Browsing by Author "Ofori-Atta, A."

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Aggression in mental health settings: a case study in Ghana
(Bulletin of the World Health Organization, 2015-08) Jack, H.; Canavan, M.; Bradley, E.; Ofori-Atta, A.
Stigma towards people living with mental health problems is often the result of deep-rooted fears about irrational behaviour or loss of control.1 When we conducted a study of recruitment and retention factors for staff in Ghanaian psychiatric hospitals, we found that the stigma was directed towards mental health professionals too. Some of our respondents linked the pervasive stigma of mental health to perceptions that patients with mental disorders could be aggressive or violent. We used a semi-structured discussion guide with follow-up prompts in face-to-face interviews with 28 mental health workers of all levels. Inclusion criteria were employment in one of Ghana’s three psychiatric hospitals and ability to speak English. We selected respondents using the chain referral method of sampling2 to theoretical saturation,3 seeking diversity in roles within the hospital, gender, age and length of time working in mental health services. We asked respondents about daily job activities and reasons why they started and stayed working at a psychiatric hospital. For data analysis, we used the qualitative constant comparative method,4 adapted for health services research.5 We have described the findings relevant to worker recruitment and retention elsewhere.6 Although we asked no questions specifically about stigma or the behaviour of people with mental health problems, many respondents revealed that one of the greatest challenges they encountered at work was fear of and injury from aggression. Aggressive behaviours of people attending psychiatric hospitals7 and primary care settings8 have previously been documented. Our work on Ghana’s mental health system suggests that aggression and stigma are central challenges for mental health workers. Appropriate support for mental health professionals could play a key role in reducing stigma, increasing health worker recruitment and retention and improving mental health care. These efforts must be central, not secondary, in global efforts to scale-up access to mental health care. In low- and middle-income countries, less than 25% of people with the most severe mental disorders receive any conventional treatment. Treatment rates are far lower for people with moderate or mild disorders.9 Mental health care, perhaps even more than other areas of medical treatment, relies on trained workers. If the mental health treatment gap is to be addressed, a global effort to strengthen human resources for mental health will be required. There are currently fewer than 1.7 mental health workers of any kind per 100 000 population in in Africa and 5.3 per 100 000 in south-east Asia, compared with 14.8 in the Americas and 43.9 in Europe.10 Less than 3% of the medical curriculum is devoted to mental health, leaving many health workers under-prepared to manage people living with mental health problems.10 The number of specialized workers, including psychiatrists, psychiatric nurses, counsellors and social workers needs to increase; and other health professionals need to be more involved in managing mental health disorders.11 Many participants in our study felt unprepared to manage aggressive behaviour and consequently resorted to inappropriate restraint, overuse of medication or ignoring people with mental health problems. Calling attention to aggressive behaviour could be viewed as blaming the person with mental health problems, adding to stigma. Failing to address the issue, however, threatens both human rights and worker morale. Given the increasing global focus on task-shifting mental health service provision away from specialist workers, all levels of staff who work with patients with mental health disorders should be prepared to manage aggressive behaviour. The management of aggressive behaviour is not covered by international guidelines on training for, and support of, mental health workers and is largely absent from research on global mental health. Thus far, mental health workforce development materials – including the WHO Human resources and training in mental health and the mhGap intervention guide for mental, neurological and substance use disorders in non-specialized health settings – have insufficient training on managing aggression.12,13 Explicit training on effective and safe handling of aggressive behaviour is most important for frontline workers, such as nurses, nurse assistants and community health workers, who have the most direct contact with people living with mental health disorders. Health professionals in primary care also see people with psychosis, dementia, drug and alcohol dependence and other conditions that can lead to aggression. Physicians, hospital managers and others in supervisory roles should also receive training on how to lead organizational responses to aggression, which target the causes of aggressive behaviour, such as overcrowding or inappropriate medication use, and help build a safe work environment.14 Clinical management protocols could be useful in management of aggressive behaviour. These types of protocols have been helpful in the context of human immunodeficiency virus (HIV) care, where a protocol for emergency prophylaxis is increasingly standard practice. Even if protocols are infrequently used, having them in place can ease health worker anxiety and as a result, reduce stigma towards service users.15,16 The field of global mental health could also borrow other strategies from work on HIV stigma, which includes mass media campaigns featuring testimonials of people living with HIV, structural interventions in hospitals or other organizations to ensure that people living with HIV are fully integrated; large scale-up of access to treatment and development and evaluation of many innovative education interventions for health workers and communities.17 While the call for an expanded mental health workforce is well founded, we must also consider workforce development efforts to address the unique and sensitive challenges that mental health workers tackle on a daily basis. Mechanisms for helping mental health workers handle stigma, job stress and aggression are paramount, particularly as efforts to integrate mental health into primary care and increase the involvement of non-specialist workers are scaled up.11 Issues of stigmatization and aggression must be addressed with careful planning and discussion among community representatives, educators, clinicians and researchers.
