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Papers by Vasco Cumbe

Additional file 2 of The Systems Analysis and Improvement Approach: specifying core components of an implementation strategy to optimize care cascades in public health

Figshare, 2023

Frontiers in public health, Apr 16, 2024

Background: Humanitarian emergencies are a major global health challenge with the potential to ha... more Background: Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people's mental and psychological health. Displacement is a traumatic event that disrupts families and affects physical and psychological health at all ages. A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder, depression, and anxiety disorder in low and middle-income countries in humanitarian emergency contexts such as Mozambique. This study aimed to assess the prevalence of PTSD, depression, and anxiety, and associated factors among armed conflict survivors in Cabo Delgado, north region of Mozambique in 2023. Methods: A community-based cross-sectional study was conducted between January and April 2023 among 750 participants, who were selected by convenience. A face-to-face interview used the Primary Care Post-Traumatic Stress Disorder Checklist (PC-PTSD-5) to evaluate PTSD, the Generalized Anxiety Disorder Scale (GAD-7) to evaluate anxiety and the Patient Health Questionnaire-Mozambique (PHQ-9 MZ) to evaluate depression. The association between PTSD and demographic and psychosocial characteristics was analyzed using bivariate and multivariable binary logistic regression. We used a 5% significance level. Results: The three mental disorders assessed were highly prevalent in our sample with 74.3% PTSD, 63.8% depression, and 40.0% anxiety. The chance of developing PTSD was higher in females (AOR = 2.30, 95% CI 1.50-3.51), in patients with depression symptoms (AOR = 8.27, 95% CI = 4.97-13.74) and anxiety symptoms (AOR = 1.45, 95% CI = 0.84-2.50). Conclusion: This study reported that the prevalence of PTSD, depression, and anxiety were high. Patients having depressive symptoms, anxiety symptoms, and being female are more at risk of developing PTSD. There is a need to integrate

Implementation Science, Jun 6, 2022

Background: Significant investments are being made to close the mental health (MH) treatment gap,... more Background: Significant investments are being made to close the mental health (MH) treatment gap, which often exceeds 90% in many low-and middle-income countries (LMICs). However, limited attention has been paid to patient quality of care in nascent and evolving LMIC MH systems. In system assessments across sub-Saharan Africa, MH lossto-follow-up often exceeds 50% and sub-optimal medication adherence often exceeds 60%. This study aims to fill a gap of evidence-based implementation strategies targeting the optimization of MH treatment cascades in LMICs by testing a low-cost multicomponent implementation strategy integrated into routine government MH care in Mozambique. Methods: Using a cluster-randomized trial design, 16 clinics (8 intervention and 8 control) providing primary MH care will be randomized to the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) or an attentional placebo control. SAIA-MH is a multicomponent implementation strategy blending external facilitation, clinical consultation, and provider team meetings with system-engineering tools in an overall continuous quality improvement framework. Following a 6-month baseline period, intervention facilities will implement the SAIA-MH strategy for a 2-year intensive implementation period, followed by a 1-year sustainment phase. Primary outcomes will be the proportion of all patients diagnosed with a MH condition and receiving pharmaceutical-based treatment who achieve functional improvement, adherence to medication, and retention in MH care. The Consolidated Framework for Implementation Research (CFIR) will be used to assess determinants of implementation success. Specific Aim 1b will include the evaluation of mechanisms of the SAIA-MH strategy using longitudinal structural equation modeling as well as specific aim 2 estimating cost and cost-effectiveness of scaling-up SAIA-MH in Mozambique to provincial and national levels.

Research Square (Research Square), Jan 9, 2020

Background: Depression is one of the leading causes of disability in Mozambique; however, few pat... more Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique. Methods: The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 503 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool. Results: The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach's alpha of

International Journal of Environmental Research and Public Health, Nov 21, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Toward 90-90-90 Goals for Global Mental Health

JAMA Psychiatry

This Viewpoint discusses the adoption of 90-90-90 goals for global mental health, specifically ta... more This Viewpoint discusses the adoption of 90-90-90 goals for global mental health, specifically targeting neurologic and substance use disorders, to prioritize mental health quality improvement within existing health services and destigmatize these conditions to promote treatment.

