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

Published online by Cambridge University Press:  15 February 2018

Byamah B. Mutamba ,
Jeremy C. Kane ,
Joop T. V. M. de Jong ,
James Okello ,
Seggane Musisi  and
Brandon A. Kohrt
Byamah B. Mutamba*
Affiliation:
Butabika National Mental Hospital, Kampala, Uganda Amsterdam Institute of Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
Jeremy C. Kane
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Joop T. V. M. de Jong
Affiliation:
Amsterdam Institute of Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
James Okello
Affiliation:
Department of Mental Health, Gulu University, Gulu, Uganda
Seggane Musisi
Affiliation:
Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
Brandon A. Kohrt
Affiliation:
Department of Psychiatry, George Washington University, Washington, DC, USA
*
Author for correspondence: Byamah B. Mutamba, E-mail: byamamutamba@yahoo.com, B.B.Mutamba@uva.nl
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Abstract

Background

Despite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma.

Methods

A non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention.

Results

Caregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10–0.62] and 6 months (RR 0.33, 95% CI 0.11–0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers.

Conclusion

IPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.

Keywords

Caregiversdepressiongovernment health systemgroup interpersonal psychotherapylow- and middle-income countrynodding syndromeUgandaID ISRCTN11382067
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 15 , November 2018 , pp. 2573 - 2583
Copyright
Copyright © Cambridge University Press 2018 

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