Changing trends in mental health care and research in Ghana
(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ofori-Atta, A.; Ohene, S.
This Reader is about the changing trends in mental health care and research in Ghana. The book includes a brief history of the department and Mental Health Care in Ghana through the eyes of professionals who have lived this history. There is also a revised situation analysis of mental health services and legislation from 2005. These are followed by three main sections on Conceptualization of Mental Illness (depression, religion and illness, autism, substance use disorders and schizophrenia), Mental Health Practice in a teaching hospital setting (referrals to Korle-Bu, how psychiatric illnesses manifest, how people's lives are affected and what skill sets and resources are available for dealing with them) and finally the Department's focus on research includes the Mental Health Information System, Sickle Cell Disease, Medical Ethics, and Liaison Psychiatry. In the concluding paragraph, read about the way forward in mental health care and research. © University of Ghana, 2014. All Right Reserved.
Common understandings of women's mental illness in Ghana: Results from a qualitative study
(International Review of Psychiatry, 2010-12) Ofori-Atta, A.; Cooper, S.; Akpalu, B.; Osei, A.; Doku, V.; Lund, C.; Flisher, A.
Despite the high rates of depression and anxiety disorders amongst women, the mental health of women is a neglected area, particularly in Africa. This study sought to explore what key stakeholders perceive as the main causes of mental illness in women in Ghana. Using qualitative methods, 81 semi-structured interviews and seven focus group discussions were conducted with 120 key stakeholders drawn from 5 of the 10 regions in Ghana. The analysis was undertaken using a grounded theory approach. Respondents attributed mental illness in women to a number of causes. These included women being the weaker sex, hormones, witchcraft, adultery, abuse and poverty. Explanations could be clustered under three broad categories: women's inherent vulnerability, witchcraft, and gender disadvantage. The way in which women's subordinate position within society may underpin their mental distress needs to be recognized and addressed. The results from this study offer opportunities to identify how policy can better recognize, accommodate and address the mental health needs of women in Ghana and other low-income African countries. © 2010 Informa UK Ltd All rights reserved.
A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study
(JMIR, 2021) Ben-Zeev, D.; Meller, S.; Snyder, J.; Attah, D.A.; Albright, L.; Le, H.; Asafo, S.M.; Collins, P.Y.; Ofori-Atta, A.
The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining. The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community. Methods: We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing. A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable.The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable.
Dilemmas of healthcare professionals in Ghana
(Changing Trends in Mental Health Care and Research in Ghana, 2014-01) Ofori-Atta, A.; Jack, H.
Empowerment and use of antenatal care among women in Ghana: a cross-sectional study
(2014-11-01) Sipsma, H.; Ofori-Atta, A.; Canavan, M.; Udry, C.; Bradley, E.
Abstract Background Empowerment among women in the context of a romantic relationship may affect the use of reproductive healthcare services; however, current literature examining this association is limited and inconsistent. We therefore aimed to examine the relationship between several measures of empowerment and use of inadequate antenatal care among women in Ghana. Methods We conducted a cross-sectional study using data from a nationally representative cohort of women in Ghana. Our analytic sample was limited to non-pregnant women who had been pregnant and involved in a relationship within the last 12 months. We used multivariable logistic regression to assess the associations between empowerment and inadequate use of antenatal care and interaction terms to assess moderation by education. Results Approximately 26% of women received inadequate antenatal care. Multivariable analysis indicated that having experienced physical abuse in the past year was directly associated with inadequate use of antenatal care (OR = 5.12; 95% CI = 1.35, 19.43) after adjusting for socio-demographic characteristics. This effect was particularly pronounced among women with no formal education and was non-significant among women with at least some formal education (P-value for interaction <0.001). Conclusions Results suggest that improving use of reproductive health care services will require reducing partner abuse and enhancing empowerment among women in Ghana and other low-income countries, particularly among those with no formal education. Furthermore, the involvement of male partners will be critical for improving reproductive health outcomes, and increasing education among girls in these settings is likely a strong approach for improving reproductive health and buffering effects of low empowerment among women.
