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International audience; BackgroundAlthough the World Health Organization has called for mental health services to be integrated into primary care, mental health remains in most countries, and especially in low- and middle-income countries, one of the most neglected topics in the training curriculum of frontline health workers. As a result, primary healthcare professionals leave medical and nursing schools with insufficient knowledge, and often with negative attitudes towards mental disorders.AimWe investigated the effect of a brief training intervention on schizophrenia and depression conducted among general practitioners and nurses in Armenia.MethodsTraining interventions were one-day, face-to-face, interactive workshops, including didactic presentations and discussions of case studies. We used a quasi-experimental design of the before/after type, to compare data on knowledge, attitudes and practices collected before and after the training sessions.ResultsMean scores for knowledge, attitudes and practices increased significantly (p < 0.001) among both nurses and GPs for both schizophrenia (111 GPs and 167 nurses) and depression (459 GPs and 197 nurses).ConclusionsOur experience suggests that a brief training intervention can result in significant improvements in knowledge, attitudes and practices among primary healthcare workers and could help improve mental health services.

International audience; Aim: To study the knowledge, attitudes and practices regarding mental health amongst health professionals at the end of their curriculum in Burkina Faso.Design: A descriptive and cross-sectional study was adopted.Methods: A simple random sampling was used to select 420 health students in Burkina Faso. Self-administered questionnaires on sociodemographic profile, knowledge, attitudes and practices about mental health were distributed.Results: The response rate to the questionnaires was 93%. Our study sample included 391 students amongst whom 35% (138/391) were nurse students, 32% (125/391) medical students, 26% (100/391) midwife students and 7% (28/391) were pharmacy students. A quarter of our sample had completed an internship in psychiatry.Medical students’ average knowledge, attitudes and practices in mental health were significantly higher than that of other students. Medical students had more time dedicated to mental health lectures and more opportunities for a mental health internship, unlike nurse students.

International audience; Introduction: Epilepsy is a chronic disease of the brain that affects approximately 50 million people globally, with over 80 % of them living in low- and middle-income countries (LMICs). In Madagascar, as in most LMICs, one of the main obstacles to treatment is the stigma and discrimination experienced by patients. Beliefs and prejudices regarding this disease are common, especially among children. "Ao Tsara" is an educational comic book regarding epilepsy, which has been translated in Malagasy from a French version, and which objective is to raise awareness and fight epilepsy related stigma and discrimination. Comic books have indeed been used successfully to raise awareness and change behaviors in several areas of public health. Methods: We conducted a study to evaluate the effect of a single reading of this comic book on epilepsy related knowledge, attitudes and practices (KAP) in schoolchildren in Madagascar. This quasi-experimental study compared data collected before and immediately after reading "Ao Tsara". It was conducted both in a school in an urban area and in a school in a rural area. Results: We recruited 244 children with a mean age of 11.4 (±1.5) in this study. We noted a significant improvement in the global KAP score after reading the comic book, overall as well as both in the urban school and the rural school. Out of a maximum score of twenty, the global KAP score increased from 9.4 to 11.2 (p < 0.001). Although the increase in knowledge was reasonable (10.2-12.9, p < 0.001) and the corresponding subscore after reading the comic book was at a satisfactory level, that was not the case for attitudes & practices, where the sub-score despite a significant increase remained low (8.7-9.5 out of a maximum score of twenty, p < 0.001). The comic book was much appreciated by the children with more than 50.0 % giving it the top rating, and 66.4 % stating they had learned a lot from it. Conclusion: A single reading of the comic book has demonstrated a positive effect on the knowledge, attitudes and practices of primary school children in Madagascar. This educational tool, which was much enjoyed by the children, could be of great value to raise awareness about epilepsy in Madagascar. By targeting a slightly older age group and adjusting the reading approach, the outcomes could be optimized especially in terms of attitudes and practices.

Introduction:despite the high prevalence and significant burden of mental disorders, they remain grossly under-diagnosed and undertreated. In low-income countries, such as Mali, integrating mental health services into primary care is the most viable way of closing the treatment gap. This program aimed to provide a mental health training intervention to rural general practitioners (GPs), to organize community awareness activities, and to evaluate the impact on mental health knowledge and through the number of new patients diagnosed with mental disorders and managed by these general practitioners. Methods:a pre-test/post-test design and the monthly monitoring of the number of new patients diagnosed with mental disorders by the trained GPs were used to evaluate the effect of the training interventions (two face-to-face group training workshops followed by individual follow-up supervisions) and of the community awareness activities. Results:the mean knowledge score of the 19 GPs who completed the initial 12-day group training raised from 24.6/100 at baseline, to 61.5/100 after training (p

