88 research outputs found
Shine a light on suicide: Mixed-methods research in Africa
No full textSummary Risk factors linked to suicidal behaviour vary considerably by specific population and setting under study. This project is geared towards providing a better understanding of suicidal behaviour burden, its risk factors, its sociocultural perspectives and its associations with mental disorders in low- and middle-income countries (LMICs). We use a mixed methods approach to examine these factors in various settings. Specifically in chapter 2, we focus on factors associated with suicidal behaviour in persons with mental, neurological and substance use disorders. We use a systematic review and meta-analytic approach to examine these factors in a broader setting, low- and middle-income countries. In chapter 3, we specifically examine completed suicides in a community setting and narrow our study goals to the Kenyan population. In this chapter, we use a 5-year retrospective data from a health and demographic system in Western Kenya. Using this data, we estimate a cumulative incidence of definite suicides reported in the area. We further undertake content analysis of available verbal autopsies and additionally analyze for probable suicide incidence and factors associated with completed suicides in the western Kenya region. In the next chapter (4), we direct our attention to suicidal behaviour among general outpatients in the coastal region of Kenya. The study examines prevalence of suicidal behaviour in this cohort and further investigates factors associated with suicidal ideation in this cohort. In chapter 5, we narrow our focus on a cohort of patients diagnosed with psychotic disorders in the coastal region of Kenya. We prospectively recruit these patients from various psychiatric clinics and using a cross sectional survey design we examine factors associated with suicidal ideation and suicidal attempt. We analyze this data using both categorical suicidality outcomes and continuous risk score of suicidality outcomes. For the qualitative objectives of this thesis work, we focus on gaining an in depth understanding of how suicide is contextualized at the coastal region of Kenya and examine socio-cultural perspectives of suicide in chapter 6 of the thesis. In chapter 7, we explore perceptions on reasons for suicidal behaviour and community's recommendations for suicide prevention interventions in the area. For both chapter 6 and 7 we use individual in depth interviews from various key informants (persons with a history of suicidal attempts, bereaved family members, health care providers, community and religious leaders etc) to collect the data and thematic analysis technique to analyze the data. High prevalence of suicidality in the various settings (hospital and general population) and its strong link with mental disorders underscore the need for improving access to mental health care and routine screening for suicidality in health care settings. The exploratory qualitative research emphasizes suicidal behaviour as a complex multicausal human behaviour at the centre of which of lies a psychologically distressed individual. Increasing mental health literacy in our communities as well as decriminalizing suicide is key in destigmatizing suicidal behaviour and improving access to care for individuals in need
Marine bioprospecting - Trawling for treasure and pleasure
No full textThis Microreview seeks to highlight the molecular diversity present in marine organisms, and illustrate by example some of the challenges encountered in exploring this resource. Marine natural products exhibit an impressive array of structural motifs, many of which are derived from biosynthetic pathways that are uniquely marine, Most importantly some marine metabolites possess noteworthy biological activities, activities that have potential application outside marine ecosystems, such as antibiotics, antiparasitics, anticancer agents etc... The isolation, spectroscopic characterisation and assignment of stereostructures to these unusual metabolites is both challenging and rewarding. Examples featured in this Microreview follow a common theme in that they are all recent accounts of the isolation of natural products from Australian marine sponges, carried out in the laboratories of the author. In addition to presenting brief comments on specific structure elucidation strategies, an effort is made to emphasize techniques for solving stereochemical issues, as well as to speculate on the biosynthetic origins of some of these exotic marine natural products
A cross-sectional mixed methods protocol to describe correlates and explanations for a long duration of untreated psychosis among patients with first episode psychosis in Uganda
No full textINTRODUCTION: Among patients with psychotic disorders, the 'duration of untreated psychosis' (DUP) is a predictor of key outcomes such as symptom remission and quality of life. In sub-Saharan Africa, DUP is up to five times longer than in high-income countries, with many patients going without antipsychotic medication for 5 years or longer. One contributor to this high DUP may relate to cultural norms that drive use of alternative and complementary therapies (ACTs) as first-line treatment strategies, rather than biomedical care with antipsychotic medicine. We aim to1 determine the prevalence and factors associated with DUP and ACT use in Uganda, and2 Identify factors that drive patient and family choices to use ACT as a first-line treatment strategy.
