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Mutiso VN, Musyimi CW, Gitonga I, Tele A, Ndetei DM. Depression and Intimate Partner Violence (IPV) in mothers 6 weeks to 12 months post-delivery in a rural setting in Kenya. Transcult Psychiatry 2024:13634615231187259. [PMID: 38500372 DOI: 10.1177/13634615231187259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Using a cohort of 544 postpartum mothers, 6 weeks to 12 months post-delivery in the largely rural Makueni County in Kenya, we aimed to determine: (1) the prevalence of postpartum depression (PPD) and the prevalence of each of the four domains of intimate partner violence (IPV), that is physical violence, sexual violence, emotional violence, and controlling behavior; (2) the co-occurrence of PPD and IPV; (3) risk factors and associations between sociodemographic variables and IPV, PPD and IPV and PPD co-occurring. We concurrently administered a researcher-designed sociodemographic ad hoc questionnaire, the WHO Intimate Partner Violence questionnaire and the Mini-International Neuropsychiatric Interview for adults (MINI Plus) for DSM-IV/ICD10 depression. The prevalence of PPD was 14.5%; Emotional violence 80.3%; Controlling behavior 74.4% (a form of emotional violence); Physical violence 40.3%; Sexual violence 28.9%. We found the following overlaps: 39% of participants reported both physical and emotional violence; 39% had both sexual and emotional violence; 15% experienced physical and sexual violence; and 15% of participants reported physical, sexual, and emotional violence. Postpartum depression was associated with physical violence during pregnancy, self-employed status, history of mood disorders and medical problems in the child. Further, we report associations between various types of IPV and history of depression, physical violence during pregnancy, low education level, marital status, and current depression diagnosis. IPV and PPD were highly prevalent in our population of postpartum mothers. Various types of IPV were significantly associated with various sociodemographic indicators while only sexual violence was significantly associated with PPD. Based on our results, we provide suggestions for potential interventions in the Kenyan setting.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Mutiso VN, Musyimi CW, Tele A, Alietsi R, Andeso P, Ndetei DM. Edinburgh Postnatal Depression Scale (EPDS) for screening for depression in the first year post delivery in a low-resourced rural setting in Kenya. Transcult Psychiatry 2023; 60:476-483. [PMID: 34986050 DOI: 10.1177/13634615211043764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postnatal depression is one of the most common mental disorders among postnatal mothers and may have severe consequences for mothers and their children. Locally validated screening tools that can be self- or lay interviewer-administered are required to identify at-risk women, especially in settings with no mental health specialists. This study aimed to assess the validity and reliability of a culturally adapted version of the Edinburgh Postnatal Depression Scale (EPDS) in a local dialect (Kamba) in a Kenyan setting. Trained research assistants administered the local-language version of self-report scales (EPDS) to a sample of 544 Kamba-speaking women. The same scale was re-administered to the same research participants two weeks later by the same research assistants. The test scores were compared with an external 'gold standard' according to the DSM-IV criteria Mini-International Neuropsychiatric Interview for adults (MINI-Plus). The EPDS had an area under the curve (AUC) of 0.867 with 95% C.I of 0.836 to 0.894, with a cut-off point of ≥11, sensitivity of 81.0% (95% C.I 70.6-89.0) and specificity of 82.6% (95% CI 78.8-85.9). The positive predictive value (PPV) and negative predictive value (NPV) were 44.1% and 96.2%, respectively. The internal reliability was 0.852 and the test-retest reliability was 0.496. The EPDS showed good utility in detecting depressive disorder in Kamba-speaking postnatal women. It does not have to be administered by mental health workers (who are few in low- and middle-income countries); rather, this can be done by a trained lay interviewer.
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Affiliation(s)
| | | | - Albert Tele
- Africa Mental Health Research and Training Foundation
| | - Rita Alietsi
- Africa Mental Health Research and Training Foundation
| | | | - David M Ndetei
- Africa Mental Health Research and Training Foundation
- University of Nairobi
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Musyimi CW, Muyela LA, Mutiso VN, Mutunga E, Ndetei DM. Understanding dementia care pathways for policy development and service planning in Kenya. Dementia (London) 2023:14713012231166743. [PMID: 37036049 DOI: 10.1177/14713012231166743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND In Kenya, there is lack of evidence on existing dementia care pathways, with minimal or no presentation for dementia-related symptoms in health care settings. Understanding the services available for people with dementia as well as how communities access the services could offer a practical pattern for policy makers to identify strategies that encourage early detection, care and support for people with dementia and their families. OBJECTIVES To elucidate initial responses of individuals and their families to dementia and challenges encountered in help seeking through care pathways to inform dementia care-related policies and practice. METHODS The Strengthening Responses to dementia in Developing Countries (STRiDE) Kenya team adapted case vignettes (brief hypothetical stories meant to elicit responses on how the characters would behave) developed by the entire STRiDE team. A total of 29 stakeholders were then asked to provide feedback on the completed vignettes and summarize a common pathway to dementia care in Kenya while using the proposed case vignettes. FINDINGS We found four initial responses to dementia suspicion in Kenya where individuals:(i) Perceive symptoms as normal part of ageing, (ii) Consult a spiritual or traditional healer, (iii) Visit a private clinic or primary health care facilities, or (iv) No action taken. These were the first points within the care pathways which determined the care trajectory the person with dementia would follow. CONCLUSIONS Identification of dementia care pathways could form a basis for improving the way communities perceive dementia etiology and establish standard pathways to care whilst ensuring that some pathways do not further pose an impediment to care and treatment for dementia.
