Medicine and Health Sciences Commons^™

Who Should Pay The Bill For The Mental Health Crisis In Africa?, Cyprian Mostert, Olivera Nesic Taylor,, Chinedu Momoh, Murad M. Khan Dr., Thomas Thesen, Edna Bosire, Dominic Trepel, Karen Blackmon, Manasi Kumar, Zul Merali

Brain and Mind Institute

No abstract provided.

The 2022 Symposium On Dementia And Brain Aging In Low- And Middle-Income Countries: Highlights On Research, Diagnosis, Care, And Impact, Raj Kalaria, Gladys Maestre, Simin Mahinrad, Daisy Acosta, Rufus Akinyemi, Suvarna Alladi, Ricardo Allegri, Faheem Arshad, Wambui Karanja, Chinedu Momoh

Brain and Mind Institute

Two of every three persons living with dementia reside in low- and middle-incomecountries (LMICs). The projected increase in global dementia rates is expected toaffect LMICs disproportionately. However, the majority of global dementia care costsoccur in high-income countries (HICs), with dementia research predominantly focus-ing on HICs. This imbalance necessitates LMIC-focused research to ensure thatcharacterization of dementia accurately reflects the involvement and specificities ofdiverse populations. Development of effective preventive, diagnostic, and therapeu-tic approaches for dementia in LMICs requires targeted, personalized, and harmonizedefforts. Our article represents timely discussions at the 2022 Symposium on Demen-tia and Brain Aging in LMICs that identified the foremost …

Use Of Mobile Technology To Identify Behavioral Mechanisms Linked To Mental Health Outcomes In Kenya: Protocol For Development And Validation Of A Predictive Model, Willie Njoroge, Rachel Maina, Frank Elena, Lukoye Atwoli, Anthony Ngugi, Srijan Sen, Stephen Wong, Linda Khakali, Andrew Aballa, James Orwa, Moses Nyongesa, Jasmit Shah, Amina Abubakar, Zul Merali

Brain and Mind Institute

Objective:This study proposes to identify and validate weighted sensor stream signatures that predict near-term risk of a major depressive episode and future mood among healthcare workers in Kenya.

Approach: The study will deploy a mobile application (app) platform and use novel data science analytic approaches (Artificial Intelligence and Machine Learning) to identifying predictors of mental health disorders among 500 randomly sampled healthcare workers from five healthcare facilities in Nairobi, Kenya.

Expectation: This study will lay the basis for creating agile and scalable systems for rapid diagnostics that could inform precise interventions for mitigating depression and ensure a healthy, resilient …

Correction: Prevalence Of Lifestyle Cardiovascular Risk Factors And Estimated Framingham 10-Year Risk Scores Of Adults With Psychotic Disorders Compared To Controls At A Referral Hospital In Eldoret, Kenya., Edith Kwobah, Nastassja Koen, Ann Mwangi, Lukoye Atwoli, Dan Stein

Brain and Mind Institute

No abstract provided.

Making Cities Mental Health Friendly For Adolescents And Young Adults, Pamela Y. Collins, Moitreyee Sinha, Tessa Concepcion, George Patton, Thaisa Way, Layla Mccay, Augustina Mensa-Kwao, Helen Herrman, Evelyne De Leeuw, Lukoye Atwoli

Brain and Mind Institute

Urban life shapes the mental health of city dwellers, and although cities provide access to health, education and economic gain, urban environments are often detrimental to mental health1,2. Increasing urbanization over the next three decades will be accompanied by a growing population of children and adolescents living in cities3. Shaping the aspects of urban life that influence youth mental health could have an enormous impact on adolescent well-being and adult trajectories4. We invited a multidisciplinary, global group of researchers, practitioners, advocates and young people to complete sequential surveys to identify and prioritize the characteristics of a mental health-friendly city for …

Prevalence Of Lifestyle Cardiovascular Risk Factors And Estimated Framingham 10-Year Risk Scores Of Adults With Psychotic Disorders Compared To Controls At A Referral Hospital In Eldoret, Kenya, Edith Kwobah, Nastassja Koen, Ann Mwangi, Lukoye Atwoli, Dan Stein

Brain and Mind Institute

Introduction: Lifestyle factors such as smoking, alcohol use, suboptimal diet, and inadequate physical activity have been associated with increased risk of cardiovascular diseases. There are limited data on these risk factors among patients with psychosis in low- and middle-income countries.

