Major psychiatric disorders are growing public health concern that attributed 14% of the global burden of diseases. The management of major psychiatric disorders is challenging mainly due to ...medication non-adherence. However, there is a paucity of summarized evidence on the prevalence of psychotropic medication non-adherence and associated factors. Therefore, we aimed to summarize existing primary studies' finding to determine the pooled prevalence and factors associated with psychotropic medication non-adherence.
A total of 4504 studies written in English until December 31, 2017, were searched from the main databases (n = 3125) (PubMed (MEDLINE), Embase, CINAHL, PsycINFO, and Web of Science) and other relevant sources (mainly from Google Scholar, n = 1379). Study selection, screening, and data extraction were carried out independently by two authors. Observational studies that had been conducted among adult patients (18 years and older) with major psychiatric disorders were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Systematic synthesis of the studies was carried out to summarize factors associated with psychotropic medication non-adherence. Meta-analysis was carried using Stata 14. Random effects model was used to compute the pooled prevalence, and sub-group analysis at 95% confidence interval.
Forty-six studies were included in the systematic review. Of these, 35 studies (schizophrenia (n = 9), depressive (n = 16), and bipolar (n = 10) disorders) were included in the meta-analysis. Overall, 49% of major psychiatric disorder patients were non-adherent to their psychotropic medication. Of these, psychotropic medication non-adherence for schizophrenia, major depressive disorders, and bipolar disorders were 56%, 50%, and 44%, respectively. Individual patient's behaviors, lack of social support, clinical or treatment and illness-related, and health system factors influenced psychotropic medication non-adherence.
Psychotropic medication non-adherence was high. It was influenced by various factors operating at different levels. Therefore, comprehensive intervention strategies should be designed to address factors associated with psychotropic medication non-adherence.
PROSPERO CRD42017067436.
Objective
This study aimed to determine the burden of depression, suicidal ideation and suicidal behaviour amongst adolescents at sites in six sub‐Saharan African countries and examine associated ...risk and protective factors.
Methods
Household‐based cross‐sectional study involving male and female adolescents ages 10‐19 years. A total of 7,662 adolescents from eight sites in six countries participated in the survey. Three sites were urban: Dar es Salaam (Tanzania), Harar (Ethiopia) and Ibadan (Nigeria); five were rural: Dodoma (Tanzania), Iganga/Mayuge (Uganda), Kersa (Ethiopia), Ningo Prampram (Ghana) and Nouna (Burkina Faso). Log‐binomials models were used to estimate relative risks and confidence intervals for factors associated with depression and suicidal behaviour. This was supplemented using log‐Poisson models as needed.
Results
The prevalence of suicidal behaviour over the last 12 months ranged between 1.2% and 12.4% in the eight sites. Depressive symptoms and suicidal ideation/behaviours were associated with older age, female sex, food insecurity, poor access to health care and substance use. Depression was strongly associated with increased risk of suicidal behaviour at two sites where the multivariate model converged: Harar, Ethiopia (RR = 3.5, 95% CI 1.8, 7.0, P < 0.05) and Ibadan, Nigeria (RR = 3.7, 95% CI 2.2, 6.3, P < 0.0001).
Conclusions
Depressive symptoms and suicidal behaviour are common amongst sub‐Saharan African adolescents at these 8 sites. Most factors associated with depressive symptoms are modifiable and preventable. Routine screening for depressive symptoms in services frequented by adolescents in these and similar communities would be crucial in early detection and prompt intervention.
Objectif
Cette étude visait à déterminer la charge de morbidité de la dépression, des idées suicidaires et du comportement suicidaire chez les adolescents sur des sites dans six pays d’Afrique subsaharienne et examiner les facteurs de risque et de protection associés.
Méthodes
Etude transversale réalisée auprès des ménages sur des adolescents masculins et féminins âgés de 10 à 19 ans. 7.662 adolescents de huit sites dans six pays ont participé à l'enquête. Trois sites étaient en zones urbaines: Dar es Salaam (Tanzanie), Harar (Ethiopie) et Ibadan (Nigéria); cinq étaient en zones rurales: Dodoma (Tanzanie), Iganga/Mayuge (Ouganda), Kersa (Ethiopie), Ningo Prampram (Ghana) et Nouna (Burkina Faso). Des modèles de logarithme binomial ont été utilisés pour estimer les risques relatifs et les intervalles de confiance pour les facteurs associés à la dépression et au comportement suicidaire. Cela a été complété à l'aide de modèles log‐Poisson lorsque nécessaire.