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Affiliation(s)
| | - Levi A Muyela
- 585760Africa Mental Health Research and Training Foundation, Kenya
| | | | | | - David M Ndetei
- 585760Africa Mental Health Research and Training Foundation, Kenya
- University of Nairobi, Kenya
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Oliveira D, da Mata F, Mateus E, Musyimi CW, Farina N, Ferri CP, Evans-Lacko S. Experiences of stigma and discrimination among people living with dementia and family carers in Brazil: Qualitative study. Ageing Soc 2023; 43:447-468. [PMID: 37920698 PMCID: PMC10621398 DOI: 10.1017/s0144686x21000660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study aimed to understand stigma in relation to people living with dementia in Sao Paulo, Brazil. Critical Narrative Inquiry methodology was used. Semi-structured interviews were conducted between January and March 2020 with six people living with dementia and 15 family carers. Inductive and deductive techniques were used. The latter was informed by Link and Phelan's (2001) sociological theory of stigma. Dementia was commonly viewed by people living with dementia as part of ageing and carers reported low levels awareness about the condition. To avoid negative reactions from people, people living with dementia managed the negative views of dementia by minimising and normalising the condition, by expressing their ability to live an active life, and by emphasising the positive impacts of dementia in their lives. Fear of negative reactions appeared to lead to a selective disclosure of their diagnosis. Among carers, stigmatising attitudes coincided with a strong willingness to provide good care, to protect the person cared for, as well as to understand and validate their caring experiences, rather than to cause harm. In doing so, however, carers ended up depersonalising and infantilising people living with dementia, underestimating their capacities, demanding 'obedience', and restricting their freedom. There is a need to increase awareness about dementia and to provide support and training on person-centred care for carers in Brazil.
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Affiliation(s)
- Déborah Oliveira
- Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, Sao Paulo, Brazil
| | - Fabiana da Mata
- Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, Sao Paulo, Brazil
| | - Elaine Mateus
- Federação Brasileira das Associações de Alzheimer (FEBRAZ), Parana, Brazil
- Universidade Estadual de Londrina (UEL), Applied Linguistics, Department of Modern Languages, Parana, Brazil
| | - Christine W. Musyimi
- Africa Mental Health Research and Training Foundation, Research Department, Kenya
| | - Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Cleusa P. Ferri
- Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, Sao Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics, London, United Kingdom
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Ndetei DM, Mutiso VN, Musyimi CW, Alietsi RK, Shanley JR, Bhui KS. The feasibility of using life skills training in primary schools to improve mental health and academic performance: a pilot study in Kenya. BMC Psychiatry 2022; 22:131. [PMID: 35177007 PMCID: PMC8855590 DOI: 10.1186/s12888-022-03781-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is no Kenyan evidence on the relationship between mental illness and academic performance. We aimed to determine the effect of life skills training on mental health and academic performance. METHODS We administered to 1848 primary school children a researcher designed socio-demographic questionnaire, and the Youth Self Report (YSR) and Child Behavior Checklist (CBCL) to their parents, followed by eight sessions of life skills training. We extracted data from the individual records of each child on overall performance pre and post training separated by one year. We conducted descriptive statistics, paired sample t-tests, multivariate linear regression analysis and linear mixed model analysis to assess changing patterns of academic performance and any predictive characteristics. RESULTS There was significant (p < 0.05) improvement in overall academic performance (aggregate marks and all individual subjects) for both lower primary and upper primary classes after the life-skills training intervention. For lower classes (2-4 grades) increase in academic performance was significantly associated with fathers and mothers education levels, region and class. For upper classes, (5-7 grades) increase in academic performance was associated with region, class and age. CONCLUSIONS Life skills training is recommended as it could improve academic performance, but predicted by socio-demographic factors.
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Affiliation(s)
- David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya. .,Department of Psychiatry, University of Nairobi, Nairobi, Kenya. .,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Rita K Alietsi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Jenelle R Shanley
- School of Graduate Psychology, Pacific University, Forest Grove, USA
| | - Kamaldeep S Bhui
- Department of Psychiatry, University of Oxford, Oxford, England.,World Psychiatric Association Collaborating Centre for Research and Training, London, UK
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Mutiso VN, Musyimi CW, Gitonga I, Rebello TJ, Tele A, Pike KM, Ndetei DM. Toward Community Coverage on Self-Screening, Diagnosis, and Help-Seeking Behavior for Both Gender Victims of Intimate Partner Violence (IPV) in a Kenyan Setting: The Development of IPV-Brief Self-Screener (IPV-BSS) Version of the WHO-IPV Instrument. J Interpers Violence 2021; 36:NP9344-NP9363. [PMID: 31208269 DOI: 10.1177/0886260519855666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intimate partner violence (IPV) is a major public health concern. The prevalence of IPV in women in Kenya is in the range of 41% to 45% but has also been reported in 20% of men. The most widely used instrument for the screening and diagnosis of IPV is the World Health Organization-Intimate Partner Violence (WHO-IPV). However, it is lengthy for routine large-scale screening and is administered by a trained person, thus limiting the number it can reach for screening. There is therefore a need for a shorter screening version that can be self-administered to reach critical masses. Those who screen positive can then be subjected to the longer version. In addition, the short version should be culturally sensitive, can be used by either gender, can be used in busy clinical settings as the patients wait to be attended to, and can be used for large-scale community populations to raise awareness and promote help-seeking behavior. It should be applicable in similar cultural settings and is aligned to the longer version of the WHO-IPV instrument. This study aimed to develop such a tool. We administered the WHO-IPV to two groups: firstly, postnatal mothers attending postnatal clinics and secondly, men and women attending general clinics to which they had been referred. These referrals were by traditional healers (TH), faith healers (FH), and community health workers (CHW) who had been trained to screen for mental disorders using the Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG) master checklist. Using factor analysis of the scores, we came up with questions that had the highest predictive value for different types of IPV diagnosis and which could therefore be used for self-screening purposes. We call the tool the Intimate Partner Violence-Brief Self-Screener (IPV-BSS; Adapted by the Africa Mental Health Research and Training Foundation from the WHO-IPV).
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Kathleen M Pike
- Columbia University, Global Mental Health Program, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Musyimi CW, Ndetei DM, Evans-Lacko S, Oliveira D, Mutunga E, Farina N. Perceptions and experiences of dementia and its care in rural Kenya. Dementia (London) 2021; 20:2802-2819. [PMID: 33928810 DOI: 10.1177/14713012211014800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aimed to explore the perceptions towards dementia and related care across three stakeholder groups in rural Kenya. METHODS A total of 38 key stakeholders (carers of persons with dementia, health care providers and the general public) participated in focus group discussions. Additional five individual interviews were held with carers. Thematic analysis was used to analyse the data. FINDINGS Across the three participant groups, a total of four themes were identified: (i) negative stereotypes of dementia, (ii) limited knowledge about dementia, (iii) diagnostic pathway and (iv) neglect and abuse. CONCLUSIONS We found a general lack of knowledge of dementia amongst family carers, healthcare professionals and the general public. The combination of poor awareness and ill-equipped healthcare systems leads to stigma manifested in the form of patchy diagnostic pathways, neglect and abuse. Local governments could take advantage of the existing family- and community-based systems to improve understanding of dementia nationally.
