BackgroundThe process to seek for care by patients who experience episodes of mental disorders may determine how and where they receive the needed treatment. This study aimed to understand the pathways that people with mental disorders traversed for psychiatric services, particularly where these individuals will first seek treatment and the factors that influence such pathways to mental health care.MethodsA cross-sectional study conducted at Pantang psychiatric hospital in Accra, Ghana involving 107 patients of ages 18 and older and their family members. The study adapted the World Health Organization’s (WHO) pathway encounter form to collect information about patients’ pathway contacts for psychiatric care. Chi Square test was done to determine patients’ first point of contact and any association between the independent variables (clinical diagnosis and socio-demographic factors) and first pathway contact. Multiple regression analyses were also done to estimate the odds of patients’ first pathway contact.ResultsOverall, nearly 48 % of patients initially contacted non-psychiatric treatment centers (faith-based, traditional healers and general medical practitioners) as their first point of contact for treatment of mental disorders. A little more than half of the patients went directly to the formal public psychiatric facility as their first point of contact for care of their mental disorders. Patients’ occupation was significantly associated with their first point of contact for psychiatric care (χ2 = 6.91; p < 0.033). Those with secondary education were less likely to initially seek care from the formal public psychiatric hospital compared to those with no formal education (uOR = 0.86; 95 % CI 0.18–4.08).ConclusionPatients used different pathways to seek psychiatric care, namely direct pathway to a psychiatric hospital or through transition from informal non-psychiatric service providers. Since nearly half of patients do not initially seek mental health care directly at the formal psychiatric facility, it is important for the government of Ghana to increase funding to the mental health authorities in Ghana as a matter of priority so that more individuals can be identified and integrated into mainstream psychiatric treatment and general health facilities where there are trained Community Mental Health Officers (CMHO) and Clinical Psychiatric Officers (CPO) to provide early intervention and treatment.

West African policymakers should adopt a preventive approach consistent with the World Health Organization Framework Convention on Tobacco Control to prevent an adolescent from initiating smoking and developing into future regular smokers.

BackgroundApplying global estimates of the prevalence of mental disorders suggests that about 2.4 million Ghanaians have some form of psychiatric distress. Despite the facts that relatively little community-based treatment is available (only 18 psychiatrists are known to actively practice in Ghana), and that mental disorders are more concentrated among the incarcerated, there is no known research on mental disorders in Ghana prisons, and no forensic mental health services available to those who suffer from them. This study sought to determine the rate of mental distress among prisoners in Ghana.MethodsThis cross-sectional research used the Kessler Psychological Distress Scale to estimate the rates and severity of non-specific psychological distress among a stratified probability sample of 89 male and 11 female prisoners in one of the oldest correctional facilities in the country. Fisher’s exact test was used to determine the rates of psychological distress within the study population.ResultsAccording to the Kessler Scale, more than half of all respondents had moderate to severe mental distress in the four weeks preceding their interviews. Nearly 70% of inmates with only a primary education had moderate to severe mental distress. Though this was higher than the rates among inmates with more education, it exceeded the rates for those with no education.ConclusionsThe high rate of moderate to severe mental distress among the inmates in this exploratory study should serve as baseline for further studies into mental disorders among the incarcerated persons in Ghana. Future research should use larger samples, include more prison facilities, and incorporate tools that can identify specific mental disorders.

BackgroundDespite improvements over time, West Africa lags behind global as well as sub-Saharan averages in its maternal, newborn and child health (MNCH) outcomes. This is despite the availability of an increasing body of knowledge on interventions that improve such outcomes. Beyond our knowledge of what interventions work, insights are needed on others factors that facilitate or inhibit MNCH outcome improvement. This study aimed to explore health system factors conducive or limiting to MNCH policy and programme implementation and outcomes in West Africa, and how and why they work in context.MethodsWe conducted a mixed methods multi-country case study focusing predominantly, but not exclusively, on the six West African countries (Burkina Faso, Benin, Mali, Senegal, Nigeria and Ghana) of the Innovating for Maternal and Child Health in Africa initiative. Data collection involved non-exhaustive review of grey and published literature, and 48 key informant interviews. We validated our findings and conclusions at two separate multi-stakeholder meetings organised by the West African Health Organization. To guide our data collection and analysis, we developed a unique theoretical framework of the link between health systems and MNCH, in which we conceptualised health systems as the foundations, pillars and roofing of a shelter for MNCH, and context as the ground on which the foundation is laid.ResultsA multitude of MNCH policies and interventions were being piloted, researched or implemented at scale in the sub-region, most of which faced multiple interacting conducive and limiting health system factors to effective implementation, as well as contextual challenges. Context acted through its effect on health system factors as well as on the social determinants of health.ConclusionsTo accelerate and sustain improvements in MNCH outcomes in West Africa, an integrated approach to research and practice of simultaneously addressing health systems and contextual factors alongside MNCH service delivery interventions is needed. This requires multi-level, multi-sectoral and multi-stakeholder engagement approaches that span current geographical, language, research and practice community boundaries in West Africa, and effectively link the efforts of actors interested in health systems strengthening with those of actors interested in MNCH outcome improvement.

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