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Online learning improves substance use care in Kenya: Randomized control trial results and implications
... An associated comprehensive mixed-methods research program evaluated the impact of the training on health workers and patients' outcomes: the computer-based drug and alcohol Training and Assessment in Kenya (eDATA-K), under which this study is nested. Other eDATA-K studies are published elsewhere (Clair et al., 2022a;Clair et al., 2016aClair et al., , 2016bClair et al., , 2016cClair et al., , 2019Clair et al., , 2022bHsiang-Te Tsuei et al., 2017). ...
... We suspect that a more accurate interpretation is that trainees now feel more confident that people can change their behaviors even if they suffer from a SUD, while before, they would have thought that most people who suffer from a SUD would not be able to change, making it harder for them to "snap out of it." In other words, we believe that the training increased the health workers' confidence in the substance user's ability to change their substance use patterns, alongside health workers' increased self-efficacy, consistent with answers to other survey items and supported by other studies part of the eDATA-k program of research (Clair et al., in press;Clair et al., 2019Clair et al., , 2016aClair et al., , 2016bClair et al., , 2016cClair et al., , 2016bClair et al., , 2016cHsiang-Te Tsuei et al., 2017). ...
... We suspect that a more accurate interpretation is that trainees now feel more confident that people can change their behaviors even if they suffer from a SUD, while before, they would have thought that most people who suffer from a SUD would not be able to change, making it harder for them to "snap out of it." In other words, we believe that the training increased the health workers' confidence in the substance user's ability to change their substance use patterns, alongside health workers' increased self-efficacy, consistent with answers to other survey items and supported by other studies part of the eDATA-k program of research (Clair et al., in press;Clair et al., 2019Clair et al., , 2016aClair et al., , 2016bClair et al., , 2016cClair et al., , 2016bClair et al., , 2016cHsiang-Te Tsuei et al., 2017). ...
This study evaluated factors affecting the completion of blended-eLearning courses for health workers and their effect on stigma. The two courses covered the screening and management of harmful alcohol, tobacco, and other substance consumption in a lower-middle-income country setting. The courses included reading, self-reflection exercises, and skills practice on communication and stigma. The Anti-Stigma Intervention-Stigma Evaluation Survey was modified to measure stigma related to alcohol, tobacco, or other substances. Changes in stigma score pre- and post-training period were assessed using paired t-tests. Of the 123 health workers who registered, 99 completed the pre- and post-training surveys, including 56 who completed the course and 43 who did not. Stigma levels decreased significantly after the training period, especially for those who completed the courses. These findings indicate that blended-eLearning courses can contribute to stigma reduction and are an effective way to deliver continuing education, including in a lower-middle-income country setting.
... We have previously described our work on building Public Health capacity in LMICs and High Income Countries (HICs) through e-learning, using OERs and volunteer tutors (Heller et al, 2007;Heller, 2009;Galway, Corbett, Takaro, Tairyan & Frank, 2014;Frank et al., 2016;Clair, Mutiso, Musau, Frank & Ndetei, 2016), which have been identified as innovative models for global health education (Crisp & Chen, 2014;Ladner, 2014). ...
... The NextGenU.org free model has been tested in North American medical and public health students (Galway et al, 2014;Frank et al, 2016), and in community health workers and primary care physicians in Kenya (Clair et al, 2016), with as much knowledge gain and greater student satisfaction than with traditional courses, and the creation of a community of practice that has learned to interact globally and productively. While the rates of completion by individuals is low and similar to that of MOOCs, when these NextGenU.org ...
The first Open Praxis issue in volume 10 includes six research papers section and two innovative practice papers.
... We have previously described our work on building Public Health capacity in LMICs and High Income Countries (HICs) through e-learning, using OERs and volunteer tutors (Heller et al, 2007;Heller, 2009;Galway, Corbett, Takaro, Tairyan & Frank, 2014;Frank et al., 2016;Clair, Mutiso, Musau, Frank & Ndetei, 2016), which have been identified as innovative models for global health education (Crisp & Chen, 2014;Ladner, 2014). ...
