Mental Health

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Assessing the psychological, social and economic impact of caregiving on caregivers of mentally challenged older patients accessing services at St John of God hospital, Mzuzu
(Kamuzu University of Health Sciences, 2020-09-02) Chikopa, Fryness
The topic of the study is to assess the psychological, social and economic impact of caregiving on caregivers of mentally challenged older patients accessing services at St John of God hospital. This will help health professionals to design interventions that will help to address the needs of the caregivers resulting into improved quality care to older clients. PROBLEM Currently, in Malawi there is scarcity of data on studies conducted on psychological, social and economic impact of caregiving on caregivers of mentally challenged patients who are also older persons above 60 years of age. A number of caregivers are affected psychologically, socially and economically due to their role of caregiving this affects quality of care and little is done in managing these effects. Hence the study will help to identify psychological, social and economic challenges that affect the care givers which can inform the development of appropriate strategies. OBJECTIVES The objectives will include; describing the psychosocial and economic impact of caregiving on caregivers of mentally challenged older patients, describing how the psychosocial and economic impact of caregiving on caregivers of mentally challenged older patients affects the quality of care of mentally challenged older patients and documenting recommendations to 02-Sep-2019 7 address psychosocial and economic impact of caregiving on caregivers of mentally challenged older patients. TYPE OF STUDY This is a descriptive qualitative study design. METHODOLOGY The study will be conducted at St John of God Hospital in Mzuzu city. Purposive sampling will be used to select respondents. About 30 caregivers and 10 health care workers will be interviewed. However, the actual sample will depend on the saturation point: a point at which no new information is emerging from the data. The researcher will use in depth interviews. These will be administered to the caregiver and the health care workers who interact with caregivers of the older clients. The questionnaire/ topic guide will have three parts namely; demographic data of the care givers and questions assessing psychosocial and economic impact of caregiving on caregivers and how such impact affects the quality of care provided by caregivers. The other part of the topic guide will assess the health care workers perceptions of the psychosocial and economic impact of caregiving on caregivers. All interviews will be audio recorded. Study population will consists of two groups. First are caregivers of the patients who are aged 60 years and above. The second group will be health care workers who interact with the caregivers in order to assess the health workers perceptions of the psycho-social and economic impact of caregiving on the caregivers. Thematic data analysis will be used. The data will be analysed aided by a computer package called NVIVO 12. Descriptive statistics will be computed and reported for social demographic data. 02-Sep-2019 8 The study limitations will include bias as the study will be conducted at a hospital setting and therefore some participants may not be free to express themselves. Some caregivers may also feel coerced to participate. EXPECTED FINDINGS There will be psychosocial and economic impact of caregiving on caregivers of a mentally challenged older patients accessing services at St John of God hospital. DISSEMINATION Findings of the study will be shared during journal club meetings at St John of God and research conferences. The results will also be shared to COMREC. An article based on the findings will also be published in a peer –reviewed journal.
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Assessment of prevalence and predictive factors of perceived Stigma among clients with mental illness attending mental health clinics in Lilongwe district
(Kamuzu University of Health Sciences, 2022-08-17) Angasi, Emma
This study will be a cross-sectional, quantitative and descriptive design that will assess the prevalence and predictive factors of perceived stigma among clients with mental illness attending mental health clinics in Lilongwe district. Problem Statement Stigmatized persons may internalize perceived prejudices and develop negative feelings about themselves (Tesfaw et al., 2020). This can be manifested by decreased self-esteem and increased depression and a person with internalized stigma may feel shame and embarrassment about having mental illness (Latalova et al., 2014). This can impact on how mental health service users utilize mental health service (Mascayano et al., 2020). However, the magnitude of perceived stigma among clients who attend outreach mental health services in Lilongwe is not known. Intervention of perceived stigma among mental health service users can be possible and meaningful when factors that contribute to the perceived stigma are known. In the case of Lilongwe health office, it is not known which factors are associated with perceived stigma among mental health service users. Studies done in Africa, such as Ethiopia have explored the prevalence of perceived stigma but factors such as medical or clinical have not been explored. Furthermore, more studies have been conducted on different population rather than clients themselves to explore the magnitude of perceived stigma (Bifftu & Dachew, 2014). This study therefore assesses the prevalence and predictive factors of perceived stigma among clients with mental illness accessing mental health services at mental health clinics in Lilongwe. Objectives of the study Broad objectives of the study The broad objective of this study is to assess the prevalence and predictive factors of perceived stigma among clients with mental illness attending mental health clinics, Lilongwe district. Specific objectives of the study The specific objectives of the study are to; 1. Measure the prevalence of perceived stigma among clients with mental illness in Mental health clinics in Lilongwe 2. Determine social factors associated with perceived stigma among illness in mental health clinics in Lilongwe 3. Determine clinical/medical factors associated with perceived stigma among clients with mental illness in Mental health clinics in Lilongwe Methodology This study will use mental health clinics which are, facility based (1) and mobile outreach clinics (5), quantitative cross-sectional study using systematic random sampling technique in assessing the prevalence and predictive factors of perceived stigma. Data collection will be conducted for two months with a sample size of two hundred and sixty-one (261). Data will be collected by the Principal Investigator and the research assistants with the use of adopted data collection questionnaire developed in English version and translated into Chichewa version. Data will be analyzed by use of statistical package of social sciences version 22. Expected Findings The study will document the prevalence of perceived stigma and predictive social, clinical/medical factors associated with perceived stigma. Dissemination of Findings The report of this study will be submitted to Lilongwe District Health Office, Kamuzu University of Health Sciences (KUHeS), College of Medicine Research and Ethics Committee (COMREC), Ministry of Health, Non-Communicable Diseases and Mental Health department. The findings will be published in reputable peer reviewed journals and presented at conferences
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Barriers and facilitators for screening for anxiety and depression among children and young people attending Pediatric Epilepsy Clinic at Queen Elizabeth Central Hospital, Malawi
(Kamuzu University of Health Sciences, 2022-05-12) Makiyi, Precious
Type of Study: A qualitative study Problem: Despite the high prevalence of depression and anxiety among children and young people with epilepsy, screening for these mental disorders in CYP with epilepsy is not routinely done in most health facilities in Malawi. Objectives: Broad objective The broad objective of the study is to assess the barriers and facilitators for implementation of routine and universal screening for anxiety and depression among children and young people (CYP) attending Pediatric Epilepsy Clinic at Queen Elizabeth Central Hospital. Specific objectives The specific objectives of the study are: 1. To assess the acceptability of screening for depression and anxiety among CYP with epilepsy and their guardians. 2. To explore the individual and institutional barriers and facilitators for screening for depression and anxiety among CYP with epilepsy. 3. To explore the views of patients and their carers, and clinical staff (including doctors, nurses and counsellors working in the epilepsy clinic) regarding the following commonly used and free-of-cost screening instruments for anxiety and depression in CYP: Revised Child Anxiety and Depression Scale (RCADS) (8-18 years), Short Mood and Feelings Questionnaire (SMFQ) (8-18 years), Hospital Anxiety and Depression Scale (HADS) (from 12 years), Beck Depression Inventory (from 14 year), Beck Anxiety Inventory (from 14 years), and Patient Health Questionnaire (PHQ-9) (from 13 years). In addition, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) would be discussed with participants. Although the NDDI-E) has only been validated in adults, we will consider its potential utility because it is specific for patients with epilepsy, short, and free of charge. Methodology: This study shall adopt qualitative research design involving Focus Group Discussions as well as In-depth Interviews with key stakeholders including CYP with epilepsy and their guardians, epilepsy and psychiatric nurses, a pediatrician, a psychiatrist, a hospital administrator, and staff of the Ministry of Health (director of non-communicable diseases (NCD) or his/her representative”). Expected Findings: Based on previous studies of barriers and facilitators of screening for mental health conditions in other Low and Middle Income Countries (LMICs), we hypothesize that the barriers may include mental health stigma, lack of appropriate culturally adapted screening instruments, limited training for clinicians about screening, limited time available for clinicians to conduct the screening in addition to their existing workload, and limited opportunity for subsequent mental health assessment and treatment for the CYP identified from the screening 12-May-2022 19 | P a g e Makiyi, Ani, Udedi, and Matanje; Barriers and Facilitators for depression screening among CYP with epilepsy. Protocol version 3- May, 2022 as requiring further support. We hypothesize that facilitators may include strong institutional support for screening. Dissemination of results plan: The findings will be shared with the COMREC, SHARP Program Coordinator, QECH, Ministry of Health, all participants, presented as relevant academic conferences, and published in peer reviewed journals.