Empowerment and use of antenatal care among women in Ghana: A cross-sectional study
(BMC Pregnancy and Childbirth, 2014-11) Sipsma, H.; Ofori-Atta, A.; Canavan, M.; Udry, C.; Bradley, E.
Background: Empowerment among women in the context of a romantic relationship may affect the use of reproductive healthcare services; however, current literature examining this association is limited and inconsistent. We therefore aimed to examine the relationship between several measures of empowerment and use of inadequate antenatal care among women in Ghana. Methods: We conducted a cross-sectional study using data from a nationally representative cohort of women in Ghana. Our analytic sample was limited to non-pregnant women who had been pregnant and involved in a relationship within the last 12 months. We used multivariable logistic regression to assess the associations between empowerment and inadequate use of antenatal care and interaction terms to assess moderation by education. Results: Approximately 26% of women received inadequate antenatal care. Multivariable analysis indicated that having experienced physical abuse in the past year was directly associated with inadequate use of antenatal care (OR = 5.12; 95% CI = 1.35, 19.43) after adjusting for socio-demographic characteristics. This effect was particularly pronounced among women with no formal education and was non-significant among women with at least some formal education (P-value for interaction <0.001). Conclusions: Results suggest that improving use of reproductive health care services will require reducing partner abuse and enhancing empowerment among women in Ghana and other low-income countries, particularly among those with no formal education. Furthermore, the involvement of male partners will be critical for improving reproductive health outcomes, and increasing education among girls in these settings is likely a strong approach for improving reproductive health and buffering effects of low empowerment among women. © Sipsma et al.
Ethical dilemmas in psychological services in Ghana: the views of clinical psychologists
(Taylor & Francis Group, 2021) Oppong, V.B.; Osafo, J.; Ofori-Atta, A.
Ethics reflects the moral principles upon which most professional practices rest. It forms the basis to do good, to do no harm, to respect others, and ensure justice. The purpose of this study was to investigate ethical dilemmas experienced by 20 clinical psychologists in Ghana. Semi-structured interviews were used to investigate ethical dilemmas faced in professional practice. Using thematic analysis, the reported dilemmas included third-party involvement, (sub-themes: Therapy with Minors, Marital Disclosures, Source of referral, Duty to Warn), Dual relationships (subthemes: Collegial Relationships, Power Differential in Relationships), Cultural competence, and Policies and practices. The findings showed that although some of these dilemmas are universal, others arise (e.g., cultural competence) from the general cultural context of Ghana and the professional culture within which clinical psychologists are socialized. Recommendations to assist clinical psychologists address ethical dilemmas in Ghana and implications for the development of ethical regulations in the country are addressed.
Experience of strengthening the mental health information system in Ghana's three psychiatric hospitals
(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ofori-Atta, A.; Mirzoev, T.; Mensah-Kufuor, A.; Osei, A.; Dzadey, A.; Armah-Aloo, K.; Atweam, D.
