience fewer harmful treatment practices from the CAPs than patients receiving CAU at 6 months after study entry. An estimated sample of 296 participants will be recruited from across 51 clusters, with a cluster consisting of a primary care clinic and its neighboring CAP facilities. CSC is a manualized intervention package consisting of regular and scheduled visits of PHCPs to CAP facilities to assist with the management of trial participants. Assistance includes the administration of antipsychotic medications, management of comorbid physical condition, assisting the CAP to avoid harmful treatment practices, and engaging with CAPs, caregivers and participants in planning discharge and rehabilitation. The primary outcome, assessed at 6 months following trial entry, is improvement on the Positive and Negative Symptom Scale (PANSS). Secondary outcomes, assessed at 3 and 6 months, consist of levels of disability, experience of harmful treatment practices and of victimization, and levels of perceived stigma and of caregivers’ burden. Discussion: Information about whether collaboration between orthodox and complementary health providers is feasible and can lead to improved outcome for patients is important to formulating policies designed to formally engage the services of traditional and faith healers within the public health system.
Community study of knowledge of and attitude to mental illness in Nigeria
(Taylor and Francis Group, 2005) Gureje, O.; Lasebikan, V. O.; Ephraim-Oluwanuga, O.; Olley, B. O.; Kola, L.
Background: The improvement of community tolerance of people with Mental illness is important for their integration. Little is known about the knowledge of and attitude to mental illness in sub-Saharan Africa. Aims: To determine the knowledge and attitudes of a representative community sample in Nigeria. Method: A multistage, clustered sample of household respondents was studied in three states in the Yoruba-speaking parts of Nigeria (representing 22% of the national population). A total of 2040 individuals participated (response rate 74.2%). Results: Poor knowledge of causation was common. Negative views of mental illness were wide spread, with as many as 96.5% (s.d. =0.5) believing that people with mental illness are dangerous because of their violent behaviour. Most would not tolerate even basic social contacts with a mentally ill person: 82.7% (s.e.=1.3) would be afraid to have a conversation with a mentally ill person and only16.9% (s.e.=0.9) would consider marrying one. Socio-demographic predictors of both poor knowledge and intolerant attitude were generally very few. Conclusions: There is widespread stigmatisation of mental illness in the Nigerian community. Negative attitudes to mental illness may be fuelled by notions of causation that suggest that affected people are in some way responsible for their illness, and by fear.
Determinants of quality of life of elderly Nigerians: results from the Ibadan study of ageing
(Elsevier Ltd., 2008) Gureje, O; Kola, L.; Afolabi, E.; Olley, B. O.
Background: Little is known about factors that determine the QoL of elderly persons living in developing societies undergoing rapid social changes. Method: A representative sample of elderly Nigerians, aged 65 years and over (n= 2152), was assessed for QoL using the World Health Organization Quality of Life instrument (WHOQoLBref). Other than sociodemographic factors, respondents were also evaluated for major depressive disorder, physical conditions as well as for social network, support and engagement. Using linear regression modeling, these factors were explored for their ability to predict the physical, psychological, social and environmental domains of QoL. Results:Economic status was the most consistent predictor of the four domains of QoL, with the coefficients ranging between 1.0 and 1.68 (p < 0.001 in every instance). Among health variables, functional disability (range: 7.07 – 19.86) and self-rated overall health (range: 7.89 – 18. 42) were the most salient. Participation in community activities (range 7.74 – 17.48) was the most consistent social predictor. As a group, social factors, especially those relating to social support and participation, were the strongest determinants of QoL. Conclusion: Even though health factors are important, social factors, in particular those relating to the quality of social support and participation, are the most important predictors of QoL.
Do beliefs about causation influence attitudes to mental illness?
(Elsevier Ltd., 2006-06) Gureje, O.; Olley, O.; Ephraim-Oluwanuga, O.; Kola, L.
Studies indicate that stigmatizing attitudes to mental illness are rampant in the community worldwide. It is unclear whether views about the causation of mental disorders identify persons with more negative attitudes. Using data collected as part of a community study of knowledge of and attitudes to mental illness in Nigeria, we examined the relationships between views about causation and attitudes. Persons holding exclusively biopsychosocial views of causation were not different from those holding exclusively religious-magical views in regard to socio-demographic attributes, and the two groups were not very dissimilar when general knowledge of the nature of mental illness was compared. However, religious-magical views of causation were more associated with negative and stigmatizing attitudes to the mentally ill. Findings demonstrate the challenge of developing and delivering an educational program to change public attitudes to mental illness.
