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Yang JMK, Vaiphei K, Siliya M, Mkandawire T, Dolman C, Heron J, Wilson S, Yaresheemi S, Kitney D, Bailey L, Apsey C, Liwimbi O, Stewart R, Thippeswamy H, Jones I, Chorwe-Sungani G, Chandra P, Di Florio A. Postpartum psychosis: a public involvement perspective across three continents. Arch Womens Ment Health 2023; 26:831-837. [PMID: 37615717 PMCID: PMC10632256 DOI: 10.1007/s00737-023-01347-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/01/2023] [Indexed: 08/25/2023]
Abstract
Postpartum psychosis is a psychiatric emergency that is currently not represented in diagnostic systems, to the detriment of people with lived experience. Engaging with stakeholders offers an important avenue to improve clinical practice and make research more impactful, by providing perspectives based on first-hand, expert experience. There is a paucity of reports on stakeholders' engagement in psychiatry. Activities have thus far been limited to Western countries and there are few reports on postpartum psychosis. We report the results of public involvement activities (in the form of discussion groups) with key stakeholders in India, Malawi and the UK. These discussions centred around the clinical picture of postpartum psychosis and the terminologies used to describe these episodes. Seven major areas were highlighted: how postpartum psychosis is handled within services, common symptoms and characteristics, impact of episode, barriers to care, non-medical approaches, terminology and research areas of interest. According to the discussions, postpartum psychosis presents similarly across countries, although there are differences in access to services, approaches to mental health and terminologies used within and across countries. With this understanding comes the foundation for cross-cultural assessment, service improvement and a stakeholder-informed research agenda.
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Affiliation(s)
- Jessica Mei Kay Yang
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Kimneihat Vaiphei
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | | | | | - Clare Dolman
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Bipolar UK, 32 Cubitt Street, London, UK
| | - Jessica Heron
- Action on Postpartum Psychosis, Institute of Mental Health, University of Birmingham, Birmingham, UK
| | - Sally Wilson
- Action on Postpartum Psychosis, PO Box 137, Swansea, UK
| | - Shivanand Yaresheemi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Danielle Kitney
- National Centre for Mental Health, Cardiff University, Cardiff, UK
| | - Leah Bailey
- National Centre for Mental Health, Cardiff University, Cardiff, UK
| | - Chloe Apsey
- National Centre for Mental Health, Cardiff University, Cardiff, UK
| | | | - Robert Stewart
- Division of Psychiatry, University of Edinburgh, Scotland, UK
| | - Harish Thippeswamy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, Cardiff, UK
| | | | - Prabha Chandra
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Arianna Di Florio
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
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Lawrie S, Hanlon C, Manda-Taylor L, Knapp M, Pickersgill M, Stewart RC, Ahrens J, Allardyce J, Amos A, Bauer A, Breuer E, Chasweka D, Chidzalo K, Gondwe S, Jain S, Kokota D, Kulisewa K, Liwimbi O, MacBeth A, Mkandawire T, Sefasi A, Sibande W, Udedi M, Umar E. Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) protocol. PLoS One 2023; 18:e0293370. [PMID: 38032862 PMCID: PMC10688724 DOI: 10.1371/journal.pone.0293370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023] Open
Abstract
Malawi has a population of around 20 million people and is one of the world's most economically deprived nations. Severe mental illness (largely comprising psychoses and severe mood disorders) is managed by a very small number of staff in four tertiary facilities, aided by clinical officers and nurses in general hospitals and clinics. Given these constraints, psychosis is largely undetected and untreated, with a median duration of untreated psychosis (DUP) of around six years. Our aim is to work with people with lived experience (PWLE), caregivers, local communities and health leaders to develop acceptable and sustainable psychosis detection and management systems to increase psychosis awareness, reduce DUP, and to improve the health and lives of people with psychosis in Malawi. We will use the UK Medical Research Council guidance for developing and evaluating complex interventions, including qualitative work to explore diverse perspectives around psychosis detection, management, and outcomes, augmented by co-design with PWLE, and underpinned by a Theory of Change. Planned deliverables include a readily usable management blueprint encompassing education and community supports, with an integrated care pathway that includes Primary Health Centre clinics and District Mental Health Teams. PWLE and caregivers will be closely involved throughout to ensure that the interventions are shaped by the communities concerned. The effect of the interventions will be assessed with a quasi-experimental sequential implementation in three regions, in terms of DUP reduction, symptom remission, functional recovery and PWLE / caregiver impact, with quality of life as the primary outcome. As the study team is focused on long-term impact, we recognise the importance of having embedded, robust evaluation of the programme as a whole. We will therefore evaluate implementation processes and outcomes, and cost-effectiveness, to demonstrate the value of this approach to the Ministry of Health, and to encourage longer-term adoption across Malawi.
