Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice,policy and research agendas

Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio‐environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual‐focused, health system‐focused, and community level and policy‐focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.     

Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries

Background

With more than 2 million children living in group homes, or “institutions”, worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers.

Methods

A two-stage random sampling methodology identified community representative samples of 1,357 institution-dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6–12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites.

Findings

At 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11–27% of total variation) or care settings within sites (8–14%), with most variation attributable to differences between children within settings (60–75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0–4% at baseline, 0–3% at 36-month follow-up, and 0–4% for changes between baseline and 36 months.

Interpretation

These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting.     

Sero-prevalence,risk factors and distribution of sheep and goat pox in Amhara Region,Ethiopia

Background

Sheep pox and goat pox are contagious viral diseases of sheep and goats, respectively. The diseases result in substantial economic losses due to decreased milk and meat production, damage to hides and wool, and possible trade restriction. A study was undertaken in Amhara region of Ethiopia. A cross-sectional study design was used to estimate the sero-prevalence and identify associated risk factors, while retrospective study design was used to assess the temporal and spatial distribution of the disease. A total of 672 serum samples were collected from 30 Kebeles and tested using virus neutralization test.

Results

From a total of 672 sera tested, 104 (15.5%) were positive for sheep and goat pox virus antibody; from which 56 (17%) were sheep and 48 (14%) were goats. The diseases were prevalent in all study zones, the highest sero-prevalence was observed in South Gondar (20.9%) and the lowest in North Gondar and West Gojjam zones (11.9% each). From the potential risk factors considered (species, sex, age, agro-ecology and location); only sex and age were significantly associated (p?<?0.05) with the diseases in multivariable logistic regression. Female and young animals were at higher risk than their counterparts. From January 2010 to December 2014, a total of 366 outbreaks, 12,822 cases and 1480 deaths due to SP and 182 outbreaks, 10,066 cases and 997 deaths due to GP were recorded in Amhara National Regional State.

Conclusion

Both the serological and the outbreak data revealed that sheep and goat pox is one of the most prevalent and widespread diseases of sheep and goats in the study area. Hence, annual mass vaccination program must be implemented for economic and viable control of sheep and goat pox diseases in the Amhara region in particular and at a national level in general.

     

Stone walls and sacred forest conservation in Ethiopia

Many tropical forests worldwide are protected due to their sacredness to religious communities. In the south Gondar region of Ethiopia, most of the remaining native forests are tiny fragments (5.42 ha ± 0.34) surrounded by pasture and agriculture that are protected because they encompass churches of the Ethiopian Orthodox Tewahido Church (EOTC). A small number of communities have erected stone walls around the perimeter of the forests to demarcate the boundary, and/or protect the interior of the forest. We evaluated the effectiveness of these walls at protecting ecological conditions by examining tree and seedling communities among sacred forests with and without walls in Montane and Upper Montane sites. We found the wall to be an effective conservation tool as regeneration potential was higher in forests with a wall. The density and species richness of seedlings were significantly higher in forests with a wall and these effects were more pronounced in Upper Montane forests. Forests with a wall also had seedlings of many native tree species that were not found in forests without walls. As expected, there were few differences in tree communities in forests with and without a wall. Although rare on the landscape, the presence of a stone wall around these forests was effective at protecting the seedling community because it likely reduced access to the forests by grazers and directed human visitors to trails. The use of a stone wall may protect seedling communities in other sacred forest fragments, particularly for those that are small, isolated, surrounded by agriculture, and have a depleted seed bank.     

Potential impacts of water hyacinth invasion and management on water quality and human health in Lake Tana watershed,Northwest Ethiopia