... The NextGenU.org free model has been tested in North American medical and public health students (Galway et al, 2014;Frank et al, 2016), and in community health workers and primary care physicians in Kenya (Clair et al, 2016), with as much knowledge gain and greater student satisfaction than with traditional courses, and the creation of a community of practice that has learned to interact globally and productively. While the rates of completion by individuals is low and similar to that of MOOCs, when these NextGenU.org ...
Rising disease burden and health inequalities remain global concerns, highlighting the need for health systems strengthening with a sufficient and appropriately trained workforce. The current models for developing such a workforce are inadequate and newer approaches are needed. In this paper we describe a model for public health capacity building through online Global Learning, defined as “innovative, integrated, global opportunities for capacity building through online learning and shared experiences between and within Low- to Middle-Income Countries and High-Income Countries, in a continuous process that helps health care workers learn as they progress through their careers”. We demonstrate how two programmes, Peoples-uni and NextGenU.org, have implemented this model using a mix of low-cost and free online learning courses, a global community of volunteer tutors, mentors and peers, and appropriate high quality competence-based content.
... From nurses and doctors to support staff and policymakers, governments and other entities should provide continued opportunities for professional training and development on integrated mental healthcare and UHC ethos. In 2021, Kenya has a 109% mobile penetration (many have more than one SIM card) and 43% internet penetration (far leading other East African countries) (43), there has been an increased report on the use of digital mental health applications in intervention delivery, training and capacity building, and supervision (44)(45)(46)(47) (3) a lack of public mental health leadership. There are three key strategies that the MOH is presently actively pursuing to achieve these objectives. ...
Background: How can we fast-track the global agenda of integrated mental healthcare in low- and middle-income countries (LMICs) such as Kenya? This is a question that has become increasingly important for individuals with lived experiences, policymakers, mental health advocates and health care providers at the local and international levels.
Discussion: This narrative synthesis and perspective piece encompasses an overview of mental health care competencies, best practices and capacity building needed to fast track patient responsive services. In that vein we also review key policy developments like UHC to make a case for fast-tracking our four-step framework.
Results: While there is an increasingly global impetus for integrated mental healthcare, there is a lack of clarity around what patient-responsive mental healthcare services should look like and how to measure and improve provider readiness appropriately. Here, our collaborative team of local and international experts proposes a simple four-step approach to integrating responsive mental healthcare in Kenya. Our recommended framework prioritizes a clear understanding and demonstration of multidimensional skills by the provider. The four steps are (1) provider sensitization , (2) continuous supervision , (3) continuous professional training , and (4) leadership empowerment .
Conclusion: Our proposed framework can provide pointers to embracing patient-centered and provider empowerment focused quality of care improvements. Though elements of our proposed framework are well-known, it has not been sufficiently intertwined and therefore not been integrated. We think in the current times our integrated framework offers an opportunity to “building back better” mental health for all.
... org has registrants from 145 countries, generating near-100% pilot-student completion rates in adopting institutions (though much lower retention for individual users), with student enhancement of knowledge and skills, learner satisfaction, and patient outcomes identical to or superior to the world's finest universities, from the United States to Kenya. [1][2][3][4][5] In 2015-2016, NextGenU.org focused on public health offerings and developing a MedSchoolInABox, including now having full residency programs in family medicine, preventive medicine, and pediatrics underway. ...
NextGenU.org now uniquely offers a free, accredited, globally-available online training in Lifestyle Medicine. Courses such as Lifestyle Medicine for Primary Care Physicians, Prevention and Treatment of Alcohol Use Disorders/Tobacco Use, Substance Use Disorder Screening, Public Health Nutrition, and more are competency-based and include knowledge transfer, a web-based global peer community of practice, and local, skills-based mentorships. Trainings use existing, expert-created resources from governments, universities, and medical specialty societies thus ensuring their quality and simultaneously making them free of costs, advertisement, and geographic barriers. To offer free credits for these courses, NextGenU.org partners with universities and professional societies. NextGenU.org’s comprehensive Lifestyle Medicine Curriculum will launch in early 2017.