Résultats
La prévalence des comportements suicidaires au cours des 12 derniers mois variait entre 1,2% et 12,4% dans les huit sites. Les symptômes dépressifs et les idées/comportements suicidaires étaient associés à l'âge plus avancé, au sexe féminin, à l'insécurité alimentaire, au faible accès aux soins de santé et à la toxicomanie. La dépression était fortement associée à un risque accru de comportement suicidaire sur deux sites où il y avait une convergence dans le modèle multivarié: Harar, en Ethiopie (RR = 3,5; IC95%: 1,8–7,0; P < 0,05) et Ibadan, au Nigéria (RR = 3,7; IC95%: 2,2–6,3; P < 0,0001).
Conclusions
Les symptômes dépressifs et les comportements suicidaires sont fréquents chez les adolescents africains subsahariens de ces 8 sites. La plupart des facteurs associés aux symptômes dépressifs sont modifiables et évitables. Le dépistage de routine des symptômes dépressifs dans les services fréquentés par les adolescents dans ces communautés et dans des communautés similaires serait crucial pour la détection précoce et une intervention rapide.
Health facilities' level of readiness to provide adolescent and youth-friendly health services (AYFHS) is crucial for preventing and reducing teenage pregnancies and maternal mortality. This study ...examined friendliness and satisfaction with AYFHS among users. A cross-sectional study was conducted among 419 adolescents and youths recruited from six health institutions in the East Shewa Zone, Oromia region, and Addis Ababa, Ethiopia from August 1 to October 28, 2022. Based on the WHO Quality Assessment Guidebook, the friendliness of AYFHS was evaluated as a proxy for the quality of care. Descriptive measures were computed to summarize the participants' socio-demographic characteristics. Bivariate and multivariable logistic regression analysis was used to evaluate the potential association between each independent variable and client satisfaction. The type, magnitude, and precision of association were presented using an adjusted odds ratio (AOR) with 95% Confidence Intervals (CI) and a p-value of < 0.05 ascertained statistical significance. The overall friendliness was 69%: Specifically, 82% of the participants stated the service was accessible, 72% said it was acceptable, and 90% thought it was effective. However, only 33% and 34% of respondents reported the services were equitable and appropriate respectively. The overall satisfaction with AYFHS was 25.3%. Increased age (AOR = 0.70, 95% CI: 0.57-0.86), being female (AOR = 0.11, 95%CI: 0.04-0.33), no prior information about AYFHS (AOR = 0.20, 95%CI: 0.10-0.44), and higher number of sexual partners (AOR = 0.3, 95%CI: 0.21-0.65) were factors statistically associated with client satisfaction with AYFHS. The overall quality of AYFHS was sub-optimal and did not meet the four components of WHO's good quality standards; equity, appropriateness, acceptability, and accessibility must be improved. Female and older adolescents and youths and those with a higher number of sexual partners should be targeted for intervention.
Head porters working in markets in sub-Saharan Africa (SSA) are one of the world's most vulnerable and socioeconomically disadvantaged groups. They consist predominantly of uneducated women and girls ...seeking to escape poverty, early marriage, and other issues of domestic violence. Most female head porters are in their reproductive years and often lack access to sexual reproductive health services (SRHS) despite being at high risk for sexually transmitted infections (STIs), unplanned pregnancies, and gender-based violence. The low priority for women and girls' SRH in many SSA countries highlights the need to explore the factors influencing the accessibility of services for failure to do so restrains human development. An initial search of the literature was conducted and revealed no current scoping or systematic reviews on the accessibility to SRHS for female head porters in SSA. We outline a scoping review protocol, using the Joanna Briggs Institute methodology, to determine the interventions that influence the accessibility of SRHS for female head porters in SSA. The protocol is registered with Open Science Framework (
Early pubertal development induces early sexual activities among adolescents. In Ghana, despite the high sexual activity among Ghanaian adolescents, sexual and reproductive health (SRH) services are ...underutilised, primarily due to SRH stigma and a lack of SRH knowledge and information. This study examined the use of SRH services among adolescents aged 15-19 years in Ghana over a ten year period. The study utilised data from the 2007 and 2017 Ghana Maternal Health Surveys (GMHSs). Responses from 2056 and 4909 adolescent females captured in the 2007 and 2017 GMHSs, respectively, were used. The results showed a declining utilisation of SRH services among adolescents from 28.3% in 2007 to 22.5% in 2017. The odds of using family planning among sexually active adolescents increased from 2007 AOR-0.32, CI-(0.135, 0.77),
< 0.001 to 2017 AOR-68.62, CI-(36.104, 130.404),
< 0.001. With increasing age at first sex, adolescents were less likely to use a family planning method in 2007 AOR-0.94, CI-(0.89,0.99)
< 0.001, but this improved in 2017 AOR-1.26, CI-(1.220, 1.293),
< 0.001. Despite this, knowledge of sources for family planning was found to predict its lower utilisation in both 2007 AOR = 0.15 (95% CI-0.081, 0.283),
< 0.0001 and 2017 AOR = 0.206 (95% CI-(0.099, 0.426),
< 0.001. The findings show that even though knowledge of family planning methods predicted low utilisation, knowledge of sources, age at first sex, and educational level positively predicted the utilisation of SRH services from 2007 to 2017. Opportunities for both enhancing the clinical environment and health provider attitudes exist and should be explored for improving SRH outcomes among sexually active adolescents in Ghana.
