Traumatic stress due to conflict and war causes major mental health problems in many resource-poor countries. The objective of this study was to examine whether trained lay counselors can carry out effective treatment of posttraumatic stress disorder (PTSD) in a refugee settlement. In a randomized controlled dissemination trial in Uganda with 277 Rwandan and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors.
The prevalence of anxiety/depression is quite high during the perinatal period but unfortunately its detection and treatment have been less than satisfactory. Many women are reluctant to take pharmacotherapy for fear of excretion of drugs into their breast milk. This study assesses the effectiveness of counseling from minimally trained community health workers in reducing anxiety/depression, the rate of recurrence and the interval preceding recurrence in women during first two and a half years after childbirth.
It has been suggested that lay community health workers (LHWs) could play a role in primary and secondary prevention of Mental, Neurological and Substance use (MNS) disorders in low resourced settings. The paper conducts a systematic literature review aimed to assess the existing evidence base for the roles and effectiveness of lay community health workers in primary and secondary prevention of mental, neurological and substance us disorders in low and middle income countries.
The REACH NOLA Mental Health Infrastructure and Training Project (MHIT) aimed to reduce disparities in access to and quality of services for depression and posttraumatic stress disorder (PTSD) in post-Katrina New Orleans by developing a mental health outreach role for community health workers (CHWs) and case managers as a complement to the collaborative care model for depression treatment.This intervention development approach and model may be used to address post-disaster mental health disparities and as a complement to traditional implementation of collaborative care.
Depressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare. This article discusses the effectiveness of an intervention led by lay health counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders. Results showed that trained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.
In Senegal, an HMM pilot study in 2008 demonstrated the feasibility of integrated use of RDTs and ACT in remote villages by volunteer Home Care Providers (HCP). This paper reports the results of the scale-up in the targeted communities and the impact of the strategy on malaria in the formal health sector. Results show home-based management of malaria including diagnosis with RDT and treatment based on test results is a promising strategy to improve the access of remote populations to prompt and effective management of uncomplicated malaria and to decrease mortality due to malaria.
Ethiopia has been deploying specially trained cadres:health extension workers (HEWs) and this study investigates their role in improving utilization of maternal health services. Although HEWs have contributed to utilization of maternal health services, improved health facility delivery and skilled birth attendance remains an important problem. More effort is needed to improve the effectiveness of HEWs in these regards.
The objective of this study was to determine if, with appropriate training, volunteers known as community-based reproductive health agents can administer injectable contraceptives to women in a rural region of Ethiopia with the same effectiveness, safety and acceptability as health extension workers. The demand for injectable contraceptives in Ethiopia has been amply documented and both the results of this study and the technical review of the evidence highlight the need for plans to introduce, sustain, and scale up the administration of DMPA by CBRHAs in Ethiopia.
Community-based maternal and newborn care programs with postnatal home visits from providers who deliver preventive or curative services that save lives have been tested in Bangladesh, Malawi, and Nepal. This paper examines coverage and content of home visits in pilot areas and factors associated with receipt of postnatal visits. Findings show home visits during pregnancy and within three days after birth is achievable using existing community health systems if workers are available; linked to communities; and receive training, supplies, and supervision.