Objectives: This study aimed to establish the prevalence of lifestyle cardiovascular risk factors, and the 10-year cardiovascular risk scores and associated factors in patients with psychosis compared to controls at Moi Teaching and Referral Hospital in Eldoret, Kenya.

Methods: A sample of 297 patients with schizophrenia, schizoaffective disorder, or bipolar mood disorder; and 300 controls matched for age and sex …

12-Month Substance Use Disorders Among First-Year University Students In Kenya, Florence Jaguga, Muthoni Mathai, Caroline Ayuya, Ongecha Francisca, Catherine Mawia Musyoka, Jasmit Shah, Lukoye Atwoli

Brain and Mind Institute

Objectives: The period of entry into university represents one of vulnerability to substance use for university students. The goal of this study is to document the 12-month prevalence of substance use disorders among first year university students in Kenya, and to test whether there is an association between substance use disorders and mental disorders.

Methods: This was a cross-sectional online survey conducted in 2019 and 2020 as part of the World Health Organization’s World Mental Health International College Student (WMH-ICS) survey initiative. A total of 334 university students completed the survey. Descriptive statistics were used to summarize the demographic characteristics …

‘We Were Not Allowed To Gather Even For Christmas.’ Impact Of Covid-19 On South African Young People: Exploring Messaging And Support, Gudani Mukoma, Edna Bosire, Polly Hardy-Johnson, Mary Barker, Shane A. Norris

Brain and Mind Institute

COVID-19 prevention measures including lockdowns, school closures, and restricted movement disrupted young people’s lives. This longitudinal qualitative study conducted in Soweto, South Africa aimed to explore young people’s knowledge and perceptions of COVID-19, vaccination, and the impact of infections. A convenience sample of 30 young black people (n = 15 men; n = 15 women, aged 16–21 years) from Soweto participated in 24 focus group discussions (FGDs), conducted in six phases – each phase had four FGDs stratified by gender and age. Young people’s understanding of COVID-19 deepened throughout the study, however, did not always translate into adherence (following the …

Coping Mechanisms During The Covid-19 Pandemic And Lockdown In Metropolitan Johannesburg, South Africa: A Qualitative Study, Nerli Paredes Ruvalcaba, Andrew Wooyoung Kim, Nokubonga Ndaba, Lindile Cele, Someleze Swana, Edna Bosire, Aneesa Moolla

Brain and Mind Institute

Background: The COVID-19 pandemic has caused prolonged stress on numerous fronts. While the acute health impacts of psychosocial stress due to the pandemic are well-documented, less is known about the resources and mechanisms utilized to cope in response to stresses during the pandemic and lockdown.

Objective: The aim of this study was to identify and describe the coping mechanisms adults utilized in response to the stressors of the COVID-19 pandemic during the 2020 South African lockdown.

Methods: This study included adults (n=47: 32 female; 14 male; 1 non-binary) from the greater Johannesburg region in South Africa. Interviews …

Healthy Eating And Physical Activity: Analysing Soweto’S Young Adults’ Perspectives With An Intersectionality Lens, Gudani Mukoma, Edna Bosire, Sonja Klingberg, Shane A. Norris

Brain and Mind Institute

Background and objectives: Non-communicable diseases (NCDs) are taking a toll on Africa’s youth at younger ages than in other regions. These are attributed to risk factors that usually advance in adolescence, such as unhealthy diets and reduced physical activity. Young adults in South Africa, particularly women, tend to be sedentary, consume energy-dense diets low in micronutrients, and are more likely to develop NCDs much earlier in life than those in high-income countries. With an intersectionality perspective, this study explored young adults’ barriers and solutions to addressing these risk factors in Soweto.

