Search

Research-generated information about mental disorders is crucial in order to establish the health needs in a given setting, to propose culturally apt and cost-effective individual and collective interventions, to investigate their implementation, and to explore the obstacles that prevent recommended strategies from being implemented. Yet the capacity to undertake such research in low- and middle-income countries is extremely limited. This article describes two methods that have proved successful in strengthening, or that have the potential to strengthen, mental health research capacity in low-resource settings. We identify the central challenges to be faced, review current programs offering training and mentorship, and summarize the key lessons learned. A structured approach is proposed for the career development of research staff at every career stage, to be accompanied by performance monitoring and support. A case example from the Mental Health and Poverty Project in sub-Saharan Africa illustrates how this approach can be put into practice-in particular, by focusing upon training in core transferrable research skills. [ABSTRACT FROM AUTHOR]

Developing countries have limited resources, so it is particularly important to invest in healthcare that works. The case for evidence-based practice has long been made in the West. However, poor access to information makes this endeavour near impossible for health professionals working with vulnerable communities in low-income economies. This paper provides a call to action to create an evidence base for health professionals in developing countries and identify appropriate strategies for the dissemination of this information in realistic and meaningful ways. [ABSTRACT FROM AUTHOR]

In this paper we have defined integration as being the health unit team acceptance of responsibility for all aspects of care at the health service/community interface level. The health unit functions within a system whose elements (hospitals, laboratory, pharmacy, etc.) function in complementarity with those of the FLHS. Vertical approaches are often adopted because of weaknesses in some elements of the NHS, thereby further undermining such an NHS. The development of innovative community-based approaches in some areas and countries has resulted from this type of situation. However, isolated from the NHS, such approaches cannot be expected to be sustainable or to have long-term impact. Integration is the best choice of approach; it offers a chance to influence the course of the AIDS epidemic and the response of health systems in each country. The basic structure of the NHS and the characteristics of a FLHS are analyzed. The challenge to AIDS programs is to define more exactly objectives and activities at the operational, interface levels. Based on this analysis, planning of operations should be delegated to the district. Weakness of some elements and aspects of the NHS which are relevant to AIDS control program implementation can be overcome, not by organizing the program vertically and independently from the NHS, but rather by sharing resources to strengthen the weak elements. Integration may be more difficult in the early stages of implementation, but in the long term it offers sustainable development of AIDS prevention and control activities.

The article discusses a paper published within this issue which focuses on the human immunodeficiency virus (HIV) risks among men who have sex with men (MSM) in Africa.

Presents information regarding the influence of culture and politics on psychiatric practice in Africa. Establishment of various mental asylums by colonial government in the nation; Reasons behind the avoidance of mental asylums by mentally-ill people in the nation; Analysis of the language and ideology of colonial psychiatric theories and text in the nation.

