18 research outputs found

    Modifying Group Interpersonal Psychotherapy for Peripartum Adolescents in Sub-Saharan African Context: Reviewing Differential Contextual and Implementation Considerations

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    Background: This study describes adaptation and modification of World Health Organization (WHO) recommended group interpersonal psychotherapy (IPT-G) for depressed peripartum adolescents. The adaptation process includes accommodating contextual factors and strategies to address intervention implementation barriers, such as engagement problems with adolescents, caregivers, and providers, and stigma and dearth of mental health specialists. The modifications include and adolescent relevant iterations to the therapy format and content. Methods: A multi-stakeholder led two-stage intervention adaptation and modification process integrating mixed qualitative methods were used with pregnant and parenting adolescents, their partners, and health care workers. In-depth interviews focusing on personal, relationship, social, and cultural barriers experienced by adolescents were carried out modeled on the Consolidated Framework for Implementation Research. Focus group discussions with depressed adolescents on their experiences, feedback from caregivers, partners, health workers inform focused modifications. An IPT expert committee of three practitioners, along with UNICEF adolescent officer, and mental health policy expert from Ministry of Health and representative community advisory body reviewed the adaptations and modifications made to the WHO IPT-G manual. Discussion: Integration of mental health needs of peripartum adolescents as demonstrated in the stakeholder engagement process, adaptation of key terms into locally relevant language, determination of number of sessions, and user-centric design modifications to digitize a brief version of group interpersonal psychotherapy are presented

    Influence of Phosphorus Fertilizer on Potato Seed Production in Acid Soils in Kenya

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    One of the major challenges facing potato (Solanum Tuberosum L) production in Kenya is the inadequate supply of high-quality seed. The required amount of potato seed in Kenya is about 70,000 tones annually but, only 1 % is available. Otherwise, farmers use low quality farm saved seed (KEPHIS, 2016). A major contributor to this situation is low and declining soil fertility, particularly phosphorus, among other challenges. Unfortunately, there is no available phosphorus fertilizer rate recommendation for seed potato production in Kenya. This hinders economic utilization of phosphorus fertilizers to achieve optimal production of quality potato seed in Kenya where its deficiencies are dominant. Therefore, this study investigated influence of different rates of phosphorus fertilizer on seed potato tuber yield and quality in three acidic (pH ‚ȧ 5.8) test sites: Lari, Ainabkoi and Saboti sub Counties. Unica and Shangi varieties were tested. The field experiment was a split plot arrangement in Randomised Complete Block Design (RCBD) with six treatments (0 N & 0 P), 0, 30, 60, 90 and 120 kg ha-1 phosphorus, replicated three times. Data collected included tuber weight, number of tubers, tuber grade, number of eyes per tuber, tuber specific density and final germination percentage. To monitor soil nutrient dynamics, soil pH, soil available phosphorus, total nitrogen, total carbon, potassium, calcium, magnesium, copper, iron, zinc, sodium and exchangeable acidity (Lari only) were determined at planting while available phosphorus and potato tuber phosphorus were determined at harvesting. Data was statistically analysed using ANOVA at 5 % confidence levels with General Statistics (GENSTAT) and excel softwares. Results indicated that phosphorus rate significantly influenced seed tuber yield in the test sites. At Saboti, (0N & 0P) and no phosphorus application treatments for Shangi and Unica resulted in the highest seed tuber yield of 33.7 t ha-1 and 33.2 t ha-1 , respectively. At Ainabkoi, application of 60 kg ha-1 and 30 kg ha-1 phosphorus produced the highest seed tuber yields of 20.0 t ha-1 and 18.9 t ha-1 of Shangi and Unica, respectively. In Lari, application of 60 kg ha-1 and 90 kg ha-1 phosphorus produced the highest seed tuber yields of 19.0 t ha-1 and 10.4 t ha-1 of Shangi and Unica, respectively. Unica had better final germination percentage than Shangi. During the season, there was a build-up of soil available phosphorus. Thus, there is need for farmers to test their soils at the onset of every potato season

    Neurocognitive correlates of the use of combined Antiretroviral Therapy among HIV-infected adults attending care and treatment center at Muhimbili National Hospital, Dar es Salaam, Tanzania: An analytical crosssectional study

