Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper.

BACKGROUND: Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. METHODS: The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations.

Impact of the COVID-19 pandemic on mental health care and people with mental health conditions in Ethiopia: the MASC mixed-methods study.

BACKGROUND: The COVID-19 pandemic has had far-reaching effects on the mental health of populations around the world, but there has been limited focus on the impact on people with existing mental health conditions in low-income countries. The aim of this study was to examine impact of the pandemic on mental health care and people with mental health conditions in Ethiopia. METHODS: A convergent mixed methods study was conducted. We systematically mapped information from publicly available reports on impacts of the pandemic on mental health care. Monthly service utilisation data were obtained from Amanuel Mental Specialised Hospital, the main psychiatric hospital, and analysed using segmented Poisson regression (2019 vs. 2020). In-depth interviews were conducted with 16 purposively selected key informants. Framework analysis was used for qualitative data. Findings from each data source were integrated. RESULTS: In the early stages of the pandemic, participants indicated a minimal response towards the mental health aspects of COVID-19. Mental health-related stigma and discrimination was evident. Scarce mental health service settings were diverted to become COVID-19 treatment centres. Mental health care became narrowly biomedical with poorer quality of care due to infrequent follow-up. Households of people with pre-existing mental health conditions in the community reported worsening poverty and decreased access to care due to restricted movement, decreased availability and fear. Lack of reliable medication supplies increased relapse and the chance of becoming chained at home, abandoned or homeless. Caregiver burden was exacerbated. Within mental health facilities, prisons and residential units, infection control procedures did not adequately safeguard those with mental health conditions. Meanwhile, the needs of people with mental health conditions in COVID-19 quarantine and treatment facilities were systematically neglected. Only late in the day were integrated services developed to address both physical and mental health needs. CONCLUSIONS: The COVID-19 pandemic had substantial negative impacts on the lives of people with mental health conditions in Ethiopia. Future emergency response should prioritise the human rights, health, social and economic needs of people with mental health conditions. Integration of mental and physical health care would both expand access to care and increase resilience of the mental health system.

Impact of depression on stroke outcomes among stroke survivors: Systematic review and meta-analysis.

BACKGROUND: Depression may negatively affect stroke outcomes and the progress of recovery. However, there is a lack of updated comprehensive evidence to inform clinical practice and directions of future studies. In this review, we report the multidimensional impact of depression on stroke outcomes. METHODS: Data sources. PubMed, PsycINFO, EMBASE, and Global Index Medicus were searched from the date of inception. Eligibility criteria. Prospective studies which investigated the impact of depression on stroke outcomes (cognition, returning to work, quality of life, functioning, and survival) were included. Data extraction. Two authors extracted data independently and solved the difference with a third reviewer using an extraction tool developed prior. The extraction tool included sample size, measurement, duration of follow-up, stroke outcomes, statistical analysis, and predictors outcomes. Risk of bias. We used Effective Public Health Practice Project (EPHPP) to assess the quality of the included studies. RESULTS: Eighty prospective studies were included in the review. These studies investigated the impact of depression on the ability to return to work (n = 4), quality of life (n = 12), cognitive impairment (n = 5), functioning (n = 43), and mortality (n = 24) where a study may report on more than one outcome. Though there were inconsistencies, the evidence reported that depression had negative consequences on returning to work, functioning, quality of life, and mortality rate. However, the impact on cognition was not conclusive. In the meta-analysis, depression was associated with premature mortality (HR: 1.61 (95% CI; 1.33, 1.96)), and worse functioning (OR: 1.64 (95% CI; 1.36, 1.99)). CONCLUSION: Depression affects many aspects of stroke outcomes including survival The evidence is not conclusive on cognition and there was a lack of evidence in low-income settings. The results showed the need for early diagnosis and intervention of depression after stroke. The protocol was pre-registered on the International Prospective Register of Systematic Review (PROSPERO) (CRD42021230579).

Problematic substance use and its associated factors among street youth in Bahir Dar city, Ethiopia.