•255• Chapter 20 Experience of Strengthening the Mental Health Information System in Ghana’s Three Psychiatric Hospitals A.Ofori-Atta, T. Mirzoev, A. Mensah-Kufuor, A. Osei, A. Dzadey, K. Armah-Aloo, K.D.Atweam Introduction The World Health Organization deﬁnes a Mental Health Information System (MHIS) as ‘a system for collecting, processing, analysing, disseminating and using information about a mental health service and the mental health needs of the population it serves (WHO, (2005). Developing MHIS may be considered a costly intervention, and yet the ultimate aim in establishing MHIS in low-income countries is for a more equitable distribution of resources in the context of scarcity (Husein, Adeyi, Bryant et al., 1993) . This is particularly pertinent for mental health care in Ghana, where there is inequitable distribution of mental health services (Doku, Ofori-Atta, Akpalu, et al., 2008). A situation analysis of mental health policy implementation in Ghana was conducted as the ﬁrst phase of the Mental Health and Poverty Project (MHAPP). The MHAPP was a 5-year (research consortium project funded by the Department for International Development of the United Kingdom (DfID) and it ended in December 2010. The situation analysis revealed numerous challenges faced by the existing Mental Health Information System (MHIS) in Ghana (Doku et al., 2008). There was limited information on mental health collected routinely at the three psychiatric hospitals, and the district and regional hospitals. The information also focused on four disease categories only (psychotic disorders, epilepsy, substance use disorders and neurosis). The deﬁnitions of the categories were not standardized across the different data-gathering institutions, results were poorly analysed, rarely disseminated and the output was not useful to policy makers or for mental health advocacy. In response to the above •256• Chapter 20 challenges, an intervention to strengthen the MHIS in Ghana was implemented with support from the MHAPP and in collaboration with the Ghana Health Service. MHIS is owned by the Ministry of Health and the Ghana Health Service (GHS). This intervention was therefore a collaboration between the Ghana Health Service and the Mental Health and Poverty Project (MHAPP). A basic understanding to work conjointly towards the strengthening of the MHIS was agreed upon, with the MHAPP acting as collaborator and catalyst, and the Ministry of Health and its institutions as the implementers. The GHS provided the human resources, with the MHAPP contributing specialist and ﬁnancial resources. The objective of this paper is to report on the design and implementation of the MHIS, and to deliberate on the factors which inﬂuenced these processes and the key intervention effects. General principles on health management information systems which were considered in the design of the MHIS Our design for the development of the MHIS was informed by general principles deduced from literature. The literature showed that challenges when developing health information systems generally in developing countries include insufﬁcient training for staff responsible for implementation, lack of understanding of the changes introduced, inadequate supervision for staff involved, and lack of the skills and abilities necessary to undertake additional responsibilities required by the HMIS (Gladwin, Dixon, and Wilson, 2003) . Furthermore, systems must be ‘user friendly’ (WHO 2005) in order to have the best chance of consistent and accurate collection of data by health care workers (Husein et al., 1993). There is the need to focus on a broad spectrum of mental disorders, not only those for which treatment is available in order to illustrate unmet need so as to lobby for greater resources. One must also decide whether data collected should be population or facility-based depending on how comprehensive the data need to be ( Kustner, Varo, and Gonzales, 2002). An MHIS that collects data only from mental health services is likely to exclude many cases. Finally, process issues such as consultation with stake-holders, and the need •257• Experience of Strengthening the Mental Health Information System for monitoring and evaluation, are worth planning for (OdhiamboOtieno , 2005a; Odhiambo-Otieno, 2005b). Intervention design and implementation Intervention design. The intervention was aimed to strengthen and expand MHIS at the psychiatric hospitals, focusing on the functions of collection, processing, analysis, and use of information. The MHIS was designed to include a combination of paper-based and computerized elements. Patients were given a registration form on each visit, which was ﬁlled in as they contacted professionals in each department of the hospital. On exit, the form was retained and sent to the records department, where it was entered into the database. Sites: The intervention was...
Female genital cutting: Current practices and beliefs in western Africa
(Bulletin of the World Health Organization, 2012-02) Sipsma, H.L.; Chen, P.G.; Ofori-Atta, A.; Ilozumba, U.O.; Karfo, K.; Bradley, E.H.
Objective To conduct a cross-national comparative study of the prevalence and correlates of female genital cutting (FGC) practices and beliefs in western Africa. Methods Data from women who responded to the Multiple Indicator Cluster Surveys between 2005 and 2007 were used to estimate the frequencies of ever having been circumcised, having had a daughter circumcised, and believing that FGC practices should continue. Weighted logistic regression using data for each country was performed to determine the independent correlates of each outcome. Findings The prevalence of FGC was high overall but varied substantially across countries in western Africa. In Sierra Leone, Gambia, Burkina Faso and Mauritania, the prevalence of FGC was 94%, 79%, 74% and 72%, respectively, whereas in Ghana, Niger and Togo prevalence was less than 6%. Older age and being Muslim were generally associated with increased odds of FGC, and higher education was associated with lower odds of FGC. The association between FGC and wealth varied considerably. Burkina Faso was the only country in our study that experienced a dramatic reduction in FGC prevalence from women (74%) to their daughters (25%); only 14.2% of the women surveyed in that country said that they believe the practice should continue. Conclusion The prevalence of FGC in western Africa remains high overall but varies substantially across countries. Given the broad range of experiences, successful strategies from countries where FGC is declining may provide useful examples for high-prevalence countries seeking to reduce their own FGC practices.
Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: Rationale, overview and methods of AFFIRM
(Epidemiology and Psychiatric Sciences, 2015-04) Lund, C.; Alem, A.; Schneider, M.; Hanlon, C.; Ahrens, J.; Bandawe, C.; Bass, J.; Bhana, A.; Burns, J.; Chibanda, D.; Cowan, F.; Davies, T.; Dewey, M.; Fekadu, A.; Freeman, M.; Honikman, S.; Joska, J.; Kagee, A.; Mayston, R.; Medhin, G.; Musisi, S.; Myer, L.; Ntulo, T.; Nyatsanza, M.; Ofori-Atta, A.; Petersen, I.; Phakathi, S.; Prince, M.; Shibre, T.; Stein, D.J.; Swartz, L.; Thornicroft, G.; Tomlinson, M.; Wissow, L.; Susser, E.
There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators. © Cambridge University Press 2015.
HIV knowledge, stigma, and illness beliefs among pediatric caregivers in Ghana who have not disclosed their child's HIV status
(AIDS Care, 2015-11) Paintsil, E.; Renner, L.; Antwi, S.; Dame, J.; Enimil, A.; Ofori-Atta, A.; Alhassan, A.; Ofori, I.P.; Cong, X.; Kyriakides, T.; Reynolds, N.R.
The majority of HIV-infected children in sub-Saharan Africa have not been informed of their HIV status. Caregivers are reluctant to disclose HIV status to their children because of concern about the child’s ability to understand, parental sense of guilt, and fear of social rejection and isolation. We hypothesized that the low prevalence of pediatric HIV disclosure in Ghana is due to lack of accurate HIV information and high HIV stigma among caregivers. This is a preliminary analysis of baseline data of an HIV pediatric disclosure intervention study in Ghana (“Sankofa”). “Sankofa” – is a two-arm randomized controlled clinical trial comparing disclosure intervention plus usual care (intervention arm) vs usual care (control arm) at Korle-Bu Teaching Hospital (KBTH; control arm) and Komfo-Anokye Teaching Hospital (KATH; intervention arm). We enrolled HIV-infected children, ages 7–18 years who do not know their HIV status, and their caregivers. Baseline data of caregivers included demographic characteristics; Brief HIV Knowledge Questionnaire (HIV-KQ-18); Brief Illness Perception Questionnaire; and HIV Stigma Scale. Simple and multivariable linear regression analyses were used to assess the relationship between caregiver characteristics and HIV knowledge, stigma, and illness perception. Two hundred and ninety-eight caregivers were enrolled between January 2013 and July 2014 at the two study sites; KBTH (n = 167) and KATH (n = 131). The median age of caregivers was 41 years; 80.5% of them were female and about 60% of caregivers were HIV-positive. Seventy-eight percent of caregivers were self-employed with low household income. In both unadjusted and adjusted analyses, HIV negative status and lower level of education were associated with poor scores on HIV-KQ. HIV positive status remained significant for higher level of stigma in the adjusted analyses. None of the caregiver’s characteristics predicted caregiver’s illness perception. Intensification of HIV education in schools and targeted community campaigns are needed.
Introduction
(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ofori-Atta, A.
Play therapy; a pilot project supporting children undergoing cancer treatment at the korle-bu teaching hospital
(Changing Trends in Mental Health Care and Research in Ghana, 2014-01) Osae-Larbi, J.; Acquah-Arhin, R.; Mork, S.; Ofori-Atta, A.
Prayer camps and biomedical care in Ghana: Is collaboration in mental health care possible?
(Public Library of Science, 2016) Arias, D.; Taylor, L.; Ofori-Atta, A.; Bradley, E.H.
