Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial.

BACKGROUND: Care of people with serious mental illness in prayer camps in low-income countries generates human rights concerns and ethical challenges for outcome researchers. Aims To ethically evaluate joining traditional faith healing with psychiatric care including medications (Clinical trials.gov identifier NCT02593734). METHOD: Residents of a Ghana prayer camp were randomly assigned to receive either indicated medication for schizophrenia or mood disorders along with usual prayer camp activities (prayers, chain restraints and fasting) (n = 71); or the prayer camp activities alone (n = 68). Masked psychologists assessed Brief Psychiatric Rating Scale (BPRS) outcomes at 2, 4 and 6 weeks. Researchers discouraged use of chaining, but chaining decisions remained under the control of prayer camp staff. RESULTS: Total BPRS symptoms were significantly lower in the experimental group (P = 0.003, effect size -0.48). There was no significant difference in days in chains. CONCLUSIONS: Joining psychiatric and prayer camp care brought symptom benefits but, in the short-run, did not significantly reduce days spent in chains. Declaration of interest None.

Provider knowledge about emergency contraception in Ghana.

In 1996, the Ministry of Health in Ghana included emergency contraception (EC) in its newly issued National Reproductive Health Service Policy and Standards. A short survey was conducted in the summer of 1997 to evaluate health providers' knowledge of EC. Of the 325 providers interviewed, about one-third (34%) had heard of EC. No provider had sufficient knowledge to prescribe EC correctly. A well-coordinated training programme for providers will have to precede successful introduction of EC in Ghana. Moreover, a dedicated product may be critical for the successful introduction of EC in a country like Ghana, where provider knowledge is low.

PIP: In 1996, the Ministry of Health in Ghana included emergency contraception (EC) in its newly issued National Reproductive Health Service Policy and Standards. This paper reports a short survey conducted to evaluate the success of these early efforts to introduce EC into Ghana and evaluate health providers' knowledge of EC. Short structured interviews were conducted with health care providers at a sample of family planning outlets in two regions of Ghana. Findings revealed that health providers' knowledge about EC is low. Out of the 325 people interviewed, only about one-third (34%) had heard of EC. Furthermore, no provider had sufficient knowledge to prescribe EC correctly. Two policy implications can be drawn from this research: 1) well coordinated training of providers will have to precede a successful introduction of EC in Ghana; 2) a dedicated product may be critical for the successful introduction of EC, where providers' knowledge is low.

Syndromic management of urethral discharge in Ghanaian pharmacies.

OBJECTIVES: To evaluate the training of pharmacists in Accra, Ghana, in the syndromic management of STIs. METHODS: We randomly selected 50 pharmacy outlets that had received the training (intervention) and 50 outlets that had not received the training (no intervention). Simulated clients described the symptoms of urethral discharge to the first pharmacy staff encountered and completed a standardised questionnaire after each encounter. RESULTS: Correct drug provision for urethral discharge improved with the educational intervention but remained relatively low (no intervention 18%; intervention 39%; p < 0.05). More encouraging, treatment for gonorrhoea was usually correct without the intervention (64%) and improved further in the intervention outlets (76%). The treatment for chlamydia was less often appropriate but also improved (31% and 41%). Condom promotion was poor, with almost no outlets offering condoms. CONCLUSIONS: The current training led to improvements in the treatment of urethral discharge. Future training needs to be improved, especially with regard to condom promotion. Moreover, since less than one third of simulated clients were seen by pharmacists, the training should be expanded to other pharmacy staff. With enhanced training of all pharmacy staff, the role of pharmacy outlets in STI management and prevention in Ghana and elsewhere can be optimised.