Psychiatry

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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.
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.
Caring for HIV positive children: psychological functioning of care-givers with HIV positive children: a qualitative study Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Ababa University, 2019) Negash, Ashenafi; Bahiretibeb, Yonas (MD)
Background: HIV/AIDS is an epidemic infectious illness which affects anyone regardless of age, sex, social class, academic level and race. It has a significant direct or indirect impact not only on the patient but also on the care-givers with significant morbidity, mortality and economic burden. Despite an increased care for the infected individual, the psychological impact of the illness on the care-givers has been undermined specially in low to middle income countries including Ethiopia. To date there have been no studies about the psychological functioning of care-givers raising HIV positive children. Objective: The objective of this study is to explore the psychological functioning of care-givers of HIV positive children following at Tikur Anbessa Specialized Hospital. Methods: Data was gathered on 14 participants, biological parent and close relative, using semi-structured interviews. The interviews were conducted in Amharic, transcribed and then translated into English. The data were analyzed using thematic analysis Result; This finding showed that the care-givers age range from 22-85 and 13 out 14 care-givers were female. Majority of them were at low academic level, low socioeconomic status and have temporary employment. Most of them were biological and single parent and they were also sero-positive. The result identified that caregivers experienced emotional pain after hearing the result, persistent or transient maternal guilty, depression, dealing with sero-discordance, discrimination, disclosure concern and change of behaviors in the child. The finding also highlighted the presence of economical struggle, house problem and unemployment on the care-givers. To get through their psychological distress care-givers also used spirituality, hope, getting financial or material support and sharing responsibility with older children as their coping mechanisms. Conclusion; Caring for HIV positive children is found to be psychologically burdensome especially in a resource limited setting. So, having an integrated mental health service for care-givers is unquestionable. Considering the high burden of care-giving in women, it will be very important to involve male care-givers and empower women economically.
Caring for HIV Positive children: Psychological functioning of care-givers with HIV positive children: a Qualitative study.
(Addis Abeba University, 2019-01) Negash, Ashenafi; Bahiretibeb, Yonas ((MD), MSc, Associate professor, Department of Psychiatry); Girma, Fikirte ( (MD), Assistant professor, Department of Psychiatry, School of Medicine); Abebe, Workeabeba( MD, MPH,Associate professor, Department of Pediatrics and Child Health, School of Medicine)
Background: HIV/AIDS is an epidemic infectious illness which affects anyone regardless of age, sex, social class, academic level and race. It has a significant direct or indirect impact not only on the patient but also on the care-givers with significant morbidity, mortality and economic burden. Despite an increased care for the infected individual, the psychological impact of the illness on the care-givers has been undermined specially in low to middle income countries including Ethiopia. To date there have been no studies about the psychological functioning of care-givers raising HIV positive children. Objective: The objective of this study is to explore the psychological functioning of care-givers of HIV positive children following at Tikur Anbessa Specialized Hospital. Methods: Data was gathered on 14 participants, biological parent and close relative, using semistructured interviews. The interviews were conducted in Amharic, transcribed and then translated into English. The data were analyzed using thematic analysis Result; This finding showed that the care-givers age range from 22-85 and 13 out 14 care-givers were female. Majority of them were at low academic level, low socioeconomic status and have temporary employment. Most of them were biological and single parent and they were also seropositive. The result identified that caregivers experienced emotional pain after hearing the result, persistent or transient maternal guilty, depression, dealing with sero-discordance, discrimination, disclosure concern and change of behaviors in the child. The finding also highlighted the presence of economical struggle, house problem and unemployment on the care-givers. To get through their psychological distress care-givers also used spirituality, hope, getting financial or material support and sharing responsibility with older children as their coping mechanisms. Conclusion; Caring for HIV positive children is found to be psychologically burdensome especially in a resource limited setting. So, having an integrated mental health service for caregivers is unquestionable. Considering the high burden of care-giving in women, it will be very important to involve male care-givers and empower women economically.
Clients’ perception of psychotherapy after psychotherapy termination in Tikur Anbessa specialized hospital and Zewditu memorial hospital.
