The practice of electroconvulsive therapy in Malawi

Objectives: To describe the practice of electroconvulsive therapy (ECT), including indications, efficacy, and side effects, in patients treated with unmodified ECT at Zomba Mental Hospital (ZMH) in Malawi. Methods: A naturalistic, descriptive cohort study that includes all patients receiving ECT in March and April 2006. Efficacy of ECT treatment was assessed with the "Clinical Global Impression" of change scale, and side effects and complications were systematically assessed with a checklist. Results: The circumstances and procedure of ECT at ZMH are described. Forty-seven patients underwent unmodified ECT for various affective and psychotic disorders. Depending on the indication, improvement was reported in 71% to 90%. Cognitive side effects (confusion and amnesia), muscle aches, headache, and lesions of the oral cavity were the most prevalent side effects. Serious complications were not encountered. Conclusions: Unmodified ECT in Malawi is an effective treatment with less severe side effects than commonly thought. Efforts to improve treatment standards are undertaken.