Faculty Bibliography
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158
Suicide prevention by emergency nurses: perceived self-efficacy in assessment, management and referral at Kenyatta National Hospital in Kenya
BACKGROUND:Emergency Departments are underutilized settings for suicide prevention and management as patients with occult (camouflaged) suicides and suicidal ideation are rarely screened by nurses and other health workers in these sites. The under-detection rates could be a result of lack of suicide assessment and management confidence among the hospital staff. The aim of the study was to find out the perceived self-efficacy in suicide risk assessment, management and referral among nurses working in an emergency department within a lower income country. METHOD/METHODS:The Risk Assessment and Management Self-Efficacy Scale (RAMSES) was administered among nurses in an emergency department (ED) within an urban region in a descriptive study. The risk assessment, management and referral domains among 64 respondents were evaluated using mean and standard deviation calculations in SPSS v 21. RESULTS:The total RAMSES composite score in risk assessment, management and referral was 6.19 (SD 2.107) with risk assessment having the lowest mean score of 6.09 (SD 2.08), while risk referral process mean score was the highest at 6.55 (SD 2.36). The nurses had the least confidence in developing a written risk management plan 5.68 (SD 2.51) as well as using screening instruments to assess risk 5.90 (SD 2.15). FINDINGS/RESULTS:Nurses in emergency department have below average self-efficacy in suicide assessment and management necessitating training as well as integration of protocols that could enhance effective utilization of emergency departments as suicide prevention and management settings.
PMCID:6710859
PMID: 31462903
ISSN: 1744-859x
CID: 5831882
Mapping 123 million neonatal, infant and child deaths between 2000 and 2017
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
PMID: 31619795
ISSN: 1476-4687
CID: 5831902
A Qualitative Exploration of Gaps and Challenges in Knowledge and Practices of Electroconvulsive Therapy by Key Personnel in Public and Private Mental Health Units in Kenya
PMCID:6824151
PMID: 31708804
ISSN: 1664-0640
CID: 5831912
Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
ISI:000500912300019
ISSN: 2352-3018
CID: 4703042
Depression and its psychosocial risk factors in pregnant Kenyan adolescents: a cross-sectional study in a community health Centre of Nairobi
BACKGROUND:Adolescent pregnancies within urban resource-deprived settlements predispose young girls to adverse mental health and psychosocial adversities, notably depression. Depression in sub-Saharan Africa is a leading contributor to years lived with disability (YLD). The study's objective was to determine the prevalence of depression and related psychosocial risks among pregnant adolescents reporting at a maternal and child health clinic in Nairobi, Kenya. METHODS:A convenient sample of 176 pregnant adolescents attending antenatal clinic in Kangemi primary healthcare health facility participated in the study. We used PHQ-9 to assess prevalence of depression. Hierarchical multivariate linear regression was performed to determine the independent predictors of depression from the psychosocial factors that were significantly associated with depression at the univariate analyses. RESULTS:Of the 176 pregnant adolescents between ages 15-18 years sampled in the study, 32.9% (n = 58) tested positive for a depression diagnosis using PHQ-9 using a cut-off score of 15+. However on multivariate linear regression, after various iterations, when individual predictors using standardized beta scores were examined, having experienced a stressful life event (B = 3.27, P = 0.001, β =0.25) explained the most variance in the care giver burden, followed by absence of social support for pregnant adolescents (B = - 2.76, P = 0.008, β = - 0.19), being diagnosed with HIV/AIDS (B = 3.81, P = 0.004, β =0.17) and being young (B = 2.46, P = 0.038, β =0.14). CONCLUSION:Depression is common among pregnant adolescents in urban resource-deprived areas of Kenya and is correlated with well-documented risk factors such as being of a younger age and being HIV positive. Interventions aimed at reducing or preventing depression in this population should target these groups and provide support to those experiencing greatest stress.
