Browsing by Author "Ramlall, Suvira"
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Item Depression in older adults: prevalence and risk factors in a primary health care sample(MedPharm Publications, NISC (Pty) Ltd and Informa UK Limited, 2017) Padayachey, U.; Ramlall, Suvira; Chipps, JenniferBACKGROUND: Depression in the geriatric population has been identified as a significant problem in view of the associated negative outcomes regarding poor functioning, increased perception of poor health and increased utilisation of medical services. Significantly associated with increased morbidity and mortality, depression has been found to be an independent cause of disability as well as adding to disability due to primary physical illnesses. Early identification and treatment of depression reduces medical costs and lessens caregiver burden. Epidemiological data and prevalence rates of geriatric depression in Africa are limited, although such data are vital to mobilise and plan government mental health initiatives aimed at screening and early intervention. OBJECTIVE: To determine the prevalence of depression and associated clinical and socio-demographic factors amongst older adult patients attending a primary health care clinic in the Ethekwini District in Kwa-Zulu Natal, South Africa. METHODS: The 15-item Geriatric Depression Scale and a socio-demographic questionnaire were administered in English to 255 geriatric outpatients, randomly selected, at a local community clinic in Durban. DATA ANALYSIS: Data were analysed using SPSS version 23®. Descriptive statistics were used to summarise the sample demographics and response rate and non-parametric statistics were used to test for associations and differences. RESULTS: A Cronbach’s alpha for the GDS was calculated (p = 0.793). Some 40% of participants screened positive for depression. Female gender, widowhood and a negative subjective health status rating were significantly associated with depression and marriage appeared to be protective (p < 0.001). Participants with a poor subjective health rating were 21 times more likely to be depressed and widowhood conferred an almost fourfold increased risk of being depressed, with widows at greater risk than widowers. No association between depression and specific medical conditions was identified. CONCLUSION: There is a high rate of undetected depression among the elderly attending a local primary health care clinic with widowhood and poor subjective health being strong predictors of mood disorders. The findings warrant replication in bigger samples.Item Developing telepsychiatry services in KwaZulu-Natal - an action research study(OMICS Publishing Group, 2012) Chipps, Jennifer; Ramlall, Suvira; Madigoe, Thebe; King, Howard; Mars, MauriceOBJECTIVE: In 2009, the Departments of Psychiatry and Telehealth of the University of KwaZulu-Natal (UKZN) initiated a three year project to develop telepsychiatry services in KwaZulu-Natal. This paper describes the challenges and opportunities of this project. METHOD:This was a collaborative, in situ health service project and an action research framework was adopted. Over the three years, following a needs assessment and an e-health Readiness Assessment, two action research cycles were completed. Cycle 1: The preparation, implementation and evaluation of educational material, technical requirements and clinical guidelines and clinical support materials. Cycle 2: Preparation and evaluation of educational and clinical outreach sessions. RESULTS: Videoconference education sessions were beneficial to health staff without post-qualification psychiatry training. A flexible format for education improved knowledge outcomes. Clinical sessions are feasible, but require administration and technical support for facilitation. With facilitator training, 128Kbps is a suitable bandwidth for education but 384Kbps is preferred for clinical consultation. CONCLUSION: Telepsychiatry offers tremendous potential to facilitate the three strategies suggested by the World Psychiatric Association to address the treatment gap, save time and costs and improve access to the small pool of specialist psychiatrists in resource constrained environments.Item Knowledge, beliefs and mental treatment seeking practices of Black African and Indian outpatients in Durban, South Africa(African Association for Health, Physical Education, Recreation, Sport and Dance, 2015) Oosthuizen, F.; Buthelezi, M.B.; Buthelezi, M.M.; Buthelezi, P.F.; Jeewa, S.; Munsami, S.; Simamane, B.C.; Singh, P.; Vaid, B.A.; Ramlall, Suvira; Chipps, JenniferMental illness is a major contributor to the global burden of disease in the world. Patients’ knowledge of mental illness and their treatment options play an important role in the effectiveness of service delivery and health outcomes in developing countries. The objectives of this study were to assess the knowledge, attitudes and beliefs of mental health outpatients about mental illness and its treatment, and their knowledge and satisfaction with traditional and Western/allopathic health systems. A self-designed questionnaire was used to assess the knowledge, attitudes and beliefs of mental health patients about mental illness