Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities.

As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers' (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients' experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.

Emotional and behavioral problems in children with epilepsy attending the pediatric neurology clinic at a referral hospital in Kenya.

INTRODUCTION: Epilepsy is a common neurological condition, with a lifetime prevalence of 1% in children. Research has shown a high prevalence of emotional and behavioral problems in children with epilepsy. The aim of this study was to determine the prevalence of emotional and behavioral problems in children with epilepsy attending the pediatric neurology clinic in a referral hospital in Kenya and examine associated sociodemographic and clinical variables. METHODS: This was a cross-sectional descriptive study. Children with epilepsy aged between 6 and 12 years attending the Kenyatta National Hospital pediatric neurology clinic were recruited. Inclusion criteria for the study were children diagnosed with epilepsy, age between 6 and 12 years, accompanied by a primary caregiver, and the primary caregiver being willing to participate in the study. A sociodemographic questionnaire as well as the Child Behavior Checklist school-age version (CBCL/6-18) was administered to the caregiver accompanying the child. RESULTS: One hundred and seventy-seven children with epilepsy were recruited (66% males) with a mean age of 8.9 (standard deviation (SD): 2) years. The mean age at onset of seizures was 4.5 years; 48% of the children had first seizure while aged less than 2 years, 76% reported generalized tonic-clonic seizures, and 58% were on antiepileptic drugs (AEDs). The overall prevalence of emotional and behavioral problems was 46%, and the four leading symptom clusters were attention problems, aggressive behavior, social problems, and withdrawal/depression. The risk of emotional and behavioral problems was increased in children using more than one AED (odds ratio (OR) = 2.21, 95% confidence interval (CI), 1.18-4.14) and those aged ten years and above (OR = 2.7, 95% CI, 1.3-5.64). The risk of emotional and behavioral problems was reduced in children with infrequent seizures (OR = 0.08, 95% CI, 0.01-0.06) and in children reporting no seizure in the past year (OR = 0.08, 95% CI, 0.01-0.65). CONCLUSION: Emotional and behavioral problems are common among children with epilepsy in Kenya. This highlights the need to screen for these problems in children on treatment for epilepsy for early identification and subsequent management to improve outcome.

Mental health research in Botswana: a semi-systematic scoping review.

Mental and substance use disorders are a leading cause of disability worldwide. Despite this, there is a paucity of mental health research in low- and middle-income countries, especially in sub-Saharan Africa. We carried out a semi-systematic scoping review to determine the extent of mental health research in Botswana. Using a predetermined search strategy, we searched the databases Web of Science, PubMed, and EBSCOhost (Academic Search Complete, CINAHL with Full Text, MEDLINE, MEDLINE with Full Text, MLA International Bibliography, Open Dissertations) for articles written in English from inception to June 2020. We identified 58 studies for inclusion. The most researched subject was mental health aspects of HIV/AIDS, followed by research on neurotic and stress-related disorders. Most studies were cross-sectional and the earliest published study was from 1983. The majority of the studies were carried out by researchers affiliated to the University of Botswana, followed by academic institutions in the USA. There seems to be limited mental health research in Botswana, and there is a need to increase research capacity.

Traumatic experiences, posttraumatic stress symptoms, depression, and health-risk behavior in relation to injury among University of Nairobi students in Kenya.