International audience; Although psychiatric and neurological disorders are among the first contributors to the global burden of disease, they remain among the most neglected topics of Global Health. There is a real need to raise their profile, to improve advocacy so that the impact of these diseases is better understood, and greater political efforts are made to improve access to health care for mental disorders and epilepsy. This is the reason why in September 2019, the Interactive Meetings Promoting Access to Care and Treatment (IMPACT) Forum co-organized by the Institute of Epidemiology and Tropical Neurology UMR 1094 Inserm, the World Association of Social Psychiatry (WASP), and Sanofi Global Health was focused on “Advocacy: how to create political will for mental health and epilepsy in low- and middle-income countries?” This forum involved 40 people from 20 countries (from Africa, Asia, Latin America, but also from Europe), from various backgrounds (public, private, associative, and academic sectors), all committed to developing access to care for people living with mental disorders or epilepsy in low- and middle-income countries. The 2-day meeting combining plenary didactic sessions and group workshops provided participants with an opportunity to get a better understanding of advocacy, of its importance to drive policy and societal changes, and encouraged them to develop local advocacy plans. A survey conducted at the start of the IMPACT Forum, to evaluate the baseline understanding and attitudes toward advocacy, and repeated at the end, showed improvements in the overall score, as well as in every single item.

International audience; Psychiatric and neurological disorders are now considered among the first contributors to the globalburden of disease. In low‑ and middle‑income countries (LMICs), insufficient specialized humanresources, inadequate training of primary care workers, traditional beliefs, stigmatization, anddiscrimination are the most common barriers to access to care. Availability and cost of medicinesare also common problems. Although in many cases effective treatments exist, 76%–85% of patientswith mental disorders or epilepsy living in LMICs are not treated. Over the last 8 years, throughthe Interactive Meetings Promoting Access to Care and Treatment (IMPACT) forum, the Instituteof Epidemiology and Tropical Neurology UMR 1094 INSERM, the World Association of Social Psychiatry, and Sanofi Global Health Programs have convened every year a group of approximately forty people from about twenty countries (not only from Africa, Asia, and Latin America, but also from Europe), and from various backgrounds (public, private, associative, and academic sectors), who are all involved in developing access to care for people living with mental disorders or epilepsy in LMICs. The meeting held in Versailles, France, on September 13 and 14, 2018, focused on “Scaling Up Interventions for Better Access to Mental Health and Epilepsy Care.” Through didactic presentations based on the World Health ganization‑ExpandNet “Nine steps for developing a scaling‑up strategy” guide, as well as case studies and workshops around three pilot projectsimplemented in Cambodia, Guatemala, and Madagascar, this forum provided participants with an opportunity to gain in knowledge and understanding of scaling‑up theories and to apply these to practical cases.

Background As the data on the association of mental disorders and chronic physical diseases in developing and emerging countries is heterogeneous, this study aims to produce the first meta-analysis of these comorbidities. Methodology The meta-analysis protocol was registered in PROSPERO (N°CRD42017056521) and was performed in accordance with PRISMA guidelines. Initially, an article search was conducted on Medline, Embase, Lilacs and the Institut d’Epidémiologie et de Neurologie Tropicale database [Institute of Epidemiology and Tropical Neurology], as well as manually, with no restriction on language or date focusing on mental disorders, chronic diseases and neurotropic diseases. Two independent investigators assessed the quality of the studies which met the inclusion criteria using the Downs and Black assessment grid. The pooled estimates were calculated out using a random-effects method with CMA software Version 3.0. A meta-regression was then performed, and the significance level was set at 0.05. Results Of the 2604 articles identified, 40 articles involving 21,747 subjects met the inclusion criteria for co-morbidities between mental disorders and chronic physical diseases. Thirty-one articles were included in the meta-analysis of prevalence studies and 9 articles in that of the analytical studies. The pooled prevalence of mental disorders in patients with chronic physical diseases was 36.6% (95% CI, 31.4–42.1) and the pooled odds ratio was 3.1 (95% CI, 1.7–5.2). There was heterogeneity in all the estimates and in some cases, this was explained by the quality of the studies. Conclusion Some estimates regarding the prevalence of mental disorders in people with chronic physical diseases living in developing and emerging countries were similar to those in developed countries. Mental disorders are a burden in these countries. In order to respond effectively and efficiently to the morbidity and mortality associated with them, mental health care could be integrated with physical care. Electronic supplementary material The online version of this article (10.1186/s12889-019-6623-6) contains supplementary material, which is available to authorized users.

Background Although they are declining worldwide, neurotropic parasitic diseases are still common in developing and emerging countries. The aim of this study was to estimate the pooled prevalence and pooled association measures of comorbidities between mental disorders (anxiety, depression, bipolar disorder, and schizophrenia) and neurotropic parasitic diseases (malaria, cysticercosis, toxoplasmosis, human African trypanosomiasis, Chagas disease, and human toxocariasis) in developing and emerging countries.Methods As the first meta-analysis on this topic, this study was performed in accordance with PRISMA guidelines. The protocol was registered in PROSPERO (N°CRD42017056521). The Medline, Embase, Lilacs, and Institute of Epidemiology and Tropical Neurology databases were used to search for articles without any restriction in language or date. We evaluated the quality of studies independently by two investigators using the Downs and Black assessment grid and pooled estimates using the random-effects method from CMA (Comprehensive Meta Analysis) Version 3.0.Results In total, 18 studies studies published between 1997 and 2016 met our inclusion criteria. We found that the prevalence of anxiety and depression in people suffering from Chagas disease and/or neurocysticercosis was 44.9% (95% CI, 34.4 – 55.9). In 16 pooled studies that included 1,782 people with mental disorders and 1,776 controls, mental disorders (schizophrenia and/or bipolar disorders) were associated with increased risk of toxoplasmosis and/or toxocariasis (odds ratio = 2.3; 95% CI, 1.7 – 3.2). Finally, schizophrenia was associated with an increased risk of the onset of toxocariasis and/or toxoplasmosis (odds ratio = 2.4 / 95% CI, 1.7 – 3.4).Conclusion Our pooled estimates show that the association between neurotropic parasitic diseases among people with related mental disorders, and mental disorders among people with neurotropic parasitic diseases are relatively high in developing and emerging countries even though most studies have been found in Asia. This meta-analysis could prove useful to researchers who want to further explore and understand the associations between mental disorders and neurotropic patristic diseases in developing and emerging countries.

