Psychiatry

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Collaboration between Spiritual (Holy Water) Treatment and Biomedical Treatment at St. Mary Church Outreach Program, Entoto: Pattern of Service Utilization and Attitude of Holy Water Attendants
(Addis Ababa University, 2014-11) Birhanu, Ribka; Baheretibeb, Yonas(PhD); Asher, Laura(PhD)
Introduction: The explanation for mental illness in Ethiopia is mainly supernatural .That is why the majority of mentally ill people go to spiritual treatments, mainly holy water treatments. The benefits of collaboration between biomedical services and holy water sites are many, including early detection and treatment of mental illness. The St. Mary outreach program aims to help mentally ill people at the St. Mary and St. Michael holy water sites by taking the bio-medical treatment near them. This is done by volunteer Addis Ababa University (AAU) residents. Methods: This is a mixed quantitative and qualitative study. Study 1: Descriptive evaluation of psychiatric patients that have attended the St. Mary outreach program, Entoto from December of 2011 up to July of 2014. A data extraction form was used to extrat data from patient charts. Data was analyzed using SPSS statistical software. Study 2: A qualitative study of the holy water attendants ’ attitudes and role was conducted from September to October of 2014. A semi-structured interview was conducted using a topic guide. The interviews were audio recorded, transcribed and coded manually. A thematic analysis was conducted. Result: Study 1: A total of 174 charts were analyzed. The m ean number of patients seen per clinic session have increased by 50 %( 14) in 2005, then by 75 %( 25) in 2006. 79.3% were men, 73.3% had schizophrenia, 89.6% were educated and 61.7% came from Addis Ababa. Study 2: The roles of the holy water attendants include ensuring the hygiene, security and medication adherence of patients . They also act as gatekeepers to the St Mary Clinic. There are two main attitudes towards treatment: both treatments are from God and we should use both and they contradict because using both is like doubting God. The other attitude is they complement each other. The attitude of the attendants towards biomedical treatment is changing since the training from AAU psychiatrists. The attendants have their own way of differentiating who should come to the clinic and who should not. They bring patients who they consider mentally ill but they don’t bring people who have mental illness and spirit possession. Conclusion: The conclusion of the study is that it is possible to collaborate between spiritual treatment and biomedical treatment. Recommendation: To continue having trainings for the attendants and community awareness campaigns focusing on family members of people with mental illness
A Screening for Antenatal Depression: A Formative Study for Development of a Perinatal Mental Health Liaison Service in Zewditu Hospital
(Addis Ababa University, 2014-11) Andebirhan, Asmeret; Hanlon, Charlotte(PhD)
Pregnancy is a time when a woman experiences major psychological and biological changes. Many factors can affect the emotional state of the mother during pregnancy. This changes might predispose her for mental distress. Studies have shown grave consequences both on the mother and on the fetus in high and LMIC countries like Ethiopia .Screening might decrease the occurrence ,early treatment and prevention of complications of CMD The aim of the study was to study the probable depressive symptoms and treatment acceptability of perinatal service among women who come for ANC visit in Zewditu Memorial Hospital ,Addis Ababa Ethiopia .It was a cross sectional study ,taking 187 women from the ANC clinic and administered PHQ 9 and other scales to asses violence, alcohol consumption and treatment acceptability questions. The study found 30% of high depressive score .High association with being unmarried, lack of support, exposure to violence in pregnancy, having a ‘low risk’ pregnancy and reported lower relative wealth .Negative association with HIV status and high risk pregnancy .Low treatment seeking behavior .Participants prefer to be screened at the ANC clinic rather than the psychiatric clinic . The study concluded that having a separate intervention for their mental distress is unlikely to succeed so joint intervention with their obstetric care is recommended .Obstacles that women have from getting psychiatric service also should be studied for a better intervention outcome
Self-Stigma among out Patients with Mood Disordersat St. Paul’s Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Facility-Based Study
(Addis Ababa University, 2014-12) Tesfaye, Elias; Worku, Benyam(PhD)
Background: There is little information on the degreeof self-stigma experienced by patients with mood disorder across Ethiopia. This study describes the levels of self-stigma, stigma resistance, self esteem and the level of disability reported in these groups who had follow up as outpatient in Psychiatry clinic at St. Paul’s Hospital, Addis Abeba, Ethiopia. Methods: Facility based cross-sectional study was conducted on 235 consecutive samples of people with mood disorder using interviewer administered (ISMI) scale. Data was entered and analysis was done using SPSS version 20. Bivariate and multivariate linear regressions were done to identify correlates of self stigma. Results:Almost one in three patients (31.5%) reported moderate or high levels of self-stigma, (54.9%) had moderate or high stigma resistance score, (67.2%) hadmoderate or high self esteem,(27.7%) had moderate to high level of discrimination experience and One fourth of them (26.4%) had moderate to severe or extreme disability. And also,Females had higher self stigma (std. β = .169 with P < 0.01) than males and good adherence to medication was significantly correlated with lower self stigma (std. β = -.212 with P < 0.01) when compared with non adherence. In a multivariate linear regression model (60%) of the variancein self-stigma scores, among people with a diagnosis of bipolar disorder or depression, wasaccounted for by levels of self esteem and stigma resistance. Conclusions: These findings suggested that self-stigma occurs among approximately 1 in 3 people with mood disorder in urban city of Ethiopiawhich was much higher than the findings in Europe. Female showed higher self stigma than male. So, Patient empowerment, psychosocial interventions and psychoeducation to increase compliance to medication can be helpful in reducing self stigma among people with mood disorder.
Burnout among Clinical Staff in Amanuel Specialized Mental Hospital
(Addis Ababa University, 2014-12) Mengesha, Filmon; Worku, Biniam(PhD); Wondimagegn, Dawit (PhD); Haile, Kibrom(PhD)
Objective: Burnout has a significant negative impact on the employees, service provided to patients and the organization. As there are no data on burnout among staff in Amanuel Specialized Mental Hospital, this study sought to document the prevalence of burnout among theclinical staff at the hospital. Methods: This was a cross sectional study of clinical staff working at Amanuel specialized Mental Hospital. The hospital staff completed selfadministered questionnaires on socio-demographic characteristics and work related features, and the Maslach Burnout Inventory – Human Services and General Survey, and Oslo social support scale. Analysis of the data was undertaken using the Statistical Package for the Social Sciences (SPSS) version 21.0. Results: 40.5% percent of the respondents reported moderate to high level of emotional exhaustion while 45.8% reported moderate to highlevel of depersonalization. Low level of personal accomplishment was reported by 36.6%. The number of out-patients seen and male gender were positively associated with depersonalization. The level of social support wasassociated with both depersonalization and emotional exhaustion. Staff made several recommendations how to decrease burnout among the staff. Conclusion: Significant levels of burnout were reported. These should be addressed at an individual, and institutional levels. More studies are needed to identify the risk factors.
