Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda

Mutamba, Byamah B; Kane, Jeremy C.; Jong, Joop T. V. M. de; Okello, James; Musisi, Seggane; Kohrt, Brandon A.

doi:10.1017/s0033291718000193

Cited by 40 publications

(24 citation statements)

References 72 publications

(115 reference statements)

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“…Testing the effectiveness of this psychosocial intervention within the structure of an existing interdisciplinary adolescent maternity hospital clinic is ideal to facilitate successful transfer of research-based knowledge to routine clinical practice. The potential for dissemination of this psychosocial intervention is further enhanced by evidence showing that IPT can be delivered effectively and with fidelity by trained facilitators who do not necessarily have an advanced degree in psychology, such as lay community health workers [99].…”

Section: Discussionmentioning

confidence: 99%

Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents

Shomaker

Gulley

Clark

et al. 2020

Pilot Feasibility Stud

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Background: Excess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity.Methods: The current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hospital clinic and randomized to IPT + usual care or usual care alone. IPT involves 6 individual 60-minute sessions delivered by a trained behavioral health clinician during 12-30 weeks gestation. Sessions include relationship psychoeducation, emotion identification and expression, and teaching/role-playing communication skills. Between sessions, adolescents are instructed to complete a daily journal and to have conversations to work on relationship goals. Outcomes are assessed at baseline, mid-program, post-program, and 3-months postpartum. Primary outcomes are feasibility and acceptability based upon rate of recruitment, session attendance, program acceptability ratings, and follow-up retention. Secondary outcomes are perinatal social functioning, stress, depression, and eating behaviors assessed with validated surveys and interviews; perinatal physical activity and (Continued on next page)

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Section: Discussionmentioning

confidence: 99%

Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents

Shomaker

Gulley

Clark

et al. 2020

Pilot Feasibility Stud

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“…This has included reports of the common trauma syndromes of posttraumatic stress disorder, the anxieties, depression, psychosis, traumatic brain injury, epilepsies, and other physical injuries, all with their attendant complications/associations including substance abuse, epidemics e.g., HIV, cholera, Ebola etc. There have also been reports of unusual or atypical/uncommon presentations of trauma sequels in Africa such as dissociative disorders, spirit possessions (9), somatization syndromes (3), rape trauma syndrome (10), mass hysteria, or "demon attack disease" (11,12), cult indoctrination syndromes (13), and controversial ones like nodding syndrome in Uganda (14)(15)(16). There are also new and re-emerging stress threats to the African continent posed by the ongoing mass traumatization including mass radicalizations, brainwashing, fundamentalist fanatics or religionists, destructive cults, jihadists, suicide bombers, genocidaires, appetitive aggression, child soldiers, and finally the problem of population displacements, migration, and the reemergence of slavery (17).…”

Section: Current War Traumatization In Africamentioning

confidence: 99%

“…In Northern Uganda's war conflictaffected areas, reports of nodding syndrome first appeared in 1997 (54). Nodding syndrome, NS, was characterized by malnutrition, stunted growth, mental retardation, and seizures in about 50% of the cases leading some researchers to designate it as a neurological epilepsy disorder (15,16). However, the affected Acholi people called it "luc luc or yengo wic" and recognized it as a new disease in their midst and related to the LRA insurgency war.…”

Section: Nodding Syndrome and Starvation Syndromesmentioning

confidence: 99%

Long-Term Impact of War, Civil War, and Persecution in Civilian Populations—Conflict and Post-Traumatic Stress in African Communities

Musisi

Kinyanda

2020

Front. Psychiatry

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This chapter describes how chronic conflict, warfare, and persecution, as lived experiences, have created significant mental distress in communities on the African continent. There is a growing body of research that highlights increasing mental distress in Africa e.g., about sexuality, health, disease, modernity, climate, politics, culture, religion, ethnicities, race, economies etc. Many of these stresses and uncertainties are driven by political persecution, war, and conflict. This has shaped many African people's attitudes and government policies and an increasing scholarly interest in exploring these "uncertainties and mental distresses in Africa." The chapter will show how trauma, as seen in conflict/post-conflict settings in Africa, causes significant mental stress and associated social problems as well as medically-defined PTSD syndromes, anxiety, and depression which cause much morbidity and retard development in many African communities. Taking a classical look at post-traumatic stress disorder, PTSD, the chapter explores the presentation of the various physical and mental clinical syndromes related to war-trauma on the African continent and the consequent health-seeking behaviors of the African peoples in this regard. The term "culture-bound PTSD syndromes" will be introduced and discussed in the broader context of treatment, rehabilitation, and prevention on the continent and worldwide. It will also discuss the dilemma of the vicious cycles of trauma driven by appetitive aggression in today's Africa which portends to further retard socioeconomic development and drives the trans-generational perpetuation of ethnic-based conflicts including genocides. Despite this mass traumatization, the chapter points to the virtual absence of post-conflict mental health policies in almost all African countries, hence leading to discussions of "best-practices" recommendations.