BackgroundPatients determine quality of healthcare by their perception of the gap between the healthcare they experience/receive and that which they expect. This can be influenced by the ability of ...healthcare staff to adequately communicate information about the healthcare provided. This study assessed the level of relevance of meeting patients’ information needs with respect to their assessment of healthcare quality in a private hospital’s general outpatient department in Ghana.DesignStudy design was cross-sectional using exit self-administered questionnaires among 390 outpatients. Healthcare quality was measured using a modified form of the Service Quality model gap analysis (gap between experience and expectations). A negative gap signifies unmet patient expectations. Microsoft Excel and Stata V.15.0 were used for analysis using t-test and multiple linear regression. A p value ≤0.05 denotes statistical significance.FindingsThe mean percentage of patients’ expectations of quality of healthcare was 87.6% (SE 0.031), while patient experience was 86.0% (SE 0.029), with a significant negative gap of −0.08 (p<0.002). Their highest expectation of the quality of healthcare was for their information needs to be met, with a mean score of 4.44 (SE 0.03). Two of the four items under the information needs dimension that showed no statistically significant gaps were ‘saying all their problems’ (gap=0.00; p<0.9) and ‘explanation of treatment/medications’ (gap=0.01; p<0.6). Those with statistically significant negative gaps were ‘explanation of investigations and procedures’ (gap=−0.18; p<0.0001) and ‘explanation of the diagnoses’ (gap=−0.11; p<0.02), signifying unmet expectations.ConclusionsThe outpatient’s greatest need for quality healthcare in this study was for their information needs to be met. Providing information on patient diagnoses and investigations are the areas least likely to be adequately communicated to patients.
Intimate Partner Violence is a global public health problem. Attitude towards wife-beating is a major determinant of both intimate partner violence perpetration and victimization. However, little is ...known about the attitudes of Ghanaian young people towards wife-beating. The objectives of this study were to assess young people's attitudes towards wife-beating, and identify salient factors influencing young people's acceptance of wife-beating.
Data used in this study were obtained from the 2014 Ghana Demographic and Health Survey. The survey was nationally representative and provides estimates for population and health indicators across the former ten regions of Ghana, including rural and urban areas. Data were analyzed with Stata/SE version 16.
We found that 32% of young women and 19% of young men accepted wife-beating. Among young women, acceptance of wife-beating was significantly influenced by younger age, wealth index, low educational status, religion, the region of residence, ethnicity, frequency of reading newspaper and frequency of listening to radio (p < 0.05). Among young men, acceptance of wife-beating was significantly influenced by wealth index, the region of residence and frequency of reading newspaper (p < 0.05).
This study demonstrates that a substantial proportion of young people in Ghana accept wife-beating. Young women were more likely to accept wife-beating compared to young men. Acceptance of wife-beating was influenced by socio-demographic and behavioral factors. Efforts to end violence against women and girls in Ghana should focus on promoting girl education, economic empowerment of women and public education on laws that prohibit Intimate Partner Violence.
Effective control of blood pressure is necessary to avert the risk of cardiovascular diseases from uncontrolled hypertension. Despite evidence on the benefits of hypertension control, rates of ...control in Ghana remain low. This study assessed the patient-level factors that influence hypertension control among adults in Accra, Ghana.
A total of 360 hypertensive patients from two hospitals in Accra, Ghana were enrolled in the study. Patient socio-demographic characteristics were tabulated and associations between patient characteristics and hypertension control were estimated using chi-square tests and logistic regression.
