Consequences of COVID-19 on access and delivery of mental health care in two rural Ethiopian districts. A mixed method study

Introduction: The impact of COVID-19 on people with Severe Mental Health Conditions (SMHCs) has been neglected. We aimed to describe the effect and explore the consequences of COVID-19 on people with SMHCs and mental health services in rural districts of Ethiopia. Methods: We conducted a mixed-method study nested within well-characterized population cohorts in Butajira and Sodo districts. We sampled 336 people (168 people with SMHCs, 168 comparisons) in a cross-sectional survey. We conducted qualitative key informant interviews with psychiatric nurses (n=3), primary health care workers (n=3), service users (n=4), family members (n=6) and community members (n=2). We assessed wellbeing (WHO wellbeing index), social support (Oslo social support scale; OSS) and food security quantitatively and used thematic analysis to explore impacts. Results: People with SMHCs reported significantly lower wellbeing (WHO wellbeing score 52 vs. 72; p<0.001), less social support (OSS score 8.68 vs. 9.29; p<0.001), worse living standards (47.0% vs. 29.0%; p<0.001) and increased food insecurity (26.0% vs. 12.5%; p<0.001). Household economic status worsened for over one-third of participants. Participants reported increased relapse, exacerbated stigma due to perceived susceptibility of people with SMHCs to COVID-19, and increased restraint. In mental healthcare settings, there was decreased patient flow but an increase in new cases. Innovations included flexible dispensing of medicines, longer appointment intervals and establishing new treatment centers. Conclusions: COVID-19 had negative consequences on people with SMHCs and mental health services, which must be anticipated and prevented in any future humanitarian crisis. Adaptive responses used during COVID may increase health system resilience

Demystifying writing papers for biomedical journals

This paper attempts to demystify the publication process in biomedical journals by offering simple step by step recipes on how to write and get published. The author relies on a narrative review and personal experience as a fellow student of publishing to achieve objective. Five stages in the publication process were identified: Planning, Writing, Submission, Managing editorial decisions and Post-acceptance. Planning is probably the most neglected yet the most important stage. The author begins by making sure that all necessary resources are in place, develops careful outline, decides on authorship and selects potential journal for publication. The paper will typically have three sections. The title which contains title of the paper and the list of authors and also key words is the first section. The abstract and the body of the paper are also the second and third sections. The title and abstract are critical and are usually revised many more times than the other parts of the paper. Choosing key words carefully increases the chance of the paper being read and cited. The body of the paper follows what is called the Introduction, Methods, Results and Discussion structure. Submission begins by writing a cover letter that makes the case for the article. Following all the key steps of the submission process avoids early rejection. Respond speedily and graciously and in sufficient detail to reviewers' and editors' comments. Following publication,the author should ensure that the published knowledge is disseminated widely. Overall, writing for biomedical journals is not too mysterious. However, there is no short cut: learning to write successfully takes time and practice

Mortality trends among inpatients at a tertiary psychiatric hospital in Ethiopia

Introduction: Mortality among people with mental illness is higher than the general population. Given the changes in the health service delivery in the past decade in Ethiopia, evaluating the pattern of mortality during this period may provide policy relevant information. The aim of this study was to assess the mortality pattern in a tertiary psychiatric hospital in Ethiopia.Method: A case-control design was employed. Using the Health Management Information System records and clinical records kept at the tertiary hospital; data on inpatient mortality was collected respectively for a period of nine years (2006-2014). Changes in the service configuration were also tracked over the nine years period to explore the potential impact of changes in management upon mortality. Data was analyzed through simple descriptive methods and logistic regression.Result: A total of 16,081 patients were admitted during the nine year period. The overall mortality rate of inpatients was 2.5/1000 admitted patients. The sex specific all-cause mortality rates were high in females (4.6/1000) than in males (1.8/1000). The mortality rate varied over the nine years between 0.5/1000 to 5.0/1000, with indications of fluctuations commensurate with changes in service organizational changes although these changes were not statistically significant. Although suicide accounted for the death of 12.5% (n=5), most died of natural causes and also primarily of infectious diseases .Conclusion:Mortality occurs mainly from preventable causes including suicide. Service reconfigurations may play important role in mitigating mortality. However, further systematic studies are required to determine the impact of service configurations on mortality and general morbidity

A Placebo-controlled Trial of Folate with B12 in Patients with Schizophrenia with Residual Symptoms in Ethiopia Using a Sequential Parallel Comparison Design.

Background: Approximately 30% of patients with schizophrenia suffer from treatmentresistant psychotic symptoms, which can produce substantial distress, result in hospitalization and disrupt school or work functioning. Studies have found low blood folate concentrations in psychiatric populations and recent reports have consistently linked schizophrenia to low folate levels. We aim to examine the efficacy of a four-month trial of folate with B12 supplementation for reducing symptoms of schizophrenia. Methods: This study is a randomized, sequential parallel comparison design (SPCD) for double-blind phase fixed dose, 4-month trial of folate plus B12 as add-on therapy to reduce symptoms of schizophrenia. Participants will be adults (ages 18 to 65 years) diagnosed with schizophrenia, any subtype, who are psychiatrically and medically stable, but have residual positive or negative symptoms of moderate or greater intensity, despite antipsychotic treatment. The study is divided into 2 double-blind phases of 56 days each. Two hundred total participants will be randomized to adjunctive treatment with either folate with vitamin B12 (n=50) or placebo (n=150), with a 2:3:3 ratio for random assignment to the treatment sequences drug/drug (DD; n=50), placebo/placebo (PP; n=75), and placebo/drug (PD; n=75), while all continue to receive their current antipsychotic agent for the duration of the study. Diagnosis will be established using the Structured Clinical Interview for DSM-IV for clinical trials (SCID-CT). The primary outcome measure will be change in symptom severity measured by the change from baseline in Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcome measures will include change in severity of psychotic symptoms as measured by the PANSS psychosis subscale score; and change in severity of negative symptoms as measured by the modified Scale for Assessment of Negative Symptoms (SANS) total score. Key assessments for primary and secondary outcomes will be conducted at baseline, week 8, and week 16. Trial Registration: Clinicaltrials.gov identifier: NCT01724476.