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Pathare S, Funk M, Drew Bold N, Chauhan A, Kalha J, Krishnamoorthy S, Sapag JC, Bobbili SJ, Kawade R, Shah S, Mehta R, Patel A, Gandhi U, Tilwani M, Shah R, Sheth H, Vankar G, Parikh M, Parikh I, Rangaswamy T, Bakshy A, Khenti A. Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India. Br J Psychiatry 2021; 218:196-203. [PMID: 31218972 DOI: 10.1192/bjp.2019.138] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recognising the significant extent of poor-quality care and human rights issues in mental health, the World Health Organization launched the QualityRights initiative in 2013 as a practical tool for implementing human rights standards including the United Nations Convention on Rights of Persons with Disabilities (CRPD) at the ground level. AIMS To describe the first large-scale implementation and evaluation of QualityRights as a scalable human rights-based approach in public mental health services in Gujarat, India. METHOD This is a pragmatic trial involving implementation of QualityRights at six public mental health services chosen by the Government of Gujarat. For comparison, we identified three other public mental health services in Gujarat that did not receive the QualityRights intervention. RESULTS Over a 12-month period, the quality of services provided by those services receiving the QualityRights intervention improved significantly. Staff in these services showed substantially improved attitudes towards service users (effect sizes 0.50-0.17), and service users reported feeling significantly more empowered (effect size 0.07) and satisfied with the services offered (effect size 0.09). Caregivers at the intervention services also reported a moderately reduced burden of care (effect size 0.15). CONCLUSIONS To date, some countries are hesitant to reforming mental health services in line with the CRPD, which is partially attributable to a lack of knowledge and understanding about how this can be achieved. This evaluation shows that QualityRights can be effectively implemented even in resource-constrained settings and has a significant impact on the quality of mental health services.
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Affiliation(s)
- Soumitra Pathare
- Consultant Psychiatrist and Director, Centre for Mental Health Law & Policy, Indian Law Society, India
| | - Michelle Funk
- Co-ordinator, Mental Health Policy & Service Development, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
| | - Natalie Drew Bold
- Technical Officer, Mental Health Policy & Service Development, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
| | - Ajay Chauhan
- Consultant Psychiatrist and State Nodal Officer, Hospital for Mental Health, Ahmedabad, India & Department of Health & Family Welfare, Government of Gujarat, India
| | - Jasmine Kalha
- Program Manager and Research Fellow, Centre for Mental Health Law & Policy, Indian Law Society, India
| | | | - Jaime C Sapag
- Associate Professor, Office of Transformative Global Health, Institute of Mental Health Policy Research, Centre for Addiction & Mental Health, Canada; Division of Public Health & Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Chile; and Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Sireesha J Bobbili
- Project Manager, Office of Transformative Global Health, Institute of Mental Health Policy Research, Centre for Addiction & Mental Health, Canada
| | - Rama Kawade
- Co-ordinator of Data Management and Analysis, Centre for Mental Health Law & Policy, Indian Law Society, India
| | - Sandeep Shah
- Professor of Psychiatry and Head, Department of Psychiatry, GMERS Medical College, Gotri, Vadodara, India
| | - Ritambhara Mehta
- Professor of Psychiatry and Head, Department of Psychiatry, Government Medical College, Surat, India
| | - Animesh Patel
- Consultant Psychiatrist, Department of Psychiatry, General Hospital, Mehesana, India
| | - Upendra Gandhi
- Assistant Director, Medical Services, General Hospital, Mehesana, India
| | - Mahesh Tilwani
- Psychiatrist, Gujarat medical services Class 1, Hospital for Mental Health, Bhuj, India
| | - Rakesh Shah
- Psychiatrist and Superintendent, Hospital for Mental Health, Vadodara, India
| | - Hitesh Sheth
- Psychiatrist, Gujarat Health Services, Class I, Hospital for Mental Health, Jamnagar, India
| | - Ganpat Vankar
- Professor of Psychiatry and Head, Department of Psychiatry, B J Medical College, Ahmedabad, India