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Affiliation(s)
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, 107854University of Nairobi, Nairobi, Kenya
| | - Sara Evans-Lacko
- 4905Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | | | | | - Nicolas Farina
- Centre for Dementia Studies, 12190Brighton and Sussex Medical School, Brighton, UK
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Musyimi CW, Mutiso VN, Nyamai DN, Ebuenyi I, Ndetei DM. Suicidal behavior risks during adolescent pregnancy in a low-resource setting: A qualitative study. PLoS One 2020; 15:e0236269. [PMID: 32697791 PMCID: PMC7375578 DOI: 10.1371/journal.pone.0236269] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Suicide is one of the most common causes of death among female adolescents. A greater risk is seen among adolescent mothers who become pregnant outside marriage and consider suicide as the solution to unresolved problems. We aimed to investigate the factors associated with suicidal behavior among adolescent pregnant mothers in Kenya. Methods A total of 27 Focus Group Discussions (FGDs) and 8 Key Informant Interviews (KIIs) were conducted in a rural setting (Makueni County) in Kenya. The study participants consisted of formal health care workers and informal health care providers (traditional birth attendants and community health workers), adolescent and adult pregnant and post-natal (up to six weeks post-delivery) women including first-time adolescent mothers, and caregivers (husbands and/or mothers-in-law of pregnant women) and local key opinion leaders. The qualitative data was analyzed using Qualitative Solution for Research (QSR) NVivo version 10. Results Five themes associated with suicidal behavior risk among adolescent mothers emerged from this study. These included: (i) poverty, (ii) intimate partner violence (IPV), (iii) family rejection, (iv) social isolation and stigma from the community, and (v) chronic physical illnesses. Low economic status was associated with hopelessness and suicidal ideation. IPV was related to drug abuse (especially alcohol) by the male partner, predisposing the adolescent mothers to suicidal ideation. Rejection by parents and isolation by peers at school; and diagnosis of a chronic illness such as HIV/AIDS were other contributing factors to suicidal behavior in adolescent mothers. Conclusion Improved social relations, economic and health circumstances of adolescent mothers can lead to reduction of suicidal behaviour. Therefore, concerted efforts by stakeholders including family members, community leaders, health care workers and policy makers should explore ways of addressing IPV, economic empowerment and access to youth friendly health care centers for chronic physical illnesses. Prevention strategies should include monitoring for suicidal behavior risks during pregnancy in both community and health care settings. Additionally, utilizing lay workers in conducting dialogue discussions and early screening could address some of the risk factors and reduce pregnancy- related suicide mortality in LMICs.
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Affiliation(s)
| | | | - Darius N. Nyamai
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Ikenna Ebuenyi
- Department of Psychology and Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- University of Nairobi, Nairobi, Kenya
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Harder VS, Musau AM, Musyimi CW, Ndetei DM, Mutiso VN. A randomized clinical trial of mobile phone motivational interviewing for alcohol use problems in Kenya. Addiction 2020; 115:1050-1060. [PMID: 31782966 PMCID: PMC8353663 DOI: 10.1111/add.14903] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/06/2019] [Accepted: 11/08/2019] [Indexed: 01/13/2023]
Abstract
AIM To test the effectiveness of a motivational interviewing (MI) intervention using the mobile phone among adults with alcohol use problems. DESIGN A randomized clinical trial of mobile MI and standard in-person MI with 1- and 6-month follow-up, including a 1-month waitlist control followed by mobile MI. SETTING A primary health center in rural Kenya. PARTICIPANTS Three hundred adults screening positive for alcohol use problems were randomized and received immediate mobile MI (n = 89), in-person MI (n = 65) or delayed mobile MI (n = 76) for waiting-list controls 1 month after no treatment, with 70 unable to be reached for intervention. INTERVENTION AND COMPARATOR One MI session was provided either immediately by mobile phone, in-person at the health center or delayed by 1 month and then provided by mobile phone. MEASUREMENTS Alcohol use problems were repeatedly assessed using the Alcohol Use Disorder Identification Test (AUDIT) and the shorter AUDIT-C. The primary outcome was difference in alcohol score 1 month after no intervention for waiting-list control versus 1 month after MI for mobile MI. The secondary outcomes were difference in alcohol score for in-person MI versus mobile MI one and 6 months after MI. FINDINGS For our primary outcome, average AUDIT-C scores were nearly three points higher (difference = 2.88, 95% confidence interval = 2.11, 3.66) for waiting-list controls after 1 month of no intervention versus mobile MI 1 month after intervention. Results for secondary outcomes supported the null hypothesis of no difference between in-person and mobile MI at 1 month (Bayes factor = 0.22), but were inconclusive at 6 months (Bayes factor = 0.41). CONCLUSION Mobile phone-based motivational interviewing may be an effective treatment for alcohol use problems among adults visiting primary care in Kenya. Providing mobile motivational interviewing may help clinicians in rural areas to reach patients needing treatment for alcohol use problems.