Effect of a stepped-care intervention delivered by lay health workers on major depressive disorder among primary care patients in Nigeria (STEPCARE): a cluster randomised controlled trial
(Elsevier Ltd., 2019) Gureje, O.; Oladeji, B. D.; Montgomery, A. A.; Bello, T.; Kola, L.; Ojagbemi, A.; Chisolm, D.; Araya, R.
Background Little is known about how to scale up care for depression in settings where non-physician lay workers constitute the bulk of frontline providers. We aimed to compare a stepped-care intervention package for depression with usual care enhanced by use of the WHO Mental Health Gap Action Programme intervention guide (mhGAP-IG). Methods We did a cluster-randomised trial in primary care clinics in Ibadan, Nigeria. Eligible clinics were those with adequate staffing to provide various 24-h clinical services and with regular physician supervision. Clinics (clusters), anonymised and stratified by local government area, were randomly allocated (1:1) with a computer-generated random number sequence to one of two groups: an intervention group in which patients received a stepped-care intervention (eight sessions of individual problem-solving therapy, with an extra two to four sessions if needed) plus enhanced usual care, and a control group in which patients received enhanced usual care only. Patients from enrolled clinics could participate if they were aged 18 years or older, not pregnant, and had moderate to severe depression (scoring ≥11 on the nine-item patient health questionnaire [PHQ-9]). The primary outcome was the proportion of patients with remission of depression at 12 months (a score of ≤6 on the PHQ-9, with assessors masked to group allocation) in the intention-to-treat population. This trial is registered with the International Standard Randomised Controlled Trials Number registry (ISRCTN46754188) and is completed. Findings 35 of 97 clinics approached were eligible and agreed to participate, of which 18 were allocated to the intervention group and 17 to the control group. 1178 patients (631 [54%] in the intervention group and 547 [46%] in the control group) were recruited between Dec 2, 2013, and June 29, 2015, among whom 976 (83%) were female and baseline mean PHQ-9 score was 13·7 (SD 2·6). Of the 562 (89%) patients in the intervention group and 473 (86%) in the control group who completed 12-month follow-up, similar proportions in each group had remission of depression (425 [76%] in the intervention group vs 366 [77%] in the control group; adjusted odds ratio 1∙0 [95% CI 0·70–1·40]). At 12 months, 17 (3%) deaths, one (<1%) psychotic illness, and one (<1%) case of bipolar disorder in the intervention group, and 16 deaths (3%) and one (<1%) case of bipolar disorder in the control group were recorded. No adverse events were judged to be related to the study procedures. Interpretation For patients with moderate to severe depression receiving care from non-physician primary health-care workers in Nigeria, a stepped-care, problem-solving intervention combined with enhanced usual care is similarly effective to enhanced usual care alone. Enhancing usual care with mhGAP-IG might provide simple and affordable approach to scaling up depression care in sub-Saharan Africa.
Effect of collaborative care between traditional and faith healers and primary health-care workers on psychosis outcomes in Nigeria and Ghana (COSIMPO): a cluster randomised controlled trial
(Elsevier Ltd, 2020) Gureje, O.; Appiah-Poku, J.; Bello, T.; Kola, L.; Araya, R.; Chisholm, D.; Esan, O.B.; Harris, B.; Makanjuola, V.; Othieno, C.; Price, L.