(Addis Abeba University, 2020-06) Alemwork, Amare; Dr.Girma, Engida(MD); Khan, Matlob(Ph.D.); Getaneh, Fikir
Background- Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, and relationship factors between an individual and a trained mental health professional. Modern psychotherapy is time-limited, focused, and usually occurs once a week for 45-50 minutes per session. Methods- This qualitative study investigates clients’ perceptions of psychotherapy after psychotherapy termination. Eight clients (5 female) and (3 male) who took psychotherapy in Tikur Aabessa Specialized Hospital and Zewditu Memorial Hospital have participated. In-depth semi-structured interviews were carried out to investigate the participants' perceptions of psychotherapy after therapeutic termination. Audio recorded data was manually transcribed and translated, then thematically analyzed. Result- Psychotherapy was perceived as positive it solved most of the participants' problems. There were diverse perceptions of the helpfulness of psychotherapy. Most perceive it as very helpful. Others perceived as to some extent it was helpful. There were also negative perceptions about the termination of psychotherapy because they didn't aware before 3 or 4 sessions of termination of therapy. Most of the clients revealed their real problems by the 2 of the therapy. Conclusion- The study showed most clients have a positive perception of psychotherapy after therapeutic termination. More studies are needed about therapeutic factors and termination processes that have impacts on the outcome of psychotherapy. nd or 3 rd session
Clinical Care of Patients with Anxiety Disorders Receiving Care at Psychiatric Outpatient Clinic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Chart Review
(Addis Ababa University, 2022-02) Asrat, Emmanuael; Baheretebeb, Yonas(MD, Associate Professor and Consultant Child Psychiatrist); Milkias, Barkot(MD, Assistant Professor and Consultant Psychiatrist)
Introduction: Anxiety Disorders are a group of disorders that have a core symptom of excessive fear and anxiety and associated behavioral symptoms. It is a condition that can be experienced by anyone but it needs intervention when symptoms become excessively distressing or disabling, or reduce quality of life. Background: Anxiety Disorders constitute the leading prevalent mental disorders in the world. Globally, there are around 45.82 million incidences of anxiety disorders and 301.39 million prevalence rate of Anxiety Disorders. The DALYs as estimated by the GBD in 2019 was estimated to be around 28 million years. In Ethiopia, it is estimated that the lifetime prevalence of anxiety disorders is around 7.5 % in a study done in Addis Ababa. National Institute for Clinical Excellence (NICE) guidelines recommend the use of psychological interventions in anxiety spectrum disorders. The most evidence is for Cognitive Behavioral Therapy (CBT) which has the highest empirical evidence whereas the most evidence for pharmacotherapy is the use of Antidepressant medications. The treatment gap for mental illness throughout the world is universally large. Despite the enormous burden Anxiety disorders pose to our health care system there hasn’t been much evaluation done regarding the quality of care mental health services. Objective: the objective of the study was to evaluate the types of care patients with anxiety received including the psychological and pharmacological treatment provided to them. This study also aims to determine the level of patient engagement to treatment and to determine the associated factors. Method: A Retrospective chart (EMR) review was done to explore the socio-demographic characteristics, Clinical Evaluation, Treatment modalities offered and Treatment Engagement of patients with Anxiety disorders in psychiatric outpatient department of Tikur Anbessa specialized hospital patients that visited the OPD from Hamle 1, 2010 E.C to Hamle 30, 2013 EC. Once the data was obtained it was exported to Excel spreadsheet and it was cleaned and checked for errors and missing variables, and then it was exported to SPSS version 26 and descriptive analysis was done. Result: This study found the commonest diagnosis to be GAD (58.5%) and the second commonest diagnosis was Panic Disorder (32.7%). The study found that there is a high psychiatric comorbidity of anxiety disorders with MDD and other anxiety disorders accounting for 33.3% and 28.3% respectively. Out of the other anxiety disorders, a higher co-occurrence between panic disorders and generalized anxiety disorders was seen. From the 98 cases that were in the study 32 (32.6%) were offered only medications while 18 (18.4%) of patients were offered only psychotherapy. Both of these modalities were offered in combination in 25 (25.5%) of the cases. Neither medication nor psychotherapy was offered for 23(23.5%) of the cases in the study. Psychoeducation, psychotherapy referral and prescription of medication were found to increase the likelihood of treatment engagement in the study.
