Alan J Flisher's research while affiliated with Stellenbosch University and other places

Publications (303)

Conference Paper
Intimate partner violence (IPV) during pregnancy is prevalent across the world, but more so in low- and middle-income countries. It is associated with adverse outcomes for mothers and infants. This study sought to determine the prevalence and predictors of IPV among pregnant women attending one midwife and obstetrics unit (MOU) in the Western Cape,...
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In contemporary South African academia, “community engagement” is a valued commodity. My work as a nondisabled white man with disability activists and as editor of the African Journal of Disability is viewed as good for my career, and as an appropriate form of engagement and empowerment. In this article, I engage critically with the question of the...
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& link to free access e-print: http://www.tandfonline.com/eprint/UMdi8jaYAWm2Y3CPe3I3/full This study aimed to investigate contextual influences on condom use by South African university students. Twenty one-to-one, semi-structured interviews were conducted with male and female South African undergraduates. The data were thematically analysed. Res...
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Evidence suggests that comorbid psychopathology can negatively affect treatment outcomes in substance users. In South Africa, limited information exists regarding the prevalence, nature and role of psychiatric comorbidity in substance users. This study examined psychiatric comorbidity and its association with specific substance use, and young adult...
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Although substance use is commonly associated with mental disorders, limited data on this association are available from low and middle income countries such as South Africa. The aims of the study were i) to determine patterns of substance use in young adults, ii) to identify trends of common psychiatric disorders in relation to use of specific sub...
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Introduction: Although substance use is commonly associated with mental disorders, limited data on this association are available from low and middle income countries such as South Africa. The aims of the study were i) to determine patterns of substance use in young adults, ii) to identify trends of common psychiatric disorders in relation to use o...
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Introduction: Evidence suggests that comorbid psychopathology can negatively affect treatment outcomes in substance users. In South Africa, limited information exists regarding the prevalence, nature and role of psychiatric comorbidity in substance users. This study examined psychiatric comorbidity and its association with specific substance use, a...
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The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting.
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The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting. The need for treatment guidelines has frequently been expressed by South African psychiatrists and other medical practitioners, as well as by other ro...
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Attention deficit hyperactivity disorder (ADHD), although commonest in childhood and adolescence, can be diagnosed across the age span.
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Although many studies indicate that traditional healers are willing to collaborate with Western practitioners in South Africa, none focus specifically on mental health care, and none use a theory of health behaviour to explain their findings. The present study applies the Theory of Planned Behaviour (TPB) to predict traditional healer referral prac...
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Comorbid psychopathology in substance users is thought to be associated with poor substance use treatment outcomes. This study followed up with 95 substance users after inpatient treatment for substance use. Males and patients who were single were more likely to complete treatment. Females were more likely than males to relapse or not complete trea...
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To evaluate the effects of a high school peer educator training programme on the sexual behaviour and related psychosocial outcomes of peer educators. A total of 728 students from 15 randomly selected public high schools in the Western Cape, South Africa, with a peer education programme and 15 matched comparison schools were recruited, comprising 2...
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This study was carried out among university undergraduates in Cape Town, South Africa. Structural equation models were tested with Mplus to predict intentions to use condoms and actual (subsequent) condom use. Theory of planned behavior (TPB) predictors (attitudes, subjective norms, perceived behavioral control) explained 43% of the variance of int...
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Purpose Little is known regarding the links between mental disorder and lost income in low- and middle-income countries. The purpose of this study was to investigate the association between mental disorder and lost income in the first nationally representative psychiatric epidemiology survey in South Africa. Methods A probability sample of South A...
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Purpose The purpose of this paper is to provide detailed assessments of the mental health laws of Ghana, South Africa, Uganda and Zambia. Design/methodology/approach The mental health laws of four countries were assessed both by country partners and staff of WHO, Geneva, using the World Health Organization (WHO) Checklist on Mental Health Legislat...
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The AIDS pandemic has resulted in a dramatic rise in the number of orphans in South Africa. This study was designed to investigate the associations between family, peer, and community factors and resilience in orphaned adolescents. Self-report questionnaires were administered verbally to 159 parentally bereaved adolescents (aged 10-19) in an econom...
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Research has shown a positive relationship between substance use and delinquent-type behaviours among adolescents. The aim of this study is to explore the temporal relationships between these outcomes through secondary data analysis of a longitudinal study of high-school students' risk behaviours. Two regression models were compared and gender, soc...
Data
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This study was carried out among university undergraduates in Cape Town, South Africa. Structural equation models were tested with Mplus to predict intentions to use condoms and actual (subsequent) condom use. Theory of planned behavior (TPB) predictors (attitudes, subjective norms, perceived behavioral control) explained 43% of the variance of int...