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Exploring challenges and opportunities facing public mental health promotion in Lilongwe district, Malawi
(Kamuzu University of Health Sciences, 2022-09-16) Mhango, Jones
EXECUTIVE SUMMARY The type of this study will be a cross-sectional study that will collect qualitative data at one point in time. The researcher will explore challenges and opportunities facing public mental health promotion. The Problem Mental health is fundamental to our collective and individual ability as humans to think, interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world (WHO, 2018). Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully managed and prevented using evidence-based interventions such as community based mental health promotion. However, public mental health promotion is still not properly implemented due to challenges, (Bolsinger et al., 2020; Møller et al., 2020; Petersen et al., 2016; Wainberg et al., 2017; WHO, 2018). In Malawi, mental health delivery is centralized in very few hospitals in urban areas namely Zomba and Bwaila mental hospital in Lilongwe (Kutcher et al., 2019; Udedi, 2016). However, the majority of Malawians stay in the rural areas where mental health services accessibility is a huge challenge. Therefore, there is need to explore the challenges facing mental health promotion and identifying opportunities in implementing the mental health promotion delivery in the country. Study objectives Broad Objectives The aim of the study is to explore the challenges and opportunities facing public mental health promotion. 16-Sep-2022 Exploring challenges and opportunities facing public mental health promotion in Lilongwe district, Malawi, Version 2, 5th September, 2022 v Specific Objectives a. Explore challenges faced in implementation of public mental health promotion. b. Explore opportunities that would enable the implementation of public mental health promotion. c. Identify effective evidence-based practices in public mental health promotion. Methodology The study design will be cross-sectional study that will use a purposive sampling of ten mental health service providers to be interviewed at a health facility. Semi-structured in-depths interviews will be used in this study and the questionnaire will contain topic guides containing major themes to inform the elements of the phenomenon under study that will be used in the same way in every interview. The semi-structured interviews will be digitally recorded then transcribed, coded and analyzed using NVivo software. Expected results This study will document the results of the challenges and opportunities faced in public mental health promotion. Dissemination of the findings Study findings will be submitted to Kamuzu University of Health Sciences, Malawi College of Health Sciences, College of Medicine Research and Ethical Committee (COMREC). The findings will also be presented in conferences and published reputable journals.
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Prevalence and Associated Factors of Substance use in Medical Students at Kamuzu University of Health Sciences
(Kamuzu University of Health Sciences, 2022-03-08) Farooqui, Fatimah; Kayesa, Stella; Shaikh, Ikra
Medical students who are future doctors hold a unique place in society and earn privileges and responsibilities different from other students. Studies on the prevalence of substance use done in Malawi included various university students but not medical students in particular. However, our study is based on whether the perception of medical students is manipulated after being subjected to medical education or not. The study aims at estimating the prevalence in medical students and what its associated factors are, that contribute to students being involved in substance use during their studies. A quantitative cross-sectional study will be carried out at Kamuzu University of Health Sciences, which will be looking at the prevalence and associated factors of substance use in students at KUHeS. Participants will be selected by random sampling method. The data collection methods will be through a questionnaire and Google forms (for Lilongwe campuses). We expect to study these participants for no more than 6 weeks. The data will be collected and entered into Microsoft excel spread sheets and analysis will be done, therefrom. Most medical students are consuming substances despite having thorough knowledge on the fatal effects of substance use, and this is least expected from them. 1 out of 3 medical students used some of the illicit drugs. This is building a generation of medical doctors who indulge in substance use. It can affect efficiency and degrade their performance at work, and also has an impact on their career as they may not set a good example to their patients therefore, affecting their perception (patient’s) on medical care. As mentioned above, in Malawi there are no studies done on substance use primarily among medical students. Therefore, this study will focus on medical students only, and the main objective is to explore the main causes for the prevalence of substance use in this population. The study also aims at relating the level of awareness of the harmful effects of substance use to the practice of using the substances. Data will be collected by the use questionnaires that will be rolled out by the investigators. For participants in Lilongwe campus, google forms will be used whose contents are similar to those of the questionnaires that will be administered in Blantyre campus. It is expected that the findings will show that there will be low prevalence of substance use in medical students as they are subjected to more medical knowledge (higher academic years). It is also more likely that males will indulge more in substance use as compared to females. Generally, in Malawi, the prevalence of substance intake is higher than other countries hence expecting higher prevalence in medical students too.