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Affiliation(s)
- Valerie S. Harder
- University of Vermont, Departments of Pediatrics and Psychiatry, 1 S. Prospect Street, Burlington, VT, 05401 USA,Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya,CORRESPONDING AUTHOR: Valerie S. Harder, PhD, MHS, Associate Professor of Pediatrics and Psychiatry, University of Vermont Larner College of Medicine, 1 S. Prospect Street, Burlington, VT, 05401 USA, , Phone: 802-656-8210
| | - Abednego M. Musau
- Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya
| | | | - David M. Ndetei
- Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya,University of Nairobi, Department of Psychiatry, P.O. Box 19676-00202, Nairobi, Kenya
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Mutiso VN, Musyimi CW, Gitonga I, Tele A, Pervez R, Rebello TJ, Pike KM, Ndetei DM. Using the WHO-AIMS to inform development of mental health systems: the case study of Makueni County, Kenya. BMC Health Serv Res 2020; 20:51. [PMID: 31959175 PMCID: PMC6971996 DOI: 10.1186/s12913-020-4906-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In order to develop a context appropriate in mental health system, there is a need to document relevant existing resources and practices with a view of identifying existing gaps, challenges and opportunities at baseline for purposes of future monitoring and evaluation of emerging systems. The World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) was developed as a suitable tool for this purpose. Our overall objective of this study, around which research questions and specific aims were formulated, was to establish a baseline on mental health system as at the time of the study, at Makueni County in Kenya, using the WHO-AIMS. METHODS To achieve our overall objective, answer our research questions and achieve specific aims, we conducted a mixed methods approach in which we did an audit of DHIS records and county official records, and conducted qualitative interviews with the various officers to establish the fidelity of the data according to their views. The records data was processed via the prescribed WHO-Aims 2.2 excel spreadsheet while the qualitative data was analyzed thematically. This was guided by the six domains stipulated in the WHO AIMS. RESULTS We found that at the time point of the study, there were no operational governance, policy or administrative structures specific to mental health, despite recognition by the County Government of the importance of mental health. The identified interviewees and policy makers were cooperative and participatory in identifying the gaps, barriers and potential solutions to those barriers. The main barriers and gaps were human and financial resources and low prioritization of mental health in comparison to physical conditions. The solutions lay in bridging of the gaps and addressing the barriers. CONCLUSION There is a need to address the identified gaps and barriers and follow up on solutions suggested at the time of the study, if a functional mental health system is to be achieved at Makueni County.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Romaisa Pervez
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, N6A 5C1, Canada
| | - Tahilia J Rebello
- Columbia University Global Mental Health Program, 1051 Riverside Drive, New York, NY, 1003, USA
| | - Kathleen M Pike
- Columbia University Global Mental Health Program, 1051 Riverside Drive, New York, NY, 1003, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya. .,Department of Psychiatry, University of Nairobi, P. O. Box 30197 - 00100, Nairobi, Kenya.
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Mutiso VN, Musyimi CW, Rebello TJ, Ogutu MO, Ruhara R, Nyamai D, Pike KM, Ndetei DM. Perceived impacts as narrated by service users and providers on practice, policy and mental health system following the implementation of the mhGAP-IG using the TEAM model in a rural setting in Makueni County, Kenya: a qualitative approach. Int J Ment Health Syst 2019; 13:56. [PMID: 31423149 PMCID: PMC6693225 DOI: 10.1186/s13033-019-0309-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background A team approach is key to reduction of the mental health treatment gap. It requires collaborative effort of all formal and informal community based service providers and the consumers of the services. Qualitative evaluations of such an approach add value to the quantitative evaluations. Methods A qualitative study was conducted among 205 participants. These were grouped into a total of 19 focus group discussions for community health workers (CHW), traditional healers (TH), faith healers (FH) and patients. For nurses and clinical officers we held 10 key informant interviews and three key informant discussions. We aimed to document personal perceptions as expressed in narratives on mental health following a community based application of the WHO mental health treatment Gap-intervention guideline (mhGAP-IG) using the TEAM model. We also aimed to document how the narratives corroborated key findings on the quantitative wing of the TEAM model. Results There were three categories of perceptions: (i) patient-related, (ii) health provider-related and, (iii) health system related. The patient related narratives were linked to improvement in their mental and physical health, increased mental health awareness, change in lifestyle and behavior, enhanced social functioning and an increase in family productivity. Health provider perceptions were related to job satisfaction, capacity building and increased interest in mental health training. Mental health system related narratives included effectiveness and efficiency in service delivery and increase in number of referrals at the primary health care facilities. Conclusion The TEAM is a feasible model for the implementation of the mhGAP-IG. It led to positive perceptions and narratives by service provides and service consumers. The qualitative findings corroborated the quantitative findings of TEAM.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | | | - Michael O Ogutu
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Ruth Ruhara
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Darius Nyamai
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Kathleen M Pike
- 2Global Mental Health Program, Columbia University, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya.,3Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Mutiso VN, Pike KM, Musyimi CW, Gitonga I, Tele A, Rebello TJ, Thornicroft G, Ndetei DM. Feasibility and effectiveness of nurses and clinical officers in implementing the WHO mhGAP intervention guide: Pilot study in Makueni County, Kenya. Gen Hosp Psychiatry 2019; 59:20-29. [PMID: 31096165 DOI: 10.1016/j.genhosppsych.2019.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES (1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mental health Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability, improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in a Kenyan rural setting. (2) To identify any gaps that can be contributed towards future research. METHODS This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya. This county had a population of approximately one million people, with no psychiatrist or clinical psychologist. We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously been exposed to the community mental health awareness campaigns, while being subjected to screening for the mhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability using WHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depression using Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure questionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). These measurements were at the baseline, followed by the training for the health professionals on using the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention. RESULTS Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months a follow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most depending on condition also received medication. Overall, there was significant decline in disabilities, improvement in seizure control and improvement in clinical outcomes on the identified mental disorders. CONCLUSIONS Trained, supervised and supported nurses and clinical officers can produce good outcomes using the mhGAP-IG for mental health.