Metabolic Side Effects of Second Generation Antipsychotics: A Comparative Cross-Sectional Study
(Addis Ababa University, 2015-11) Hailu, Tsion; Fekadu, Abebaw(PhD); Haile, Kibrom(PhD)
Background There is evidence that people with mental illness are more likely to suffer from metabolic syndrome compared to the general population, especially those taking second generation antipsychotics (SGAs). However, there is dearth of data comparing the metabolic side effects of first generation and second generation antipsychotics. SGAs are also newly introduced in the Ethiopian setting. The objective of this study was to explore the potential metabolic side effect of SGAs. Method Design: A cross sectional study, comparing the prevalence of metabolic syndrome in patients with severe mental illness taking FGAs or SGAs (for at least 6weeks) Setting: Study was conducted at Amanuel Specialized Mental Hospital in Ethiopia and participants were recruited from the inpatient departments. Participants: An initial sample size of 150 was required for the detection of a 50% difference in the rate of metabolic syndrome between SGAs and FGAs at a 1:1 allocation ratio. However, only one hundred participants were recruited because SGAs were often running out off stock and took longer than anticipated to get adequate number on SGAs. However, candidate believes 100 participants would be adequate for this kind of exploratory and hypothesis generating study. Measurement: Data on basic demographics, including relevant family history, dietary habit, clinical information (diagnosis, duration of illness and medication) and metabolic profile was collected. Diagnosis of metabolic syndrome was made according to the criteria of the International Diabetes Federation. Analysis: Focused on simple descriptive approaches with limited bivariate analysis. Result 5 In the 4month study period 100 participants were included, who fulfilled the inclusion criteria. For ease of access, all participants were inpatients. Sixty six percent (n=66) were male and 34% (n=34) were female. The mean age of the patients was 31.1years (SD 9.7). Fifty four (n=54) percent of the participants were prescribed SGA and 46 of the participants were prescribed FGA. According to IDF criteria 8.5% (n= 8) met the diagnostic criteria for metabolic syndrome. The prevalence of metabolic syndrome in FGA group was 2.3% and SGA group was 14%. (Crude OR= 7; 95% CI = 0.82, 59.3; P = .074). Conclusion Overall, the prevalence of metabolic syndrome is relatively low, especially among those taking FGAs. Although the study failed to find statistically significant difference between those taking SGAs and FGAs, there was a strong trend of association between SGAs and metabolic syndrome. Further confirmatory studies are required; however, taken together with the broader literature regarding SGAs and metabolic syndromes, careful screening and monitoring has to be part of standard clinical practice. Introduction
Assessment of Sleep Disorder Pattern of Patients with Parkinson Disease Attending Neurology Referral Clinic in Tikur Anbessa Specialized and Zewditu Memorial Hospitals, Addis Ababa, Ethiopia
(Addis Ababa University, 2015-11) Melka, Dereje; Tafesse, Abenet (Assistant Professor)
Background: Parkinson’s disease (PD) is progressive neurodegenerative disorder characterized by abnormal motor symptoms such as bradykinesia, tremor, rigidity, and postural instability. However, the nonmotor symptoms (NMS) of PD, including cognitive impairment, depression, psychosis,& sleep disorders are also important and could have greater significance for disability, decreased quality of life, and reduced lifespan of the patients. Sleep-related problems specific to PD may occur early and even predate the diagnosis of the disease but are generally more frequent and more severe in patients with advanced PD. Little is known about sleep disorder pattern in people with Parkinson’s disease (PD) in Ethiopia and Africa. Objective: To assess the prevalence of sleep disorder pattern and their associated predictors in PD patients in Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital, Addis Ababa, Ethiopia. Methods: A cross-sectional follow up study was used to collect data on all 155 study respondents who visited the clinic over the four months of the study period. Data was collected using tool (standardized questionnaire) by trained neurology nurses and neurology residents. All the respondents were identified using a selection a criterion satisfying the required ethical clearance procedure was used including securing verbal consent before data collection. Then collected data was cleaned and analyzed using SPSS version 20 to determine the magnitude/prevalence of sleep disorder and regression with p-value to determine the associated factors that explained the dependent variable. Included: All PD patients on follow up or diagnosed during a study period fulfilling the UK Brain Bank Criteria for idiopathic PD. Exclusion criteria: included the following: PD Patients with cognitive impairment who was unable to respond for the PDSS-2, PD Patients who didn’t have willingness to give informed consent and PD patients out of the study period.The data included 155 PD patients. We used the PDSS-2 to collect sleep disorder Symptoms. Data were entered and analyzed by a computer software SPSS version 20. First bivariate analysis was done to identify those factors that determine the dependent variable then multivariate analysis and Chi-Squares were used to determine those factors that determine the their possible associated predicting factors. P values<0.05 at confidence interval 95% were considered significant. Results: Majoirity, 127 (81.9%) of the respondents were male. Almost all 140(90.6%) of the respondents getting up at night to pass urine at least one day per week and followed by 104(67%) who were unable to turn around while in bed in at least one day in a week. Patients reported problems on all items of sleep disorder, the least score being 4 and maximum score being 39 which indicates there was no patient without sleep disturbance pattern. The most striking point was 13.5% of patient had a score of more than 30. Over all 30.1% of patient slept well for less than 3 days per week. About one third of Parkinson disease (PD) patients (35%) Wake up early in the morning with painful posturing of limbs. Patient’s age, marital status, employment status, Page vi PD symptom duration, historical reportable sleep disturbance and disease severity were related to advanced sleep disturbance with p- value of 0.04, 0.02, 0.00, 0.01, 0.002 and 0.001 respectively. Conclusions: Sleep disturbance symptoms on PD patients are prevalent in our study. When disaggregated, it increase with age ,higher disease severity, disease duration, being un married and un employed and presence of reportable previous sleep disturbance before PD symptoms. Considering the prominence of sleep disturbance in PD patients in this study, there warrants increase clinical awareness and efficacious therapies by neurology department on internal medicine and neurology residents as part of teaching and learning activities.