PMCID:5960084
PMID: 29776353
ISSN: 1471-244x
CID: 5831042
Attributions and private theories of mental illness among young adults seeking psychiatric treatment in Nairobi: an interpretive phenomenological analysis
BACKGROUND:Mental illness affects every segment of population including young adults. The beliefs held by young patients regarding the causes of mental illness impact their treatment-seeking behaviour. It is pertinent to know the commonly held attributions around mental illness so as to effectively provide psychological care, especially in a resource constrained context such as Kenya. This helps in targeting services around issues such as stigma and extending youth-friendly services. METHODS:Guided by the private theories interview (PTI-P) and attributional framework, individual semi-structured interviews were carried out with ten young adults of ages 18-25 years about their mental health condition for which they were undergoing treatment. Each interview took 30-45 min. We mapped four attributions (locus of control, stability, controllability and stigma) on PTI-P questions. Data was transcribed verbatim to produce transcripts coded using interpretive phenomenological analysis. These codes were then broken down into categories that could be used to understand various attributions. RESULTS:We found PTI-P to be a useful tool and it elicited three key themes: (a) psychosocial triggers of distress (with themes of negative thoughts, emotions around mental health stigma and negative childhood experiences, parents' separation or divorce, death of a loved one etc.), (b) biological conditions and psychopathologies limiting intervention, and (c) preferences and views on treatment. Mapping these themes on our attributional framework, PTI-P themes presented as causal attributions explaining stigma, locus of control dimensions and stability. External factors were mainly ascribed to be the cause of unstable and uncontrollable attributions including persistent negative emotions and thoughts further exacerbating psychological distress. Nine out of the ten participants expressed the need for more intense and supportive therapy. CONCLUSION/CONCLUSIONS:Our study has provided some experiential evidence in understanding how stigma, internal vs external locus of control, stability vs instability attributions play a role in shaping attitudes young people have towards their mental health. Our study points to psychosocial challenges such as stigma, poverty and lack of social support that continue to undermine mental well-being of Kenyan youth. These factors need to be considered when addressing mental health needs of young people in Kenya.
PMCID:5984772
PMID: 29881454
ISSN: 1753-2000
CID: 5831052
Understanding mental health difficulties and associated psychosocial outcomes in adolescents in the HIV clinic at Kenyatta National Hospital, Kenya
BACKGROUND:Globally adolescents continue to have an upward trend in HIV incidence and AIDS-related mortality. The interplay between the rapid physical growth, sexual maturation, and enormous albeit slow-evolving cognitive and psychological changes in adolescence may partly explain this trend. Our main purpose was to highlight key psychosocial characteristics of HIV-infected adolescents and explore if these characteristics are associated with depression symptoms. METHODS:From August to December 2016 after obtaining informed consent, adolescents living with HIV at Kenyatta National Hospital were interviewed using the Home environment, Education and Employment, Activity, Sexuality, Suicide and depression traits (HEADSS) tool combined with the Patient Health Questionnaire (PHQ-9) to elucidate which key symptoms of depression and link with psychosocial characteristics mapped on HEADSS. In order to determine which psychosocial characteristics were linked with risk of depression, the traits of adolescents who were symptomatic were compared to those who were not using univariate and multivariate regression analysis. RESULTS: = 0.06]. CONCLUSION/CONCLUSIONS:One in two of the adolescents interviewed had depression symptoms which were significantly associated with lack of school fees, missing meals, non-adherence to medication, and substance abuse.
PMCID:6038280
PMID: 30002721
ISSN: 1744-859x
CID: 5831062
Improving psychotherapies offered in public hospitals in Nairobi, Kenya: extending practice-based research model for LMICs
BACKGROUND:Psychotherapy and mental health services in Nairobi's public hospitals are increasing. Rather than prematurely imposing psychotherapy protocols developed in Western countries to Kenya, we argue that first studying psychological interventions as they are practiced may generate understanding of which psychological problems are common, what interventions therapists use, and what seems to be effective in reducing psychiatric problems in a lower and middle income country like Kenya. METHOD/METHODS:We present preliminary findings from a process-outcome study involving 345 patients from two public institutions, Kenyatta National and Mathare National Hospitals. We asked our patients to fill out a brief personal information questionnaire, Clinical Outcomes in Routine Evaluation-Outcome Measure (Evans et al. in Br J Psychiatry 180:51-60, 2002, and the Session Alliance Inventory (Falkenström et al. in Psychol Assess 27:169-183, 2015) after each session. We present descriptives for CORE-OM, patient-therapist concordance on the SAI, and using longitudinal mixed-effects model, test change in CORE-OM over time with various therapy and patient factors as predictors in regression analyses. RESULTS: = 0.02). DISCUSSION/CONCLUSIONS:Our objective was to study psychotherapies as they are practiced in naturalistic settings. The overall significant finding is that our participants report improvement in their functioning mental health condition and distress reduced as psychotherapy progressed. There were many more male than female participants in our sample; younger patients improved more than older ones; and while interns had patients with higher distress, their patients improved better than those patients attended by professionals. CONCLUSIONS:These are preliminary observations to consider for a larger sample follow-up study. Before changing practices, evaluating the existing practices by mapping clinical outcomes is a helpful route.
