Global Mental Health
|
|
- Bryan May
- 5 years ago
- Views:
Transcription
1
2 Global Mental Health Geetha Jayaram M.D.,M.B.A. October 2016 The Maanasi Story 2
3
4
5
6
7
8 Demographics for women Two thirds of India's households are in rural areas. More than one-third of India's population (35%) is under age 15. Twenty eight percent of the rural population is in the lowest wealth quintile Forty one percent of women aged have never been schooled. Thirty five percent of women have experienced physical or sexual violence, including married women. Of 43% of married women who were employed, a quarter received no payment for their work and 12% were paid only in kind (International Institute for Population Sciences and Macro International, 2007)
9
10 Common Mental Disorders CMD, which are neurotic disorders presenting with anxiety and depressive symptoms, are widespread and are known to cause significant disability worldwide. In India, prevalence rates of CMD range from 2% to 57% Majority of patients with CMD present at primary care centers but end up receiving symptomatic treatments like painkillers and vitamins because they are not recognized by primary care physicians as being mental illnesses N. Isaacs, K. Srinivasan, I. Neerakkal, G. Jayaram. Indian J of Comm Med. Vol. 31, No. 2, April - June, 2006 This study was funded by the rotary foundation through a matching grant programme (M.G#20594)
11 Global burden of mental illness Mental disorders are highly prevalent, have greater effects on role functioning than other chronic physical illnesses Across the world, such disorders have a substantial role in disability. Seventy six and % of serious cases in less developed countries received no treatment often due to structural barriers The reallocation of treatment resources is recommended by the World Health Organization to substantially decrease the problem of unmet needs for treatment (WHO, 2004)
12 Global Burden 2 A study from four low income countries points toward a significant association of common mental disorders with female gender, low education, poverty, lack of access to running water in the home, experiencing hunger, and difficulties making ends meet Gynecological complaints are associated with an increased risk and this association remains evident after adjustment for socioeconomic factors
13
14
15
16
17 Cooperative work by Rotary Club of Howard West, Maryland, USA Rotary Club of Bangalore Midtown, India St. John s Medical College, Bangalore, India, Departments of Community Medicine and Psychiatry
18 Mugalur Is 30 km from an urban center- Bangalore It serves as a center for all community related activities of the medical school Services include a general health clinic, antenatal and postnatal care, childcare, services for the elderly, and for the blind and deaf The center serves more than 206 villages Other medical care is 10 km away
19 Background Started as a humanitarian project Collaboration between service and humanitarian organizations, academic institutions and local village leadership Involved 25 villages at first and has spread over 10 years to 206 villages with care for 1700 active patients on a shoestring budget; population reach of 6 million households
20 Maanasi project objectives To bring mental health care to villages in rural Southern India In phases - provide transportation, manpower, training and assessments - provide medical and psychiatric evaluations and treatment - sustain psychiatric care/ evaluate outcomes
21 Phase 1 and 2 Identifying and training HS educated community health workers A door to door survey of a population of 17,000 using the symptoms in others questionnaire derived from the Indian Psychiatric Survey Schedule by Kapur and Carstairs Referral of patients to the clinic, screening by and internist and evaluation by a psychiatrist
22 Work enabled by Carl P. Miller Discovery Grant RI Matching Grant Rotary University Teachers Grant Support from the Rotary Clubs of Columbia and Koremangala Matching Grant 58871
23 Surveys conducted across the world show that Lifetime prevalence of depression may be around 25% Depression more in women and alcoholism in men In India prevalence estimates vary between urban and rural areas, possibly due to differences in methodology A meta analysis yielded a rate of 70-73/ 1000 persons Previous models at providing mental health care have not been successful
24 Background Common mental disorders that refer to anxiety and depression syndromes are important cause of psychiatric morbidity in primary health centers. Studies evaluating outcomes of common mental disorders (CMD) from India are few
25 Background 2 Women suffer from depression at times that of men. When women are affected, it impacts the whole family While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males (WHO, 2008). In fact, depression is the leading cause of disease burden for women in both highincome and low- and middle-income countries (WHO, 2008)
26 Obstacles to care delivery Cultural Geographic Economical Structural Lack of knowledge, low literacy, lack of training, lack of resources
27 Background 3 Started as a humanitarian project Collaboration between service and humanitarian organizations, academic institutions and local village leadership Involved 25 villages at first and has spread over 17 years to 206 villages with care for 1800 active patients on a shoestring budget
28 Background 4 Research in developing countries suggests that maternal depression may be a risk factor for poor growth in young children (Rahman et al, 2008) This risk factor could mean that maternal mental health in low-income countries may have a substantial influence on growth during childhood, with the effects of depression affecting not only this generation but also the next (Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Rahman, Atif et al. The Lancet, Volume 372, Issue 9642, )
29 Maanasi Project Phase 1 and 2 Identifying and training HS educated community health workers A door to door survey of a population of 17,000 using the symptoms in others questionnaire derived from the Indian Psychiatric Survey Schedule by Kapur and Carstairs Referral of patients to the clinic, screening by and internist and evaluation by a psychiatrist
30 Gender Distribution Females between ages years Male Female percent
31 Demographics Age distribution : Assessed in 2000 Age group Frequency Percent 0 15 years > Total Mean Age = /
32 Standard of Living Index SLI Frequency Valid Percent Low Middle High Total Standard of living index (SLI) based on household ownership of assets and possessions; the index can be used to measure socioeconomic disadvantage or poverty. The SLI was created by assigning scores to a range of 30 household goods and assets, including the type of house and toilet facilities, fuel used for cooking, and ownership of durable goods*. (International Institute for Population Sciences and ORCMacro. National Family Health Survey (NFHS 2) : India. Mumbai: IIPS; 2000.)
