Browsing by Author "Tsai, Alexander C."

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    Inequitable and ineffective : exclusion of mental health from the post-2015 development agenda
    (Public Library of Science, 2015) Tsai, Alexander C.; Tomlinson, Mark
    The Millennium Development Goals (MDGs), adopted at the turn of the century, represented a milestone in global development by committing United Nations member states to eradicating extreme poverty and achieving specific targets over the subsequent decade and a half. At this time the world's attention is increasingly focused on the post-2015 development agenda, which will be unveiled in September of this year in the form of Sustainable Development Goals (SDGs). Given that mental health and other non-communicable diseases were conspicuously omitted from the MDGs, and have only been weakly mentioned in draft SDG targets, in this essay we argue for a place for mental health on the post-2015 development agenda. Its continued exclusion will not only contribute to the failure of the SDGs given the centrality of mental health in most aspects of human development and well-being but also formalize our collective failure to care for the most vulnerable among us.
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    Intimate partner violence and depression symptom severity among South African women during pregnancy and postpartum : population-based prospective cohort study
    (Public Library of Science, 2016) Tsai, Alexander C.; Tomlinson, Mark; Comulada, W. Scott; Rotheram- Borus, Mary Jane
    Background: Violence against women by intimate partners remains unacceptably common worldwide. The evidence base for the assumed psychological impacts of intimate partner violence (IPV) is derived primarily from studies conducted in high-income countries. A recently published systematic review identified 13 studies linking IPV to incident depression, none of which were conducted in sub-Saharan Africa. To address this gap in the literature, we analyzed longitudinal data collected during the course of a 3-y cluster-randomized trial with the aim of estimating the association between IPV and depression symptom severity. Methods and Findings: We conducted a secondary analysis of population-based, longitudinal data collected from 1,238 pregnant women during a 3-y cluster-randomized trial of a home visiting intervention in Cape Town, South Africa. Surveys were conducted at baseline, 6 mo, 18 mo, and 36 mo (85% retention). The primary explanatory variable of interest was exposure to four types of physical IPV in the past year. Depression symptom severity was measured using the Xhosa version of the ten-item Edinburgh Postnatal Depression Scale. In a pooled cross-sectional multivariable regression model adjusting for potentially confounding time-fixed and time-varying covariates, lagged IPV intensity had a statistically significant association with depression symptom severity (regression coefficient b = 1.04; 95% CI, 0.61–1.47), with estimates from a quantile regression model showing greater adverse impacts at the upper end of the conditional depression distribution. Fitting a fixed effects regression model accounting for all time-invariant confounding (e.g., history of childhood sexual abuse) yielded similar findings (b = 1.54; 95% CI, 1.13–1.96). The magnitudes of the coefficients indicated that a one–standard-deviation increase in IPV intensity was associated with a 12.3% relative increase in depression symptom severity over the same time period. The most important limitations of our study include exposure assessment that lacked measurement of sexual violence, which could have caused us to underestimate the severity of exposure; the extended latency period in the lagged analysis, which could have caused us to underestimate the strength of the association; and outcome assessment that was limited to the use of a screening instrument for depression symptom severity. Conclusions: In this secondary analysis of data from a population-based, 3-y cluster-randomized controlled trial, IPV had a statistically significant association with depression symptom severity. The estimated associations were relatively large in magnitude, consistent with findings from high-income countries, and robust to potential confounding by time-invariant factors. Intensive health sector responses to reduce IPV and improve women’s mental health should be explored.
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    Mental health spillovers and the millennium development goals : the case of perinatal depression in Khayelitsha, South Africa
    (Edinburgh University Global Health Society, 2012-06-29) Tsai, Alexander C.; Tomlinson, Mark
    Mental illness currently ranks among the top ten causes of burden of disease in low-income countries [1]. In the African region specifically, neuropsychiatric disorders account for approximately 5% of disability-adjusted life years lost, with nearly one quarter of this burden attributable to unipolar depressive disorders .
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    Scaling up mHealth : where is the evidence?
    (Public Library of Science, 2013-02-12) Tomlinson, Mark; Rotheram-Borus, Mary Jane; Swartz, Leslie; Tsai, Alexander C.
    Despite hundreds of mHealth pilot studies, there has been insufficient programmatic evidence to inform implementation and scale-up of mHealth. We discuss what constitutes appropriate research evidence to inform scale up. Potential innovative research designs such as multi-factorial strategies, randomized controlled trials, and data farming may provide this evidence base. We make a number of recommendations about evidence, interoperability, and the role of governments, private enterprise, and researchers in relation to the scale up of mHealth.
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    The use of mobile phones as a data collection tool : a report from a household survey in South Africa
    (BioMed Central, 2009-12) Tomlinson, Mark; Solomon, Wesley; Singh, Yages; Doherty, Tanya; Chopra, Mickey; Ijumba, Petrida; Tsai, Alexander C.; Jackson, Debra
    Background: To investigate the feasibility, the ease of implementation, and the extent to which community health workers with little experience of data collection could be trained and successfully supervised to collect data using mobile phones in a large baseline survey Methods: A web-based system was developed to allow electronic surveys or questionnaires to be designed on a word processor, sent to, and conducted on standard entry level mobile phones. Results: The web-based interface permitted comprehensive daily real-time supervision of CHW performance, with no data loss. The system permitted the early detection of data fabrication in combination with real-time quality control and data collector supervision. Conclusions: The benefits of mobile technology, combined with the improvement that mobile phones offer over PDA's in terms of data loss and uploading difficulties, make mobile phones a feasible method of data collection that needs to be further explored.
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    Value of a mobile information system to improve quality of care by community health workers
    (AOSIS Publishing, 2013) Tomlinson, Mark; Rotheram-Borus, Mary Jane; Doherty, Tanya; Swendeman, Dallas; Tsai, Alexander C.; Ijumba, Petrida; Le Roux, Ingrid; Jackson, Debra; Stewart, Jackie; Friedman, Andi; Colvin, Mark; Chopra, Mickey
    Background: We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support the management of CHWs are central to bridging the gap. Mobile phones are broadly available, particularly in low and middle income countries (LAMIC), where the penetration rate approaches 100%. Objectives: In this article, we describe how mobile phones and may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa. Methods: This article is a descriptive study, drawing lessons from two randomised controlled trials outlining how a mobile phone information system can be utilised to enhance the quality of health interventions. We organised our comprehensive management and supervision system around a previously published management framework. The system is composed of mobile phones utilised by CHWs and a web-based interface utilised by CHW supervisors. Computerised algorithms were designed with intervention and assessment protocols to aid in the real-time supervision and management of CHWs. Results: Community health workers used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits. Supervisors used the web-based interface for real-time monitoring of the location, timing and content of intervention visits. Additional real-time support was provided through direct support calls in the event of crises in the field. Conclusion: Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions. The extent to which these efficiency gains can be translated into realised health gains for communities is yet to be tested.