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Affiliation(s)
- V N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - K M Pike
- Columbia University, Global Mental Health Program, New York, USA.
| | - C W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - I Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - A Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - T J Rebello
- Columbia University, Global Mental Health Program, New York, USA.
| | | | - D M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
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Mutiso VN, Musyimi CW, Krolinski P, Neher CM, Musau AM, Tele A, Ndetei DM. Relationship between Bullying, Substance Use, Psychiatric Disorders, and Social Problems in a Sample of Kenyan Secondary Schools. Prev Sci 2019; 20:544-554. [PMID: 30993591 DOI: 10.1007/s11121-019-01014-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We aimed to investigate how direct bullying and victimization relate with substance use, the presence of psychiatric disorders, poor school performance, disruptive behaviors, and social problems among secondary school students. A cross-sectional study was conducted in 20 randomly selected mixed-day secondary school students in forms one to three in Machakos County, equivalent to students in grades 1 to 11. From a random starting point, every sixth student in the class was invited to participate. The Drug Use Screening Inventory (revised) (DUSI-R) and the Olweus Bully/Victim Questionnaire (OBVQ) were administered in a classroom-setting by trained research assistants with experience in data collection. Four categories, i.e., bully only, bully-victim, victim only, and neither bully nor victims (neutrals) were developed and problem density scores computed. Descriptive statistics, bivariate, and multinomial logistic regression analysis summarized the findings. Of the 471 students, 13.6% had not experienced bullying problems. Bully-victim was the most prevalent form of bullying. No significant gender differences were reported across categories. Bully-victims reported significant higher problem density scores in eight out of the nine problem domains, and effect sizes of the differences in problem scores between neutrals and bully-victims were larger compared with other categories. Behavioral and family system problem scores retained a significant relationship with bully-victim category (p < 0.001). A high prevalence of bullying problems was documented in both genders. However, bully-victims had a higher risk of multiple negative individual and environmental and social problems. Assessment of bullying problems is an indirect route to identifying significant youth problems. Bullying interventions should be multifaceted to address psycho-socio-behavioral problems.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya.,Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - Abednego M Musau
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya. .,University of Nairobi, Nairobi, Kenya.
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14
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Musyimi CW, Mutiso VN, Loeffen L, Krumeich A, Ndetei DM. Exploring mental health practice among Traditional health practitioners: a qualitative study in rural Kenya. BMC Complement Altern Med 2018; 18:334. [PMID: 30547778 PMCID: PMC6295025 DOI: 10.1186/s12906-018-2393-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/28/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Involvement of traditional health practitioners (THPs) in the form of collaboration with the formal health care system is suggested to improve the pathways to mental health care in Kenya, yet understanding of the current traditional practice and THPs' perspectives is lacking. The aim of this study was to explore the views of THPs with respect to their mental health practice. METHODS This study qualitatively explored the views of THPs, using four focus group discussions (FDGs) each consisting of 8-10 traditional and faith healers, resulting in a total of 36 participants. Thematic content analysis using a grounded theory approach was performed using QSR NVivo 10. Emerging topics were identified and examined by re-reading the transcripts several times and constantly re-sorting the material. RESULTS Four themes that reflect THPs' mental health practice perspectives emerged as follows: 1) Categorization of mental illness; 2) Diagnostics in traditional mental health practice; 3) Treatments and challenges in current traditional mental health practice; and 4) Solutions to improve traditional mental health practice. CONCLUSIONS These themes provide insight into the perspectives of Kenyan traditional and faith healers on their mental health practice, in an attempt to offer a meaningful contribution to the debate on collaboration between informal and formal health care providers in improving mental health services in Kenya. Furthermore, the presented challenges and solutions can inform policy makers in their task to improve and scale up mental health services in resource-poor areas in Kenya. Addressing these issues would be a first step towards understanding the solid foundation of traditional medicine that is necessary before collaboration can be successfully attempted. Further research is also recommended to assess patients' needs and explore potential forms of collaboration, in order to achieve sustainable improvement in the mental health care pathways for patients.
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Affiliation(s)
- Christine W. Musyimi
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
- Vrije Universiteit, 1081 HV Amsterdam, Netherlands
| | - Victoria N. Mutiso
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
| | - Lianne Loeffen
- Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - Anja Krumeich
- Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - David M. Ndetei
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
- University of Nairobi, P. O. Box 30197 00100, Nairobi, Kenya
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Mutiso VN, Gitonga I, Musau A, Musyimi CW, Nandoya E, Rebello TJ, Pike KM, Ndetei DM. A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya. Int J Ment Health Syst 2018; 12:57. [PMID: 30356953 PMCID: PMC6191998 DOI: 10.1186/s13033-018-0234-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/06/2018] [Indexed: 12/26/2022] Open
Abstract
Background The World Health Organization developed the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) as guidelines for innovative utilization of available resources in low- and middle-income countries (LMICs) in order to accelerate the reduction of the mental health treatment gap. The mhGAP-IG calls for each country to contextualize the guide to their social, cultural and economic context. The objective of this paper is to describe a model for a stepwise approach for implementation of mhGAP-IG in a rural Kenyan setting using existing formal and informal community resources and health systems. Methods We conducted an analysis of mental health services in Makueni County, one of the 47 counties in Kenya, in order to understand the existing gaps and opportunities in a low-resource setting. We conducted stakeholder analysis and engagement through interactive dialogue in order for them to appreciate the importance of mental health to their communities. Through the process of participatory Theory of Change, the stakeholders gave their input on the process between the initiation and the end of the process for community mental health development, with the aim of achieving buy-in and collective ownership of the whole process. We adapted the mhGAP-IG to the local context and trained local human resources in skills necessary for the implementation of mhGAP-IG and for monitoring and evaluating the process using instruments with good psychometric properties that have been used in LMICs. Results We were able to demonstrate the feasibility of implementing the mhGAP-IG using existing and trained community human resources using a multi-stakeholder approach. We further demonstrated the feasibility to transit seamlessly from research to policy and practice uptake using our approach. Conclusions An inclusive model for low resource settings is feasible and has the potential to bridge the gap between research, policy and practice. A major limitation of our study is that we did not engage a health economist from the beginning in order to determine the cost-effectiveness of our proposed model, occasioned by lack of resources to hire a suitable one.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Abednego Musau
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Eric Nandoya
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | | | - Kathleen M Pike
- 2Global Mental Health Program, Columbia University, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya.,3University of Nairobi, Nairobi, Kenya
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Mutiso VN, Musyimi CW, Musau AM, Nandoya ES, Mckenzie K, Ndetei DM. Pilot towards developing a school mental health service: Experiences and lessons learnt in implementing Kenya integrated intervention model for dialogue and screening to promote children's mental well-being. Early Interv Psychiatry 2018; 12:972-978. [PMID: 29464876 DOI: 10.1111/eip.12543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/21/2017] [Accepted: 12/17/2017] [Indexed: 11/29/2022]
Abstract
AIM This paper aims at documenting the process of implementing "Kenya Integrated intervention model for Dialogue and Screening to promote children's mental wellbeing (KIDS)", with emphasis on activities, experiences, challenges and lessons learnt through the process that can inform improvement in Kenya and other social-economically and culturally similar settings. METHODS KIDS aimed at providing early and integrated culturally acceptable intervention to promote child mental health in 6 to 13 year olds, targeting 5429 children in 24 schools. It was a pilot study conducted in 2 administrative counties in Kenya (Machakos and Makueni). The main goal of this study was to test the efficacy and feasibility of the proposed model that incorporated several significant stakeholders. RESULTS The implementation of KIDS was grouped into 6 stepwise and 2 ongoing processes: (1) Stakeholder engagement and collaboration; (2) Selecting, adapting, translating, piloting and adopting the study tools; (3) Conducting Participatory Theory of Change (ToC); (4) Building the capacity of the key implementing partners; (5) Community awareness and psycho-education, (6) Using school-based life skills and peer clubs counselling to provide psychosocial support; (7) Ongoing monitoring, supervision and quality assurance and (8) Ongoing knowledge exchange and dissemination. Specific logistical challenges and possible solutions for future school mental health services are also stated in this article. CONCLUSION KIDS is a feasible model for school mental health service programme in Kenya but there are challenges which provide innovative opportunities for better designed school mental health services programme.