33 Educational Status: Education Frequency Valid Percent Illiterate Primary Middle High PUC Degree
34 Results of the Maanasi project Majority of patients were between the ages of 21 and 50 (21 villages) Patients were predominantly females At least a third of patients had multiple illnesses Major Depression and Dysthymia were the predominant diagnoses Among Anxiety disorders, GAD was most often diagnosed (6.47%), followed by Social Phobia (1.94%), Panic Disorder (1.29%), and Agoraphobia (0.65%)
35 Aspects of care in villages A sliding fee scale is offered or care is free Care is accessible The caregiver is trusted Walk in care is permitted Support systems are in place Outside informants are available Medications are free or a nominal amount is charged; payment may be in kind
36 Outcomes are influenced by Cultural identity of the providers The environment in which they practice Cultural perceptions of mental illness and its treatment Economic environment in which care is rendered
37 Aim of this study The aim of the present study was to examine the outcomes of the broad category of CMD and specifically major depression in individuals resident in a rural community following naturalistic treatment with antidepressants
38 Outcomes- phase 1 Initial screening by trained health care workers who administered the symptoms in others checklist derived from the instrument devised by Kapur etal. - caseness was identified Potential patients underwent a medical screening and psychiatric evaluation Community health workers are women who live in the villages, have a HS education, and are trusted by the villagers
39 Methods Individuals with a diagnosis of CMD using a 2 stage diagnostic process were invited to seek treatment from a primary health center Outcome was assessed in 144 patients diagnosed with major depression using a structured interview schedule (SCID) at 6 months Outcome was measured using 17-item Hamilton Depression Rating Scale (HAMD) and WHO QOL (Brev) version. Individuals with a score of 7 on HAMD were deemed to have incomplete remission (Williams JW. A Structured Interview Guide for the Hamilton Depression Rating Scale.Arch Gen Psychiatry. 1988;45(8): doi: /archpsyc ) The WHOQOL Assessment. The WHOQOL group. Soc. Sci. Med. Vol. 41, No. 10, pp , 1995)
40 Outcomes -2 A cohort of 300 patients treated at the clinic for Major Depression were consecutively selected to be evaluated for outcomes A trained research investigator went to the patients homes to interview them using the -SCID to generate a DSM IV diagnosis -outcome of treatment was measured using the HAM-D and the WHO quality of life scale (Structured Clinical Interview for DSM 4)
41 Preliminary results-1 Of the 300 patients interviewed, 99 did not meet criteria for MDD either current or lifetime, and had no other psychiatric diagnosis Of the remaining 201, 90% of the sample were women. Mean age was 38.7±12.7 Among the 201, with the HAM-D, 129 subjects were noted to have significant depression after 6 months (HAM D score = or >10). Depression had remitted in 72 subjects
42 Outcomes were poor in those That had co morbid anxiety, had interpersonal difficulties, such as those with spouse or mother in law, financial problems, alcoholism in spouse, and bereavement, severe poverty In our second outcome study, lack of transportation, financial problems, inability to take time off work were associated with poorer outcomes
43 Other causes for failure of treatment Logistic regression analyses showed comorbid medical conditions and life stressors were significant variables predicting a poor outcome, while past psychiatric illness predicted a better outcome
44 Preliminary results-2 The two groups were compared across a host of clinical and socio-demographic factors Analysis indicates that co-morbid anxiety disorders results in the persistence of depression The quality of life as measured by the WHO scale is poorer in the group with depression at 6 months
45 Results 114 (79%) individuals with CMD continued to be symptomatic at 6 months. Co-morbid psychiatric conditions, especially anxiety was associated with poor outcome. Individuals with higher score on HAMD had poorer quality of life as measured by WHO QOL. Treatment with antidepressant medication did not significantly influence the outcome.
46 Conclusions from the first outcome study A significant majority of individuals diagnosed with major depression resident in a rural community had a poor outcome However, many patients either did not seek treatment or prematurely discontinued treatment Implications for public health approaches to the treatment of CMD are highlighted Further work entailed actively addressing these issues
47 How do you remedy the problem? Education Outreach Teaching in women s cooperatives Focus groups at schools Data gathering Enrolling the help of community leaders
48 Study of Caregiver Burden 73 caregivers consented to participate in the study, 48 (65.7%) were females. The average score for caregiver wellbeing was 6.00 ± 1.81, for marital relationships was 6.53 ± 1.37, appreciation for care giving was 6.07 ± 1.40, for perceived severity of disease was 5.99 ± 1.90, and for relations with others was 5.64 ± 1.59, the last of which was significantly associated with type of mental illness (p<0.05) The burden among caregivers in general was lower than expected, probably due to the interventions made in the community based program (Swaroop N., Shilpa Ravi., B. Ramakrishna Goud., Maria Archana., Tony M Pius., Anjali Pal., Vimal John., Twinkle Agrawal., Jayaram G. Burden among caregivers of mentally ill patients: a rural community based study. International Journal of Research and Development of Health. Vol 1., Issue 2. Pg 25-34)