... The second caveat is that there are no local findings in the Kenyan context on the relative impact or relevance of mobilebased screening which allows clinicians in rural settings to easily track patients over time. Though not on mobile assessments, we have demonstrated in a Kenyan setting that training involving computer-based learning can be effective (Clair et al. 2016). Thus, there is prima facie evidence that use of technology can be useful in mental health. ...
We aimed to determine the prevalence and determinants of depression using mobile based mental health Global Action Programme Intervention guide (mhGAP-IG) in remote health care settings where most priority mental health problems are managed by non-mental health specialists and evaluate the feasibility of the application. Adult patients were recruited from four rural public health facilities in Kenya using systematic random sampling and screened for depression. There were no missing items since the application prevented saving of data unless all the items were answered. The prevalence of depression was 25% with suicidal behavior being the most significant comorbid problem. Older age, personal and a family history of a mental disorder were significantly correlated with depression. Exploring the use of health-related mobile applications in identification of priority mental health problems is useful notably in low-resource settings; and also forms a basis for prevention of mental disorders and intervention at acute stages.
Background:
Harmful alcohol use is defined as unhealthy alcohol use that results in adverse physical, psychological, social, or societal consequences and is among the leading risk factors for disease, disability and premature mortality globally. The burden of harmful alcohol use is increasing in low- and middle-income countries (LMICs) and there remains a large unmet need for indicated prevention and treatment interventions to reduce harmful alcohol use in these settings. Evidence regarding which interventions are effective and feasible for addressing harmful and other patterns of unhealthy alcohol use in LMICs is limited, which contributes to this gap in services.
Objectives:
To assess the efficacy and safety of psychosocial and pharmacologic treatment and indicated prevention interventions compared with control conditions (wait list, placebo, no treatment, standard care, or active control condition) aimed at reducing harmful alcohol use in LMICs.
Search methods:
We searched for randomized controlled trials (RCTs) indexed in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, the Cochrane Clinical Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, Embase, PsycINFO, CINAHL, and the Latin American and Caribbean Health Sciences Literature (LILACS) through 12 December 2021. We searched clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, Web of Science, and Opengrey database to identify unpublished or ongoing studies. We searched the reference lists of included studies and relevant review articles for eligible studies.
Selection criteria:
All RCTs comparing an indicated prevention or treatment intervention (pharmacologic or psychosocial) versus a control condition for people with harmful alcohol use in LMICs were included.
Data collection and analysis:
We used standard methodological procedures expected by Cochrane.
Main results:
We included 66 RCTs with 17,626 participants. Sixty-two of these trials contributed to the meta-analysis. Sixty-three studies were conducted in middle-income countries (MICs), and the remaining three studies were conducted in low-income countries (LICs). Twenty-five trials exclusively enrolled participants with alcohol use disorder. The remaining 51 trials enrolled participants with harmful alcohol use, some of which included both cases of alcohol use disorder and people reporting hazardous alcohol use patterns that did not meet criteria for disorder. Fifty-two RCTs assessed the efficacy of psychosocial interventions; 27 were brief interventions primarily based on motivational interviewing and were compared to brief advice, information, or assessment only. We are uncertain whether a reduction in harmful alcohol use is attributable to brief interventions given the high levels of heterogeneity among included studies (Studies reporting continuous outcomes: Tau² = 