GlobalHealthAfrica

Posts Tagged ‘stigma’

Responding to the Needs of the Vulnerable: The State of Mental Health Care in Africa

In Community Health, Health Policies, Mental Health on May 18, 2014 at 12:28 am

In Africa, the problem of mental health and substance use disorders is particularly pronounced. GHA contributor, Diana Kingsbury, calls for governments and donors to increase their focus on mental health issues.

Among the many public health challenges that impact countries worldwide, mental health and substance use disorders continue to rank among the most persistent. These disorders are the leading cause of death and disability worldwide and account for about 23% of all years of life lost globally, according to the World Health Organization (WHO). For low- and middle-income countries, adequately addressing mental health needs is particularly challenging. Statistics show that 75-85% of individuals living with severe mental disorders in low-and middle-income countries are not receiving necessary treatment, compared to 35-50% in high-income countries.

Picketing in Cape Town, South Africa. Image by Halden Krog

Picketing in Cape Town, South Africa. Image by Halden Krog

In Africa, this problem is particularly pronounced. While the overall prevalence of mental health and substance use disorders across the continent is largely unreported, the lack of adequate services has been identified and is growing in relevance in the global health arena. The mental health care crisis within Africa is the result of several inter-related factors including a significantly understaffed mental health care workforce. For example, in the Niger Delta region of Nigeria, there is only one neuro-psychiatric hospital for the region’s four million inhabitants.

In Uganda, a nation of 33 million, there are only 33 psychiatrists. In Kenya, there are only 83 psychiatrists for a population of 40 million. In Ghana, there is only one psychiatrist available for 1.5 million people.

Across Africa, the burden of inadequate access to mental health care has resulted in lack of treatment, follow-up, and often inhumane treatment of the mentally ill. The additional burden of stigmatization often leaves individuals with mental disorders without any source of social support. Coupled with the significant social stresses that challenge the continent, such as poverty, food insecurity, conflict, and infectious disease, the risk of developing a mental disorder also increases. Very few prevention programs are currently in place to assist those at-risk in confronting these stresses. The limited availability of an appropriate mental health care system is a significant public health problem that needs to be addressed.

From a governmental perspective, there is limited infrastructure available to provide appropriate mental health care for those in need. It has been reported that 70% of African nations spend less than 1% of their health budgets on mental health and the majority of available funds are put toward psychiatric institutions and not community-based programs. Additionally, only 50% of African nations have a mental health policy, and if they do have a law, it is usually archaic and obsolete. In light of recent events in South Sudan and the disappearance of over 260 school girls in Nigeria, it is clear that in order to heal psychological wounds caused by violent conflict and social unrest, a commitment to building a mental health care system that can readily respond to the needs of the people should be of paramount importance.

Efforts that have been made to reverse current trends have proven successful. For example, former U.S. President Jimmy Carter’s “Carter Center” has established a mental health program in Liberia that seeks to train mental health care professionals within the country so that access to necessary mental health care services may be improved. As a result of the center’s efforts, mental health care access can be expanded to nearly 70% of the country. Organizations such as “BasicNeeds” also seek to break through stigmas associated with mental health disorders in the developing world, and create community supports that are vital to the integration and care of the mentally ill within the community. Through the work of non-governmental and philanthropic organizations, an organized effort to integrate mental health care into the primary care system, as well as an emerging focus on the mental health needs of the developing world, more attention has been brought to this issue. The relevance of adequate mental health care across the globe should not be underestimated.

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The Global Program to Eliminate Lymphatic Filariasis

In NTDs on April 28, 2014 at 9:22 pm

Global Health Africa contributor, Patrick Saunders Hastings, draws attention to lymphatic filariasis, a neglected tropical disease also known as elephantiasis.

Lymphatic filariasis (LF) is a neglected tropical disease (NTD) caused by three species of thread-like nematode worms. The clinical symptoms of the infection involve skin fissures and painful swelling of the legs, genitals, and breasts. The second most common global cause of long-term disability, LF is endemic in 82 countries in Africa, Asia, South America, and the Pacific, afflicting over 120 million people. Severe morbidity arises from acute episodes of inflammation called adenolymphangitis, while social and economic well-being are severely compromised by stigmatization resulting from the debilitating and disfiguring nature of the disease. Manifestations of such exclusion include limited marriage and employment prospects, while shame associated with affliction can reduce motivation to seek treatment. These issues further reduce the economic independence of patients, perpetuating the cycle of poverty faced by those afflicted with LF.