Background: Problematic substance use is becoming a common problem in marginalized groups such as street youths. However, there is a dearth of studies on the prevalence and factors associated with problematic substance use among street youth in Ethiopia. Objective: The objective of this study was to determine the prevalence of problematic substance use and identify its associated factors among street youth. Methods: This community-based cross-sectional study was conducted between June and July 2020. A total of 252 participants were included in this study. Systematic random sampling was used to recruit participants. Cut down, annoyed, guilty feeling, and eye opening-adapted to include drugs (CAGE-AIDs) were used to assess problematic substance use. The data were entered into epidata and exported to SPSS version 25 for analysis. Logistic regression with a 95% confidence interval (CI) was used to show the strength of association. A p-value < 0.5 was statistically significant. Results: The prevalence of problematic substance use was 55.8%, 95% CI (49-63%). Peer pressure [adjusted odds ratio (AOR) = 3.01, 95% CI: 1.38, 6.59], family conflict [AOR = 5.05, 95% CI: 1.67, 15.25], physical abuse [AOR = 2.56, 95% CI: 1.11, 5.84], and substance use in the family [AOR = 2.85, 95% CI: 1.29, 6.27] were the factors significantly associated with problematic substance use. Conclusion: The prevalence of problematic substance use was high. It was also found that peer pressure, family conflict, substance use in the family, and physical abuse were the factors associated with problematic substance use. Therefore, proper screening and intervention for individuals with problematic substance use are needed, and further research should be conducted for marginalized groups.

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

Efficacy and safety of chloroquine and hydroxychloroquine for the treatment of COVID19 infection: An umbrella review

Introduction: Among all therapeutic approaches for COVID-19, most controversies have been raised about the efficacy and safety hydroxychloroquine (HCQ) and chloroquine. We conducted an umbrella review to assess any potential benefits of hydroxychloroquine and chloroquine in treating COVID-19.Methods: We searched the Cochrane Database of Systematic Reviews, PubMed and covid-evidence.org from December 2019 until July 2022. Time to viral clearance, need for mechanical ventilation and mortality were assessed as main efficacy outcomes. The analysis was performed using R package version 4.1.2.Result : Hydroxychloroquine had no benefit in decreasing time to viral clearance at days 7 (RR 0.81; 95% CI 0.63, 1.03) and 14 (RR 1.00; 95% CI 0.90, 1.139). Chloroquine has no statistically significant effect in decreasing the time of viral negativity at days 7 (RR 1.20; 95%CI 0.64, 2.25) and 14 (RR 1.08; 95%CI 0.85, 1.36). There is no difference in the need for mechanical ventilation among hydroxychloroquine plus azithromycin versus standard of care groups. Hydroxychloroquine marginally increased the mortality rate compared to placebo but not statistically significant (RR 1.09; P-value 0.05). Adding azithromycin to hydroxychloroquine had no statistically significant effect of decreasing mortality (RR 0.52; 95%CI 0.13, 2.07). Treatments with hydroxychloroquine increased the risk of adverse effects (RR 2.71; 95%CI 1.66, 4.43; p-value <0.0001). Adding azithromycin to hydroxychloroquine increased the adverse events (RR 1.74; 95% CI 1.27, 2.38). Conclusion: Though access to antivirals is an important challenge in developing countries, the decision to sus-pend hydroxychloroquine and chloroquine in treating COVID-19 appears right

Multidimensional and intergenerational impact of Severe Mental Disorders.

BACKGROUND: Severe Mental Disorders (SMDs) affect multiple generations although this is poorly studied. The aim of this study was to investigate the intergenerational and multidimensional impacts of SMD in rural Ethiopia. METHODS: This comparative study was nested within an existing population-based cohort study. We collected data from a total 5762 family members of 532 households (266 households with at least one family member with SMD and 266 sex and age matched mentally well controls from the neighborhood) in 2019. The main outcomes were multidimensional poverty, mortality, food insecurity, and family satisfaction. FINDINGS: Multidimensional poverty Index was higher in the households of persons with SMD (74·44%) than the comparison households (38·35%). School attendance was lower in children of people with SMD (63·28%) than children of the comparisons (78·08%). The median years of schooling was also lower among children of people with SMD than the controls. This lower attendance was also true among siblings of people with SMD (35·52%) than the comparisons (49·33%). Over the course of 20 years, family members who have a person with SMD in their household had 23% increased risk of death compared to family members who did not have a person with SMD in their household. Severe food insecurity was also higher in the SMD households (20·68%) than the comparison (13·53%) while family satisfaction was lower. INTERPRETATION: Families of people with SMD experience pervasive multidimensional and intergenerational impacts. Interventions should consider the broader family social and healthcare needs of the broader family.

Depressive symptoms among people with HIV/AIDS in Northwest Ethiopia: comparative study.