International Journal of Mental Health Systems, 2022

Background Lay Health Workers (LHW) are important providers of community mental health services a... more Background Lay Health Workers (LHW) are important providers of community mental health services and help mitigate access and treatment gaps in Africa. However, there is a paucity of knowledge about the role and performance of these workers, as well as about the extent to which the interventions delivered are culturally adapted to the African context. Aims This scoping review aimed to explore the content and aspects concerning the cultural adaptation and sustainability of psychological interventions delivered by LHW to people with mental disorders in Africa. Methods We conducted a scoping review of the peer-reviewed literature published from January 2000 to December 2018 to identify psychological interventions delivered by LHW for people with mental disorders in Africa. We systematically searched PubMed, Google scholar and Hinari to select relevant publications. The articles were evaluated for risk of bias according to study design with the National Heart, Lung, and Blood Institute’s...

International Journal of Mental Health Systems, 2022

Demonstration project of a lay counselor delivered trans-diagnostic mental health intervention for newly diagnosed HIV patients in Mozambique

AIDS Care

Objective: We assessed the availability of essential medicines for mental healthcare (MH) across ... more Objective: We assessed the availability of essential medicines for mental healthcare (MH) across levels of the public healthcare system to aid in future systems planning. Design: Non-expired MH medications were assessed in 24 public health facilities and 13 district warehouses across Sofala Province, Mozambique, from July to August 2014. Medication categories included: anti-psychotics, antidepressants, benzodiazepines, antiepileptics and mood stabilizers, and anticholinergics and antihistamines. Results: Only 7 of 12 (58.3%) district warehouses, 11 of 24 (45.8%) of all health facilities, and 10 of 12 (83.3%) of facilities with trained MH staff had availability of at least one medication of each category. Thioridazine was the most commonly available antipsychotic across all facilities (9 of 24, 37.5%), while chlorpromazine and thioridazine were most common at facilities providing MH care (8 of 12, 66.7%). The atypical antipsychotic risperidone was not available at any facility or dis...

Supplemental material, sj-pdf-1-asm-10.1177_10731911211032285 for Psychometric Validation of a Co... more Supplemental material, sj-pdf-1-asm-10.1177_10731911211032285 for Psychometric Validation of a Combined Assessment for Anxiety and Depression in Primary Care in Mozambique (CAD-MZ) by Jennifer M. Belus, Alberto Muanido, Vasco F. J. Cumbe, Maria Nelia Manaca and Bradley H. Wagenaar in Assessment