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Affiliation(s)
- Stephen Lawrie
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry Psychology & Neuroscience, King’s College, London, United Kingdom
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lucinda Manda-Taylor
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Martin Knapp
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Martyn Pickersgill
- Centre for Biomedicine, Self and Society, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Robert C. Stewart
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Jen Ahrens
- Tower Hamlets Early Intervention Service, East London NHS Foundation Trust, London, United Kingdom
| | - Judith Allardyce
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Action Amos
- Pan African Network for Persons with Psychosocial Disabilities (PANPPD), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Annette Bauer
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Erica Breuer
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Dennis Chasweka
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Kate Chidzalo
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Saulos Gondwe
- Saint John of God (SJOG) Hospital Services, Lilongwe, Malawi
| | - Sumeet Jain
- School of Social & Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Demoubly Kokota
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Kazione Kulisewa
- Department of Psychiatry & Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Olive Liwimbi
- Zomba Mental Hospital, Ministry of Health, Zomba, Malawi
| | - Angus MacBeth
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Thandiwe Mkandawire
- Mental Health Users and Carers Association (MeHUCA), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Anthony Sefasi
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Wakumanya Sibande
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Michael Udedi
- Curative and Medical Rehabilitation Services Directorate, Ministry of Health, Lilongwe, Malawi
- African Mental Health Research Initiative (AMARI), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Eric Umar
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
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Kokota D, Stewart RC, Bandawe C, Chorwe-Sungani G, Liwimbi O, Mwale CM, Kulisewa K, Udedi M, Gondwe S, Sefasi A, Banda R, Mkandawire T, Lawrie SM. Pathways to care for psychosis in Malawi. BJPsych Int 2023; 20:84-89. [PMID: 38029442 PMCID: PMC10659844 DOI: 10.1192/bji.2023.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/15/2023] [Accepted: 06/15/2023] [Indexed: 12/01/2023] Open
Abstract
People with psychosis in Malawi have very limited access to timely assessment and evidence-based care, leading to a long duration of untreated psychosis and persistent disability. Most people with psychosis in the country consult traditional or religious healers. Stigmatising attitudes are common and services have limited capacity, particularly in rural areas. This paper, focusing on pathways to care for psychosis in Malawi, is based on the Wellcome Trust Psychosis Flagship Report on the Landscape of Mental Health Services for Psychosis in Malawi. Its purpose is to inform Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE), a longitudinal study that aims to build on existing services to develop sustainable psychosis detection systems and management pathways to promote recovery.
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Affiliation(s)
- Demoubly Kokota
- Postdoctoral Fellow, Division of Psychiatry, University of Edinburgh, Edinburgh, UK.
