Medicine and Health Sciences Commons^™

A Four-Component Framework Toward Patient-Centered, Integrated Mental Healthcare In Kenya, Manasi Kumar, Thomas L. Osborn, Cyrus Mugo, Hossein Akbarialiabad, Osman Warfa, Wangui Muthigani Mbuthia, Christine Wambugu, Carol Ngunu, Fatima Gohar, Shillah Mwaniga

Brain and Mind Institute

Background: How can we fast-track the global agenda of integrated mental healthcare in low- and middle-income countries (LMICs) such as Kenya? This is a question that has become increasingly important for individuals with lived experiences, policymakers, mental health advocates and health care providers at the local and international levels.

Discussion: This narrative synthesis and perspective piece encompasses an overview of mental health care competencies, best practices and capacity building needed to fast track patient responsive services. In that vein we also review key policy developments like UHC to make a case for fast-tracking our four-step framework.

Results: While there is …

Depression And Its Associated Factors: Perceived Stress, Social Support, Substance Use And Related Sociodemographic Risk Factors In Medical School Residents In Nairobi, Kenya, Sayed Shah Nur Hussein Shah, Ahmed Laving, Violet Caroline Okech-Helu, Manasi Kumar

Brain and Mind Institute

Abstract: Background: Little data exists regarding depression and its associated factors in medical residents and doctors in Sub-Saharan Africa. Residents are at high risk of developing depression owing to the stressful nature of their medical practice and academic training. Depression in medical residents leads to decreased clinical efficiency, and poor academic performance; it can also lead to substance abuse and suicide. Our primary aim was to measure depression prevalence among medical residents in Kenya’s largest national teaching and referral hospital. Secondary aims were to describe how depression was associated with perceived stress, perceived social support, substance use, and educational environment. …

Mapping Services At Two Nairobi County Primary Health Facilities: Identifying Challenges And Opportunities In Integrated Mental Health Care As A Universal Health Coverage (Uhc) Priority, Manasi Kumar, Vincent Nyongesa, Martha Kagoya, Byamah B. Mutamba,, Beatrice Amugune, Neha S. Krishnam, Grace Nduku Wambua, Inge Petersen, Onesmus Gachuno, Shekhar Saxena

Brain and Mind Institute

Abstract: Introduction There is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground.

Method and measures This study utilized a qualitative evidence synthesis through …

Evaluation Of A Two-Way Sms Messaging Strategy To Reduce Neonatal Mortality: Rationale, Design And Methods Of The Mobile Wach Neo Randomised Controlled Trial In Kenya, Keshet Ronen, Esther M. Choo, Brenda Wandika, Jenna L. Udren, Lusi Osborn, Peninah Kithao, Anna B. Hedstrom, Millicent Masinde, Manasi Kumar, Dalton C. Wamalwa

Brain and Mind Institute

Abstract: Introduction Globally, approximately half of the estimated 6.3 million under-5 deaths occur in the neonatal period (within the first 28 days of life). Kenya ranks among countries with the highest number of neonatal deaths, at 20 per 1000 live births. Improved identification and management of neonates with potentially life-threatening illness is critical to meet the WHO’s target of ≤12 neonatal deaths per 1000 live births by 2035. We developed an interactive (two-way) short messaging service (SMS) communication intervention, Mobile Solutions for Neonatal Health (Mobile women’s and children’s health (WACh) NEO), focused on the perinatal period. Mobile WACh NEO sends …

Routine Outcome Measurement In Adolescents Seeking Mental Health Services: Standardization Of Honosca In Kenyan Sample, Grace Nduku Wambua, Manasi Kumar, Fredrik Falkenström, Pim Cuijpers

Brain and Mind Institute

Abstract: Background The evaluation of treatment outcomes is important for service providers to assess if there is improvement or not. The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) was developed for this use in child and adolescent mental health services. Outcome measurement in routine mental health services is limited. This paper evaluates the psychometric properties of the self and clinician rated versions of the HoNOSCA for routine use in child and adolescent mental health services in Kenya.

