BackgroundMental illness may cause a variety of psychosocial problems such as decreased quality of life of the patient’s family members as well as increased social distance for the patient and the family caring for the patient. Psychosocial challenges are enhanced by the stigma attached to mental illness, which is a problem affecting not only the patient but also the family as a whole. Coping mechanisms for dealing with mentally ill patients differ from one family to another for a variety of reasons.The aim of the study was to determine the psychosocial problems of mental illness on the family including the coping strategies utilized by family members caring for a person with mental illness.MethodA qualitative study was conducted, involving four focus group discussions and 2 in-depth interviews of family members who were caring for patient with mental illness at Temeke Municipality, Dar es Salaam. Purposive sampling procedure was used to select participants for the study. Audio-recorded interviews in Swahili were conducted with all study participants. The recorded interview was transcribed and qualitative content thematic analysis was used to analyse the data.ResultsFinancial constraints, lack of social support, disruption of family functioning, stigma, discrimination, and patients’ disruptive behaviour emerged as the main themes in this study. Acceptance and religious practice emerged as the major coping strategies used by family members.ConclusionFamilial care for a person with mental illness has its advantages, yet it has multiple social and psychological challenges. Coping strategies and skills are important for the well-being of the caregiver and the patient. Addressing these psychosocial challenges requires a collaborative approach between the health care providers and government so that the needs of the family caregivers and those of the patients can be addressed accordingly.

BackgroundLow and middle income countries face many challenges in meeting mental health needs in their regions. Treatment of patients with mental disorders is inadequate in most of these countries and majority of individuals with severe mental disorders remain untreated. The bad news is that mental health problems in these countries are on the rise due to socioeconomic challenges being faced. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. This study aimed at exploring mental health care and delivery system at Temeke district hospital, and how services were organized to meet the increasing mental health needs of its population.MethodsA qualitative study was conducted at Temeke hospital in Dar es Salaam, involving 7 in-depth interviews with mental health care providers, 7 in-depth interviews with mentally ill patients, and 2 focus group discussions with caregivers. A convenient sampling procedure was used to select participants for the study. All interviews were audio-recorded in Kiswahili and transcribed. A qualitative Content Analysis was used to analyze data after translation with the aid of Nvivo 10 software.ResultsThree main themes were identified. These were resource challenges, environmental/system challenges, and satisfaction with mental health services. Temeke health facility faced resource and environmental/system challenges, and there were mixed feelings on satisfaction with services. Funding and priority issues were found to mainly affect delivery of appropriate services to clients.ConclusionHealth facilities that provide mental health services in the community need to be well equipped with necessary resources to meet the vast needs of people they serve. Having a political will, improving the health systems governance for mental health, and priority setting, are necessary to address the challenges experienced in the delivery of mental health services.

Young adults face unemployment-related challenges, particularly in low- and middle-income countries. Self-employment is encouraged by the Tanzanian government and international institutions such as the World Bank. It has been found that young adults who are employed or self-employed show more functional independence and less inequality and social polarization, as well as a decrease in deviant behaviour. However, limited knowledge and skills related to entrepreneurial activities contribute to lack of motivation towards self-employment among young adults. In order to examine these behaviours, an intervention study implementing an entrepreneurship and beekeeping training in Dar es Salaam, Tanzania was conducted. After completion of the intervention, a qualitative study was conducted that used focus group discussions (FGDs) to explore the experiences and changes in behaviour of young adults following the intervention. A total of 36 of the original 57 young adults from four camps who fully participated in the four arms of interventions were recruited. Qualitative content analysis was used to analyze the FGD data. Three themes emerged from the findings: establishment and maintenance of an entrepreneurial business, changes in behaviour, and perceived challenges. Improved entrepreneurial skills, customer care, and financial management were expressed as positive changes the participants attained relating to business management. Similarly, changes in the participants’ behaviours, attitudes, and lifestyle practices led to improved health and increased recognition and respect in their communities. Insufficient start-up capital and long intervals between sessions were the main challenges. The study showed an improvement in the ability of the participants to generate the human, social, and financial capital prerequisite to business development. Increase in customer care, social capital and financial management are key factors for successful microbusiness activities for stable self-employment.