Conference Paper
This study explored culture and context-relevant factors shaping condom use in South African university students. Twenty one-to-one, semi-structured interviews were conducted (15 female, five male, aged between 18 and 25, representing six racial/cultural backgrounds). Data were coded using NVivo and thematically analysed, following guidelines of Br...
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Mental health problems in childhood and adolescence pose a major threat to public health. Epidemiological studies in high, middle and low income countries indicate that approximately one in five children and adolescents suffer from a mental disorder. In many instances these persist into adulthood. In South Africa, HIV infection, substance use, and...
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Intimate or dating relationships play an important role in young people's psychosocial development and well-being. Yet, we know relatively little about how teenagers conceptualise and experience them. Research knowledge about young people's intimate relationships is largely gleaned from studies whose primary focus has been on adolescent sexuality a...
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Objective: To examine psychosocial correlates of lifetime alcohol use among adolescents in rural South African high schools. Method: Questionnaires were administered to 1600 students from 20 randomly selected high schools in the Mankweng district within Limpopo province. Self-report data on alcohol use, demographic, environmental and psychosocia...
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Amongst the psychological theories that have been used to help understand why people have unprotected sex, the Theory of Planned Behaviour (TPB: Ajzen 1991) has earned a prominent position. This article is a critical review of 11 peer-reviewed studies conducted in sub-Saharan Africa during 2001 to 2009, which used the TPB as a model of predicting s...
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In this study, the effects on young adolescent sexual risk behaviour of teacher-led school HIV prevention programmes were examined in two sites in South Africa (Cape Town and Mankweng) and one site in Tanzania (Dar es Salaam). In Cape Town, Dar es Salaam and Mankweng, 26, 24 and 30 schools, respectively, were randomly allocated to intervention or c...
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Objective: To investigate whether methamphetamine use is associated with sexual risk behavior among adolescents. Method: A cross-sectional survey of 1,561 male and female high school students in Cape Town (mean age 14.9 years) was conducted using items from the Problem Oriented Screening Instrument for Teenagers (POSIT) HIV Risk Scale. Results: Nin...
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Tobacco use has been found to be related to contextual-environmental characteristics. This study focuses on the influence of contextual norms on adolescent smoking behavior with consideration of racial differences. Data for this study were derived from the South African Community Epidemiology Network on Drug Use survey. Students (n = 1,277) complet...
Chapter
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In this Chapter, we provide a comprehensive presentation of what is known about bullying in schools. We begin with highlighting the epidemiology and nature of bullying, and we proceed with the research findings of hypothesised antecedents and consequences of bullying. Then, we present the anti-bullying intervention programmes, along with a commenta...
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The Camberwell Assessment of Need (CAN) is a widely used instrument to assess the service needs for people with a severe mental illness. No reliability data are available for its use in South Africa. Interrater and test-retest reliability were documented for a sub-sample of 194 patients participating in a needs assessment study among people receivi...
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This study aimed to assess the reliability of a number of self report questionnaires for epidemiological investigations of adolescents' mental health in Cape Town, South Africa. The scales used were: the Short Mood and Feelings Questionnaire (SMFQ), Zung Self-rating Anxiety Scale (SAS), Self-esteem Questionnaire (SEQ), Harvard Trauma Questionnaire...
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The Leadership Project (LP) in Cape Town, South Africa, is a wilderness-based leadership development programme that targets young people from diverse backgrounds. The aim of this study was to evaluate the LP, focusing on process and perceived outcomes. Document analysis and key informant interviews were used to evaluate programme reach and implemen...
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Community studies and studies of admissions to drug treatment centers indicate a dramatic increase in the prevalence of methamphetamine use in Cape Town since 2003. There has also been a substantial increase over this time period in the prevalence of HIV infection among women attending public antenatal clinics in the Western Cape province. This stu...
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International studies have documented the association between poverty, low education levels and poor mental health, including suicide attempts. Many farm worker communities in the Western Cape, South Africa, are exposed to poor living and working conditions throughout their lives. They also tend to suffer from chronic illness such as tuberculosis a...
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Peer education is popular both with governments and with young people. The purpose of this quasi-experimental study was to evaluate the effectiveness of a government-led peer education program on the self-reported sexual health behavior and related psychosocial outcomes of adolescent students in public high schools in the Western Cape of South Afri...
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HIV-Associated Neurocognitive Disorders (HAND) exert an impact on everyday functions, including adherence. The prevalence of and risk factors for HAND in patients commencing anti-retroviral therapy in Southern Africa are unknown. Participants from primary care clinics in Cape Town, South Africa underwent detailed neuropsychological, neuropsychiatri...
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Few studies examine smoking in rural areas of countries in Africa. This study examines the roles of families, community influences, and key sociodemographic factors and school-age smoking among adolescent boys in rural South Africa. A total of 1,116 black male students were included in this analysis. Descriptive analyses were conducted, and multipl...