OBJECTIVES: The objective of this study was to compare depressive symptoms among people with HIV/AIDS and the general population sample. We also assessed the factors associated with depressive symptoms. DESIGN: A comparative cross-sectional study was conducted. SETTINGS: Antiretroviral therapy clinics in three primary healthcare facilities and semi-urban area in Northwest Ethiopia. PARTICIPANTS: A total of 1115 participants (558 people with HIV/AIDS and 557 comparison group) aged 18 years and above were recruited. A total of 1026 participants (530 people with HIV/AIDS and 496 comparison group) completed the interview. We excluded people with known HIV-positive status from the comparison group. OUTCOME MEASURE: Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. The proportion of depressive symptoms was compared between samples of the general population and people with HIV/AIDS using χ2 statistics. Multivariable logistic regression analysis was done to examine the associated factors. RESULTS: The overall prevalence of depressive symptoms was 13.3% (11.2%-15.4%). The prevalence was significantly higher in people with HIV/AIDS compared with the community sample (16.6% vs 12.3%), p=0.001. The difference was also significant in the multivariable logistic regression (OR 1.7). For the overall sample, depressive symptoms were significantly associated with older age, being single, divorced/widowed marital status, and poor social support. CONCLUSIONS: Depressive symptoms were higher in people with HIV/AIDS compared with the general population. It is necessary to include mental healthcare and screening for depression in routine HIV/AIDS care.

Perceived stigma and associated factors among adults with problematic substance use in Northwest Ethiopia.

BACKGROUND: Substance use-related problems including cigarette smoking and alcohol use are among leading preventable risk factors for premature death. However, people with these problems did not get the appropriate treatment they need. Stigma against substance use could be the potential barrier for people with problematic substance use to seek professional help. Therefore, the objective of this study was to investigate magnitude and associated factors of perceived stigma towards problematic substance use. METHODS: A total of 2400 participants were screened using the Cut down, Annoyed, Guilty, and Eye-opener (CAGE) Adapted to Include Drugs (CAGE-AID) questionnaire. We found 540 participants screened positive for problematic substance use (alcohol, hashish, tobacco and khat) and interviewed them for perceived stigma using Perceived Stigma of Substance Abuse Scale (PSAS). Logistic regression was used to examine associated factors with perceived stigma. RESULTS: Three hundred forty-five (63.9%) participants reported perceived stigma above the mean value of Perceived Stigma of Substance Abuse Scale (PSAS). Variables positively associated with perceived stigma were lower wealth and joblessness, history of separation from family members before age of 18 years, poly-substance misuse and awareness about economic crisis of substance use. CONCLUSION: Approximately, three in five people with problematic substance use perceived having been stigmatized by others. Health planning for problematic substance use should focus on stigma.

Suicidal behavior among people with epilepsy in Northwest Ethiopia: A comparative cross-sectional study.

INTRODUCTION: Premature mortality is common in people with epilepsy, but the causes vary where suicide is considered as one of the commonest. OBJECTIVE: The objective of this study was to compare suicidal behavior between people with epilepsy and the general population and identify associated factors in Northwest Ethiopia. METHODS: We have conducted a comparative cross-sectional study in Northwest Ethiopia. We have selected people with epilepsy from outpatient departments and the comparisons from the general population. Suicidal behavior was assessed by the revised version of Suicidal Behaviors Questionnaire (SBQ-R). Logistic regression was implemented to look for associations between factors and the dependent variable. RESULTS: The prevalence of suicidal behavior in people with epilepsy was 18.2%, significantly higher than the community sample, which was 9.8% (p-value = .001). This difference persists in the multivariable logistic regression model by which the odds of suicidal behavior in people with epilepsy was two times more as compared to the community sample. Other variables positively associated with suicidal behavior for the overall sample were depressive symptoms, no formal education, divorced/widowed marital status, and higher perceived criticism. Better social support was protective factor for suicidal behavior. CONCLUSION: The proportion of suicidal behavior is twofold higher in people with epilepsy than the general population. Routine screening for suicide risk should be an integral part of epilepsy treatment.

Level of Undernutrition and Its Determinants Among Children Aged 12-59 Months in Wolaita District, Ethiopia.