Setting: Soweto, Johannesburg, South Africa, is one …

The Effects Of Height-For-Age And Hiv On Cognitive Development Of School-Aged Children In Nairobi, Kenya: A Structural Equation Modelling Analysis, Rachel Maina, Jia He, Amina Abubakar, Miguel Perez-Garcia, Manasi Kumar, Jelte M. Wicherts

Brain and Mind Institute

Background: Empirical evidence indicates that both HIV infection and stunting impede cognitive functions of school-going children. However, there is less evidence on how these two risk factors amplify each other’s negative effects. This study aimed to examine the direct effects of stunting on cognitive outcomes and the extent to which stunting (partially) mediates the effects of HIV, age, and gender on cognitive outcomes.

Methodology: We applied structural equation modelling to cross-sectional data from 328 children living with HIV and 260 children living without HIV aged 6–14 years from Nairobi, Kenya to test the mediating effect of stunting and predictive …

Macroeconomics And Health: Understanding The Impact Of A Declining Economy On Health Outcomes Of Children And Young Adults In South Africa, Cyprian Mostert

Brain and Mind Institute

Background: The current covid-19 economic crisis continues to weaken economic growth in South Africa. This study was designed to show how a declining economic state affects the mental health conditions, metabolic risk factors, communicable conditions, and non-communicable conditions of adolescent (18-year cohorts) and adult (25-year cohorts) population groups comparatively.

Study design: This was a panel analysis using secondary data issued by Statistic South Africa.

Methods: The author used a Two-stage Least Squared Model (2SLS) to quantify the impact of the declining economy on mental health conditions (depression and traumatic stress), non-communicable conditions (cancer and diabetes), metabolic risk factors …

Psychometric Evaluation Of The Computerized Battery For Neuropsychological Evaluation Of Children (Benci) Among School Aged Children In The Context Of Hiv In An Urban Kenyan Setting, Rachel Maina, He Jia, Amina Abubakar, Miguel Perez-Garcia, Manasi Kumar, Jelte M. Wicherts

Brain and Mind Institute

Introduction Culturally validated neurocognitive measures for children in Low‐ and Middle‐Income Countries are important in the timely and correct identification of neurocognitive impairments. Such measures can inform develop‐ ment of interventions for children exposed to additional vulnerabilities like HIV infection. The Battery for Neuropsy‐ chological Evaluation of Children (BENCI) is an openly available, computerized neuropsychological battery specifically developed to evaluate neurocognitive impairment. This study adapted the BENCI and evaluated its reliability and validity in Kenya.

Methodology The BENCI was adapted using translation and back‐translation from Spanish to English. The psy‐ chometric properties were evaluated in a case–control study of 328 …

Reducing The Mental Health Treatment Gap In Kashmir: Scaling Up To Maximise The Potential Of Telepsychiatry, Arshad Hussain, Bhupinder Kumar, Manasi Kumar, Fazle Roub

Brain and Mind Institute

No abstract provided.

The Ethical And Validity Conundrum In Epilepsy Research In Lmic Settings, Pauline Samia, Adeel Shah, Archana Patel, Philip Olielo, Lionel Mudave, Samson Gwer

Brain and Mind Institute

In the last few decades, research in epilepsy has significantly improved understanding of risk factors and etiologies associated with epilepsy, promoting greater access to interventions and medications that have improved health-related outcomes for patients. However, these advances and benefits are not being felt evenly on a global scale due to significant inequalities in access to and utilization of research resources and expertise in Low-and Middle-Income Countries (LMICs).