and its treatment. Of the 157 outpatients who identified themselves as having a mental illness, 77.7% were aware of their condition, 33.8% only knew it as a mental illness and 21.5% patients did not know what caused their mental illness. Of the 195 patients interviewed, the majority (76.9%) preferred Western treatment, believing that taking medication would help their condition. Sixty-three patients reported that they did access both Western clinics as well as traditional healers. Overall, the majority of patients (82.5%) expressed satisfaction with their current treatment, with 76.9% indicating preference for consulting a medical practitioner, and 13.8% indicating preference for a traditional healer. Indian and African patients with mental illness attending two urban psychiatric clinics expressed confidence in Western treatment with a minority preferring traditional healing. Future research should focus more exclusively on the various categories of alternative treatment, the healers involved, the reasons for seeking these treatments, the roles that they play in the South African context.Item Mild cognitive impairment and dementia in a heterogeneous elderly population: prevalence and risk profile(OMICS Publishing Group, 2013) Ramlall, Suvira; Chipps, Jennifer; Pillay, Basil; Bhigjee, AhmedOBJECTIVE: To describe the demographic, clinical and risk profile of Mild Cognitive Impairment and dementia in a sample of elderly South Africans within a residential setting. METHOD: One hundred and forty participants residing in a group of residential homes for the elderly were assessed by psychiatrists and assigned diagnoses of dementia or Mild Cognitive Impairment (MCI). Participants diagnosed with dementia were also offered haematological investigations and a CT scan of the brain. RESULTS: The sample consisted of 140 participants comprising 46.4% White, 29.3% Coloured, 20% Asian and 4.3% Black participants. There were 97 (69.3%) females and 106 (75.7%) participants had less than 12 years of education. Eleven (7.9%) dementia and 38 (27.1%) MCI cases were diagnosed. Increasing age was associated with cognitive impairment (MCI and dementia) (p=.020) but there was no association between gender and cognitive impairment (p=.165). MCI was significantly associated with a lower education level (p=.036) and no association was found between depression (current-p=.646; past-p=.719) and dementia or MCI. The presence of vascular risk factors (n=140) ranged from 66.4% (hypertension) to 14.3% (stroke). Subjective memory complaints were significantly associated with cognitive impairment (p=.001). Except for the use of the telephone (p=.225) and the television (p=.08), impairment in all domains of instrumental activities of daily living that were assessed were significantly associated with a dementia diagnosis. CONCLUSION: The study showed that cognitive impairment was associated with increasing age and low education levels. The presence of vascular risk factors places this population at risk for future cognitive decline.Item A Model for Telepsychiatry for South Africa(2012) Chipps, Jennifer; Ramlall, Suvira; Mars, MauriceThe access of rural Mental Health Care Users in South Africa to specialist psychiatrists and quality mental health care is currently sub-optimal. Health professionals and planners working in psychiatry lack a well-defined and feasible outreach model to facilitate the delivery of services to remote and rural areas. In response to this challenge, a three-year action research telepsychiatry study was undertaken by the Departments of Psychiatry and TeleHealth at the University of KwaZulu-Natal, to develop a telepsychiatry outreach model based on local research and international evidence. The Model draws on needs and infrastructure assessments of the designated psychiatric hospitals in the province, a review of the published international evidence on telepsychiatry and videoconference-based education, and an evaluation of local clinical and educational telepsychiatry implementations in KwaZulu-Natal. The Model proposed is “virtual”, i.e. not bound to provincial or district referral patterns, aims not to add to the burden on the current workforce and is intended to be integrated into psychiatry outreach services and policy. The Model should be subjected to in situ testing for validation and implementation. It is hoped that an implementation of this Model will improve the access of Mental Health Care Users to specialist psychiatry care.Item Practice guidelines for videoconference-based telepsychiatry in South Africa(OMICS Publishing Group, 2012) Chipps, Jennifer; Ramlall, Suvira; Mars, MauriceTelepsychiatry, the practice of psychiatry over distance using information and communication technologies is, after teleradiology, the most practiced form of telemedicine in the world. As with any new technology, clinical service, or intervention in medicine, it is prudent to have guidelines for the safe and efficacious use of the technology in clinical practice. Guidelines facilitate best practice and provide both clinicians and patients with a set of standards and procedures that serve to protect their interests. Protection is particularly important when dealing