Reverse Innovation in Mental Health: Review and Recommendations

The global health community has strived to attain equitable partnerships in global mental health. To this end, there has been a growing interest in Reverse Innovation. This is defined as the development of an initiative in a Low- or Middle-Income Country setting that is then adopted by a Western counterpart or High-Income Country setting. While often referenced in other branches of medicine, Reverse Innovation remains especially underexplored in mental health care. This paper presents a commentary and literature review examining the status quo on Reverse Innovation in mental health. Barriers to knowledge exchange between Low- and Middle-Income, and High-Income country partners are discussed, and potential solutions are presented

Reverse Innovation in Mental Health: Review and Recommendations

The global health community has strived to attain equitable partnerships in global mental health. To this end, there has been a growing interest in Reverse Innovation. This is defined as the development of an initiative in a Low- or Middle-Income Country setting that is then adopted by a Western counterpart or High-Income Country setting. While often referenced in other branches of medicine, Reverse Innovation remains especially underexplored in mental health care. This paper presents a commentary and literature review examining the status quo on Reverse Innovation in mental health. Barriers to knowledge exchange between Low- and Middle-Income, and High-Income country partners are discussed, and potential solutions are presented

Systematic review on epidemiology, interventions and management of noncommunicable diseases in acute and emergency care settings in Kenya

Introduction: Mortality and morbidity from Non-Communicable Diseases (NCDs) in Africa are expected to worsen if the status quo is maintained. Emergency care settings act as a primary point of entry into the health system for a spectrum of NCD-related illnesses, however, there is a dearth of literature on this population. We conducted a systematic review assessing available evidence on epidemiology, interventions and management of NCDs in acute and emergency care settings in Kenya, the largest economy in East Africa and a medical hub for the continent. Methods: All searches were run on July 15, 2015 and updated on December 11, 2020, capturing concepts of NCDs, and acute and emergency care. The study is registered at PROSPERO (CRD42018088621). Results: We retrieved a total of 461 references, and an additional 23 articles in grey literature. 391 studies were excluded by title or abstract, and 93 articles read in full. We included 10 articles in final thematic analysis. The majority of studies were conducted in tertiary referral or private/mission hospitals. Cancer, diabetes, cardiovascular disease and renal disease were addressed. Majority of the studies were retrospective, cross-sectional in design; no interventions or clinical trials were identified. There was a lack of access to basic diagnostic tools, and management of NCDs and their complications was limited. Conclusion: There is a paucity of literature on NCDs in Kenyan emergency care settings, with particular gaps on interventions and management. Opportunities include nationally representative, longitudinal research such as surveillance and registries, as well as clinical trials and implementation science to advance evidence-based, context-specific care

The last frontier for global non-communicable disease action: The emergency department—A cross-sectional study from East Africa

Introduction: Deaths due to non-communicable diseases (NCDs) have surpassed those due to communicable diseases globally and are projected to do so in Africa by 2030. Despite demonstrated effectiveness in high-income country (HIC) settings, the ED is a primary source of NCD care that has been under-prioritized in Africa. In this study, we assess the burden of leading NCDs and NCD risk factors in Kenyan Casualty Department patients to inform interventions targeting patients with NCDs in emergency care settings. Materials and methods: Using the WHO STEPwise approach to surveillance (STEPS) tool and the Personal Health Questionnaire (PHQ-9), we conducted a survey of 923 adults aged 18 and over at Kenyatta National Hospital Emergency Department (KNH ED) between May-October 2018. Age, income, household size(t-test), sex, education, marital status, work status, and poverty status (chi-squared test or fisher’s exact test) were assessed using descriptive statistics and analyzed using covariate-adjusted logistic analysis. Results: Over a third of respondents had hypertension (35.8%, n = 225/628), 18.3% had raised blood sugar or diabetes (18.3%, n = 61/333), and 11.7% reported having cardiovascular disease (11.7%, n = 90/769). Having lower levels of education was associated with tobacco use (OR 6.0, 95% CI 2.808–12.618, p \u3c 0.0001), while those with higher levels of education reported increased alcohol use (OR 0.620 (95% CI 0.386–0.994, p = 0. 0472). While a predominant proportion of respondents had had some form of screening for either hypertension (80.3%, n = 630/772), blood sugar (42.6%, n = 334/767) or cholesterol (13.9%, n = 109/766), the proportion of those on treatment was low, with the highest proportion being half of those diagnosed with hypertension reporting taking medication (51.6%, n = 116/225). Conclusions: This study establishes the ED as a high-risk population with potential for high impact in East Africa, should targeted interventions be implemented. Comprehension of the unique epidemiology and characteristics of patients presenting to the ED is key to guide care in African populations