Background: Traditional and faith healers (TFH) provide care to a large number of people with psychosis in many sub Saharan African countries but they practise outside the formal mental health system. We aimed to assess the effectiveness and cost-effectiveness of a collaborative shared care model for psychosis delivered by TFH and primary health-care providers (PHCW). Methods: In this cluster-randomised trial in Kumasi, Ghana and Ibadan, Nigeria, we randomly allocated clusters (a primary care clinic and neighbouring TFH facilities) 1:1, stratified by size and country, to an intervention group or enhanced care as usual. The intervention included a manualised collaborative shared care delivered by trained TFH and PHCW. Eligible participants were adults (aged ≥18 years) newly admitted to TFH facilities with active psychotic symptoms (positive and negative syndrome scale [PANSS] score ≥60). The primary outcome, by masked assessments at 6 months, was the difference in psychotic symptom improvement as measured with the PANSS in patients in follow-up at 3 and 6 months. Patients exposure to harmful treatment practices, such as shackling, were also assessed at 3 and 6 months. Care costs were assessed at baseline, 3-month and 6-month follow-up, and for the entire 6 months of follow-up. This trial was registered with the National Institutes of Health Clinical Trial registry, NCT02895269. Findings: Between Sept 1, 2016, and May 3, 2017, 51 clusters were randomly allocated (26 intervention, 25 control) with 307 patients enrolled (166 [54%] in the intervention group and 141 [46%] in the control group). 190 (62%) of participants were men. Baseline mean PANSS score was 107∙3 (SD 17∙5) for the intervention group and 108∙9 (18∙3) for the control group. 286 (93%) completed the 6-month follow-up at which the mean total PANSS score for intervention group was 53∙4 (19∙9) compared with 67∙6 (23∙3) for the control group (adjusted mean difference –15∙01 (95% CI –21∙17 to –8∙84; 0·0001). Harmful practices decreased from 94 (57%) of 166 patients at baseline to 13 (9%) of 152 at 6 months in the intervention group (–0∙48 [–0∙60 to –0∙37] (p<0.001) and from 59 (42%) of 141 patients to 13 (10%) of 134 in the control group (–0·33 [–0∙45 to –0∙21] (p<0.001) with no significant difference between the two groups. Greater reductions in overall care costs were seen in the intervention group than in the control group. At the 6-month assessment, greater reductions in total health service and time costs were seen in the intervention group; however, cumulative costs over this period were higher (US $627 per patient vs $526 in the control group). Five patients in the intervention group had mild extrapyramidal side effects. Interpretation: A collaborative shared care delivered by TFH and conventional health-care providers for people with psychosis was effective and cost-effective. The model of care offers the prospect of scaling up improved care to this vulnerable population in settings with low resources
Effect of intervention delivered by lay maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): a cluster randomized controlled trial
(Elsevier, 2022) Gureje, O.; Oladeji, B. D.; Kola, L.; Bello, T.; Ayinde, O.; Faregh, N.; Bennett, I.; Zelkowitz, P.
Background: Perinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression. Methods: In a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self- identified adult to care as usual. Pregnant adolescents (aged <20 years) at fetal gestational age16–36 weeks with moderate to severe depression were recruited. Primary outcomes were depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and parenting practices (Infant-Toddler version of the Home Inventory for Measurement of the Environment, HOME-IT) at six-months postnatal. Results: There were 242 participants (intervention arm: 141; Control arm: 101), with a mean age of 18∙0 (SD- 1∙2). Baseline mean EPDS score was 14∙2 (SD-2.1); 80∙1 % completed the six-month postnatal follow-up. The intervention group had lower level of depressive symptoms than the control group, mean EPDS scores: 5∙5 (SD- 3∙6) versus 7∙2 (SD-4∙0) (adjusted mean difference -1∙84 (95%CI- 3∙06 to 􀀀0∙62; p =0∙003) and better parenting practices, mean total HOME-IT scores: 29∙8 (SD-4∙4) versus 26∙4 (SD-4∙2) (adjusted mean difference 3∙4 (95%Cl- 2∙12 to 4∙69, p =0∙001). Limitations: This study explored the effect of complex interventions making it difficult to know precisely what aspects produced the outcomes. Conclusions: An age-appropriate psychosocial intervention package holds promise for scaling up care for adolescents with perinatal depression especially in resource-constrained settings.
Explanatory model of psychosis: impact on perception of self-stigma by patients in three sub-saharan African cities
(Springer Science + Business Media, 2016) Makanjuola, V.; Esan, O.B.; Oladeji, B.; Kola, L.; Appiah-Poku, J.; Harris, B.; Othieno, C.; Price, L.; Seedat, S.; Gureje, O.
Mental disorders are cross-culturally ubiquitous [1]. Psychosis is, by far, the more easily recognisable form of mental disorder by the lay public and traditional healers [2]. While the experience of psychosis is universal, interpretation of the experience, notions of causation, treatment, preferred source of care, and the consequences and perceptions of associated stigma vary from one culture to another. We used a mixed-methods approach consisting of in-depth interviews with key informants to explore respondents’ explanatory models of the causation of psychosis as well as questionnaire assessment of the level of internalized (or self) stigma. The conduct of the interviews was guided by the specifications of the McGill Illness Narrative Interview (MINI) [32], a semi-structured interview guide which, among other things, elicits lay illness narratives. A purposively selected sample of patients who were receiving treatment from traditional healers was interviewed. The transcribed interviews were read several times by the first author and subjected to thematic analysis. Supernatural and biopsychosocial explanatory models of the causation of psychosis were both endorsed by our respondents. Despite this, the majority of the respondents with severe forms of self-stigma held supernatural attributions. However, we also found that some respondents with low self-stigma embraced a supernatural model while some respondents with high self-stigma proffered a biopsychosocial explanation. Our findings suggest that individualising interventions to minimize self-stigma may be a better approach than programs that generically promote biopsychosocial models or discourage supernatural models.