Subjective experience of patients with schizophrenia participating in arts involving activities at a specialized psychiatric hospital in Addis Ababa, Ethiopia: A Qualitative study
(Addis Ababa University, 2017-01) Alemayehu, Biruh (MD); Assefa, Dawit (MD)
Arts therapies have positive effects on psychotic symptoms, psychosocial functioning and the ability to mentalize in patients with schizophrenia (3). These therapiesare not formally practiced by trained art therapists in Ethiopia however the term ‘arts involving activities’ is used in this paper to describe interventions that promote the experience of creative artistic activities such as painting and drawing, dancing, music and drama. In our country, Amanuel Mental Specialized Hospital is the only psychiatric specialized hospital that provides art involving activities, and thesubjective experiences of patients with schizophrenia participating in such activities are not yet explored. Statement of the problem Patients’ subjective experiences of participating in arts involving activities are unexplored. Research question What is participants’ understanding of the reasons for participating in arts involving activities? What do participants enjoy/ like about, not like/ avoid from the activities and what are their respective reasons? What are participants’ perceived benefits from the activities and their opinions regarding the service they were involved in? Method An exploratory qualitative research design was used. In-depth interviews with the use of prepared topic guides were conducted after obtaining consent form each participant. We involved 18 patients with the diagnosis of schizophrenia who fulfilled inclusion criteria. Data was recorded, transcribed verbatim, translated into English, coded and thematically analyzed. Results Majority of patients reported having mental illness and need for treatment as their reason of admission; getting entertainment and happiness was reported as their reason of participation in rehabilitation center. Significant number of patients reported positive experiences by participating in arts involving activities. Few of patients reported their negative experiences in their participation of specific arts involving activities. Majority of patients reported positive outcomes but no negative outcome from their participation. Our findings indicate postitive impact of arts involving activities on their mood, communication skills, social engagement, overcoming stigma, physical health and on their motivation to take role for their recovery. Nearly all of them were content with the service provision with some indicating room for improvement. Conclusion In treatment of schizophrenia, focus on the patient as a whole rather than symptom reduction is required to facilitate the process of recovery.
Effect of Antenatal Depressive Symptoms on Women’s Access to Healthcare and Perinatal Complications: A Population-Based Study in Rural Ethiopia
(Addis Ababa University, 2017-03) Bitew, Tesera; Fekadu, Abebaw(PhD); Hanlon, Charlotte(PhD)
Background Maternal Mortality in Low and Middle Income Countries (LMICs) remains a major public health challenge despite the encouraging achievement of the fifth Millennium Development Goal (MDG-5). Almost all (99.0%) of the global maternal deaths occur in LMICs where there are high resource constraints and low access to health care services. In Sub-Saharan Africa, more than half of perinatal women have no access to maternal healthcare services. The situation is reflected in Ethiopia where only 34% of women attended for antenatal care (ANC) and skilled practitioners attended only 26% of deliveries in 2015. Mental disorders, especially depressive disorders, are also common affecting about one in seven perinatal women. Perinatal depression has been shown to be an independent risk factor for maternal healthcare service utilisation on behalf of the child but there has been little exploration of its potential impact on utilisation of maternal healthcare services. Objective The main objective of this study was to investigate the impact of antenatal depressive symptoms on utilisation of maternal healthcare services (antenatal care, uptake of institutional delivery and postnatal care use) and its effect on perinatal complications. Methods Study Design: The study that formed the basis of this thesis was a population-based study that comprises three sub-studies linked to three main outcomes. Sub-study-I was a cross-sectional study carried out at the initiation of the prospective study. Sub-study-II and III were prospective follow-ups of participants identified with probable depression in sub-study-I to assess impact of depressive symptoms on (a) institutional delivery and postnatal care use; b) perinatal complications respectively. Participants: The participants were pregnant women in their second and third trimester residing in Sodo District, Gurage Zone, Southern Nations, Nationalities and Peoples Region of Ethiopia. Eligibility Criteria included: (1) Age 15 years and above; (2) permanent residence as defined by continuous residence in the area for at least the preceding six months; xiv (3) Able to provide informed consent; (4) Not having hearing or cognitive impairment to the extent of impairing capacity to give informed consent or to communicate adequately. Assessments: During baseline assessment, at the second and third trimesters of pregnancy, participants were screened for antenatal depressive symptoms and background demographic and socio-economic information along with other potential confounders such as intimate partner violence, social support, history of chronic medical conditions and adverse perinatal outcomes. Antenatal depressive symptoms were assessed using a locally validated version of the Patient Health Questionnaire-9 (PHQ-9). Participants scoring five or more on the PHQ-9 were considered to have probable antenatal depression. ANC attendance and pregnancy related emergency healthcare visits were cross-sectional outcomes that were assessed as part of the initial baseline assessment. At a median of eight weeks after childbirth, the participants were re-interviewed about their place of delivery, attendance of postnatal care services and whether they had experienced an of perinatal and postpartum complications. Statistical Analysis: Poisson and Negative binomial regression models were used for cross-sectional evaluation of the association of antenatal depressive symptoms with antenatal service use and pregnancy related emergency healthcare provider visits. Binary logistic regression was used to examine the association of antenatal depressive symptoms with early initiation and adequacy of ANC services. Binary logistic regression was also used to examine association of antenatal depressive symptoms with uptake of institutional delivery, having assisted delivery and women’s experience of perinatal complications. Results Participant Characteristics: Among study participants, 98.7% were married, 67.5% were non-literate, 92.2% were rural residents and the mean age of the participants was 26.8 years. The majority (64.8%) of women initiated ANC visits (37.0% by 16 weeks gestation) and nearly two-thirds (62.3%) delivered in healthcare institutions. Baseline (Cross-sectional) Study: At PHQ-9 cut-off of five or more, 29.5% of baseline participants and 28.7% of followed up participants had probable antenatal depression. Women with depressive symptoms had an increased risk of having greater number of un-scheduled ANC visits (adjusted Risk Ratio (aRR)=1.41, 95% CI: 1.20, 1.65). These group of women also had an increased number of emergency healthcare provider visits to both xv traditional healthcare providers (aRR=1.64, 95% CI: 1.17, 2.31) and biomedical healthcare providers (aRR=1.31, 95% CI: 1.04, 1.69) for pregnancy-related emergencies. Prospective Studies: Women with probable antenatal depression also had increased odds of reporting institutional birth [adjusted Odds Ratio (aOR) =1.42, 95% Confidence Interval (CI): 1.06, 1.92] and increased odds of reporting having had an assisted delivery (aOR=1.72, 95% CI: 1.10, 2.69) than women without these symptoms. In sub-group analysis of women with institutional deliveries, the increased odds of institutional delivery was associated with emergency reasons during labour (aOR = 1.62, 95% CI: 1.09, 2.42) rather than pre-planning to deliver in healthcare institutions. Furthermore, there was increased odds of pregnancy (OR=2.44, 95% CI: 1.84, 3.23), labour (OR= 1.84 95% CI: 1.34, 2.53) and postpartum (OR=1.70, 95% CI: 1.23, 2.35) complications among these group of women compared to women without antenatal depressive symptoms. However, antenatal depressive symptoms were not significantly associated with early initiation of ANC or postnatal care visits, pregnancy loss or neonatal mortality. Conclusion Establishment of a system for detection, referral and treatment of antenatal depression, integrated within existing antenatal care, has the potential to reduce treatment costs and promote efficiency of the health care system through increased use of scheduled ANC and planned uptake of institutional delivery. It also has potential to reduce perinatal complications, thus contributing to a reduction in maternal morbidity and mortality, as well as improved neonatal health. But, further studies should ensure whether early detection and treatment of depressive symptoms may reduce the risk of perinatal complications.
