Major grant to research schizophrenia care in developing countries

Keele University has been awarded a £500,000 research grant by the Medical Research Council (UK) to assess the effectiveness of a community-based intervention in Pakistan in order to address the current gap in care for Schizophrenia patients within developing countries.

Schizophrenia is a long-term disorder which involves the breakdown between a person’s thoughts, emotions, and behaviour. Often this can lead to faulty perceptions and delusions that cause inappropriate actions and feelings, and withdrawal from reality and personal relationships into fantasy.
Recent research led by the World Health Organisation found that 69% of schizophrenia patients across developing countries receive no treatment, rising to a staggering 96% in Pakistan. Studies also suggest that patients are nearly three times as likely to be admitted to hospital, and their risk of suicide is increased almost four-fold, after just one month or less of no treatment.

Lack of treatment for Schizophrenia occurs due to a number of reasons, such as a lack of primary care involvement and poor access to treatment. Poor treatment adherence is a key factor, with more than approximately 50% of patients failing to take their prescribed medication either regularly or not at all.

Dr Saeed Farooq, Clinical Senior Lecturer at Keele University, previously led the development and evaluation of a trial called Supervised Treatment in Out-Patients for Schizophrenia (STOPS). The randomised controlled trial showed that STOPS was successful in significantly improving treatment adherence with medication and controlling symptoms.

STOPS, which was modelled on a successful public health approach developed by the World Health Organisation to tackle poor treatment adherence in Tuberculosis (TB), involves a named supervisor being responsible for watching and recording the patient swallowing the correct dosage of antipsychotic medication.

The intervention is comprised of four components; registration and recording of all individuals diagnosed with schizophrenia within a geographically defined catchment area; training of a close relative in collecting, administering, supervising and recording the medication; consistent drug supply and standardised monitoring of the treatment and its outcomes.

The Medical Research Council has now awarded this large grant which will allow Dr Farooq and his team to use the STOPS intervention in a larger community setting. The research, called STOPS+ will take place in a semi-urban setting of Peshawar, Pakistan in the province of Kyhber Pukhtunkwa, and has established a collaboration with two academic partners, Lady Reading Hospital and Khyber Medical University.

Dr Farooq explained: “Although we know the strategies needed to reduce the treatment gap, our main challenge is how we translate that evidence into practice. This research will allow us to scale-up STOPS, which showed evidence of its effectiveness within a tertiary care mental health facility. Whereas STOPS+ will be implemented into primary care, incorporating the well-established strategies for reducing the treatment gap.

“I’m thoroughly excited to lead this study, which not only hopes to close the treatment gap, but also reduce family burden and the stigma associated with the disorder amongst communities, and also improve the overall physical health in people with schizophrenia.

“To be awarded this research grant is a great achievement, given the competitive nature of the application process. But global health is high on the university’s agenda, and I am confident that this research will be a real game changer for healthcare within developing countries.”