Despite significant advancements in the development of psychotropic medications, increasing adherence rates remain a challenge in the treatment and management of psychiatric disorders. The purpose of this study is to qualitatively explore the challenges underlying medication adherence and strategies to improve it among adolescents with psychiatric disorders in Malaysia. This qualitative research design presents results from 17 semi-structured interviews with adolescent psychiatric patients, aged 11 to 19 years old, from public hospitals across Peninsular Malaysia. The data collected from interviews were transcribed and processed through thematic analysis using the NVivo 11 software. A total of three main themes concerning medication adherence were identified: (1) challenges; (2) coping strategies and (3) protective factors. In this study, thirteen subthemes emerge as challenges underlying medication adherence experienced by adolescent psychiatric patients. The coping strategies identified in this study fall under three broad subthemes which are problem-focused strategies, emotion-focused strategies and maladaptive strategies. This study also highlights social support and positive medicinal effects as protective factors for non-adherence issues in adolescent psychiatric patients. In conclusion, this study supports the notion that adherence is a multi-factorial phenomenon. This study can inform future development of interventions and targeted health promotion programmes in enhancing adherence.

This article examines the alignment of bilateral investment treaties (BITs) with domestic development policies. The analysis reveals the presence of considerable disparity between Ethiopian BITs and the country's domestic development policies and the importance of ensuring consistency between the two. The potential options to resolve this disparity can be combined on a case-by-case basis, depending on different challenges, such as bargaining power, political commitment, procedural requirements and resistance from other treaty partners. The changing dynamics of global politics and the growing backlash against BITs have created a conducive environment for such reform.

Addis Ababa initiated a universal Home-Grown School Feeding Program (HGSFP) in February 2019 to address hunger and improve the educational outcomes of schoolchildren. This study aimed to document the perceived benefits and challenges of the HGSFP in Addis Ababa, where such information was lacking. In May 2023, a qualitative phenomenological study was conducted to collect data from 20 schools participating in the HGSFP. Data were collected through key informant interviews and focus group discussions (FGDs) involving 98 purposively selected participants. The study encompassed 48 student mothers in 5 FGDs, 20 student interviews, 20 school principals, and 10 experts from the Ministry of Education, Sub-cities, and the School Feeding Agency for in-depth interviews. Data collected in the local language were transcribed, translated into English, and thematically analysed using ATLAS-TI software. The study’s findings unveiled the transformative impact of the HGSFP in Addis Ababa, Ethiopia. It demonstrated remarkable improvements in attendance, concentration, academic performance, reduced dropout rates, financial relief, enhanced behaviour, and a safer learning environment. However, urgent measures are imperative to tackle pressing challenges such as underpaid kitchen workers, operational issues, reduced reading time, rising food costs, limited market access, inadequate infrastructure, and growing dependency. To ensure the enduring sustainability of HGSFP, addressing challenges like workload reduction, kitchen infrastructure enhancement, government guideline implementation, promoting self-reliance, overcoming budget limitations, and addressing school gardening obstacles is vital.

Drawing upon data from a study examining experiences of accessing support for pets from the UK animal welfare charity Blue Cross, this paper illuminates reasons why people might not seek support when they need it. This applies to those who are struggling financially and are eligible for, but do not take, free/reduced cost veterinary care, or are having other problems (e.g. the animal’s disruptive behaviour or ill health, struggling to care for the pet due to changing circumstances or health problems, or coping with pet loss). Twenty Blue Cross service users (15 female, five male, age 29–67) took part in individual online interviews using a semi-guided narrative approach, where they were encouraged to share their experiences of reaching out. They were also asked to reflect upon why others may not do the same, and if they had any recommendations for organisations to help them reach these people. Findings echo other studies that highlight a fear of being judged, disclosure and stigma. Guilt, shame, lack of awareness, financial concerns, and wanting to manage independently, all play important roles. These factors have implications for the way support services are advertised and delivered to ensure animals receive the care needed. We describe these reflections and recommendations and identify three broader ideological narratives underpinning participants’ stories: ‘giving back’; ‘equity’, and ‘sacrifice’. These reveal how wider societal attitudes and values shape identities and behaviours. It is vital that support on offer is reframed to explicitly counteract these influences to ensure optimal animal and human welfare.