49 Cultural aspects of care Delhi psychiatrists saw more patients daily (24.3 vs. 11, P < 0.001), and spent less time on new evaluations (33.3 vs. 69 min, P < 0.001) Both groups had similar approaches to major disorders. But, Delhi psychiatrists were less likely to combine medication treatment with psychotherapy (P < 0.05), and more likely to advise families to secretly administer medications in treatment refusal, such as in acute schizophrenia (P < 0.001) or major depression (P < 0.01)
50 Cultural aspects of care 2 These differences highlight the salience of local cultural context in the practice of psychiatry and in the treatment of Indian patients Delhi psychiatrists are overwhelmed by the epidemic levels of untreated illness, spend less time with patients, and rely more heavily on medication treatment Delhi psychiatrists employ unique approaches to handling difficult treatment issues, such as treatment refusal, intensive involvement of the family, and recommendations to the family about suitability for marriage for a patient (Practice patterns and treatment choices among psychiatrists in New Delhi, India. AD Wasan, K Neufeld, G Jayaram - Social psychiatry and psychiatric epidemiology, Vol.44. Issue 2. Pg )
51 Cultural aspects of care 3 Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC) Countries were classified according to their rating on the Human Development Index (HDI composite statistic of life expectancy, education, and income per capita indicators). Multilevel negative binomial and Poisson models were used for analyses (Antonio Lasalvia, Tine Van Bortel, Chiara Bonetto, Geetha Jayaram, Jaap van Weeghel, Silvia Zoppei, Lee Knifton, Neil Quinn,Kristian Wahlbeck, Doriana Cristofalo, Mariangela Lanfre di, Norman Sartorius, Graham Thornicroft, the ASPEN/INDIGO Study Group. BJP. Dec 2015, 207 (6) )
52 Cultural aspects of care 4 People living in very high HDI countries reported higher discrimination than those in medium/low HDI countries Variation in reported discrimination across countries was only partially explained by individual-level variables The contribution of country-level variables was significant for anticipated discrimination only Contextual factors play an important role in anticipated discrimination Country-specific interventions should be implemented to prevent discrimination towards people with MDD
53 Cultural aspects of care Resistance from care givers and care obtainers: Incorporating psychiatric care into community medicine concepts and total health care Involving village leadership Appointing women case workers and using women s cooperatives/ schoolrooms for teaching Addressing myths and misconceptions about medication and injections Overcoming geographic and access barriers
54 Partnerships Local and International Academic and philanthropic; ministries and government entities Sustaining funding sources Sharing experiences and quality with a Global network Developing common teaching and training videos Public health/ service announcements, advertising and articles detailing the work (G Jayaram, R Goud, K Srinivasan - Asian journal of psychiatry, 2011;Overcoming cultural barriers to deliver comprehensive rural community mental health care in Southern India. Vol 4, Issue 4. Pg )
55
56
57
58
59
60 Total # of households served Bangalore Urban Anekal Taluk, Bangalore East, North and South 2,139,413 Bangalore Rural Devanahalli, Dodballapur, Hoskote and Nelamangala 850,968 Kolar District Bangarapet, Kolar, Malur, Mulbagal, Srinivasapur 1, 387,062 Tumkur District Chinayakanhalli, Gubbi, Koratagere, Kunigal, Madugiri, Pavagada, Sira, Tiptur, Tumkur, Turuvekere 2,584,711 Total Over 6 million households until ,962,154
61 Patient data as of Jan 2015 AGE 19 (children and adolescent), 193, 13% 60 ( Elderly), 208, 13% 19 (children and adolescent) (Adults) 60 ( Elderly) (Adults), 1138, 74%
62 Gender distribution Gender Distribution Male, 384, 25% Female, 1155, 75% Female Male
63 Literacy levels Educational status Educational status Illiterate Primary school High school Higher secondary Graduates
64 Standard of Living Index socio ecconomic status Low, 392, 26% High, 231, 15% High Medium Low Medium, 885, 59%
65 Standard of Living Index Composite of life expectancy, education and income Highest 5 countries are Finland, Norway, Sweden, Germany, Australia / USA
66 Patient visits Number of visits: Average no of visits by each patient to the clinic=6.5 times (minimum of 1, maximum of 198) About 1209 (About 80%) out of 1539 patients visited the clinic five or less times. Or in other words, about 20% of our patients have visited our clinic six or more times. Distance from clinic: Average distance from where the patient is coming is about 25 Km. (Maximum of 300 Km, Minimum of 0 Km)
67
68 Results today Today the Maanasi Clinic" at Mugalur village is serving mainly poor women and children with varying degrees of mental illness by providing medical care to patients from 206 villages, 8 districts around Bangalore with a reach of 6 million households
69
70 Further steps Construction of an interactive database Development of simple teaching modules and training videos Duplication of efforts in other districts, and countries Formation of a Rotary world wide Action Group Better outcomes through the use of information technology Social and economic development through rehabilitation Networking with Global and Academic partners (JHH and INDIGO group) Safety studies
71
72
73
74
75
76
77 Ongoing needs Maintenance costs Vehicles to be replaced Duplication of efforts locally and globally Ongoing funding for studies Costs of infrastructure, both physical and IT related such as databases Teaching videos for patients and staff
Papua Maternal, Newborn and Child Health and Nutrition Project
Papua Maternal, Newborn and Child Health and Nutrition Project INDONESIA Project Brief FY 2016 HEALTH Page 2 You can help reduce child mortality rates in Papua communities by supporting their improved
More informationIndia Factsheet: A Health Profile of Adolescents and Young Adults
India Factsheet: A Health Profile of Adolescents and Young Adults Overview of Morbidity and Mortality With a population of 1.14 billion people, the more than 200 million youth aged 15-24 years represent
