Empowering health workers and leveraging digital technology to improve access to mental health and epilepsy care: A longitudinal quasi-experimental study in Hlaing Thar Yar Township.
| Autor: | Gyee KM; Myanmar Medical Association, Yangon, Myanmar., Mroueh L; Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France., Bruand PE; Global Health Programs, Sanofi, Paris, France., Min S; Myanmar Mental Health Society, Yangon, Myanmar., Kleinebreil L; Université Numérique Francophone Mondiale, Paris, France., Ohmmar; Myanmar Medical Association, Yangon, Myanmar., Tun YM; Myanmar Medical Association, Yangon, Myanmar., Preux PM; Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France., Myint WA; Myanmar Mental Health Society, Yangon, Myanmar., Boumediene F; Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France. |
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| Jazyk: | angličtina |
| Zdroj: | The Lancet regional health. Southeast Asia [Lancet Reg Health Southeast Asia] 2022 Aug 06; Vol. 5, pp. 100052. Date of Electronic Publication: 2022 Aug 06 (Print Publication: 2022). |
| DOI: | 10.1016/j.lansea.2022.100052 |
| Abstrakt: | Background: Despite an estimated 8% prevalence of mental disorders in Myanmar, the treatment gap is high, up to 90%. This project aimed to assess the effects of a series of activities implemented by the Myanmar Medical Association over a 2-year period in Hlaing Thar Yar Township involving community health workers (CHWs) and general practitioners (GPs) on the identification, diagnosis and management of people with psychotic disorders, depression and epilepsy. Methods: Seventy-six CHWs were trained to raise awareness, identify people with mental disorders and refer them to GPs. Fifty GPs were upskilled to diagnose and manage patients. Prevalence, treatment gap and general population's Knowledge-Attitudes-Practices (KAP) were evaluated through door-to-door surveys, whilst CHWs' and GPs' KAP were measured pre-, and post-training as well as post-intervention. Patient identification, diagnosis and management were analysed through data collected by CHWs and GPs via smartphones and tablets. Findings: At baseline, the average treatment gap was 79·7%. During the 2 year-intervention, 1,378 suspected cases were referred by CHWs to GPs and 1,186 (86%) of them saw a GP. Among the 1,088 patients (92%) diagnosed, the concordance between GPs' diagnosis and CHWs' screening was 75·6%. For CHWs, knowledge improved post-training (16·9 vs. 15·3; p = 0·0010), whilst attitudes and practices improved post-intervention (17·1 vs. 15·7; p = 0·010 and 19·4 vs. 11·2; p < 0·0001 respectively). GPs' global KAP score improved post-training (14·6 vs. 12·8; p = 0·0010), and remained stable post-intervention. General population's KAP score improved between baseline and end-line (8·3 vs. 12·7; p < 0·0001). Interpretation: This project suggests that a 2-year intervention including the training of frontline health workers and raising awareness among the population can have positive outcomes and lead to a greater number of people with mental disorders being diagnosed and managed. Funding: This project was implemented as part of a partnership involving the Myanmar Medical Association, the Myanmar Mental Health Society, the World Association of Social Psychiatry, the Université Numérique Francophone Mondiale and Sanofi Global Health. It was funded by Sanofi Global Health, within the framework of the Fight Against STigma (FAST) Program. Competing Interests: P.E.B. is a Sanofi employee and owns Sanofi shares. All other authors report grants or personal fees received either directly or indirectly from Sanofi Global Health in the context of the submitted work. F.B., P.M.P. and L.K. report grants from Sanofi Global Health outside the submitted work. (© 2022 The Authors.) |
| Databáze: | MEDLINE |
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