Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study

Introduction: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children’s Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. Materials and methods: Using a qualitative approach, we explored adolescent participants’ views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. Results: We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. Discussion: Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10–19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. Conclusion: Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools

Antimicrobial susceptibility of bacteria that infect diabetic foot ulcers at Kenyatta National Hospital, Kenya

Background: Diabetic foot ulcers are prone to bacterial infection and this forms the major cause of hospital admission among patients with diabetes. Local bacterial sensitivity patterns to antimicrobials used to treat the infections is necessary in guiding drug selection for prompt management of the diabetic foot infections. Objective: To determine the etiology and antimicrobial sensitivity patterns of bacteria that infects diabetic foot ulcers at Kenyatta National Hospital. Methodology: A cross- sectional study was carried out on 75 adult diabetic patients attending Kenyatta National Hospital.  The patients were selected by convenient sampling and data obtained via a questionnaire and antimicrobial susceptibility determination of bacteria from the diabetic foot ulcers using disk diffusion method. Results: A total of 85 bacterial isolates were identified with Staphylococcus aureus (37.3%), Proteus spp (21.3%) and Klebsiella spp (14.7%) as the most prevalent organisms.  Among the Staphylococcus aureus, 39.3% were methicillin resistant. All the bacteria were sensitive to imipenem.   Gram positive and negative bacteria were sensitive to ciprofloxacin and piperacillin-tazobactam, respectively. Varied sensitivities to commonly used antibiotics: amoxicillin-clavulanate, meropenem, clindamycin, ceftriaxone, piperacillin-tazobactam and ciprofloxacin to different isolates are reported. Conclusion: In Kenyatta National Hospital, diabetic foot ulcers are infected with both gram negative and positive bacteria that are highly sensitive to imipenem. This study recommends the initiation of empirical antibiotic therapy with imipenem for moderate to severe diabetic foot infections as culture and sensitivity tests to determine more specific antimicrobials are awaited. Key words: Antimicrobial, Antimicrobial susceptibility, Diabetic foot ulcers

Management of Type 2 Diabetes at Vihiga County referral hospital, Kenya: compliance with guidelines and prevalence of complications

Background: In 2013, 382 million people suffered from diabetes globally, with 19.8 million in Africa and a Kenyan prevalence of 4.2%. Poor diabetic related outcomes such as complications, high blood sugar levels have resulted due to inadequate management of the condition. To ensure effective diagnosis, management and monitoring of Type 2 diabetic patients, the healthcare team should adopt and adhere to standard treatment guidelines that are valid and up-to date Objective: To assess the management, monitoring and complications of Type 2 diabetes among adult outpatients at Vihiga County Referral Hospital, Kenya. Methodology: A retrospective cross sectional study design was used to obtain data from 212 patient files selected through a systematic random sampling. Using a pre-designed data collection form, data on patient demographics, blood pressure, blood sugar, weight and complications was collected. Descriptive statistics were used to summarize findings to determine the proportion of adult Type 2 diabetic cases diagnosed, managed and monitored as per the Institute of Clinical Systems Improvement (ICSI) guidelines. Inferential analysis using t-test and chi square test were also carried out to ascertain extent of adherence to the guidelines. Results: Majority of the participants (31.1%) were aged 50 – 59 years (31.1%), and most were female (70.3%). Most, 39.6% had had diabetes for 1 to 5 years. Random blood sugar test was the most used method of diagnosis (58.5%) whilst fasting blood glucose test was performed in 34%. A compliance rate of 72.2% was reported in ensuring metformin was part of first line therapy as recommended. The recommended blood pressure, weight and cholesterol monitoring at initiation of treatment was observed in 96.7, 1.4 and 6.1% of the patients, respectively. Of the 141 patients monitored using fasting blood sugar, 113 (80.1%) had uncontrolled blood sugar levels (median blood sugar = 8.9(IQR.7.4, 12.75) mmol/L; P=0.741). The prevalence of reported neuropathy, retinopathy and nephropathy were 41, 33 and 0.9% respectively. Discussion: The diagnosis, management and monitoring of most patients fell short of the ICSI treatment guideline recommendations especially to monitoring of blood sugar, lipid levels and weight. The presence of anomalies calls for sensitization of healthcare workers on the importance of adoption and adherence to evidence based, up to date treatment guidelines and optimize patient health outcomes. Key words: Type 2 diabetes, treatment guidelines, healthcare provider