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Although adolescents are at high risk for human immunodeficiency virus (HIV) infection, they have not been, included in HIV vaccine trials. In preparation for enrollment in HIV vaccine trials, 100 HIV-negative adolescents aged 14-17 years from Cape Town were recruited into a cohort. HIV, syphilis, pregnancy testing, and sexual risk questionnaires w...
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The present study examines the impact of the HealthWise South Africa prevention intervention on condom use self-efficacy. Students from the Cape Town area were assessed at the beginning and end of each school year, beginning in the 8th grade and ending in the 11th. The intervention was delivered in 12 lessons during the 8th grade and 6 lessons duri...
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In recent years South Africa has taken some important steps forward in strengthening its mental health systems. Mental health legislation has been reformed and there is some level of policy commitment to mental health. However, there remain ongoing challenges, largely related to implementation. The aim of this paper is to review the major challenge...
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This paper has the following aims: (i) to explore the extent to which students who received an intervention involving HIV/AIDS and sexuality perceived that their teacher cared for their health and well-being, (ii) to investigate the characteristics of students who reported to have caring teachers and (iii) to document the association between studen...
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Little is known about the treated prevalence and services received by children and adolescents in low- and middle-income countries (LAMICs). The purpose of this study is to describe the characteristics and capacity of mental health services for children and adolescents in 42 LAMICs. The World Health Organization Assessment Instrument for Mental Hea...
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This study was designed to evaluate the efficacy of the HealthWise South Africa HIV and substance abuse prevention program at impacting adolescents’ polydrug use and sexual risk behaviors. HealthWise is a school-based intervention designed to promote social-emotional skills, increase knowledge and refusal skills relevant to substance use and sexual...
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Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. The WHO Mental Health Policy Checklist was used to...
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A 14-item human immunodeficiency virus/acquired immunodeficiency syndrome knowledge scale was used among school students in 80 schools in 3 sites in Sub-Saharan Africa (Cape Town and Mankweng, South Africa, and Dar es Salaam, Tanzania). For each item, an incorrect or don't know response was coded as 0 and correct response as 1. Exploratory factor a...
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In this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation...
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Mental health facilities in Uganda remain underutilized, despite efforts to decentralize the services. One of the possible explanations for this is the help-seeking behaviours of people with mental health problems. Unfortunately little is known about the factors that influence the help-seeking behaviours. Delays in seeking proper treatment are know...
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In this paper we explore the perceived desirable characteristics of South African Life Orientation teachers for teaching sexuality and HIV/AIDS. We also investigate the extent to which these characteristics can be understood as parts of a role script for teaching HIV/AIDS and sexuality. Data were collected from teachers who taught Grade Eight and G...
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BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypot...
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Regular HIV bio-behavioural surveillance surveys (BBSS) among high risk heterosexual (HRH) men who have multiple female sexual partners is needed to monitor HIV prevalence and risk behaviour trends, and to improve the provision and assessment of HIV prevention strategies for this population. In 2006 and 2008 we used respondent-driven sampling to re...
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The Diagnostic Interview Schedule for Children (DISC-IV) is a widely used structured psychiatric diagnostic instrument for children that is designed to be administered by non-clinicians. Although reliability data on several versions of the DISC are available, none have assessed the Xhosa version for use in the South African context. The objective o...
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Integrating mental health into primary health care is widely promoted for a host of reasons, chief among which is providing a more comprehensive health care service. However, only a few countries have adequate mental health resources to undertake the integration of mental health into primary health care in a uniform manner, with wide variations amo...
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Intersectoral action is increasingly recognized as necessary to address the social determinants of mental health. This study aims to assess South Africa's progress in intersectoral collaboration for mental health, and provide recommendations for intersectoral collaboration, to generate lessons for other low- and middle-income countries. We conducte...
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There has been increased global concern about the human rights violations experienced by people with mental disorders. The aim of this study was to analyse Uganda's mental health care system through a human rights lens. A survey of the existing mental health system in Uganda was conducted using the WHO Assessment Instrument for Mental Health System...
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Limited information exists regarding the association between psychopathology and specific substance use in young people both globally and locally. We examined the association between psychopathology and substance use in high school students to determine the nature of the associations and the role of demographic factors in these associations. Grade...
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Despite the high rates of depression and anxiety disorders amongst women, the mental health of women is a neglected area, particularly in Africa. This study sought to explore what key stakeholders perceive as the main causes of mental illness in women in Ghana. Using qualitative methods, 81 semi-structured interviews and seven focus group discussio...
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Mental health is a crucial public health and development issue in sub-Saharan Africa (SSA), a region where little progress has been made towards achieving the Millennium Development Goals (MDGs). In this paper we argue that not only will limited progress in achieving these targets have a significant impact on mental health, but it will be impossibl...