Figure 1. LF results in painful swelling of the legs, genitals, and breasts.

In 1997, the World Health Organization (WHO) classified LF as one of six infectious maladies where there was sufficient diagnostic and treatment capability to potentially eradicate the disease. In response to this, the Global Program to Eliminate Lymphatic Filariasis (GPELF) was set up in 2000, aiming to “eliminate LF as a public health problem by 2020”. This goal was to be accomplished through a “two-pillar” system, combining the interruption of transmission through annual mass drug administration (MDA) covering at least 80% of the at-risk population for at least five years, and morbidity management through the provision of care for those already infected. Elimination programs are conducted on national scales, operating at the community level to improve local relevance, drug coverage, and compliance.

To date, over one billion treatments have been given, with the annual number gradually increasing over time. Around 64% of endemic countries have begun MDA, while another 12% have low levels of transmission that are unlikely to require MDA. In 2008, 695 million people were offered MDA, and 496 million participated. Since 2000,  millions of people have been protected from LF infection, resulting in pronounced benefits including savings of approximately 24.2 billion USD. Educational and awareness campaigns have also been effective in increasing knowledge, reducing stigma, and improving practices associated with the disease. Moreover, this initiative has promoted country and community ownership and empowerment, and served as a platform for integration with other health programs such as control of other NTDs

Figure 2. African LF-endemic countries and territories by MDA (2007)

Figure 2. African LF-endemic countries and territories by MDA (2007)

However, despite the successes of the MDA program, many countries have not been able to achieve sufficient drug coverage to interrupt disease transmission, even after implementing the recommended annual MDA for over 5 years. Meanwhile, 16 of the 19 countries that require MDA, but have not begun, are located in Africa. Key barriers and challenges include co-endemicity with other diseases, fragile infrastructures, and post-conflict situations. In addition, morbidity management has been largely neglected in favor of MDA, with only 35% of endemic countries implementing any sort of disability service. While celebration of past successes is warranted, recognition of short-comings and anticipation of current and future challenges is vital to achieving success over the next six years. Although significant progress has been made, there is still much to be done

References

Addiss, D. (2010). The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis: A half-time review of lymphatic filariasis elimination and its integration with the control of other neglected tropical diseases. Parasites and Vectors 3(1), 100.

Bangoura, O. (2008) “Health system approaches to NTD control”. 5th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis. Arusha, Tanzania pp. 36-40.

Bockarie, M. & Deb, R. (2010). Elimination of lymphatic filariasis: do we have the drugs to complete the job? Current Opinion in Infectious Diseases 23(6), 617-20.

El-Setouchy, M. (2003). Stigma reduction and improved knowledge and attitudes towards filariasis using a comic book for children. Journal of the Egyptian Society of Parisitology, 33, 55-65

Molyneux, D. (2003). Lymphatic Filariasis (Elephantiasis) Elimination: A public health success and development opportunity. Filaria Journal2, 13.

Autism in Africa

In Mental Health on November 10, 2012 at 4:02 am

Autism is a popular topic in developed countries. My perception was that it was a phenomena confined to the West with little or no occurrence in Africa. Therefore, I was surprised to watch a TED video of someone, who I suspect to be originally from Nigeria, share her experience with Autism. I was intrigued  to learn more about this disorder and its impact on Africans.

Autism is a developmental disorder which usually manifests in early childhood. Children with autism exhibit repetitive behaviour  patterns and interests, and obvious deficits in communication and social interaction. The earliest research on autism in Africa was carried out by Victor Lotter as far back as 1978. His research was carried out in 6 African countries. The result of his research was a low prevalence of autism. However, his research methods appeared to be flawed. Since then, not a lot of a studies has been carried out on this disorder. The prevalence rate in the various countries on the continent is unknown. Outside the African continent, it has been observed that children born to Africans immigrants in Europe exhibit a higher prevalence of autism compared to the indigenous population.

There is a need for research to be carried out to determine the burden of Autism in Africa. Also, it is important that health care providers are trained to identify and address cases. Policymakers also need to focus on providing the necessary infrastructure to manage this condition. In the video below, Faith Jegede shares her experience of living with 2 brothers with Autism.

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