Background: Few studies have examined the prevalence of mental, neurological and substance use disorders, case detection and treatment in primary healthcare in rural settings in Africa. We assessed needs and case detection rate at primary healthcare facilities in low-resource settings in Ghana. Methods: A cross-sectional study was conducted at the health facility level in three demonstration districts situated in Northern, Middle and Southern belts in Ghana. These districts are Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region). Data were collected on five priority mental, neurological and substance use conditions of interest including depression, psychosis, suicidal ideation, epilepsy and alcohol use disorders. Results: Nine hundred and nine (909) people participated in the survey. The prevalence of depression was 15.6% (142/909), psychosis was 12% (109/909), suicidal ideation was 11.8% (107/909), epilepsy was 13.1% (119/909) and alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, psychosis, epilepsy and alcohol use disorders (AUD) ranged from 94.4% to 99.2%, and was similar across study districts. Depression was associated with psychosis (RR: 1.68; 95% CI: 1.12-1.54). For psychosis, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39-0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02-0.84). Increased risk of suicidal ideation was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27-4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93-5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20-0.90) and attending a health facility in the Anloga district (RR: 0.43; 95% CI: 0.20-0.90) were associated with reduced risk of epilepsy, but not for those more than 35 years (RR: 3.06; 95% CI:1.14-8.24). Being female (RR: 0.19; 95% CI: 0.12-0.31) and having a tertiary education were associated with reduced risk of AUD (RR: 0.27; 95% CI: 0.08-0.92). Conclusions: Our study found a relatively high prevalence of MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage mental health conditions, together with improved medication supply and referral pathways.

In Northern and Northeast Ghana, women accused of witchcraft are banished from society to live in special locations designated “witches camps.” The processes leading to their banishment, admission, and living in the camps may affect their psychological wellbeing and quality of life. This study was conducted to determine the prevalence of depression and assess the quality of life of 277 alleged witches in four camps located in these two regions in Ghana. A structured questionnaire was developed and administered using the open data collection kit (ODK). The Patient Health Questionnaire-8 (PHQ-8) and the World Health Organisation Quality of Life (WHOQOL) questionnaires were adopted to measure depression and health-related quality of life, respectively. The data were analysed using STATA version 16. The prevalence of depression among the alleged witches was 52.7%. Out of this, 37.2% had moderate depression, 7.2% had moderate or severe depression whilst 2.9% had severe depression. The sociodemographic factors that have a statistically significant association with depression included gender, marital status, being widowed or separated, and not having biological children. Over 97% of alleged witches have a low or extremely low quality of life. In conclusion, the majority of the people accused of witchcraft have a low or extremely low quality of life with high-probable depression.

Background Few studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana. Methods A cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders. Results Nine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12–1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39–0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02–0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27–4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93–5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20–0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12–0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08–0.92) were associated with reduced risk of AUD. Conclusions Our study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions.