M.W Kuria

The prevalence of mental disorders in adults in different level general medical facilities in Kenya: a cross-sectional study

BackgroundThe possibility that a significant proportion of the patients attending a general health facility may have a mental disorder means that psychiatric conditions must be recognised and managed appropriately. This study sought to determine the prevalence of common psychiatric disorders in adult (aged 18 years and over) inpatients and outpatients seen in public, private and faith-based general hospitals, health centres and specialised clinics and units of general hospitals.MethodsThis was a descriptive cross-sectional study conducted in 10 health facilities. All the patients in psychiatric wards and clinics were excluded. Stratified and systematic sampling methods were used. Informed consent was obtained from all study participants. Data were collected over a 4-week period in November 2005 using various psychiatric instruments for adults. Descriptive statistics were generated using SPSS V. 11.5.ResultsA total of 2,770 male and female inpatients and outpatients participated in the study. In all, 42% of the subjects had symptoms of mild and severe depression. Only 114 (4.1%) subjects had a file or working diagnosis of a psychiatric condition, which included bipolar mood disorder, schizophrenia, psychosis and depression.ConclusionThe 4.1% clinician detection rate for mental disorders means that most psychiatric disorders in general medical facilities remain undiagnosed and thus, unmanaged. This calls for improved diagnostic practices in general medical facilities in Kenya and in other similar countries.

Attitudes Toward Psychiatry: A Survey of Medical Students at the University of Nairobi, Kenya

ObjectivesThe authors aim to determine the attitudes of University of Nairobi, Kenya, medical students toward psychiatry.MethodsThe study design was cross-sectional. Self-administered sociodemographic and the Attitudes Toward Psychiatry-30 items (ATP-30) questionnaires were distributed sequentially to every third medical student in his or her lecture theater before or immediately after the lectures. Analysis was done using SPSS version 11.5 and the results are presented in tables.ResultsNearly 75% of the students had overall favorable attitudes toward psychiatry but only 14.3% considered psychiatry as a potential career choice. Sixty-six percent reported that they would not choose psychiatry as a career while the remaining 19.7% were not decided.ConclusionsThere is dissonance between positive attitudes toward psychiatry and the choice of psychiatry as a potential career. Therefore, there is a need to bridge the gap by addressing the various factors that potentially account for this dissonance.

The Prevalence of Depression among Family Caregivers of Children with Intellectual Disability in a Rural Setting in Kenya.

Caregivers of children with intellectual disability have a great responsibility that may be stressful. The psychological well-being of the care giver may affect the quality of care given to children with intellectual disability. Objective. The objective of the study was to determine the risk of depression in caregivers of children with intellectual disability. Setting. The study was conducted at Gachie Catholic Parish, Archdiocese of Nairobi (Kenya). Design. Cross sectional, descriptive study. Method. The study was conducted among 114 caregivers registered at the Gachie Parish program (in Kenya) for the intellectual disabled children. A researcher-designed social demographic questionnaire and the Beck depression inventory were administered to those that met the inclusion criteria. Results. Seventy-nine percent (79%) of the caregivers were at risk of clinical depression. Conclusion. Majority of the caregivers of children with intellectual disability were at risk of developing clinical depression.

The Association between Alcohol Dependence and Depression before and after Treatment for Alcohol Dependence.

The presence of depression in alcohol-dependent persons is likely to influence treatment process and outcomes. Identification of depression is important though not every depressed alcohol-dependent person requires treatment with antidepressants. Understanding the association between depression and alcohol dependence is essential for proper management of alcohol dependence. Objectives. To determine the prevalence of depression among alcohol-dependent persons before and after alcohol detoxification and rehabilitation. Design. Clinical trial with pre-/postmeasurements. Method. The CIDI and WHO-ASSIST were administered to 188 alcohol-dependent persons at intake and after six months. A researcher-designed sociodemographic questionnaire was also administered at intake. Results. The prevalence of depression among alcohol-dependent persons is high (63.8%) with a significant association between depression and the mean AUDIT score. At posttest, depressed participants had a statistically significant craving for alcohol. Conclusion. Alcohol dependence is associated with major depression.

The prevalence of personality disorders in a Kenyan inpatient sample.

DSM-IV Axis I and II comorbidities and the pattern of Axis II diagnoses in patients admitted at Mathari (Psychiatric) Hospital, Nairobi, Kenya are unknown. To determine DSM-IV Axis I and II comorbidities and patterns of Axis II diagnoses in patients admitted at Mathari Hospital. Cross-sectional study on 148 randomly sampled patients. Twenty percent of the patients were confirmed for an Axis II diagnosis. Eighty-seven percent of the Axis II disorders were Cluster B Personality Disorders of various types. Using chi2 tests, significant associations were found between Axis I and II diagnoses and substance use/dependence (p < 0.001; 66.7%), mood disorder (p = 0.002; 46.7%) and schizophrenia (p < 0.001; 23.3%). The prevalence of personality disorders was lower than that reported in psychiatric patients in USA and Europe. The results are likely to be a true reflection of the actual epidemiological situation, but cannot be generalized to outpatient or general populations.