Exploring differences between adolescents and adults with perinatal depression-data from the expanding care for perinatal women with depression trial in Nigeria
(2019-10) Oladeji, B. D.; Bello, T.; Kola, L.; Araya, R.; Zelkowitz, P.; Gureje, O.
Background: Depression is common among women in the perinatal period. Although pregnancy and motherhood among adolescents are global public health issues, little is known about how adolescents differ from adults in the occurrence and correlates of perinatal depression. Methods: Data were derived from a cluster randomized controlled trial of psychosocial interventions for perinatal depression in primary maternal care in Nigeria (the Expanding Care for Perinatal Women with Depression trial). Adolescents and adult participants recruited during pregnancy and followed up till 6-month postpartum were compared: proportions with depression [screening positive to depression on the Edinburgh Postnatal Depression Scale (score ≥ 12) and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria using the short form of the Composite International Diagnostic Interview]; adjustment and attitude to pregnancy and motherhood (using the Maternal Adjustment and Maternal Attitudes scale); and parenting skills (measured on Infant–Toddler version of the Home Inventory for Measurement of the Environment). Infant and fetal growth were assessed by measures of weight and head circumference at birth and upper mid-upper arm circumference (MUAC) at 6 months. Results: Of 8,580 adults screened, 6.9% had major depression compared with 17.7% of 772 screened adolescents (p < 0.001). Adolescents had significantly poorer adjustment and attitudes to pregnancy, lower mean fetal gestational age at birth, and a smaller mean baby’s birth weight. At 6-month postpartum, there were no significant differences in the rates of remission from depression between adolescent and adult women (Edinburgh Postnatal Depression Scale score <6). Adolescent mothers continued to have poorer maternal attitudes and parenting skills indicated by significantly lower scores on the Infant–Toddler version of the Home Inventory for Measurement of the Environment responsivity and involvement subscales. Infants of adolescent mothers had a higher rate of undernutrition (defined as MUAC < 12.5 cm) compared with those of adult mothers: 14.8 and 6.3%, respectively (p = 0.008), with the mean MUAC remaining significantly lower for infants of adolescent mothers after adjusting for their lower birth weight (p = 0.04). Conclusion: Perinatal depression is more common and is associated with poorer maternal attitudes and parenting skills in adolescents compared with those in adults. Evidence from this exploratory study suggests that in improving outcomes in infants of adolescent mothers with perinatal depression, depression treatment may need to be supplemented with specific approaches to improve parenting skills.
High versus low intensity interventions for perinatal depression delivered by non-specialist primary maternal care providers in Nigeria: a cluster randomized controlled trial: (the EXPONATE trial)
(2019) Gureje, O.; Oladeji, B. D.; Montgomery, A. A.; Araya, R.; Bello, T.; Chisholm, D.; Groleau, D.; Kirmayer, L. J.; Kola, L.; Olley, L.; Tan, W.; Zelkowitz, P.
Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression. Aim To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression. Method Cluster randomised clinical trial, conducted in Ibadan, Nigeria between 18 June 2013 and 11 December 2015 in 29 maternal care clinics allocated by computed-generated random sequence (15 HIT; 14 LIT). Interventions were delivered individually to antenatal women with DSM-IV (1994) major depression by trained PMCPs. LIT consisted of the basic psychosocial treatment specifications in the World Health Organization Mental Health Gap Action Programme – Intervention Guide. HIT comprised LIT plus eight weekly problem-solving therapy sessions with possible additional sessions determined by scores on the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome was remission of depression at 6 months postpartum (EPDS < 6). Results There were 686 participants; 452 and 234 in HIT and LIT arms, respectively, with both groups similar at baseline. Follow-up assessments, completed on 85%, showed remission rates of 0% with HIT and 66% with LIT: risk difference 4% (95% CI −4.1%, 12.0%), adjusted odds ratio 1.12 (95% CI 0.73, 1.72). HIT was more effective for severe depression (odds ratio 2.29; 95% CI 1.01, 5.20; P = 0.047) and resulted in a higher rate of exclusive breastfeeding. Infant outcomes, cost-effectiveness and adverse events were similar. Conclusions Except among severely depressed perinatal women, we found no strong evidence to recommend high-intensity in preference to low-intensity psychological intervention in routine primary maternal care.
