Outpatient Mental Health Services in Mozambique: Use and Treatments

Wagenaar, Bradley H.; Cumbe, Vasco; Raunig-Berhó, Manuela; Rao, Deepa; Kohrt, Brandon A.; Stergachis, Andy; Napua, Manuel; Sherr, Kenneth

doi:10.1176/appi.ps.201500508

Cited by 29 publications

(28 citation statements)

References 7 publications

(9 reference statements)

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“…), or the use of antipsychotics with anticholinergics (Wagenaar et al. ). When comparing first‐ and second‐generation antipsychotics, Lawal et al.…”

Section: Resultsmentioning

confidence: 99%

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Treatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review

Chidarikire

Cross

Skinner

et al. 2017

International Nursing Review

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Mental health services in Sub-Saharan Africa are limited by fiscal shortages, lack of mental health services and qualified mental health professionals. This review provides evidence to inform nursing and healthcare policy, including recruiting and training mental health professionals and ensuring access to evidence-based, person-centred and culturally relevant mental health services within the primary care context.

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“…), or the use of antipsychotics with anticholinergics (Wagenaar et al. ). When comparing first‐ and second‐generation antipsychotics, Lawal et al.…”

Section: Resultsmentioning

confidence: 99%

“…; Wagenaar et al. ). Although available data provide a limited picture of mental health service delivery in Sub‐Saharan Africa, many countries in the region have an acute shortage of mental health trained staff that can provide specialized care for people living with schizophrenia and other mental health disorders (Morris et al.…”

Section: Discussionmentioning

confidence: 98%

Treatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review

Chidarikire

Cross

Skinner

et al. 2017

International Nursing Review

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“…has been a leader in Sub-Saharan Africa in training a task-shared cadre of mental health professionals (Psychiatric Technicians) who can diagnose and treat all major categories of mental illness, with a focus on psychopharmacology. In 2014, the Mozambican Ministry of Health accomplished their goal of placing at least one psychiatric technician at a primary care health facility within each of the 135 districts nationally (23,29); however, the vast majority of psychiatrists are located in the capital of Maputo, Mozambique.…”

Section: Introductionmentioning

confidence: 99%

Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

Cumbe

Muanido

Manaca

et al. 2020

Preprint

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Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique.Methods: The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 502 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool.Results: The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach’s alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%. Conclusions: The PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.

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“…In 2014 the Mozambican Ministry of Health implemented a strategy of training CHWs to care for common health problems in regions with limited access to healthcare and placing at least one Psychiatric Technician at primary healthcare (PHC) facilities in all 135 districts nationally (6,13) .…”

Section: Introductionmentioning

confidence: 99%

Community Health Worker Knowledge, Attitudes, and Practices Towards Epilepsy in Mozambique

Cumbe¹,

Greene²,

Fumo

et al. 2020

Preprint

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Background: Epilepsy is the most common neurological disease in the world, affecting 50 million people, with the majority living in low- and middle-income countries (LMICs). A major focus of epilepsy treatment in LMICs has focused on task-sharing identification and epilepsy care by community health workers (CHWs). The present study aimed to assess the KAPs of CHWs towards epilepsy in Sofala province, Mozambique.Methods: One hundred and thirty five CHWs completed a questionnaire that included socio-demographic characteristics and 44-items divided in six subscales pertaining to KAPs towards epilepsy (QKAP-EPI) in nine districts of Sofala Province, Mozambique. The internal consistency and factor structure were examined to evaluate the reliability and construct validity of the QKAP-EPI, respectively. To examine correlates of KAPs toward epilepsy we evaluated the association between sociodemographic variables and QKAP-EPI subscales using linear regression models.Results: CHWs demonstrated adequate knowledge regarding epilepsy for medical treatment details (Mean=1.63, SD=0.28) and epilepsy safety/risks (Mean=1.62, SD=0.59). However, CHWs reported low levels of knowledge related to the causes of epilepsy, espousing stigmatizing attitudes, as well as cultural treatment, which is the perception in different cultures of how epilepsy should be treated. Knowledge about how to manage epilepsy during crisis varied across the different types of emergency care practices. Heterogeneity in the level of knowledge regarding epilepsy was observed among CHWs in the different districts of Sofala Province and when using different local names of epilepsy (Dzumba, Nzwiti).Conclusion: CHWs knowledge of medical treatment and epilepsy safety/risks were adequate. However, information on the causes of epilepsy, stigmatizing attitudes, cultural treatment, and some aspects of epileptic crisis response were low. These areas of poor knowledge should be the focus of educating CHWs in increasing their ability to provide quality care for patients with epilepsy in LMICs.

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Outpatient Mental Health Services in Mozambique: Use and Treatments

Cited by 29 publications

References 7 publications

Treatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review

Treatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review

Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

Community Health Worker Knowledge, Attitudes, and Practices Towards Epilepsy in Mozambique

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