Surgical access remains a pressing public health concern in African nations, with a substantial portion of the population facing challenges in obtaining safe, timely, and affordable surgical care. This paper delves into the impact of health insurance schemes on surgical accessibility in Africa, exploring the barriers, challenges, and future directions. It highlights how high out-of-pocket costs, reliance on traditional healing practices, and inadequate surgical infrastructure hinder surgical utilization. Financing mechanisms often need to be more effective, and health insurance programs face resistance within the informal sector. Additionally, coverage of the poor remains a fundamental challenge, with geographical and accessibility barriers compounding the issue. Government policies, often marked by inconsistency and insufficient allocation of resources, create further obstacles. However, strategic purchasing and fund integration offer avenues for improving the efficiency of health insurance programs. The paper concludes by offering policy recommendations, emphasizing the importance of inclusive policies, streamlined financing mechanisms, coverage expansion, and enhanced strategic purchasing to bridge the surgical access gap in Africa. Decoupling entitlement from the payment of contributions, broadening the scope of coverage for outpatient medicines and related expenses, and enhancing safeguards against overall costs and charges, especially for individuals with lower incomes. Ultimately, by addressing these challenges and harnessing the potential of health insurance schemes, the continent can move closer to achieving universal surgical care and improving the well-being of its people., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Stroke is a major health concern worldwide, and its impact is particularly pronounced across Africa. This paper delves into the challenges faced in African stroke care and explores the significant potential benefits of mobile stroke units (MSUs) in mitigating these issues. Key challenges include the limited healthcare infrastructure, funding constraints, difficulties reaching remote and rural areas, and shortages of qualified healthcare professionals, especially neurologists and stroke specialists. To address these challenges, recommendations are provided, emphasizing the importance of infrastructure development, sustainable funding mechanisms, solutions for rural accessibility, and healthcare workforce development through training programs and incentives. Additionally, the paper discusses prospects for MSUs in Africa, highlighting the potential for technology advancements to yield more cost-effective and compact MSU models. The integration of telemedicine capabilities within MSUs is examined to enhance communication with specialist physicians at remote hospitals, ultimately improving stroke care outcomes. Furthermore, data collection on MSU outcomes and their impact on stroke care is emphasized to inform evidence-based policies and enhance MSU operations. Collaboration and partnerships between governments, healthcare organizations, and international stakeholders are critical for facilitating MSU expansion. These partnerships can provide essential funding, expertise, and support for the implementation and sustainable operation of MSUs in Africa., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose of Review: Nongovernmental organizations (NGOs) are pivotal to the HIV response, supporting access to HIV services since the start of the epidemic. Against the backdrop of the impact of NGOs, is the recognition of the unique role that local NGOs bring to the HIV response, drawing from their deep understanding of the context and knowledge of local health problems., Recent Findings: The Centre for Infectious Disease Research in Zambia (CIDRZ) is one such NGO. Through various implementation science research and programs, CIDRZ has supported the Zambian government's HIV response. As Zambia moves closer to epidemic control, understanding reasons for patient disengagement from care and patient preferences for HIV care demonstrated by CIDRZ have contributed to global and national HIV treatment and care guidelines., Summary: This paper offers a case study for how NGOs like CIDRZ can serve as health system-wide catalyst to identify, integrate, and scale up evidence-based practices for HIV prevention, care, and treatment. It draws from the public health literature, CIDRZ extensive program and research experience and implementation science theory, to illustrate key strategies that can be deployed by local NGOs to spark innovation, quality improvement, and support governments to achieve and sustain HIV epidemic control., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: To establish the nature of publications emanating from or relating to intellectual disability in Africa in the previous 12-18 months, and to critically analyse the nature and content of any new knowledge arising from them., Recent Findings: Three papers satisfied the criteria set, one from Nigeria on epilepsy and intellectual disability, the other two were from South Africa. Kromberg's paper puts intellectual disability in context for South Africa, emphasizing the role potentially played by traditional healers. Pillay's paper tackles emerging issues in the psycholegal arena in South Africa, many of which are relevant to the rest of the continent., Summary: Of the many challenges facing persons with intellectual disability in Africa, high prevalence, discrimination, and access to justice and education are key considerations, in all countries, and without exception are coupled with poor resource allocation. The challenges posed by HIV, wars and internal displacement are significant and demand examination by researchers. Opportunities for beneficial research exist between Africa and the centres of academic excellence around the rest of the world. Those centres with the skill and will to collaborate with Africa will be handsomely rewarded by the wide scope of challenges in intellectual disability that are available for scientific enquiry. Opportunities for skills transfer are many and available.

Rigorous empirical research on the socioeconomic effects of AIDS is important for developing appropriate strategies to mitigate impacts and ultimately improve living standards. This paper provides a broad overview of the challenges in studying the impact of the epidemic on individuals, households and economies, drawing examples from existing studies. We start with a discussion of macro-economic studies and argue that they reach vastly different conclusions about the impact of AIDS, depending on what parameter assumptions they make. Whereas microstudies could provide insights into some of these parameters and effects, there are many technical hurdles to overcome. We discuss the use of comparator groups, spillover effects, longitudinal datasets and the time horizons of studies. Under scrutiny of these technical requirements, the existing empirical evidence of the impoverishing effects of AIDS deaths on African households seems unexpectedly limited. After many years of study, large gaps remain in the empirical literature with regard to our understanding of the magnitude and heterogeneity of these impacts. We conclude that the literature thus far has not convincingly shown that AIDS is the main contributor to low levels and high inequities of socioeconomic outcomes in Africa. Demand for research on the causal impact of HIV/AIDS on poverty is only increasing with the scaling up of antiretroviral treatment.