To promote effective research output, and advance evidence-based practices; the context, disease burden, and challenges that hinder good research need to be re-defined and addressed. This is key in facilitating implementation of coherent …

Strengthening The Understanding Of South Partnerships And Rigor In Addressing Social Determinants Of Child And Adolescent Mental Health, Manasi Kumar

Brain and Mind Institute

The Journal of Adolescent Health's current supplement presents the work of a highly active team of researchers who are focusing on developing a strong body of evidence around child and adolescent mental health in Sub-Saharan Africa. The supplement lays out scholarship generated through years of partnership between researchers based in the United States—some of whom are from Sub-Saharan context, specifically Uganda—in connecting applied social work, community mental health for children and adolescents, and family development. The work comprises a series of articles embedded within several National Institutes of Health–funded grants by authors based in the United States in partnership with …

Addition Of Mental Health To The Lady Health Worker Curriculum In Pakistan: Now Or Never, Fauziah Rabbani, Samina Akhtar, Javeria Nafis, Shahid Khan, Sameen Siddiqi, Zul Merali

Brain and Mind Institute

The technical advisory group of the World Health Organization (Geneva, Switzerland) has suggested person-centered and community-based mental health services in response to the long-term and far-reaching mental health impacts of the COVID-19 pandemic. Task shifting is a pragmatic approach to tackle the mental health treatment gap in low- and middle-income countries. Pakistan is dismally resourced to address the mental health challenges. Pakistan’s government has established a lady health worker’s program (LHW-P) which can be effectively utilized to provide some basic mental health services at community doorsteps. However, lady health workers’ current curriculum does not include mental health as a subject. …

Mental Health And Psychosocial Interventions Integrating Sexual And Reproductive Rights And Health, And Hiv Care And Prevention For Adolescents And Young People (10–24 Years) In Sub-Saharan Africa: A Systematic Scoping Review, Otsetswe Musindo, Sheharbano Jafry, Joseph Nyamiobo, Kimberly D. Becker, Resham Gellatly, Caitlin Maloy, Alvaro Lozano-Ruiz, Borja Romero-Gonzalez, Zul Merali, Manasi Kumar

Brain and Mind Institute

Background: Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature.

Methods: We carried …

Making Morbidity Multiple: History, Legacies, And Possibilities For Global Health, Justin Dixon, Emily Mendenhall, Edna Bosire, Felix Limbani, Rashida A. Ferrand, Clare I R. Chandler

Brain and Mind Institute

Multimorbidity has been framed as a pressing global health challenge that exposes the limits of systems organised around single diseases. This article seeks to expand and strengthen current thinking around multimorbidity by analysing its construction within the field of global health. We suggest that the significance of multimorbidity lies not only in challenging divisions between disease categories but also in what it reveals about the culture and history of transnational biomedicine. Drawing on social research from sub-Saharan Africa to ground our arguments, we begin by describing the historical processes through which morbidity was made divisible in biomedicine and how the …

Multimorbidity Research In Sub-Saharan Africa: Proceedings Of An Interdisciplinary Workshop, Gift T. Banda, Edna Bosire, Christopher Bunn, Clare I.R. Chandler, Edith Chikumbu, Jonathan Chiwanda, Justin Dixon, Rashida A. Ferrand, Andre-Pascal Kengne, Felix Limbani

Brain and Mind Institute

As life expectancies rise globally, the number of people living with multiple chronic health conditions – commonly referred to as ‘multimorbidity’ – is rising. Multimorbidity has been recognised as especially challenging to respond to in countries whose health systems are under-funded, fragmented, and designed primarily for acute care, including in sub-Saharan Africa. A growing body of research in sub-Saharan Africa has sought to better understand the particular challenges multimorbidity poses in the region and to develop context-sensitive responses. However, with multimorbidity still crystallising as a subject of enquiry, there remains considerable heterogeneity in conceptualising multimorbidity across disciplines and fields, hindering …

Impact Of Climate Events, Pollution, And Green Spaces On Mental Health: An Umbrella Review Of Meta-Analyses, Pim Cuijpers, Clara Miguel, Marketa Ciharova, Manasi Kumar, Luke Brander, Pushpam Kumar, Eirini Karyotaki