More informationDeterminants of Infertility and Treatment Seeking Behaviour among Currently Married Women in India. Ramesh Chellan India
Determinants of Infertility and Treatment Seeking Behaviour among Currently Married Women in India Ramesh Chellan India Background Infertility is a worldwide problem affecting about 50 80 million couples
More informationPrevalence and Pattern of Psychiatric Disorders in School Going Adolescents
The International Journal of Indian Psychology ISSN 2348-5396 (e) ISSN: 2349-3429 (p) Volume 4, Issue 3, No. 100, DIP 18.01.074/20170403 ISBN: 978-1-387-00243-6 http://www.ijip.in April-June, 2017 Prevalence
More informationDoes Empowerment of Women helps in use of Maternal Health Care Services in India: Evidences from North-East Region
Does Empowerment of Women helps in use of Maternal Health Care Services in India: Evidences from North-East Region Introduction Near about 500,000 women die every year because of pregnancy related complications
More informationModelling the impact of poverty on contraceptive choices in. Indian states
Int. Statistical Inst.: Proc. 58th World Statistical Congress, 2, Dublin (Session STS67) p.3649 Modelling the impact of poverty on contraceptive choices in Indian states Oliveira, Isabel Tiago ISCTE Lisbon
More informationHelp-seeking behaviour and its impact on patients attending a psychiatry clinic at National Hospital of Sri Lanka
Help-seeking behaviour and its impact on patients attending a psychiatry clinic at National Hospital of Sri Lanka DM Gomez, C Gunarathna, S Gunarathna, K Gnanapragasam, R Hanwella Abstract Background Mental
More informationExecutive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services
United Nations Executive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services Distr.: General 29 September 2011 Original:
More information*Corresponding author. 1 Mailman School of Public Health, Columbia University, New York, USA 2 Ifakara Health Institute, Dar es Salaam, Tanzania
Do women bypass village services for better maternal health care in clinics? A case study of antenatal care seeking in three rural Districts of Tanzania Christine E. Chung 1*, Almamy M. Kante, 1,2, Amon
More informationBeliefs and practices of women related to maternal care and newborn care in selected areas of rural Bengaluru
Original article Beliefs and practices of women related to maternal care and newborn care in selected areas of rural Bengaluru Lalitha H Email: lalitahosamane@gmail.com Abstract Introduction: Traditional
More informationThe role of international agencies in addressing critical priorities: the example of Born On Time
The role of international agencies in addressing critical priorities: the example of Born On Time Overview Introduction to Born On Time Role of international agencies in: Partnership-driven Community-owned
More informationCountdown to 2015: tracking progress, fostering accountability
Countdown to 2015: tracking progress, fostering accountability Countdown to 2015 is a global movement to track, stimulate and support country progress towards achieving the health-related Millennium Development
More informationCHARACTERISTICS OF SURVEY RESPONDENTS 3
CHARACTERISTICS OF SURVEY RESPONDENTS 3 The health, nutrition, and demographic behaviours of women and men vary by their own characteristics, such as age, marital status, religion, and caste, as well as
More informationEducate a Woman and Save a Nation: the Relationship Between Maternal Education and. Infant Mortality in sub-saharan Africa.
Educate a Woman and Save a Nation: the Relationship Between Maternal Education and Infant Mortality in sub-saharan Africa. Nyovani Madise 1,2, Eliya Zulu 1 and Zoe Matthews 2 1 African Population and Health
More informationExecutive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services
United Nations Executive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services Distr.: General 12 July 2011 Original:
More informationExecutive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services
United Nations DP/FPA/CPD/NGA/7 Executive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services Distr.: General 18 July2013
More informationExecutive Board of the United Nations Development Programme and of the United Nations Population Fund
United Nations DP/FPA/CPD/MOZ/7 Executive Board of the United Nations Development Programme and of the United Nations Population Fund Distr.: General 18 October 2006 Original: English UNITED NATIONS POPULATION
More informationMessage from. Dr Samlee Plianbangchang Regional Director, WHO South-East Asia. At the
Message from Dr Samlee Plianbangchang Regional Director, WHO South-East Asia At the Regional Review Meeting on Strengthening WHO Technical Role in Family Planning in the South-East Asia Region 20-23 September
More informationKeywords health care services, gestation, rural communities, awareness
Examining the Social and Cultural Barriers Present for Women Seeking Healthcare in Rural Communities of Karachi, Pakistan Nofel Karatela 1, Maria Altaf 2, Shamoon Noushad 2, Amna Khan 2, Shershah Syed
More informationAn APA Report: Executive Summary of The Behavioral Health Care Needs of Rural Women
1 Executive Summary Of The Behavioral Health Care Needs of Rural Women The Report Of The Rural Women s Work Group and the Committee on Rural Health Of the American Psychological Association Full Report
More informationglobally. Public health interventions to improve maternal and child health outcomes in India
Summary 187 Summary India contributes to about 22% of all maternal deaths and to 20% of all under five deaths globally. Public health interventions to improve maternal and child health outcomes in India
More informationModule 2. Analysis conducting gender analysis
Module 2 Analysis conducting gender analysis Slide 2.1 Learning objectives of Module 2 Outline the principles of gender analysis Understand the health and gender related considerations when conducting