Impact of Training Health Extension Workers in Relation to Child Mental Health Care in Rural Ethiopia
(Addis Ababa University, 2017-05) Tilahun, Dejene
Back ground: Child mental disorders, including autism, are major contributors to the global burden of disease leading to long lasting burden, disability and cost toward affected children and their families. These problems are aggravated by severe shortage of services. Access to services is further impeded by negative beliefs and stigmatising attitudes towards affected children and their families. Task-shifted care provided by community health extension workers (HEWs) has the potential of increasing access to services, and improving community perceptions. This study was conducted as an initial step for developing interventions to improve task-shifted care provision for children with autism and their families. Objective: This thesis is based on three sub-studies that aimed to evaluate: (i) experiences of stigma, explanatory models and unmet needs of caregivers of children with autism (sub-study 1); (ii) the training needs of HEWs to provide integrated child mental health care (sub-study 2); and (iii) the impact of training HEWs through the Health Education and Training (HEAT) programme in relation to child mental health disorder including autism, and appropriateness to the needs of HEWs and affected families in Ethiopia (sub-study 3). Methods: Study setting: The first sub-study was conducted in Addis Ababa, while the second and third sub-studies were conducted in the Southern region. Study design: The studies were primarily cross-sectional with a mixed-methods approach in sub-study 2. Participants and methods Sub-study 1: Participants were caregivers (n=102) of children with developmental disorders—two third of whom were caring for children with intellectual disability (n=68) and a third for children with autism (n=34). Caregivers‘ perceived experiences of stigma (Family Interview schedule) and explanatory models of illness and unmet needs were assessed. Data were subject to descriptive and multi variate analysis. Sub-study 2: In a mixed study approach, 104 HEWs who had received HEAT training were interviewed using a structured questionnaire designed to assess their experience and service practice, and 11 HEWs were involved in in-depth interviews. The quantitative data were subject to descriptive analysis while the qualitative (in-depth) interviews were subject to framework analysis. xiii Sub-study 3: participants comprised of three groups of HEWs: i) HEWs who completed a basic mental health training module (HEAT group, N=104); ii) HEWs who received enhanced training, comprising basic HEAT as well as video-based training on developmental disorders and a mental health pocket guide (HEAT+ group, N=97); iii) HEWs untrained in mental health (N=108). All participants completed a questionnaire assessing beliefs and social distance towards children with autism. Impact of training was assessed by comparing attitudes, experiences and service practices between the three groups. Results: Sub-study 1: Most caregivers reported experience of stigma: 43.1% worried about being treated differently, 45.1% felt ashamed about their child‘s condition and 26.7% made an effort to keep their child‘s condition secret. Reported stigma was significantly higher in caregivers who had sought traditional help (p<0.01), provided supernatural explanations for their child‘s condition (p=0.02) and in caregivers of Orthodox Christian faith (p=0.03). Caregivers gave a mixture of biomedical and supernatural explanations for their child‘s condition. The biggest reported unmet need was educational provision for their child (74.5%), followed by treatment by a health professional (47.1%). Most caregivers reported that talking to health professionals (86.3%) and family (85.3%) helped them to cope. Sub-study 2: Most HEWs (88.5%; n=93/104) reported that they were interested in the training provided and all respondents considered child mental health to be important. Participants in the qualitative interviews considered the problem of child mental disorders to be widespread and to cause a large burden to the family and the affected children. They reported that improving their competence was important to address the problem and to tackle stigma and discrimination. Participants also listed some barriers (e.g. lack of competence, stigma and institutional constraints), and opportunities (e.g. staff commitment, and positive attitude) toward service provision. Sub-study 3: Training intervention had significant positive impact on belief, attitude and social distancing. HEAT+ trained (Z=-6.24, p< 0.001, r=-0.44) and basic HEAT trained (Z=-6.14, p< 0.001, r=-0.42) HEWs were more likely to believe that children with autism can improve their language skills compared to untrained HEWs. Both the HEAT (p=0.004) and HEAT+ group (p<0.001) showed fewer negative-beliefs towards children with autism than the untrained-group. The HEAT+ group in turn displayed fewer negative-beliefs than the HEAT-group (p<0.001). xiv Both the HEAT (p<0.001) and the HEAT+ group (p<0.001) showed decreased social-distance towards children with autism compared to the untrained-group; the HEAT+ group displayed a lower preferred social-distance than the HEAT-group (p=0.017). Planned contrasts using Bonferroni correction for multiple comparisons revealed that the HEAT+ group had significantly lower positive-beliefs scores than the untrained-group (p=0.01). Conclusions: Caregivers of children with developmental disorders and autism have high levels of unmet needs and perceived stigma. HEWs have high levels of motivation to engage in integrated child mental health care and are important resources in scaling up care for child mental health. Brief training has the potential to equip HEWs for the task of supporting integrated child mental healthcare. These findings have relevance for task-sharing and scale-up of autism services in low-resource settings worldwide. Recommendation: It appears that caregivers and children with developmental disorders and autism are neglected. Appropriate policy response should include strategies to guide healthcare delivery to children with mental health problems including autism. The tools used in this study may support such a policy response. Keywords: Stigma, Child community health care, Impact of training; Autism; child mental disorder, child developmental disorder, health extension workers; Ethiopia
