The prevalence of anxiety and depression symptoms and syndromes in Kenyan children and adolescents

Background: Community studies on children and adolescents in Western settings suggest prevalence rates of anxiety and depressive symptoms that require intervention. Aim: To establish equivalent prevalence rates in a Kenyan (developing country) situationMethod: Self-administered questionnaires for socio-demographic data, three Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV)-based instruments for anxiety symptoms and syndromes in children, one instrument for depression and one culture sensitive instrument for depression and anxiety were administered in three different sets to 3 775 randomly sampled students drawn from a stratified sample of 34.7% of all public secondary schools in Nairobi, Kenya. Results: The prevalence rates of anxiety and depression symptoms and syndromes varied widely depending on sex and age and also on the emphasis of the different instruments used, and also according to the cut-off points for the various syndromes and instruments. Clinical diagnostic scores for depression were recorded in 43.7% of all the students. Using the cut-off points for the Multidimensional Anxiety Scale for Children (MASC), anxiety was recorded in 12.9% of all students. Nearly half (40.7%) of the respondents who completed the Short Leyton Obsessional Inventory for Children and Adolescents had positive scores for obsessive disorder, 81.1% were positive for compulsive disorder and an average of 69.1% had positive scores for both obsessive and compulsive disorders combined. Amongst those who completed the Ndetei-Othieno-Kathuku (NOK) scale for Depression and Anxiety, 49.3% had positive scores for moderate to severe anxiety with or without depression. The Screen for Child Anxiety Related Disorders – Revised (SCARED-R) yielded high levels (50–100%) for the different syndromes, with obsessive-compulsive disorder at 99.3%, just below separation anxiety and school phobia at 100%. Suicidal thoughts and plans were prevalent at 4.9–5.5%. Conclusion: Anxiety and depression were found at prevalence rates no less than is found in the West. This calls for appropriate clinical practices and policies.Journal of Child and Adolescent Mental Health 2008, 20(1): 33–5

The prevalence of mental disorders in adults in different level general medical facilities in Kenya: a cross-sectional study

Abstract Background The possibility that a significant proportion of the patients attending a general health facility may have a mental disorder means that psychiatric conditions must be recognised and managed appropriately. This study sought to determine the prevalence of common psychiatric disorders in adult (aged 18 years and over) inpatients and outpatients seen in public, private and faith-based general hospitals, health centres and specialised clinics and units of general hospitals. Methods This was a descriptive cross-sectional study conducted in 10 health facilities. All the patients in psychiatric wards and clinics were excluded. Stratified and systematic sampling methods were used. Informed consent was obtained from all study participants. Data were collected over a 4-week period in November 2005 using various psychiatric instruments for adults. Descriptive statistics were generated using SPSS V. 11.5. Results A total of 2,770 male and female inpatients and outpatients participated in the study. In all, 42% of the subjects had symptoms of mild and severe depression. Only 114 (4.1%) subjects had a file or working diagnosis of a psychiatric condition, which included bipolar mood disorder, schizophrenia, psychosis and depression. Conclusion The 4.1% clinician detection rate for mental disorders means that most psychiatric disorders in general medical facilities remain undiagnosed and thus, unmanaged. This calls for improved diagnostic practices in general medical facilities in Kenya and in other similar countries.</p

Effects of valacyclovir on markers of disease progression in postpartum women co-infected with HIV-1 and herpes simplex virus-2.

Herpes simplex virus type 2 (HSV-2) suppression has been shown to reduce HIV-1 disease progression in non-pregnant women and men, but effects on pregnant and postpartum women have not been described.We analyzed data from a cohort of Kenyan women participating in a randomized clinical trial of HSV-2 suppression. Pregnant HIV-1-seropositive, HSV-2-seropositive women who were not eligible for antiretroviral therapy (WHO stage 1-2, CD4>250 cells/µl) were randomized to either 500 mg valacyclovir or placebo twice daily from 34 weeks gestation through 12 months postpartum. Women received zidovudine and single-dose nevirapine for prevention of mother-to-child HIV-1 transmission. HIV-1 progression markers, including CD4 count and plasma HIV-1 RNA levels, were measured serially. Multivariate linear regression was used to compare progression markers between study arms.Of 148 women randomized, 136 (92%) completed 12 months of postpartum follow-up. While adjusted mean CD4 count at 12 months (565 cells/µl placebo arm, 638 cells/µl valacyclovir arm) increased from antenatal levels in both arms, the mean CD4 count increase was 73 cells/µl higher in the valacyclovir arm than placebo arm (p = 0.03). Mean increase in CD4 count was 154 cells/µl in the valacyclovir arm, almost double the increase of 78 cells/µl in the placebo arm. At 12 months, adjusted HIV-1 RNA levels in the placebo arm increased by 0.66 log(10) copies/ml from baseline, and increased by only 0.21 log(10) copies/ml in the valacyclovir arm (0.40 log(10) copies/ml difference, p = 0.001).Women randomized to valacyclovir suppressive therapy during pregnancy and postpartum had greater increases in CD4 counts and smaller increases in plasma HIV-1 RNA levels than women in the placebo arm. Valacyclovir suppression during pregnancy and breastfeeding may improve outcomes and delay antiretroviral therapy for HIV-1/HSV-2 co-infected women