with vulnerable groups.Item A profile of social isolation and the influence of demographics in older persons living in residential care, Durban, South Africa(International Journal of Africa Nursing Sciences, 2020-12-02) Chipps, Jennifer; Ramlall, Suvira; Jarvis, Mary AnnIntroduction: Residential care settings have shown high social isolation rates with incumbent risks necessitating measurement to formulate health promotion policies. Objective: To measure social isolation levels in older persons living in a lower socio-economic residential care setting in South Africa. Method: A cross sectional survey with older persons from four inner city residential care facilities. A researcher administered questionnaire was developed based on the Working Paper No.66, Oxford Poverty and Human Development Initiative. Data were analysed to describe social isolation and assess the influence of demographics. Results: The response rate was 72.14% (n = 277) and representative of the residential care population for age and gender. Nearly half of the respondents (47.3%) met criteria for social isolation in terms of social network support and density and almost 20% for perceived isolation through decreased levels of friendship. Conclusion: Although residential care does not prevent social isolation, the residents in the setting may provide a buffering in the provision of some social supportItem Research in lower middle income countries – recommendations for a national mental health research agenda in South Africa.(2012) Chipps, Jennifer; Ramlall, SuviraIn the current mental health environment in South Africa, the development of a relevant mental health research agenda poses several challenges. This paper provides a brief overview of the current state of published research in mental health and, using a translation research framework, makes recommendations for five strategic directions to be considered in the development to be considered in the development of a national mental health research agenda.Item Screening a heterogeneous elderly South African population for cognitive impairment: the utility and performance of the Mini-Mental State Examination, Six Item Screener, Subjective Memory Rating Scale and Deterioration Cognitive Observee(OMICS Publishing Group, 2013) Ramlall, Suvira; Chipps, Jennifer; Pillay, Basil; Bhigjee, AhmedOBJECTIVE: The aim of this study was to report on the prevalence of cognitive impairment, and to assess the performance and utility of subjective, objective and informant screening tools in a heterogeneous community sample. METHOD: A sample of 302 elderly participants (>60 years) living in residential homes in a large city in South Africa were screened for the presence of cognitive impairment using objective (Mini-Mental State Examination [MMSE] and Six Item Screener-[SIS]), subjective (Subjective Memory Complaint [SMC]and Subjective Memory Rating Scale [SMRS]) and informant (Deterioration Cognitive Observee [DECO]) screening tools. All tools were compared to the MMSE and the influence of demographic variables on the performance on these tools was considered. RESULTS: Significantly lower MMSE scores were found in participants aged 80-89 years (p=.023) and those who had 8-11 years of education (p=.002). For every one additional year of education, participants were 0.71 times less likely to screen positive on the MMSE. Differential item functioning on various components of the MMSE was demonstrated due to the effects of education, race and gender. There was significant differential performance between the recommended and alternate attention/concentration items (p<.001) with the alternate item favouring better performance. Based on the MMSE cutoff score of < 23, the prevalence of cognitive impairment was 16.9%; the prevalence yielded by the remaining tools ranged from 10.5% using the DECO to 46% as determined by the presence of a SMC. Using the MMSE as the reference standard for the presence of cognitive impairment, the SIS, SMC, SMRS and DECO had sensitivities of 82.3%, 54.6%, 17.0% and 37.5%, and specificities of 71.3%, 57.6%, 87.4% and 96.7% respectively. Age and race influenced performance on the MMSE, SIS and SMRS. CONCLUSION: Different types of cognitive screening tools yielded varying sensitivities and specificities for identifying cognitive impairment when compared to the MMSE. The influence of race, age and education on test performance highlights the need for suitable, culture-fair screening tools. Locally, the alternate item for attention/concentration should be preferred.Item Sensitivity and specificity of neuropsychological tests for dementia and mild cognitive impairment in a sample of residential elderly in South Africa(Health & Medical Publishing Group, 2014) Chipps, Jennifer; Ramlall, Suvira; Pillay, Basil; Bhigjee, AhmedBACKGROUND. Neuropsychological tests can successfully distinguish between healthy elderly persons and those with clinically significant cognitive impairment. Objectives. A battery of neuropsychological tests was evaluated for their discrimination validity of cognitive impairment in a group of elderly persons in Durban, South Africa. METHOD. A sample of 117 English-speaking participants of different