BackgroundManagement of patients with mental disorders is inadequate in the majority of low and middle income countries. The main treatment modality for patients with severe mental disorders in these countries is mainly pharmacological approach. Patients face many challenges in meeting medication needs. In this context, high percentages of individuals who have severe mental disorders are not treated. Regular and adequate supplies of appropriate, safe and affordable medications are some of the important aspects required for provision of quality mental health services. Psychotropic medications are an important component of holistic care that provides treatment options for those suffering from mental illnesses. In Tanzania, mental health services face many challenges including inadequate mental health care providers, infrastructure, and medication supply. Relapse is a common problem among patients attending mental health facilities. This study is aimed at exploring views and experiences of patients, caregivers and mental health care providers on the psychotropic medication in Dar es Salaam, TanzaniaMethodsA qualitative study was conducted, involving two focus group discussions with seven and nine caregivers in each group. Eleven in-depth interviews with four patients and seven mental health care providers at Temeke Municipality, Dar es Salaam, were conducted. Convenient sampling procedure was used to select participants for the study. Discussion and interview guides were used during data collection. Interviews were audio-recorded in Kiswahili with all study participants. The recorded interviews were transcribed and qualitative content thematic analysis was used to analyze data after translation.ResultsFour themes were identified. These include attitudes of patients towards psychotropic medication, availability of psychotropic medications, financial concerns towards psychotropic medications, and coverage of free treatment policy.ConclusionThe availability and affordability of psychotropic medications to patients are big problems. This was partly attributed to insufficient funds to support the budget of health facilities and technical challenges contributed by both the health facilities and other stakeholders. To improve mental health services in the country, it is important to ensure adequate supply of psychotropic medications in the health facilities. Access to psychotropic medications is essential in addressing the public health problem of untreated mental illnesses. These findings call for the government and other stakeholders to increase funding for essential psychotropic medications.

Background. Promoting mental health and care in the community setting leads to the recovery of patients with mental illness. Although recovery in mental health is a complex phenomenon, caregivers and community members have important roles to play in the recovery process for patients with mental illness. Little is documented on how recovery is promoted in the community setting. This study explored the experience of patients, caregivers, and community members on how recovery can be realized in a patient with severe mental illness in Dar es Salaam. Methods. We conducted four focus group discussions (FGDs): two with caregivers and the other two with community members. Also, six in-depth interviews were held with patients with mental illness. Participants were purposively selected based on the type of information needed. Both FGD and in-depth interviews were digitally recorded and transcribed. Qualitative content analysis was used to analyze data. Findings. Four themes emerged from this study, which include promoting patients’ participation in household activities, improving patients’ support system, promoting patients’ self-care management, and providing safety and protection among patients with mental illness. However, financial, psychological, and establishing care and support centers and professional supports emerged as subthemes from patients’ support system. Conclusion. Caregivers and community members are significant stakeholders for promoting recovery for people with mental illness. The current study reveals that patients’ involvement in home activities, promoting self-care management, improving patients’ support systems, and providing safety and protection are important factors that promote recovery for people with mental illness. Advocating mental health awareness for caregivers and community members will bridge the gap to enhance the recovery for people with mental illness. Further research is needed in this area to explore the health care providers’ perspectives on the recovery process of mental illness in the hospital setting.