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“…70 Psychological interventions have been shown to mitigate depression in caregivers. 71 The 2013 guidelines for the management of NS suggest that, depending on severity, care may include anti-epileptics or anti-convulsants, appropriate management of comorbidities, psychiatric support, nutritional assistance and physical, occupational, speech and language therapy. 5 A cross-sectional cohort study of NS and other convulsive epilepsy (OCE) patients treated according to these guidelines showed improvement in both groups of patients, with 25% of NS and 51% of OCE patients being seizure free after 12 months.…”

Section: Autoimmunitymentioning

confidence: 99%

Aetiologies and therapies of nodding syndrome: a systematic review and meta-analysis

Stacey

Woodhouse²,

Welburn³

et al. 2019

Journal of Global Health Reports

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Nodding syndrome (NS) is a childhood epileptic disorder of unknown aetiology confined to parts of South Sudan, Uganda and the United Republic of Tanzania. Patients suffer from atonic seizures that result in characteristic head nodding, and may develop other neurological, endocrinological and psychiatric manifestations. The objective of this study was to adopt a non-judgemental approach to review the hypothesised aetiologies and therapeutic options available for NS. To explore the reported association between NS and Onchocerca volvulus (OV) a meta-analysis of the prevalence of OV among NS cases and controls was performed. Methods MethodsSystematic searching of five electronic databases yielded 26 articles that addressed potential aetiologies of NS and 12 that explored the treatment of NS. R Results esultsNine articles contained data about the prevalence of OV in NS cases that was suitable for inclusion in the meta-analysis. Four broad aetiological themes were identified. 1) Nutritional associations included biomarkers of malnutrition and conflicting reports regarding the consumption of some foodstuffs. 2) Regional conflict and the associated psychological trauma have led to consideration of psychiatric aetiologies. 3) There is a strong epidemiological association between NS and Onchocerca volvulus. The meta-analysis in this study revealed that 68.0% (95% confidence interval (CI)=45.2-87.0) of 416 NS patients were OV+, compared to 46.6% (95% CI=16.4-78.1) of 321 controls. Heterogeneity among both cases (I 2 =95.5%, 95% CI=93.3-97.0) and controls (I 2 =97.1%, 95% CI=95.5-98.2) was high. The difference of 21.4% in OV prevalence between the pooled populations was significant (P<0.0001). It is thought that NS represents a form of onchocerciasis-associated epilepsy, however there are also reported associations with Mansonella pestans and measles virus. 4) Autoantibodies against leiomodin-1 and the voltage-gated potassium channel have been associated with NS. Molecular mimicry between leiomodin-1 and O. volvulus tropomyosin is a recently suggested aetiology. Without a clear aetiology treatment is symptomatic and patients have been shown to improve with a combination of anti-epileptic medication and supportive therapy. C Conclusions onclusionsThe aetiology of NS remains unclear. The leading theory is that NS represents a form of onchocerciasis-associated epilepsy secondary to autoimmunity driven by molecular mimicry. Alternatively, it has been suggested that NS may represent a post-infectious sequelae of measles virus infection. However, each theory currently leaves some questions unanswered. It remains important to understand the aetiology of NS to better prevent or treat future outbreaks.Nodding syndrome (NS) is a neurological condition of unknown aetiology confined to parts of the United Republic of Tanzania (URT), South Sudan and Uganda. The characteristic head nodding that gives the syndrome its name was

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Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda

Cited by 40 publications

References 72 publications

Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents

Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents

Long-Term Impact of War, Civil War, and Persecution in Civilian Populations—Conflict and Post-Traumatic Stress in African Communities

Aetiologies and therapies of nodding syndrome: a systematic review and meta-analysis

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