YANET HEALTH SCIENCE COLLEGE

MSC IN GENERAL PUBLIC HEALTH

INDIVIDUAL ASSIGNEMENT

SUBMIITED BY: TIBLET TADESSE

ID:

SUBMITTED TO:

FEBRUARY 25, 2024 G.C

ADDIS ABABA, ETHIOPIA

1. Prevalence and Correlates of internalized stigma among patients with severe mental disorder
Attending Outpatient Department at Amanuel Mental Specialized Hospital, Addis Ababa,
Ethiopia, 2024 G.C
2. Prevalence and associated factors of medication non-adherence among schizophrenia patients
at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia 2024 G.C
3. Quality of life and associated factors among patients with schizophrenia attending the
outpatient department at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia, 2024
G.C
TITLE-ONE
Prevalence and Correlates of internalized stigma among patients with severe mental disorder
Attending Outpatient Department at Amanuel Mental Specialized Hospital, Addis Ababa,
Ethiopia, 2024 G.C

Rationale of the study:Research has shown that internalized or self-stigma greatly affects
individuals with mental health issues, leading to poorer treatment adherence, health
outcomes, and quality of life. Although societal stigma towards people with mental illnesses
is high in many low-income countries like Ethiopia, little research has been conducted to
determine the magnitude and causes of self-stigma among patients in these regions.
Understanding the prevalence and factors that contribute to self-stigma is critical to
developing effective stigma-reducing interventions aimed at enhancing the mental health and
well-being of individuals suffering from severe mental disorders.
General Objective:
o To assess the prevalence and correlates of internalized stigma among patients with
severe mental disorders attending outpatient services at Amanuel Mental Specialized
Hospital in Addis Ababa, Ethiopia 2024 G.C
Specific Objective:
o To determine the prevalence of internalized stigma among patients with severe
mental disorders attending outpatient services at Amanuel Mental Specialized
Hospital in Addis Ababa, Ethiopia.
To identify the correlates of internalized stigma among patients with severe mental
disorders attending outpatient services at Amanuel Mental Specialized Hospital in Addis
Ababa, Ethiopia.
Dependent Variable:Internalized Stigma (Low internalized stigma or severe internalized
stigma
Independent Variable:

Sociodemographic:

 Age
 Sex
 Education level
  Marital status
 Employment status

Clinical:

 Diagnosis (e.g. schizophrenia, bipolar disorder, depression)

 Illness duration
 Number of hospitalizations
 Symptom severity
 Social:

Social support

 Experiences of discrimination/stigma from others

 Treatment-related:
 Adherence to medication
 Adherence to therapy/ follow-up appointments

Other potential factors

 Substance use
 Coping strategies
 Religion/spirituality
 Stigma coping mechanisms
Type of Analysis: This hospital-based cross-sectional study will employ a variety of
statistical analyses. Descriptive statistics will be used to outline the characteristics of
participants. Bivariate analyses such as chi-square tests will explore associations between
internalized stigma and sociodemographic as well as clinical variables. Following this,
multivariable logistic regression will identify independent factors correlated with stigma after
adjusting for confounders. The results will help discern the most influential determinants of
internalized stigma to guide the development of targeted interventions aimed at stigma
reduction for this vulnerable patient group.
Expected Outcome:This study seeks to quantify self-stigma among patients and discern
factors that influence it. Findings will provide insight into vulnerabilities and predictive
patterns. With a deeper understanding of determinants, recommendations can be made to
design interventions addressing internalized stigma. Ultimately, the aim is to advance stigma
reduction and foster better care, outcomes, and advocacy for people suffering with mental
illness.
TITLE 2
Prevalence and associated factors of medication non-adherence among schizophrenia patients at
Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia 2024 G.C

Rationale of the study: Medication non-adherence is a major challenge in the long-term

management of schizophrenia, exacerbating symptoms and increasing relapse risk. Poor
adherence to treatment is associated with increased healthcare costs, worse functional
outcomes, and reduced quality of life. While non-adherence is recognized globally as an
important issue, there is limited research on its prevalence and determinants among patients
in low-income settings like Ethiopia.Identifying modifiable barriers and facilitators of
medication-taking would aid in developing targeted, evidence-based interventions to promote
sustained treatment adherence. This is crucial for improving the long-term management of
schizophrenia in Ethiopia.
General Objective:To assess the prevalence and associated factors of medication non-
adherence among schizophrenia patients attending outpatient services at Amanuel Mental
Specialized Hospital in Addis Ababa, Ethiopia 2024 G.C
Special Objective: To determine the prevalence of medication non-adherence among
schizophrenia patients at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia 2024
G.C To identify the associated factors of medication non-adherence among schizophrenia
patients at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia 2024
Dependent variable:

Medication non-adherence (dichotomous: adherent vs non-adherent)

Independent variables:

Sociodemographic:

 Age
 Sex
 Marital status
 Education level
 Occupation

Clinical:
  Diagnosis (schizophrenia subtype)
 Illness duration
 Symptom severity
 Comorbid substance use
 Number of hospitalizations

Treatment-related:

 Medication beliefs/attitudes
 Insight into illness
 Side effects experienced

Psychosocial Factors

 Social support
 Stigma experiences
 Functioning:
 Activities of daily living
 Social functioning

Type of analysis: Hospital based cross-sectional study, descriptive statistics was used to see the
frequency, mean, standard deviation, and percentages of the characteristics. Binary logistic
regression was used to the assess relationship between the independent variables with the
dependent variable and multivariate logistic regression to control the effect of possible
confounders. All variables with p-value ≤ 0.2 were taken into the multivariable model to control
for all possible confounders and finally, the strength of the association was measured by odds
ratio with 95% CI and P-value less than 0.05 will be considered as statistically significant.

Expected Outcome:This study will quantify the scope of non-adherence in schizophrenia and
uncover influences on this issue. Findings can guide local efforts to promote medication taking.
By addressing adherence barriers, outcomes like symptoms and quality of life may also improve.
Ultimately, the goal is better care for patients through a deeper understanding of challenges to
treatment.
TITLE-3
Quality of life and associated factors among patients with schizophrenia attending the outpatient
department at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia, 2024 G.C

Rationale of the study: While quality of life impairment is recognized as a core aspect of
schizophrenia, there remains a lack of research exploring life quality and influencing
determinants among patients receiving care in low-resource settings. This is an important gap
to address given the needto cope with severe mental illness often without robust family and
social support systems present in Ethiopia. This study aims to quantify subjective well-being
and discern associated clinical, treatment, and psychosocial barriers and facilitators among
outpatients at Amanuel Mental Specialized Hospital in Addis Ababa. The goal is to better
understand life quality challenges facing this vulnerable group to guide culturally-informed
efforts to improve community functioning outcomes through targeted strategies.
General Objective:To assess the quality of life and associated factors among patients with
schizophrenia attending outpatient services at Amanuel Mental Specialized Hospital in Addis
Ababa, Ethiopia, 2024 G.C.
Specific Objective: To determine the quality of life levels among patients with
schizophrenia attending outpatient services at Amanuel Mental Specialized Hospital in Addis
Ababa, Ethiopia, 2024 G.C.

To identify the associated factors of quality of life among patients with schizophrenia attending
outpatient services at Amanuel Mental Specialized Hospital in Addis Ababa, Ethiopia, 2024 G.C.

Dependent variable:

Quality of life (using a validated scale like WHOQOL-BREF)

Independent variables:

Sociodemographic:

 Age
 Sex
 Education level
 Marital status
  Employment status

Clinical:

 Diagnosis
 Illness duration
 Symptom severity
 Comorbidities
 Number of hospitalizations

Treatment-related:

 Insight into illness

 Adherence to medication
 Duration of treatment
 Contact with mental health services

Psychosocial:

 Social support
 Internalized stigma
 Functioning in daily activities
Type of Analysis: Hospital Based cross-sectional study, descriptive statistics will be used to
see the frequency, mean, standard deviation, and percentages of the characteristics. Binary
logistic regression will be used to assess the relationship between the independent variables
with the dependent variable and multivariate logistic regression to control the effect of
possible confounders. All variables with p-value ≤ 0.2 will be taken into the multivariable
model to control for all possible confounders and finally the strength of the association will
be measured by odds ratio with 95% CI and P-value less than 0.05 will be considered as
statistically significant
Expected Outcome: This study will provide valuable insights into the quality of life
challenges faced by patients with schizophrenia in Ethiopia. By measuring current life
quality levels, the true burden experienced by this vulnerable population will be
characterized. Identifying sociodemographic, clinical, and psychosocial correlates of well-
being will offer a clearer picture of at-risk groups and influencing life domains.With a deeper
understanding of barriers and unmet needs, targeted strategies can then be developed and
tested. Recommendations will aim to strengthen community reintegration support through
addressing modifiable determinants.