The prevalence of substance use disorders and associated patterns among patients admitted to a psychiatric hospital in Botswana

Objective: Substance use disorders (SUDs) have risen substantially, especially in developing nations, and has become one of the world\u27s most significant public health and socioeconomic challenge. This study aimed to determine the prevalence and patterns of substance use disorders among patients admitted at the main psychiatric hospital, Sbrana Psychiatric Hospital in Botswana. Method: The study design was descriptive cross-sectional, involving patients admitted to a psychiatric hospital. SUDs were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) v13.0. Bivariate analysis was conducted to determine the association between socio-demographic characteristics and SUDs. Multivariate logistic regression was performed to rule out the effect of confounders. Results: The final analysis involved one hundred and one (101) participants. Participants ages ranged from 18-60 years with over half (59.4%) being male. Majority of participants (85.1%) had ever used studied substances; with 63.4% found to have substance use disorders. The most frequently used substances were tobacco, cannabis, alcohol and cocaine at 58.4%, 42.6%, 34.7% and 12.8% respectively. SUDs were more common among participants who were male, younger age of 18–35 years, single, tertiary education and unemployed. Conclusions: There is a high prevalence of substance use and SUDs among psychiatric patients in Botswana. Structured screening and interventions to manage substance use disorders should be part of routine care at the psychiatric health care facilities in Botswana. Consideration should be given to screening all patients admitted to psychiatric hospitals in Botswana for SUDs using the ASSIST

(Ophtha), H.Dip. Ophtha (Cataract Surgery) (Kenya medical training college

ABSTRACT Sexual dysfunction can impact a person's ability to form or sustain intimate relationships and co morbidity between sexual dysfunction and anxiety as well as depression has been reported. Yet epidemiological, etiological, and health association to sexual dysfunction has only begun to be explored in Kenya. Aim: To determine the prevalence, types of sexual dysfunction and their socio demographic correlate in diabetic patients. Design: Descriptive cross-sectional study Setting: The study was conducted at the outpatient diabetic clinic of Kenyatta National Hospital. This is the main referral hospital in Kenya. Methods: A total of 350 participants were enrolled in the study. The Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) questionnaires were used to evaluate sexual dysfunctions in female and male patients respectively. Results: The participants were composed of 164 females aged between 18-74 years and 186 males aged between 19-100 years. In males, prevalence of sexual dysfunctions were: erectile dysfunction (68.8%); orgasmic dysfunction (48.4%); sexual desire (81.7%); intercourse satisfaction (86.6%) and overall satisfaction (68.4%).The female sexual dysfunction was 36.6% and was categorized as mild (17.1%); moderate (18.3%) and severe (1.2%). Conclusion: Diabetic patients have a high prevalence of sexual dysfunctio

Adverse childhood experiences among patients with substance use disorders at a referral psychiatric hospital in Kenya

Abstract Background Substance use disorders are a major cause of health and social problems worldwide. Research evidence shows a strong graded relationship of adverse childhood experiences and substance use in adulthood. This study aimed at determining the prevalence of adverse childhood experiences and their association with substance use among patients with substance use disorders. Method The study used a descriptive cross-sectional design. A total of 134 patients aged 18 years and above receiving inpatient treatment for substance use disorders were recruited into the study. A mental state exam was done to rule out active psychopathology. Data on socio demographic variables, adverse childhood experiences (ACEs) and substance use was collected using Adverse Childhood Experiences International Questionnaire and The Alcohol, Smoking and Substance Involvement Screening Test respectively. Data was analysed using statistical package for social sciences (SPSS) version 20 for windows. Results Males accounted for the majority of the study participants (n = 118, 88.1%). Only 43.3% (n = 58) of the participants had a family history of substance use disorder. The most frequently used substance was alcohol which was reported by 82.1% of the participants. Nearly 93% of the respondents had experienced at least one ACE and the most prevalent ACE was one or no parent which was reported by half of the respondents. The adverse childhood experiences significantly associated with current problematic substance use were; emotional abuse, having someone with mental illness in the household, physical abuse and physical neglect. Emotional abuse significantly predicted tobacco (A.O.R = 5.3 (1.2–23.9)) and sedative (A.O.R = 4.1 (1.2–14.2)) use. Childhood exposure to physical abuse was associated with cannabis use [A.O.R = 2.9 (1.0–7.9)]. Experiencing five or more ACEs was associated with increased risk of using sedatives. Conclusion There is a high prevalence of adverse childhood experiences among patients with substance use disorders. Experiencing emotional abuse, having someone with mental illness in the household, physical abuse and physical neglect in childhood are risk factors of substance use disorders. ACEs screening and management should be incorporated in substance abuse prevention programs and policies

Is sexual abuse a part of war? A 4-year retrospective study on cases of sexual abuse at the Kenyatta National Hospital, Kenya

The harmful effects of sexual abuse are long lasting. Sexual abuse when associated with violence is likely to impact negatively on the life of the victim. Anecdotal reports indicate that there was an increase in the number of cases of sexual violence following the 2007 post election conflict and violence in Kenya. Although such increases in sexual abuse are common during war or conflict periods the above reports have not been confirmed through research evidence. The purpose of the current study is to establish the trend in numbers of reported cases of sexual abuse at Kenyatta National Hospital over a 4-year period (2006-2009). Data on sexually abused persons for the year 2006-2009 was retrieved from the hospitals record. A researcher designed questionnaire was used to collect relevant data from the completed Post Rape Care (PRC) form. The PRC-Ministry of Health no. 363 (MOH363) form is mandatorily completed by the physician attending the sexually abused patient. There was an increase in the number of cases of sexual abuse reported in 2007 election year in Kenya, with a statistically significant increase in the sexually abused male cases. Sexual crime is more prevalent when there is war or conflict

Agroforestry's contribution to livelihoods and carbon sequestration in East Africa: A systematic review

Agroforestry is a powerful practice for sustainable and regenerative intensification because it promotes multifunctional landscapes that deliver ecological functions that contribute to livelihoods, land productivity, biodiversity conservation, and other ecosystem services. Despite a large body of literature on agroforestry in East Africa, a systematic understanding of its livelihood benefits and contribution to carbon sequestration is still lacking. A systematic review was used to provide a quantitative and qualitative synthesis of available evidence and knowledge gap from 185 publications that met the selection criteria regarding the contribution of agroforestry to livelihoods (n = 152) and carbon sequestration (n = 43) in East Africa. The main livelihood benefits include fodder, food, firewood and income, reported in over 70, 63, 56 and 40 publications, respectively. These and other benefits diversify livelihoods of rural communities and act as safety nets in times of climate shocks. Agroforestry systems in East Africa stock an average of 24.2 ± 2.8 Mg C ha−1 in biomass and 98.8 ± 12.2 Mg C ha−1 in the soil. Much of the aboveground carbon is held in homegardens (34.3 ± 7.9 Mg C ha−1), perennial tree-crop systems (29.9 ± 12.7 Mg C ha−1) and trees on boundaries (26.7 ± 14.1 Mg C ha−1). Empirical studies are needed for better understanding of belowground carbon in agroforestry and emission of greenhouse gases in different agroforestry practices. A smaller number of studies reported income from sale of carbon credits, suggesting a gap in the development of science regarding carbon rights, land tenure, tree tenure rights, and the potential impact of climate change on the growing niches of tree species in the region. The results show that agroforestry is a powerful climate adaptation and mitigation solution as it can increase household resilience and sequesters significant amounts of carbon dioxide from the atmosphere

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