Muthoni Mathai

Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community

Abstract The course of HIV/AIDS in children has been transformed from an acute to a chronic one with the advent of Anti-Retroviral Therapy. The aim of this study was to determine the prevalence and pattern of psychiatric morbidity in HIV-infected children and adolescents between 6 and 18 years of age and the relationship between their socio-demographic factors, immune suppression and psychiatric morbidity. The study was conducted at a paediatric HIV clinic in Nairobi, between February and April 2010. One hundred and sixty-two HIV-infected children and adolescents aged between 6 and 18 years and their guardians were interviewed. Seventy-nine (48.8%) of the study participants were found to have psychiatric morbidity. The most prevalent Diagnostic Statistical Manual, 4th Edition TR psychiatric disorders were: Major depression (17.8%), Social phobia (12.8%), Oppositional Defiant Disorder (12.1%) and Attention Deficit Hyperactivity Disorder (12.1%). Twenty-five per cent of the study participants had more than one psychiatric disorder. The prevalence of psychiatric morbidity in HIV-infected children is higher than that found in children in the general population. There is therefore a need to integrate psychiatric services into the routine care of HIV-infected children.

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). CDI scores 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.

Translation of EPDS Questionnaire into Kiswahili: Understanding the Cross-Cultural and Translation Issues in Mental Health Research

The need for a suitable tool for assessing postpartum depression in Kenya led to the process of translation of the 10 items Edinburgh Postnatal Scale into Kiswahili. The idea was to seek semantic, conceptual as well as normative equivalence in this translation. The paper discusses issues and the process of translation and provides in depth discussions around translation from the point of view of cross-cultural mental health research and practice. The English version of the EPDS screening tool was finally successfully translated into Kiswahili and the translated version is attached with this paper.

Risk factors for postpartum depression in women living with HIV attending prevention of mother-to-child transmission clinic at Kenyatta National Hospital, Nairobi

ABSTRACT Mothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) among women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending prevention of mother-to-child transmission (PMTCT) clinic at Kenyatta National Hospital located in Nairobi, Kenya. We used the Edinburgh Postnatal Depression Scale and HIV/AIDS Stigma Instrument – PLWHA (HASI – P). Forty-eight percent (N = 59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR = 0.14, 95% CI [0.04–0.46], p = .001) and lack of family support (OR = 2.49, 95% CI [1.14–5.42], p = .02) were associated with the presence of elevated depressive symptoms. The presence of stigma implied more than ninefold risk of development of PPD (OR = 9.44, 95% CI [1.132–78.79], p = .04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother–baby dyad.

Major depressive disorder in a Kenyan youth sample: relationship with parenting behavior and parental psychiatric disorders

BackgroundStudies on mental health problems during childhood and youth development phases have reported that families of children diagnosed with a depressive disorder tend to be dysfunctional. These dysfunctions have been shown to be mediating factors for children to develop psychiatric disorders in the future.ObjectiveThis study was designed to investigate whether perceived parenting behavior and parental psychiatric disorders have any relationship with youth presenting with major depressive disorder.MethodologyThe study sample had a total number of 250 purposely selected youth attending the Youth Clinic at Kenyatta National Hospital in Nairobi.ResultsThis study found associations between major depressive disorders (MDD) in the youth and co-morbid psychiatric disorders among the youth: conduct disorder (OR = 2.93, 95% CI 1.04 to 8.26, p = 0.035), any anxiety disorder (OR = 2.41, 95% CI 1.20 to 4.87, p = 0.012), drug abuse (OR = 3.40, 95% CI 2.01 to 5.76, p < 0.001), alcohol use (OR = 3.29, 95% CI 1.94 to 5.57, p < 0.001), and suicidal behavior (OR = 5.27, 95% CI 2.39 to 11.66, p < 0.001). The results also indicate that a higher proportion of youth between 16 and 18 years had major depressive disorder than the youth below 16 years or above 18 years of age (OR = 2.66, 95% CI 1.40 to 5.05, p = 0.003). Multivariate analysis shows that both rejecting maternal behavior (AOR = 2.165, 95% CI 1.060 to 4.422, p = 0.003) and maternal MDD (AOR = 5.27, 95% CI 1.10 to 14.76, p < 0.001) are associated with MDD in youth.ConclusionNegative maternal parenting behavior and maternal depressive disorder are associated with major depressive disorder in children.

Access and Attitudes to HPV Vaccination amongst Hard-To-Reach Populations in Kenya

Background Sub-Saharan Africa bears the greatest burden of cervical cancer. Human papillomavirus (HPV) vaccination programmes to prevent the disease will need to reach vulnerable girls who may not be able access health and screening services in the future. We conducted formative research on facilitators and barriers to HPV vaccination and potential acceptability of a future HPV vaccination programme amongst girls living in hard-to-reach populations in Kenya. Methods Stakeholder interviews with Ministry of Health staff explored barriers to and support for the uptake of HPV vaccination. A situation assessment was conducted to assess community services in Maasai nomadic pastoralist communities in Kajiado County and in Korogocho informal settlement in Nairobi city, followed by focus group discussions (n=14) and semi-structured interviews (n=28) with health workers, parents, youth, and community and religious leaders. These covered marriage, knowledge of cervical cancer and HPV, factors that might inhibit or support HPV vaccine uptake and intention to accept HPV vaccine if a programme was in place. Results Reported challenges to an HPV vaccination programme included school absenteeism and drop-out, early age of sex and marriage, lack of parental support, population mobility and distance from services. Despite little prior knowledge of cervical cancer and HPV, communities were interested in receiving HPV vaccination. Adequate social mobilisation and school-based vaccination, supplemented by out-reach activities, were considered important facilitating factors to achieve high coverage. There was some support for a campaign approach to vaccine delivery. Conclusions Given the high level of support for a vaccine against cervical cancer and the experience of reaching pastoralist and slum-dwellers for other immunizations, implementing an HPV vaccine programme should be feasible in such hard-to-reach communities. This may require additional delivery strategies in addition to the standard school-based delivery, with vaccine offered at multiple venues, potentially through a campaign approach.