Burnout syndrome is a multidimensional syndrome consisting of the dimensions emotional exhaustion... more Burnout syndrome is a multidimensional syndrome consisting of the dimensions emotional exhaustion, depersonalization or dehumanization and reduced personal accomplishment at work as a response to chronic occupational stress associated with lack of strategies to overcome it. This entity has attracted attention from several agencies including the World Health Organization, International Labour Organization, among various other entities, because of its impact at individual, organizational, family level and some maladaptive behaviour that may be associated with substance use of toxic and illegal drugs by those affected, in addition to other complications such as depression, anxiety and labour disputes. The situation described above leads to a state characterized by a feeling of emotional and physical exhaustion, with the finding of lack of energy, to carry out professionals activities. Thus, the daily works takes place in a distressing and painful way. Although it can be triggered by any type of activity, it is very common in people with activities to people and requiring very close contact, and specially the emotional type. It is within this philosophy that has been found a considerable number of affected among people who are dedicated to helping professionals, and in this case, physicians and nurses in oncology. The present work aims to assess the importance of burnout in physicians and nurses caring for patients in outpatient treatment services in oncology, assessment of the influence of sociodemographic factors in the emergence of this entity and its relationship with coping strategies. The study, also, aims to contribute to a better understanding and analysis of this issue in the context of oncology. To better understand the study, we structure our work into two parts. In the first part is a general approach on the importance of work for humans, an approach on stress in general and occupational stress, in particular, burnout and its causes or aggravating factors and, finally, the coping strategies. The second part is the study conducted in 46 professionals (physicians and nurses) of outpatient cancer units at São João Hospital, Santo António General Hospital and Hospital of Beja and Faro. To the participants were applied three instruments: Sociodemographic Schedule, Burnout Inventory (C. Manita, 2003) and Problem-Solving Inventory (Vaz-Serra, 1987). The results of this study allow us to conclude that our sample has the lowest average levels of burnout. Comparing these figures are not alarming, but worrying, because very often the professionals who suffer neither know this and nor seek help, becoming thus a chronic problem and quite debilitating. It was found that the sample had medium and high burnout average by about 63% in the dimension emotional exhaustion, 15,2% in the depersonalization dimension, and 47,8% in personal accomplishment dimension. Variables having sons, coping, diversified activity, correlated significantly and negatively with emotional exhaustion dimension, explaining 32.8% of the variability of this dimension and the first two with the greatest predictive value. Variables hobbies, participation in conferences/training correlated significantly and positively to the first and negative for the second with the depersonalization dimension, explaining 10% of the variability of this dimension and hobbies was found to be the variable with greater predictive value. Variables having sons, diversified activity, had a positive correlation and the variable employment status had a negative correlation with the dimension personal accomplishment, explaining 22.1% of the variability of this dimension and the variables having sons, employment status were found with the greatest predictive value. The variable having sons, diversified activity, appeared in this study as protective factors against burnout in the dimension emotional exhaustion and personal accomplishment. The participation in conferences or training was protective factor for the dimension depersonalization, while the variable hobbies worked as a risk factor for its development. The final employment status emerged as a risk factor for the development of burnout on personal accomplishment dimension, where individuals with this bond had lower achievement and consequently higher burnout in this dimension. Internal/external control of problems appeared as the main coping strategy correlated significantly with the dimensions emotional exhaustion and personal accomplishment. The results, although still modest, may point out some guidelines for future investigations and the implementation of some preventive mechanism at work.

Patient Health Questionnaire-9--Mozambican Portuguese Version

Optimizing treatment cascades for mental healthcare in Mozambique: preliminary effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH)

Health Policy and Planning

Substantial investments are being made to scale-up access to mental healthcare in low- and middle... more Substantial investments are being made to scale-up access to mental healthcare in low- and middle-income countries, but less attention has been paid to quality and performance of nascent public-sector mental healthcare systems. This study tested the initial effectiveness of an implementation strategy to optimize routine outpatient mental healthcare cascade performance in Mozambique [the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH)]. This study employed a pre–post design from September 2018 to August 2019 across four Ministry of Health clinics among 810 patients and 3234 outpatient mental health visits. Effectiveness outcomes evaluated progression through the care cascade, including: (1) initial diagnosis and medication selection; (2) enrolling in follow-up care; (3) returning after initial consultation within 60 days; (4) returning for follow-up visits on time; (5) returning for follow-up visits adherent to medication and (6) achieving function improvement. ...

Validity and item response theory properties of the Alcohol Use Disorders Identification Test for primary care alcohol use screening in Mozambique (AUDIT-MZ)

Journal of substance abuse treatment, 2021

BACKGROUND No validated tools exist to screen for substance use or dependence in Mozambique. The ... more BACKGROUND No validated tools exist to screen for substance use or dependence in Mozambique. The aim of this study was to validate the Alcohol Use Disorder Identification Test (AUDIT) for use in primary care settings in Mozambique. METHODS The study administered a final adapted Mozambican 10-item AUDIT (AUDIT-10-MZ) to 502 individuals from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary health care clinics in Sofala Province, Mozambique. The study evaluated the AUDIT-10-MZ against the MINI 5.0-MZ as a gold standard diagnostic tool. RESULTS Using the MINI 5.0-MZ, 16 (3.2%) of the sample tested positive for alcohol dependence and 3 (0.6%) tested positive for harmful alcohol use. The full AUDIT-10-MZ had acceptable internal consistency (α = 0.74); however, the shorter AUDIT-C-MZ had a higher alpha value than the full AUDIT screener (α = 0.79). The AUDIT-10-MZ performed well for screening in primary care, achieving areas under the receiver...