Acute renal failure is a frequent cause of morbidity and mortality in the hospitalized population worldwide. In Africa, apart from hemodynamic causes and infections, herbal remedies contribute to both morbidity and mortality, although these causes often go unrecognized. This paper reviews reports of herbal remedies that have been shown to result in nephrotoxicity. The indications for use of the remedies, signs and symptoms in poisoned patients, and the methods used to detect toxic compounds in plant specimens or in biological fluids are covered.

Objective: Antenatal clinic (ANC)-based surveillance through unlinked anonymous testing (UAT) for HIV without informed consent provides solid long-term trend data in resource-constrained countries with generalized epidemics. The rapid expansion of the prevention of mother-to-child transmission (PMTCT) and voluntary counseling and testing (VCT) programmes prompts the question regarding their utility for HIV surveillance and their potential to replace UAT-based ANC surveillance., Methods: Four presentations on the use of PMTCT or VCT data for HIV surveillance were presented at a recent international conference. The main findings are presented in this paper, and the operational and epidemiological aspects of using PMTCT or VCT data for surveillance are considered., Results: VCT data in Uganda confirm the falling trend in HIV prevalence observed in ANC surveillance. Thailand, a country with nationwide PMTCT coverage and a very high acceptance of HIV testing, has replaced UAT data in favor of PMTCT data for surveillance. Studies from Botswana and Kenya showed that PMTCT-based HIV prevalences was similar, but the quality and availability of the PMTCT data varied., Conclusion: The strength of UAT lies in the absence of selection bias and the availability of individual data. Conversely, the quantity of VCT and PMTCT programme testing data often exceed those in UAT, but may be subject to bias due to self-selection or test refusal. When using VCT or PMTCT data for surveillance, investigators must consider these caveats, as well as their varying data quality, accessibility, and availability of individual records.

The main features of research into HIV and AIDS between 1981 and 1990 were examined using a database of medical, nursing and dental journals [compact disc read-only memory (CD-ROM) version of the Medline database (Silver Platter Information Services, London, UK)]. More than 30,000 papers on HIV and AIDS were indexed by Medline between 1981 and 1990. Of these, only 3% were concerned with African populations although a quarter of AIDS cases worldwide were reported from African countries during the decade. The number of papers on HIV/AIDS increased from 24 in 1982 to an estimated 8300 in 1990. Between 1983 and 1988 the number of indexed papers on HIV/AIDS increased at around 50-60% per year; between 1988 and 1989, however, the rate of growth fell to 6%. The percentage of papers discussing the aetiology of AIDS fell from 25 to 3% between 1983 and 1990. During the same period, papers concerned with HIV increased from 2 to 37% of the HIV/AIDS total. Research into drug therapy also accounted for an increasing proportion of indexed papers during the decade. The percentage of papers dealing with prevention and control rose to 18% in 1988, but had declined to 12% by 1990. Priorities for the 1990s should include a renewed interest in aetiology and a sustained emphasis on prevention. Furthermore, countries that have so far been neglected should be granted priority in future research.

Any reduction in the rate of spread of HIV infection has consequences for the incidence and demographic effects of AIDS. In this paper, output from a published mathematical model of the dynamics of HIV transmission through heterosexual contact is used to study the implications of reducing HIV transmission on demographic patterns and national health budgets in sub-Saharan Africa. The major conclusion is that both the timing and the effectiveness of reducing HIV transmission are non-linearly related to their potential demographic and economic effects. The analysis emphasizes the benefits to be gained from a concerted effort to reduce the spread of HIV infection as early as possible in the time course of the epidemic.