BACKGROUND: Undernutrition remains one of the most common causes of morbidity and mortality among children throughout the world particularly in developing countries. The present study aimed to assess the magnitude and associated factors of undernutrition among children aged 12-59 months. METHODS: A community-based cross-sectional study was conducted in Wolaita district from May to June 2015. Multi-stage stratified systematic random sampling procedure was used. Data were collected using a pretested interviewer-administered questionnaire from 626 children aged 12-59 months. Height and weight were measured by trained data collectors and WHO Anthro version 3.2.2 software was used. Data were entered into Epi Info version 3.3.5 and were exported and analyzed using SPSS version 21. Multivariable logistic regression model with a step-wise method was used to determine the predictors of undernutrition. RESULTS: One third (34.1%; 95% CI 30.4-37.9%) of children were stunted while 6.9% and 11.9% of them were wasted and underweight, respectively, based on WHO Z score <-2. Children live in mother-headed households which often use unprotected sources of water and children who did not get minimum dietary diversity were more likely to be stunted compared to their counterparts. Children residing in rural residences, being a male child, having less power for mother decision-making, presence of diarrhea in the last 2 weeks of the survey and who did not get the minimum dietary diversity were found to be significant determinants of underweight. Children living rural, male sex, their order of birth being 5th and above and who had not got the minimum meal frequency were more likely to be wasted than their counterparts. CONCLUSION AND RECOMMENDATION: Undernutrition has a high prevalence in under-5-year-old children of Wolaita district. Under nutrition was associated with female-headed households, unprotected sources of water, below the minimum dietary diversity, rural residence, participation of mother in decision-making, presence of diarrhea, and minimum meal frequency. Thus, nutritional intervention programs in Wolaita district in Ethiopia should focus on these factors.

Child development and nutritional status in 12-59 months of age in resource limited setting of Ethiopia.

BACKGROUND: Early years of life are period of maximal growth and development of human brain. Development of young child is influenced by biological endowment and health of child, nutritional status of child, relationships with primary caregivers, family, and support systems in the community. This study was aimed to assess childhood development in relation to their nutritional status. METHOD: Community-based cross-sectional study was employed. Multi-stage systematic random sampling technique was used to select 626 children aged 12-59 months with mother/caregivers' pairs in Wolaita district in 2015. Child development assessment was done using third edition of age and stage questionnaire. Height and weight were measured by trained data collectors then the WHO Anthro version 3.2.2 software was used to convert nutritional data indices. Data were entered into Epi-info version 3.3.5 and was exported and analyzed using STATA version 14. Correlation and multiple logistic regression were used. RESULT: High risk of developmental problem in children were 19.0% with 95% CI (16.06%, 22.3%), and it is expressed as communication 5.8%, gross motor 6.1%, fine motor 4.0%, personal social 8.8%, and problem solving 4.1%. One-third (34.1%) of the study participants were stunted while 6.9% and 11.9% of them were wasted and underweight respectively. Weight-for-age (WAZ) and height-for-age positively correlated with all five domains of development, i.e., with communication, gross motor, fine motor, personal social, and problem solving (r = 0.1 - 0.23; p < 0.0001, and r = 0.131 - 0.249; p < 0.0001) respectively. CONCLUSION AND RECOMMENDATION: Overall child development was directly related with nutritional status. So, available resources should be offered to decrease children undernutrition. Further assessment on childhood development of children is necessary.

Community's Perception and Attitude towards People with Epilepsy in Ethiopia.

INTRODUCTION: Most people with epilepsy suffer from a dual burden. In one hand, they struggle with the symptoms and disabilities on the other hand from misconceptions and stigma associated with it. But there are no recent studies which assess the community's perception and attitude. OBJECTIVE: To assess the perception and attitude of the community towards people with epilepsy and identify associated factors. METHODS: A community-based cross-sectional study was conducted in South Ethiopia from a total of 701 participants. Data were collected with face to face interview using a structured questionnaire developed based on the Health Belief Model (HBM). Data were presented with frequencies, tables, and figures. Univariate and multivariable logistic regression was done to identify significantly important variables. The presence of association was presented by odds ratio and 95% confidence interval. Ethical clearance was obtained from Wolaita Sodo University. RESULTS: The most frequently mentioned perceived causes for epilepsy were stress (91%), substance use (61.8%), and bad spirit (49.8%) while loss of consciousness and falling (80.7%) and sleep problems (78%) were considered symptoms of epilepsy. Only 13.1% of the participants think that they may be susceptible for epilepsy. Six hundred sixty (94.2%) participants will not employ a person with epilepsy while only 47 (6.7%) of the participants will allow a family member to marry a person with epilepsy. In multivariable analysis, understanding the illness as a medical problem was associated with perceived susceptibility and perceived benefit of modern treatment was significantly associated with having a current medical problem. CONCLUSIONS: The knowledge about the cause, possible susceptibility, better treatment options, and attitude of the participants were similar to other low-income settings. The negative attitude was high and multidimensional. All stakeholders must work to increase awareness about the cause, symptoms, and treatment options for epilepsy and to decrease the negative attitude of the community.

