Degloving injuries: Patterns, treatment and early complications among patients at a Teaching Hospital in Western Kenya

Background: Degloving injuries result from avulsion of extensive portion of skin and subcutaneous tissue from the underlying fascia, muscles and tendons. They commonly occur in orthopaedic surgery with accompanied blood loss, concomitant injuries and contamination.Objective: To determine the pattern, treatment, and early complications of degloving injuries.Methods: A prospective study among 48 patients admitted with degloving injuries at Moi Teaching and Referral Hospital-Kenya between 1st December 2016 and 30th November 2017. The diagnosis was made through physical examination and ultrasonography followed by photo documentation while demographic and injury history were recorded in a questionnaire. Fisher’s exact test of association between pattern of injury and complications was conducted.Results: Median age was 26 (IQR: 18.5, 42.5) years with male to female ratio of 1.5:1. Most (75%) of the injuries were from road traffic accidents commonly (n=23) affecting the lower limbs. Open degloving injuries (n=44) either had single (n=29) or serial debridement (n=15) with the commonest definitive treatment being primary closure (n=22). Closed degloving injuries were either conservatively managed (n=2) or drained (n=2). Only 31.2% of the patients developed complications which statistically was significantly associated (p=0.002) with the patterns of degloving injury.Conclusion: Open degloving injuries affecting the lower limbs were commonest and were mainly treated through primary closure. Early complications were associated with injury patterns and treatment modality. There is need to develop institutional protocols for the treatment of degloving injuries to reduce early complications

PSYCHOMETRIC PROPERTIES OF AN AFRICAN SYMPTOMS CHECK LIST SCALE: THE NDETEI – OTHIENO – KATHUKU SCALE

Objectives: To profile and quantify the psychometric properties of the NOK (Ndetei-Othieno-Kathuku) scale against internationally used Gold-standards and benchmarks for mild psychiatric disorders and post-traumatic stress disorders and to provide a potential easy to administer culture sensitive instrument for screening and assessing those with possible psychiatric disorders for the Kenyanand similar social-cultural situations.Design: Cross-Sectional quantitative study.Setting: A psychiatric clinical consultation setting and Kyanguli Secondary School psychotrauma counselling clinical set-up.Subjects: Survivors of the Nairobi USA Embassy bombing who were referred for psychiatric treatment and survivors of a fire disaster from a rural Kenyan school (Kyanguli School fire disaster) including students, parents of the diseased children and staff members.Results: Positive correlation was found between the NOK and all the instruments. The highest correlations were between the NOK and the BDI and SCL–90 (r = 0.557 to 0.786). The differences between the NOK scores among the different groups were statistically significant (F ratio = 13.54to 160.34, p < 0.01). The reliability coefficient (internal consistency) of the scale, alpha = 0.9733.Other item statistics and correlations of the scale are discussed.Conclusion: It is concluded that the NOK has high concurrent and discriminant validity as well as a high internal consistency and that it can be used for the rapid assessment of psychotrauma victimsof all age groups; and stress in general in similar age groups in the local setting. It is culture appropriate and sensitive

Mental Health Outcomes of Psychosocial Intervention Among Traditional Health Practitioner Depressed Patients in Kenya

Task-shifting in mental health such as engaging Traditional Health Practitioners (THPs) in appropriate management of mental disorders is crucial in reducing global mental health challenges. This study aims to determine the outcomes of using evidence-based mental health Global Action Programme Intervention guide (mhGAP-IG) to provide psychosocial interventions among depressed patients seeking care from THPs. THPs were trained to deliver psychosocial interventions to their patients screening positive for mild to severe depression on Beck’s Depression Inventory (BDI). Assessments were conducted at 0, 6 and 12 weeks and Analysis of Variance (ANOVA) performed to determine the change in depression scores over the three time period. BDI mean score was 26.52 before intervention and reduced significantly at 6 (13%) and 12 (35%) weeks after intervention. 58 and 78% of patients showed reduction in symptoms of depression at 6 and 12 weeks. It is therefore crucial to engage THPs in the care of patients with depression and the need for inclusion of training packages; and other mental disorders in order to establish and maintain collaboration between THPs and conventional health workers and promote evidence-based care among marginalized populations. Moreover, further research on randomized control trials of mhGAP-IG intervention versus usual care is required