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
Common Symptoms of Depression among Patients with Depressive Disorders Receiving Outpatient Care in Tertiary Hospitals in A.A., Ethiopia:A Cross Sectional Study
(Addis Ababa University, 2022-01) Solomon, Eyerusalem; Milkias, Barkot(Assistant professor of Psychiatry); Yared, Mahlet (Assistant professor of Psychiatry); Medhin, Girmay(Associate Professor of Epidemiology and Biostatistics)
Background The major assessment tool that is of use in Ethiopia to diagnose and treat depressive disorders is DSM 5. However, DSM -5 might not represent the diverse symptomatology of depression in a country with diverse ethnic and cultural background. Having a clear knowledge of the type of common presentations or complaints of patients with depression coming to outpatient services in tertiary hospitals has significant implication for clinicians to provide appropriate patient care. Objective To identify the common presenting symptoms of depressive disorders among patients who came to receive outpatient care for depressive disorders in tertiary hospitals in Addis Ababa. Another objective is to identify common symptoms along the domains and to investigate its association with sociodemographic factors of the study participants. Method A cross sectional facility-based study design was used. The study participants included patients who visited outpatient psychiatric services in 3 tertiary hospitals in Addis Ababa in the past 2 years, by mainly focusing on patients who are currently visiting the OPDs and going back up to 2 years until the sample size was reached. Potentially eligible patients were selected by filtering those who have been diagnosed with depressive disorders. Then, using the inclusion and exclusion criteria samples were identified until the sample size which was needed reached starting from the most recently recorded patient (consecutive sampling). Consecutive patients were recruited starting from those currently on follow up to until about those who were seen in the past 2 years at least once. Study participants were interviewed through Face to Face interview. Descriptive statistical methods were used to summarize the collected data and to help us understand the collected information. The most distressing symptom domains were analyzed. Cross tabulation was done to see association between sociodemographic and symptom domains. Results- Feeling down, depressed or hopeless were the most frequently endorsed symptoms occurring in >90% of the patients. All items were rated with fainting spells being the lowest rated occurring in only 10.9% of the patients. At least one symptom was seen in 98.8% of them from somatic domain, 96.4% from affective, 93.3% from other and 78.2% from cognitive domains. From the patients who reported most distressing symptoms, around 58(35.2%) of them mentioned symptoms from the affective domain as their most distressing symptom, 46(27.8%) mentioned symptoms from somatic domain, 21(12.7%) mentioned two or more symptom combinations from different domains, 12(7.2%) from cognitive and 1(0.6%) from other domain. Conclusion- Above 90 % of the study participants reported to have symptoms from the 3 domains of depression which are affective, somatic, and other. Around 78% of the patients also reported to have one or more symptoms from cognitive domain of depression. When expressing symptoms which are most distressing to them, significant proportion of the patients reported symptoms which are combinations from all the 4 domains of depression. Symptoms which are not included in DSM criteria and screening tools being used in clinical setup are shown to be reported in high frequency and also as most distressing in this study.
Demographic, Clinical, and Treatment Profiles of Newly Diagnosed Patients with Bipolar Disorder in Amanuel Mental Specialized Hospital: A Retrospective Chart Review
(Addis Abeba University, 2020-12) Asefa, Abdulselam; Dr.Fekadu, Abebaw (M.D., Psychiatrist); Dr.Getachew, Meron (M.D., Psychiatrist)
Background Bipolar disorders are among the most common severe mental illnesses. They are characterized by episodes of mania, hypomania and depression of various severity. Worldwide the prevalence of the disorder is similar with little differences across ethnicity, gender or socioeconomic status. Antipsychotics, mood stabilizers and lithium are among the medications used to treat the disorder. Objective The study aimed to identify and describe the clinical profiles, demographic characteristics, and treatment trends of newly diagnosed patients with bipolar and related disorders. Methodology The study was conducted at Amanuel Mental Specialized Hospital (AMSH) focusing only on the newly diagnosed patients with bipolar disorders. All newly diagnosed patients with bipolar disorder who visited the hospital from January 1, 2019 – March 30, 2019 were included in the study. All the data were extracted from the charts of the patients. Results: Records of a total of 147 newly diagnosed patients with bipolar disorders were evaluated. The study showed a comparable proportion of male (47.6%) and female (52.4%) participants. The mean age of the patients during their visit to the hospital was 29.57 years with a standard deviation of 11.46 years. Aggressiveness 64(43.5%), urge to be on the move 23(15.6%), difficulty of sleeping 18 (12.2%) were the three most common presenting complaints. From the reviewed 147 records, 144 were shown to be bipolar I disorder and the rest 3 were not labelled at all- a simple “bipolar disorder” was recorded as a diagnosis. Most presented with manic episode with psychotic features (42.2%) followed by psychotic features, and depressive episode with psychotic features. More women (n=14) presented with depressive episodes than men (n=7). A total of 57 patients reported/showed various degrees of suicidality, 29 of them had suicidal ideation, while 26 had attempted suicide. All of the patients were prescribed with orally taken antipsychotics. Three quarter of them were also given mood stabilizing anticonvulsants. 59.2% of the patients were prescribed with a combination of antipsychotics and mood stabilizers. Conclusion: The sociodemographic characteristics found from this research is comparable to other studies around the world. Bipolar I disorder was the prevailing diagnosis. Most were found to have psychotic features in the study and most had manic episodes at first presentation to the hospital. Most of the patients were administered antipsychotics and required emergency admission.
