• Closing the gap: decentralising mental health care to primary care centres in one rural district of Rwanda

      Nyirandagijimana, B; Edwards, JK; Venables, E; Ali, E; Rusangwa, C; Mukasakindi, H; Borg, R; Fabien, M; Tharcisse, M; Nshimyiryo, A; et al. (International Union Against Tuberculosis and Lung Disease, 2017-09-21)
      Setting: Programmes that integrate mental health care into primary care settings could reduce the global burden of mental disorders by increasing treatment availability in resource-limited settings, including Rwanda. Objective: We describe patient demographics, service use and retention of patients in care at health centres (HC) participating in an innovative primary care integration programme, compared to patients using existing district hospital-based specialised out-patient care. Design: This was a retrospective cohort study using routinely collected data from six health centres and one district hospital from October 2014 to March 2015. Results: Of 709 patients, 607 were cared for at HCs; HCs accounted for 88% of the total visits for mental disorders. Patients with psychosis used HC services more frequently, while patients with affective disorders were seen more frequently at the district hospital. Of the 68% of patients who returned to care within 90 days of their first visit, 76% had a third visit within a further 90 days. There were no significant differences in follow-up rates between clinical settings. Conclusion: This study suggests that a programme of mentorship for primary care nurses can facilitate the decentralisation of out-patient mental health care from specialised district hospital mental health services to HCs in rural Rwanda.
    • Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014.

      Hassanain, SA; Edwards, JK; Venables, E; Ali, E; Adam, K; Hussien, H; Elsony, A (BioMed Central, 2018-05-16)
      Sudan is a fragile developing country, with a low expenditure on health. It has been subjected to ongoing conflicts ever since 1956, with the Darfur crisis peaking in 2004. The conflict, in combination with the weak infrastructure, can lead to poor access to healthcare. Hence, this can cause an increased risk of infection, greater morbidity and mortality from tuberculosis (TB), especially amongst the poor, displaced and refugee populations. This study will be the first to describe TB case notifications, characteristics and outcomes over a ten-year period in Darfur in comparison with the non-conflict Eastern zones within Sudan.
    • Twenty years of home-based palliative care in Malappuram, Kerala, India: a descriptive study of patients and their care-givers

      Philip, RR; Philip, S; Tripathy, JP; Manima, A; Venables, E (BioMed Central, 2018-02-14)
      The well lauded community-based palliative care programme of Kerala, India provides medical and social support, through home-based care, for patients with terminal illness and diseases requiring long-term support. There is, however, limited information on patient characteristics, caregivers and programme performance. This study was carried out to describe: i) the patients enrolled in the programme from 1996 to 2016 and their diagnosis, and ii) the care-giver characteristics and palliative care support from nurses and doctors in a cohort of patients registered during 2013-2015.