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Integrating mental health into primary health care in Nigeria: management of depression in a local government (district) area as a paradigm.

BACKGROUND
In Nigeria, the primary health care (PHC) manned by non-physician health workers, forms the bedrock of the health care system. And mental health care has not yet been integrated into primary health care system.


OBJECTIVE
To demonstrate how the training of primary health care workers in the recognition and management of depression can form an example of systematic integration of mental health into primary health care.


METHODS
The training needs and knowledge of 62 primary health care workers were assessed through focus group discussions and structured self-administered questionnaire. A two-day training program on the recognition and management of depression was conducted using an adapted version of the World Psychiatric Association (WPA) guidelines for the management of depression in primary health care. The trainees completed a pre and post-training assessments to determine the immediate outcome of the training.


RESULTS
Pre-training, the health workers had very poor knowledge of depression. None of the participants could mention any antidepressant. There were significant improvements in knowledge post training, with the greatest gain in knowledge occurring in drug management of depression. General outcome evaluation showed significant increase in knowledge and skills for the recognition and management of depression.


CONCLUSIONS
The training increased PHC workers knowledge about the concept, recognition and management of depression. And the methods adopted could be helpful means of integrating mental health into PHC.