Descriptive Analysis of Cases Seen At Psychiatric Outpatient Department Of Tikur Anbessa Specialized Hospital from Sep 11, 2019 - Mar 9, 2020:A retrospective crossectional study in Addis Ababa, Ethiopia
(Addis Abeba University, 2020-10) Abebe, Tesfanesh; Dr.Birhanu, Ribka; Dr.Bahiretibeb, Yonas
Background In mental health descriptive studies on the socio-demographic variables provides data regarding study participants and it is necessary for the determination of whether the individuals in a particular study are a representative sample of the target population for the generalizability purpose. It helps to Identify and address differences in care for specific population and for the development of additional patient centered services. Among the study done in Ethiopia, there is an existing inpatient visit study at Amanuel mental specialized hospital. At TASH there is a lack of organized data regarding socio-demographic characteristics, diagnosis, and frequency of psychiatric illnesses. Objective To identify the socio-demographic characteristics, diagnosis, and frequency of psychiatric illness at TASH outpatient department of psychiatry. Method Descriptive study was conducted. The study material was 981 charts of patients, which was assessed from electro-medical recording system, by using a convenient non-probability sampling method to explore the socio-demographics of the patients and their diagnosis. Data was collected by a means of data extraction sheet from electro-medical recording system at TASH. The collected data was analyzed by using SPSS version 25, in the analysis process frequency distribution of variables was calculated. Results The result of this research has shown that the mean age of patients to care is 30.5, 54.5% were male in gender. 18.1 % have a higher-level education, 42.7% are employed, and 43.5% single. 21.9% had a diagnosis of depressive disorder, 20.7 % had schizophrenia spectrum and other psychotic disorder and 17.2 % have neurodevelopmental disorders. 71.5% are treated with only medication and 23.3% are treated with psychotherapy. Conclusion The present study point to the need for further research and attention to lack of completeness of the records seen on the socio-demographic and diagnosis variables which could be detrimental to the quality of healthcare service and the need for child and adolescent clinic that is found to hold significantly high number compare to the service provide currently.
Determinants of health-related quality of life in patients with schizophrenia at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
(Addis Abeba University, 2019-11) Yared, Mahlet; Prof.Araya, Mesfin(MD, Ph.D.); Dr.Teferra, Solomon( MD, Ph.D)
Introduction: Quality of life of patients living with schizophrenia has been shown to be lower compared with those that are not affected by it, Understanding the possible contributing factors could create awareness as well as help design patient centered therapeutic interventions Objective: To determine socio-demographic, clinical and psychosocial characteristics associated Quality of life of patients with schizophrenia. Methods: Study participants who filled the SF-36 questionnaire were included in this study, the association between socio-demographic, clinical and psychosocial parameters with health related quality of life of patients living with schizophrenia was determined. Result: The study sample consisted of 200 patients living with schizophrenia. The mean score of the study participants was found to be lower than the general population, the female participants scored lower than the male and those who use substances overall score was also lower. The total score of PANSS showed negative association with the SF-36 domains, duration of illness showed no significant association with quality of life. Khat and tobacco use did not show significant association but consumption of alcohol was found to be associated in the mental health and bodily pain domains. Conclusion: The variables Sex, occupation, PANSS total score and alcohol use showed associations with the SF-36 domains.