Incursion of water hyacinth, Eichhornia crassipes, has been a potential threat to Lake Tana and its ecosystem services. Its expansion is currently managed by abstraction (removing by hand); nonetheless, the disposal of mats and formation of pools are remaining problematic. This study aimed to assess the potential effects of water hyacinth and its management on water quality and human health. Biotic and abiotic data were collected on open water, water hyacinth covered and water hyacinth cleared out habitats. A total of 3673 invertebrates belonging to twenty-one families were collected from 45 sites. Culicidae was the most abundant family accounting (37.2%), followed by Unionoidae (19.4%) and Sphaeriidae (8.1%). Abundance of anopheline and culicine larvae were significantly higher in water hyacinth cleared out habitats (p?<?0.05). Water conductivity and total dissolved solids were significantly higher in habitats covered with water hyacinth (p?<?0.05). In conclusion, water hyacinth infestation had a negative impact on water quality and biotic communities. The physical abstraction of water hyacinth provided a very good habitat for the proliferation of mosquito larvae. Therefore, integrating water hyacinth management practices along with mosquito larvae control strategy could help to abate the potential risk of malaria outbreak in the region. In addition, developing watershed scale nutrient management systems could have a vital contribution for managing water hyacinth invasion in the study area.     

Postdispersal seed predation and seed viability in forest soils: implications for the regeneration of tree species in Ethiopian church forests

Almost all dry Afromontane forests of Northern Ethiopia have been converted to agricultural, grazing or scrub lands except for small fragments left around churches (‘Church forests’). Species regeneration in these forests is limited. We investigated (i) how intense postdispersal seed predation was in church forest, and if this seed predation varied with species and/or habitat, and (ii) for how long tree seeds maintained their viability while buried in forest soil. In the seed predation experiment, we monitored seeds of six tree species in four habitats for a period of 14 weeks (the peak seeding season). In the seed viability experiment, we assessed seed viability of five species in four habitats after being buried 6, 12, or 18 months. Ninety‐two percent of the tree seeds were predated within 3.5 months. Predation was mainly dependent on species whereas habitat had a weaker effect. Seed viability decreased sharply with burial time in soil for all species except for Juniperus. To minimize seed availability limitation for regeneration of such species in the forest, the standing vegetation needs to be persistently managed and conserved for a continuous seed rain supply. Additional seed sowing, and seed and seedling protection (by e.g. animal exclosures) may increase successful regeneration of important species in these forests.     

Soil seed banks in church forests of northern Ethiopia: Implications for the conservation of woody plants

Church forests are sanctuaries for different organisms, ranging from microbes to large animals, which have almost disappeared in most parts of northern Ethiopia. Despite the actual and potential significance of these forests, studies and documented information on their bio-physical features and socio-economic setting are either scanty or totally lacking. A study was, therefore, carried out in seven of these church forests, namely Hiruy, Zahara, Gibtsawit, Gelawdiwos, Dengolt, Debresena and Ascha with the objective of assessing the composition, densities and spatial heterogeneity of soil seed banks. The number of viable seeds in the soil samples, from both germination and sieving, corresponded to a seed bank density down to 9 cm in the soil of 7594 seeds m⁻² at Ascha, 2064 seeds m⁻² at Debresena, 4208 seeds m⁻² at Dengolt, 3158 seeds m⁻² at Gelawdiwos, 2754 seeds m⁻² at Gibtsawit, 2759 seeds m⁻² at Hiruy, and 1909 seeds m⁻² at Zahra. The total number of species recorded was 50, representing at least 22 plant families, in the seven church forests, of which 13 were recorded from Ascha, 29 from Debresena, 26 from Dengolt, 19 from Gibtsawit, 22 from Gelawdiwos, 20 from Hiruy and 21 from Zahra. There was a significant difference in seed densities and number of species recovered from the soil seed banks of the seven church forests. Ascha had a significantly higher seed bank density than all other church forests. Dengolt exhibited a significantly higher number of species compared with other church forests. Of the identified species recorded from the seven church forests, 83% were herbs, 11% trees and 6% shrubs. Our results revealed that church forests accumulate large quantities of persistent seeds of herbaceous species in the soil while only five (6%) of the 91 woody species recorded in the standing vegetation of the seven church forests were represented in the soil seed banks. The fact that most of the dominant tree species do not accumulate seeds in the soil suggests that their regeneration from seeds would be prevented by removal of mature individuals in the standing vegetation. The results also provided further evidences that consolidate the conclusions of previous studies, i.e. the future existence of the woody flora characteristic of dry Afromontane areas in Ethiopia depends on the conservation and sustainable utilization of the few remnant natural forests.