OBJECTIVE: To describe the prevalence and types of injuries in relation to traumatic experiences, posttraumatic stress symptoms, depression, and health-risk behaviors among university students in Kenya. METHOD: A cross-sectional study collected data on a random sample of university students using a questionnaire to record sociodemographic variables while injuries experiences recorded using the Centers for Disease control criteria and Breslau's seven-item screener was used to identify post-traumatic stress disorder (PTSD) symptoms. Depressive symptoms were measured using Center for Epidemiological Studies Short Depression Scale. RESULTS: Nine hundred and twenty-three students (525 male and 365 female) were included in the study, mean age 23 years (SD 4.0). Serious injury in the previous 12 months was reported by 29.00% of the students. PTSD was present in 15.67% (men 15.39% and women 16.1%). Out of the total, 41.33% of the students had depressive symptoms (35.71% mild-moderate symptoms and 5.62% severe). In the multivariable logistic regression being poor, binge drinking, tobacco use, ever been diagnosed with HIV, physically abused as a child, high PTSD score, and depression (adjusted odds ratio 5.49, 95% confidence interval 4.32-13.21) were significantly (p value<5%) associated with injury in the last 12 months. CONCLUSION: Unintentional injuries and PTSD symptoms are common in this student population and are positively linked to depression and other risky behaviors. Measures aimed at improving the mental health, such as early identification and treatment of depression, may be useful in reducing the prevalence of such injuries among the youth.

Risky HIV sexual behaviour and depression among University of Nairobi students.

BACKGROUND: Prevalence rates of human immunodeficiency virus (HIV) infection among the youth are disproportionately high compared to that of other age groups in Kenya. Poor mental health has been linked to risky HIV behaviour, yet few local studies have explored these aspects. This study sought to determine associations between HIV risky sexual behaviour and depression among undergraduate students at the University of Nairobi. METHOD: A random sample of 923 (525 males and 365 females) undergraduate students was interviewed using a questionnaire to record sociodemographic variables and risky sexual behaviour including having multiple sexual partners, inconsistent condom use and engaging in sex after drinking. Depressive symptoms were measured using the Centre for Epidemiological Studies Short Depression Scale (CES-D 10). RESULTS: The students' mean age was 23 years (s.d.4.0). Overall, 41.33% of the students scored above the cut-off point of 10 on the CES-D 10 scale, with 35.71% having moderate symptoms and 5.62% having severe depressive symptoms. The percentage of those who had ever been diagnosed with sexually transmitted infections (STIs) was 9.71% (males 8.65%; females 11.01%); and for HIV 3.04% (males 2.02%; females 4.05%). Nearly 30% reported having had multiple partners in the previous 12 months, 27.4% of the students did not use condoms with sexual partners and 21% had engaged in sex after drinking within the previous 3 months. In multivariable-bivariate logistic regression, being older, having depressive symptoms, alcohol use/binge drinking, tobacco use, sex after drinking, previous diagnosis of STI, physical abuse, sexual coercion and history of sexual abuse as a child were significantly associated with having multiple partners. Further, younger age, being female, tobacco use and previous diagnosis of STI were significantly associated with inconsistent condom use. CONCLUSION: The prevalence of HIV rate infection is low compared to the national average but risky sexual behaviour is common among the students and is positively linked to depressive symptoms among other factors. Programmes aimed at HIV prevention should be integrated with mental health interventions.

Depression among university students in Kenya: prevalence and sociodemographic correlates.

BACKGROUND: Depression is a common cause of morbidity but prevalence levels among Kenyan university students are poorly understood. A better understanding of depression and its correlates is essential in planning for appropriate interventions in this population group. METHOD: A random sample of 923 University of Nairobi students (525 male and 365 female) were interviewed using a questionnaire to record sociodemographic variables. Depressive symptoms were measured using Centre for Epidemiological Studies Short Depression Scale (CES - D 10). RESULTS: The mean age was 23 (s.d. 4.0). Using a cut-off point of 10, the overall prevalence of moderate depressive symptoms was 35.7% (33.5% males and 39.0% females) and severe depression was 5.6% (5.3% males and 5.1% female). Depressive illness was significantly more common among the first year students, those who were married; those who were economically disadvantaged and those living off campus. Other variables significantly related to higher depression levels included year of study, academic performance, religion and college attended. Logistic regression showed that those students who used tobacco, engaged in binge drinking and those who had an older age were more likely to be depressed. No difference was noted with respect to gender. LIMITATIONS: This was a cross sectional study relying on self report of symptoms and could therefore be inaccurate. Although the study was conducted in the largest university in the country that admits students from diverse backgrounds in the country there could still be regional differences in other local universities. CONCLUSION: Depression occurs in a significant number of students. Appropriate interventions should be set up in higher institutions of learning to detect and treat these disorders paying particular attention to those at risk.

