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Training primary health care workers in mental health and its impact on diagnoses of common mental disorders in primary care of a developing country, Malawi: a cluster-randomized controlled trial

Published online by Cambridge University Press:  31 May 2013

F. Kauye ,
R. Jenkins  and
A. Rahman
F. Kauye*
Affiliation:
College of Medicine, Blantyre, Malawi
R. Jenkins
Affiliation:
WHO Collaborating Centre, Institute of Psychiatry, King's College London, London, UK
A. Rahman
Affiliation:
Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
*
*Address for correspondence: F. Kauye, Ph.D., College of Medicine, Blantyre, Malawi. (Email: [email protected])
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Abstract

Background

Mental health problems are common in primary care, with prevalence rates of up to 40% reported in developing countries. The study aim was to evaluate the impact of a specially designed toolkit used to train primary health care (PHC) workers in mental health on the rates of diagnosed cases of common mental disorders, malaria and non-specific musculoskeletal pains in primary care in Malawi.

Method

Clinics with out-patient services in the designated district were randomly divided into control and intervention arms. Using a two-phase sampling process, Self-Reporting Questionnaire scores, data on diagnoses made by PHC workers and results of the Structured Clinical Interview for DSM-IV for depression were collected from 837 consecutively attending adult patients in the pre-intervention study and 2600 patients in the post-intervention study.

Results

The point prevalence rates for probable common mental disorder and depression were 28.8% and 19%, respectively. Rates for both anxiety and depression diagnoses by PHC workers at baseline were 0% in both arms. Following training, there were significant differences between the two arms in the rates of diagnosed cases of depression [9.2% v. 0.5%, odds ratio (OR) 32.1, 95% confidence interval (CI) 7.4–144.3, p ⩽ 0.001], anxiety (1.2% v. 0%, p ⩽ 0.001) and malaria (31% v. 40%, OR 0.62, 95% CI 0.43–0.89, p = 0.01). The intervention arm had more cases diagnosed with depression and anxiety while the control arm had more cases diagnosed with malaria.

Conclusions

Training of PHC workers in mental health with an appropriate toolkit will contribute significantly to the quality of detection and management of patients seen in primary care in developing countries.

Keywords

Common mental disordersmalarianon-specific musculoskeletal painsprimary health care workerstraining
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 3 , February 2014 , pp. 657 - 666
Copyright
Copyright © Cambridge University Press 2013 

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References

Bass, J, Neugebauer, R, Clougherty, K, Verdeli, H, Wickramaratne, P, Ndogoni, L, Speelman, L, Weissman, M, Bolton, P (2006). Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes. British Journal of Psychiatry 188, 567–573.Google Scholar
Bowie, C (2006). The burden of diseases in Malawi. Malawi Medical Journal 18, 103–110.Google Scholar
Cohen, A (2001). The effectiveness of mental health services in primary care: the view from the developing world. Geneva: World Health Organization (http://www.who.int/mental_health/media/en/50.pdf). Accessed February 2009.Google Scholar
Collins, PY, Patel, V, Joestl, SS, March, D, Insel, TR, Daar, AS; Scientific Advisory Board and the Executive Committee of the Grand Challenges on Global Mental Health, Anderson, W, Dhansay, MA, Phillips, A, Shurin, S, Walport, M, Ewart, W, Savill, SJ, Bordin, IA, Costello, EJ, Durkin, M, Fairburn, C, Glass, RI, Hall, W, Huang, Y, Hyman, SE, Jamison, K, Kaaya, S, Kapur, S, Kleinman, A, Ogunniyi, A, Otero-Ojeda, A, Poo, MM, Ravindranath, V, Sahakian, BJ, Saxena, S, Singer, PA, Stein, DJ (2011). Grand challenges in global mental health. Nature 475, 27–30.CrossRefGoogle ScholarPubMed
Dhadphale, A, Ellison, AH, Griffin, L (1983). Frequency of psychiatric disorders among patients attending semi-urban and rural general out-patient clinics in Kenya. British Journal of Psychiatry 142, 379–388.Google Scholar
Goldberg, D, Gater, R (1996). Implications of the World Health Organization study of mental illness in general health care for training primary care staff. British Journal of General Practice 46, 483–485.Google ScholarPubMed
Jenkins, R, Kiima, D, Njenga, F, Okonji, M, Kingora, J, Kathuku, D, Lock, S (2010 a). Integration of mental health into primary care in Kenya. World Psychiatry 9, 118–120.CrossRefGoogle ScholarPubMed
Jenkins, R, Kiima, D, Okonji, M, Njenga, F, Kingora, J, Lock, S (2010 b). Integration of mental health into primary care and community health working in Kenya: context, rationale, coverage and sustainability. Mental Health in Family Medicine 7, 37–47.Google ScholarPubMed
Ministry of Health and Population (2003). Malawi Health Management Information Bulletin, Special Issue 2002. Health Management Information Unit, Ministry of Health, Lilongwe, Malawi.Google Scholar
National Statistical Office of Malawi (2008). Population and Housing Census Preliminary Report, 2008 (http://www.nso.malawi.net/images/stories/data_on_line/demography/census_2008/Main%20Report/Census%20Main%20Report.pdf). Accessed May 2009.Google Scholar
Ndetei, D (2008). Mental healthcare programs in Kenya: challenges and opportunities. International Psychiatry 5, 31–32.Google Scholar
Ngoma, MC, Prince, M, Mann, A (2003). Common mental disorders among those attending primary health clinics and traditional healers in urban Tanzania. British Journal of Psychiatry 183, 349–355.CrossRefGoogle ScholarPubMed
Prince, M, Patel, V, Saxena, S, Maj, M, Maselko, J, Phillips, M, Rahman, A (2007). No health without mental health. Lancet 370, 859–879.Google Scholar
Rahman, A, Malik, A, Sinkander, S, Roberts, C, Creed, F (2008). Cognitive behavioural therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster controlled randomised trial. Lancet 372, 902–909.CrossRefGoogle Scholar
Stewart, RC, Kauye, F, Umar, E, Vokhiwa, M, Bunn, J, Fitzgerald, M, Tomenson, B, Rahman, A, Creed, F (2009). Validation of a Chichewa version of the Self-Reporting Questionnaire (SRQ) as a brief screening measure for maternal depressive disorder in Malawi, Africa. Journal of Affective Disorders 112, 126–134.Google Scholar
Stewart, RC, Umar, E, Kauye, F, Bunn, J, Vokhiwa, M, Fitzgerald, M, Tomenson, B, Rahman, A, Creed, F (2008). Maternal common mental disorder and infant growth – a cross-sectional study from Malawi. Maternal and Child Nutrition 4, 209–219.CrossRefGoogle ScholarPubMed
Ustün, TB (1999). The global burden of mental disorders. American Journal of Public Health 89, 1315–1319.Google Scholar
Vermani, M, Marcus, M, Katzman, M (2011). Rates of detection of mood and anxiety disorders in primary care: a descriptive, cross-sectional study. Primary Care Companion for CNS Disorders 13. Published online 28 04 2011 . doi:10.4088/PCC.10m01013.Google Scholar
WHO (2005). Mental Health Atlas. WHO: Geneva.Google Scholar
WHO UK Collaborating Centre (2003–2004). WHO Guide to Mental and Neurological Health in Primary Care: (http://www.mentalneurologicalprimarycare.org/downloads.asp). Accessed May 2009.Google Scholar