| | - Minakshi Parikh
- Professor of Psychiatry and Head, Department of Psychiatry, B J Medical College, Ahmedabad, India
| | - Indravadan Parikh
- Psychiatrist, Gujarat Health Services, Class I, Department of Psychiatry, M G General Hospital, India
| | - Thara Rangaswamy
- Vice-Chairman and Chair, Research, Schizophrenia Research Foundation, India
| | | | - Akwatu Khenti
- Senior Scientist, Director of the Office of Transformative Global Health, Office of Transformative Global Health, Institute of Mental Health Policy Research, Centre for Addiction & Mental Health, Canada
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Joag K, Shields-Zeeman L, Kapadia-Kundu N, Kawade R, Balaji M, Pathare S. Feasibility and acceptability of a novel community-based mental health intervention delivered by community volunteers in Maharashtra, India: the Atmiyata programme. BMC Psychiatry 2020; 20:48. [PMID: 32028910 PMCID: PMC7006077 DOI: 10.1186/s12888-020-2466-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many community-based intervention models for mental health and wellbeing have undergone robust experimental evaluation; however, there are limited accounts of the implementation of these evidence-based interventions in practice. Atmiyata piloted the implementation of a community-led intervention to identify and understand the challenges of delivering such an intervention. The goal of the pilot evaluation is to identify factors important for larger-scale implementation across an entire district in India. This paper presents the results of a feasibility and acceptability study of the Atmiyata intervention piloted in Nashik district, Maharashtra, India between 2013 and 2015. METHODS A mixed methods approach was used to evaluate the Atmiyata intervention. First, a pre-post survey conducted with 215 cases identified with a GHQ cut-off 6 using a 3-month interval. Cases enrolled into the study in one randomly selected month (May-June 2015). Secondly, a quasi-experimental, pre-post design was used to conduct a population-based survey in the intervention and control areas. A randomly selected sample (panel) of 827 women and 843 men age between 18 to 65 years were interviewed to assess the impact of the Atmiyata intervention on common mental disorders. Finally, using qualitative methods, 16 Champions interviewed to understand an implementation processes, barriers and facilitators. RESULTS Of the 215 participants identified by the Champions as being distressed or having a common mental disorder (CMD), n = 202 (94.4%) had a GHQ score at either sub-threshold level for CMD or above at baseline. Champions accurately identified people with emotional distress and in need of psychological support. After a 6-session counselling provided by the Champions, the percentage of participants with a case-level GHQ score dropped from 63.8 to 36.8%. The second sub-intervention consisted of showing films on Champions' mobile phones to raise community awareness regarding mental health. Films consisted of short scenario-based depictions of problems commonly experienced in villages (alcohol use and domestic violence). Champions facilitated access to social benefits for people with disability. Retention of Atmiyata Champions was high; 90.7% of the initial selected champions continued to work till the end of the project. Champions stated that they enjoyed their work and found it fulfilling to help others. This made them willing to work voluntarily, without pay. The semi-structured interviews with champions indicated that persons in the community experienced reduced symptoms and improved social, occupational and family functioning for problems such as depression, domestic violence, alcohol use, and severe mental illness. CONCLUSIONS This study shows that community-led interventions using volunteers from rural neighbourhoods can serve as a locally feasible and acceptable approach to facilitating access social welfare benefits, as well as reducing distress and symptoms of depression and anxiety in a low and middle-income country context. The intervention draws upon social capital in a community to engage and empower community members to address mental health problems. A robust evaluation methodology is needed to test the efficacy of such a model when it is implemented at scale.
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Affiliation(s)
- Kaustubh Joag
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004, India.