Quality Control Report of Drugs Analyzed in the Drug Analysis and Research Unit during the Period 2011-2015

During the period 2011-2015, the Drug Analysis and Research Unit (DARU) analyzed 1972 drug samples. The samples consisted of 21.5% locally manufactured and 78.2% imported products while the origin of 0.3% of products was indeterminate. Samples were subjected to compendial and/or in-house analytical specifications. The overall non-compliance rate was 4.5% comprising 2.5% local products and 2.0% imports. High failure rates were recorded for uterotonics (37.5%), hemostatics (33%), anthelmintics (17%) and anticancers (10.5%) while ophthalmic, immunomodulatory, musculoskeletal and endocrine drugs all complied with the quality acceptance criteria. Erectile dysfunction drugs, received by the laboratory for the first time, all complied with specifications. The results obtained demonstrate an improvement in the quality of samples submitted to DARU when compared to previous performance

Accessibility of medicines used in the management of substance use disorders in selected hospitals in Nairobi

Background: Substance use disorder is a complex chronic disease that requires a multidisciplinary approach in treatment. Pharmacotherapy is one of the components in the treatment of this condition. This study sought to assess the accessibility of medicines used in the treatment of substance use disorders in both a public and a private health facility in Nairobi. Methodology: This descriptive cross-sectional study with both qualitative and quantitative components was carried out in April and May 2015 at two hospitals in Nairobi, Mathare Mental Hospital (public) and Chiromo Lane Medical Centre (private).  Data on availability and affordability was collected from the two sites and the WHO performance indicators for health facilities used to assess availability. Affordability was determined using the daily wage of the lowest paid government worker. Interviews with the key informants were conducted to determine factors that influence the accessibility of the medicines. Results: About 50% of medicines on the Kenya Essential Medicines List for management of substance use disorders were available in Mathare while Chiromo Lane had all of them. The mean stock out duration was 8 months and 0.5 months in Mathare and Chiromo Lane, respectively.  More than 67 % of the medicines required less than a single day’s wage to buy a month’s supply in Mathare while in Chiromo Lane all the medicines required more than a single day’s wage to purchase.  The cheapest medicine required 0.3 days wage to purchase while the most expensive drug required 50 days wage to purchase. Conclusion: Medicines for the treatment of substance use disorders had limited availability but were relatively affordable in Mathare while their availability was better in Chiromo Lane but with limited affordability.  The Kenya Essential Medicines List for substance use disorders requires updating to include newer and more efficacious medicines. National guidelines for the treatment of substance use disorders should be developed and disseminated. Key words: Substance use disorders, pharmacotherapy, accessibility and affordabilit

Prevalence and risk factors associated with depression in pregnant adolescents in Nairobi, Kenya

Background: Adolescent parenthood can be associated with a range of adverse outcomes for young mothers such as depression, substance abuse, and posttraumatic stress disorder. Identification of depression and understanding risk factors among pregnant adolescents is important for development of appropriate interventions and programs focused on adolescent mental health. This paper reports on the findings of the prevalence of depression and its associated risk factors among pregnant adolescents in Nairobi, Kenya. Methods: We recruited 153 pregnant adolescent (14-18 years) who were accessing maternal health services in one of two Nairobi County primary health care facilities in the cross-sectional survey conducted in 2021. The Patient Health Questionnaire 9 was used to screen for depression. Multivariate Stepwise linear regression modelling was used to identify key predictors of depression. Results: Using a cut off of 10 and above on PHQ-9, we found that 43.1% of the respondents were depressed. Depressive symptoms in were independently associated with being in school, experience of intimate partner violence, substance use within the family and having experienced pressure to use substances by family or peers. Limitations: Cross-sectional by design and the applications of our findings are limited to settings that are similar to our study population. The PHQ-9 used has not been psychometrically validated locally in this sample. Conclusion: We found a high prevalence of depressive symptoms among respondents. These risk factors identified merit further investigation. Comprehensive mental health screening needs to be integrated in primary and community health services on the possible presence of depression

Impact of depression on adherence to antiretroviral therapy among HIV/AIDS patients at a Kenyan referral hospital

