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The mortality gap compared with the general population is with 29 years of potential life lost for people with bipolar disorder (BD) highest in Africa. The most significant contributor to premature mortality are preventable cardiovascular diseases due to an unhealthy lifestyle. This study investigated if the Physical Activity Vital Sign (PAVS), i.e. two questions which clarify if someone meets the recommended 150 min of physical activity (PA) per week, can identify patients with BD at higher risk of cardiometabolic abnormalities and mental health symptoms in a low-income country from Sub-Sahara Africa. 99 (54♀) Ugandan in- and outpatients (mean age = 34.5 ± 9.4 years) with BD completed the PAVS and Brief Symptoms Inventory-18. Participants were screened for abdominal obesity (waist circumference > 90 cm), overweight (body mass index≥25) and hypertension (systolic pressure ≥ 140 mmHg and/or diastolic pressure ≥ 90 mmHg). 49.5 % (n = 49) met the PA recommendation. 43.4 % (n = 43) were overweight, 43.3 % (n = 43) had abdominal obesity and 20.2 % (n = 20) hypertension. Those who did not meet the PA recommendation were older (37.1 ± 10.4 versus 32.2 ± 7.7 years, p = 0.009), had a higher BSI-18 somatisation score (13.7 ± 4.5 versus 10.4 ± 4.2, p = 0.026), and a higher risk for overweight [relative risk (RR) = 2.99, 95 % confidence interval (CI) = 1.69–5.29], abdominal obesity (RR = 1.92, 95%CI = 1.19–3.09), and hypertension (RR = 2.23, 95%CI = 1.02–4.88). The PAVS might be an important risk identification tool in patients with BD in low-income countries such as Uganda. The low-cost and brevity of the PAVS may help promote the importance of PA assessment and prescription as a core part of the treatment of patients with BD in low-income settings. • More than half of Ugandan patients with bipolar disorder are not sufficiently physically active. • Physically inactive patients with bipolar disorder have a higher risk for overweight, abdominal obesity and hypertension. • Physically inactive patients with bipolar disorder report more somatization symptoms. [ABSTRACT FROM AUTHOR]

Background: There is a need for psychosocial interventions to address the escalating mental health burden in Sub-Saharan Africa (SSA). Physiotherapists could have a central role in reducing the burden and facilitating recovery within the multidisciplinary care of people with mental health problems. The aim of this systematic review was to explore the role of physiotherapists within the current mental health policies of SSA countries and to explore the current research evidence for physiotherapy to improve functional outcomes in people with mental health problems in SSA. Methods: The Mental Health Atlas and MiNDbank of the World Health Organization were screened for the role of physiotherapy in mental health plans. Next, we systematically searched PubMed from inception until August 1st, 2017 for relevant studies on physiotherapy interventions in people with mental health problems in SSA. The following search strategy was used: "physiotherapy" OR "physical therapy" OR "rehabilitation" AND "mental" OR "depression" OR "psychosis" OR "schizophrenia" OR "bipolar" AND the name of the country. Results: The current systematic review shows that in 22 screened plans only 2 made reference to the importance of considering physiotherapy within the multidisciplinary treatment. The current evidence (N studies = 3; n participants = 94) shows that aerobic exercise might reduce depression and improve psychological quality of life, self-esteem, body image and emotional stress in people with HIV having mental health problems. In people with depression moderate to high but not light intensity aerobic exercise results in significantly less depressive symptoms (N = 1, n = 30). Finally, there is evidence for reduction in post-traumatic stress symptoms (avoidance and arousal), anxiety and depression following body awareness related exercises (N = 1, n = 26). Conclusions: Our review demonstrated that physiotherapy is still largely neglected in the mental health care systems of SSA. This is probably due to poor knowledge of the benefits of physiotherapy within mental health care by policymakers, training institutes, and other mental health care professionals in SSA. Based on the current scientific evidence, this paper recommends the adoption of physiotherapy within mental health care services and investment in research and in training of professionals in SSA. [ABSTRACT FROM AUTHOR]

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

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