Psychiatric morbidity among sexually abused children and adolescents.

OBJECTIVES: To describe the social demographic profile and identify psychiatric morbidity in sexually abused children and adolescents. DESIGN: A Cross-sectional descriptive survey. SETTING: Nairobi Women's Hospital (NWH) Gender Violence Recovery Centre (GVRC), Hurlingham, Nairobi-Kenya. SUBJECTS: A sample of 61 sexually abused children and adolescents aged 7-17 years. RESULTS: Eighty two percent of the survivors were sexually abused by acquaintances such as neighbours, caregivers and parents. Ninety percent of the sampled group were females. Abuse occurred in both single and both parent families and regardless of the guardian/parental economic status. Sixty six percent of the survivors' parents were abusing psychoactive substances. Sexual abuse variables and most of the social demographic variables did not predict either presence or absence of psychiatric morbidity. Only 66% of the abuse came to the notice of the child's caregiver within the first 48 hours. On the socio demographic profile, the only factor that showed a statistical significant difference in predicting presence or absence of psychiatric morbidity was the family's way of sorting out their disagreements (p = 0.045). The prevalence of psychiatric morbidity among the subjects studied as measured by the Diagnostic Statistical Manual Text Revision (DSM IV-TR) was found to be 69%. Eight different types of DSM IV-TR diagnoses were made. Twenty nine percent of the AXIS-I DSMIV-TR diagnoses were co-morbidities (Multiple DSM IV-TR diagnoses). CONCLUSIONS: The psychiatric morbidity prevalence is comparable to that found in other studies. Sexual abuse occurred regardless of the social demographic variables. Family's way of sorting out disagreement predicted presence or absence of psychiatric morbidity among the study subjects. Majority (82%) of the sexual abusers were acquaintances to the study subjects. RECOMMENDATIONS: It is recommended that all children and adolescents who have been sexually abused be evaluated for psychiatric morbidity regardless of their social demographic and abuse profiles and that all parents and care givers, be sensitised on childhood sexual abuse and the fact that majority of the perpetrators are acquaintances to the subjects. Families need to be sensitised on their role on prevention and reduction of psychiatric morbidity among children and adolescents in general.

Post traumatic stress disorder among Mau Mau concentration camp survivors in Kenya.

BACKGROUND: A decade before Kenya's independence in 1963 thousands of 'Mau Mau' fighters were arrested and incarcerated in concentration camps where many underwent torture and inhuman treatment. No studies have been done to establish the presence of post traumatic stress disorder (PTSD) and other psychiatric morbidity among the survivors of those concentration camps. OBJECTIVES: To establish the prevalence of PTSD and other psychiatric morbidity and associated factors among the Mau Mau Concentration Camp survivors. DESIGN: A cross-sectional, descriptive study of all consecutive concentration camp survivors included in the study. SETTING: Mau Mau War Veterans' Association (MMWVA) headquarters at Mwea House, Nairobi, Kenya Human Rights Commission headquarters in Nairobi, Tumaini House (Venue of MMWVA elections, 2005) and the MMWVA branch office in Kajiado District, Rift Valley Province, Kenya. SUBJECTS: One hundred and eighty one Mau Mau Concentration Camp Survivors who gave consent to participate in the study. MAIN OUTCOME MEASURES: Lifetime and Current PTSD, IES-R score and other Psychiatric Morbidity as measured using the SCID and the IES-R. RESULTS: A DSM-IV-TR diagnosis of current PTSD was made in 65.7% of the survivors. Current PTSD was associated with higher IES-R scores and older age, lower income, non-Catholic religion, larger household size, older age at incarceration, greater length of incarceration, incarceration in two or more camps, experiencing other traumatic events, family history of mental illness and having other psychiatric illness. CONCLUSIONS: Similar to other former Prisoners of War (POWs) elsewhere, these survivors suffer high PTSD prevalence rates and a special veterans' service is recommended to address this problem and its associated factors among these and other veterans in Kenya.

Psychiatric morbidity among leprosy patients in Teso and Busia districts of Western Kenya.