Brain and Mind Institute

Climate change may affect mental health. We conducted an umbrella review of meta-analyses examining the association between mental health and climate events related to climate change, pollution and green spaces. We searched major bibliographic databases and included meta-analyses with at least five primary studies. Results were summarized narratively. We included 24 meta-analyses on mental health and climate events (n = 13), pollution (n = 11), and green spaces (n = 2) (two meta-analyses provided data on two categories). The quality was suboptimal. According to AMSTAR-2, the overall confidence in the results was high for none of the studies, for three …

Flourishing With Chronic Illness(Es) And Everyday Stress: Experiences From Soweto, South Africa, Megan Schmidt-Sane, Lindile Cele, Edna Bosire, Alexander C. Tsai, Emily Mendenhall

Brain and Mind Institute

The pursuit of flourishing, or living a good life, is a common human endeavor with different meanings across individuals and contexts. What is needed is a further exploration of the relationship between flourishing and health, particularly chronic illness, which affects individuals across the life course and is affected by experiences of stress derived from social and structural vulnerability.

Drawing on data from the Soweto Syndemics study, including a locally derived stress scale and in-depth interviews, we explore the connections between flourishing and health for those living with multiple chronic illnesses in Soweto, South Africa within a syndemic of communicable and …

Does Social Pension Buy Improved Mental Health And Mortality Outcomes For Senior Citizens? Evidence From South Africa's 2008 Pension Reform, Cyprian Mostert, Diana Mackay, Alex Awiti, Manasi Kumar, Zul Merali

Brain and Mind Institute

In South Africa, men were traditionally eligible to receive government pensions at 65 years. However, that eligibility criterion was changed in 2008 to allow men to receive a pension payout at 60 years. This study is designed to quantify the impact of the 2008 pension reform on mental health outcomes (depression and traumatic stress) and deaths among 60-year-old men from disadvantaged households without advanced education. This analysis used secondary data issued by Statistic South Africa- General Household Survey. Men who reported earning a pension at 60 years from 2008 to 2014 were exposed to the 2008 pension reform and thus …

Interpersonal Psychotherapy’S Problem Areas As An Organizing Framework To Understand Depression And Sexual And Reproductive Health Needs Of Kenyan Pregnant And Parenting Adolescents: A Qualitative Study, Manasi Kumar, Obadia Yator, Vincent Nyongesa, Martha Kagoya, Shillah Mwaniga, Joseph Kathono, Isaiah Gitonga, Nancy Grote, Helena Verdeli, Keng Yen Huang

Brain and Mind Institute

Background: Peripartum adolescents experience signifcant interpersonal transitions in their lives. Depression and emotional distress are often exacerbated by adolescents’ responses to these interpersonal changes. Improved understanding of pregnancy-related social changes and maladaptive responses to these shifts may inform novel approaches to addressing the mental health needs of adolescents during the perinatal period. The paper aims to understand the sources of psychological distress in peripartum adolescents and map these to Interpersonal Psychotherapy’s (IPT) problem areas as a framework to understand depression.

Method: We conducted interviews in two Nairobi primary care clinics with peripartum adolescents ages 16–18 years (n=23) with …

Cultural And Contextual Adaptation Of Mental Health Measures In Kenya: An Adolescent-Centered Transcultural Adaptation Of Measures Study, Vincent Nyongesa, Shillah Mwaniga, Joseph Kathono, Obadia Yator, Beatrice Madeghe, Sarah Kanana, Beatrice Amugune, Naomi Anyango, Darius Nyamai, Manasi Kumar

Brain and Mind Institute

Introduction: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children’s Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents.

Materials and methods: Using a qualitative approach, we explored adolescent participants’ views on cultural acceptability, comprehensibility, relevance, and completeness of …

Health And Socioeconomic Resource Provision For Older People In South Asian Countries: Bangladesh, India, Nepal, Pakistan And Sri Lanka Evidence From Neesama, Natasha Roya Matthews, George James Porter, Mathew Varghese, Nidesh Sapkota, Murad Khan, Ammu Lukose, Stella-Maria Paddick, Malathie Dissanayake, Naila Zaman Khan, Richard Walker

Brain and Mind Institute

Background: The global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. As the number of older adults in LMICs increases, services able to effectively address their physical and mental health needs will be increasingly important.

