Emergency mental health and psychosocial support for survivors of post-election violence in Eldoret, Kenya

Objective: To describe the design and delivery of emergency mental health and psychosocial support services for the survivors of Post-Election Violence in Eldoret, Kenya.Design: A longitudinal intervention.Setting: The North Rift Valley region in western Kenya.Subjects: A total of 80,772 survivors received mental health and psychosocial support services.Results: Counselling and Psychological First Aid services were successfully offered to most survivors in the North Rift Valley region. Common issues addressed included looking for lost relatives, sudden traumatic death of relatives, anger at their attackers, feelings of revenge, fear of seeing the corpse, loss of all property and source of livelihood and denial.Conclusion: It is possible and necessary to integrate a mental health and psychosocial support intervention into a disaster response even in limited resource settings. Further studies are recommended to evaluate the effectiveness of this approach

Mental Disorders Among Health Care Workers at the Early Phase of COVID-19 Pandemic in Kenya; Findings of an Online Descriptive Survey

Background: Healthcare workers responding to the Corona Virus Pandemic (COVID-19) are at risk of mental illness. Data is scanty on the burden of mental disorders among Kenyan healthcare workers responding to the pandemic that can inform mental health and psychosocial support. The purpose of this study was to establish the frequency and associated factors of worry, generalized anxiety disorder, depression, posttraumatic stress disorder and poor quality of sleep among Kenyan health care workers at the beginning of COVID-19 pandemic. Methods: We conducted an online survey among 1,259 health care workers in Kenya. A researcher developed social demographic questionnaire and several standardized tools were used for data collection. Standardized tools were programmed into Redcap, (Research Electronic Data Capture) and data analysis was performed using R Core Team. In all analysis a p-value \u3c 0.05 was considered significant. Results: 66% of the participants reported experiencing worry related to COVID-19. 32.1% had depression, 36% had generalized anxiety, 24.2% had insomnia and 64.7% scored positively for probable Post Traumatic Stress Disorder (PTSD). Depression was higher among females compared to men (36.5 vs. 26.9%, p = 0.003), workers \u3c35 years old compared to older ones (38.1 vs. 26.4%, p \u3c 0.001), and those who were not married compared to those who were married (40.6 vs. 27.6%, p \u3c 0.001). Generalized anxiety was commoner among workers aged \u3c35 years (43.5 vs. 29.3%, p \u3c 0.001), females (41.7 vs. 29.2%, p \u3c 0.001), those who mere not married compared to the married (45.2 vs. 31.2%, p \u3c 0.001) and those with \u3c10 years working experience (41.6 to 20.5%, p \u3c 0.001). Younger health care professional had a higher proportion of insomnia compared to the older ones (30.3 vs. 18.6%, p \u3c 0.001). Insomnia was higher among those with \u3c10 years\u27 experience compared to those with more than 20 years\u27 experience(27.3 vs. 17.6%, p = 0.043) Conclusion: Many Kenyan healthcare workers in the early phase of COVID-19 pandemic suffered from various common mental disorders with young, female professionals who are not married bearing the bigger burden. This data is useful in informing interventions to promote mental and psychosocial wellbeing among Kenyan healthcare workers responding to the pandemic

Substance use among inmates at the Eldoret prison in Western Kenya

Background:Criminal activity and social problems are recognized as important outcomes of substance use and abuse. Little research has been carried out on substance use among prison inmates in Kenya. General population surveys that have examined drug use usually omit this‘hidden’population which may offer insight into drug related morbidity and invaluable preventive measures. This study is set out to determine the lifetime prevalence and factors associated with substance use, including the most frequently used substances, among inmates at a government prison in Western Kenya. Methods:Design: A cross-sectional descriptive study, using the WHO model questionnaire and an additional drug use and effects questionnaire among prisoners at the Eldoret Government of Kenya (GK) prison, Kenya.Setting: Study was carried out at the Eldoret G.K. prison, with a population of 1325 (1200 males and 125 females) inmates.Subjects: Three hundred and ninety five prisoners, who gave consent, were selected, consisting of 271 males (68.6%)selected by simple random sampling, and 124 females (31.4%) enrolled consecutively due to their small number. The mean age was 33.3 years (18–72, s.d. 9.8) while the mean number of years of formal education was 8.4 (0–15,s.d.3.4). Results:Lifetime prevalence of substance use was 66.1%, while that of alcohol use was 65.1%. Both were significantly associated with male gender, urban residence and higher level of education. The lifetime prevalence of cigarette use was 32.7% while 22.5% admitted to chewing tobacco. Factors significantly associated with tobacco use were male gender,urban residence, being unmarried, younger age, lack of income in the past year. The prevalence of cannabis use was 21%,and this was associated with male gender, urban residence,being unmarried, and being a student in the past year. Other substances used included amphetamines (9.4%), volatile inhalants (9.1%), sedatives(3.8%), tranquillizers (2.3%), cocaine(2.3%), and heroine (1.3%). Users were commonly introduced to the habit by friends (70.8%), immediate family members(13.7%) and other close relatives (6.2%). Among those who reported lifetime substance use the common reasons attributed to the habit were the need to relax (26.5%), relieve stress (24.5%) and confidence to commit a crime (4.5%).Majority of those who reported alcohol use were already suffering ill effects. Conclusions:There is a high prevalence of substance use among prisoners at the Eldoret G.K. prison. The increased morbidity and unpleasant psychosocial consequences of this habit suggest a need for establishment of substance use management programmes in Kenyan prisons