This study discusses the significant topic of mental health challenges in Nigeria, focusing on the shortage of mental health professionals, particularly psychiatrists, and the factors influencing medical students’ hesitation to pursue psychiatry as a career path. We examine the multifaceted difficulties in Nigeria’s mental health environment using various sources, including research studies and statistical data. The scarcity of psychiatrists, with only 250 for a population of 200 million, underscores the urgent need for attention to mental health within the country. Factors such as brain drain, inadequate learning infrastructure, limited research exposure and insufficient health coverage contribute to this crisis. Additionally, societal stigma and financial constraints discourage students from pursuing psychiatry as a career. To address these challenges comprehensively, we propose a holistic approach that involves cross-disciplinary collaboration, robust mental health education in all healthcare programs, community-based awareness initiatives and transdisciplinary teamwork among mental health providers. We highlight the importance of mentorship, scholarships and national advocacy to encourage more individuals to enter the mental health profession, emphasizing the need for diversity and inclusiveness. Furthermore, our paper stresses the significance of research and innovation in advancing mental health treatment and inspiring passion for mental health among students and aspiring professionals. By embracing this comprehensive set of recommendations, we aim to cultivate a diverse, talented and compassionate workforce capable of effectively addressing Nigeria’s pressing mental health challenges.

Psychiatric sequelae may occur following traumatic injury irrespective of whether an insult has been caused to the brain. A range of psychiatric illnesses have been either causative of or associated with road traffic accidents and traumatic injuries, including depression, anxiety, post-traumatic stress disorder, substance use disorder and attention-deficit hyperactivity disorder. Despite literature on such associations, psychiatric intervention in the treatment of patients following traumatic injury is limited. The authors share their experience of challenges in addressing mental health problems in a tertiary care trauma centre located in North India. Steps in overcoming those challenges included: developing a semi-structured form to be completed for referrals and consultations, a psychiatrist attending weekly rounds with the surgeons, and initiating a psychiatry out-patient clinic for patients discharged from the trauma centre. It may be worthwhile in the future to set up a trauma psychiatry unit at the centre, involving a clinical psychologist, a psychiatric social worker and an occupational therapist for the comprehensive care of patients.

Requests by patients for providers of specific demographic backgrounds pose an ongoing challenge for hospitals, policymakers, and ethicists. These requests may stem from a wide variety of motivations; some may be consistent with broader societal values, although many others may reflect prejudices inconsistent with justice, equity, and decency. This paper proposes a taxonomy designed to assist healthcare institutions in addressing such cases in a consistent and equitable manner. The paper then reviews a range of ethical and logistical challenges raised by such requests and proposed guidance to consider when reviewing and responding to them.

The Home-grown School Feeding Program (HG-SFP) is a model designed to provide school meals to students using foods sourced from local markets. HG-SFP recently has been incorporated as one of the strategies of educational development in Ethiopia aiming to address hunger and food insecurity problems of school children. Yet, evaluation of the successes and challenges of the program has been limited evaluated. The purpose of the present study was to explore the successes and challenges of the SFP in Sidama Region, Southern Ethiopia. This exploratory qualitative study collected data from eight schools targeted for HG-SFP through key informant interviews and focus group discussions (FGDs). A total of sixteen FGDs and twenty-one in-depth interviews were conducted. Purposive sampling was used to include study participants based on their potential relevance in delivering in-depth information. The findings of the present study showed that HG-SFP was successful in improving class attendance and academic performance of school children. In addition, the program had a contribution in saving the parents’ money and time as a result of the food provided. With regard to SFP challenges, lack of permanent clean water provision, delay in ration delivery, poor-quality food provision, inadequate amount of food allocated for the academic year, lack of necessary infrastructure for the program, and lack of training in sanitation and hygiene for cooks were among the major challenges identified. Therefore, program challenges need high-level attention in order to make the school feeding program more successful in Sidama Region, Ethiopia.