Table S2. Characteristics of Analytical Studies of Co-morbidities of Mental Disorders with Chronic Physical Diseases. COPD: Chronic Obstructive Pulmonary Disease, GHQ: General Health Questionnaire, PSE: Present State Examination, ICD: International Classification of Diseases, IDF: International Diabetes Federation, SCL: Syndrome Checklist, SCL: Syndrome Checklist, HADS: Hospital Anxiety and Depression Scale, BDI: Beck Depression Inventory, PHQ: Patient Health Questionnaire, BAI: Beck Anxiety Inventory, BAE: Beck Depression Inventory, F: Female, M: male, Age in years. (DOCX 129 kb)

Table S4. Characteristics of quality scores of analytical studies. Global quality (Items: 1–2–3-5-6-7-9-10); External validity (Items:11–12-13); Results bias (Items: 15–16–18-20); Confusion and selection bias (Item: 25); Power (Item: 27) and S: Quality score. (DOCX 30 kb)

Additional file 2 : Table S2. Characteristics of quality scores of analytical studies. Global quality (Items: 1–2–3-5-6-7-9-10); External validity (Items:11–12-13); Results bias (Items: 15–16–18-20); Confusion and selection bias (Item: 25); Power (Item: 27) and S: Quality score.

Table S1. Characteristics of Prevalence Studies of Co-morbidities of Mental Disorders with Chronic Physical Diseases. MINI: Mini International Neuropsychiatric Interview, HADS: Hospital Anxiety and Depression Scale, BDI: Beck Depression Inventory, STAI: State-Trait Anxiety Inventory, PHQ: Patient Health Questionnaire, DSM: Diagnostic and Statistical Manual for Mental Disorders, SCIDI/CV: Structured Clinical Interview for DSM-IV—Clinical Version; PSE: Present State Examination, MMSE: Mini Mental State Examination, SADS-L: Schedule for Affective Disorders and Schizophrenia-Lifetime, MSE: Mental Status Examination, SAS: Self- rating anxiety scale, SDS: Self-rating depression scale, HAMA: Hamilton Anxiety Rating Scale, HAMD: Hamilton Depression Rating Scale, ICD: International Classification of Diseases, HAD-D: Hospital anxiety and depression, FBG: Fasting Blood Glucose; HbA1c: Glycated Hemoglobin, COPD: Chronic Obstructive Pulmonary Disease, CVD: CerebroVascular Disease, F: Female, M: male, Age in years. (DOCX 149 kb)

Table S3. Characteristics of quality scores of prevalence studies. Global quality (Items: 1–2–3-5-6-7-9-10); External validity (Items:11–12-13); Results bias (Items: 15–16–18-20); Confusion and selection bias (Item: 25); Power (Item: 27) and S: Quality score. (DOCX 71 kb)

Objective The main objective of this study was to evaluate the knowledge, attitudes, and practices (KAP) of health sciences students regarding epilepsy at the end of their curriculum in Benin. Methods We conducted a cross-sectional survey among medical, pharmacy, nursing, and midwife students in their last year of health sciences training in the University of Abomey-Calavi in Benin. Students completed a self-administered questionnaire, containing items addressing demographics, epilepsy treatment, diagnosis, clinical practice, and social tolerance regarding a person with epilepsy (PWE). Results The response rate to our survey was 87.7% (n = 164). The sample consisted of 64 medical students, 22 pharmacy students, 43 nursing students, and 35 midwife students. They were divided into 95 female subjects and 69 males; sex ratio was 0.7. The mean age of participants was 23.6 ± 1.8 years. The mean scores for epilepsy knowledge, practices, and attitudes were respectively 7.6 ± 1.7 out of a maximum score of 11, 3.9 ± 1.8 out of 8, and 9.6 ± 0.8 out of 10. The KAP overall score was 21.1 ± 3.4 out of a maximum score of 29.0. The variables associated with the overall KAP score were training school, gender, having heard about epilepsy before health sciences studies (p = 0.017), and having a relative with epilepsy (p = 0.001). Male students and medical school students had significantly better overall KAP score than female students or the other training schools respectively (p Significance These findings support the need to improve the health sciences students' knowledge of epilepsy, in particular, during their training.