Mental health and climate change in Africa

It is now widely acknowledged that low- and middle-income countries in Africa are among global hotspots for high vulnerability to climate change, despite making comparatively low contributions to this phenomenon. Climate change has been shown to affect mental health as a result of disruption of social and economic structures that populations depend on for good health, including mental health. After decades of neglect, recent efforts by governments such as in Kenya to address the twin issues of climate change and mental health demonstrate the growing importance of these issues. Here we briefly review the evidence of climate change impacts on mental health in Africa and demonstrate that there is need for more contextual awareness and research in this area in Africa to mitigate or forestall potential mental health crises in the near future. We recommend systematic efforts to support funding for research and interventions at the nexus between climate change and mental health in Africa, and urge institutions and governments in Africa to begin paying attention to this emerging threat to the health of African populations

The Prevalence of Post-Traumatic Stress Disorder Among Sexually Abused Children at Kenyatta National Hospital in Nairobi, Kenya

Background: Post-Traumatic Stress Disorder (PTSD) develops following some stressful events. There has been increasing recognition that children who have been exposed to traumatic events like child sexual abuse can develop post-traumatic stress disorder just like adults.Objective: To determine prevalence of PTSD in sexually abused children seen at the Gender Based Violence Recovery Centre at Kenyatta National Hospital.Design: A cross sectional descriptive study.Setting: Gender Based Violence Recovery Centre – Kenyatta National Hospital. Subjects One hundred and forty-nine (n = 149) sexually abused children were recruited in the study.Results: The mean age 14.8%boys and 85.2% girls was 13.2 years (SD 4.2) the age at which sexual abuse most frequently (55%) occurred between 15-17 years. Sixty three percent of children reported that the perpetrator was known to them, and 76.5% of perpetrators used verbal or physical force during sexual assault. The prevalence of PTSD among the sexually abused children was 49%. PTSD was significantly associatedwith shorter duration of sexual abuse i.e. daily which is 67% as compared to months which is 4.7% (p = 0.005), Greater severity of injuries sustained during assault (p = 0.023), parent’s marital status those whose parents were married or cohabiting 40% were affected as compared to 52% whose parents were separated or divorced (p = 0.003) and the family's way of sorting out their disagreements was also significantly associated with PTSD. Parents who sorted their disagreement by talking was at 31% while thosewho sorted their disagreement by fighting was at 67% (p < 0.001).Conclusions: This study highlights the high prevalence of PTSD among sexually abused children presenting at Kenyatta National Hospital Nairobi-Kenya. PTSD is associated with the degree of physical or verbal abuse during sexual abuse, injuries during assault, and parent-child relationships. These findings are important in formulation of appropriate prevention and care interventions to be implemented by families and other stakeholders

Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV - positive women: Evidence from government facilities in Kenya

