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Alem, Atalay
Publications (10 of 42) Show all publications
Teferra, S., Shibre, T., Fekadu, A., Medhin, G., Waqwoya, A., Alem, A., . . . Jacobsson, L. (2011). Five-year mortality in a cohort of people with schizophrenia in Ethiopia. BMC Psychiatry, 11(1), Article ID 165.
Open this publication in new window or tab >>Five-year mortality in a cohort of people with schizophrenia in Ethiopia
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2011 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 11, no 1, article id 165Article in journal (Refereed) Published
Abstract [en]

Background: Schizophrenia is associated with a two to three fold excess mortality. Both natural and unnatural causes were reported. However, there is dearth of evidence from low and middle income (LAMIC) countries, particularly in Africa. To our knowledge this is the first community based report from Africa. 

Methods: We followed a cohort of 307 (82.1% males) patients with schizophrenia for five years in Butajira, rural Ethiopia. Mortality was recorded using broad rating schedule as well as verbal autopsy. Standardized Mortality Ratio (SMR) was calculated using the mortality in the demographic and surveillance site as a reference.

Result: Thirty eight (12.4%) patients, 34 men (11.1%) and 4 women (1.3%), died during the five-year follow up period. The mean age (SD) of the deceased for both sexes was 35 (7.35). The difference was not statistically significant (p = 0.69). It was 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to7.87). Rural residents had lower mortality with adjusted hazard ratio (HR) of 0.30 (95% CI = 0.12-0.69) but insidious onset and antipsychotic treatment for less than 50% of the follow up period were associated with higher mortality, adjusted HR 2.37 (95% CI = 1.04-5. 41) and 2.66(1.054-6.72) respectively.

Conclusion: The alarmingly high mortality observed in this patient population is of major concern. Most patients died from potentially treatable conditions. Improving medical and psychiatric care as well as provision of basic needs is recommended.

Place, publisher, year, edition, pages
London: BioMed Central, 2011
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-48525 (URN)10.1186/1471-244X-11-165 (DOI)21985179 (PubMedID)
Available from: 2011-10-20 Created: 2011-10-20 Last updated: 2018-06-08Bibliographically approved
Teferra, S., Hanlon, C., Alem, A., Jacobsson, L. & Shibre, T. (2011). Khat-chewing in persons with severe mental illness in Ethiopia: A qualitative study exploring perspectives of patients and caregivers. Transcultural Psychiatry, 28(4), 455-472
Open this publication in new window or tab >>Khat-chewing in persons with severe mental illness in Ethiopia: A qualitative study exploring perspectives of patients and caregivers
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2011 (English)In: Transcultural Psychiatry, ISSN 1363-4615, E-ISSN 1461-7471, Vol. 28, no 4, p. 455-472Article in journal (Refereed) Published
Abstract [en]

People with severe mental illness (SMI) in Ethiopia chew khat despite advice from their physicians to desist. We wanted to better understand their reasons for khat chewing, including any benefits that they might gain. A qualitative study was conducted involving patients with SMI and their caregivers in Butajira. Reasons given by patients as well as caregivers were more or less congruent: social pressure, a means for survival by improving function, combating medication side effects, to experience pleasure and curbing appetite. These findings will be of value to health workers, caregivers and policymakers alike in improving care and understanding for this patient group. Furthermore, our study indicates a role for future research to explore potentially beneficial effects of khat in this population.

Place, publisher, year, edition, pages
London: Sage Publications on behalf of McGill University, 2011
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-43825 (URN)10.1177/1363461511408494 (DOI)
Available from: 2011-05-11 Created: 2011-05-11 Last updated: 2018-06-08Bibliographically approved
Ross, J., Hanlon, C., Medhin, G., Alem, A., Tesfaye, F., Worku, B., . . . Prince, M. (2011). Perinatal mental distress and infant morbidity in Ethiopia: a cohort study. Archives of Disease in Childhood: Fetal and Neonatal Edition, 96(1), F59-F64
Open this publication in new window or tab >>Perinatal mental distress and infant morbidity in Ethiopia: a cohort study
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2011 (English)In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 96, no 1, p. F59-F64Article in journal (Refereed) Published
Abstract [en]

Persistent perinatal CMD was associated with infant diarrhoea in this low-income country setting. The observed relationship was independent of maternal health-promoting practices. Future research should further explore the mechanisms underlying the observed association to inform intervention strategies.