Integrating a transdiagnostic psychological intervention into routine HIV care

JAIDS Journal of Acquired Immune Deficiency Syndromes

Psychometric Validation of a Combined Assessment for Anxiety and Depression in Primary Care in Mozambique (CAD-MZ)

Assessment

This study sought to validate a combined assessment for major depression and generalized anxiety,... more This study sought to validate a combined assessment for major depression and generalized anxiety, administered by health providers in a primary care setting in Mozambique. Patients attending a primary care visit ( N = 502) were enrolled in the study and completed the Patient Health Questionniare–9, the Generalized Anxiety Disorder–7, and six items identified in a global systematic qualitative review of depression that were not captured in existing measures (e.g., social isolation, “thinking too much,” and “heart problems”). A separate trained mental health provider conducted the Mini International Neuropsychiatric Interview 5.0, adapted for Mozambique, to establish clinical diagnoses. Item response theory, factor analysis, and receiver operating characteristics were all used to identify the best screening items. Eight items were identified for the final screener: four items from the Patient Health Questionniare–9, two from the Generalized Anxiety Disorder–7, and two from the global ...

Community Health Worker Knowledge, Attitudes, and Practices Towards Epilepsy in Mozambique

Background: Epilepsy is the most common neurological disease in the world, affecting 50 million p... more Background: Epilepsy is the most common neurological disease in the world, affecting 50 million people, with the majority living in low- and middle-income countries (LMICs). A major focus of epilepsy treatment in LMICs has focused on task-sharing identification and epilepsy care by community health workers (CHWs). The present study aimed to assess the KAPs of CHWs towards epilepsy in Sofala province, Mozambique.Methods: One hundred and thirty five CHWs completed a questionnaire that included socio-demographic characteristics and 44-items divided in six subscales pertaining to KAPs towards epilepsy (QKAP-EPI) in nine districts of Sofala Province, Mozambique. The internal consistency and factor structure were examined to evaluate the reliability and construct validity of the QKAP-EPI, respectively. To examine correlates of KAPs toward epilepsy we evaluated the association between sociodemographic variables and QKAP-EPI subscales using linear regression models.Results: CHWs demonstrate...

BMC Psychiatry

Primary Familial Basal Ganglia Calcification presented with depression and obsessive–compulsive symptoms: a case report

Psychiatry and Clinical Neurosciences

Additional file 2 of The Systems Analysis and Improvement Approach: specifying core components of an implementation strategy to optimize care cascades in public health

Figshare, 2023

Frontiers in public health, Apr 16, 2024

Implementation Science, Jun 6, 2022

Research Square (Research Square), Jan 9, 2020

International Journal of Environmental Research and Public Health, Nov 21, 2022

Toward 90-90-90 Goals for Global Mental Health

JAMA Psychiatry

International Journal of Mental Health Systems, 2022

Demonstration project of a lay counselor delivered trans-diagnostic mental health intervention for newly diagnosed HIV patients in Mozambique

AIDS Care

Patient Health Questionnaire-9--Mozambican Portuguese Version

Optimizing treatment cascades for mental healthcare in Mozambique: preliminary effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH)

Health Policy and Planning

Validity and item response theory properties of the Alcohol Use Disorders Identification Test for primary care alcohol use screening in Mozambique (AUDIT-MZ)

Journal of substance abuse treatment, 2021

Integrating a transdiagnostic psychological intervention into routine HIV care

JAIDS Journal of Acquired Immune Deficiency Syndromes

Psychometric Validation of a Combined Assessment for Anxiety and Depression in Primary Care in Mozambique (CAD-MZ)

Assessment

Community Health Worker Knowledge, Attitudes, and Practices Towards Epilepsy in Mozambique

BMC Psychiatry

Primary Familial Basal Ganglia Calcification presented with depression and obsessive–compulsive symptoms: a case report

Psychiatry and Clinical Neurosciences