Substance abuse and psychiatric co-morbidities: a case study of patients at Mathari Psychiatric Hospital, Nairobi, Kenya

Substance abuse co-morbidity with psychiatric disorders is common and has been widely reported, except in Kenya. This study aimed to determine the prevalence, pattern and socio-economic burden of a dual diagnosis of substance abuse disorder and other psychiatric conditions. This was a cross-sectional descriptive study of 691 patients admitted at Mathari hospital. Only 42 patients had a first working diagnosis of substance abuse but nearly thirty-five percent of the patients scored for a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of alcohol dependance/abuse. There was high co-morbidity of alcohol abuse/dependence with opiate, sedative and 'khat' use, as well as with mood and other psychotic disorders. Substance abuse disorders correlated significantly with other psychiatric disorders. Only 12 patients were in a drug rehabilitation unit, all of whom had a dual psychiatric diagnosis of affective disorder. There were high co-morbidity rates of substance abuse in both general psychiatric wards and drug rehabilitation units. KEY WORDS: substance abuse, co-morbidity, psychiatric disorders, Keny

Worldwide Incidence of Malaria in 2009: Estimates, Time Trends, and a Critique of Methods

Richard Cibulskis and colleagues present estimates of the worldwide incidence of malaria in 2009, together with a critique of different estimation methods, including those based on risk maps constructed from surveys of parasite prevalence, and those based on routine case reports compiled by health ministries

Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

<p>Abstract</p> <p>Background</p> <p>An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN) and artemisinin-based combination therapy (ACT) had been distributed nationwide by 2007.</p> <p>Methods</p> <p>In Ethiopia, a stratified convenience sample covered four major regions where (moderately) endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children < 5 years old prior to (2001–2005/6) and after (2007) nationwide implementation of LLIN and ACT.</p> <p>Results</p> <p>In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively, and in Ethiopia by 73% and 62%. Over this same time period, non-malaria cases and deaths generally remained stable or increased.</p> <p>Conclusion</p> <p>Initial evidence indicated that the combination of mass distribution of LLIN to all children < 5 years or all households and nationwide distribution of ACT in the public sector was associated with substantial declines of in-patient malaria cases and deaths in Rwanda and Ethiopia. Clinic-based data was a useful tool for local monitoring of the impact of malaria programmes.</p

Reductions in malaria and anaemia case and death burden at hospitals following scale-up of malaria control in Zanzibar, 1999-2008

Background: In Zanzibar, the Ministry of Health and partners accelerated malaria control from September 2003 onwards. The impact of the scale-up of insecticide-treated nets (ITN), indoor-residual spraying (IRS) and artemisinin-combination therapy (ACT) combined on malaria burden was assessed at six out of seven in-patient health facilities. Methods. Numbers of outpatient and inpatient cases and deaths were compared between 2008 and the pre-intervention period 1999-2003. Reductions were estimated by segmented log-linear regression, adjusting the effect size for time trends during the pre-intervention period. Results: In 2008, for all age groups combined, malaria deaths had fallen by an estimated 90% (95% confidence interval 55-98%)(p < 0.025), malaria in-patient cases by 78% (48-90%), and parasitologically- confirmed malaria out-patient cases by 99.5% (92-99.9%). Anaemia in-patient cases decreased by 87% (57-96%); anaemia deaths and out-patient cases declined without reaching statistical significance due to small numbers. Reductions were similar for children under-five and older ages. Among under-fives, the proportion of all-cause deaths due to malaria fell from 46% in 1999-2003 to 12% in 2008 (p < 0.01) and that for anaemia from 26% to 4% (p < 0.01). Cases and deaths due to other causes fluctuated or increased over 1999-2008, without consistent difference in the trend before and after 2003. Conclusions: Scaling-up effective malaria interventions reduced malaria-related burden at health facilities by over 75% within 5 years. In high-malaria settings, intensified malaria control can substantially contribute to reaching the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015