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Affiliation(s)
- Victoria N Mutiso
- Department of Research Africa Mental Health Foundation, Nairobi, Kenya
| | - Christine W Musyimi
- Department of Research Africa Mental Health Foundation, Nairobi, Kenya.,Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Abednego M Musau
- Department of Research Africa Mental Health Foundation, Nairobi, Kenya
| | - Erick S Nandoya
- Department of Research Africa Mental Health Foundation, Nairobi, Kenya
| | | | - David M Ndetei
- Department of Research Africa Mental Health Foundation, Nairobi, Kenya.,Professor of Psychiatry, University of Nairobi, Nairobi, Kenya
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Mutiso VN, Musyimi CW, Tomita A, Loeffen L, Burns JK, Ndetei DM. Epidemiological patterns of mental disorders and stigma in a community household survey in urban slum and rural settings in Kenya. Int J Soc Psychiatry 2018; 64:120-129. [PMID: 29258407 PMCID: PMC5836746 DOI: 10.1177/0020764017748180] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study investigated the epidemiological patterns of mental illness and stigma in community households in Kenya using a cross-sectional community household survey among 846 participants. METHODS A cross-sectional community household survey was conducted around urban slum (Kangemi) and rural (Kibwezi) selected health facilities in Kenya. All households within the two sites served by the selected health facilities were included in the study. To select the main respondent in the household, the oldest adult who could speak English, Kiswahili or both (the official languages in Kenya) was selected to participate in the interview. The Opinion about Mental Illness in Chinese Community (OMICC) questionnaire and the MINI-International Neuropsychiatric Interview-Plus Version 5 (MINI) tools were administered to the participants. Pearson's chi-square test was used to compare prevalence according to gender, while adjusted regression models examined the association between mental illness and views about mental illness, stratified by gender. RESULTS The overall prevalence of mental illness was 45%, showing gender differences regarding common types of illness. The opinions about mental illness were similar for men and women, while rural respondents were more positively opinionated than urban participants. Overall, suffering from mental illness was associated with more positive opinions among women and more negative opinions among men. CONCLUSION More research is needed into the factors explaining the observed differences in opinion about mental illness between the subgroups, and the impact of mental illness on stigma in Kenya in order to create an evidence-based approach against stigma.
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Affiliation(s)
| | - Christine W Musyimi
- Africa Mental Health Foundation, Nairobi. Kenya
- Vrije Universiteit, Amsterdam. Netherlands
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban. South Africa
- Africa Health Research Institute, University of KwaZulu-Natal,
Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform,
University of KwaZulu-Natal, Durban, South Africa
| | | | - Jonathan K Burns
- Department of Psychiatry, University of KwaZulu-Natal, Durban. South
Africa
- Institute for Health Research, University of Exeter, Exeter. United
Kingdom
| | - David M Ndetei
- Africa Mental Health Foundation, Nairobi. Kenya
- University of Nairobi, Nairobi. Kenya
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Mutiso VN, Musyimi CW, Nayak SS, Musau AM, Rebello T, Nandoya E, Tele AK, Pike K, Ndetei DM. Stigma-related mental health knowledge and attitudes among primary health workers and community health volunteers in rural Kenya. Int J Soc Psychiatry 2017; 63:508-517. [PMID: 28679343 DOI: 10.1177/0020764017716953] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The study was conducted in rural Kenya and assessed stigma in health workers from primary health facilities. AIMS This study compared variations in stigma-related mental health knowledge and attitudes between primary health workers (HWs) and community health volunteers (CHVs). METHODS Participants ( n = 44 HWs and n = 60 CHVs) completed the self-report Mental Health Knowledge Schedule and the Reported and Intended Behavior Scale, along with sociodemographic questions. Multiple regression models were used to assess predictors of mental health knowledge and stigmatizing behaviors. RESULTS HWs had significantly higher mean mental health knowledge scores than CHVs, p < .001, and significantly higher mean positive attitudes scores than CHVs, p = .042. When controlling for relevant covariates, higher positive attitudes was the only significant predictor of higher mental health knowledge, and self-rating of sense of belonging to the community and mental health knowledge remained the main predictors of positive attitudes. CONCLUSION Results suggest that stigma-related mental health knowledge and attitudes are associated, and interventions should target these areas with health workers. There is scope for intervention to increase knowledge and positive attitudes for individuals who feel a strong sense of community belonging. Future studies should test feasible ways to reduce stigma in this population.