Objective: We review the health and socioeconomic resources currently available for older people in South Asian countries, Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement.

Methods: We conducted a search of grey and published literature via Google Search, Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, …

In-School Adolescents’ Loneliness, Social Support, And Suicidal Ideation In Sub-Saharan Africa: Leveraging Global School Health Data To Advance Mental Health Focus In The Region, Richard Gyan Aboagye, Bright Opoku Ahinkorah, Abdul-Aziz Seidu, Joshua Okyere, James Boadu Frimpong, Manasi Kumar

Brain and Mind Institute

Introduction: Adolescent and youth mental health problems are increasingly becoming an area of concern in global health. Young people in sub-Saharan Africa experience significant adversities and systemic challenges despite technological advancements and demographic transition that the region is experiencing. We examined the nexus between experiences of loneliness, low social support, and presence of suicidal ideation among in-school adolescents in sub-Saharan Africa.

Method: A total of 19,119 in-school adolescents from eight countries in sub-Saharan Africa were included in this study. Suicidal ideation was the main outcome variable and loneliness, and social support were the explanatory variables. Percentages were used to summarise …

Patterns Of Suicide And Self-Harm In Pakistan: A Retrospective Descriptive Study Protocol, Nargis Asad, Summaiya Tariq, Asra Qureshi, Mohammad Zaman, Mustafa Aslam, Farhat Mirza, Murad Khan

Brain and Mind Institute

Introduction Suicide is a major global public health problem. Low-income and middle-income countries contribute 78% of all suicidal deaths. Pakistan, a South Asian country, lacks official statistics on suicides at national level. Statistics on suicide are neither collected nationally nor published in the annual national morbidity and mortality surveys. Medicolegal reports on suicides and self-harm are extremely rich and important source of information but greatly underused in Pakistan. We aim to examine the patterns of suicides and self-harm retrospectively in patients who were registered with medicolegal centres (MLCs) in Karachi, during the period January 2017 to December 2021.

Methods and …

Genetic Structure Correlates With Ethnolinguistic Diversity In Eastern And Southern Africa, Elizabeth G. Atkinson, Shareefa Dalvie, Yakov Pichkar, Allan Kalungi, Lerato Majara, Anne Stevenson, Tamrat Abebe, Dickens Akena, Melkam Alemayehu, Lukoye Atwoli

Brain and Mind Institute

African populations are the most diverse in the world yet are sorely underrepresented in medical genetics research. Here, we examine the structure of African populations using genetic and comprehensive multi-generational ethnolinguistic data from the Neuropsychiatric Genetics of African Populations-Psychosis study (NeuroGAP-Psychosis) consisting of 900 individuals from Ethiopia, Kenya, South Africa, and Uganda. We find that self-reported language classifications meaningfully tag underlying genetic variation that would be missed with consideration of geography alone, highlighting the importance of culture in shaping genetic diversity. Leveraging our uniquely rich multi-generational ethnolinguistic metadata, we track language transmission through the pedigree, observing the disappearance of several …

Prevalence And Risk Factors Associated With Depression In Pregnant Adolescents In Nairobi, Kenya, Albert Tele, Joseph Kathono, Shillah Mwaniga, Vincent Nyongesa, Obadia Yator, Onesmus Gachuno, Dalton Wamalwa, Beatrice Amugune, Zul Merali, Manasi Kumar

Brain and Mind Institute

Background: Adolescent parenthood can be associated with a range of adverse outcomes for young mothers such as depression, substance abuse, and posttraumatic stress disorder. Identification of depression and understanding risk factors among pregnant adolescents is important for development of appropriate interventions and programs focused on adolescent mental health. This paper reports on the findings of the prevalence of depression and its associated risk factors among pregnant adolescents in Nairobi, Kenya.

Methods: We recruited 153 pregnant adolescent (14-18 years) who were accessing maternal health services in one of two Nairobi County primary health care facilities in the cross-sectional survey …