Suicidal ideation and attempt among alcohol use disorder patients attending addiction clinic at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
(Addis Ababa University, 2017-10) Negussie, Mohammed (MD); Teferra, Solomon (MD, PhD)
Background: -Alcohol is one of commonly used psychoactive substances. Harmful use of alcohol results in a cluster of behavioral and physical symptoms known as Alcohol use disorder. WHO suggests that harmful use of alcohol to be an individual risk factor for suicidal behavior, accounting for 25-50% of all suicides linked to alcohol and other substance. Many studies were done on alcohol and suicidal ideation and attempt. Most of these study suggest that alcohol have association with suicidal ideation and attempt. But there are studies with no association between alcohol use disorder and suicidal ideation and attempt. Objective: - To assess the prevalence of suicidal ideation and attempt among alcohol use disorder patients attending addiction clinic at Amanuel Mental Specialized Hospital (AMSH). It also determines the association of alcohol use disorder and suicidal ideation and attempt. Method: - This was a hospital based cross-sectional study, that include 120 patients of age above and equal 18 years. Data were collected by using ASSIST 3.1 (Alcohol, Smoking and Substance Involvement Screening Test), to assess alcohol use disorder, CSSRS (Colombia suicide severity rating scale) to assess suicidal ideation and attempt, and PHQ-9 (patient health questioners-9) to assess the depression and severity of depressive symptoms. Chi square and binary logistic regression was used to assess factor relation. Result: - The overall prevalence of suicide ideation and attempt among alcohol use disorder patients was 30.6% for the past month and 31.7% for past year of time of data collection. Suicide attempt was 14.9% and 13.3% respectively. Older age was associated significantly with suicidal ideation and attempt (X2 =6.128, P=0.047). Alcohol use disorder had no association with suicidal ideation and attempt for both past month (OR = 0.827; 95% CI 0.116, 5.914) (P = 0.850) and the past year (OR=1.360; 95% CI 0.122, 15.165) (P=0.803) of data collection. Major depressive disorder was significantly associated with alcohol use disorder (P=0.047). Conclusion: -. Suicide ideation and attempt was significantly associated with advancement of age among alcohol use disorder patients. Alcohol use disorder has no association with suicide ideation and attempt among the respondents. Alcohol use disorder and major depressive disorder was significantly associated with and could lead to suicidal ideation and attempt indirectly. Recommendation: -Further researches on alcohol use disorder, depression and suicide are necessary to assess the relationship each character.
A dissertation submitted to the Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University in partial fulfillment of the requirements for the Specialty Certificate in Psychiatry
(Addis Ababa University, 2017-11) Getachew, Meron; Dr. Pain, Clare
Introduction Numerous studies have shown that mental distress is a common problem among medical students. Factors associated varied across studies, however, the negative impact of mental distress on medical students has been shown to be manifold. Mental distress profiles may show variation over time, requiring periodic assessments so as to tailor interventions that best suit the current situation. Objective The objective of this study is to assess the level of mental distress and associated factors among medical students of Addis Ababa University. Methods A facility-based, cross-sectional, quantitative study was conducted on medical students of Addis Ababa University. Stratified random sampling was employed & data was collected from consenting medical students (preclinical year 1 to internship) using a 2-part structured, self-administered questionnaire (Part I: Background Data & Part II: The 20- item Self Reporting Questionnaire [SRQ-20] English version). SPSS version 20 was used for data entry and univariate and multivariate analyses were carried out to assess factors associated with mental distress. vi Results A total of 291 medical students participated in the study. The one-month prevalence of mental distress among medical students of Addis Ababa University was 64.9%, which is nearly double the prevalence 12 years ago. Suicidal ideation was reported by 14.1% of the respondents (6% in the original study). Female sex (AOR=2.187, 95% CI=1.131- 4.231), current feelings of dissatisfaction about having joined Medicine (AOR=2.839, 95% CI=1.278- 6.302) and having experienced a challenging life event in the preceding 30 days (AOR= 3.787 95% CI=1.179- 12.167) were associated independently with greater odds of mental distress. Lifetime substance use (X2= 10.658, df= 1, p=0.001) and current substance use (X2=4.080, df=1, p=0.043) had significant associations with mental distress but no such association was present in multivariate analysis. Other variables including age and year of study showed no (significant) association with mental distress in univariate or multivariate analyses. Conclusion The study shows that the prevalence of mental distress among medical students of Addis Ababa University is higher than that reported 12 years ago. Continued supportive interventions for medical students and studies of a qualitative nature are recommended.
Inpatient Forensic psychiatry Service and Assessment outcome at Amanuel Specialized Mental Hospital.