Developing Service User and Caregiver Involvement in Mental Health System Strengthening in Ethiopia
(Addis Abeba University, 2021-05) Abayneh, Sisay(Phd); Dr.Hanlon, Charlotte; Dr.Lempp, Heidi
Background: Service user and caregiver involvement has become an expectation in all aspects of the mental health system, including in policy, planning, service delivery, quality improvement, research and education around the world. Service user involvement is particularly promoted as a strategy to scale-up quality mental healthcare service in low-and-middle-income countries (LMICs). However, little is known about actual involvement experiences and how best to involve service users and caregiversin mental health systems. No study of involvement has been conducted in Ethiopia. Hence, this study aimed to achieve the following objectives. General objective: To develop, pilot and evaluate a model of service user/caregiver involvement in mental health system strengthening in Ethiopia The specific objectives of the study were to:  explore the experiences, perceived barriers and facilitators regarding service user and caregiver involvement in mental health system strengthening.  develop an acceptable, sustainable and feasible Theory of Change model of service user and caregiver involvement in the expanding mental health system.  equip service users and health professionals for greater involvement in mental health system strengthening.  pilot the feasibility and acceptability of a co-developed model of service user and caregiver involvement in mental health system strengthening. Methods: A predominantly qualitative approach was used, which was conducted in three phases. The study was situated within participatory approaches informed by a critical social theoretical perspectives and social-ecological system theory. The thesis consists of 5 articles, which have been published or are about to be submitted for publication. Phase 1 provides the context for the thesis, which was a formative qualitative study conducted to explore the experiences of involvement, barriers to, facilitators and capacity building needs for greater involvement from the perspective of key stakeholders (Paper 1). In the study, 39 semistructured interviews were carried out with purposively selected service users (n=13), caregivers (n=10), heads of primary care facilities (n=8) and policy makers/planners/service developers (n=8). Thematic analysis was applied. In Phase 2, a Theory of Change(ToC) model was developed in iterative participatory workshops conducted in (i) Addis Ababa with purposively selected psychiatrists (n=4) and multidisciplinary researchers (n=3), and (ii) a rural district in south-central Ethiopia (Sodo) with community stakeholders (n=24). Information from the workshops (provisional ToC maps, minutes, audio recordings), and inputs from Paper1 were triangulated to develop the detailed ToC map. This ToC map was further refined with written feedback and further consultative meetings with the research team (n=6) and community stakeholders (n=35) (Paper 2). Based on findings from paper 1 and 2, an empowerment training programme was developed, delivered and evaluated for acceptability, feasibility and preliminary impacts using a mixed-methods design in Paper 3 (Chapter 7). The training was delivered separately for service users (n=12) and caregivers (n=12), and health professionals (n=18). The quantitative data consisted of process data, satisfaction questionnaires, and a retrospective pre-test survey. Qualitative data included exit and follow-up in-depth interviews with service users and caregivers. Descriptive statistics were performed for quantitative data, and qualitative data were analysed using a thematic analysis approach. The findings were integrated through triangulation for convergent themes following analysis. Phase 3 involved Participatory Action Research (PAR) implementation strategy development, piloting the ToC model and a case study of the piloting process and participants‘ experiences of involvement. Accordingly, a PAR protocol was developed to guide the ToC model implementation process (Paper 4) and the ToC model was piloted using PAR in three stages, each with iterative activities of plan, act, observe and reflect. Two stakeholder groups, a Research Advisory Group (RAG) and Research Participant Group (RPG), were established and collaborated in all stages of the PAR process. Data collection involved process documentation of meetings and activities: attendances, workshop minutes, discussion outputs, and reflective notes, participatory observation of sessions, and in-depth interviews with service users (n=6), caregivers (n=4) and health professionals (n=2) involved throughout the PAR process. Descriptive analysis was used for process data, and thematic analysis was used for qualitative data. Triangulation and synthesis of findings was carried out to develop the case study (Paper 5Chapter 8). Results: The formative qualitative study showed that the concept of service user involvement is new within the Ethiopian mental health system and that service user participants had little direct involvement in mental health systems strengthening. Several potential benefits were identified, included were improved appropriateness and quality of services, and greater protection against mistreatment and promotion of respect for service users. This study identified key multilevel barriers and facilitators to effective involvement, and many areas of capacity building needs for greater involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. There was a strong need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. The participatory ToC model co-produced described the causal pathways