Suicidal behaviour among youths associated with psychopathology in both parents and youths attending outpatient psychiatric clinic in Kenya

BackgroundSuicide is a major cause of death among youths particularly with psychiatric, alcohol abuse and substance abuse disorders. There are relatively few studies on the relationship between psychiatric and substance abuse disorders with suicidal behaviour from low-income countries. This study examines the relationship between suicidal behaviour and co-existing psychiatric or substance disorders among youths and depressive and alcohol use disorders in their parents.MethodThe study sample had 678 respondents: 250 youths and 226 and 202 biological mothers and fathers, respectively.ResultsThis study found a significant statistical association between depressive (p < 0.001), alcohol abuse (p <0.001) and substance abuse (p < 0.001) disorders and suicidal behaviour in youths. There was a significant relationship between maternal depressive disorder (p < 0.001) and perceived maternal rejecting parenting behaviour (p < 0.001) with suicidal behaviour in youths. There was a greater odds of a youth with two to three (odds ratio (OR) = 3.63; p = 0.009) and four or more (OR = 8.23; p < 0.001) co-existing psychiatric disorders to have suicidal behaviour than a youth with only one psychiatric disorder. The results also indicate that a higher proportion of youths between ages 16–18 years had suicidal behaviour than youths below 16 years or above 18 years of age (p = 0.004).ConclusionThese findings suggest that youths with psychiatric and substance abuse disorders have mothers living with a depressive disorder. Also, perceived maternal rejecting parenting behaviour contributes significantly to the development of suicidal behaviour later in adolescent years.

University Medical Education In Kenya: The Challenges.

There are two medical schools training doctors in Kenya: the Moi University established in 1984 and the University of Nairobi established in 1967. The University of Nairobi has so far produced the majority of Kenyan doctors. Both are public universities with the Government being the main financier. The increased demand for university education and the inability to meet these demands has led to the introduction of a system of training self-sponsored medical students alongside Government-subsidised students. One other public university has started a medical school. The pressure to increase the number of schools and students in the absence of increased resources poses a particular challenge to the country.

Antepartum Risk Factors for Postpartum Depression: A Follow up Study amongUrban Women Living in Nairobi, Kenya

Introduction: Longitudinal studies that assess antepartum risk factors and outcome in the postpartum period can help provide a wealth of information in understanding maternal depression. In addition to collecting information on prevalence and correlates of antepartum depression, such studies reveal postpartum outcomes of depression as well as its risk factors while avoiding recall bias, a limitation frequently seen in cross sectional postpartum studies. Methodology: We consecutively recruited 188 adult women residing in an urban, resource poor setting and attending maternal and child health clinics in 2 major public hospitals in Nairobi, Kenya. A translated Kiswahili EPDS was used to screen for depressive symptoms at baseline assessment in the 3rd trimester and a follow up assessment at 6-10 weeks post-partum. A different questionnaire was administered at baseline to collect information on potential socio demographic and clinical antepartum risk variables. Study results: At a cut off of 13 or more on the EPDS, our study found a prevalence of 18% for antepartum depression. Associated correlates of antepartum depression were partner current alcohol use and partner wanting current pregnancy. Out of the 171 women we followed up at 6-12 weeks postpartum, 21% were found to have postpartum depression. Antenatal depression and conflict with partner were the strongest independent predictors of postpartum depression. In the adjusted analysis, the risk of having postpartum depression is increased six-fold in the presence of antepartum depression and ten times in the presence of conflict with partner. Conclusion: High rates of perinatal depression among women residing in Africa underscore the need for addressing this public health burden. Despite the comparably little emphasis on antenatal depression, antenatal depressive symptoms appear to be as common as postnatal depressive symptoms. Depression screening and psychosocial support that especially addresses conflict resolution during pregnancy should therefore be targeted for future interventions.

‘Haven of safety’ and ‘secure base’: a qualitative inquiry into factors affecting child attachment security in Nairobi, Kenya

ABSTRACT Secure attachment in childhood and adolescence protects children from engagement in high-risk behaviors and development of mental health problems over the life span. Poverty has been shown to create impoverishment in certain aspects of caregiving and correspondingly to compromise development of secure attachment in children. Nineteen children 8–14 years old from two schools in a middle-income area and an urban informal settlement area of Nairobi were interviewed using an adapted Child Attachment Interview (CAI) protocol. CAI was developed to provide a glimpse into the ‘meta-theories’ children have about themselves, parents, parenting, and their attachment ties with parents and extended family members. Narratives obtained with the CAI were analyzed using thematic analysis. Both Bowlby’s idea of ‘secure base’ and Bronfrenbrenner’s ‘ecological niche’ are used as reference points to situate child attachment and parenting practices in the larger Kenyan context. We found that with slight linguistic alterations CAI can be used to assess attachment security of Kenyan children in this particular age range. We also found that the narration ability in both groups of children was generally good such that formal coding was possible despite cultural differences. Our analysis suggested differences in narrative quality across the children from middle class and lower socioeconomic class schools on specific themes such as sensitivity of parenting (main aspects of sensitivity were associated with disciplinary methods and child’s access to education), birth order, parental emotional availability, and severity of interparental conflicts and child’s level of exposure. The paper puts in context a few cultural practices such as greater household responsibility accorded to the eldest child and stern to harsh disciplinary methods adopted by parents in the Kenyan setting.