Is Sexual Abuse a Part of War? A 4-Year Retrospective Study on Cases of Sexual Abuse at the Kenyatta National Hospital, Kenya

The harmful effects of sexual abuse are long lasting. Sexual abuse when associated with violence is likely to impact negatively on the life of the victim. Anecdotal reports indicate that there was an increase in the number of cases of sexual violence following the 2007 post election conflict and violence in Kenya. Although such increases in sexual abuse are common during war or conflict periods the above reports have not been confirmed through research evidence. The purpose of the current study is to establish the trend in numbers of reported cases of sexual abuse at Kenyatta National Hospital over a 4-year period (2006-2009). Data on sexually abused persons for the year 2006-2009 was retrieved from the hospitals record. A researcher designed questionnaire was used to collect relevant data from the completed Post Rape Care (PRC) form. The PRC-Ministry of Health no. 363 (MOH363) form is mandatorily completed by the physician attending the sexually abused patient. There was an increase in the number of cases of sexual abuse reported in 2007 election year in Kenya, with a statistically significant increase in the sexually abused male cases. Sexual crime is more prevalent when there is war or conflict.

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.

Factor analysis of the Clinical Outcomes in Routine Evaluation – Outcome Measures (CORE-OM) in a Kenyan sample

BackgroundThere is no generic psychotherapy outcome measure validated for Kenyan populations. The objective of this study was to test the acceptability and factor structure of the Clinical Outcomes in Routine Evaluation – Outcome Measure in patients attending psychiatric clinics at two state-owned hospitals in Nairobi.MethodsThree hundred and forty-five patients filled out the CORE-OM after their initial therapy session. Confirmatory and Exploratory Factor Analysis (CFA/EFA) were used to study the factor structure of the CORE-OM.ResultsThe English version of the CORE-OM seemed acceptable and understandable to psychiatric patients seeking treatment at the state-owned hospitals in Nairobi. Factor analyses showed that a model with a general distress factor, a risk factor, and a method factor for positively framed items fit the data best according to both CFA and EFA analysis. Coefficient Omega Hierarchical showed that the general distress factor was reliably measured even if differential responding to positively framed items was regarded as error variance.ConclusionsThe English language version of the CORE-OM can be used with psychiatric patients attending psychiatric treatment in Nairobi. The factor structure was more or less the same as has been shown in previous studies. The most important limitation is the relatively small sample size.

Cost Effectiveness of Community Based and Residential Based treatment of Alcohol Use Disorders: Findings of a study in Kenya

Alcohol Use disorder (AUD) treatment should be effective, available and affordable. The treatment of AUDs in Kenya, which is traditionally residential, based and community based treatment, has not been documented. Objective: to Determine Cost effectiveness of Community based and residential based treatment for AUD. Design: Clinical trial with pre-/post measurements. Method : The WHO- ASSIST and the CIDI questionnaires were administered to 188 alcohol-dependent persons at intake and after six months for the community based group. A socio demographic questionnaire was also administered at intake. They were then subjected to outpatient detoxification and follow-up within the community. Similar instruments were administered to 88 persons admitted for AUD treatment to 2 residential treatment centres during the study period. They were treated as per the set standards of the treatment centers and discharged after three months. They were contacted after 6 months and their alcohol use determined. Results: After six months, 56.9 % of the community based treatment group and 44.3% of the residential based treatment group were abstinent for the entire six months. Community based treatment was more cost effective and 1.7 times cheaper than the non- subsidized residential based treatment. Conclusion: Community based treatment for persons with AUD are more cost effective.

Sexual Dysfunction among Patients with Diabetes Mellitus

Sexual dysfunction can impact a person’s ability to form or sustain intimate relationships and co morbidity between sexual dysfunction and anxiety as well as depression has been reported. Yet epidemiological, etiological, and health association to sexual dysfunction has only begun to be explored in Kenya. Aim: To determine the prevalence, types of sexual dysfunction and their socio demographic correlate in diabetic patients. Design: Descriptive cross- sectional study Setting: The study was conducted at the outpatient diabetic clinic of Kenyatta National Hospital. This is the main referral hospital in Kenya. Methods: A total of 350 participants were enrolled in the study. The Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) questionnaires were used to evaluate sexual dysfunctions in female and male patients respectively. Results: The participants were composed of 164 females aged between 18-74 years and 186 males aged between 19- 100 years. In males, prevalence of sexual dysfunctions were: erectile dysfunction (68.8%); orgasmic dysfunction (48.4%); sexual desire (81.7%); intercourse satisfaction (86.6%) and overall satisfaction (68.4%).The female sexual dysfunction was 36.6% and was categorized as mild (17.1%); moderate (18.3%) and severe (1.2%). Conclusion: Diabetic patients have a high prevalence of sexual dysfunction