for greater service user involvement with key components (community, health organisation, service user and caregiver), interventions, preconditions, assumptions and indicators for each component along the pathway to the long-term outcomes and impact. The participatory nature of ToC process raised awareness of the possibilities for servicer user and caregiver involvement, promoted co-working and stimulated immediate commitments to mobilise support for a grass roots service user organization. The empowerment training content, delivery process and standard of the training program met participants‘ expectations, improved positive gains in understanding about metal illness, stigma, service-user involvement, and human rights. The training had positive impacts, including increased self-confidence, sense of empowerment, social benefits, and perceived therapeutic benefits. Through active collaboration and involvement the stakeholder groups identified their top research priorities considered as significant problems in their specific settings (particularly the need for public awareness-raising and addressing stigma and discrimination) and developed intervention programmes, action plans and initiated actions that could resolve some of these problems. Key mechanisms used for inclusive participation included capacity building and bringing together diverse stakeholders, anchoring the study in established strong community involvement structures, and making use of participatory strategies and activities during the PAR process. The case study about participants‘ experiences of involvement in PAR identified and explained about: (i) expectations and motivation, (ii) experiences of the dynamics of the PAR process, (iii) perceived impacts of involvement in the PAR process, and (iv) implementation challenges and future directions. Conclusions: Service user and caregiver involvement in mental health system strengthening is a complex process, which is affected by multilevel factors that demands interventions that recognize this complexity.This thesis shows that effective involvement could be achieved by empowering key stakeholders for greater involvement. PAR can be a feasible and acceptable approach for empowerment and collaborative engagement of a range of stakeholders in mental health system strengthening. Combining ToC with a PAR approach can provide a more inclusive active involvement model of stakeholders including service users and caregivers. Embedding effective service user and caregiver involvement can be hindered with lack of strategic enabling regulatory infrastructure within the mental health system. Implications: The findings of this thesis can be of practical relevance to researchers and those working in health care settings to develop service user and caregiver involvement in mental health system strengthening. It contributes theoretical understanding for future research and provides practical knowledge for application of participatory action oriented approaches about how to develop participatory models and actively involve key stakeholders in the contexts of low resource setting.
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.
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.
Exploring the Care-receiving Experiences of People with Severe Mental Illness, Amanuel Mental Specialized Hospital, Addis Ababa,Ethiopia:A Qualitative Study.
(Addis Ababa University, 2022-01) Legesse, Gizachew; Abera, Selam(MD, Assistant professor of Psychiatry); Girma, Engida(MD, Assistant professor of Psychiatry); Worku, Beniam (MD, Assistant professor of Psychiatry)
Background: - An understanding of the experience of individuals living with severe mental illness cared by mental health professionals and caregivers promote better understanding of the patient. This may in turn promote enhancement of the therapeutic relationship, engagement of people living with severe mental illness in their care and finally improvement of clinical outcomes. Objective: - To explore the care-receiving experience of people with severe mental illness receiving care at Ammanuel Mental Specialized Hospital. Method: - a qualitative study design was used. Nine in-depth interviews were conducted using semi-structured questions. The in-depth interviews were audio recorded, transcribed and translated into English. Data was coded by using open code 4.03 software package and thematic analysis was used to identify key themes. Results: - There appear five overarching themes with underlying subthemes: firstly, the meaning to illness and care received. Most participants mentioned that it is very difficult to accept mental illness and they tend to accept it gradually and mentioned the care received was lifesaving and mean a lot for their survival. Secondly, Positive experiences of care received, most had positive experiences regarding the care they received. They mentioned variety of positive expectations and hopes about what the care they received would lead to in terms of improvement in their current and future situations. Thirdly, negative experiences of care received, their negative care receiving experiences emanated from different problems they encountered and stigma they faced while receiving care. Fourthly, relationships with care provider in which most experienced good relationships while few experienced bad relationships and finally coping mechanisms. Conclusion: - The study revealed the positive and negative experiences of people with severe mental illness regarding the care received. It is paramount importance to continue positive aspect of the care provided and to devise ways to tackle negative aspect of care voiced by care receivers to improve care provisions that enhance patients’ recovery.
