Substance abuse in outpatients attending rural and urban health centres in Kenya

Objectives: To estimate the prevalence and pattern of substance use among patients attending primary health centres in urban and rural areas of Kenya.Design: A descriptive cross-sectional prevalence survey.Setting: Urban health centres of Jericho and Kenyatta University (KU) and rural health centres in Muranga district.Subjects: One hundred and fifty adult patients (seventy eight males and seventy two females) were included in the study.Intervention: Semi-structured questionnaires and the DSM IV diagnostic criteria were used to record the socio-demographic data and to determine substance dependence or abuse.Results: The substances commonly used in descending order of frequency were alcohol, tobacco, khat and cannabis. Only alcohol and tobacco were extensively used. Lifetime prevalence rates of alcohol use for the two urban health centres were 54% and 62% compared to 54% for the rural health centres. For tobacco the lifetime prevalence rates were 30% for Jericho, 28% for KU and 38% for Muranga. The differences between the rural and urban samples were not statistically significant. More males than females had used alcohol(average lifetime use 80.8% for males compared to 30.6% for females:

Knowledge, attitude and practice (KAP) of mental illness among staff in general medical facilities in Kenya: practice and policy implications

Objective: To determine the knowledge, attitudes and beliefs about mental illness among staff in general hospitals. Method: A descriptive cross-sectional study conducted on staff in ten medical facilities in Kenya on their socio-demographic characteristics, professional qualifications and knowledge, attitudes and practice (KAP) toward mental illness. Results: A total of 684 general hospital staff: nurses (47.8%); doctors (18.1%); registered clinical officers (5.1%); students (9.5%) and support staff (19.5%) were recruited. About three quarters were under 40 years of age; most thought mental illness could be managed in general hospital facilities; the older the doctors were (age 40 years and older) the more they were aware of and positive towards mental illness. Most of the workers did not suspect any psychiatric symptoms among the patients they treated resulting in low referral rates for psychiatric services. Conclusion: There are gaps in knowledge on mental illness which could be constructively filled with Continued Medical Education (CME).Key words: Hospital, General; Health Knowledge, Attitudes, Practice; Mental disorders; Keny

Traditional healers and provision of mental health services in cosmopolitan informal settlements in Nairobi, Kenya

Objective: The study aimed to investigate the types of mental illnesses treated by traditional healers, and their methods of identifying and treating mental illnesses in their patients. Method: In urban informal settlements of Kibera, Kangemi and Kawangware in Nairobi, Kenya, we used opportunistic sampling until the required number of traditional healers was reached, trying as much as possible to represent the different communities of Kenya. Focus group discussions were held with traditionalhealers in each site and later an in-depth interview was conducted with each traditional healer. An in-depth interview with each patient of the traditional healer was conducted and thereafter the MINIPLUS was administered to check the mental illness diagnoses arrived at or missed by the traditional healers. Quantitative analysis was performed using SPSS while focus group discussions and in-depth interviews were analysed for emerging themes.Results: Traditional healers are consulted for mental disorders by members of the community. They are able to recognize some mental disorders, particularly those relating to psychosis. However, they are limited especially for common mental disorders.Conclusion: There is a need to educate healers on how to recognize different types of mental disorders and make referrals when patients are not responding to their treatments.Keywords: Traditional Healers; Mental illness; Informal settlements; Keny

The relationship between schizoaffective, schizophrenic and mood disorders in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya

Objective: The prevalence of schizoaffective disorder (SAD) and the relationship between schizophrenia (SCZ), SAD and mood disorders (MD) in non-Western countries is unknown. To determine the prevalence of SAD and the relationship between SCZ, SAD and MD in relation to socio-demographic, clinical and therapeutic variables in 691 patients admitted at Mathari Psychiatric Hospital, Kenya.Method: A cross-sectional comparative study using both clinician and SCID-1 for DSM-IV diagnoses.Results: Approximately twenty three percent (n=160) met DSM-IV criteria for SAD using SCID-1. There were significant differences between SCZ, SAD and MD regarding: affective and core symptoms of schizophrenia (with the exception of core symptoms of schizophrenia between SCZ and SAD); presence of past trauma; a past suicide attempt; and comorbidity with alcohol and drug abuse disorders. SAD and MD patients took significantly more mood stabilizers than SCZ patients. There were no significant differences between the three groups regarding socio-demographic  variables, brief psychiatric rating scale scores, cognitive performance, anxiety and depressive symptoms, presence of obsessions, and usage of both antipsychotics and antidepressants. Conclusion: There is no distinct demarcation between the three disorders. This lends support to recent evidence suggesting that SAD might constitute a heterogeneous group composed of both SCZ and MD patients or a middle point of a continuum between SCZ and MD.Keywords: Schizoaffective Disorder; Schizophrenia; Mood disorders; Epidemiology; Afric