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Affiliation(s)
| | - Christine W Musyimi
- 1 Africa Mental Health Foundation, Nairobi, Kenya.,2 Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sameera S Nayak
- 3 Columbia University Global Mental Health Program, New York, NY, USA
| | | | - Tahilia Rebello
- 3 Columbia University Global Mental Health Program, New York, NY, USA
| | | | | | - Kathleen Pike
- 3 Columbia University Global Mental Health Program, New York, NY, USA
| | - David M Ndetei
- 1 Africa Mental Health Foundation, Nairobi, Kenya.,4 University of Nairobi, Nairobi, Kenya
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Musyimi CW, Mutiso VN, Ndetei DM, Unanue I, Desai D, Patel SG, Musau AM, Henderson DC, Nandoya ES, Bunders J. Mental health treatment in Kenya: task-sharing challenges and opportunities among informal health providers. Int J Ment Health Syst 2017; 11:45. [PMID: 28775764 PMCID: PMC5540195 DOI: 10.1186/s13033-017-0152-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background The study was conducted to explore challenges faced by trained informal health providers referring individuals with suspected mental disorders for treatment, and potential opportunities to counter these challenges. Methods The study used a qualitative focus group approach. It involved community health workers, traditional and faith healers from Makueni County in Kenya. Ten Focus Group Discussions were conducted in the local language, recorded and transcribed verbatim and translated. Using a thematic analysis approach, data were entered into NVivo 7 for analysis and coding. Results Results demonstrate that during the initial intake phase, challenges included patients’ mistrust of informal health providers and cultural misunderstanding and stigma related to mental illness. Between initial intake and treatment, challenges related to resource barriers, resistance to treatment and limitations of the referral system. Treatment infrastructure issues were reported during the treatment phase. Various suggestions for solving these challenges were made at each phase. Conclusions These findings illustrate the commitment of informal health providers who have limited training to a task-sharing model under difficult situations to increase patients’ access to mental health services and quality care. With the identified opportunities, the expansion of this type of research has promising implications for rural communities.
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Affiliation(s)
- Christine W Musyimi
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya.,Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
| | - Victoria N Mutiso
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - David M Ndetei
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya.,University of Nairobi, P.O Box 30197, Nairobi, 00100 Kenya
| | - Isabel Unanue
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Dhru Desai
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Sita G Patel
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Abednego M Musau
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - David C Henderson
- Boston University School of Medicine, 72 E. Concord St, Boston, MA 02118 USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Erick S Nandoya
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - Joske Bunders
- Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
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Musyimi CW, Mutiso VN, Musau AM, Matoke LK, Ndetei DM. Prevalence and determinants of depression among patients under the care of traditional health practitioners in a Kenyan setting: Policy implications. Transcult Psychiatry 2017; 54:285-303. [PMID: 28517969 DOI: 10.1177/1363461517705590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Kenya, there is paucity of information on depression among traditional health practitioner (THP) patients, particularly in rural areas. The aim of this study was to estimate prevalence and identify determinants of major depressive disorder (MDD) among patients of THP in rural Kenya using the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guideline (mhGAP-IG). All adult patients seeking care from trained THPs (either traditional healers such as diviners and herbalists or faith healers, who use treatments such as prayers, laying hands on patients, or providing holy water and ash to their patients) over a period of 3 months (September 2014 to November 2014) were screened for depression using mhGAP-IG and their sociodemographic characteristics recorded. Overall, the prevalence of depression among THP patients was 22.9%. Being older, female, single, divorced or separated, as well as unemployment and lack of education were found to be significant determinants of depression. Patients with MDD frequently presented with suicidal behavior (32.9%, OR = 5.94, p < .0001) compared to those that had at least one psychotic symptom (26.3%, OR = 3.65, p < .0001). A measure of the accuracy of THPs' assessment of MDD showed 86% specificity and 46% sensitivity and the area under receiver operating characteristics (ROC) curve was 0.686. Our findings shed light on the prevalence of depression among THP patients and thus highlight the need for further research on diagnostic tools for use among THPs in order to avoid substandard care and promote reliance on more evidence-based methods of care.
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Affiliation(s)
| | | | | | - Lydia K Matoke
- National Traditional Health Practitioners Association, Kenya.,Herbalist Society of Kenya
| | - David M Ndetei
- Africa Mental Health Foundation, Kenya.,University of Nairobi, Kenya
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Musyimi CW, Mutiso VN, Nayak SS, Ndetei DM, Henderson DC, Bunders J. Quality of life of depressed and suicidal patients seeking services from traditional and faith healers in rural Kenya. Health Qual Life Outcomes 2017; 15:95. [PMID: 28482849 PMCID: PMC5422872 DOI: 10.1186/s12955-017-0657-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background In rural Kenya, traditional and faith healers provide an alternative pathway to health care, including mental health care. However, not much is known about the characteristics of the populations they serve. The purpose of this study was to determine the relationship between depression, suicidal ideation, and socio-demographic variables with Quality of Life (QoL) indicators in a sample seeking mental health services from traditional and faith healers in rural Kenya. Understanding QoL in this sample can help develop mental health policy and training to improve the well-being of this population. Method This was a cross-sectional epidemiological survey (n = 443) conducted over a period of 3 months among adult patients seeking care from traditional and faith healers in rural Kenya. Data were collected using the Beck Depression Inventory II (BDI-II), Beck Scale for Suicide Ideation (BSS) and WHO Quality of Life Survey- BREF (WHOQOL-BREF), and analyzed using correlation analyses, parametric tests, and regression analyses. Results Increasing levels of depression were associated with lower QoL among patients seeking care from traditional and faith healers. BSS scores were significantly negatively correlated with overall, physical, psychological, and environmental QoL, p < .05. There was a statistically significant difference between mean scores for overall QoL between depressed (M = 2.35, SD = 0.76) and non-depressed participants (M = 3.03, SD = 0.67), t(441) = 8.899, p < .001. Overall life satisfaction for depressed participants (M = 2.23, SD = 0.69) was significantly lower than non-depressed participants. Regression analyses indicated that depression, suicidal ideation, and being married predicted lower overall QoL controlling for other variables. Post hoc tests and subgroup analysis by gender revealed significant differences for females only. Depression, and older age predicted lower life satisfaction whereas being self-employed predicted higher life satisfaction, when controlling for other variables. Conclusion This study sheds light on correlates of QoL in depressed and non-depressed patients in rural Kenya. Evidence suggests that traditional and faith healers treat patients with a variety of QoL issues. Further research should focus on understanding how these issues tie into QoL, and how these healers can target these to improve care.