OBJECTIVE: To establish the magnitude of psychiatric disorders among leprosy patients in western Kenya. DESIGN: A cross-sectional descriptive study. SETTING: Busia and Teso districts in western Kenya. SUBJECTS: A sample of 152 male and female, adult leprosy patients. RESULTS: The prevalence of psychiatric morbidity (PM) was 53.29%. The PM was positively correlated with physical disability and marital status but not with age, sex, education, type of leprosy, or duration of the illness. The prevalence of psychiatric morbidity was lower among Kenyan leprosy patients compared to studies carried out in India (56% to 78%). It was high compared to the rate of psychiatric morbidity in those seeking medical help in primary health care centres in Kenya, which was recently estimated to be 10%. CONCLUSION: The prevalence of PM in leprosy patients in western Kenya was lower than that in studies carried out in India. This could be attributed to de-institutionalisation and re-integration of leprosy sufferers back into their local communities. Since the rate was more than double that in the general Kenyan population and seemed to be related to presence of physical disability, an appraisal of psychiatric services offered to these patients is needed.

Prevalence of tardive dyskinesia among psychiatric in-patients at Mathari Hospital, Nairobi.

OBJECTIVE: To determine the prevalence of tardive dyskinesia among psychiatric in-patients. DESIGN: A cross-sectional survey. SETTING: Mathari Hospital, Nairobi, the main psychiatric referral hospital in Kenya. SUBJECTS: Two hundred and two randomly selected in-patients seen in the hospital between January and April 2000. RESULTS: The prevalence of tardive dyskinesia was 11.9%. Neither the psychiatric diagnosis nor the sex was significantly associated with tardive dyskinesia. The antipsychotic dosage was also not associated with tardive dyskinesia but an increase in age was significantly associated with the abnormal movements. CONCLUSION: The prevalence rate of tardive dyskinesia among patients at Mathari Hospital is much lower than that found in western countries but similar to that from Asian studies. These findings indicate the possibility of racial differences in the aetiology of TD. Prospective cross-racial studies are necessary to confirm these findings.

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: p<0.05) and tobacco (average lifetime use 56.4% for males compared to 5.6% for females p<0.05). CONCLUSION: The rates of substance abuse were generally low with the exception of alcohol and tobacco. Socio-cultural factors might be responsible for the differences noted. It is suggested that preventive measures and education should be emphasised at the primary care level.

Psychiatric morbidity among children and young persons appearing in the Nairobi Juvenile Court, Kenya.

OBJECTIVES: To estimate the prevalence and pattern of psychiatric disorders among children and young persons appearing in the Nairobi juvenile court, Kenya. DESIGN: A point prevalence survey. SETTING: The Nairobi Juvenile Court, Kenya. SUBJECTS: Ninety (sixty-four males and twenty-six females) children and young persons aged 8 to 18 years classified as criminal offenders, group I (60), and those for protection and discipline, group II (30), were selected. METHOD: A socio-demographic questionnaire, reporting questionnaire for children (RQC), follow-up interview for children (FIC), present state examination (PSE) and clinical interview were administered to the subjects. International Classification of Diseases, 10th Edition (ICD-10) diagnostic criteria were used. RESULTS: The crude psychiatric morbidity (CPM) rate was 44.4%. ICD-10 documented psychiatric disorders detected in those with CPM were conduct disorders 45%, mixed disorders of conduct and emotion 20%, emotional disorders with onset specific to childhood 20%, mood disorders 12.5% and hyperkinetic disorders 2.5%. CONCLUSION: This study has shown a high presence of psychiatric morbidity in children and young persons appearing in the Nairobi Juvenile Court. These juveniles need and would benefit from mental treatment as recommended in section 18 of Cap 141 of the laws of Kenya; The Children's and Young Persons Act.

Substance use among children and young persons appearing in the Nairobi Juvenile Court, Kenya.

OBJECTIVE: To estimate the prevalence and pattern of substance use among children and young persons appearing in the Nairobi Juvenile Court, Kenya. DESIGN: A point prevalence survey. SETTING: The Nairobi Juvenile Court, Kenya. SUBJECTS: Ninety (sixty four males and twenty six females) children and young persons aged 8 to 18 years classified as criminal offenders, group I (60) and those for protection and discipline, group II (30), were selected. METHOD: Socio-demographic and substance use questionnaires were administered to the subject. International classification of diseases, 10th Edition (ICD-10) diagnostic criteria were used. RESULTS: Crude rate for substance use in this study was found to be 39 out of the total sample of 90(43.3%), children and young persons. Of these thirty nine, 33 (85.8%) were males and six(14.2%) were females. Twenty nine (32.2%) used nicotine, 19(21.1%) used volatile hydrocarbons, 8(8.9%) used cannabis six (6.7%) used alcohol, five (5.6%) used khat and three (3.3%) used sedatives. Multiple substance use was also evident. CONCLUSION: This study has shown a high presence of substance use in children and young persons appearing in the Nairobi Juvenile Court.

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 socio-demographic 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