Agenesis of the corpus callosum with associated inter-hemispheric cyst and right frontal pachygyria presenting with psychiatric symptoms in a Kenyan

This case report presents a 26 year old man who had a history of childhood onset seizures, mild cognitive slowing and social withdrawal. He gradually developed symptoms of depression and attempted suicide once. He presented to the authors following a recurrence of his seizures. On examination they noted a normal general and neurological examination apart from some frontal lobe signs on mental status examination. He also had features of psychosis and labile mood. On CT brain scan he had agenesis of the corpus callosum (CC) with associated interhemispheric cyst and right frontal pachygyria. The authors suggest that clinicians in developing countries should be alert to organic disorders presenting with psychiatric symptoms. South African Psychiatry Review Vol. 9(4) 2006: 229-23

The prevalence of depressive symptoms among adolescents in Nairobi public secondary schools: association with perceived maladaptive parental behaviour

Objective: Depression in adolescents is a matter of concern because of its high prevalence, potential recurrence and impairment of functioning in the affected individual. The study sought to determine the prevalence of depressive symptoms among adolescents in Nairobi (Kenya) public secondary schools; make a comparison between day and boarding students; and identify associated factors in this population. Method: A random sample of school going adolescents was taken from a stratified sample of 17 secondary schools out of the 49 public secondary schools in Nairobi province. The sample was stratified to take into account geographical distribution, day and boarding schools, boys only, girls only and mixed (co-education) schools in the capital city of Kenya. Self administered instruments (EMBU and CDI) were used to measure perceived parental behaviour and levels of depression in a total of 1,276 students excluding those who had no living parent. Results: The prevalence of clinically significant depressive symptoms was 26.4%. The occurrence was higher in girls than it was in boys p<0.001. Students in boarding schools had more clinically significant depressive symptoms compared to day students (p=0.01). More girls exhibited suicidal  behaviour than boys (p<0.001). There was a significant correlation between depressive symptoms and suicidal behaviour (p<0.001). CDIscores correlated positively with age (p<0.001) with an increase in CDI  score with unit increase in age among students 14-17 years old, perceived rejecting maternal parenting behaviour (p<0.001), perceived no emotional attachment paternal behaviour (p<0.001), perceived no emotional attachment maternal behaviour (p<0.001), and perceived under protective paternal behaviour (p=0.005).Conclusion: Perceived maladaptive parental behaviours are substantially associated with the development of depressive symptoms and suicidal behaviour in children.Key words: Depression; Adolescent; Parent; Keny

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

Lifetime mental disorders and suicidal behaviour in South Africa

Background: There is relatively little data on the relationship between lifetime mental disorders and suicidal behaviour in low and middle income countries. This study examines the relationship between lifetime mental disorders, and subsequent suicide ideation, plans, and suicide attempts in South Africa. Method: A national survey of 4185 South African adults was conducted using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate psychiatric diagnoses and suicidal behaviour. Bivariate, multivariate and discrete-time survival analyses were employed to investigate the associations between mental disorders and subsequent suicide ideation, plans, and attempts. Results: Sixty-one percent of people who seriously considered killing themselves at some point in their lifetime reported having a prior DSM-IV disorder. Mental disorders predict the onset of suicidal ideation, but have weaker effects in predicting suicide plans or attempts. After controlling for comorbid mental disorders, PTSD was the strongest predictor of suicidal ideation and attempts. There is a relationship between number of mental disorders and suicidal behaviour, with comorbidity having significantly sub-additive effects. Conclusion: Consistent with data from the developed world, mental disorders are strong predictors of suicidal behaviour, and these associations are more often explained by the prediction of ideation, rather than the prediction of attempts amongst ideators. This suggests some universality of the relevant mechanisms underlying the genesis of suicidal thoughts, and the progression to suicide attempts.Key Words: Suicide; Survey; South Africa; Mental Disorders

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