Experience with UIDC insertion outside of menses in Kenya

Objective: To determine if women receiving intrauterine devices (IUCDs) outside of menses have an acceptable rate of insertion problems and subsequent IUCD-related complications.Design: Cross-sectional and prospective cohort study of insertions at times other than during menses.Setting: The study was carried out in two government family planning (FP) clinics in Nairobi,Kenya.Subjects: After appropriate pre-test and post-test HIV counselling, 1686 women requesting IUCDs at two FP clinics between 1994 and 1995 in Nairobi were enrolled at baseline into a study examining the effect of human complications. Six hundred and forty nine women (156 HIV-infected and 493 HIVuninfected) were selected for the four month follow up study. They were classified according to their menstrual cycle status at time of IUCD insertion.Main outcome measures: Problems at the time of insertion (pain, bleeding, immediate expulsion) and IUCD-related complications through four months.Results: Rates of immediate insertion problems were low in the women who had insertions during menses (7.0%), outside of menses (4.0%) or had oligomenorrhea/amenorrhea (2.6%). The adjusted odds ratios for IUCD insertion problems outside of menses and in oligomenorrhea/amenorrhea (versus women with insertion during menses) were 0.54 (95% CI 0.18 -1.59) and 0.39 (95% CI 0.12 -1.29) respectively. IUCD-related complications were higher in the iligomenorrhea/amenorrhea (11.5%) or insertion outside of menses (6.9%), than the within menses (4.3%) groups. However, the differences were not statistically significant. Adjusted odds ratios for IUCD outside of menses and oligomenorrhoea/amenorrhea groups were 1.65 (95% CI 0.21 - 12.91) and 2.72 (95% CI 0.34 - 21.71) respectively.Conclusion: The results confirm that the IUCD can be safely inserted outside of menses with minimal insertion difficulties and subsequent complications. Availability of IUCDs outside of menses may enhance IUCD acceptance in Kenya and create better opportunity for visualscreening of the cervix for sexually transmitted infections

Perceived economic and behavioural effects of the mentally ill on their relatives in Kenya: a case study of the Mathari Hospital

Objective: There is no documented evidence in Kenya on relatives’ perceptions of economic and behavioural effects of the mentallyill patients and their coping mechanisms. To document what relatives of mentally ill patients perceive to be the economic effects of the patients on the family and how they are affected by and cope with the disturbed behaviours of the patients. Method: This was a cross-sectional descriptive study conducted at the Mathari Psychiatric Hospital. Informed consent was obtained from both the relatives and the patients admitted at the hospital. Data on socio-demographic and economic profiles were obtained from thepatients and their relatives. The relatives were interviewed using a structured questionnaire to determine what they perceived to be the economic effects of the mental illness, how the various disturbed behaviours of the mentally ill affected them, and how they coped. The data were analysed using SPSS version 11.5 and results are presented in narratives and tables. Results: One hundred and seventy-five relatives and 107 patients were recruited and interviewed. The patients were younger and better educated but economically less well off than their relatives. The relatives perceived that the mentally ill patients caused financial constraints and that various disturbed behaviours, particularly, verbal and physical aggression and refusal of the patient to take medicine or go to hospital, affected the family in different ways. Different coping mechanisms were used, depending on whether or not the behaviours were intrusive. Conclusion: Mentally ill patients adversely affect their families in diverse ways. There is need for appropriate policy to address the needs of families with mentally ill patients at the family and community levels. However, these must be evidence-based and this calls for further research.Key words: Mental illness; Caregivers; Keny

Psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi public secondary school children, Kenya

Background: There are few psychometric instruments whose properties have been studied in a developing country's context. Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children, Kenya. Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools. Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample, which is similar to Western findings, and is hence a reliable tool for measuring anxiety in the study population. It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms, social anxiety, separation anxiety and harm avoidance. The correlation co-efficient with CDI was similar to Scandinavian findings. Conclusion: The MASC can be used in Kenyan children and, by extension, other Africa children. Journal of Child and Adolescent Mental Health 2008, 20(2): 101–10

Burnout in staff working at the Mathari psychiatric hospital

No Abstract. African Journal of Psychiatry Vol. 11 (3) 2008: pp. 199-20

Psychometric properties of an African symptoms check list scale: the Ndetei-Othieno-Kathuku scale

No Abstract. East African Medical Journal Vol. 83(5) 2006: 280-28