race groups (9 with dementia, 30 with mild cognitive impairment (MCI) and 78 controls) from a group of residential homes for the elderly was administered a battery of 11 neuropsychological tests. Kruskal-Wallis independent sample tests were used to compare performance of tests in the groups. Sensitivity and specificity of the tests for dementia and MCI were determined using random operating curve (ROC) analysis. RESULTS. Most tests were able to discriminate between participants with dementia or MCI, and controls (p<0.05). Area under the curve (AUC) values for dementia v. non-dementia participants ranged from 0.519 for the digit span (forward) to 0.828 for the digit symbol (90 s), with 14 of the 29 test scores achieving significance (p<0.05). AUC values for MCI participants ranged from 0.754 for controlled oral word association test (COWAT) (Animal) to 0.507 for the Rey complex figure test copy, with 17 of the 29 scores achieving significance (p<0.05). CONCLUSION. Several measures from the neuropsychological battery had discrimination validity for the differential diagnosis of cognitive disturbances in the elderly. Further studies are needed to assess the effect of culture and language on the appropriateness of the tests for different populations.Item The sensitivity and specificity of subjective memory complaints and the subjective memory rating scale, deterioration cognitive observee, mini-mental state examination, six-item screener and clock drawing test in Dementia Screening.(Karger, 2013) Ramlall, Suvira; Chipps, Jennifer; Bhigjee, Ahmed; Pillay, BasilBackground: The effectiveness of dementia screening depends on the availability of suitable screening tools with good sensitivity and specificity to confidently distinguish normal age-related cognitive decline from dementia. The aim of this study was to evaluate the discriminant validity of 7 screening measures for dementia. Methods: A sample of 140 participants aged ≥60 years living in a residential facility for the aged were assessed clinically and assigned caseness for dementia using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revised diagnostic criteria. Sensitivity and specificity of a selection of the following screening measures were tested using receiver operating characteristic (ROC) analysis for individual and combined tests: the Mini-Mental State Examination (MMSE), Six-Item Screener (SIS), Subjective Memory Complaint, Subjective Memory Complaint Clinical (SMCC), Subjective Memory Rating Scale (SMRS), Deterioration Cognitive Observee (DECO) and the Clock Drawing Test (CDT). Results: Using ROC analyses, the SMCC, MMSE and CDT were found to be ‘moderately accurate' in screening for dementia with an area under the curve (AUC) >0.70. The AUCs for the SIS (0.526), SMRS (0.661) and DECO (0.687) classified these measures as being ‘less accurate'. At recommended cutoff scores, the SMCC had a sensitivity of 90.9% and specificity of 45.7%; the MMSE had a sensitivity of 63.6% and a specificity of 76.0%, and the CDT had a sensitivity of 44.4% and a specificity of 88.9%. Combining the SMCC and MMSE did not improve their predictive power except for a modest increase when using the sequential rule. Conclusion: The SMCC is composed of valid screening questions that have high sensitivity, are simple to administer and ideal for administration at the community or primary health care level as a first level of ‘rule-out' screening. The MMSE can be included at a second stage of screening at the general hospital level and the CDT in specialist clinical settings. Sequential use of the SMCC and MMSE will improve the specificity of the former and the sensitivity of the latter.Item Videoconference-based education for psychiatry registrars at the University of KwaZulu-Natal, South Africa(OMICS group, 2012) Chipps, Jennifer; Ramlall, Suvira; Mars, MauriceObjective: Psychiatry registrars form the backbone of specialized psychiatric service provision in South Africa. Medical schools are centralized while clinical services need to be widespread and accessible. Video-conferencing has the potential to link registrars at satellite hospitals with academic centers. The study thus evaluated of the use of videoconferencing in a Psychiatry Education Program delivered via videoconferencing. Method: To evaluate the implementation of the videoconference-based psychiatry registrar program, a pre- and post evaluative design was used. This involved all registrars in the 2008 and 2009 academic education program at the University of KwaZulu-Natal, South Africa. Access to education, satisfaction, suitability and costs of the psychiatry registrar education were studied. Results: In the evaluation of the Registrar Program, general satisfaction with the videoconferencing program was reported, though concerns were expressed about the level of interaction using this mode, the quality of the transmitted pictures of the anatomy specimens and the quality of the sound. Access to education was improved with potential cost savings identified. Conclusion: Well supported and planned videoconference-based teaching is a feasible, cost-effective and acceptable method of supporting registrars at sites distant from academic centers.