Mental disorders and earnings: results from the Nigerian National Survey of Mental Health and Well-Being (NSMHW)
(International Center of Mental Health Policy and Economics, 2012) Esan, O. B.; Kola, L.; Gureje, O.
Background: Mental disorders are associated with a loss in earnings both at the individual and societal level. Very few studies have addressed the issue of the cost of mental illness in Sub-Saharan Africa. These studies have been largely hospital based, localized, and have addressed only a few mental disorders using very small sample sizes. Aims of the Study: To examine the impact of mental disorders on earnings of affected persons. Methods: Mental disorders on and personal earnings were assessed in a representative sample of 1,889 Nigerians aged 18-64 years in an epidemiological survey. Version 3.0 of the World Health Organization Composite International Diagnostic Interview (WHO CIDI) was used to assess mental disorders. Respondents were also asked to report their personal earnings before tax in the past 12 months, while authors predicted personal earnings in the same period from information about 12 month and life time DSM IV mental disorders among respondents. Results: A 12-month prevalence of Serious Mental Illness (SMI) was found in 0.5% of the sample while other 12-month disorders had a prevalence of 4.83%. The prevalence of other lifetime disorders was 4.14%. The mean annual impact of serious mental illness was 60,126 Naira (US$ 463). At the level of the society the annual impact was 21.6 billion Naira (US$ 166.2 million). Discussion: Mental disorders have an enormous individual and societal financial burden. This impact appears more severe in males. Implications for Health Care Provision and Use: Mental disorders have enormous negative impacts on earnings both at the individual and societal level. This analysis highlights the financial value of lost earnings in the absence of such disorders. Implications for Health Policies: An increase in spending on mental health based on proportionate economic burden of mental disorders may substantially reduce financial losses due to mental disorders. Implications for Further Research: In the present study, only the indirect health care costs have been assessed. Future research should consider direct costs.
Mental health care in Anglophone West Africa
(American Psychiatric Association Publishing, 2014) Esan, O.B.; Abdumalik, J.O.; Eaton, J.; Kola, L.; Fadahunsi, W.; Gureje, O.
This column describes the current state of resources and practice in mental health care in the Anglophone countries of West Africa: the Gambia, Sierra Leone, Ghana, Nigeria, and Liberia. Information was systematically gathered from the five countries by using a standard framework for country situation analysis. Mental health services, which are in various stages of development, are characterized by inadequate human resources and long policy neglect. Despite the low numbers of specialists, the region has made important contributions to community service development and global mental health research. Challenges include man power development, policy and legislation updates, and increased attention to policy and budget. Although mental health service is still grossly inadequate in the con text of human and material constraints, there are slowly evolving signs of positive modernization and service development.
Partnership for mental health development in Sub-Saharan Africa (PaM-D): a collaborative initiative for research and capacity building
(Cambridge University Press & Assessment, 2019) Gureje, O.; Seedat, S.; Kola, L.; Appiah-Poku, J.; Othieno, C.; Harris, B.; Makanjuola, V.; Price, L.N.; Ayinde, O. O.; Esan, O. B.