0.15, Q =139.64, df =16, P<.001, I² = 89%, 3913 participants, 17 trials, very low certainty; Studies reporting dichotomous outcomes: Tau²=0.18, Q=58.26, df=3, P<.001, I² =95%, 1349 participants, 4 trials, very low certainty). The other types of psychosocial interventions included a range of therapeutic approaches such as behavioral risk reduction, cognitive-behavioral therapy, contingency management, rational emotive therapy, and relapse prevention. These interventions were most commonly compared to usual care involving varying combinations of psychoeducation, counseling, and pharmacotherapy. We are uncertain whether a reduction in harmful alcohol use is attributable to psychosocial treatments due to high levels of heterogeneity among included studies (Heterogeneity: Tau² = 1.15; Q = 444.32, df = 11, P<.001; I²=98%, 2106 participants, 12 trials, very low certainty). Eight trials compared combined pharmacologic and psychosocial interventions with placebo, psychosocial intervention alone, or another pharmacologic treatment. The active pharmacologic study conditions included disulfiram, naltrexone, ondansetron, or topiramate. The psychosocial components of these interventions included counseling, encouragement to attend Alcoholics Anonymous, motivational interviewing, brief cognitive-behavioral therapy, or other psychotherapy (not specified). Analysis of studies comparing a combined pharmacologic and psychosocial intervention to psychosocial intervention alone found that the combined approach may be associated with a greater reduction in harmful alcohol use (standardized mean difference (standardized mean difference (SMD))=-0.43, 95% confidence interval (CI): -0.61 to -0.24; 475 participants; 4 trials; low certainty). Four trials compared pharmacologic intervention alone with placebo and three with another pharmacotherapy. Drugs assessed were: acamprosate, amitriptyline, baclofen disulfiram, gabapentin, mirtazapine, and naltrexone. None of these trials evaluated the primary clinical outcome of interest, harmful alcohol use. Thirty-one trials reported rates of retention in the intervention. Meta-analyses revealed that rates of retention between study conditions did not differ in any of the comparisons (pharmacologic risk ratio (RR) = 1.13, 95% CI: 0.89 to 1.44, 247 participants, 3 trials, low certainty; pharmacologic in addition to psychosocial intervention: RR = 1.15, 95% CI: 0.95 to 1.40, 363 participants, 3 trials, moderate certainty). Due to high levels of heterogeneity, we did not calculate pooled estimates comparing retention in brief (Heterogeneity: Tau² = 0.00; Q = 172.59, df = 11, P<.001; I2 = 94%; 5380 participants; 12 trials, very low certainty) or other psychosocial interventions (Heterogeneity: Tau² = 0.01; Q = 34.07, df = 8, P<.001; I2 = 77%; 1664 participants; 9 trials, very low certainty). Two pharmacologic trials and three combined pharmacologic and psychosocial trials reported on side effects. These studies found more side effects attributable to amitriptyline relative to mirtazapine, naltrexone and topiramate relative to placebo, yet no differences in side effects between placebo and either acamprosate or ondansetron. Across all intervention types there was substantial risk of bias. Primary threats to validity included lack of blinding and differential/high rates of attrition.
Authors' conclusions:
In LMICs there is low-certainty evidence supporting the efficacy of combined psychosocial and pharmacologic interventions on reducing harmful alcohol use relative to psychosocial interventions alone. There is insufficient evidence to determine the efficacy of pharmacologic or psychosocial interventions on reducing harmful alcohol use largely due to the substantial heterogeneity in outcomes, comparisons, and interventions that precluded pooling of these data in meta-analyses. The majority of studies are brief interventions, primarily among men, and using measures that have not been validated in the target population. Confidence in these results is reduced by the risk of bias and significant heterogeneity among studies as well as the heterogeneity of results on different outcome measures within studies. More evidence on the efficacy of pharmacologic interventions, specific types of psychosocial interventions are needed to increase the certainty of these results.