Keywords
african periurban settlement; low-birth-weight; maternal depression; postnatal-depression; postpartum depression; developing-countries; risk-factors; young-children; health-care; diarrhea
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-41130 (URN)10.1136/adc.2010.183327 (DOI)20667895 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2018-06-08Bibliographically approved
Amberbir, A., Medhin, G., Alem, A., Britton, J., Davey, G. & Venn, A. (2011). The role of acetaminophen and geohelminth infection on the incidence of wheeze and eczema: a longitudinal birth-cohort study. American Journal of Respiratory and Critical Care Medicine, 183(2), 165-170
Open this publication in new window or tab >>The role of acetaminophen and geohelminth infection on the incidence of wheeze and eczema: a longitudinal birth-cohort study
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2011 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 183, no 2, p. 165-170Article in journal (Refereed) Published
Abstract [en]

These findings suggest frequent acetaminophen use early in life increases the risk of new-onset wheeze, whereas the role of geohelminth infection on allergic disease incidence remains to be seen as the cohort matures.

Keywords
acetaminophen, parasite, asthma, wheeze, eczema
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-41127 (URN)10.1164/rccm.201006-0989OC (DOI)20935107 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2018-06-08Bibliographically approved
Hanlon, C., Whitley, R., Wondimagegn, D., Alem, A. & Prince, M. (2010). Between life and death: exploring the sociocultural context of antenatal mental distress in rural Ethiopia. Archives of Women's Mental Health, 13(5), 385-393
Open this publication in new window or tab >>Between life and death: exploring the sociocultural context of antenatal mental distress in rural Ethiopia
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2010 (English)In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 13, no 5, p. 385-393Article in journal (Refereed) Published
Abstract [en]

The high prevalence of antenatal common mental disorders in sub-Saharan Africa compared to high-income countries is poorly understood. This qualitative study explored the sociocultural context of antenatal mental distress in a rural Ethiopian community. Five focus group discussions and 25 in-depth interviews were conducted with purposively sampled community stakeholders. Inductive analysis was used to develop final themes. Worry about forthcoming delivery and fears for the woman's survival were prominent concerns of all participants, but only rarely perceived to be pathological in intensity. Sociocultural practices such as continuing physical labour, dietary restriction, prayer and rituals to protect against supernatural attack were geared towards safe delivery and managing vulnerability. Despite strong cultural norms to celebrate pregnancy, participants emphasised that many pregnancies were unwanted and an additional burden on top of pre-existing economic and marital difficulties. Short birth interval and pregnancy out of wedlock were both seen as shameful and potent sources of mental distress. The notion that pregnancy in traditional societies is uniformly a time of joy and happiness is misplaced. Although antenatal mental distress may be self-limiting for many women, in those with enduring life difficulties, including poverty and abusive relationships, poor maternal mental health may persist.

Keywords
Mental health, Ethiopia, Sub-Saharan Africa, Pregnancy, Qualitative
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-41133 (URN)10.1007/s00737-010-0149-3 (DOI)20148274 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2018-06-08Bibliographically approved
Alem, A., Pain, C., Araya, M. & Hodges, B. D. (2010). Co-creating a psychiatric resident program with Ethiopians, for Ethiopians, in Ethiopia: the Toronto Addis Ababa Psychiatry Project (TAAPP). Academic Psychiatry, 34(6), 424-432
Open this publication in new window or tab >>Co-creating a psychiatric resident program with Ethiopians, for Ethiopians, in Ethiopia: the Toronto Addis Ababa Psychiatry Project (TAAPP)
2010 (English)In: Academic Psychiatry, ISSN 1042-9670, E-ISSN 1545-7230, Vol. 34, no 6, p. 424-432Article in journal (Refereed) Published
Abstract [en]

An important issue that underscores such a partnership is the risk of simply exporting Western, America-centric psychiatric training versus creating culturally appropriate models of education.