Emergency care surveillance and emergency care registries in low-income and middle-income countries: Conceptual challenges and future directions for research

Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future

Odds of Having a Regular Physician and Perceptions of Care: Ethnic Patterns for Women Ages 25–45

Background and Objectives: This study’s purpose was to simultaneously investigate demographic, socioeconomic status, health status, and access-to-care factors to see if they could explain racial/ethnic differences in the odds of reproductive-aged women having a regular physician and perceptions of those women about their care. Methods: Data come from a nationally representative sample of 4,520 women ages 25–45. We used logistic regression models to ascertain the odds of having a regular doctor and feeling cared for among black, Hispanic, and Asian women as compared to non-Hispanic white women. Models contained controls for factors found significant in prior research and interaction terms. Results: Hispanic women have significantly lower odds of having a regular doctor than white non-Hispanic women, a gap primarily explained by differences in language and insurance status. Asian and Hispanic women have significantly lower odds of reporting feeling cared for by their doctor, and black women have higher odds of reporting feeling cared for by their doctor than white women. Significant interaction terms of race/ethnicity by economic level, residence, and health status show that the associations between race/ethnicity and having a regular doctor, and feeling cared for by that doctor, depend on other characteristics. Conclusions: The odds that women of reproductive age will have a regular doctor and report feeling cared for by that doctor differ by race/ethnicity and socioeconomic characteristics. Black women have higher odds, and Spanish-speaking women have lower odds of having a regular doctor than white women, and Hispanic and Asian women have lower odds of feeling cared for

Tobacco use and its determinants in the 2015 Kenya WHO STEPS survey

Abstract Background According to the World Health Organization (WHO), in 2015, over 1.1 billion people smoked tobacco, which represents around 15% of the global population. In Africa, around one in five adults smoke tobacco. The 2014 Kenya Global Adult Tobacco Survey reported that 2.5 million adults use tobacco products. The objective of our study was to describe patterns and determinants of tobacco use from the 2015 Kenya STEPS survey, including use of “smokeless” tobacco products and the more novel e-cigarettes. Methods The WHO STEPwise approach to surveillance (STEPS) was completed in Kenya between April and June 2015. Logistic regression analyses was used to assess factors affecting prevalence and frequency of tobacco use. Sociodemographic variables associated with tobacco use were considered: age, sex, level of education, wealth quintile, and residence. The relationship with alcohol as an intervening risk factor was also assessed. Our main outcomes of interest were current tobacco use, daily tobacco use and use of smokeless tobacco products. Results Of 4484 respondents, 605 (13.5%) reported being current tobacco users. Most active tobacco users were male (n = 507/605, 83.8%). Three out of four tobacco users (n = 468/605, 77.4%) reported being less than 50 years old, with the average start age being 21 (20.6, 95% CI 19.3–21.8) and the average quit age 27 (27.2, 95% CI 25.8–28.6). Most tobacco users had only ever attended up to primary school (n = 434/605, 71.7%). Men had nearly seven times higher odds of being tobacco users as compared to women (OR 7.63, 95% CI 5.63–10.33). Alcohol use had a positive effect on tobacco use. Finally, less than ten respondents reported having used e-cigarettes. Conclusion The 2015 Kenya WHO STEPS provided primary data on the status of tobacco use in the country and other leading NCD risk factors, such as alcohol, and associated diseases. Our findings highlight key target populations for tobacco cessation efforts: young people, men, those with lower levels of education, and alcohol consumers. Further data is needed on the use of smokeless tobacco, and its impact on smoked tobacco products, as well as on the novel use of e-cigarettes

Prevalence and correlates of depression and substance use disorders in emergency department populations: A cross-sectional study at East Africa's largest public hospital