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Psychosocial experiences of guardians caring for children with cancer at Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2022-01-14) Aubrey, Elijah; Msosa, Florence; Thove, David
Type of study This is a qualitative study which will use an explorative descriptive design to explore the psychosocial experiences of guardians caring for children with cancer at Queen Elizabeth Central Hospital (QECH). Problem statement Cancer is a chronic illness which requires long term treatment, hospital appointments and hospitalisation. In addition to physical care, children are also provided with psychosocial care which focuses on their mental wellbeing. Throughout the trajectory of their life, children are accompanied and supported by their guardians who play a big role in ensuring that the children comply with treatment and attend to hospital appointments. During this period, guardians experience different psychosocial problems which may not be fully attended to by palliative care service providers. Similarly, psychosocial experiences of guardians caring for children with cancer at QECH are diverse and unknown for the most part. This study will therefore explore psychosocial experiences of guardians caring for children with a variety cancer diagnoses. We anticipate that findings will help health care professionals attend appropriately to guardians’ psychosocial needs. Additionally, the study will provide a point of reference for further research to address identified issues. Broad objective To explore the psychosocial experiences of guardians caring for children with cancer at QECH. Specific objectives 1. To assess the psychological experiences of guardians caring for children with cancer. 2. To discover the social experiences of guardians caring for children with cancer. 3. To describe the impact of psychosocial experiences on guardians’ ability to cope with caring for children with cancer. 4. To identify sources of psychosocial support that guardians caring for children with cancer receiveMethodology This is a descriptive qualitative study. Study participants will be guardians caring for children with cancer admitted at QECH paediatric oncology ward. Participants will be purposively selected to attend focus group discussions. Data will be analysed using thematic analysis. Expected findings and dissemination This study expects to find psychological and social challenges affecting guardians caring for children with cancer. The findings of the study will be presented at Queen Elizabeth Central Hospital oncology department, Continuing Professional Development (CPD) sessions, and national conferences. Information will be published in a peer reviewed journal. Copies of the dissertation will be made available to the department of Family Medicine, College of Medicine Research and Ethics Committee (COMREC) and College of Medicine library
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The STREAM (Scalable TRansdiagnostic Early Assessment of Mental Health) study
(Kamuzu University of Health Sciences, 2021-10-18) Mbale, Emmie;
Cross sectional study design with a qualitative component to study. Problem To Be Studied It is estimated that a staggering 95% (50.2 million) of children with developmental disabilities reside in low to middle income countries (LMICs). Due to the scarcity of highly skilled professionals and the use of time-intensive, specialist-dependent, proprietary tools for assessment in these settings, it is very difficult to detect mental health problems in young children. This ‘detection gap’ poses the biggest challenge to developing and implementing effective interventions in early childhood, which is when brains are maximally plastic and responsive to changes. Neurodevelopmental assessments tool that can be administered by non-specialist workers (NSW) and which are applicable across diverse cultural settings would greatly help bridge the detection gap in child mental health. Objectives - Broad: To develop and test a platform for Scalable Transdiagnostic Assessment of Mental Health (STREAM) in young children. - Aim 1: To develop a scalable mobile platform to map the population distribution of scores in key neurodevelopmental domains relevant to mental health in 0-6-year-old children in two diverse low-resource settings (India and Malawi). - Aim 2: To test the acceptability, feasibility, reliability, validity, and sensitivity of this transdiagnostic platform in identifying the presence of any neurodevelopmental disorder as well as clinical needs of these children through an assessment of their level of functioning based on the World Health Organization (WHO) International Classification of Functioning (ICF) framework.

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