(Addis Ababa University, 2017-12) yitayih, Sewbesew; Dr. Lemeneh, Asnake
Background: -Offenders who have mental illness present complex challenges for public policy and the criminal justice system. The identification, assessment, processing and treatment of these mentally ill offenders are the responsibility of forensic psychiatric services in collaboration with the justice system and other legal agencies. Forensic psychiatric services in Ethiopia has been provided by Amanuel Hospital for the entire country for many years, but there has not been a systematic study conducted to see how the service is going and to understand the challenges and the progress of the service. Objective: - To assessthe Forensic psychiatry Service and assessment outcome of the alleged offenders who had been admitted to Forensic unit at Amanuel Specialized Mental Hospital. Methods: - A retrospective study was conducted involving those who were assessed in the inpatient forensic psychiatry unit at ASMH between January 01/2015 and June 30/2017.Data extraction sheet were used to collect information for the study. All cases assessed by the forensic case team during the study period were included in the study. The data sheets were coded and data entry, cleaning and analysis were done using the Statistical Package for the Social Sciences (SPSS) version 20.bivariate and Multivariate logistic regression was done to see sociodemographic determinants of insanity and murder. Results: - One hundred and twelve cases were included in the study. Of these, 79.5% were males. The mean age of the cases was 33 years and Most of the accused (52.7%) were single. In terms of region, 36 (32.1%) were from Oromia, 29 (25.9%) from Amhara, 30 (26.8%) from Addis Ababa and from Tigray 8 (7.1%). Around 60% were charged with murder, followed by attempted murder (13.4%), and sexual violence (6.3%). Only (60.7%) of cases got a neuropsychiatric diagnosis. Of these, Diagnosed with schizophrenia were in (17.6%) and the same number of cases got a diagnosis of by bipolar I disorder (176%) and comorbid substance use problem (17.6%). Twenty percent of cases were found not criminally responsible (because of insanity). The majority of cases (90.2%) were found fit to stand trial and from all cases only (4.5 %) of cases are unfit to stand trial and not criminally responsible. Conclusion: - There is a huge gap between the service at Amanuel and the forensic psychiatric service in another setup with regard to the following factors; the amount of information available to help the expert‟s decision, the delay to get assessment report, number staff working in the forensic case team and the collaboration between the forensic psychiatry case team and the legal system. Recommendation: - Early diagnosis, treatment and follow up is very important for those having mental illness so as to prevent criminal activities associated with severe mental illness. Decentralize the service with the training of mental health professionals in the area of forensic psychiatry will solve some problems associated with the service.
Psychiatric out patients’ health service satisfaction at psychiatric outpatient department in Amanuel Hospital, A.A, Ethiopia
(2017-12) Dr. Yitbarek, Henok Yitbarek; Dr. Bekele, Dessalegn
Consumer satisfaction is playing an increasingly important role in quality of care reforms and health-care delivery more generally in United States of America and Europe. However, consumer satisfaction studies are challenged by the lack of a universally accepted definition or measure [1–6] and by a dual focus: while some researchers focus on patient satisfaction with the quality and type of health-care services received [7–10]. Others focus on people’s satisfaction with the health system more generally [11–14]. The importance of both perspectives has been demonstrated in the literature. For example, satisfied patients are more likely to complete treatment regimens and to be compliant and cooperative [14, 15]. Research on health system satisfaction, which is largely comparative, has identified ways to improve health, reduce costs and implement reform. Even though it is difficult to find an agreed-upon definition, patient satisfaction is “health care recipient’s reaction to salient aspects of his or her experience, expectation and preference of a service met by health care service and provider [17] and is one desired outcome of mental health care service and core parameter for the positive evaluation of a mental health care system [18-20]. For consumers of mental health services, satisfaction has become a significant contributing outcome in the assessment and improvement of quality of care, including adherence to treatment, intent to return for care and follow-up and continuity of outpatient care [21]. The absence of a solid conceptual basis and consistent measurement tool for consumer satisfaction has led, over the past 10 years, to a proliferation of surveys that focus exclusively on patient experience, i.e. aspects of the care experience such as waiting times, the quality of basic amenities, and communication with health-care providers, all of which help identify tangible priorities for quality improvement. The increasing importance of patient experience and the sustained interest in comparing people’s satisfaction with the health system across different countries and time 2 periods suggests the need to characterize the relationship between them. Research relating global satisfaction ratings with patient experience has revealed strong associations between the two [23]. Yet to what extent patient experience explains satisfaction with the health-care system remains unclear. The literature suggests that much of the remaining variation in health system satisfaction after adjusting for factors commonly used to measure the concept is a reflection of patient experience [24, 25]. Different studies showed that the global level of patient satisfaction to psychiatric services ranges from 39.3% to 91.9%. A range of factors can affect patient satisfaction, including unpleasantly built environments, staff being too busy, failure to obtain prescribed medications from the hospital pharmacies, the stigma of a psychiatric treatment service, long waiting hours, results, and payment for psychiatric services. Consequently, a dissatisfied patient is not psychologically and socially well becoming evident of lack of goal attainment by the service provider or the clinician.[31–33] Different studies also indicated that, other than the quality of service delivery, satisfaction is also affected by many factors such as patients’ demographics [34,35] diagnosis and duration of disease, [36,37] treatment program, [38] and patients’ expectation of service [39] Studies on 21 European countries showed that patient experience accounts for only a small fraction of the unexplained variation in health system satisfaction, even after adjustments for the demographic, health and institutional factors with which such satisfaction is commonly associated. [21–23, 26–30]. In this study, most of the variation in satisfaction with the health-care system was explained by factors above and beyond patient experience. Reliance on psychiatric symptoms alone as a measure of service satisfaction is somehow a narrow concept; it is rather important to see how satisfied the patients are by the service they received [42]. Despite psychiatric outpatient service being given in most of referral hospitals in Ethiopia, there had been few evidences that examined patients’ 3 satisfaction with the quality of psychiatric care based on sound theoretical frameworks and this study also probably contributes pattern of satisfaction of psychiatric patients in Ethiopia. However the scales used to measure satisfaction level was based on scales validated and used in other countries. Hence a need to understand more patients experience based on a mental health service scale (MHSSS) scale, validated and tested in Ethiopia makes this study sound helpful [45].Patient’s responses to their experiences of using services are under-researched in the context of mental healthcare in low income countries. Therefore, the purpose of this study is to explore the factors underlying psychiatric patients’ satisfaction with the health-care system and the extent to which satisfaction reflects their experience of care with the validated MHSSS (mental health service satisfaction scale) tool in Ethiopia, written in Amharic and English version as a measure of satisfaction among consumers of mental healthcare.
