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:

Prevalence, withdrawal symptoms and associated factors of khat chewing among students at Jimma University in Ethiopia

Background: Recently, khat chewing has become a common practice among high school, college, and university students. Regular khat chewing is thought to be a predisposing factor for different physical and mental health problems. It can lead to absenteeism from work and classes. In Ethiopia, to our knowledge no published study has investigated khat withdrawal symptoms. Therefore, this study was conducted to determine the prevalence, withdrawal symptoms, and associated factors of khat chewing among regular undergraduate students on the main campus of Jimma University in Ethiopia. Methods: The institution-based, cross-sectional study was conducted in January 2016. Data were collected from 651 main campus regular undergraduate students with a structured, self-administered questionnaire, entered into Epidata 3.1 and exported to SPSS version 20 for Windows. Bivariate and multivariate logistic regressions were used to explore associations and identify variables independently associated with khat chewing. Results: The study found that the lifetime and current prevalence of khat chewing among students were 26.3% (95% CI: 24.3, 28.3) and 23.9% (95% CI: 21.94, 25.86), respectively. About 25.7% of students started chewing after joining university, and 60.5% of these students started during their first year. The main reason given for starting khat chewing was for study purposes (54.6%), followed by socialization purposes (42.3%). Among current khat chewers, 72.9% reported that they had chewed khat for 1 year or more and 68.2% reported that they had experienced various withdrawal symptoms. The most frequently reported withdrawal symptoms were feeling depressed, craving, and feeling fatigued. Being male, attending a place of worship daily/2-3 times per week, cannabis use, smoking cigarettes, and having family members currently chewing khat were independently associated with khat chewing. Conclusions: This study found that large numbers of university students were currently chewing khat. In this study withdrawal symptoms and factors that significantly affect khat chewing were identified. Besides it gave new ideas regarding khat withdrawal symptoms in Ethiopia. It serves as a critical role of providing information to form rational foundation for public health policy, prevention and planning to bring change in contributing factors for Khat chewing. The finding will be serving as base line information for further study

Consultation liaison psychiatry at Kenyatta National Hospital, Nairobi

Objectives: To describe the psychiatric services offered at Kenyatta National Hospital and the types of patients and cases seen at Kenyatta National Hospital. Design: A retrospective study based on case notes and other hospital records. Setting: Kenyatta National Hospital, Nairobi, Kenya Subjects: All patients seen in the various psychiatric clinics and those who attended the Patient Support Centre Unit in the hospital in the year 2002. Results: In the year 2002, 598,119 patients were treated at KNH out of which 6,878 (1.15%) were seen in the psychiatric clinics: 1,709 adults and 1,412 children were referred to the various psychiatric clinics. At the hospital's Patient Support Centre (PSC) 3,454 patients were seen, mostly for pre and post-HIV test counselling. Consultations from the wards accounted for 332 (9.6%) of the cases referred to PSC. The main diagnoses among the latter in order of frequency were alcohol related psychiatric disorders, acute and transient psychoses, depressive disorders, dissociative and conversion disorders and dementia. Conclusion: In view of the high load of acute and transient psychotic states, as well as substance related disorders, it is recommended that the hospital should establish acute wards for the comprehensive management of such patients. An alcohol and drug detoxification and rehabilitation centre should also be developed at the hospital. Services to those with HIV related disorders should also be improved. East African Medical Journal Vol.82(2) 2005: 80-8

Post traumatic stress disorder among motor vehicle accident survivors attending the orthopaedic and trauma clinic at Kenyatta National Hospital, Nairobi

Objectives: To determine the prevalence rate of post traumatic stress disorder (PTSD) and associated risk factors among motor vehicle accident (MVA) survivors attending the orthopaedic and trauma clinic at Kenyatta National Hospital, Nairobi. Design: A cross-sectional study. Setting: Kenyatta National Hospital, Nairobi. Subjects: One hundred and ninety seven adult males and sixty seven female patients. Method: The 264 patients were interviewed using a questionnaire to collect the sociodemographic data, the Self Rating Questionnaire (SRQ) and the Impact of Event Scale -Revised (IES-R). Diagnosis was made using the Diagnostic and Statistical Manual (DSM-IV). Results: The mean age was 34.63 ± 12.71 years (range 18-65). Overall, the prevalence rate of PTSD was 13.3%. None of the cases had been previously diagnosed as having PTSD. Females had a higher rate of 17.9% (n = 67), compared to the males 11.7% (n=197). The majority of those with PTSD (42.9%) were young, 20 - 29 years. Other risk factors were having post-primary education (62.9%), experiencing the first motor vehicle accident (14.1%), previous psychiatric illness, and other medical illnesses. The type of accident, role/status and immediate reactions to the accident were not significant. Conclusions: PTSD following motor vehicle accidents is common. Although the MVA survivors do develop significant rates of PTSD, it is not easy to identify those at risk but some of the parameters documented in this study may help. A multi disciplinary approach is therefore essential in the management of the RTA survivors at the orthopaedic and trauma clinics if their physical and psychological needs are to be adequately addressed East African Medical Journal Vol.81(7) 2004: 362-36

Improving the effectiveness of psychotherapy in two public hospitals in Nairobi

This paper is the first in a planned series of papers studying the effectiveness of psychotherapy and counselling in Nairobi. It describes a method for checking the effectiveness of psychotherapy and improving service quality in a Kenyan context. Rather than prematurely imposing psychotherapy protocols developed in Western countries in another cultural context, we believe that first studying psychological interventions as they are practised may generate understanding of which psychological problems are common, what interventions therapists use, and what seems to be effective in reducing psychiatric problems. The initial step is to assess outcome of psychological treatments as they are conducted. This is followed by statistical analyses aimed at identifying patient groups who are not improving at acceptable rates. Therapists will then be trained in a 'best practice' approach, and controlled trials are used in a final step, testing new interventions specifically targeted at patient groups with sub-optimal outcomes

Improving the effectiveness of psychotherapy in two public hospitals in Nairobi

This paper is the first in a planned series of papers studying the effectiveness of psychotherapy and counselling in Nairobi. It describes a method for checking the effectiveness of psychotherapy and improving service quality in a Kenyan context. Rather than prematurely imposing psychotherapy protocols developed in Western countries in another cultural context, we believe that first studying psychological interventions as they are practised may generate understanding of which psychological problems are common, what interventions therapists use, and what seems to be effective in reducing psychiatric problems. The initial step is to assess outcome of psychological treatments as they are conducted. This is followed by statistical analyses aimed at identifying patient groups who are not improving at acceptable rates. Therapists will then be trained in a 'best practice' approach, and controlled trials are used in a final step, testing new interventions specifically targeted at patient groups with sub-optimal outcomes