Incidence of Post-Traumatic Stress Disorder After Road Traffic Accident.

Background: Post-traumatic stress disorder (PTSD) occurs after exposure to actual or threatened death, serious injury, or sexual violence. Road traffic accident (RTA) is one of the traumatic experiences, which may result in PTSD. But treatment is mainly concentrated on physical health. This may be due to a lack of evidence in low-income countries. Aim: To determine the incidence level and identify risk factors of PTSD after RTA. Methods: Longitudinal panel study was done to assess the incidence of PTSD after RTA. The study was conducted in three orthopedic settings of Bahir Dar town Northwest, Ethiopia. The study was on 299 adult car accident survivors. PTSD Checklist (PCL) civilian version, Sheehan disability assessment scale, Patient Health Question (PHQ-2), and Alcohol Use Disorder Identification Test (AUDIT) were instruments to assess the outcome and associated factors. The generalized linear model with Poisson log-linear method was applied to identify associated factors. Ethical clearance was obtained from Bahir Dar University. Individuals with PTSD symptoms were linked to the psychiatric clinic. Result: One hundred thirty-nine (46.5%) participants had at least three extremely severe symptoms that fulfil criteria B, C, and D of Diagnostic Statistical Manual IV of PTSD. The most frequent severe symptoms were having repeated, disturbing memories, thoughts, or images. Two hundred ten (70.2%) participants reported the extreme impact of the accident on work or schooling and 156 (51.9%) reported extreme problems in social functioning. Alcohol dependence, hazardous alcohol consumption, and harmful use were reported by 7.9%, 15.1%, and 4.7% of the participants, respectively. In the final model witnessing death, severe sleep problem and severe impairment in family functioning were significantly associated with PTSD. Conclusion: Nearly half of RTA survivors develop PTSD. Clinicians need to link these patients to the psychiatry clinic. Special attention should be given to patients who witnessed death, with a serious disability, and previous psychiatric history.

Help seeking behavior for problematic substance uses in north-West Ethiopia.

BACKGROUND: Substance miss use and neuro-psychiatric conditions are a growing public health challenges, but 76 to 85% of people with those disorders in low and middle-income countries did not receive treatment. The aim of this study was to see help seeking behavior and determinant factors in residents with problematic substance uses. METHODS: A total of 2400 participants had screened for problematic substance uses and 548 participants were found positive for problematic substance uses. Then, we had interviewed 548 participants for help seeking behavior by pre-tested modified General Help Seeking Questionnaire. Logistic regression with its corresponding p-value < 0.05; Adjusted odds ratios (AOR) and 95% confidence intervals (CI) have been used. RESULTS: Among five hundred and forty-eight participants with problematic substance use, only one hundred and sixty-eight (30.7%) with 95% CI (27, 35%) had sought help. Age above 35 years [AOR = .47 95% CI (.25, .90)], who had common mental disorders [AOR = 4.12, 95% CI (2.7, 6.3)], who had comorbid medical condition [AOR = 3.0, 95% CI (1.7, 5.3)], and grand-families' history of substance use [AOR = 2.18, 95% CI (1.4, 3.4)] were significantly associated with help seeking behavior. CONCLUSION: Help-seeking behavior was infrequent in people with problematic substance use. Advanced age was a barrier to seek help while medical illnesses, common mental disorders and history of substance use in grand families were found to enforce to seek help.

Multidimensional impact of severe mental illness on family members: systematic review.