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    Background: The discovery of the highly active antiretroviral therapy has improved the life span of people living with HIV/AIDS (PLWHA) to almost that of the general population. This, however, has been coupled with increased incidences of HIVassociated dementia, especially mild cognitive impairment. Combined antiretroviral therapy (cART) has been observed to improve neurocognitive functions but the ART regimen that is best suited for improvement of neurocognitive functions is still largely unknown. This study was aimed at determining how neurocognitive deficits in patients on cART were related to ART regimen.Methods: This was a cross-sectional analytical study. A sample of 351 adult patients attending care and treatment center (CTC) at Muhimbili National Hospital (MNH) in Dar es salaam, Tanzania were screened for HIV-associated neurocognitive deficits (HAND) against the ART regimens the patients were using. The study that was conducted from July to August 2012 and employed a standardized tool known as International HIV Dementia Scale (IHDS). Analysis was done using SPSS version 18. Frequency distribution, Chi-square, Fisher’s exact test and multivariate regression analysis were calculated to determine the levels of risk which was set at 5% significance level (p < 0.05).Results: Two hundred and forty of the 351 (68.4%) patients screened positive for neurocognitive deficits. Under descriptive statistics, factors such as age, years of formal education, central nervous system penetration effectiveness (CPE) score and the use of efavirenz containing regimens showed statistically significant association with HAND at p=0.03, p=0.038, p<0.001 and p=0.039, respectively, while on multivariate analysis only ART combination with CPE based on 2010 scoring system showed significant association system (p=0.02, AOR=0.449 and C.I=0.27-0.748) with HAND.Conclusion: These findings support the hypothesis that specific ART factors such as CPE may be protective against neurocognitive deficits. The study also highlights the need to choose appropriate ART regimen with special consideration to their potential neurotoxic side effect. Individual assessment for best therapeutic response is crucial for the patients’ cognitive wellbeing.Keywords: HIV-associated neurocognitive deficits (HAND), Antiretroviral, Central nervous system penetration, Muhimbili National Hospital, Dar es Salaam, Tanzani

    Perspectives and concerns of clients at primary health care facilities involved in evaluation of a national mental health training programme for primary care in Kenya

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    Abstract Background A cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact on the health, disability and quality of life of clients, despite a severe shortage of medicines in the clinics (Jenkins et al. Submitted 2012). As focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems (Sharfritz and Roberts. Health Transit Rev 4:81‚Äď85, 1994), the experiences of the participating clients were explored through qualitative focus group discussions in order to better understand the potential reasons for the improved outcomes in the intervention group. Methods Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 clients from the intervention group clinics where staff had received the training programme, and 10 clients from the control group where staff had not received the training during the earlier randomised controlled trial. Results These focus group discussions suggest that the clients in the intervention group noticed and appreciated enhanced communication, diagnostic and counselling skills in their respective health workers, whereas clients in the control group were aware of the lack of these skills. Confidentiality emerged from the discussions as a significant client concern in relation to the volunteer cadre of community health workers, whose only training comes from their respective primary care health workers. Conclusion Enhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcomes for clients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed. Trial registration ISRCTN 53515024.</p

    Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey

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    This study aimed to assess the prevalence of probable post-traumatic stress disorder (PTSD), and its associated risk factors in a general household population in Kenya. Data were drawn from a cross-sectional household survey of mental disorders and their associated risk factors. The participants received a structured epidemiological assessment of common mental disorders, and symptoms of PTSD, accompanied by additional sections on socio-demographic data, life events, social networks, social supports, disability/activities of daily living, quality of life, use of health services, and service use. The study found that 48% had experienced a severe trauma, and an overall prevalence rate of 10.6% of probable PTSD, defined as a score of six or more on the trauma screening questionnaire (TSQ). The conditional probability of PTSD was 0.26. Risk factors include being female, single, self-employed, having experienced recent life events, having a common mental disorder (CMD)and living in an institution before age 16. The study indicates that probable PTSD is prevalent in this rural area of Kenya. The findings are relevant for the training of front line health workers, their support and supervision, for health management information systems, and for mental health promotion in state boarding schools

    Bullying in public secondary schools in Nairobi, Kenya

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    Background: The prevalence and frequency of bullying in Nairobi public secondary schools in particular and in Kenyan schools in general is not known. Knowledge of the extent of the problem is essential in developing effective interventions.Aim: To study the prevalence and frequency of bullying in Nairobi public secondary schools, Kenya. Methods: A self-report sociodemographic questionnaire and the Olweus Bullying Questionnaire of 1991 were administered to 1 012 students from a stratified sample of public secondary schools in Nairobi.Results: Between 63.2% (640) and 81.8% (828) of students reported various types of bullying, both direct and indirect, with significant variations found for sex, age, class and year of study, whether in day or boarding school, and the place where bullied. Being bullied was significantly associated with becoming a bully, in turn.Discussion: Bullying is highly prevalent in Kenyan schools. Further studies are needed to characterise bullies and victims in terms of personality and environmental factors that may be associated with or conducive to bullying, as well as to determine the long-term prognosis for both bullies and victims. Further research is also required to determine the most appropriate intervention.Journal of Child and Adolescent Mental Health 2007, 19(1): 45‚Äď5
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