Background Experts have suggested that intersectoral partnerships between prayer camps and biomedical care providers may be an effective strategy to address the overwhelming shortage of mental health care workers in Africa and other low-income settings. Nevertheless, previous studies have not explored whether the prayer camp and biomedical staff beliefs and practices provide sufficient common ground to enable cooperative relationships. Therefore, we sought to examine the beliefs and practices of prayer camp staff and the perspective of biomedical care providers, with the goal of characterizing interest in-and potential for-intersectoral partnership between prayer camp staff and biomedical care providers. Methods We conducted 50 open-ended, semi-structured interviews with prophets and staff at nine Christian prayer camps in Ghana, and with staff within Ghana's three public psychiatric hospitals. We used the purposive sampling method to recruit participants and the constant comparative method for qualitative data analysis. Results Prayer camp staff expressed interest in collaboration with biomedical mental health care providers, particularly if partnerships could provide technical support introducing medications in the prayer camp and address key shortcomings in their infrastructure and hygienic conditions. Nevertheless, challenges for collaboration were apparent as prayer camp staff expressed strong beliefs in a spiritual rather than biomedical explanatory model for mental illness, frequently used fasting and chained restraints in the course of treatment, and endorsed only short-termuse of medication to treat mental illness-expressing concerns that long-term medication regimens masked underlying spiritual causes of illness. Biomedical providers were skeptical about the spiritual interpretations of mental illness held by faith healers, and were concerned by the use of chains, fasting, and the lack of adequate living facilities for patients in prayer camps; many, however, expressed interest in engaging with prayer camps to expand access to clinical care for patients residing in the camps. Conclusions The findings demonstrate that biomedical care providers are interested in engaging with prayer camps. Key areas where partnerships may best improve conditions for patients at prayer camps include collaborating on creating safe and secure physical spaces and delivering medication for mental illness to patients living in prayer camps. However, while prayer camp staff are willing to engage biomedical knowledge, deeply held beliefs and routine practices of faith and biomedical healers are difficult to reconcile Additional discussion is needed to find the common ground on which the scarce resources for mental health care in Ghana can collaborate most effectively.
Preparing for Ebola Virus Disease in West African countries not yet affected: Perspectives from Ghanaian health professionals
(Globalization and Health, 2015-02) Nyarko, Y.; Goldfrank, L.; Ogedegbe, G.; Soghoian, S.; de-Graft Aikins, A.; Koram, K.; Ohene, S.; Ofori-Atta, A.; Afari, E.; Sutherland-Addy, E.; Atobrah, D.; Boateng, W.B.; Boatemaa, S.; Sanuade, T.; Koram, N.; Anyidoho, A.; Lartey, M.; Markham-Seadey, J.; Ofori-Amankwah, G.; Amenuveve, C.
Background: The current Ebola Virus Disease (EVD) epidemic has ravaged the social fabric of three West African countries and affected people worldwide. We report key themes from an agenda-setting, multi-disciplinary roundtable convened to examine experiences and implications for health systems in Ghana, a nation without cases but where risk for spread is high and the economic, social and political impact of the impending threat is already felt. Discussion: Participants' personal stories and the broader debates to define fundamental issues and opportunities for preparedness focused on three inter-related themes. First, the dangers of the fear response itself were highlighted as a threat to the integrity and continuity of quality care. Second, healthcare workers' fears were compounded by a demonstrable lack of societal and personal protections for infection prevention and control in communities and healthcare facilities, as evidenced by an ongoing cholera epidemic affecting over 20,000 patients in the capital Accra alone since June 2014. Third, a lack of coherent messaging and direction from leadership seems to have limited coordination and reinforced a level of mistrust in the government's ability and commitment to mobilize an adequate response. Initial recommendations include urgent investment in the needed supplies and infrastructure for basic, routine infection control in communities and healthcare facilities, provision of assurances with securities for frontline healthcare workers, establishment of a multi-sector, "all-hazards" outbreak surveillance system, and engaging directly with key community groups to co-produce contextually relevant educational messages that will help decrease stigma, fear, and the demoralizing perception that the disease defies remedy or control. Summary: The EVD epidemic provides an unprecedented opportunity for West African countries not yet affected by EVD cases to make progress on tackling long-standing health systems weaknesses. This roundtable discussion emphasized the urgent need to strengthen capacity for infection control, occupational health and safety, and leadership coordination. Significant commitment is needed to raise standards of hygiene in communities and health facilities, build mechanisms for collaboration across sectors, and engage community stakeholders in creating the needed solutions. It would be both devastating and irresponsible to waste the opportunity. Â© 2015 Nyarko et al.
Prevalence and correlates of depression among caregivers of children living with HIV in Ghana: findings from the Sankofa pediatric disclosure study
(AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2018-10) Ofori-Atta, A.; Reynolds, N.R.; Antwi, S.; Renner, L.; Nichols, J.S.; Lartey, M.; Amissah, K.; Tettey, J.K.; Alhassan, A.et.al.