More informationExecutive Board of the United Nations Development Programme and of the United Nations Population Fund
United Nations Executive Board of the United Nations Development Programme and of the United Nations Population Fund Distr.: General 9 April 2010 Original: English DP/FPA/DCP/PRK/5 Annual session 2010
More informationAdult Psychiatric Morbidity Survey (APMS) 2014 Part of a national Mental Health Survey Programme
Adult Psychiatric Morbidity Survey (APMS) 2014 Part of a national Mental Health Survey Programme About the Adult Psychiatric Morbidity Survey (APMS) 2014 The Adult Psychiatric Morbidity Survey (APMS) 2014
More informationTTC Evidence Brief: Evidence for Maternal Mental Health within World Vision Core Health Model Timed and Targeted Counselling (ttc)
TTC Evidence Brief: Evidence for Maternal Mental Health within World Vision Core Health Model Timed and Targeted Counselling (ttc) Introduction Megan McGrath, World Vision Australia Polly Walker, World
More informationWomen Empowerment and Maternal Health Care Utilisation in North-East India
Journal of North East India Studies Vol. 4(2), Jul-Dec. 2014, pp. 69-80. Women Empowerment and Maternal Health Care Utilisation in North-East India Mousumi Gogoi Maternal health care services have always
More informationMarie Stopes International A human rights-based approach to reduce preventable maternal mortality and morbidity
Marie Stopes International A human rights-based approach to reduce preventable maternal mortality and morbidity Marie Stopes International (MSI) exists to support a woman s right to choose if and when
More informationSubmission to. MBS Review Taskforce Eating Disorders Working Group
Submission to MBS Review Taskforce Eating Disorders Working Group Contact: Dr Vida Bliokas President ACPA President@acpa.org.au Introduction The Australian Clinical Psychology Association (ACPA) represents
More informationAddressing Maternal Mental Health to Promote Early Childhood Development in Kenya and Tanzania
Addressing Maternal Mental Health to Promote Early Childhood Development in Kenya and Tanzania Huynh-Nhu (Mimi) Le, John Hembling, Elena McEwan, Maureen Kapiyo Global Health Practitioner Conference, June
More informationMaternal Malnutrition in Urban India: A Study of Indian Cities (Mega, Large and Small)
International Research Journal of Social Sciences ISSN 2319 3565 Maternal Malnutrition in Urban India: A Study of Indian Cities (Mega, Large and Small) Abstract Yogendra Musahar * Centre for the Study
More informationDevelopment of a complementary feeding manual for Bangladesh
TERMS OF REFERENCE #14 For the research proposal to be funded under NFPCSP Phase II Development of a complementary feeding manual for Bangladesh 1. Background and Rationale Inappropriate infant and young
More informationChoice of place for childbirth: prevalence and correlates of utilization of health facilities in Chongwe district, Zambia
Choice of place for childbirth: prevalence and correlates of utilization of health facilities in Chongwe district, Zambia * Hazemba AN, Siziya S Department of Community Medicine, School of Medicine, University
More informationA Tale of Two Upazilas Exploring Spatial Differences in MDG Outcomes. Zulfiqar Ali Taifur Rahman
A Tale of Two Upazilas Exploring Spatial Differences in MDG Outcomes Zulfiqar Ali Taifur Rahman Outline of the Presentation Introduction Objectives Study Area Data and Methodology Highlights of Findings
More informationInequalities in childhood immunization coverage in Ethiopia: Evidence from DHS 2011
Inequalities in childhood immunization coverage in Ethiopia: Evidence from DHS 2011 Bezuhan Aemro, Yibeltal Tebekaw Abstract The main objective of the research is to examine inequalities in child immunization
More informationRetraction Retracted: Immunization Coverage: Role of Sociodemographic Variables
Hindawi Publishing Corporation Advances in Preventive Medicine Volume 2014, Article ID 890248, 1 page http://dx.doi.org/10.1155/2014/890248 Retraction Retracted: Immunization Coverage: Role of Sociodemographic
More informationEvaluation of the Kajiado Nutrition Programme in Kenya. May By Lee Crawfurd and Serufuse Sekidde
Evaluation of the Kajiado Nutrition Programme in Kenya May 2012 By Lee Crawfurd and Serufuse Sekidde 1 2 Executive Summary This end-term evaluation assesses the performance of Concern Worldwide s Emergency
More informationExecutive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services
Executive Board of the Development Programme, the Population Fund and the Office for Project Services Distr.: General 19 October 2012 Original: English First regular session 2013 28 January to 1 February
More informationExtended Abstract: Background
Urban-Rural Differences in Health Status among Older Population in India Joemet Jose 1 Ph.D. Scholar, International Institute for Population Sciences, Mumbai, India. Email: joemetjose@gmail.com Abstract
More informationSECOND AUSTRALIAN CHILD AND ADOLESCENT SURVEY OF MENTAL HEALTH AND WELLBEING HIGHLIGHTS
The Mental Health of Children and Adolescents 3 SECOND AUSTRALIAN CHILD AND ADOLESCENT SURVEY OF MENTAL HEALTH AND WELLBEING HIGHLIGHTS A second national survey of the mental health and wellbeing of Australian
More informationInnovative Approaches for Eliminating Mother-to-Child Transmission of HIV
Innovative Approaches for Eliminating Mother-to-Child Transmission of HIV Community Mentor Mothers: Empowering Clients Through Peer Support A Spotlight on Malawi COMMUNITY MENTOR MOTHERS 1 Optimizing HIV
More informationStigma in Patients Using Mental Health Services
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861Volume 17, Issue 12 Ver 2 (December 2018), PP 16-23 wwwiosrjournalsorg Stigma in Patients Using Mental Health
More informationIJCISS Vol.2 Issue-09, (September, 2015) ISSN: International Journal in Commerce, IT & Social Sciences (Impact Factor: 2.