OBJECTIVE: The impact of severe mental illnesses (SMIs) is not limited to the person with the illness but extends to their family members and the community where the patient comes from. In this review, we systematically analyse the available evidence of impacts of SMI on family members, including parents, grandparents, siblings, spouses and children. DATA SOURCES: PubMed, PsycINFO, Embase and Global Index Medicus were searched from the inception of each database up to 9 November 2019. We also did manual searches of grey literature. ELIGIBILITY CRITERIA: We included studies that assessed the impacts of SMI on any family member. We excluded studies in admitted clinics and acute wards to rule out the acute effect of hospitalisation. DATA EXTRACTION: Two reviewers extracted data independently using the Cochrane handbook guideline for systematic reviews and agreed on the final inclusion of identified studies. RISK OF BIAS: The quality of the included studies was assessed using effective public health practice project quality assessment tool for quantitative studies.The review protocol was registered in the PROSPERO database. RESULTS: We screened a total of 12 107 duplicate free articles and included 39 articles in the review. The multidimensional impact of SMI included physical health problems (sleeplessness, headache and extreme tiredness.), psychological difficulties (depression and other psychological problems) and socioeconomic drift (less likely to marry and higher divorce rate and greater food insecurity). Impacts on children included higher mortality, poor school performance and nutritional problems. However, the quality of one in five studies was considered weak. CONCLUSIONS: Our review indicated a high level of multidimensional impact across multiple generations. The serious nature of the impact calls for interventions to address the multidimensional and multigenerational impact of SMI, particularly in low/middle-income countries. Given the relatively high number of studies rated methodologically weak, more robust studies are indicated. PROSPERO REGISTRATION NUMBER: CRD42018064123.

Prevalence and correlates of post-traumatic stress disorder among survivors of road traffic accidents in Ethiopia.

BACKGROUND: Post-traumatic stress disorder is the most common mental disorders occurring among survivors of road traffic accident. However, research into post-traumatic stress disorder and correlates in low and middle-income countries is limited. To the best of our knowledge, there is no published study of the post-traumatic stress disorder and associated factors conducted in Ethiopia. Therefore, this study aimed to determine the prevalence of post-traumatic stress disorder and associated factors among survivors of road traffic accident. METHODS: Institution based cross-sectional study was conducted in May 2016. Data were collected using a pretested, structured, standardized post-traumatic stress disorder Checklist-Specific version (PCL-S) questionnaire. Systematic sampling technique was used to select the study participants. Binary logistic regression analysis was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength of associations. RESULTS: The prevalence of post-traumatic stress disorder was found to be 22.8% (CI 19.2, 26.6) among survivors of road traffic accident. In the multivariable analysis, Being female [AOR = 2.23, 95% CI 1.40, 3.56], having poor social support [AOR = 2.1, 95% CI 1.34, 3.46], duration since accident (1-3 months) [AOR = 1.72, 95% CI 1.07, 2.76] and having depression [AOR = 3.46, 95% CI 1.99, 5.99] were significantly associated with PTSD among survivors of road traffic accident. CONCLUSION: In the current study the magnitude of post-traumatic stress disorder was high. Being female, poor social support, duration since the accident (1-3 months) and depression were found to be significant predictors of post-traumatic stress disorders. The finding suggests a need for early screening for post-traumatic disorder among survivors of road traffic accidents.

Health care seeking behavior for depression in Northeast Ethiopia: depression is not considered as illness by more than half of the participants.

BACKGROUND: Depression is one of the most disabling and chronic mental illnesses. Despite its high burden, many people suffering from depression did not perceive that they had a treatable illness and consequently most of them did not seek professional help. The aim of this study was to assess the level of professional help-seeking behavior and associated factors among individuals with depression. METHODS AND MATERIALS: The community-based cross-sectional study was conducted among residents of Dessie, Northeast Ethiopia. First, 1165 residents were screened for depression using patient health questionnaire and then 226 individuals who were screened positive for probable depression were interviewed with General Help-Seeking Questionnaire to assess the professional help-seeking behavior of participants with depression. Major associated variables were identified using logistic regression with 95% confidence interval (CI), and variables with a p value less than 0.05 were considered statistically significant. RESULTS: Among the total participants with depressive symptoms, only 25.66% of them did seek professional help. Being female [adjusted odds ratio (AOR) = 2.769, 95% CI (1.280, 5.99)], current alcohol drinking [AOR = 2.74, 95% CI (1.265, 5.940)], co-morbid medical-surgical illness [AOR = 4.49, 95% CI (1.823, 11.071)], perceiving depression as illness [AOR = 2.44, 95% CI (1.264, 4.928)], having moderate depressive symptoms [AOR = 2.54, 95% CI (1.086, 5.928)] and moderately severe depressive symptoms [AOR = 7.67, 95% CI (2.699, 21.814)] were significantly associated with help seeking behavior of participants. CONCLUSIONS: Level of professional help-seeking behavior is as low as previous studies in different countries. The severity of depressive symptoms, co-morbidity of medical-surgical illness, current drinking of alcohol, being female, and perceiving depression as illness were significantly associated with professional help-seeking behavior for depressive symptoms. Working on mental health literacy in the community is important to increase help-seeking behavior.