Hirani 2010 CRCT Pakistan (Continued)
ity, education, and income level. Three sets of two adjacent similar clusters were randomly assigned to the interventions of economic skill-building, counselling and control group. Each cluster had several hundred adult women. The randomisa- tion took place maintaining the commu- nity based participatory approach and the internal validity of the research remained strong”
Reliable primary outcome measures Unclear risk Comment: The tools do not seem vali-
dated for the setting in which they are used, so difficult to know if they are reliable
Selective reporting (reporting bias) Unclear risk Comment:All outcomes reported but need
to check with protocol to check if these are also the prespecified outcomes
Other bias Low risk Comment:No other bias
Jenkins 2012 C-RCT Kenya
Methods Study design:Cluster RCT, allocated by clinic, analysed at individual level for patient outcome, analysed at clinic level for GHQ cases
Duration of study:Conducted in 2010
Participants Country:Kenya
Income classification:Low income
Geographical scope:Urban and rural; Nyanza province, Kenya, as this was the region where the national training programme 2005/2010 had hither to trained fewest staff, and thus most clinics were eligible for study. The districts of Siaya, Bondo and Rachuonya were selected, allocated around Kisumu near Lake Victoria
Healthcare setting:PC facilities (dispensaries and PHC centres) Mental health condition:All mental disorders
Population:Patients (adults and children), anyone attending PHC Age:> 16 years
Gender:Both
Socioeconomic background:Livelihoods were based on subsistence farming, an exten- sive fishing industry along the lake, and some commercial business. The majority tribe is Luo. The area was the site of significant election violence in January 2007
Inclusion criteria:The sample framework was the Ministry of Health list of all pub- licly funded primary care facilities in Siaya, Bondo and Rachuonya districts in Nyanza province. The criteria for entry for clinics was that they were in the Ministry of Health list of PHCs, and were publicly funded. Criterion for entry for patients was that they were over 16 years
Exclusion criteria:Centres where staff had previously received training from the KMTC mental health training programme were excluded from the study; publicly funded. Cri-
Jenkins 2012 C-RCT Kenya (Continued)
terion for entry for patients was that they were over 16 years of age; criteria for exclu- sion were dementia and learning disability of such severity as to be unable to complete the questionnaires; life threatening illness; did not speak the language spoken by the researchers; and refusal to co-operate
Interventions Stated purpose:To conduct a phase 2 exploratory trial as a cluster RCT, testing the effect of a low-cost training intervention, integrated with the national health sector reforms, 1. on the competencies of primary care staff to recognise mental disorders, treat and make appropriate referrals to the scarce specialist services and 2. on recovery (improved health and social outcomes and quality of life) of clients
INTERVENTION:
Name:PC mental health training Delivered by:
Title/name of NSHW/OPHR and number:PHC staff (all nurses and clinical officers (doctors) eligible for training); 2 in each centre
Selection:Self selection: 2 invited from each centre
Educational background:Nurses and clinical officers at PHC
Training:RJ trained local trainers (3 courses) to deliver the course to frontline workers, in 2005 (By RJ) and gave them a refresher course in 2009 (40 hours in total). The trainers had done the KMTC mental health training and had been delivering training since then. These trainers included 20 senior staff from Kenya medical college (KMTC) (i.e. from Nairobi, provincial medical training colleges and the Ministry of Health rural health training centres). They were supplied with good practice guidelines and handouts to those who attended the training course, and the project also provided a training course on mental health for the local district public health nurses. Course structure: compre- hensive structured interactive mental health training programme for 5 days. Curriculum and teaching materials developed by the WHO Collaborating Centre in dialogue with Kenya partners, based on the Kenya adaptation of the WHO primary carePC guidelines. Ccontent: 5 modules: 1. core concepts of MH, MDs, their contribution to physical health economic and social outcomes; 2. core skills (examination, communication, assess- ment, managing difficult cases/ violence/bad news); 3. neurological disorders (epilepsy, Parkinson’s disease, headache, dementia, toxic confusional states), 4. psychiatric disor- ders (content based on the WHO primary care PC guidelines for mental health, Kenya adaptation); 5. system issues of policy; legislation; links between mental health and child health, reproductive health, HIV and malaria; roles and responsibilities; health manage- ment information systems; working with community health worker CHWs and with traditional healers; and integration of mental health into annual operational plans. Use of role plays (25 each), theory, discussion, videos, emphasis on acquisition of practical skills and competencies for assessment, diagnosis and management)
Supervision:No supervision available from district level and poor medication supply Incentives/remuneration:“Each health facility is staffed by one or more nurses and clinical officers on Ministry of Health salaries, and around 15-20 community health workers are not remunerated by the Ministry by the Ministry of Health but are now expected to receive small remuneration from the community”
Intervention details:
Duration/frequency:Varying depending on patient
Content of intervention:Diagnosis and treatment with medicines, and follow-up CONTROL:Usual care, PHCs that had not received prior KMTC training, neither
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