(Impact Factor: 2.446) Infant and Child Mortality in India: Levels, Trends and Determinants Naveen Sood Naveen Sood, Assistant Professor PG Department of Economics, DAV College, Jalandhar, Punjab ABSTRACT
More informationFACT SHEET DELHI. District Level Household and DLHS - 3. International institute for population sciences (Deemed University) Mumbai
2007-2008 DLHS - 3 Ministry of Health and Family Welfare District Level Household and Facility survey FACT SHEET DELHI International institute for population sciences (Deemed University) Mumbai Introduction
More informationEFFECTS OF FEMALE S LITERACY ON MATERNAL HEALTH: AN EMPIRICAL STUDY OF JAMMU AND KASHMIR STATE
EFFECTS OF FEMALE S LITERACY ON MATERNAL HEALTH: AN EMPIRICAL STUDY OF JAMMU AND KASHMIR STATE DR DEEPTI GUPTA Assistant Professor (Sociology) The Law School University of Jammu Jammu and Kashmir ABSTRACT
More informationWHO Collaborating Centre
Mental Health and disability key concepts Rachel Jenkins Mental health, mental illness, causes, consequences, interventions Mental health and healthy lifestyles Mental disorder, Prevalence, symptoms and
More informationCanadian Mental Health Association
Canadian Mental Health Association Manitoba and Winnipeg Supports & Services Founded in 1918, CMHA National is a Canada-wide charitable organization with 87 branches in over 330 communities across the
More informationThe treatment of postnatal depression: a comprehensive literature review Boath E, Henshaw C
The treatment of postnatal depression: a comprehensive literature review Boath E, Henshaw C Authors' objectives To evalute treatments of postnatal depression. Searching MEDLINE, PsycLIT, Sociofile, CINAHL
More informationRoutine Immunization Status among Children under 5 Years of Age living in Rural District of Pakistan
International Journal of Health Research and Innovation, vol. 3, no. 2, 2015, 13-20 ISSN: 2051-5057 (print version), 2051-5065 (online) Scienpress Ltd, 2015 Routine Immunization Status among Children under
More informationExecutive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services
United Nations DP/FPA/CPD/ZMB/8 Executive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services Distr.: General 30 June
More informationEXTENDED ABSTRACT. Integration of Reproductive Health Service Utilization and Inclusive Development Programme in Uttar Pradesh, India
INTEGRATION, REPRODUCTIVE HEALTH, INCLUSIVE DEVELPOMENT PROGRAMME IN INDIA 1 EXTENDED ABSTRACT Integration of Reproductive Health Service Utilization and Inclusive Development Programme in Uttar Pradesh,
More informationExecutive Board of the United Nations Development Programme and of the United Nations Population Fund
United Nations DP/FPA/CPD/ALB/2 Executive Board of the United Nations Development Programme and of the United Nations Population Fund Distr.: General 11 October 2005 Original: English UNITED NATIONS POPULATION
More informationnamibia Reproductive Health at a May 2011 Namibia: MDG 5 Status Country Context
Country Context May 211 In its Vision 23, Namibia seeks to transform itself into a knowledge economy. 1 Overall, it emphasizes accelerating economic growth and social development, eradicating poverty and
More informationWhy Poor Women Don t Deliver at Health Facilities in Developing Countries? A Comparison of Economic and Cultural Barriers
Why Poor Women Don t Deliver at Health Facilities in Developing Countries? A Comparison of Economic and Cultural Barriers Saifuddin Ahmed, Mona Sharan and Qingfeng Li Although significant progress has
More informationIMPACT OF SOCIO-DEMOGRAPHIC FACTORS ON AGE APPROPRIATE IMMUNIZATION OF INFANTS IN SLUMS OF AMRITSAR CITY (PUNJAB), INDIA
ORIGINAL ARTICLE pissn 0976 3325 eissn 2229 6816 Open Access Article www.njcmindia.org IMPACT OF SOCIO-DEMOGRAPHIC FACTORS ON AGE APPROPRIATE IMMUNIZATION OF INFANTS IN SLUMS OF AMRITSAR CITY (PUNJAB),
More informationDr. Jacob Roy Kuriakose, Chairman, Alzheimer s Disease International
Dr. Jacob Roy Kuriakose, Chairman, Alzheimer s Disease International Agenda Dementia A Significant Challenge in India Importance of Advocacy in Dealing with Dementia Dementia India Report Recommendations
More informationZIMBABWE: Humanitarian & Development Indicators - Trends (As of 20 June 2012)
ZIMBABWE: Humanitarian & Development Indicators - Trends (As of 20 June Indicators Sub-Saharan Africa DEMOGRAPHY Population (million 842 (2012, UNDP Africa HDR) Zimbabwe Current Value (Data Date, Source)
More informationFirst 1,000 Days of Human Life Approach to improve Health & Nutritional Status of Pregnant Women & Children.