Methods Using a prospective design, the clinician- and self-rated versions of the HoNOSCA and the Paediatric Symptom Checklist (PSC) …

Mental Health Service Preferences Of Patients And Providers: A Scoping Review Of Conjoint Analysis And Discrete Choice Experiments From Global Public Health Literature Over The Last 20 Years (1999–2019), Anna Larsen, Albert Tele, Manasi Kumar

Brain and Mind Institute

Abstract: Background: In designing, adapting, and integrating mental health interventions, it is pertinent to understand patients’ needs and their own perceptions and values in receiving care. Conjoint analysis (CA) and discrete choice experiments (DCEs) are survey-based preference-elicitation approaches that, when applied to healthcare settings, offer opportunities to quantify and rank the healthcare-related choices of patients, providers, and other stakeholders. However, a knowledge gap exists in characterizing the extent to which DCEs/CA have been used in designing mental health services for patients and providers. Methods: We performed a scoping review from the past 20 years (2009–2019) to identify and describe applications …

Is There An Optimal Screening Tool For Identifying Perinatal Depression Within Clinical Settings Of Sub-Saharan Africa?, Anna Larsen, Jillian Pintye, Amritha Bhat, Manasi Kumar, John Kinuthia, Pamela Y. Collins, Grace John Stewart

Brain and Mind Institute

Abstract: Depression is a leading cause of maternal morbidity and mortality worldwide and the most common complication of the perinatal period. Women in sub-Saharan Africa (SSA) are disproportionately impacted by perinatal depression. Maternal and child health (MCH) clinics are widely attended in SSA, offering a potential access point for depression screening. Yet, selection of optimal depression screening instruments for use within MCH clinics in SSA remains unclear. We synthesized evidence depicting relative strength of perinatal depression screening scales for use among African perinatal women within four evaluation domains: 1) diagnostic performance, 2) cultural adaptation, 3) feasibility and ease of implementation, …

Use Of Multidimensional Item Response Theory Methods For Dementia Prevalence Prediction: An Example Using The Health And Retirement Survey And The Aging, Demographics, And Memory Study, Manasi Kumar, Gbd 2019 Dementia Collaborators

Brain and Mind Institute

Abstract: Background: Data sparsity is a major limitation to estimating national and global dementia burden. Surveys with full diagnostic evaluations of dementia prevalence are prohibitively resource-intensive in many settings. However, validation samples from nationally representative surveys allow for the development of algorithms for the prediction of dementia prevalence nationally. Methods: Using cognitive testing data and data on functional limitations from Wave A (2001–2003) of the ADAMS study (n=744) and the 2000 wave of the HRS study (n=6358) we estimated a two-dimensional item response theory model to calculate cognition and function scores for all individuals over 70. Based on diagnostic information …

Long Covid, A Comprehensive Systematic Scoping Review, Hossein Akbarialiabad, Mohammad Hossein Taghrir, Ashkan Abdollahi, Nasrollah Ghahramani, Manasi Kumar, Shahram Paydar, Babak Razani, John Mwangi, Ali A. Asadi-Pooya, Leila Malekmakan

Brain and Mind Institute

Abstract: Purpose To fnd out what is known from literature about Long COVID until January 30, 2021. Methods We undertook a four-step search with no language restriction. A preliminary search was made to identify the keywords. A search strategy of all electronic databases resulted in 66 eligible studies. A forward and backward search of the references and citations resulted in additional 54 publications. Non-English language articles were translated using Google Translate. We conducted our scoping review based on the PRISMA-ScR Checklist. Results Of 120 papers, we found only one randomized clinical trial. Of the 67 original studies, 22 were cohort, …

Perinatal Depression And Its Impact On Infant Outcomes And Maternal-Nurse Sms Communication In A Cohort Of Kenyan Women, Alyssa Hummel, Keshet Ronen, Amritha Bhat, Brenda Wandika, Esther M Choo M. Choo, Lusi Osborn, Maneesh Batra, John Kinuthia, Manasi Kumar, Jennifer A. Unger

Brain and Mind Institute

Abstract: Background Perinatal depression is broadly defined as depressive symptoms during pregnancy or within the 12 months following delivery, affecting approximately 20-25% of pregnant and postpartum women in low- and middle-income countries. The wide accessibility of mobile phones allows mobile health (mHealth) interventions to be considered a solution to identify perinatal depression and provide appropriate referrals for treatment. This study, nested in a larger SMS communication project, examined the prevalence and correlates of perinatal depression, determined the association between antenatal depression and infant morbidity/mortality, and compared SMS communication patterns between women with and without perinatal depression. Methods This was a …

Search For Dark Matter Produced In Association With A Standard Model Higgs Boson Decaying Into B-Quarks Using The Full Run 2 Dataset From The Atlas Detector, Georges Aad, B Abbott, Dc Abbott, A Abed Abud, Kira Abeling, Deshan Kavishka Abhayasinghe, Sh Abidi, Os Abouzeid, Halina Abramowic, Manasi Kumar

