A Practical Guide for Mental Health Service Providers
BMJ VOLUME 322 24 FEBRUARY 2001 bmj.com
The rise of the discourse of 'trauma' as a major articulator of suffering within Western culture is a facet of the medicalization of life that has gathered pace in the last century. In recent years, Western mental health professionals have been increasingly involved in services addressing the plight... of war-affected populations - largely non-Western - in war zones or as refugees. Querying the extent to which their experiences can be reduced to a matter of mental health, this article addresses child refugees from war via three questions that go to the heart of the debate about how they are to be understood, the implications for their future maturation as individuals and citizens, and the role of psychological therapies aimed at catharsis of 'traumatic' memory.
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PLoS Med 16(3): e1002768. https://doi.org/10.1371/journal.pmed.1002768
Home delivery and late and infrequent attendance at antenatal care (ANC) are responsible for substantial avoidable maternal and pediatric morbidity and mortality in sub-Saharan Africa. This cluster-randomized trial aimed to de...termine the impact of a community health worker (CHW) intervention on the proportion of women who visit ANC fewer than 4 times during their pregnancy and deliver at home.
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Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expan...ding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
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Cardiovascular diseases (CVDs) are a growing public health problem in Ghana and other African countries. Strokes and other CVDs have become a leading cause of death due to increasing risk factors such as hypertension. According to the Global Burden of Disease study (GBD), ischaemic heart disease was... the fourth leading cause of death in Ghana in 2016. The prevalence of hyper-
tension, a major risk factor for CVDs, is increasing rapidly and ranges from 19% to 48%, according to the Ghana Health Service Annual Report, 2017, due to rising life expectancy and the increasing prevalence of contributing factors such as overweight/obesity. Early diagnosis and adequate management of the risk factors can reduce the fatal consequences of CVDs.
At the heart of improving risk assessment and management of CVDs are nationally approved guidelines, which facilitate standardisation of care approaches.
These guidelines developed by experts from all levels of health care and stakeholders capture all recommended approaches and necessary information for clinicians and other healthcare workers on CVDs. They also serve as a practical guide for assessing and managing the most important CVDs prevalent in Ghana and can be used at all levels of care namely health facilities without a doctor; with a general practitioner and with a physician specialist.
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Many low- and middle-income countries (LMICs) are undergoing an epidemiological transition. With an improvement in socioeconomic conditions and an aging population, cardiovascular diseases (CVDs), like cardiac arrhythmias, are expected to increase in these countries. However, there are limited studi...es on the epidemiology and management of cardiac arrhythmias in LMICs. This review will highlight the unique challenges and opportunities that these countries face when managing cardiac arrhythmias.
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Bonchial asthma is the most common chronic respiratory disease in the world. In Kenya, it has been estimated that about 7.5% of the Kenyan population, nearly 4 million people, are currently living with asthma. Many cases tend to be underdiagnosed and undertreated which leads to high levels of morbid...ity and avoidable deaths. The consequences of poorly controlled asthma, including physical, mental, social, and economic impacts, are magnified in the poor on account of poor access to asthma services and sub-optimal quality of those services. With these guidelines, Kenya's Ministry of Health aims to work towards embedding asthma care in Universal Health Care (UHC) to ensure that quality asthma services are available in primary care settings with
referral networks strengthened for those who may require secondary and tertiary care. These national asthma guidelines will also ensure that treatment for asthma is standardized in both the public and the non-state health care sector.
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Asthma is the most common chronic disease in children, imposing a consistent burden on health system. In recent years, prevalence of asthma symptoms became globally increased in children and adolescents, particularly in Low-Middle Income Countries (LMICs). Host (genetics, atopy) and environmental fa...ctors (microbial exposure, exposure to passive smoking and air pollution), seemed to contribute to this trend. The increased prevalence observed in metropolitan areas with respect to rural ones and, overall, in industrialized countries, highlighted the role of air pollution in asthma inception. Asthma accounts for 1.1% of the overall global estimate of “Disability-adjusted life years” (DALYs)/100,000 for all causes. Mortality in children is low and it decreased across Europe over recent years. Children from LMICs particularly suffer a disproportionately higher burden in terms of morbidity and mortality. Global asthma-related costs are high and are usually are classified into direct, indirect and intangible costs. Direct costs account for 50–80% of the total costs. Asthma is one of the main causes of hospitalization which are particularly common in children aged < 5 years with a prevalence that has been increased during the last two decades, mostly in LMICs. Indirect costs are usually higher than in older patients, including both school and work-related losses. Intangible costs are unquantifiable, since they are related to impairment of quality of life, limitation of physical activities and study performance. The implementation of strategies aimed at early detect asthma thus providing access to the proper treatment has been shown to effectively reduce the burden of the disease.