Background: Kenya is faced with an increasing challenge of co-morbid psychological and social factors among HIV-Infected patients which has had a profound impact on their medication adherence. A major psychosocial factor that is a barrier in adherence is depression associated with HIV. This study aimed at measuring the effect of depression on participants’ own reported adherence to antiretroviral therapy. Objectives: To determine the impact depression has had on adherence to antiretroviral therapy among HIV-infected patients at a Kenyatta Hospital. Methodology: A cross-sectional study design was carried out at Kenyatta National Hospital, Nairobi, Kenya. Three hundred and eighty four (384) HIV infected participants were assessed for HIV related depression and adherence to ART. Levels of HIV related depression and adherence to ART were ascertained. Results: The prevalence of depression was 23.3 %.  The prevalence of mild, moderate and severe depression was 21.2 %, 1.8 % and 0.3 % respectively. The mean non adherence and average mean adherence rate were 27.9 % and 22.4 % respectively. Conclusion: There was a minimal relationship between depression and non-adherence to antiretroviral therapy among adult HIV infected patients. Depression was not statistically significantly associated with adherence to antiretroviral therapy. Key words: Depression, adherence, antiretroviral therap

Mapping services at two Nairobi County primary health facilities: identifying challenges and opportunities in integrated mental health care as a Universal Health Coverage (UHC) priority

Abstract: Introduction There is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground. Method and measures This study utilized a qualitative evidence synthesis through mapping facility-level services and key-stakeholder interviews. Services-related data were collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 10 key informant interviews (KIIs) with clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies. Results Our findings show that health care services centered around physical health were offered daily while the mental health services were still vertical, offered weekly through specialist services by the Ministry of Health directly or non-governmental partners. Despite health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental disorders and reported paucity of trained mental health personnel in these sites. Significantly, more funding and resources are needed to provide mental health services, as well as the need for training of general health care providers in the identification and treatment of mental disorders. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls. Conclusion There is a need for further refining of the integrated care model in mental health services and targeted capacity-building for health care providers to deliver quality services

Antimicrobial activity of organic total extracts of three Kenyan medicinal plants

In recent years, drug resistance to human pathogenicbacteria and fungi has increasingly been reported all over the world (Levy and Marshall, 2004; WHO 2004). Consequently, the increasing prevalence of multidrugresistant strains of microorganisms raises an urgent need to search for new sources of antimicrobial agents (Sieradzki et al, 1999) alongside other strategies such as regulated and rational use of antibiotics (Hernandez, 2005). The vast majority of traditionally used medicinal plants have not been adequately evaluated. This study was therefore undertaken to screen organic extracts obtained from three Kenyan medicinal plants for antibacterial and antifungal activity as a basis for further phytochemical studies. The plants to be studied were selected on the basis of ethnopharmacological reports of their use in traditional medicine; this approach is generally considered effective in the discovery of new bioactive agents from higher plants (Kloucek et al, 2005)

Shifting parental roles, caregiving practices and the face of child development in low resource informal settlements of Nairobi: experiences of community health workers and school teachers

Abstract Approximately, 42% of the Kenyan population live below the poverty line. Rapid growth and urbanization of Kenya’s population have resulted in a changing poverty and food security environment in high-density urban areas. Lack of basic food needs in Kenya affects approximately 34.8% rural population and 7.6% of its urban population. Using multi-community stakeholders such as teachers and community health workers (CHWs), this paper examined food insecurity and its consequences on caregiving practices and child development. A qualitative study design was utilized. Key informant interviews and focused-group discussions with four primary school teachers and three CHWs and a nurse in-charge working within Kariobangi and Kangemi were applied to elicit various perspectives from family-, school- and community-level challenges that influence caregiving practices and child development. Grounded theory method was applied for qualitative data sifting and thematic analysis. Our findings exposed various challenges at the school, family and the community levels that affect caregiving practices and consequent child development. School-level challenges included lack of adequate amenities for effective learning, food insecurity, absenteeism and mental health challenges. Family-level barriers included lack of parenting skills, financial constraints, domestic violence and lack of social support, while community challenges such as unemployment, poor living conditions, cultural practices, lack of social support and poor community follow-up mechanisms contributed to poor parenting practices and child development. Parenting practices and holistic child development strategies in resource poor settings should focus on parenting skills, food security, quality education and addressing parents and children’s mental health challenges