Brain and Mind Institute

Abstract: The production of dark matter in association with Higgs bosons is predicted in several extensions of the Standard Model. An exploration of such scenarios is presented, considering final states with missing transverse momentum and b-tagged jets consistent with a Higgs boson. The analysis uses proton-proton collision data at a centre-of-mass energy of 13 TeV recorded by the ATLAS experiment at the LHC during Run 2, amounting to an integrated luminosity of 139 fb−1 . The analysis, when compared with previous searches, benefits from a larger dataset, but also has further improvements providing sensitivity to a wider spectrum of signal …

The Path To Global Equity In Mental Health Care In The Context Of Covid-19, Lola Kola, Brandon A. Kohrt, Bibhav Acharya, Byamah B. Mutamba, Christian Kieling, Manasi Kumar, Charlene Sunkel, Wufang Zhang, Charlotte Hanlon

Brain and Mind Institute

The theme of the 2021 World Mental Health Day is “Mental Health in an Unequal World”, highlighting unequal access to mental health care across the world. This situation has been further worsened by governmental and public responses to the COVID-19 pandemic. The response of many high-income countries (HICs) and institutions to the pandemic has been the reverse of equity, exemplified by inequitable access to COVID-19 vaccines and widening inequities in wealth.1 A crucial consideration in this context is the imbalance in social and economic factors that shape onset and outcomes of mental health across communities and countries.2 Looking through a …

Global, Regional, And National Mortality Among Young People Aged 10–24 Years, 1950–2019: A Systematic Analysis For The Global Burden Of Disease Study 2019, Joseph L. Ward, Peter S S. Azzopardi, Kate Louise Francis, John S S. Santelli, Vegard Skirbekk, Susan M. Sawyer, Nicholas J. Kassebaum, Ali H. Mokdad, Simon I. Hay, Manasi Kumar

Brain and Mind Institute

Summary: Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality …

Efficacy Of Souroubea-Platanus Dietary Supplement Containing Triterpenes In Beagle Dogs Using A Thunderstorm Noise-Induced Model Of Fear And Anxiety, Aleksandar Masic, Gary Landsberg, Bill Milgram, Zul Merali, Tony Durst, Pablo Sanchez Vindas, Mario Garcia, John Baker, Rui Liu, John Arnason

Brain and Mind Institute

A novel botanical dietary supplement, formulated as a chewable tablet containing a defined mixture of Souroubea spp. vine and Platanus spp. Bark, was tested as a canine anxiolytic for thunderstorm noise-induced stress (noise aversion). The tablet contained five highly stable triterpenes and delivered 10 mg of the active ingredient betulinic acid (BA) for an intended 1 mg/kg dose in a 10 kg dog. BA in tablets was stable for 30 months in storage at 23 °C. Efficacy of the tablets in reducing anxiety in dogs was assessed in a blinded, placebo-controlled study by recording changes in blood cortisol levels and …

Distribution Of Variations In Anatomy Of The Circle Of Willis: Results Of A Cadaveric Study Of The Malawian Population And Review Of Literature, Charles Nyasa, Anthony Mwakikunga, Lackson Temb, Charles Dzamalala, Amadi O. Ihunwo

Brain and Mind Institute

Introduction

the circle of Willis is an anatomical structure of clinical importance particularly in the evaluation of neurovascular diseases. Individuals show considerable variations in the anatomical configuration of the circle of Willis. A cross-sectional study was conducted to determine the distribution of morphological variations of the circle of Willis in Malawians and compare with other ethnic groups.

Methods

brains were collected from twenty-four recently deceased black Malawians during autopsy at Queen Elizabeth Central Hospital, a referral teaching hospital in Blantyre, Malawi and fixed in 10% buffered formalin. Digital images of the interpeduncular region (exposing the circle of Willis) were taken …

Anatomical Variations And Morphometric Properties Of The Circulus Arteriosus Cerebri In A Cadaveric Malawian Population, Charles Nyasa, Anthony Mwakikunga, Lackson H. Tembo, Charles Dzamalala, Amadi O. Ihunwo

Brain and Mind Institute

Background: Knowledge of the anatomy of the circulus arteriosus cerebri (CAC) is important in understanding its role as an arterial anastomotic structure involved in collateral perfusion and equalisation of pressure, and may explain observed variations in neurovascular disease prevalences across populations. This study was aimed at understanding the anatomical configuration and morphometric properties of the CAC in Malawian population. Materials and methods: Brains were collected from 24 recently-deceased black Malawian human cadavers during medico-legal autopsies. Photographs of the CACs were taken using a camera placed at a 30 cm height from the base of the brain. Whole-circle properties and segmental …