A Pyari Onlus Project First 1,000 Days of Human Life Approach to improve Health & Nutritional Status of Pregnant Women & Children. Location: Selected Slums of Siliguri, West Bengal, India Pyari Onlus Via
More informationGender Profile: Sierra Leone
General Total male population under 15 (2014) (CIA, 2015): 1,198,553 Total female population under 15 (2014) (CIA, 2015): 1,208,775 Total male population over 15 (2014) (CIA, 2015): 1,590,157 Total female
More informationTechnical Guidance for Global Fund HIV Proposals
Technical Guidance for Global Fund HIV Proposals Broad Area Intervention Area CARE ANS SUPPORT Protection, care and support of children orphaned and made vulnerable by HIV and AIDS Working Document Updated
More informationREQUEST FOR PROPOSALS: CONTRACEPTIVE ACCESS CHANGE PACKAGE
REQUEST FOR PROPOSALS: CONTRACEPTIVE ACCESS CHANGE PACKAGE OVERVIEW The Colorado Collaborative for Reproductive Health Equity (Collaborative), supported by the Colorado Health Foundation and Caring for
More informationTargeted interventions for asylum seeking and refugee young carers and their families
Practice example Targeted interventions for asylum seeking and refugee young carers and their families What is the initiative? CareFree Asylum Seeking, Refugee and Newly Arrived Young Carers Project Who
More informationGender, Time Use, and Health Outcomes in Rural India
Gender, Time Use, and Health Outcomes in Rural India Dates of Study Period: 7/1/2011-8/31/2011 (eight weeks) Location: Vellore District, Tamil Nadu, South India Foreign Institution: Christian Medical College,
More informationEthnicity and Maternal Health Care Utilization in Nigeria: the Role of Diversity and Homogeneity
Ethnicity and Maternal Health Care Utilization in Nigeria: the Role of Diversity and Homogeneity In spite of the significant improvements in the health of women worldwide, maternal mortality ratio has
More informationA STUDY OF PREVALENCE OF MAJOR DEPRESSIVE DISORDER IN PATIENTS PRIMARILY HAVE HEADACHE AS A SYMPTOM
3 Original article A STUDY OF PREVALENCE OF MAJOR DEPRESSIVE DISORDER IN PATIENTS PRIMARILY HAVE HEADACHE AS A SYMPTOM Dr. Vaishal N. Vora, M.D. (Psychiatry), D.P.M, Consultant Psychiatrist, Chairman,
More informationBackground. Population/Intervention(s)/Comparison/Outcome(s) (PICO) Brief structured psychological treatment
updated 2012 Brief structured psychological treatment Q 3: Is brief, structured psychological treatment in non-specialist health care settings better (more effective than/as safe as) than treatment as
More informationCommunity Needs Assessment. June 26, 2013
Community Needs Assessment June 26, 2013 Agenda Purpose Methodology for Collecting Data Geographic Area Demographic Information Community Health Data Prevalence of Alcohol & Drug Use Utilization data Findings
More informationExpectations Of Patients Using Mental Health Services
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 8 Ver. I (Aug. 2017), PP 33-37 www.iosrjournals.org Expectations Of Patients Using Mental Health
More informationFACT SHEET SIKKIM. District Level Household and DLHS - 3. International institute for population sciences (Deemed University) Mumbai
2007-2008 DLHS - 3 Ministry of Health and Family Welfare District Level Household and Facility survey FACT SHEET SIKKIM International institute for population sciences (Deemed University) Mumbai Introduction
More informationPublic Mental Health. Benedetto Saraceno University Nova of Lisbon University of Geneva Chairman Global Initiative on Psychiatry, The Netherlands
Public Mental Health Benedetto Saraceno University Nova of Lisbon University of Geneva Chairman Global Initiative on Psychiatry, The Netherlands FIVE KEY POINTS IN PMH Mental disorders: high prevalence
More informationIDSP-NCD Risk Factor Survey
Sumary: Non-Communicable Disease Risk Factor Survey, 2007-08, Phase-I states of India IDSP-NCD Risk Factor Survey Fact Sheet - India Phase - I States State AP MP MH MZ KE TN UTK Population Household surveyed
More informationExecutive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services
United Nations Executive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services Distr.: General 15 April 2011 Original:
More informationDifferentials in the Utilization of Antenatal Care Services in EAG states of India
International Research Journal of Social Sciences ISSN 2319 3565 Differentials in the Utilization of Antenatal Care Services in EAG states of India Rakesh Kumar Singh 1 and Shraboni Patra 2 International
More informationSexual Behaviour in Rural Northern India: An Insight
Sexual Behaviour in Rural Northern India: An Insight Meren Longkumer* Dr S.K.Singh** Dr.H.Lhungdim,*** Introduction As we all know, sex is usually not an overt discussion in India, but the spread of HIV/AIDS
More informationOrphanhood, Gender, and HIV Infection among Adolescents in South Africa: A Mixed Methods Study
Orphanhood, Gender, and HIV Infection among Adolescents in South Africa: A Mixed Methods Study Introduction Adolescents in Southern Africa experience some of the highest rates of HIV incidence in the world,
More informationExecutive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services
United Nations Executive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services Distr.: General 12 July 2011 Original:
More informationIMPACT EVALUATION OF PERFORMANCE BASE FINANCING
1 IMPACT EVALUATION OF PERFORMANCE BASE FINANCING FOR GENERAL HEALTH AND HIV/AIDS SERVICES In RWANDA A collaboration between the Rwanda Ministry of Health, CNLS, and SPH, the INSP in Mexico, UC Berkeley
More informationSEA-FHR-1. Life-Course. Promoting Health throughout the. Department of Family Health and Research Regional Office for South-East Asia
SEA-FHR-1 Promoting Health throughout the Life-Course Department of Family Health and Research Regional Office for South-East Asia the health and development of neonates, children and adolescents
More informationEffectiveness of Cognitive Behaviour Therapy on Patients Suffering From Depression
The International Journal of Indian Psychology ISSN 2348-5396 (e) ISSN: 2349-3429 (p) Volume 3, Issue 4, No. 64, DIP: 18.01.119/20160304 ISBN: 978-1-365-32519-9 http://www.ijip.in July-September, 2016
More informationA Comparative Study of Socio Demographic and Clinical Profiles in Patient with Obsessive Compulsive Disorder and Depression