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The occurrence of high rates of alcohol consumption in a context of high HIV prevalence in South Africa poses a significant health challenge for this country. This paper aims to answer three questions that could further our knowledge regarding the links between alcohol use and HIV infection: (a) "Are problem drinkers more likely to have multiple co...
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This paper describes current support for mental health care user participation in policy development and implementation in South Africa and suggests strategies for improving participation. The World Health Organization (WHO) Mental Health Policy Checklist and WHO Mental Health Legislation Checklist were completed. Between August 2006 and August 200...
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The treatment gap for people with mental disorders exceeds 50% in all countries of the world, approaching astonishingly high rates of 90% in the least resourced countries. We report the findings of the first systematic survey of leaders of psychiatry in nearly 60 countries on the strategies for reducing the treatment gap. We sought to elicit the vi...
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This prospective study investigated the association between life-long methamphetamine and other drug use and high school non-attendance, in a sample of high school students in Cape Town, South Africa. A random sample of 1535 high school students completed a baseline questionnaire in 2006, and were asked to complete a follow-up questionnaire 12 mont...
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The treatment gap for people with mental disorders exceeds 50% in all countries of the world, approaching astonishingly high rates of 90% in the least resourced countries. We report the findings of the first systematic survey of leaders of psychiatry in nearly 60 countries on the strategies for reducing the treatment gap. We sought to elicit the vi...
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To investigate the prevalence and correlates of missed opportunities for addressing reproductive and mental health needs during patients' visits to primary healthcare facilities. We selected a random sample of participants from 14 of the 49 clinics in Cape Town's public health sector using stratified, cluster random sampling (n = 2618). Participant...
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This study identified leisure constraints, constraints negotiation strategies, and their relative frequencies among 114 high school students from one under-resourced area of South Africa. Through focus group discussions, participants identified intrapersonal, interpersonal, structural, and sociocultural constraints to leisure, suggesting some degre...
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The majority of the black African population in South Africa utilize both traditional and public sector Western systems of healing for mental health care. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems. The aim of this study was to explore perceptions of service users and prov...
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Objective: In many traditional belief systems in Africa, including South Africa, mental health problems may be attributed to the influence of ancestors or to bewitchment. Traditional healers are viewed as having the expertise to address these causes. However, there is limited information on their explanatory models and consequent treatment practic...
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Drawing on data collected from 3 focus groups with 24 traditional healers, the aim of this qualitative study was to use the constructs of the Theory of Planned Behaviour (TPB) to gain an understanding of traditional healer referral practices of their patients with a mental illness. Results indicated that traditional healers possess a concept of men...
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Background Mental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes f...
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The purpose of this study is to describe the demographic and clinical profile, mortality rates, and effectiveness of a multifaceted treatment approach in hospitalized children and adolescents with delirium referred to psychiatry. We report a series of 23 children and adolescents prospectively diagnosed with Diagnostic and Statistical Manual of Ment...
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In spite of high levels of poverty in low and middle income countries (LMIC), and the high burden posed by common mental disorders (CMD), it is only in the last two decades that research has emerged that empirically addresses the relationship between poverty and CMD in these countries. We conducted a systematic review of the epidemiological literat...
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Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provi...
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Little is known about the association between methamphetamine use and sexual risk behaviors among young South African women between 13 and 20 years of age. To examine the association between methamphetamine use and condom use among out-of-school South African female adolescents. Black and Coloured female adolescents were interviewed and categorized...
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Objective: This paper identifies the key barriers to mental health policy implementation in Ghana and suggests ways of overcoming them. Method: The study used both quantitative and qualitative methods. Quantitatively, the WHO Mental Health Policy and Plan Checklist and the WHO Mental Health Legislation Checklist were employed to analyse the cont...
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Objective: The aim of this qualitative study was to explore the presence, causes and means of addressing individual and systemic stigma and discrimination against people with mental illness in Zambia. This is to facilitate the development of tailor-made antistigma initiatives that are culturally sensitive for Zambia and other low-income African co...
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Methamphetamine use has become a growing problem in a number of countries over the past two decades, but has only recently emerged in South Africa. This study investigated the prevalence of methamphetamine use among high-school students in Cape Town and whether students reporting methamphetamine use were more likely to be at risk for mental health...
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Objective: Approximately one in five children and adolescents (CA) suffer from mental disorders. This paper reports on the findings of a situational analysis of CA mental health policy and services in Ghana, Uganda, South Africa and Zambia. The findings are part of a 5 year study, the Mental Health and Poverty Project, which aims to provide new kn...
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Objective: Stigma plays a major role in the persistent suffering, disability and economic loss associated with mental illnesses. There is an urgent need to find effective strategies to increase awareness about mental illnesses and reduce stigma and discrimination. This study surveys the existing anti-stigma programmes in South Africa. Method: Th...