Detection and treatment initiation for depression and alcohol use disorders: facility-based cross-sectional studies in five low-income and middle-income country districts

Sujit D Rathod, Tessa Roberts, Girmay Medhin, Vaibhav Murhar, Sandesh Samudre, Nagendra P Luitel, One Selohilwe, Joshua Ssebunnya, Mark J D Jordans, Arvin Bhana, Inge Petersen, Fred Kigozi, Juliet Nakku, Crick Lund, Abebaw Fekadu, Rahul Shidhaye

BMJ Open

Published on: 10 October 2018

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.

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