Introduction: There are persistent gaps in screening, identification, and access to care for common mental disorders in Low- and Middle-Income Countries. An initial step towards reducing this gap is identifying the prevalence, co-morbidities, and context of these disorders in different clinical settings and exploring opportunities for intervention. This study evaluates the prevalence and correlates of depression and substance use disorders among adults presenting to the Emergency Department (ED) of a major national hospital in East Africa. Methods: This study utilized the World Health Organization's STEPwise Approach to Surveillance (WHO-STEPS) tool and the Patient Health Questionnaire (PHQ-9) to conduct a cross-sectional survey capturing socio-demographic data, tobacco, and alcohol use and rates of depression in a sample of adults presenting to the ED. Bivariate and multivariate analyses were conducted for each outcome of interest and socio-demographics. Results: Of 734 respondents, 298 (40.6%) had a PHQ-9 score in the “moderate” to “severe” range indicative of major depressive disorder. About 17% of respondents endorsed current tobacco use while about 30% reported being daily alcohol users. Those with high PHQ-9 score had higher odds of reporting current tobacco use (“severe range” = adjusted odds ratio (aOR) 1.85, 95% CI 1.05, 3.26). Those with a “severe” PHQ-9 scores were 9 times (aOR 2.3-35.3) more likely to be daily drinkers. Conclusions: Screening and identification of people with depression and substance use disorders in the ED of a large national hospital in Kenya is feasible. This offers an opportunity for brief intervention and referral to further treatment

Comparing Liquid and Solid Media on the Growth of Plantlets from Three Kenyan Potato Cultivars

Tissue culture has been used to produce high quality and clean planting material. In addition to viral elimination, tissue culture offers other advantages such as rapid multiplication of seed stock for basic seed production within a short period of time. The method is also useful for germplasm conservation. Although, in-vitro multiplication of potato was started 40 years ago and is promising, extensive use in developing countries has been limited by the high costs of media. There is thus need to explore cheaper alternatives without compromising on quality of in -vitro plantlets. A study was carried out to compare the effects of the liquid medium and solid medium on performance of three popular Kenyan potato cultivars i.e. Dutch, Kenya Sifa and Tigoni. Liquid medium consisted of Murashige and Skoog medium supplemented with normal vitamins and sucrose while solid medium consisted of the same chemicals into which phytagel were added to solidify the medium. Data taken were number of roots, nodes and leaves per plantlet over time. From the results, the liquid medium gave more roots, more nodes and more leaves per plantlet than the solid medium. The results therefore indicated that liquid media have a significant effect on the plant growth. In addition, liquid medium was found to be cheaper than solid media by USD 1.65. It appears more economical to use liquid media than solid media for in vitro micro-propagation of potato. However, the experiment needs to be repeated especially with different potato cultivars so as to come up with useful recommendations

Prevalence and determinants of heavy episodic drinking among adults in Kenya: analysis of the STEPwise survey, 2015

Abstract Background Globally, alcohol consumption contributes to 3.3 million deaths and 5.1% of Disability Adjusted Life Years (DALYs), and its use is linked with more than 200 disease and injury conditions. Our study assessed the frequency and patterns of Heavy Episodic Drinking (HED) in Kenya. HED is defined as consumption of 60 or more grams of pure alcohol (6+ standard drinks in most countries) on at least one single occasion per month. Understanding the burden and patterns of heavy episodic drinking will be helpful to inform strategies that would curb the problem in Kenya. Methods Using the WHO STEPwise approach to surveillance (STEPS) tool, a nationally representative household survey of 4203 adults aged 18–69 years was conducted in Kenya between April and June 2015. We used logistic regression analysis to assess factors associated with HED among both current and former alcohol drinkers. We included the following socio-demographic variables: age, sex, and marital status, level of education, socio-economic status, residence, and tobacco as an interaction factor. Results The prevalence of HED was 12.6%. Men were more likely to engage in HED than women (unadjusted OR 9.9 95%, CI 5.5–18.8). The highest proportion of HED was reported in the 18–29-year age group (35.5%). Those currently married/ cohabiting had the highest prevalence of HED (60%). Respondents who were separated had three times higher odds of HED compared to married counterparts (OR 2.7, 95% CI 1.3–5.7). Approximately 16.0% of respondents reported cessation of alcohol use due to health reasons. Nearly two thirds reported drinking home-brewed beers or wines. Tobacco consumption was associated with higher odds of HED (unadjusted OR 6.9, 95% CI 4.4–10.8); those that smoke (34.4%) were more likely to engage in HED compared to their non-smoking counterparts. Conclusion Our findings highlight a significant prevalence of HED among alcohol drinkers in Kenya. Young males, those with less education, married people, and tobacco users were more likely to report heavy alcohol use, with male sex as the primary driving factor. These findings are novel to the country and region; they provide guidance to target alcohol control interventions for different groups in Kenya