Drug use in a rural secondary school in Kenya.

Alcohol abuse and alcohol-related use problems among adolescents are highly prevalent and are a major concern worldwide. This study estimated the prevalence of drug abuse, knowledge about drug abuse and its effect on psychosocial well-being and induced behavioral problems among students of a public rural secondary school that admitted both girls and boys which offered both boarding and day school facilities. The students filled out a self-reporting substance use tool which measures the prevalence, frequency, and general patterns of substance use. Alcohol, tobacco, khat (catha edulis) and bhang (cannabis) were the most commonly reported substance of use, with user prevalence rates of 5.2%, 3.8%, 3.2%, and 1.7%, respectively. Tobacco use was initiated at 10 years, while cannabis, hard drugs, khat, and alcohol were initiated at 11, 12, 13, and 15 years of age, respectively. Among the students 71% were aware that their schoolmates were on drugs and it was known by 49.8%, 41.7%, 37.6%, 44.3%, and 32.4% of these students that using alcohol, tobacco, khat, cannabis, and hard drugs, respectively was a behavioral problem in the school. Three quarters of the students were aware that use of drugs was harmful to their health, with majority (78.6%) indicating that drug users need help to stop the drug use behavior. However most (73.6%) of the students suggested drug users in school should be punished. The drug use behavioral problems included school dropout, poor scholastic attainment, drunken driving, delinquency, and adolescence pregnancy which threaten the stability of the education system, family as an institution (family difficulties) and society at large. Therefore, teachers have an added burden of playing an active role in guidance and counselling the survivors of drug abuse, a pandemic facing teaching institutions apart from instilling knowledge.

A cross-sectional study of co-occurring suicidal and psychotic symptoms in inpatients at mathari psychiatric hospital, nairobi, kenya.

UNLABELLED: To investigate the prevalence of suicidal symptoms and their co-occurrence with psychotic symptoms in patients at Mathari Hospital. METHOD: A descriptive cross-sectional study was conducted in June 2004 on inpatients at Mathari Hospital, the national psychiatric teaching and referral hospital. Data on sociodemographic characteristics and clinical diagnoses of inpatients were extracted from their clinical notes. The Structured Clinical Interview for DSM-IV (SCID) Screening Module was used to elicit information on psychotic and suicidal symptoms. RESULTS: A total of 691 patients were interviewed, of whom 308 (44.6%) had suicidal symptoms. There were significant positive correlations (p < .05) between psychotic and suicidal symptoms diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) suggesting co-existence of these 2 sets of disorders. CONCLUSIONS: There is a high prevalence of suicidal symptoms in the patients admitted at Mathari Hospital with predominantly psychotic disorders. Although these prevalence rates are much lower than those reported elsewhere, especially for schizophrenia, they are still a cause for concern given that these suicidal symptoms were not being managed.

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

BACKGROUND: The 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. METHODS: This 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. RESULTS: A 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. CONCLUSION: The 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.

Patterns of drug abuse in public secondary schools in Kenya.

The objective of this study was to establish the association between substance abuse and the sociodemographic characteristics of secondary school students. All the students of 17 randomly stratified public secondary schools in Nairobi were required to complete self-administered sociodemographic and the School Toolkit questionnaires in a cross-sectional descriptive survey. Nearly all (96.6%; 1252/1296) the students, comprising more males (62.5%) than females, completed all the items on the questionnaires. Their mean age was 17 years. Alcohol and cigarette use were common and began as early as before age 11. No significant correlation was found between fathers' education and substance abuse. Mothers' education had a significant but negative correlation. There were increased rates of substance abuse compared to past surveys. Campaigns against drug use should include those aged 11 years and should focus on education on the dangers of alcohol and tobacco use, as these are gateways to use of other drugs.

Psychosocial and health aspects of drug use by students in public secondary schools in Nairobi, Kenya.

The objective of this study was to evaluate the influence of family, psychosocial, health, demographic, and behavioral characteristics on regular drug use. All the students of 17 randomly stratified public secondary schools in Nairobi were required to complete self-administered sociodemographic and the Drug Use Screening Inventory-Revised (DUSI-R) questionnaires in a cross-sectional descriptive study. All the 1328 students, of whom 58.9% were male, responded to all the questions, giving a response rate of 100%. The mean age of the respondents was 16 years and 78.1% were in boarding school. One third (33.9%) scored positively for substance abuse. Significant correlations were found between several domains of substance abuse and school, class, mode of school attendance, age, and gender. Students abusing drugs have multiple comorbidity of medical, psychological, and social pathologies. There are evidence-based intervention entry points for drug abuse that go beyond mere impartation on knowledge about the harmful effects of drugs.