Prior studies show an association between caregiver depression and child health outcomes. There has been little examination of depression among caregivers of HIV-infected children in sub-Saharan countries where pediatric HIV is concentrated. Using baseline data collected in the pediatric HIV disclosure intervention trial, Sankofa, we examined the prevalence and factors associated with depression among caregivers (N = 446) of children infected with HIV in Ghana. Data were analyzed with descriptive and regression analyses. The mean age of the caregivers was 42.2 ± 10.4 years. Eighty percent of the caregivers were female and 59% were HIV-infected. Twenty-eight percent (n = 126) of the caregivers were found to have mild to severe depression. In the adjusted model, factors significantly associated with caregiver depression included: HIV-positive caregiver status (P = 0.04), low income (P = 0.02), lower social support, (P = 0.01), lower HIV knowledge, (P = 0.01), worse HIV illness perceptions (P≤0.001), and greater perceived HIV stigma (P≤0.001). Although we found a high prevalence of depression among our study participants, several of the risks factors identified are modifiable and amenable to interventions that are locally available and affordable.
Prototype Development, Usability, and Preference of a Culturally-relevant Pictorial Aid to Facilitate Comprehension of Likert-type Levels of Agreement in Caregivers of Children Living With HIV in Ghana
(Computers, Informatics, Nursing, 2020-01) Kusah, J.T.; Ramos, S.R,; Paintsil, E.; Ofori-Atta, A.; Amissah, K.A.; Alhassan, A.; Ofori, I.P.; Reynolds, N.R.
Pictorial illustrations of Likert-type scales are culturally useful and may reduce error associated with usage of Westernized self-report measures in low- and middle-income countries. Pictorial illustrations can be encounter-specific decision aids in populations with low literacy or English proficiency. In an unanticipated finding from the SANKOFA study, caregivers of children living with human immunodeficiency virus experienced challenges comprehending Likert-type scales. A cross-sectional, qualitative study was conducted with a SANKOFA participant subset (n = 30) in Ghana. Using an informatics-based formative design approach, we developed a culturally-relevant pictorial aid to assess usability and preference when compared to a Likert-type self-report measure. Ninety percent (n = 27) of substudy participants preferred the pictorial of a traditional Bolga basket over a shallow basket. Forty-three percent (n = 13) preferred the pictorial aid over the Likert-type measure. Fifty percent reported the pictorial aid was easy to use. Fifty-seven percent preferred the Likert-type measure, potentially because English proficiency is regarded in Ghana as a means of upward social and financial mobility. Such cultural norms may have contributed to the lack of consensus and must be considered for pictorial aids to be meaningful. Pictorial aids have been designed for use in clinical and research settings. They reduce barriers associated with lower textual literacy while facilitating comprehension and decision-making.
Psychological distress in Ghana: associations with employment and lost productivity
(2013-03-07) Canavan, M.E.; Sipsma, H.L.; Adhvaryu, A.; Ofori-Atta, A.; Jack, H.; Udry, C.; Osei-Akoto, I.; Bradley, E.H.
Abstract Objectives Mental health disorders account for 13% of the global burden of disease, a burden that low-income countries are generally ill-equipped to handle. Research evaluating the association between mental health and employment in low-income countries, particularly in sub-Saharan Africa, is limited. We address this gap by examining the association between employment and psychological distress. Methods We analyzed data from the Ghana Socioeconomic Panel Survey using logistic regression (N = 5,391 adults). In multivariable analysis, we estimated the association between employment status and psychological distress, adjusted for covariates. We calculated lost productivity from unemployment and from excess absence from work that respondents reported was because of their feelings of psychological distress. Findings Approximately 21% of adults surveyed had moderate or severe psychological distress. Increased psychological distress was associated with increased odds of being unemployed. Men and women with moderate versus mild or no psychological distress had more than twice the odds of being unemployed. The association of severe versus mild or no distress with unemployment differed significantly by sex (P-value for interaction 0.004). Among men, the adjusted OR was 12.4 (95% CI: 7.2, 21.3), whereas the association was much smaller for women (adjusted OR = 3.8, 95% CI: 2.5, 6.0). Extrapolating these figures to the country, the lost productivity associated with moderate or severe distress translates to approximately 7% of the gross domestic product of Ghana. Conclusions Psychological distress is strongly associated with unemployment in Ghana. The findings underscore the importance of addressing mental health issues, particularly in low-income countries.