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The environment in which young people live, learn and play significantly affects their decisions about whether to consume alcohol. Environmental factors are the main risk factors driving alcohol consumption and related harm among young people. Environments that normalize alcohol consumption – term...ed alcogenic environments – include contexts with unregulated advertising and marketing of alcoholic beverages, higher alcohol outlet density, products designed to facilitate affordability and low prices of alcoholic beverages. A recent body of research evidence has emerged related to the measurement, functional significance and consequences of living in alcogenic environments. This includes findings on the complex and bidirectional interactions among alcohol acceptability, availability and affordability and how they create and perpetuate alcogenic environments. Comprehensive and enforced alcohol control policies are effective at delaying the age of onset and lowering alcohol prevalence and frequency among young people. Evidence consistently confirms the effectiveness of designing and implementing alcohol control policies that regulate upstream the drivers of alcogenic environment, including alcohol availability, acceptability and affordability. These policies need to be multipronged and address the complex interactions between these drivers and the local alcohol culture
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The Asia Pacific Observatory on Health Systems and Policies is a collaborative partnership which supports and promotes evidence-based health policy making in the Asia Pacific Region. Based in WHO’s Regional Office for South-East Asia, it brings together governments, international agencies, foundat...ions, civil society and the research community with the aim of linking systematic and scientific analysis of health systems in the Asia Pacific Region with the decision-makers who shape policy and practice.
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Despite the increasing uptake of information and communication technologies (ICT) within healthcare services across developing countries, community healthcare workers (CHWs) have limited knowledge to fully utilise computerised clinical systems and mobile apps. The ‘Introduction to Information and ...Communication Technology and eHealth’ course was developed with the aim to provide CHWs in Malawi, Africa, with basic knowledge and computer skills to use digital solutions in healthcare delivery. The course was delivered using a traditional and a blended learning approach.
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Africa is off track to reach the Sustainable Development Goals by 2030 and lags behind in building resilient health systems
and health security, against a backdrop of limited resources. The world envisaged a significant role for governments
in funding the Sustainable Development Agenda, but inadeq...uate funding for health in African countries is
persistent, despite additional continental commitments to address the problem. When commitments to global health
targets and available fiscal space do not align, innovation is warranted.
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Este manual se ha elaborado en el marco de la Iniciativa Global de la Organización Mundial de la Salud (OMS) para el Cáncer Infantil, CureAll Americas, con el propósito de mejorar la situación de los niños, niñas y adolescentes con cáncer en todo el mundo, para que puedan tener las mejores po...sibilidades de sobrevida, disfrutar de una vida plena y, sobre todo, alcanzar la mejor calidad de vida posible y morir sin sufrimiento. Está dirigido a los profesionales de la salud que se dedican al tratamiento de pacientes oncológicos pediátricos y que, directa o indirectamente, deben enfrentarse con las complicaciones que pueda causar el tratamiento a todos los niveles. Su contenido puede contribuir a la realización de un diagnóstico más certero de las alteraciones de la cavidad oral, así como al desarrollo de estrategias para la prevención y el tratamiento de estas manifestaciones. No se establecen orientaciones directas para responsables parentales ni cuidadores, pero sí se presenta información que sirve como guía para el cuidado bucal, de acuerdo con la estructura y la composición de los equipos de los distintos centros de tratamiento contra el cáncer.
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Des mains propressont des mains sûres. Mes mains sont-elles propres ?
The focus of the current quarterly edition of Eurohealth (from the European Observatory on Health Systems and Policies) is Antimicrobial Resistance (AMR) and contains the following articles:
• Strengthening implementation of AMR national action plans
• Fostering clinical developmen...t and commercialisation of novel antibiotics
• Tackling AMR in the community
• Quantifying the benefits of vaccines in combating AMR
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This Handbook is primarily for educators, to help them learn about mental health issues and better support them in educational environments. The Handbook aims to provide training to teachers, administrators, and people involved in the education of primary school children about the implementation of ...mental health literacy into daily school life. Such knowledge, skills and attitudes will equip all levels of educators with key tools to support student mental health, manage difficult classroom behavior, and promote students’ wellbeing and academic success.
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Loss and damage is an urgent concern, driven by the increasingly harmful effects of climate change. Communities are experiencing new types and forms of climate impact, of higher frequency and intensity, which they are not equipped to handle. These impacts compel vulnerable communities to migrate to ...find alternative livelihoods and ways to survive. But migration generates grave socioeconomic consequences. Through case study analysis from 12 regions in Asia, Africa and the Pacific, this paper explores how climate change-induced migration is creating physical health, mental health and wellbeing issues — both for migrants and the families they leave behind. It then provides recommendations to policymakers on how to strengthen policy, planning and response frameworks to support communities manage health and wellbeing risks created by climate impacts.
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The primary audience for these recommendations includes health professionals who are responsible for developing national and local health-care guidelines and protocols and health workers involved in the provision of care to women and their newborns during pregnancy, labour and childbirth; this inclu...des midwives, nurses, general medical practitioners and obstetricians. The primary audience also includes managers of maternal and child health programmes, and relevant staff in ministries of health and educational and training institutions, in all settings.
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Progress in prevention and treatment is faltering around the world, putting millions of people in grave danger. Eastern Europe and central Asia, Latin America, and the Middle East and North Africa have all seen increases in annual HIV infections over several years. In Asia and the Pacific, UNAIDS da...ta now show new HIV infections are rising where they had been falling. Action to tackle the inequalities driving AIDS is urgently required to prevent millions of new HIV infections this decade and to end the AIDS pandemic
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