Less than a quarter of the patients had a controlled blood pressure. The patient's sex AOR = 3.53 (95% CI:1.73-7.25, educational at junior high school AOR = 3.52(95% CI 1.72-7.22), senior and junior high school AOR = 2.64 (95% CI 1.40-6.66_ and AOR = 3.06 (95% CI 1.03-6.67) and presence of a comorbidity AOR = 2.41 (95% CI 1.32; 4.42) predicted BP control among patients. Dyslipidaemia AOR = 0.31, 0.11-0.89) an increased pill burden, and length of diagnosis of 2-5 years (AOR = 0.27 (0.1-0.73) however, were associated with reduced BP control AOR = 0.32(95% CI: 0.18-0.57). The majority of patients reported forgetfulness, side effects of medication and high pill burden as reasons for missing their medications.
Knowledge of hypertension among patients is low. Sex, formal education and the presence of comorbidity and more specifically dyslipidaemia influences blood pressure control. High pill burden and 2-5 years since diagnosis negatively affects the attainment of blood pressure control.
Young people have a higher chance of experimenting with sex before marriage, thus they engage in risky sexual behaviours that predispose them to HIV infections. The objective of this study was to ...assess the relationship between engaging in risky sexual behaviours and the uptake of HIV testing services among young people in Ghana.
We analysed secondary data from the 2017/2018 Ghana Multiple Indicator Cluster Survey, which collected data on population and health indicators across the previous ten regions of Ghana, using a Computer Personal Assisted Interviewing application. Data were analysed using descriptive statistics, Chi-square test and Binomial Logistic regression.
Seventy-nine per cent (79%) of young women and 68% of young men did not use a condom during last sexual intercourse. In addition, 68% of young women and 87% of young men had not tested for HIV. Young women (AOR = 2.19; 95% CI 1.56-3.07) and young men (AOR = 3.38; 95% CI 1.18-9.64) aged 20-24 years had a higher likelihood of being tested for HIV compared to those aged 15-19 years. Young women with junior high school education (AOR = 2.03; 95% CI 1.08-3.81) were more likely to test for HIV compared with those who had pre-primary/no formal education. In addition, young women who were never married or in a union (AOR = 0.39; 95% CI 0.27-0.56) had 61% of reduced odds of being tested for HIV compared with those who were currently married or in a union. There was no significant association between risky sexual behaviours and HIV testing (p > 0.05).
This study demonstrated that condom use among sexually active young people was low. The uptake of HIV testing services was below expectation. Age, educational status, marital status and exposure to the mass media were the salient factors influencing the uptake of HIV testing among young people. Stakeholders should implement interventions to help increase the uptake of HIV testing and condom use among young people in Ghana.
Men with have sex with men (MSM) in Africa face high levels of stigma due to elevated HIV exposure (actual or perceived), same-sex practices, and gender non-conformity. These stigmas are documented ...barriers to HIV prevention and treatment. Most stigma-reduction interventions have focused on single-level targets (e.g., health care facility level HCF) and addressed one type of stigma (e.g., HIV), without engaging the multiple intersecting stigmas that MSM encounter. Determining the feasibility and acceptability of multi-level intervention of reducing intersectional stigma and estimating its efficacy on increasing HIV testing are needed.
We proposed a mixed method study among MSM in Ghana. First, we will develop the intervention protocol using the Convergence Framework, which combines three interventions that were previously implemented separately in Ghana for reducing stigma at the HCF-level, increasing HIV testing at the peer group-level, and increasing peer social support at the individual-level. Then, we will conduct a cluster randomized controlled trial with four pairs of HCFs matched on staff size. HCFs within each pair are randomized to the HCF-level stigma-reduction intervention or control arm. MSM (n = 216) will be randomized to receive the group-level and individual-level interventions or standard of care control arm. MSM will be assigned to receive HIV testing at one of the HCFs that match their study assignment (intervention or control facility). The frequency of HIV testing between MSM in the study arms at 3 and 6 months will be compared, and the predictors of HIV testing uptake at the HCF, peer group and individual-levels will be assessed using multi-level regression models.
These findings from this study will provide important evidence to inform a hybrid implementation-effectiveness trial of a public health intervention strategy for increasing HIV case detection among key populations in sub-Saharan African communities. Accurate information on HIV prevalence can facilitate epidemic control through more precise deployment of public health measures aimed at HIV treatment and viral load suppression, which eliminates risk of transmission.
This study was prospectively registered on ClinicalTrials.gov, Identifier: NCT04108078, on September 27, 2019.
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