Mental health issues associated with the management of tuberculosis in Homabay, Busia and Kakamega Counties, Kenya.

BACKGROUND: Despite the implementation of patient-centred care, mental health issues remain a significant risk factor and comorbidity for Tuberculosis (TB) disease. Mental health issues being co-morbidities to TB are likely to increase the disease burden of the affected population. This study therefore investigated the prevalence and impact of mental health issues in Tuberculosis (TB) patients. METHODS: This cross-sectional study design used mixed methods in data collection. The study used structured questionnaires, key informant interviews and focus group discussions. 127 TB patients were purposively selected from a group of patients who previously recovered successfully, with a history of relapse or are currently on TB treatment in high-volume facilities in Homa Bay, Busia and Kakamega Counties. 30 Key informant interviews were conducted with Healthcare workers. Quantitative data analysis was done using STATA version 14. Thematic analysis was employed to analyze qualitative data using NVivo version 10. RESULTS: The findings showed that the most common mental health issues affecting TB patients were anxiety (66%) and depression (55%), which were commonly experienced during the presumptive stage of TB. Qualitative data revealed that stigma was the main barrier that hindered TB patients from accessing care. TB patients articulated the benefits of support structures ranging from positive encouragement, reminders on taking drugs, accompaniment to the clinic, and financial support in TB management. Furthermore, the study established that the majority of Health Care Workers (HCWs) were not prepared to handle TB patients' mental issues, a gap that is likely to impact the quality of care TB patients receive. CONCLUSION: The study established that mental health issues impact TB treatment outcomes. Healthcare systems should prioritize the integration of mental health care into TB programs to address the high prevalence of mental health issues among TB patients.

The prevalence and associated factors of undernutrition among under-five children in South Sudan using the standardized monitoring and assessment of relief and transitions (SMART) methodology.

BACKGROUND: Conflict regions bear the heaviest brunt of food insecurity and undernutrition. South Sudan is one of the fragile countries following years of conflict that led to large displacements. Moderate to severe undernutrition among under-five children has been associated with elevated morbidity and mortality. This study, therefore, was conducted to assess the magnitude and factors influencing undernutrition (wasting, underweight and stunting) among children aged 6 to 59 months in Yambio County, South Sudan. METHODS: A cross-sectional study was conducted from 26 October to 6 November 2018 in Yambio County, South Sudan among 630 children aged 6-59 months from the 348 households surveyed in 39 clusters using two-stage cluster sampling design. Data were collected using questionnaires and nutritional anthropometric measurements. The Standardized Monitoring and Assessment of Relief and Transitions (SMART) Methodology was followed to obtain the prevalence of wasting, underweight and stunting based on respective z scores and according to the 2006 world health organization child growth standards. Data were exported to Stata version 16 for further analysis. Bivariate analysis of independent variables and undernutrition was done using binary logistic regression. Mixed effects logistic regression analysis was conducted to control for possible confounders and account for random effects at household and cluster levels. Unadjusted and adjusted odds ratios (cOR and aOR) with 95% confidence intervals (CI) and p-values were computed. P-values of ≤0.05 were considered statistically significant. RESULTS: The prevalence of undernutrition explained by wasting (weight-for-height Z-score (WHZ) < - 2), underweight (weight-for-age z-scores (WAZ) < - 2) and stunting (height-for-age z-scores (WHZ) < - 2) were 2.3% (1.3-4.1, 95% CI), 4.8% (3.1-7.5, 95% CI) and 23.8% (19.1-29.2, 95% CI). Male sex (aOR [95% CI], p-value: 5.6 [1.10-30.04], p = 0.038), older child's age (aOR [95% CI], p-value: 30.4 [2.65-347.60], p = 0.006) and non-residents (cOR [95% CI], p-value: 4.2 [1.4-12.2] p = 0.009) were associated with increased risk of wasting. Household size (cOR [95% CI], p-value: 1.09 [1.01-1.18] p = 0.029) and younger child age (cOR [95% CI], p-value: 4.2 [1.34-13.23] p = 0.014) were significantly associated with underweight. Younger child age (aOR [95% CI], p-value: 5.4 [1.82-16.44] p = 0.003) and agricultural livelihood (aOR [95% CI], p-value: 3.4 [1.61-7.02] p = 0.001) were associated with stunting. CONCLUSION: Based on a cut off of less than - 2 standard deviations for 2006 World Health Organization (WHO) child growth standards, the wasting prevalence was very low, underweight prevalence was low while stunting prevalence was high. The county lies in the only livelihood region in South Sudan with bimodal reliable rainfall pattern and it seems that the impact of the 2016 conflicts that lead to large displacements may not have greatly affected under-five undernutrition. Interventions targeted at improving food diversity, increasing nutrition knowledge and enhancing resilience in male children might reduce undernutrition. In the short-term, investment in continued surveillance of nutritional status should be a main focus.