Introduction: Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV’s association with poor ART adherence. We investigate this association among a broad group of women. Methods: We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using the Visual Analogue Scale (VAS); responses were dichotomised at a �95% cut-off. Multiple logistic regression models assessed the association between the independent variables and ART adherence. Results: The participants’ mean age was 38.6 (range: 18–69 years). The majority had ever attended school (94%, n = 382), were in monogamous marriages (70%, n = 282), and had disclosed status to partners (94%, n = 380). Overall, 60% (n = 242) reported optimal ART adherence (� 95%) in the previous 30 days. The prevalence of IPV by the current partner was 76% (CI95 = 72–80%). Experiencing physical IPV (AOR 0.57, CI95: 0.34–0.94, p = .028), sexual IPV (AOR 0.50, CI95: 0.31–0.82, p = .005), or controlling behaviour (AOR 0.56, CI95: 0.34– 0.94, p = .027) reduced the odds of achieving optimal adherence, while a higher education level and having an HIV-positive partner increased the odds. Conclusion: IPV is common and is associated with suboptimal ART adherence rates among a broad group of HIV-positive women. ART programs could consider incorporating basic IPV interventions into regular clinic services to identify, monitor and support exposed women, as they might be at risk of poor ART adherence. Still, there is need for more research on how IPV affects ART adherence

The journey of addiction: Barriers to and facilitators of drug use cessation among street children and youths in Western Kenya

This mixed-methods study examined barriers to and facilitators of street children’s drug use cessation in Eldoret, Kenya utilizing a cross-sectional survey and focus group discussions with a community-based sample of street-involved children and youth. The primary objective of this study was to describe factors that may assist or impede cessation of drug use that can be utilized in developing substance use interventions for this marginalized population. In 2011, 146 children and youth ages 10–19 years, classified as either children on the street or children of the street were recruited to participate in the cross-sectional survey. Of the 146 children that participated in the survey 40 were invited to participate in focus group discussion; 30 returned voluntarily to participate in the discussions. Several themes were derived from children’s narratives that described the barriers to and facilitators of drug cessation. Specifically, our findings reveal the strength of the addiction to inhalants, the dual role that peers and family play in substance use, and how the social, cultural, and economic context influence or impede cessation. Our findings demonstrate the need to integrate community, family and peers into any intervention in addition to traditional medical and psychological models for treatment of substance use dependence

Trauma and posttraumatic stress disorder in South Africa: analysis from the South African Stress and Health Study

Background: South Africa’s unique history, characterised by apartheid, a form of constitutional racial segregation and exploitation, and a long period of political violence and state-sponsored oppression ending only in 1994, suggests a high level of trauma exposure in the general population. The aim of this study was to document the epidemiology of trauma and posttraumatic stress disorder (PTSD) in the South African general population. Methods: The South African Stress and Health Study is a nationally representative survey of South African adults using the WHO’s Composite International Diagnostic Interview (CIDI) to assess exposure to trauma and presence of DSM-IV mental disorders. Results: The most common traumatic events were the unexpected death of a loved one and witnessing trauma occurring to others. Lifetime and 12-month prevalence rates of PTSD were 2.3% and 0.7% respectively, while the conditional prevalence of PTSD after trauma exposure was 3.5%. PTSD conditional risk after trauma exposure and probability of chronicity after PTSD onset were both highest for witnessing trauma. Socio-demographic factors such as sex, age and education were largely unrelated to PTSD risk. Conclusions: The occurrence of trauma and PTSD in South Africa is not distributed according to the sociodemographic factors or trauma types observed in other countries. The dominant role of witnessing in contributing to PTSD may reflect the public settings of trauma exposure in South Africa and highlight the importance of political and social context in shaping the epidemiology of PTSD

“Association between Traumatic Life Events and Psychosis: A case-control study in western Kenya

Globally close to 70% of the general population has experienced at least one traumatic life event (TLE). Although child and adulthood exposure to TLEs is considered a risk factor for the subsequent development of psychosis, few studies have examined the association between trauma and psychosis in the African population. We sought to explore the association between TLEs and psychosis in patients with psychotic disorders (N = 254) and individuals without (N = 254). The participants were matched by age and sex. The study was conducted at a national referral hospital, the Life Events Checklist for DSM-5 (LEC-5) was used to obtain data on TLEs, and ethical approval was obtained from the ethics committee. The proportion of those who experienced TLEs was equal among the cases and controls at about 80%. However, more cases reported that the TLEs happened to them (cases 60.3, p = 0.004). After multivariate analysis, the following specific TLEs remained statistically significant.: Physical assault (aOR = 3.66, 95% CI 2.28–5.48), assaults with a weapon (aOR = 5.26, 95% CI 2.15–10.48), sexual assault (aOR = 4.55, 95% CI 1.08–10.48). The sudden death of a loved one (aOR = 2.33, 95% CI 1.15–4.70) and serious injury/harm to others (aOR = 10.53, 95% CI 1.47–89.37)