PMCID:6288907
PMID: 30555529
ISSN: 1752-4458
CID: 5831092
Neurocognitive functioning of HIV positive children attending the comprehensive care clinic at Kenyatta national hospital: exploring neurocognitive deficits and psychosocial risk factors
Children and adolescents are affected in different ways by HIV/AIDS. Neurocognitive deficits are one of the most significant long term effects on HIV infected children and adolescents. Several factors are thought to influence cognitive outcomes and this include immune status, Highly Active Antiretroviral Therapy (HAART), education and social support. The aim of the study was to assess the neurocognitive function of HIV infected children and adolescents and correlate it with psychosocial factors. A cross sectional study was carried out involving a sample of 90 children living with HIV between 8 and 15 years (M = 11.38, SD = 2.06) attending Comprehensive Care Clinic (CCC) at Kenyatta National Hospital (KNH). Samples were selected by using purposive sample technique. Kaufman Assessment Battery for Children-Second Edition was used to assess cognitive function and psychosocial issues were assessed using HEADS-ED. Data was analyzed using SPSS v23 and independent T-tests, Pearson's correlation and linear regression were used. The prevalence of neurocognitive deficits among HIV positive children attending CCC at KNH was 60% with neurocognitive performance of 54 children being at least 2SD below the mean based on the KABC-II scores. There was no significant correlation between mental processing index and CD4 count (Pearson's rho = -0.01, p = 0.39). There was no significant association between Mental Processing Index and viral load (p = 0.056) and early ARV initiation (0.27). Using the HEADS-ED, risks factors related to education (β = -5.67, p = 0.02) and activities and peer support (β = -9.1, p = 0.002) were significantly associated with poor neurocognitive performance. Neurocognitive deficits are prevalent among HIV positive children attending CCC-KNH. This extent of the deficits was not associated with low CD4 count, high viral load or early initiation in HIV care. However, poor school performance and problem with peers was associated with poor neurocognitive performance.
PMCID:6441111
PMID: 29353495
ISSN: 1360-0451
CID: 5831762
Adolescent Pregnancy and Challenges in Kenyan Context: Perspectives from Multiple Community Stakeholders
OBJECTIVE:The key objective of this paper is to provide a phenomenological account of the mental health challenges and experiences of adolescent new mothers. We explore the role of social support and the absence of empathy plays in depression among pregnant adolescents. The project also collected data on the adolescents' caregiving environment which includes the adolescents' mothers, their partners, the community, and health care workers, as well as feedback from staff nurses at the maternal and child health centers. The caregivers provide additional insight into some of the barriers to access of mental health services and pregnancy care, and the etiology of adolescents' distress. METHODS:The interviews were conducted in two health facilities of Kariobangi and Kangemi's maternal and child health (MCH) centers that cover a huge low-income and low-middle-income formal and informal settlements of Nairobi. A grounded theory approach provided a unique methodology to facilitate discussion around adolescent pregnancy and depression among the adolescents and their caregivers. Our interviews were cut across four samples with 36 participants in total. The sample 1 comprised of eight pregnant adolescents who screened positive for depression in Kariobangi, sample 2 were six caregivers from both sites, and sample 3 were 22 new adolescent mothers from both sites. After individual interviews, we carried out one focused group discussion (FDG) in order to understand the cross-cutting issues and to gather some consensus on key issues, and the sample 4 were 20 community health workers, health workers, and nurses from both sites. We had one FGD with all health facility-based workers to understand the cross-cutting issues. The interviews in sample 1 and 2 were individual interviews with pregnant and parenting adolescents, and their caregivers. All our adolescent participants interviewed in sample 1 were screened for depression. Individual interviews followed the FGD. FINDINGS/RESULTS:Pregnant and parenting adolescents faced several adversities such as social stigma, lack of emotional support, poor healthcare access, and stresses around new life adjustments. We highlighted a few useful coping mechanisms and strategies that these adolescents were thinking to reduce their stress. Primary social support for pregnant and parenting teens comes from the adolescent's mother. The external family and male partners provide negligible support in the rearing of the child. While the mother's reactions to the daughters' pregnancy were empathetic sometimes, absence of food and resources made the mother distant and constraint in lending support. For those adolescents who were living with partners, in their new mother role, they had to negotiate additional challenges such as solutions to everyday childcare responsibilities and other family duties. The health care workers and community health workers confirmed that adolescent mothers have multiple needs, but there is a lack of holistic approach of service, and that their own training and capacities were very limited. CONCLUSIONS:Our paper highlights several individual stakeholder-related and system-level barriers in the MCH primary care setting that affect delivery of psychosocial support for pregnant adolescent. We have identified these knowledge, practice, and institutional gaps that need addressing through careful community and health service staff engagement using implementation strategies that are effective in low-resource settings. Pregnant adolescents are highly vulnerable group and mental health services needs to be understood better.
PMCID:5937539
PMID: 29744286
ISSN: 2196-8799
CID: 5831772