Prevalence of substance abuse among patients in general medical facilities in Kenya.

Alcoholism and other substance abuse continue to be a problem among younger and older populations. The prevalence of substance abuse has only been studied among outpatients and in limited samples of inpatients in Kenya. This study therefore aimed to establish patterns of substance abuse in patients admitted in general medical facilities in Kenya. The Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to measure the prevalence of substance abuse among patients in 10 medical facilities in Kenya. Data were collected over a 4-week period in November 2005. The overall alcohol user rate using the two instruments was 25.1% and 25.5%, respectively. All the patients who used alcohol exhibited pathological use, which bordered from harmful use to dependence. Apart from alcohol, other abused substances included tobacco, cannabis, cocaine, amphetamines/khat, and sedatives. The clinicians' pick rate for substance use in general hospitals was negligible. These findings suggest the need for specific enquiry for substance abuse in patients in general medical facilities.

Clinical epidemiology in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya.

BACKGROUND: Knowledge of types and co-morbidities of disorders seen in any facility is useful for clinical practice and planning for services. AIM: To study the pattern of co-morbidities of and correlations between psychiatric disorders in in-patients of Mathari Hospital, the premier psychiatric hospital in Kenya. STUDY DESIGN: Cross-sectional. METHODS: All the patients who were admitted at Mathari Hospital in June 2004 and were well enough to participate in the study were approached for informed consent. Trained psychiatric charge nurses interviewed them using the Structured Clinical Interview for DSM-IV Axis I disorders Clinical Version (SCID-I). Information on their socio-demographic profiles and hospital diagnoses was extracted from their clinical notes using a structured format. RESULTS: Six hundred and ninety-one patients participated in the study. Sixty-three percent were male. More than three quarters (78%) of the patients were aged between 21 and 45 years. More than half (59.5%) of the males and slightly less than half (49.4%) of the females were single. All the patients were predominantly of the Christian faith. Over 85% were dependents of another family member and the remainder were heads of households who supported their own families. Schizophrenia, bipolar I disorder, psychosis, substance use disorder and schizo-affective disorder were the most common hospital and differential diagnoses. Of the anxiety disorders, only three patients were under treatment for post-traumatic stress disorder (PTSD). Nearly a quarter (24.6%) of the patients were currently admitted for a similar previous diagnosis. Schizophrenia was the most frequent DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-fourth edition) diagnosis (51%), followed by bipolar I disorder (42.3%), substance use disorder (34.4%) and major depressive illness (24.6%). Suicidal features were common in the depressive group, with 14.7% of this group reporting a suicidal attempt. All DSM-IV anxiety disorders, including obsessive-compulsive disorders, were highly prevalent although, with the exception of three cases of PTSD, none of these anxiety disorders were diagnosed clinically. Traumatic events were reported in 33.3% of the patients. These were multiple and mainly violent events. Despite the multiplicity of these events, only 7.4% of the patients had a PTSD diagnosis in a previous admission while 4% were currently diagnosed with PTSD. The number of DSM-IV diagnoses was more than the total number of patients, suggesting co-morbidity, which was confirmed by significant 2-tailed correlation tests. CONCLUSION: DSM-IV substance use disorders, major psychiatric disorders and anxiety disorders were prevalent and co-morbid. However, anxiety disorders were hardly diagnosed and therefore not managed. Suicidal symptoms were common. These results call for more inclusive clinical diagnostic practice. Standardized clinical practice using a diagnostic tool on routine basis will go a long way in ensuring that no DSM-IV diagnosis is missed. This will improve clinical management of patients and documentation.

Outcome of a working diagnosis of "psychosis" in relation to DSM-IV diagnostic criteria in a Kenyan in-patient cohort at Mathari hospital, Nairobi.