American Journal of Psychiatry and Neuroscience 2018; 6(4): 99-103 http://www.sciencepublishinggroup.com/j/ajpn doi: 10.11648/j.ajpn.20180604.12 ISSN: 2330-4243 (Print); ISSN: 2330-426X (Online) A Comparative
More informationGender in Nigeria. Data from the 2013 Nigeria Demographic and Health Survey (NDHS)
Gender in Nigeria Data from the 2013 Nigeria Demographic and Health Survey (NDHS) This report summarizes the gender-related findings of the 2013 Nigeria Demographic and Health Survey (NDHS), implemented
More informationCommunity-Based Strategies for Cancer Control
Community-Based Strategies for Cancer Control Chanita Hughes Halbert, Ph.D. Department of Psychiatry and Behavioral Sciences Hollings Cancer Center Medical University of South Carolina 1900: Ten Leading
More informationRisk factors for suicidal behaviour in developed and developing nations
Risk factors for suicidal behaviour in developed and developing nations Stephen Platt University of Edinburgh, Scotland, UK 2 nd Triple-I International Conference Koper, Slovenia, 4-6 May 2011 Outline
More informationMid year population estimate for 2010 was 1,317,714 Population increased by 10.3% between 1990 and 2010 Shift in the gradient from younger to older
Mid year population estimate for 2010 was 1,317,714 Population increased by 10.3% between 1990 and 2010 Shift in the gradient from younger to older groups between 1990 and 2010 reflecting changes in fertility
More informationReproductive Health status of Women in few villages of Bangladesh
Original article: Reproductive Health status of Women in few villages of Bangladesh Akhi Khatun 1*, Md Kabir 2 1 City Clinic, Dinajpur, Bangladesh 2Sir Salimullah Medical College, Dhaka, Bangladesh *Corresponding
More informationMaldives and Family Planning: An overview
Maldives and Family Planning: An overview Background The Republic of Maldives is an archipelago in the Indian Ocean, located 600 kilometres south of the Indian subcontinent. It consists of 92 tiny islands
More informationMyanmar national study on the socioeconomic impact of HIV on households
Myanmar national study on the socioeconomic impact of HIV on households Overview Aims Methods Findings Implications for policy and practice Study aims To establish scientific evidence and deepen understanding
More informationA Prospective Study to Assess the Health Problems Due to Ageing on Geriatrics at Various Hospitals, Palakkad District
Human Journals Research Article May 2016 Vol.:6, Issue:2 All rights are reserved by Aathira P Kariat et al. A Prospective Study to Assess the Health Problems Due to Ageing on Geriatrics at Various Hospitals,
More informationExecutive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services
United Nations Executive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services Distr.: General 25 April 2014 Original:
More informationNishant R. Bhimani*, Pushti V. Vachhani, Girija P. Kartha. Department of Community Medicine, C. U. Shah Medical College, Surendranagar, Gujarat, India
International Journal of Community Medicine and Public Health Bhimani NR et al. Int J Community Med Public Health. 2017 Apr;4(4):1289-1294 http://www.ijcmph.com pissn 2394-6032 eissn 2394-6040 Original
More informationKey Findings Afghanistan Mortality Survey 2010
Key Findings Afghanistan Mortality Survey 2010 The Afghanistan Mortality Survey (AMS) 2010 was carried out by the Afghan Public Health Institute (APHI) of the Ministry of Public Health (MoPH) and the Central
More informationSchedule Caste Women and Family Planning In Karnataka-A Critical Analysis
International Journal of Humanities and Social Science Invention ISSN (Online): 2319 7722, ISSN (Print): 2319 7714 Volume 1 Issue 1 December. 2012 PP.45-49 Schedule Caste Women and Family Planning In Karnataka-A
More informationDemographic and Health Profile. Ethiopia. Nigeria. Population is currently 73 million, annual growth rate is 2.4%
Adebola Adedimeji Demographic and Health Profile Nigeria Population is currently 150 million, annual growth rate is 2% Political structure- Federal Republic; 36 states, almost 800 local governments Multi-ethnic,
More informationThe Perinatal Mental Health Project (PMHP)
Overview of the Hanover Park maternal mental health screening study The Perinatal Mental Health Project (PMHP) The PMHP is an independent initiative based at the University of Cape Town. It is located
More informationVanuatu Country Statement
Vanuatu Country Statement Delivered at the sixth Mid Term Review of the Asian and Pacific Population Conference 26 th 28 th November 2018, United Nations Conference Centre, Bangkok, Thailand. Mr/Madam
More information18% Opening Prayer. Introduction
This is the third study on maternal health. The final study will look at maternal and child health among Canada s Aboriginal Peoples. M AT E R N A L a n d C H I L D H E A LT H : M a l a w i b y K a r e
More informationGiving Strategy
` Giving Strategy 06-09 The Robertson Trust vision is to improve the quality of life and realise the potential of people and communities in Scotland inspired by the example of our founders, the Robertson
More informationFacts and trends in sexual and reproductive health in Asia and the Pacific
November 13 Facts and trends in sexual and reproductive health in Asia and the Pacific Use of modern contraceptives is increasing In the last years, steady gains have been made in increasing women s access
More informationHealth System Members of the Milwaukee Health Care Partnership
Health System Members of the Milwaukee Health Care Partnership Aurora Health Care Children s Hospital of Wisconsin Columbia St. Mary s Health System Froedtert Health Wheaton Franciscan Healthcare In Collaboration
More informationResponse to HIV LOGISTICAL AND OTHER PERSPECTIVES
Response to HIV LOGISTICAL AND OTHER PERSPECTIVES Margaret Brandeau Department of Management Science and Engineering Department of Medicine Stanford University Topics HIV: A humanitarian crisis Planning
More informationDepressive Symptoms Among Colorado Farmers 1
February 1995 Depressive Symptoms Among Colorado Farmers 1 L. Stallones, M. Leff, C. Garrett, L. Criswell, T. Gillan 2 ARTICLE ABSTRACT Previous studies have reported farmers to be at higher risk of suicide
More information