Pathways to care for psychosis in Malawi.

People with psychosis in Malawi have very limited access to timely assessment and evidence-based care, leading to a long duration of untreated psychosis and persistent disability. Most people with psychosis in the country consult traditional or religious healers. Stigmatising attitudes are common and services have limited capacity, particularly in rural areas. This paper, focusing on pathways to care for psychosis in Malawi, is based on the Wellcome Trust Psychosis Flagship Report on the Landscape of Mental Health Services for Psychosis in Malawi. Its purpose is to inform Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE), a longitudinal study that aims to build on existing services to develop sustainable psychosis detection systems and management pathways to promote recovery.

Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) protocol.

Malawi has a population of around 20 million people and is one of the world's most economically deprived nations. Severe mental illness (largely comprising psychoses and severe mood disorders) is managed by a very small number of staff in four tertiary facilities, aided by clinical officers and nurses in general hospitals and clinics. Given these constraints, psychosis is largely undetected and untreated, with a median duration of untreated psychosis (DUP) of around six years. Our aim is to work with people with lived experience (PWLE), caregivers, local communities and health leaders to develop acceptable and sustainable psychosis detection and management systems to increase psychosis awareness, reduce DUP, and to improve the health and lives of people with psychosis in Malawi. We will use the UK Medical Research Council guidance for developing and evaluating complex interventions, including qualitative work to explore diverse perspectives around psychosis detection, management, and outcomes, augmented by co-design with PWLE, and underpinned by a Theory of Change. Planned deliverables include a readily usable management blueprint encompassing education and community supports, with an integrated care pathway that includes Primary Health Centre clinics and District Mental Health Teams. PWLE and caregivers will be closely involved throughout to ensure that the interventions are shaped by the communities concerned. The effect of the interventions will be assessed with a quasi-experimental sequential implementation in three regions, in terms of DUP reduction, symptom remission, functional recovery and PWLE / caregiver impact, with quality of life as the primary outcome. As the study team is focused on long-term impact, we recognise the importance of having embedded, robust evaluation of the programme as a whole. We will therefore evaluate implementation processes and outcomes, and cost-effectiveness, to demonstrate the value of this approach to the Ministry of Health, and to encourage longer-term adoption across Malawi.

Systematic mapping on availability, extent and distribution of mental health research in Malawi.

Background: Mental health research is essential in the implementation of evidence-based interventions. This can be impeded by unavailability or limited access to local evidence in low- and middle-income countries (LMICs) such as Malawi. Aim: The aim of this systematic mapping was to describe the availability, extent and distribution of mental health research conducted in Malawi. Setting: The study was conducted at Kamuzu University of Health Sciences in Malawi. Methods: A systematic search of four electronic databases from inception to September 2021 was carried out. All published and unpublished mental health studies in all languages were eligible for inclusion. Studies were screened against inclusion and exclusion criteria, and data were extracted, analysed and presented in tables and as a narrative synthesis. Results: Cross-sectional studies (33.6%, n = 76) were found to be the most common study design for mental health research in Malawi. More studies were conducted on women (21.2%, n = 48) compared to men (1.3%, n = 3). Mental health research was concentrated in the southern region of the country (44.8%, n = 120) and in the three cities of Lilongwe (17.9%, n = 48), Blantyre (16.4%, n = 44) and Zomba (9.0%, n = 24). Conclusion: This systematic mapping suggests that there are few studies on mental health in Malawi which are not equally distributed across the country. There is a pressing need to conduct more mental health research using robust designs across disciplines. Contribution: Research on mental health is urgently needed to produce culturally acceptable data in Malawi.

Prevalence and associated factors of intimate partner violence amongst women attending prevention of mother to child transmission services in Blantyre, Malawi.

BACKGROUND: Intimate partner violence (IPV) during the perinatal period and when one is HIV-positive is a great concern because of the physical and mental impacts it has on health and on adherence to prevention of mother to child transmission (PMTCT) services. However, factors associated with IPV amongst perinatal women on PMTCT services are not adequately explored in Malawi. The aim of this study was to estimate the various types of IPV and the associated factors amongst HIV-positive pregnant and postnatal women in selected health centres in Blantyre district. METHODS: In this cross-sectional study, we recruited 200 HIV-positive women from antenatal, postnatal and antiretroviral therapy (ART) clinics from four selected primary care facilities of Blantyre district. Data were collected between March and May 2018. RESULTS: A total of 50% of the participants reported to have experienced either physical, psychological or sexual violence from their partner in the last 12 months. The multivariate logistic regression model showed that feelings about safety of the relationship and depression were the only factors that were consistently associated with IPV in the last 12 months (p = 0.001, Pseudo R2 = 0.20). CONCLUSION: The presence of depression and safety concerns amongst our study participants calls for serious prioritisation of psychological interventions and risk assessment in the management of HIV-positive perinatal mothers who report IPV cases.