A qualitative study of stresses faced by Ghanaian medical students
(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ofori-Atta, A.; Okraku, O.; Mork, S.; Sarfo, A.; Ghanney, E.; Sefa-Dedeh, A.; Ohene, S.
•212• Chapter 17 A qualitative study of stresses faced by Ghanaian medical students Angela Ofori-Atta, Olive Okraku, Seraphim Mork, Abena Sarfo, E. Ghanney, A. Sefa- Dedeh and Sammy Ohene Introduction Medical students experience much stress throughout their period of study. The stressors include but are not limited to difﬁculties of clinical years, stressors associated with continuous assessments, economic constraints,relationshipproblems,personalityproblems,mentalhealth problems, substance abuse training and inadequate social support (Sani M, Mahfouz MS, Bani I et al., 2012; Sreeramareddy, Shankar, Binu et al., 2007; Chandrashekhar, Sreeramareddy, Suri et al.,2010; Super, 1998). Although these stresses may be considered as part of the daily hassles which all students face, the stresses faced by medical students seem to be magniﬁed by the large amount of academic workload they face, the limited amount of time they have and the excellence expected of them. The prevalence of depressive symptoms among medical students was 12.9%, signiﬁcantly higher than in the general population according to a study conducted in Sweden by Dahlin, Joneborg & Runeson (2005), and in Saudi Arabia, the sense of belittlement felt by students from both students and peers contributed signiﬁcantly to stress (Shoukat, Anis, Kella et al., 2010). According to a study conducted in Nigeria, medical students cited as stressors overcrowded accommodation, congested classrooms, prolonged and frequent strikes and lack of holidays (Omigbodun, Odukogbe, Omigbodun et al., 2006). Gunderson (2001) quotes from a director of medical humanities and medical research at Dalhousie University in Halifax: “We want people who are driven, who are competitive, who can excel at everything that they do.” This is a tall order indeed because this high expectation comes at a price; most medical students are so concerned with dealing with •213• A qualitative study of stresses faced by Ghanaian medical students the workload at school that they forget to take care of their physical, emotional, social and spiritual needs and this leads them to experience stress. “Self-care is not a part of the physician’s professional training and typically is low on a physician’s list of priorities” according to Gunderson (also Tait, Shanafelt, Bradley, et al., 2002); Dyrbye, Thomas, and Massie (2008). In addition to neglecting their own health, Werner and Korsch (1976) report L.L. Stephen’s words; “the encounter with morbidity and mortality heightens the student’s feelings of vulnerability. If he over-identiﬁes with patients, he may suffer more and be unable to provide rational medical care. If he protects himself by dehumanizing patients, humane treatment suffers.” Clearly, the medical student is caught between a rock and a hard place. In spite of this, a study from Norway concluded that the mental health of medical students in Norway did not differ signiﬁcantly from that of the general public. However, the students recorded lower levels of general self-esteem than those of the general public. Additionally, male students reported less general self-esteem and more nervous symptoms than female students (Bramness, Fixdal, & Vaglum; 1991). In Ghana, practical steps are yet to be taken to identify the stresses that are experienced by Ghanaian medical students and the methods that can be used to prevent and alleviate them in order to prevent students from dropping-out. Participants and methods Selection of participants After seeking permission from the University’s administration, the class lists for medical students in Level 200, Level 300, the ﬁrst clinical year and second clinical year were obtained. Every tenth student on the class list was selected to ensure random sampling from each class, after which the class presidents were added. They then participated in focus group discussions. •214• Chapter 17 Procedure The selected students were invited to the Department of Psychiatry at a time that was convenient for both the students and the staff at the department. Before focus group discussions began, the students were informed of the aims of the focus group discussion and their consent was sought. The students were assured conﬁdentiality. A facilitator initiated the discussions by posing open-ended questions inquiring about stressors typically faced by medical students. This led to further discussions on topics including academic workload, food, accommodation and hostel facilities, relationship problems, ﬁnancial problems, entertainment, religion and social support. Participants proposed possible solutions. These discussions were recorded with student permission by a simple digital voice recorder. Analysis of data The recordings of the focus group discussions were transcribed and emerging common themes on various stresses were identiﬁed. Similarly, solutions suggested by participants were noted...