Exploring the lived experience of adolescents with type 1 diabetes receiving treatment at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Qualitative Study
(Addis Abeba University, 2019-09) Worku, Kaleab; Dr. Baheretibeb, Yonas(MD, MSC); Dr.Girma, Engida(MD)
Introduction Type 1 diabetes demands lifestyle changes including diet controlling, monitoring of blood glucose level and administering of insulin. Improved self-care and gaining positive attitudes can help to enhance better glucose management and promote long-term benefits. Moreover, understanding the lived experience of adolescents who live with type 1 diabetes from their own perspective is a significant step in improving diabetes treatment outcomes for this age group. Methods This qualitative study explored the lived experience of adolescents who live with type 1 diabetic who are receiving outpatient treatment service at TASH. Data was gathered from ten participants and using Semi-structured interviews. The interviews were conducted in Amharic, transcribed and then translated in to English. The data was analyzed using thematic analysis. Results All participants mentioned that they have problematic relationships with their parents regarding diabetic management and self-care. The over involvement from parents is a concern for participants for independent living and self-management of their condition. The short and long term complications of the condition, the dissatisfaction in the treatment service, lack of knowledge and understanding of parents about the condition were mentioned as challenges. Accepting their condition by developing awareness and knowledge from the training they get from the Ethiopian diabetic association as well as peer acceptance and validation about their condition were helpful for better adjusting to their condition. Conclusion Finding showed type 1 diabetes is challenging for this age group. These challenges must be addressed to support adolescents in learning to manage their disease and improve health outcomes.
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.
Factors Associated with Successful 'Insanity ' Defense and Characteristics of Defendants Pleading ‘insanity’ in Ethiopia: Facility-based Retrospective Report Review.
(Addis Ababa University, 2022-02) Rediet Dribsa; Dr.Limenhe, Asnake(MD, Forensic Psychiatrist ); Dr.Haile, Tsegereda(MD, Assistant Professor of Psychiatry)
Introduction: Forensic psychiatry operates at the interface of two disparate disciplines: Law and psychiatry. Forensic psychiatry is a subspecialty of psychiatry in which scientiﬁc and clinical expertise are applied to legal issues legal contexts Amanuel Mental Specialized Hospital is one of the largest and oldest psychiatric hospital in Ethiopia; it is also the only hospital that gives inpatient forensic psychiatry service at this time. To our knowledge, the clinical & criminal justice characteristics of the 'insane' have never been a subject of study in Ethiopia. We are very hopeful that this study will be beneficial for the improvement of the forensic service training of mental health professionals and ultimately benefit those affected by the limitations of information and scarcity of research to pinpoint issues we can work on to better the care provided to forensic psychiatry patients. Objective: To describe cases and explain the reason for their acquittal due to being "criminally irresponsible" in the forensic inpatient service at Amanuel Mental Specialized Hospital in a span of 6.5 years (between 01/01/2015 and 08/01/ 2021 GC). Methods: A retrospective facility-based study was conducted in Amanuel mental specialized hospital for a study period of 6.5 years from January 2015-August 2021. Forensic reports were used as a source of data, a data extraction sheet was used to collect data, and SPSS version 24 was used to analyze the data. Descriptive statistics are displayed in text, tables, and figures. Variables that showed association with the outcome variable using binary logistic regression were subjected to multivariate logistic regression. Statistical significance was declared at p-value < 0.05. Result: A total of 205 forensic reports of defendants were identified in the study period. Of this, 15 (7.3 %) cases did not have a conclusive forensic opinion regarding criminal responsibility; these cases were excluded from the analysis. The mean age of the defendants was 33.13 years with a standard deviation of 10.6 years. This study also showed that the magnitude of insane defendants among patients who had forensic mental health assessment at Amanuel mental health specialized hospital was found to be 39.5 %. The study revealed from the cases who have neuropsychiatric diagnoses 62.2 % were found to be "criminally irresponsible." Conclusion & recommendation: The number of insane defendants among patients who had forensic mental health assessment at Amanuel mental health specialized hospital was relatively high. Factors that had an association with insane defendants include psychiatric diagnosis of schizophrenia spectrum disorder, bipolar І disorder, and disordered psychiatric condition during the time of assessment. Creating awareness about severe mental illness and early detection and initiation of treatment may contribute to the prevention of the offenses as a society and improve the quality of life for the clients.
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
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.

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