Subjective experience of patients with schizophrenia participating in arts involving activities at specialized psychiatric hospital in Addis Ababa Ethiopia: A qualitative study
(Addis Ababa University, 2017-12) Dr. Assefa, Dawit
Arts therapies have positive effects on psychotic symptoms, psychosocial functioning and the ability to mentalize in patients with schizophrenia (3). These therapiesare not formally practiced by trained art therapists in Ethiopia however the term ‘arts involving activities’ is used in this paper to describe interventions that promote the experience of creative artistic activities such as painting and drawing, dancing, music and drama. In our country, Amanuel Mental Specialized Hospital is the only psychiatric specialized hospital that provides art involving activities, and thesubjective experiences of patients with schizophrenia participating in such activities are not yet explored. Statement of the problem Patients’ subjective experiences of participating in arts involving activities are unexplored. Research question What is participants’ understanding of the reasons for participating in arts involving activities? What do participants enjoy/ like about, not like/ avoid from the activities and what are their respective reasons? What are participants’ perceived benefits from the activities and their opinions regarding the service they were involved in? Method An exploratory qualitative research design was used. In-depth interviews with the use of prepared topic guides were conducted after obtaining consent form each participant. We involved 18 patients with the diagnosis of schizophrenia who fulfilled inclusion criteria. Data was recorded, transcribed verbatim, translated into English, coded and thematically analyzed Results Majority of patients reported having mental illness and need for treatment as their reason of admission; getting entertainment and happiness was reported as their reason of participation in rehabilitation center. Significant number of patients reported positive experiences by participating in arts involving activities. Few of patients reported their negative experiences in their participation of specific arts involving activities. Majority of patients reported positive outcomes but no negative outcome from their participation. Our findings indicate postitive impact of arts involving activities on their mood, communication skills, social engagement, overcoming stigma, physical health and on their motivation to take role for their recovery. Nearly all of them were content with the service provision with some indicating room for improvement. Conclusion In treatment of schizophrenia, focus on the patient as a whole rather than symptom reduction is required to facilitate the process of recovery.
The practice of psycho-education for people with mental illness receiving treatment at Amanuel specialized mental hospital
(Addis Ababa University, 2018-01) Oldisha, Addisalem; Alem, Atalay (MD, PHD, Consultant Psychiatrist)
Background: Psycho-education has been one of the core components of psychiatric treatment methods for some time. However, there is no information about the practice of psycho-education among clinicians at Amanuel Hospital. Aim: The purpose of this study was to assess the practice of psycho-education provided for people with mental illness receiving treatment at Amanuel Specialized Mental Hospital and to see its association with treatment adherence. Method: Quantitative approach was employed to conduct the study. The study was conducted on selected consecutive outpatients attending follow-up clinics at Amanuel Hospital. Records of 1128 patients were obtained from the outpatient clinic for sampling. Of these, 120 were selected from different types of disorders using simple random sampling technique. A questionnaire developed by the PI and MMAS were used to collect data from the respondents. Data analysis was conducted using SPSS version 20. Results: The majority of the participants (54.2) were men, 52.5% were single, and 60.0% Christians and 40.0% were Muslims. Over 80.0% were unemployed and 45.0% had attained high school level of education. 58.3% of the participants reported that they had not received any information about their illness. Among those who had received psycho-education, only 42% of them said patients receive information about precautions to take to prevent relapse. This study showed that there is a significant association between gender, age, educational level, marital status, employment status, residence, and psycho-education. These socio-demographic variables were also associated with medication adherence. The participants who reported to have received psychoeducation were more likely to adhere to treatment compared to those who had not received it. Conclusion: The finding suggests that the practice of psycho-education provided for outpatients at Amanuel Hospital is very limited.
Prevalence, forms and consequence of violence against health professionals in Amanuel mental specialized hospital, Addis Ababa, Ethiopia 2017
(Addis Ababa University, 2018-01) Dr. Yirga, Demissie; Dr. Girma, Fikrte
BACKGROUND Workplace violence (WPV) is defined as physically and psychologically damaging actions that professionals face in the workplace or while on duty. Violent behavior caused by people with mental illness regularly leads to involuntarily admission to a psychiatric ward, to avoid the risk of serious harm to others. However, this risk may remain during hospitalization, resulting in violent incidents in clinical practice. Revealing the prevalence, nature and consequences of violence in psychiatry is a necessary step to instigate the development of useful interventions, policies and guidelines to protect mental health workers from violent incidents OBJECTIVE; To describe the prevalence, forms and consequences of violence against health professionals in Amanuel specialized mental hospital, Addis Ababa METHODS; A hospital based descriptive survey done in AMSH among professionals using a questionnaire developed from the research instrument for workplace violence in the health sector by ILO/ICN/WHO/PSI, adopted in a way suitable for this study and translated into Amharic. The data sheets were coded and data entry, cleaning and analysis was done using the Statistical Package for the Social Sciences (SPSS) version 20, bivariate and Multivariate logistic regression was done to see sociodemographic determinants of workplace violence. RESULT One hundred eighty one participants were involved in this study among whom 95(52.8%) were females and majority 80 (44.4%) of the participants were 25-29 years of age 108 (59.7%) has less than 5 years of work experience. Around 30% were clinical nurses and 4(2.2%) psychiatrists. Over two third of participants 140 (77.3%) had been victim of one form of violence or another in their workplace.The risk of being a victim is not associated with any of the socio-demographic characteristics.Most of the victims of workplace violence, 112(80%), have experienced verbal violence CONCLUSION; This study makes clear that the amount of violence with which health professionals have to cope is a substantial and sever problem. To develop effective strategies of violent event managementit is important to favor incident reporting by staff for all violent episodes, from verbal offenses or threats to dangerous physical attacks.BACKGROUND Workplace violence (WPV) is defined as physically and psychologically damaging actions that professionals face in the workplace or while on duty. Violent behavior caused by people with mental illness regularly leads to involuntarily admission to a psychiatric ward, to avoid the risk of serious harm to others. However, this risk may remain during hospitalization, resulting in violent incidents in clinical practice. Revealing the prevalence, nature and consequences of violence in psychiatry is a necessary step to instigate the development of useful interventions, policies and guidelines to protect mental health workers from violent incidents OBJECTIVE; To describe the prevalence, forms and consequences of violence against health professionals in Amanuel specialized mental hospital, Addis Ababa METHODS; A hospital based descriptive survey done in AMSH among professionals using a questionnaire developed from the research instrument for workplace violence in the health sector by ILO/ICN/WHO/PSI, adopted in a way suitable for this study and translated into Amharic. The data sheets were coded and data entry, cleaning and analysis was done using the Statistical Package for the Social Sciences (SPSS) version 20, bivariate and Multivariate logistic regression was done to see sociodemographic determinants of workplace violence. RESULT One hundred eighty one participants were involved in this study among whom 95(52.8%) were females and majority 80 (44.4%) of the participants were 25-29 years of age 108 (59.7%) has less than 5 years of work experience. Around 30% were clinical nurses and 4(2.2%) psychiatrists. Over two third of participants 140 (77.3%) had been victim of one form of violence or another in their workplace.The risk of being a victim is not associated with any of the socio-demographic characteristics.Most of the victims of workplace violence, 112(80%), have experienced verbal violence CONCLUSION; This study makes clear that the amount of violence with which health professionals have to cope is a substantial and sever problem. To develop effective strategies of violent event managementit is important to favor incident reporting by staff for all violent episodes, from verbal offenses or threats to dangerous physical attacks.