Aims In low and middleincome countries (LMIC) in general and sub-Saharan African (SSA) countries in particular, there is both a large treatment gap for mental disorders and a relative paucity of empirical evidence about how to fill this gap. This is more so for severe mental disorders, such as psychosis, which impose an additional vulnerability for human rights abuse on its sufferers. A major factor for the lack of evidence is the few numbers of active mental health (MH) researchers on the continent and the distance between the little evidence generated and the policymaking process. Methods: The Partnership for Mental Health Development in Africa (PaMD) aimed to bring together diverse MH stakeholders in SSA, working collaboratively with colleagues from the global north, to create an infrastructure to develop MH research capacity in SSA, advance global MH science by conducting innovative public health relevant MH research in the region and work to link research to policy development. Participating SSA countries were Ghana, Kenya, Liberia, Nigeria and South Africa. The research component of PaMD focused on the development and assessment of a collaborative shared care (CSC) program between traditional and faith healers (T&FHs) and biomedical providers for the treatment of psychotic disorders, as a way of improving the outcome of persons suffering from these conditions. The capacity building component aimed to develop research capacity and appreciation of the value of research in a broad range of stakeholders through bespoke workshops and fellowships targeting specific skillsets as well as mentoring for early career researchers. Results: In the research component of PaMD, a series of formative studies were implemented to inform the development of an intervention package consisting of the essential features of a CSC for psychosis implemented by primary care providers and T&FHs. A cluster rand was next designed to test the effectiveness of this package on the outcome of psychosis. In the capacity building component, 35 early and midcareer researchers participated in the training workshops and several established mentor mentee relationships with senior PaMD members. At the end of the funding period, 60 papers have been published and 21 successful grant applications made. CONCLUSION: The success of PaMD in energising young researchers and implementing a cutting-edge research program attests to the importance of partnership among researchers in the global south working with those from the north in developing MH research and service in LMIC.
Profile comorbidity and impact of insomnia in the Ibadan
(Elsevier Ltd., 2009) Gureje, O.; Kola, L.; Ademola, A.; Olley, B. O.
Background: Little is known about factors that determine the QoL of elderly persons living in developing societies undergoing rapid social changes. Method: A representative sample of elderly Nigerians, aged 65 years and over (n= 2152), was assessed for QoL using the World Health Organization Quality of Life instrument (WHOQoLBref). Other than sociodemographic factors, respondents were also evaluated for major depressive disorder, physical conditions as well as for social network, support and engagement. Using linear regression modeling, these factors were explored for their ability to predict the physical, psychological, social and environmental domains of QoL. Results:Economic status was the most consistent predictor of the four domains of QoL, with the coefficients ranging between 1.0 and 1.68 (p < 0.001 in every instance). Among health variables, functional disability (range: 7.07 – 19.86) and self-rated overall health (range: 7.89 – 18. 42) were the most salient. Participation in community activities (range 7.74 – 17.48) was the most consistent social predictor. As a group, social factors, especially those relating to social support and participation, were the strongest determinants of QoL. Conclusion: Even though health factors are important, social factors, in particular those relating to the quality of social support and participation, are the most important predictors of QoL.
Profile comorbidity and impact of insomnia in the Ibadan
(Elsevier Ltd., 2009) Gureje, O.; Kola, L.; Ademola, A; Olley, B. O.
Objective: To provide information on the profile, comorbidity and impact of insomnia among an understudied group of elderly Africans. Method: Using the WHO Composite International Diagnostic Interview (CIDI), the 12-month prevalence of three forms of insomnia was assessed in face-to-face interviews conducted with a regionally-representative sample of elderly Nigerians, aged 65 years and over (n=2152). The association of insomnia with quality of life, rated with the WHO Quality of Life instrument, was analyzed controlling for comorbid chronic pain, chronic medical conditions and DSM-IV major depressive disorder. Results: At least one insomnia problem was reported by 30.72%. Insomnia was more frequent among females, persons aged 70 years and over, and those who were unmarried. Insomnia was comorbid with major depressive disorder (OR = 3.9, 95% CI 2.5 – 6.1), chronic pain (OR = 4.3, 95% CI 3.2 – 6.1; particularly arthritis and spinal pain), and chronic medical conditions (OR = 2.1, 95% CI 1.8 – 2.5, particularly heart disease, high blood pressure or asthma). Persons with insomnia were more likely to report having had a fall in the previous year (OR = 1.4, 95% CI 1.0 –1.8) and, among those with fall, injury was more commonly reported by those with insomnia. Every form of insomnia was associated with decrement in quality of life. After controlling for comorbid mental and physical conditions, the β coefficients ranged between −17.9 and −20.0. Conclusion: Insomnia was highly comorbid with chronic physical conditions and with depression. These comorbid conditions partly but do not entirely account for the considerable decrement in quality of life associated with insomnia.
Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria
(BioMed Central, 2020) Kola, L.; Bennet, I. M.; Bhat, A.; Ayinde, O. O.; Oladeji, B. D.; Abiona, D.; Abdumalik, J.; Faregh, N.; Collins, P. Y.; Gureje, O.
Background: Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery. Methods: Focus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis. Results: A total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued. Conclusions: Participants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.
Task-shifting must recognize the professional role of nurses- author’s reply
(2019) Gureje, O.; Oladeji, B. D.; Kola, L.; Bello, T.