| | - Laura Shields-Zeeman
- grid.416017.50000 0001 0835 8259Trimbos Institute (Netherlands Institute for Mental Health and Addiction), Da Costakade 45, 3521 VS Utrecht, the Netherlands
| | - Nandita Kapadia-Kundu
- grid.21107.350000 0001 2171 9311Johns Hopkins Centre for Communication Programs, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21202 USA
| | - Rama Kawade
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004 India
| | - Madhumitha Balaji
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004 India ,grid.471010.3Sangath, South Goa, Goa 403720 India
| | - Soumitra Pathare
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004 India
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Chiplonkar S, Khadilkar A, Pandit-Agrawal D, Kawade R, Kadam N, Ekbote V, Sanwalka N, Khadilkar V. Influence of micronutrient status and socioeconomic gradient on growth indices of 2-18-year-old Indian girls. J Pediatr Endocrinol Metab 2013; 26:825-32. [PMID: 23729550 DOI: 10.1515/jpem-2013-0106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/15/2013] [Indexed: 11/15/2022]
Abstract
Micronutrient deficiencies are common consequences of the plant-based diet in children from developing countries which may affect their linear and ponderal growth. The aim of the study was to investigate the association between micronutrient status and growth indices in Indian girls. In cross-sectional studies (2006-2010), data on weight, height and diet were collected on 1302 girls (2-18 years) from Pune city, India. Fasting hemoglobin was measured on 1118 girls and serum zinc was measured on 695 girls. Height-for-age Z-scores (HAZ) and body mass index for age Z-score (BMIZ) were computed using contemporary Indian references. HAZ >-1 was observed in 54% girls, and 18.1% were short (HAZ <-2). BMIZ was within the reference range (-2<BMIZ<2) in majority (82.4%) of the girls. Average HAZ and BMIZ were significantly higher in higher socioeconomic (HSE) than in middle (MSE) and lower (LSE) socioeconomic groups (p<0.05). Girls in all age groups had calcium, zinc, iron and vitamin intakes of <50% of Indian recommended dietary intakes. Mean nutrient intakes were significantly higher in HSE than in MSE and LSE girls (p<0.05). Girls with short stature (HAZ <-2) had significantly lower intakes of calcium, zinc, iron, β-carotene, riboflavin, niacin, folate and ascorbic acid (p<0.05). Higher levels of serum zinc and hemoglobin were observed in girls with HAZ >-1 than in short girls even after adjusting for socioeconomic status (SES). The mean serum zinc level of thin girls (BMIZ <-2) was significantly lower than those of both normal and overweight girls after adjusting for SES. Micronutrient sufficiency is of paramount importance for adequate growth in Indian girls.
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Kawade R. Zinc status and its association with the health of adolescents: a review of studies in India. Glob Health Action 2012; 5:7353. [PMID: 22511891 PMCID: PMC3328203 DOI: 10.3402/gha.v5i0.7353] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 03/11/2012] [Accepted: 03/17/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Zinc is important in adolescence because of its role in growth and sexual maturation. Adolescents from developing countries such as India may be at high risk of zinc deficiency because of unwholesome food habits and poor bioavailability of zinc from plant-based diets. OBJECTIVE (1) to study zinc status and its association with profile of other micronutrients, (2) to construct a simple tool in the form of Adolescent Micronutrient Quality Index (AMQI) to assess quality of diets of the girls and (3) to examine the effect of zinc supplement on health of adolescent girls. METHODS Girls (10-16 years) from two secondary schools of Pune, Maharashtra state, in Western India were enrolled in a cross-sectional study (n = 630). Data were collected on dietary intake, cognitive performance, taste acuity, haemoglobin, erythrocyte zinc and plasma levels of zinc, vitamin C, β-carotene and retinol. AMQI was developed using age-sex-specific Indian dietary guidelines and healthy foods and habits described in the recent US dietary guidelines. Zinc-rich recipes were developed considering habitual diets of the girls and vegetarian sources of zinc. An intervention trial (n = 180) was conducted to assess the effect of zinc-rich dietary supplements and ayurvedic zinc (Jasad) supplementation. RESULTS Prevalence of micronutrient deficiencies was high in these girls. Poor cognitive performance was seen in half of the girls, and salt taste perception was affected in 45%. AMQI was correlated with nutrient intakes and blood micronutrient levels (p < 0.01), indicating the potential of AMQI to measure micronutrient quality of diets of adolescent girls. Results of the intervention trial indicated that supplementation of zinc-rich recipes vis-a-vis ayurvedic Jasad zinc has the potential to improve plasma zinc status, cognitive performance and taste acuity in adolescent girls. CONCLUSIONS Review of the studies on Indian adolescent girls demonstrates the necessity of adopting zinc and micronutrient-rich diets for positive health building in adolescents.
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Affiliation(s)
- Rama Kawade
- Biometry & Nutrition Group, Agharkar Research Institute, Pune, Maharashtra, India.
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