Improving adherence to ante-retroviral treatment for people with harmful alcohol use in Kariobangi, Kenya through participatory research and action.

BACKGROUND: Harmful alcohol use has been linked to the spread of HIV in Kenya. It also adversely affects those on antiretroviral (ARV) treatment through poor compliance. This study using participatory research and action (PRA) methods sought to understand factors related to alcohol abuse and non-adherence and to formulate appropriate interventions in a sample of people living with HIV and AIDS (PLWHA) who were also abusing alcohol, at Kariobangi in Nairobi, Kenya. METHODS: Entry into the community was gained through previous PRA work in that community and PLWHA were recruited through snowballing. Working together with the community members, the researchers explored the participants' understanding of alcohol use problem, its effects on compliance to ARV treatment and discussed possible action areas through PRA techniques that included focus group and market place discussions; visual aids such as spider diagrams, community mapping and ranking. Follow-up meetings were held to discuss the progress. RESULTS: By the final meeting, 67 PLWHA and 19 community members had been recruited. Through discussions, misconceptions regarding alcohol use were identified. It emerged that alcohol abuse was poorly recognised among both the community and health workers. Screening for alcohol use was not routinely done and protocols for managing alcohol related disorders were not available at the local health centres providing ARVs. The study participants identified improving communication, psychoeducation and screening for alcohol use as possible action areas. Poverty was identified as a major problem but the interventions to mitigate this were not easy to implement. CONCLUSION: We propose that PRA could be useful in improving communication between the health workers and the clients attending primary health care (PHC) facilities and can be applied to strengthen involvement of support groups and community health workers in follow up and counselling. Integrating these features into primary health care (PHC) would be important not only to PLWHA but also to other diseases in the PHC setting . Longer term follow up is needed to determine the sustained impact of the interventions. Problems encountered in the PRA work included great expectations at all levels fostered by handouts from other donors and cognitive impairment that interfered with constructive engagement in some of the PLWHA.

The epidemiology of addiction in Sub-Saharan Africa: a synthesis of reports, reviews, and original articles.

Use of alcohol and other psychoactive substances is associated with serious social and public health problems, but the extent of the problem in Sub-Saharan Africa is not well known. We set out to review epidemiological publications on alcohol and other psychoactive substances in Sub-Saharan Africa by performing a systematic search of electronic databases and paper records. Ten Sub-Saharan African countries are among the 22 in the world with the highest increase in per capita alcohol consumption. Cannabis, tobacco, and khat are widely used, and use of cocaine, stimulants, and heroin is increasing. More epidemiological research and implementation and evaluation of interventions is needed. Collaboration between African researchers and those in developed countries could help.

Use of participatory, action and research methods in enhancing awareness of mental disorders in Kariobangi, Kenya.

Worldwide, mental disorders affect 450 million people and account for 15% of the overall burden of diseases from all causes (World Health Organization, 2001). Two-thirds of those affected do not receive adequate care owing to stigma, discrimination, neglect and poverty. The World Health Organization (2001) found that only 1% of the total health expenditure went to mental health in most countries.

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.

Psychological effects of the Nairobi US embassy bomb blast on pregnant women and their children.

A descriptive study was carried out in pregnant women who were affected by the 1998 bomb blast in Nairobi, Kenya, and their babies who were in utero at the time of the blast. The psychological effects of the event on the exposed women were severe. After three years, the average score on the Impact of Event Scale - Revised was still higher than 29 for the three subscales combined, suggesting that most of the study group was still suffering from clinical post-traumatic stress disorder (PTSD). The scores on all Childhood Personality Scale (CPS) subscales were significantly higher in children of the study group than in controls. The mothers' PTSD symptom levels at one month after the blast correlated with the children's CPS profiles.

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.