Impact of HIV and AIDS on the eldery: a case study of Chiladzulu district.

UNLABELLED: HIV may affect the elderly in a number of ways. They may become infected themselves; their children may suffer prolonged illness and incapacity, and need the elderly to look after them; the same children may then die from the illness, leaving the elderly without the support of the next generation; this bereavement also leaves the older people to meet funeral costs and then to take care of orphans left behind. HIV has impacts on old people in ways that are social, economic, psychological and physical in nature. AIMS: We wanted to understand the socio-economic impacts of HIV/ AIDS on lives of older people following the death of their productive children, and to examine how the elderly struggle to take care of HIV/AIDS orphans. While it is generally appreciated that older people undergo such hardships, little research has been done in Malawi to unravel the magnitude of thes problems. We hope that our findings will increase awareness and lead to more being done to alleviate the problems faced by older people as a result of HIV/AIDS. RESULTS: The results reveal that older people have no alternative but to provide care and support to their ill children, and following the death of their children to become parents again in taking care of the orphaned grandchildren. This is a particularly big challenge in a country like Malawi, dependent on hand-hoeing for subsistence agriculture, where food production requires people who are physically strong. 79% of older people taking care of HIV/AIDS patients or orphans were found to have limited or no information about HIV/AIDS. 31% were dependent on relatives for support, while 69% sustained themselves through piece work, small business or farming. CONCLUSION: Elderly people need more resources and assistance to enable them to fulfil their vital role in caring for HIV-AIDS orphans. They are also in critical need of more information about HIV-AIDS, as many are sexually active with multiple partners, and preventive information is currently not reaching this important section of the community.

Impact of HIV and AIDS on the Eldery: A Case Study of Chiradzulu District

HIV may affect the elderly in a number of ways. They may become infected themselves; their children may suffer prolonged illness and incapacity; and need the elderly to look after them; the same children may then die from the illness; leaving the elderly without the support of the next generation; this bereavement also leaves the older people to meet funeral costs and then to take care of orphans left behind. HIV has impacts on old people in ways that are social ; economic; psychological and physical in nature.Aims :We wanted to understand the socio-economic impacts of HIV/ AIDS on lives of older people following the death of their productive children; and to examine how the elderly struggle to take care of HIV/AIDS orphans. While it is generally appreciated that older people undergo such hardships; little research has been done in Malawi to unravel the magnitude of these problems. We hope that our findings will increase awareness and lead to more being done to alleviate the problems faced by older people as a result of HIV/AIDS. Results : The results reveal that older people have no alternative but to provide care and support to their ill children; and following the death of their children to become parents again in taking care of the orphaned grandchildren. This is a particularly big challenge in a country like Malawi; dependent on hand-hoeing for subsistence agriculture; where food production requires people who are physically strong. 79of older people taking care of HIV/AIDS patients or orphans were found to have limited or no information about HIV/AIDS. 31were dependent on relatives for support; while 69sustained themselves through piece work; small business or farming. Conclusion: Elderly people need more resources and assistance to enable them to fulfil their vital role in caring for HIV-AIDS orphans. They are also in critical need of more information about HIV-AIDS; as many are sexually active with multiple partners; and preventive information is currently not reaching this important section of the community

A little knowledge: caregiver burden in schizophrenia in Malawi.

OBJECTIVE: To determine the relationship between schizophrenia knowledge and burden of care among caregivers of people with schizophrenia in Mzuzu, Malawi. METHOD: We recruited 90 patients and 90 caregivers to a randomized, controlled trial of group caregiver education in schizophrenia. At baseline, we administered the Family Questionnaire, which measures caregivers' knowledge of biomedical and psychosocial aspects of schizophrenia. We measured caregiver burden with the Involvement Evaluation Questionnaire. Using multivariate analysis, we examined the relationship between knowledge and burden, controlling for other patient and caregiver variables. We hypothesised that knowledge and burden would be inversely related. RESULTS: Caregiver burden was associated with knowledge (p = 0.001), but contrary to our hypothesis, greater knowledge was associated with greater burden. CONCLUSION: In this population, knowledge about schizophrenia was associated with higher caregiver burden. This does not prove that knowledge causes burden, but suggests that cultural factors may mediate the relationship between knowledge and burden, and that care is needed when introducing caregiver education in new cultures.

Insight, psychopathology and global functioning in schizophrenia in urban Malawi.

Insight, psychopathology and functioning are related in schizophrenia, but it is unclear whether insight relates independently to functioning after controlling for psychopathology. Equally, any such relationship may vary culturally. We investigated the relationship between insight, psychopathology and functioning in 60 patients with schizophrenia in Mzuzu, a town in Malawi. After controlling for psychopathology, functioning was associated with the ;symptom relabelling' dimension of insight (P=0.01). This preliminary finding suggests that symptom-focused psychoeducation might be appropriate for African patients with schizophrenia.