BACKGROUND: When a patient presents with mental illness and displays psychotic symptoms which are not clearly delineated, a clinical diagnosis of psychosis is usually entertained. AIM: To determine the underlying Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) disorders in clinical entities admitted with a working diagnosis of "psychosis" at Mathari Psychiatric Hospital, Nairobi, Kenya. STUDY DESIGN: Descriptive cross-sectional quantitative study METHOD: A total of 138 patients with a working diagnosis of "psychosis" on admission at Mathari Hospital during the period of this study were recruited over a one-month period. Their DSM-IV diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID). Analysis of the results was done using SPSS version 11.5. RESULTS: Nearly three quarters (72.5%) of the patients were male, 68.5% were aged between 20 and 34 years and 63.7% reported that they were single. Nearly half (49.2%) had attained up to 12 years of formal education and 90% were dependants of a member of the family. The most common DSM-IV diagnoses were schizophrenia, bipolar disorder, substance abuse, depression and anxiety disorders. Co-morbidity was recorded with an average of three DSM-IV disorders. CONCLUSION: "Psychosis" as a working diagnosis was reported in relatively young adults. The patients whose working clinical diagnosis was "psychosis" met the criteria for an average of three DSM-IV diagnoses. There is need for a proactive policy in clinical practice so that definitive diagnoses rather than just "psychosis" are made and appropriate management initiated as early as possible.

Traumatic experiences of Kenyan secondary school students.

BACKGROUND: There is no information on the socio-demographic variations and determinants of Trauma and Post-Traumatic Stress Disorder (PTSD) in Kenyan adolescents. OBJECTIVES: To describe the traumatic experiences of Kenyan high school students and to determine the levels of Post-traumatic Stress Disorder (PTSD) among them, and in relation to sociodemographic variables. DESIGN: A cross-sectional study of 1 110 students (629 males and 481 females), aged 12 to 26 years, using self-administered questionnaires. METHOD: The students completed questionnaires on sociodemographic data followed by the Trauma Checklist and the Child PTSD Checklist. RESULTS: Being confronted with bad news was the most common type of trauma encountered in 66.7% of the subjects, followed by witnessing a violent crime and domestic violence; 23.2% and 16.5% of the subjects reported physical abuse and sexual abuse respectively. PTSD symptoms were common; avoidance and re-experiencing occurred in 75% of the students and hyperarousal was reported by over 50%. The number of traumatic events was positively correlated with the occurrence of PTSD. The prevalence of full PTSD was 50.5%, while partial PTSD was 34.8%. Male and female subjects were equally affected but the boarders were more affected (p < 0.05) and the differences between the schools were statistically significant (p = 0.000). CONCLUSIONS: Kenyan secondary school students commonly experience traumatic events and have high rates of PTSD. Further studies are needed to determine the implications of these findings for their health and performance in school. The coping mechanisms need to be delineated and interventions put in place. Long-term studies are required to determine the role of such events in the causation of mental illness.

Bullying in public secondary schools in Nairobi, Kenya.

BACKGROUND: The prevalence and frequency of bullying in Nairobi public secondary schools in particular and in Kenyan schools in general is not known. Knowledge of the extent of the problem is essential in developing effective interventions. AIM: To study the prevalence and frequency of bullying in Nairobi public secondary schools, Kenya. METHODS: A self-report sociodemographic questionnaire and the Olweus Bullying Questionnaire of 1991 were administered to 1 012 students from a stratified sample of public secondary schools in Nairobi. RESULTS: Between 63.2% (640) and 81.8% (828) of students reported various types of bullying, both direct and indirect, with significant variations found for sex, age, class and year of study, whether in day or boarding school, and the place where bullied. Being bullied was significantly associated with becoming a bully, in turn. DISCUSSION: Bullying is highly prevalent in Kenyan schools. Further studies are needed to characterise bullies and victims in terms of personality and environmental factors that may be associated with or conducive to bullying, as well as to determine the long-term prognosis for both bullies and victims. Further research is also required to determine the most appropriate intervention.

Traumatic grief in Kenyan bereaved parents following the Kyanguli School fire tragedy.

Following the death of 67 boys in a fire tragedy at Kyanguli School in rural Kenya, the level of traumatic grief was assessed in a sample of 164 parents and guardians whose sons died in the fire. The study was cross-sectional. Counseling services were offered to all the bereaved parents soon after the tragedy. The subjects were interviewed using the Traumatic Grief Scale. A group of 92 parents/guardians was interviewed 2 months after the event, while the other group of 72 was assessed 7 days later. The second group of bereaved parents also completed the Self Rating Questionnaire (SRQ) and the Ndetei-Othieno-Kathuku scale (NOK). Over 90% of parents from both groups had a yearning for the departed and found themselves searching for him quite often. There was no much difference in terms of symptoms profile or intensity between the two groups. It appears that the counseling offered had minimal impact on the levels of distress.