The Practice of Holy Water Therapy for Mental Disorders and other Conditions: at St. Michael Church Addis Ababa, Ethiopia
(Addis Ababa University, 2018-01) Tadesse, Zelalem; Pain, Claire (MD)
Ethiopians tend to emphasize supernatural explanations for illness, especially in the case of mental illness. The most common indigenous therapy is the use of holy water. Despite some recent studies on indigenous therapy, there has been little exploration of the interface between mental health and religion in Ethiopia. Thus the primary purpose of this study is to systematically explore the process of holy water therapy for mental disorders at Shinkuru Michael one of the principal traditional therapy centers in the outskirts of Addis Ababa. This research project used a descriptive study methodology, which is derived from and could be classified as a sub-branch of the qualitative approach. Non probability purposive sampling methods were used due to their appropriateness in dealing with sensitive issues related to mental illness. Data was collected from nine participants through in-depth interview, participant observation, and informal interview. Primary and secondary data collection methods were also used to gather additional data. All data were organized thematically and analyzed using thematic analysis. The study found that the nature of tsebel therapy demands the individual’s active involvement in fasting, prostration, Emnet (use of holy ash) and worship, for it to be effective. A wide variety of patients frequently made use of tsebel since it has a dual nature, being considered as an effective preventive measure and also as a cure, for mental illness and other diseases. Thus, based on the research, one can conclude that since the religious establishment plays a major role in the treatment of mental illness, there is a strong imperative for a certain amount of re-education, awareness raising and the promotion of cooperation among religious healers at tsebel/holy water sites, and mental health practitioners of every kind of health care system.
PrevalenceofCannabisUseanditsadverse ImpactsamongstudentsofScienceFaculty, AddisAbebaUniversity,Ethiopia
(Addis Ababa University, 2018-01) Dr. Brhan, Segid; Teferra, Solomon(MD,PhD)
Background: Substance Misuse is common among Students of higher learning. Cannabis is one of the substances commonly Misused by this population. In Ethiopia, the issue has not been investigated. The study was conduct to evaluate the prevalence of cannabis use among students in Addis Ababa University, College of Natural Sciences. Method: An institution based survey was conducted on a sample of 208 students. Data was collected using a self administered questionnaire: Cannabis Abuse screening test, CAST and adapted to the circumstance. It was analyzed using SPSS Version16.
Mental distress and associated factors among orphan children: case of kechene and kolfe governmental child care and rehabilitation center
(Addis Ababa University, 2018-01) Tilahun, Assaye; Bekele, Desalegn (MD,MPhil)
Research in the developed world has explored effects of bereavement on children, and has showed differing mental health effects of parental loss. In our country, however, the relationship between mental distress of orphan who live in child care and rehabilitation center and associated factors has received little attention. To assess the mental distress and associated factors among orphan children in children’s care and rehabilitation center in Addis Ababa. Cross sectional quantitative study was conduct on two purposively selected governmental child care and rehabilitation center, namely Kechene and Kolfe in Addis Ababa, from January to December, 2017. All Children who were in the age group of 11 - 18 years residing in child care and rehabilitation center orphan were included in the study. A structured questionnaire from Hospital Anxiety and Depression Scale (HADS) were translated into Amharic language and used to collect data; EPI info version 7 and STATA version 12 were used to data entry and analysis. Multivariate analysis was applied to identify correlates of mental distress and independent variables. More than half (51.81%) of children who were included in the study experience mental distress; the most prevalent type of mental distress was Depression (52.9%) followed by anxiety (51.1%).On the other hand, 31.9% of respondents were experienced abnormal Anxiety and Depression Symptoms. Both children’s educational status (P<0.037) and quality of relationship with worker (P<0.004) had significantly associated with depression, while quality of relationship with worker (P<0.004) had significantly associated with Anxiety. This study finding indicate depression and anxiety among child care and rehabilitation center orphan hood were common, especially children who had poor relationship with care providers and lower educational status were the most vulnerable; suggested that they may be in need of support. So, early identification and intervention is necessary for the children living care and rehabilitation center to prevent further consequences.
Exploring the perception of people with substance related disorder towards psychotherapy at Amanuel mental specialized hospital a thesis submitted to department of psychiatry clinical psychology program
(Addis Ababa University, 2018-01) Cheru, Tringo; Dr. Mengesha, Filmon
Most People with substance-related disorders do not seek psychotherapeutic service. The aim of this study was to investigate the perceptions of people with substance-related disorder towards psychotherapy. A qualitative study, specifically phenomenological approach was employed. Nine participants were interviewed using semi-structured interview guide; selected purposively from inpatient department of addiction ward. The collected interviews were analyzed, using thematic analysis. The emerged themes main were (1) perception about psychotherapy (2) the perceived needs (3) the benefits of psychotherapy (4) the unmet needs people with substance-related disorder receiving psychotherapy. The result of this study showed that participants understand psychotherapy as an advising process, general service, and professional help. Psychotherapy was perceived as being helpful for understanding the nature of the problem, and for adjusting future life. The perceived treatment needs were varied based on the way of admission and their educational level. Participants who are admitted voluntarily and high level of education have a positive perception of the provision of psychotherapy. However, those who are admitted by others influence have a negative perception towards psychotherapy. Participants lack of awareness (where and how to get help), stigma (they afraid of what others would think of them) were raised as potential barriers to seek therapeutic interventions. Factors for unmet treatment needs were identified for lack of continuous follow up by a psychologist, Shortage of time during group therapy and absence of separated female addiction ward. There is a need to promote awareness in the community especially on psychotherapeutic help seeking. In addition, psychologist should take in to account the individuals perspective while providing psychotherapy. In general, there is a need for improving quality of mental health service.

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