Detection and treatment initiation for depression and alcohol use disorders: facility-based cross-sectional studies in five low-income and middle-income country districts. Issue 10 (10th October 2018)

• Record Type: Journal Article
• Authors: Rathod, Sujit D; Roberts, Tessa; Medhin, Girmay; Murhar, Vaibhav; Samudre, Sandesh; Luitel, Nagendra P; Selohilwe, One; Ssebunnya, Joshua; Jordans, Mark J D; Bhana, Arvin; Petersen, Inge; Kigozi, Fred; Nakku, Juliet; Lund, Crick; Fekadu, Abebaw; Shidhaye, Rahul
• Is Part Of: BMJ open. Volume 8:Issue 10(2018)
• Publication Date: 2018-10-10
• Subjects: primary care -- alcohol use disorder -- clinical detection -- low- and middle-income countries; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-023421
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To estimate the proportion of adult primary care outpatients who are clinically detected and initiate treatment for depression and alcohol use disorder (AUD) in low-income and middle-income country (LMIC) settings. Design: Five cross-sectional studies. Setting: Adult outpatient services in 36 primary healthcare facilities in Sodo District, Ethiopia (9 facilities); Sehore District, India (3); Chitwan District, Nepal (8); Dr Kenneth Kaunda District, South Africa (3); and Kamuli District, Uganda (13). Participants: Between 760 and 1893 adults were screened in each district. Across five districts, between 4.2% and 20.1% screened positive for depression and between 1.2% and 16.4% screened positive for AUD. 96% of screen-positive participants provided details about their clinical consultations that day. Primary outcomes: Detection of depression, treatment initiation for depression, detection of AUD and treatment initiation for AUD. Results: Among depression screen-positive participants, clinical detection of depression ranged from 0% in India to 11.7% in Nepal. Small proportions of screen-positive participants received treatment (0% in Ethiopia, India and South Africa to 4.2% in Uganda). Among AUD screen-positive participants, clinical detection of AUD ranged from 0% in Ethiopia and India to 7.8% in Nepal. Treatment was 0% in all countries aside Nepal, where it was 2.2%. Conclusions: The findings of this study suggest large detection and treatment gaps for adult primary care patients, which are likely contributors to the population-level mental health treatment gap in LMIC. Primary care facilities remain unfulfilled intervention points for reducing the population-level burden of disease in LMIC.