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Affiliation(s)
- Christine W Musyimi
- Africa Mental Health Foundation, Nairobi, Kenya.,Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - David M Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya. .,University of Nairobi, Nairobi, Kenya.
| | - David C Henderson
- Boston University School of Medicine, Boston, USA.,Harvard Medical School, Boston, USA
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Denckla CA, Ndetei DM, Mutiso VN, Musyimi CW, Musau AM, Nandoya ES, Anderson KK, Milanovic S, Henderson D, McKenzie K. Psychometric properties of the Ndetei-Othieno-Kathuku (NOK) Scale: A mental health assessment tool for an African setting. J Child Adolesc Ment Health 2017; 29:39-49. [PMID: 28401773 DOI: 10.2989/17280583.2017.1310729] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Research suggests that psychiatric conditions in children and adolescents are highly debilitating, with sparse resources for assessment and treatment in low- and middle-income countries (LMICs). OBJECTIVES The primary aim of this study was to evaluate the reliability, validity, and latent factor structure of an ethnographically-grounded assessment instrument for detecting common mental health complaints among rural Kenyan children and adolescents. METHODS The Ndetei-Othieno-Kathuku Scale (NOK) was delivered to 2 282 children aged 10 to 18 years old. Exploratory factor analysis identified four latent factors. This structure was confirmed in subsequent confirmatory factor analyses. External validity was explored by investigating associations among NOK factors and Youth Self-Report DSM-oriented scales. RESULTS Findings suggest the NOK possesses good internal reliability and a four-factor latent structure corresponding to depression, anxiety, somatic complaints, and a mixed factor. Significant associations ranging from small to medium effect sizes were noted between NOK factors and YSR DSM-oriented scales. CONCLUSIONS Exploratory findings suggest that the NOK possesses adequate psychometric properties among this population. This ethnographically-grounded instrument may be uniquely suited to screening for mental health complaints among Kenyan children and adolescents.
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Affiliation(s)
| | - David M Ndetei
- b Africa Mental Health Foundation , Nairobi , Kenya.,c Department of Psychiatry , University of Nairobi , Nairobi , Kenya
| | | | | | | | | | - Kelly K Anderson
- d Department of Epidemiology & Biostatistics , University of Western Ontario , London , Ontario , Canada
| | | | | | - Kwame McKenzie
- e Department of Psychiatry , Toronto University , Toronto , Canada
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Musyimi CW, Mutiso VN, Nandoya ES, Ndetei DM. Forming a joint dialogue among faith healers, traditional healers and formal health workers in mental health in a Kenyan setting: towards common grounds. J Ethnobiol Ethnomed 2016; 12:4. [PMID: 26742992 PMCID: PMC4705751 DOI: 10.1186/s13002-015-0075-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/21/2015] [Indexed: 05/17/2023]
Abstract
BACKGROUND Qualitative evidence on dialogue formation and collaboration is very scanty in Kenya. This study thus aimed at the formation of dialogue and establishment of collaboration among the informal (faith and traditional healers) and formal health workers (clinicians) in enhancing community-based mental health in rural Kenya. METHODS Qualitative approach was used to identify barriers and solutions for dialogue formation by conducting nine Focus Group Discussions each consisting of 8-10 participants. Information on age, gender and role in health care setting as well as practitioners' (henceforth used to mean informal (faith and traditional healers) and formal health workers) perceptions on dialogue was collected to evaluate dialogue formation. Qualitative and quantitative data analysis was performed using thematic content analysis and Statistical Package Social Sciences (SPSS) software respectively. RESULTS We identified four dominant themes such as; (i) basic understanding about mental illnesses, (ii) interaction and treatment skills of the respondents to mentally ill persons, (iii) referral gaps and mistrust among the practitioners and (iv) dialogue formation among the practitioners. Although participants were conversant with the definition of mental illness and had interacted with a mentally ill person in their routine practice, they had basic information on the causes and types of mental illness. Traditional and faith healers felt demeaned by the clinicians who disregarded their mode of treatment stereotyping them as "dirty". After various discussions, majority of practitioners showed interest in collaborating with each other and stated that they had joined the dialogue in order interact with people committed to improving the lives of patients. CONCLUSION Dialogue formation between the formal and the informal health workers is crucial in establishing trust and respect between both practitioners and in improving mental health care in Kenya. This approach could be scaled up among all the registered traditional and faith healers in Kenya.
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Affiliation(s)
- Christine W Musyimi
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Victoria N Mutiso
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Erick S Nandoya
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - David M Ndetei
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya.
- University of Nairobi, Nairobi, Kenya.
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Ndetei DM, Ngumi ZW, Mutiso VN, Musyimi CW, Kamau LW. Factors that influence the choice of psychiatry as a career by medical students at the School of Medicine, College of Health Sciences, University of Nairobi. Int Rev Psychiatry 2013; 25:406-12. [PMID: 24032494 DOI: 10.3109/09540261.2013.823383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this paper is to assess the particular factors facilitating and those hampering the choice of psychiatry as a career by medical students at the University of Nairobi in a cross-sectional population study of medical students at the University of Nairobi, College of Health Sciences, School of Medicine using self-administered questionnaires. A total of 31 students (13%) said they would like to be psychiatrists while 44 (18%) were neutral and 170 (69%) did not want to become psychiatrists. The factors that made psychiatry interesting for the students included the view that the problems presented by psychiatric patients were often particularly interesting and challenging and the fact that mental illness presented the field of medicine with one of the greatest challenges. Discouraging factors articulated by the students included views that psychiatry was a vague and speculative speciality, psychiatry was not an important part of the curriculum in medical schools, and psychiatric patients tend to make more emotional demands on their doctors than other patients. There was a negative view of psychiatric patients who most of the students thought were strange, dangerous and incurable, although they were curious to know more about them. Most of the negative influence in psychiatry is due to the misconceptions that students have about its prestige and scope, the rewards it offers in terms of job satisfaction and opportunities and the negative views towards psychiatric patients. Integration of psychiatry into the curriculum may address these misunderstandings.
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