| | - Robert C Stewart
- Senior Clinical Research Fellow, Division of Psychiatry, University of Edinburgh, Scotland
| | - Chiwoza Bandawe
- Professor of Clinical Psychology, Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Genesis Chorwe-Sungani
- Associate Professor, Mental Health Nursing, Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Olive Liwimbi
- Consultant Psychiatrist, Zomba Mental Hospital, Zomba, Malawi
| | | | - Kazione Kulisewa
- Consultant Psychiatrist, Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Michael Udedi
- Mental Health Desk Officer, NCDs & Mental Health Unit, Ministry of Health, Lilongwe, Malawi
| | - Saulos Gondwe
- Consultant Psychiatrist, Saint John of God Hospitaller Services, Lilongwe, Malawi
| | - Anthony Sefasi
- Head Mental Health Nursing, Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Richard Banda
- Mental Health Clinical Officer, Saint John of God Hospitaller Services, Mzuzu, Malawi
| | - Thandiwe Mkandawire
- Clinical Social Worker, Mental Health Users and Carers Association, Blantyre, Malawi
| | - Stephen M Lawrie
- Professor of Psychiatry, Division of Psychiatry, University of Edinburgh, Edinburgh, UK
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4
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MacAllister DJ, Nedaw D, Kebede S, Mkandawire T, Makuluni P, Shaba C, Okullo J, Owor M, Carter R, Chilton J, Casey V, Fallas H, MacDonald AM. Contribution of physical factors to handpump borehole functionality in Africa. Sci Total Environ 2022; 851:158343. [PMID: 36041625 DOI: 10.1016/j.scitotenv.2022.158343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Handpumps are the main water supply for rural communities across sub-Saharan Africa. However, studies show that >25 % of handpumps are non-functional at any time. We present results from a systematic field study of handpump borehole functionality. The study was designed to investigate the contribution of physical factors to functionality outcomes, including; hydrogeology, borehole configuration, and handpump components. To achieve this, we deconstructed and examined 145 handpump boreholes in Ethiopia, Uganda and Malawi. Pumping tests showed that 19 % of boreholes were located in aquifers with transmissivity below the minimum required to sustain a handpump. Water levels, measured during the dry season, had a complex relationship with borehole configuration and transmissivity. The handpump cylinder was <10 m below the water table at 38 % of sites, which increases the risk of the handpump running dry during intensive use and/or in areas of low transmissivity. The water column was <20 m at 23 % of sites and screens were <10 m long at 29 % of sites and often sub-optimally positioned in the borehole. Borehole depth had no clear relationship with functionality. Using multinomial regression and four functionality categories (functional; unreliable; low yield; unreliable and low yield) as dependant variables, we found that transmissivity is a significant risk factor for the classification of handpump boreholes as low yield. The configuration of the borehole (e.g. cylinder position, screen/casing configuration and water column) is a statistically significant risk factor for the classification of handpump boreholes as unreliable. Handpump components were in poor overall condition but rising main pipes were a particular problem with 53 % of galvanised pipes corroded and 82 % of uPVC pipes damaged, with implications for handpump performance. Our study highlights the importance of; understanding aquifer properties, investing in borehole siting, construction (including supervision) and commissioning, and improving the quality of components and maintenance of handpumps.
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Affiliation(s)
| | - D Nedaw
- School of Earth Sciences, University of Addis Ababa, Addis Ababa, Ethiopia
| | - S Kebede
- School of Earth Sciences, University of Addis Ababa, Addis Ababa, Ethiopia; University of KwaZulu Natal, Centre for Water Resources Research, Pietermaritzburg, Private Bag X01, Scottsville, South Africa
| | - T Mkandawire
- University of Malawi, The Polytechnic, Private Bag 303, Blantyre 3, Malawi
| | - P Makuluni
- University of Malawi, The Polytechnic, Private Bag 303, Blantyre 3, Malawi; University of New South Wales, School of Minerals and Energy Resources Engineering, Sydney, Australia
| | - C Shaba
- University of Malawi, Chancellor College, PO Box 280, Zomba, Malawi
| | - J Okullo
- Department of Geology and Petroleum Studies, Makerere University, Kampala, Uganda
| | - M Owor
- Department of Geology and Petroleum Studies, Makerere University, Kampala, Uganda
| | - R Carter
- Richard Carter and Associates Ltd, Second Floor Rear, The Oxlip, 2 Church Street, Ampthill, Bedford, UK
| | - J Chilton
- 16 Nun's Acre, Goring-on-Thames, Reading, UK
| | - V Casey
- WaterAid UK, WaterAid, 6th Floor, 20 Canada Square, London, UK
| | - H Fallas
- British Geological Survey, The Lyell Centre, Edinburgh, UK
| | - A M MacDonald
- British Geological Survey, The Lyell Centre, Edinburgh, UK
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