Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
PLoS One. 2019 Jul 23;14(7):e0220034. doi: 10.1371/journal.pone.0220034. eCollection 2019.
Over 75% of people with mental neurological and substance use disorders (MNSD) live in low and middle-income countries with limited access to specialized care. The World Health Organization's Mental Health Gap Action Program (mhGAP) aims to address the human resource gap but it requires contextualization.
We conducted a qualitative study in rural coastal Kenya to explore the local terms, perceived causes and management modalities of priority MNSD listed in the mhGAP, to inform implementation in this setting.
We conducted 8 focus group discussions with primary health care providers and traditional health practitioners and used the framework method to conduct thematic analysis. We identified local terms, perceived causes and treatment options for MNSD. We also explored possibilities for collaboration between the traditional health practitioners and primary health care providers.
We found local terms for depression, psychoses, epilepsy, disorders due to substance use and self-harm/ suicide but none for dementia. Child and adolescent mental and behavioral problems were not regarded as MNSD but consequences of poor parenting. Self-harm/suicide was recognized in the context of other MNSD. Causes of MNSD were broadly either biological or supernatural. Treatment options were dependent on perceived cause of illness. Most traditional health practitioners were willing to collaborate with primary health care providers mainly through referring cases. Primary health care providers were unwilling to collaborate with traditional health practitioners because they perceived them to contribute to worsening of patients' prognoses.
Local terms and management modalities are available for some priority MNSD in this setting. Community level case detection and referral may be hindered by lack of collaboration between traditional health practitioners and primary health care providers. There is need for training on the recognition and management of all priority MNSD.
超过 75%的患有精神神经和物质使用障碍（MNSD）的人生活在资源有限的中低收入国家，难以获得专业的医疗服务。世界卫生组织的精神卫生差距行动规划（mhGAP）旨在解决人力资源缺口问题，但需要进行本土化调整。
我们在肯尼亚沿海农村地区开展了一项定性研究，旨在探讨 mhGAP 中列出的优先 MNSD 的当地术语、感知病因和管理方式，为在该环境中实施提供信息。
我们与初级卫生保健提供者和传统卫生从业者进行了 8 次焦点小组讨论，并使用框架方法进行主题分析。我们确定了 MNSD 的当地术语、感知病因和治疗选择。我们还探讨了传统卫生从业者与初级卫生保健提供者之间合作的可能性。
我们找到了抑郁症、精神病、癫痫、物质使用障碍和自残/自杀的当地术语，但没有痴呆的术语。儿童和青少年的精神和行为问题不被视为 MNSD，而是不良育儿的后果。自残/自杀在其他 MNSD 的背景下被认识到。MNSD 的病因大致分为生物或超自然因素。治疗选择取决于对疾病病因的看法。大多数传统卫生从业者愿意与初级卫生保健提供者合作，主要通过转介病例。初级卫生保健提供者不愿意与传统卫生从业者合作，因为他们认为传统卫生从业者会导致患者预后恶化。
在这种情况下，一些优先 MNSD 有当地的术语和管理方式。社区层面的病例发现和转介可能会受到传统卫生从业者和初级卫生保健提供者之间缺乏合作的阻碍。需要对所有优先 MNSD 的识别和管理进行培训。
