Substance abuse in outpatients attending rural and urban health centres in Kenya

Objectives: To estimate the prevalence and pattern of substance use among patients attending primary health centres in urban and rural areas of Kenya.Design: A descriptive cross-sectional prevalence survey.Setting: Urban health centres of Jericho and Kenyatta University (KU) and rural health centres in Muranga district.Subjects: One hundred and fifty adult patients (seventy eight males and seventy two females) were included in the study.Intervention: Semi-structured questionnaires and the DSM IV diagnostic criteria were used to record the socio-demographic data and to determine substance dependence or abuse.Results: The substances commonly used in descending order of frequency were alcohol, tobacco, khat and cannabis. Only alcohol and tobacco were extensively used. Lifetime prevalence rates of alcohol use for the two urban health centres were 54% and 62% compared to 54% for the rural health centres. For tobacco the lifetime prevalence rates were 30% for Jericho, 28% for KU and 38% for Muranga. The differences between the rural and urban samples were not statistically significant. More males than females had used alcohol(average lifetime use 80.8% for males compared to 30.6% for females:

Post traumatic stress disorder among Mau Mau concentration camp survivors in Kenya

Background: A decade before Kenya's independence in 1963 thousands of ‘Mau Mau' fighters were arrested and incarcerated in concentration camps where many underwent torture and inhuman treatment. No studies have been done to establish the presence of post traumatic stress disorder (PTSD) and other psychiatric morbidity among the survivors of those concentration camps. Objectives: To establish the prevalence of PTSD and other psychiatric morbidity and associated factors among the Mau Mau Concentration Camp survivors. Design: A cross-sectional, descriptive study of all consecutive concentration camp survivors included in the study. Setting: Mau Mau War Veterans' Association (MMWVA) headquarters at Mwea House, Nairobi, Kenya Human Rights Commission headquarters in Nairobi, Tumaini House (Venue of MMWVA elections, 2005) and the MMWVA branch office in Kajiado District, Rift Valley Province, Kenya. Subjects: One hundred and eighty one Mau Mau Concentration Camp Survivors who gave consent to participate in the study. Main outcome measures: Lifetime and Current PTSD, IES-R score and other Psychiatric Morbidity as measured using the SCID and the IES-R. Results: A DSM-IV-TR diagnosis of current PTSD was made in 65.7% of the survivors. Current PTSD was associated with higher IES-R scores and older age, lower income, non-Catholic religion, larger household size, older age at incarceration, greater length of incarceration, incarceration in two or more camps, experiencing other traumatic events, family history of mental illness and having other psychiatric illness. Conclusions: Similar to other former Prisoners of War (POWs) elsewhere, these survivors suffer high PTSD prevalence rates and a special veterans' service is recommended to address this problem and its associated factors among these and other veterans in Kenya. East African Medical Journal Vol. 83(7) 2006: 352-35

Post traumatic stress disorder among motor vehicle accident survivors attending the orthopaedic and trauma clinic at Kenyatta National Hospital, Nairobi

Objectives: To determine the prevalence rate of post traumatic stress disorder (PTSD) and associated risk factors among motor vehicle accident (MVA) survivors attending the orthopaedic and trauma clinic at Kenyatta National Hospital, Nairobi. Design: A cross-sectional study. Setting: Kenyatta National Hospital, Nairobi. Subjects: One hundred and ninety seven adult males and sixty seven female patients. Method: The 264 patients were interviewed using a questionnaire to collect the sociodemographic data, the Self Rating Questionnaire (SRQ) and the Impact of Event Scale -Revised (IES-R). Diagnosis was made using the Diagnostic and Statistical Manual (DSM-IV). Results: The mean age was 34.63 ± 12.71 years (range 18-65). Overall, the prevalence rate of PTSD was 13.3%. None of the cases had been previously diagnosed as having PTSD. Females had a higher rate of 17.9% (n = 67), compared to the males 11.7% (n=197). The majority of those with PTSD (42.9%) were young, 20 - 29 years. Other risk factors were having post-primary education (62.9%), experiencing the first motor vehicle accident (14.1%), previous psychiatric illness, and other medical illnesses. The type of accident, role/status and immediate reactions to the accident were not significant. Conclusions: PTSD following motor vehicle accidents is common. Although the MVA survivors do develop significant rates of PTSD, it is not easy to identify those at risk but some of the parameters documented in this study may help. A multi disciplinary approach is therefore essential in the management of the RTA survivors at the orthopaedic and trauma clinics if their physical and psychological needs are to be adequately addressed East African Medical Journal Vol.81(7) 2004: 362-36

Psychiatric morbidity among leprosy patients in Teso and Busia districts of Western Kenya

Objective: To establish the magnitude of psychiatric disorders among leprosy patients in western Kenya.Design: A cross-sectional descriptive study. Setting: Busia and Teso districts in western Kenya. Subjects: A sample of 152 male and female, adult leprosy patients. Results: The prevalence of psychiatric morbidity (PM) was 53.29%. The PM was positively correlated with physical disability and marital status but not with age, sex, education, type of leprosy, or duration of the illness. The prevalence of psychiatric morbidity was lower among Kenyan leprosy patients compared to studies carried out in India (56% to 78%). It was high compared to the rate of psychiatric morbidity in those seeking medical help in primary health care centres in Kenya, which was recently estimated to be 10%. Conclusion: The prevalence of PM in leprosy patients in western Kenya was lower than that in studies carried out in India. This could be attributed to de-institutionalisation and re-integration of leprosy sufferers back into their local communities. Since the rate was more than double that in the general Kenyan population and seemed to be related to presence of physical disability, an appraisal of psychiatric services offered to these patients is needed.East African Medical Journal Vol. 82(9) 2005: 452-45