Background Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral childhood disorder. Children with ADHD are difficult to handle due to the symptoms causing great impairments such as inattention, hyperactivity compared to other childhood mental disorders. Having a child with ADHD is a stressful situation as it impacts the whole family. However, little is known about the experiences and challenges of parents caring for children with ADHD in low and middle-income countries such as Tanzania. Thus, this study explored the experiences and challenges of parents caring for children with ADHD in Dar es Salaam, Tanzania. Methods We conducted a qualitative descriptive study involving 16 parents of children with ADHD at Muhimbili National Hospital (MNH). We used the purposive sampling technique to obtain the participants. In-depth interviews, using a semi-structured interview guide, were used to collect data. Audio-recorded data were transcribed, translated, and analysed using qualitative content analysis. Results Parents experienced difficulties in handling the children whose level of functioning was impaired due to abnormal and disruptive behaviour such as not being able to follow parental instructions. Psychological problems were also experienced due to caring demands exacerbated by lack of support and stigma from the community. Moreover, there were disruptions in family functioning and social interactions among family members due to the children’s behaviour. Lastly, too much time and family resources spent to fulfil the needs of these children culminated into disruption in economic activities that negatively affected everyday life. Conclusion Parents struggle to meet and cope with care demands posed by children with ADHD. The disruptive nature of ADHD symptoms presents a unique caring challenge different from those experienced with other childhood mental illnesses. To address these challenges, a collaborative approach among key stakeholders such as the government, health care professionals, and non-governmental organizations, is needed.

People who inject drugs (PWID) are at increased risk of HIV infection. Pre-exposure prophylaxis (PrEP) could help in HIV prevention among PWIDs. However, little is known about PrEP use among PWIDs in low and middle-income countries. This study reports the awareness of and willingness to use PrEP and the associated factors among PWID in Tanzania. A cross-sectional survey was conducted using respondent-driven sampling (RDS) to recruit PWIDs in Dar es Salaam, Tanzania. Data were collected using an interviewer-administered questionnaire. Chi-square statistical test was used during data analysis. The P-value of < 0.05 was used to ascertain the statistically significant relationship. IBM SPSS Statistics 25.0 was used to analyze the data. The analysis consisted of 260 PWIDs. The mean age of the respondents was 39.0 years with a standard deviation (SD) of ±7.5. Most of the respondents were male (n = 232, 89.2%) with primary education (n = 176, 67.7%). Despite the low awareness of PrEP (n = 42, 165.28%) in the study sample, the majority (n = 239, 91.9%) were willing to use PrEP. Both awareness of and willingness to use PrEP were associated with gender (p = .002 and p = < .001), awareness of HIV prevention programs(p = < .001 and p = .006), selling sex (p = .010 and p = .021), and frequency of condomless sexual intercourse (p = .029 and p = .025) respectively. In multivariable logistic regression, only gender(p = 0.046) was related to awareness of PrEP while awareness of HIV prevention programs (p = 0.009), the risk level of HIV infection(p = < .001), number of sexual partners(p = 0.046), and frequency of condomless sex(p = 0.032) were associated with willingness to use PrEP. Other factors were not statistically significant. Despite low awareness, PWIDs are highly willing to use PrEP. Future research should assess the acceptability of injectable PrEP for PWID, as their acquaintance with injection may make the formulation more practical.

There is limited information about sexual behavior among volunteers who participated in phase I/II human immunodeficiency virus (HIV) vaccine trial. This article describes the sexual behavior, practices before, and after participation in phase I/II HIV vaccine trial in Dar es Salaam, Tanzania. We conducted a qualitative descriptive study involving volunteers who participated in the phase I/II vaccine trial between 2007 and 2010. Purposeful sampling was used to recruit potential informants. Twenty-four in-depth interviews were conducted. The audio-recorded interviews were transcribed verbatim and analyzed using a thematic content analysis approach. The findings revealed that before participation in the HIV vaccine trial, informants were engaging in unprotected multiple sexual relationships. After the completion of the HIV vaccine trial, informants reported strengthened marital relationships, increased understanding of safer sexual practices, and HIV testing. However, the informants reported challenges regarding vaccine-induced seropositivity that adversely affected their sexual and marital relationships. Some informants re-engaged in risky sexual practices because they perceived the experimental vaccine was protective. The informants suggested having continued interventions within the community to enhance safer sexual practices. Participation in phase I/II HIV vaccine trials may positively and negatively influence changes in volunteers’ sexual behaviors and practices. The trial interventions appear to improve compliance with safer sexual practices. However, the reported vaccine-induced seropositivity and the perception that experimental vaccines are protective need further appropriate interventions.