Medicine and Health Sciences Commons^™

Prevalence Of Psychiatric Morbidity In A Community Sample In Western Kenya, Edith Kwobah, Steve Epstein, Ann Mwangi, Debra Litzelman, Lukoye Atwoli

Internal Medicine, East Africa

Background:About 25% of the worldwide population suffers from mental, neurological and substance use disorders but unfortunately, up to 75% of affected persons do not have access to the treatment they need. Data on the magnitude of the mental health problem in Kenya is scarce.

The objectives of this study were to establish the prevalence and the socio-demographic factors associated with mental and substance use disorders in Kosirai division, Nandi County, Western Kenya.

Methods:This was a cross sectional descriptive study in which participants were selected by simple random sampling. The sampling frame was obtained from a data base of …

Unconditional Government Cash Transfers In Support Of Orphaned And Vulnerable Adolescents In Western Kenya: Is There An Association With Psychological Wellbeing?, Sylvia Shangani, Don Operario, Becky Genberg, Kipruto Kirwa, Miriam Midoun, Lukoye Atwoli, David Ayuku, Omar Gala ́Rraga, Paula Braitstein

Internal Medicine, East Africa

Background: Orphaned and vulnerable adolescents (OVA) in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs) have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA.

Objective: Among OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing.

Methods: We examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS) and positive future outlook among 655 OVA aged between 10 and 18 …

Posttraumatic Stress Disorder In The World Mental Health Surveys, K C. Koenen, A Ratanatharathorn, L Ng, K A. Mclaughlin, E J. Bromet, D J. Stein, E G. Karam, A Meron Ruscio, C Benjet, K Scott, Lukoye Atwoli

Internal Medicine, East Africa

Background: Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking.

Methods: Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country …

Sexual Behavior Among Orphaned Adolescents In Western Kenya: A Comparison Of Institutional-And Family-Based Care Settings, Lonnie Embleton, Joram Nyandat, David Ayuku, Edwin Sang, Allan Kamanda, Samuel Ayaya, Winstone Nyandiko, Peter Gisore, Rachel Vreeman, Lukoye Atwoli

Internal Medicine, East Africa

Purpose: This study sought to assess whether risky sexual behaviors and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya.

Methods: We analyzed baseline data from a cohort of orphaned adolescents aged 10–18 years living in 300 randomly selected households and 19 charitable children's institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariate logistic regression compared these between participants in institutional care and family-based care while adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, …

Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At A Tertiary Hospital In Kenya, Stephen Omondi, John Weru, Asim Jamal, Gerald Yonga

Internal Medicine, East Africa

Background: An advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on lifesustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of …

Mhealth In Palliative Care For Cancer Patients & Care Givers, Newton Andebe, Peter Waiganjo, John Weru

Internal Medicine, East Africa

Patients and caregivers in palliative care experience multidimensional pain. In current practice, information about a cancer patient progress is known when they visit a clinic or make a distress call when their conditions worsen. This strategy is not efficient for systematic monitoring of symptoms, which is key in improving palliative care. Mobile phones have helped to transform healthcare through diagnosis, health education and symptoms management of chronic illnesses. In this study, a mobile phone assessment tool was implemented at an outpatient palliative care clinic for cancer patients in Aga Khan University Hospital, Nairobi. The usefulness of the mobile phone application …

Post-Traumatic Stress Disorder Associated With Natural And Human-Made Disasters In The World Mental Health Surveys, Evelyn J. Bromet, Lukoye Atwoli, Norito Kawakami, Fernando Navarro-Mateu, P Piotrowski, A J. King, Sergio Aguilar-Gaxiola, Jordi Alonso, Brentan Bunting, Koen Demyttenaere

Internal Medicine, East Africa

Background: Research on post-traumatic stress disorder (PTSD) following natural and human-made disasters has been undertaken for more than three decades. Although PTSD prevalence estimates vary widely, most are in the 20–40% range in disaster-focused studies but considerably lower (3–5%) in the few general population epidemiological surveys that evaluated disaster-related PTSD as part of a broader clinical assessment. The World Mental Health (WMH) Surveys provide an opportunity to examine disaster-related PTSD in representative general population surveys across a much wider range of sites than in previous studies.

Method: Although disaster-related PTSD was evaluated in 18 WMH surveys, only six in high-income …

Practical Neurology Linked To The Curriculum: An Online Resource, Dilraj Sokhi, Alice Brockington, Christine Lo

Internal Medicine, East Africa

Navigating the online galaxy for up-to-date evidence-based knowledge in clinical neurology can be a challenge. Practical Neurology is a noted and popular online clinical resource,1 which according to its website is "…practical in the sense of being useful for everyone who sees neurological patients and who want to keep up to date, and safe, in managing them." As UK-based neurology trainees, we have been fortunate to have automatic access to Practical Neurology during our training. We found that the articles adequately covered most elements in our syllabus and were ideal reference material for our department. This accords with the …

Alcohol Use And Immune Reconstitution Among Hiv-Infected Patients On Antiretroviral Therapy In Nairobi, Kenya, Anthony Cagle, Christine Mcgrath, Barbra A. Richardson, Dennis Donovan, Sameh Sakr, Nelly Yatich, Richard Ngomoa, Agnes Chepngeno Langat, Grace John-Stewart, Michael Chung

Internal Medicine, East Africa

Studies on the effects of alcohol use on HIV disease progression have been contradictory, with at least one study finding a positive effect of low alcohol consumption on CD4 count. In addition, most such studies have taken place in the developed West. We investigated the association between alcohol use and immune reconstitution through CD4 count response among HIV-infected individuals on antiretroviral therapy (ART) at an urban sub-Saharan African clinic. This was a retrospective cohort study of treatment-naïve HIV-infected adults initiating ART in Nairobi, Kenya and followed for 12 months between January 2009 and December 2012. At enrollment, a standardized questionnaire …

Risk Factors For Hypoxia And Tachypnea Among Adolescents With Vertically-Acquired Hiv In Nairobi, Engi F. Attia, Noel S. Weiss, Elizabeth Maleche Obimbo, Christine J. Mcgrath, Anthony Cagle, Eoin T. West, El Antouny G. Neveen, Attwa Mena, Crothers Kristina, Michael Chung

Internal Medicine, East Africa

Background: Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya.

Methods: We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99th percentile of age-appropriate respiratory rates. Logistic regression models adjusted for …