National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-41125 (URN)10.1176/appi.ap.34.6.424 (DOI)21041465 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2018-06-08Bibliographically approved
Tesfaye, M., Hanlon, C., Wondimagegn, D. & Alem, A. (2010). Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh postnatal depression scale and Kessler scales. Journal of Affective Disorders, 122(1-2), 102-108
Open this publication in new window or tab >>Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh postnatal depression scale and Kessler scales
2010 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 122, no 1-2, p. 102-108Article in journal (Refereed) Published
Abstract [en]

The EPDS, K6 and K10 all demonstrated acceptable clinical utility as screening scales for postnatal CMD in an urban setting in Ethiopia. The marked urban-rural difference in EPDS performance within Ethiopia highlights the difficulty of applying urban-validated instruments to rural settings in LAMIC.

Keywords
Validation studies; Depression; Post-partum; Culture; Ethiopia; Developing countries; Mental disorders
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-41136 (URN)10.1016/j.jad.2009.06.020 (DOI)19615753 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2018-06-08Bibliographically approved
Shibre, T., Teferra, S., Morgan, C. & Alem, A. (2010). Exploring the apparent absence of psychosis amongst the Borana pastoralist community of Southern Ethiopia. A mixed method follow-up study.. World psychiatry : official journal of the World Psychiatric Association (WPA), 9(2), 98-102
Open this publication in new window or tab >>Exploring the apparent absence of psychosis amongst the Borana pastoralist community of Southern Ethiopia. A mixed method follow-up study.
2010 (English)In: World psychiatry : official journal of the World Psychiatric Association (WPA), ISSN 1723-8617, Vol. 9, no 2, p. 98-102Article in journal (Refereed) Published
Abstract [en]

There are few reports of the prevalence of psychotic disorders among isolated population groups. Where present, variations in prevalence estimates raise questions about the validity of methods of case ascertainment in such settings. In a previous population-based survey of the Borana pastoralist community in Ethiopia using the Composite International Diagnostic Interview, no cases of schizophrenia were identified. In order to further explore this finding and investigate how serious mental disorder is conceptualized, we conducted focus group discussions with key members of the Borana pastoralist community. Subsequently, focus group participants were used as key informants to identify cases with possible psychotic disorder, based on their conceptualization. Cases identified by key informants were interviewed by a trained psychiatrist using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), to confirm presence of disorder. Focus group discussions were subjected to thematic analysis. The incongruity between local and psychiatric concepts lay mainly in the fact that key informants described characteristics of marata ("madness") in terms of overt behavioural symptoms. Following the focus group discussions, participants identified eight individuals with schizophrenia and 13 with a psychotic mood disorder, confirmed through SCAN interview. Studies of psychotic disorders in such communities are likely to benefit from combining structured interviews with the key informant method.

Keywords
Psychotic disorders, Borana community, key informant method
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-41128 (URN)20671898 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2018-06-08Bibliographically approved
Hanlon, C., Wondimagegn, D. & Alem, A. (2010). Lessons learned in developing community mental health care in Africa. World Psychiatry, 9(3), 185-189
Open this publication in new window or tab >>Lessons learned in developing community mental health care in Africa
2010 (English)In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 9, no 3, p. 185-189Article in journal (Refereed) Published
Abstract [en]

This paper summarizes the findings for the African region of the WPA task force on steps, obstacles and mistakes to avoid in the implementation of community mental health care. We present an overview of mental health policies, plans and programmes in the African region; a summary of relevant research and studies; a critical appraisal of community mental health service components; a discussion of the key challenges, obstacles and lessons learned, and some recommendations for the development of community mental health services in the African region.

Keywords
Community mental health care, Africa, primary health care, mental health services, systematic review, lessons learned
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-41126 (URN)20975867 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2018-06-08Bibliographically approved
Servili, C., Medhin, G., Hanlon, C., Tomlinson, M., Worku, B., Baheretibeb, Y., . . . Prince, M. (2010). Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE birth cohort. BMC Public Health, 10, 693
Open this publication in new window or tab >>Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE birth cohort
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2010 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, p. 693-Article in journal (Refereed) Published
Abstract [en]

The study supports the hypothesis that it is the accumulation of risk exposures across time rather than early exposure to maternal CMD per se that is more likely to affect child development. Further investigation of the impact of chronicity of maternal CMD upon child development in LAMICs is indicated. In the Ethiopian setting, poverty, interpersonal violence and infant undernutrition should be targets for interventions to reduce the loss of child developmental potential.

National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-41124 (URN)10.1186/1471-2458-10-693 (DOI)21073710 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2018-06-08Bibliographically approved
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