Background: There is a substantial and still growing need for trained speech–language therapists (SLTs) in sub-Saharan Africa (SSA) to work with persons with communication disability. Unfortunately, there are very few university-level speech–language therapy (SLT) training programs in SSA, making it difficult for individuals interested in working with persons with communication disability to obtain the necessary skills. NextGenU.org offers a revolutionary model to address the shortages of well-trained SLTs in both SSA and globally. Methodology: A qualitative literary analysis of the current state of SLT education in SSA combined with a project report on the development of the Democratically Open, Outstanding Hybrid of Internet-aided, Computer-aided, and Human-aided Education (DOOHICHE, pronounced “doo-hickey” or gadget) model of NextGenU.org. Results/Discussion: This chapter discusses the need for trained SLTs concentrating on the challenges of SSA, the eLearning history of NextGenU.org’s DOOHICHE model, the DOOHICHE model in practice, and the DOOHICHE SLT program in SSA. This model is based on workforce capacity building, focusing on training individuals independently or with university/organizational partners. The aim is to train individuals who remain in their local communities, developing a network of local and global professionals working with persons with communication disability. As a free, accessible, customizable, and sustainable online portal to higher education, this model has the potential to rapidly increase the number of trained SLTs in SSA and strengthen partnerships between universities, institutions, and local governing agencies.
Alcohol use is the 5th most important risk factor contributing to the global burden of diseases, with stigma and a lack of trained health workers as the main barriers to adequate care. This study assesses the impact of providing blended-eLearning courses teaching the alcohol, smoking, and substance involvement screening test (ASSIST) screening and its linked brief intervention (BI). In public and private facilities, two randomized control trials (RCTs) showed large and similar decreases in alcohol use in those receiving the BI compared to those receiving only the ASSIST feedback. Qualitative findings confirm a meaningful reduction in alcohol consumption; decrease in stigma and significant practice change, suggesting lay health workers and clinicians can learn effective interventions through blended-eLearning; and significantly improve alcohol use care in a low- and middle-income country (LMIC) context. In addition, our study provides insight into why lay health workers feedback led to a similar decrease in alcohol consumption compared to those who also received a BI by clinicians.
Supplementary information:
The online version contains supplementary material available at 10.1007/s11469-022-00841-x.
Quality improvement methods could assist in achieving needed health systems improvements to address mental health and substance use, especially in low-middle-income countries (LMICs). Online learning is a promising avenue to deliver quality improvement training. This Computer-based Drug and Alcohol Training Assessment in Kenya (eDATA-K) study assessed users’ experience and outcome of a blended-eLearning quality improvement course and collaborative learning sessions. A theory of change, developed with decision-makers, identified relevant indicators of success. Data, analyzed using descriptive statistics and thematic analysis, were collected through extensive field observations, the eLearning platform, focus group discussions, and key informant interviews. The results showed that 22 community health workers and clinicians in five facilities developed competencies enabling them to form quality improvement teams and sustain the new substance-use services for the 8 months of the study, resulting in 4591 people screened, of which 575 received a brief intervention. Factors promoting course completion included personal motivation, prior positive experience with NextGenU.org’s courses, and a certificate. Significant challenges included workload and network issues. The findings support the effectiveness of the blended-eLearning model to assist health workers in sustaining new services, in a supportive environment, even in a LMIC peri-urban and rural settings.
Background:
Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning.
Authors' conclusions:
PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
Introduction: A previous review on brief alcohol interventions in sub-Sahara Africa showed most of the interventions were implemented in East and Southern Africa. We carried a scoping review to assess the current amount and types of alcohol interventions in SSA.
Methods: We searched six databases (MEDLINE, EMBASE, Global Health, Africa-wide, CINAHL and PsycINFO) for publications prior to June 2018. We used the search terms for alcohol use, alcohol intervention and African countries’ names. We identified 59 papers on alcohol interventions of which 26 were eligible for inclusion in the final analysis.
Results: Of the 26 eligible papers, 18(69 %) were carried out in South Africa. Majority 15(58%) of the interventions were randomized clinical trial, followed by seven (27%) quasi-experimental and evaluation of the intervention and five (19%) cluster randomized trials. Most of the studies targeted patients and pregnant women. Only a few studies focused on sex workers and students.
Conclusions: Our findings show that the assessment of effectiveness of individual level alcohol interventions is rare in SSA. In addition, these interventions were polarized in two countries. There is an urgent need for an evidence base on the effectiveness of alcohol interventions commensurate with the scope of the problem in SSA.
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