PSYCHIATRIC MORBIDITY AMONG CHILDREN AND YOUNG PERSONS APPEARING IN THE NAIROBI JUVENILE COURT, KENYA

ABSTRACTObjectives: To estimate the prevalence and pattern of psychiatric disorders amongchildren and young persons appearing in the Nairobi juvenile court, Kenya.Design: A point prevalence survey.Setting: The Nairobi Juvenile Court, Kenya.Subjects: Ninety (sixty-four males and twenty-six females) children and young personsaged 8 to 18 years classified as criminal offenders, group I (60), and those for protectionand discipline, group II (30), were selected.Method: A socio-demographic questionnaire, reporting questionnaire for children (RQC),follow-up interview for children (FIC), present state examination (PSE) and clinicalinterview were administered to the subjects. International Classification of Diseases, 10thEdition (ICD-10) diagnostic criteria were used.Results: The crude psychiatric morbidity (CPM) rate was 44.4%. ICD-10 documentedpsychiatric disorders detected in those with CPM were conduct disorders 45%, mixeddisorders of conduct and emotion 20%, emotional disorders with onset specific tochildhood 20%, mood disorders 12.5% and hyperkinetic disorders 2.5%.Conclusion: This study has shown a high presence of psychiatric morbidity in childrenand young persons appearing in the Nairobi Juvenile Court. These juveniles need andwould benefit from mental treatment as recommended in section 18 of Cap 141 of thelaws of Kenya; The Children’s and Young Persons Act

PSYCHIATRIC MORBIDITY AMONG SEXUALLY ABUSED CHILDREN AND ADOLESCENTS

Objectives: To describe the social demographic profile and identify psychiatric morbidity in sexually abused children and adolescents.Design: A Cross-sectional descriptive survey.Setting: Nairobi WomenÕs Hospital (NWH) Gender Violence Recovery Centre (GVRC),Hurlingham, Nairobi- Kenya.Subjects: A sample of 61 sexually abused children and adolescents aged 7-17 years.Results: Eighty two percent of the survivors were sexually abused by acquaintances such as neighbours, caregivers and parents. Ninety percent of the sampled group were females. Abuse occurred in both single and both parent families and regardless of the guardian/ parental economic status. Sixty six percent of the survivorsÕ parents were abusing psychoactive substances. Sexual abuse variables and most of the social demographic variables did not predict either presence or absence of psychiatricmorbidity. Only 66% of the abuse came to the notice of the childÕs caregiver within the first 48 hours. On the socio demographic profile, the only factor that showed a statistical significant difference in predicting presence or absence of psychiatric morbidity was the familyÕs way of sorting out their disagreements (p = 0.045). The prevalence of psychiatric morbidity among the subjects studied as measured by the Diagnostic Statistical Manual Text Revision (DSM IV-TR) was found to be 69%. Eight different types of DSM IV- TR diagnoses were made. Twenty nine percent of the AXISI DSMIV-TR diagnoses were co-morbidities (Multiple DSM IV- TR diagnoses).Conclusions: The psychiatric morbidity prevalence is comparable to that found in other studies. Sexual abuse occurred regardless of the social demographic variables. FamilyÕs way of sorting out disagreement predicted presence or absence of psychiatric morbidity among the study subjects. Majority (82%) of the sexual abusers were acquaintances to the study subjects.Recommendations: It is recommended that all children and adolescents who have been sexually abused be evaluated for psychiatric morbidity regardless of their social demographic and abuse profiles and that all parents and care givers, be sensitised on childhood sexual abuse and the fact that majority of the perpetrators are acquaintances to the subjects. Families need to be sensitised on their role on prevention and reductionof psychiatric morbidity among children and adolescents in general

Psychiatric morbidity among children and young persons appearing in the Nairobi Juvenile Court, Kenya

Objectives: To estimate the prevalence and pattern of psychiatric disorders among children and young persons appearing in the Nairobi juvenile court, Kenya. Design: A point prevalence survey. Setting: The Nairobi Juvenile Court, Kenya. Subjects: Ninety (sixty-four males and twenty-six females) children and young persons aged 8 to 18 years classified as criminal offenders, group I (60), and those for protection and discipline, group II (30), were selected. Method: A socio-demographic questionnaire, reporting questionnaire for children (RQC), follow-up interview for children (FIC), present state examination (PSE) and clinical interview were administered to the subjects. International Classification of Diseases, 10th Edition (ICD-10) diagnostic criteria were used. Results: The crude psychiatric morbidity (CPM) rate was 44.4%. ICD-10 documented psychiatric disorders detected in those with CPM were conduct disorders 45%, mixed disorders of conduct and emotion 20%, emotional disorders with onset specific to childhod 20%, mood disorders 12.5% and hyperkinetic disorders 2.5%. Conclusion: This study has shown a high presence of psychiatric morbidity in children and young persons appearing in the Nairobi Juvenile Court. These juveniles need and would benefit from mental treatment as recommended in section 18 of Cap 141 of the laws of Kenya; The Children\'s and Young Persons Act. (East African Medical Journal: 2003 80(6): 282-288

BODY DYSMORPHIC DISORDER: CASE REPORT

SUMMARYThe desire for self-mutilation in the absence of any discernible psychopathology is relativelyrare. Self-mutilation is most commonly a manifestation of an underlying psychopathology suchas depression, schizophrenia, personality disorder, transexuality, body dysmorphic disorder andfactitious disorder. In this article, a case in which a 29-year-old single Kenyan lady of Africanorigin demanded a surgical operation to modify and reduce the size of her external genitalia ispresented. Although female genital mutilation is still widespread in the country, this case is ofinterest in that the woman did not seek the usual circumcision but sought to specifi cally reducethe size of her labia minora so that she could feel like a normal woman. The unique challengesin her management are discussed. Possible aetiological factors in patients who demand surgicalremoval or modifi cation of parts of their bodies without an obvious cause is discussed

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