METHODS AND ANALYSIS: We will leverage on an ongoing cohort study at the national psychiatric and teaching hospital in Uganda. The parent study is an observational cohort design following antipsychotic naïve adults with a first episode of psychosis without substance use, HIV/AIDS or syphilis. The embedded study will use a mixed methods design including quantitative assessment of parent study participants with the Nottingham Onset Schedule-DUP to determine the DUP. Qualitative assessment will focus on patient and caregiver perceptions and use of ACT and its impact on DUP among patients with psychosis using in-depth interviews.
ETHICS AND DISSEMINATION: The study has received ethical approval from the school of medicine research and ethics committee of the college of health sciences at Makerere University. It has also received institutional support to perform the study from the Infectious Diseases Institute and Butabika hospital. Besides publication of the work in reputable peer-reviewed journals, we hope that this work will lead to evidence-based discussions on the need for early interventions to reduce DUP in Uganda
Malaria, mental disorders, immunity and their inter-relationships - A cross sectional study in a household population in a health and demographic surveillance site in KenyaResearch in Context
No full textBackground: Both malaria and mental disorders are associated with immune changes. We have previously reported the associations between malaria and mental disorders. We now report associations between malaria, mental disorders and immunity. Methods: A household survey of malaria, mental disorders and immunity was conducted in a health and demographic surveillance system's site of 70,000 population in an area endemic for malaria in western Kenya. A random sample of 1190 adults was selected and approached for consent, blood samples and structured interview. Findings: We found marginally raised CD4/CD3 ratios of participants with malaria parasites, but no difference in CD4/CD3 ratios for participants with common mental disorder (CMD) or psychotic symptoms. People with psychotic symptoms had increased levels of IL-6, IL-8, and IL-10, and lower levels of IL-1beta. People with CMD had higher levels of IL-8 and IL-10. People with malaria had higher levels of IL-10 and lower levels of TNF-alpha. At the bivariate level, CMD was associated with log TNF-α levels using unadjusted odds ratios, but not after adjusting for malaria. Psychotic symptoms were associated with log IL-10 and log TNF-α levels at the bivariate level while in the adjusted analysis, log TNF-α levels remained highly significant.. Interpretation: This is the first population based study of immune markers in CMD and psychotic symptoms, and the first to examine the 3 way relationship with malaria. Our findings suggest that TNF-α may mediate the relationship between malaria and CMD. Fund: The study was funded by UK Aid, Department for International Development, Kenya office. Keywords: Malaria, Immunity, Cytokines, Mental health, Common mental disorder, Psychotic symptoms, Search terms: Used were: malaria and immunity, Common mental disorders and immunity, Depression and immunity, Psychosis and immunity, Schizophrenia and immunity, Malaria, mental disorders and immunit
Collaborative Interpersonal Psychotherapy for HIV-Positive Women in Kenya: A Case Study From the Mental Health, HIV and Domestic Violence (MIND) Study.
No full textWe examine the efficacy of nonspecialists delivering interpersonal psychotherapy (IPT) to HIV-positive (HIV+) women. We describe a case in which local personnel without prior mental health training delivered IPT for the treatment of depression and posttraumatic stress disorder in an HIV+ woman who reported experiencing gender-based violence and was enrolled in HIV care at the Family AIDS, Care, Education and Services program in Kisumu, Kenya
Demographic, psychosocial and clinical factors associated with postpartum depression in Kenyan women
No full textAbstract Background Few longitudinal studies have examined associations between risk factors during pregnancy and mental health outcomes during the postpartum period. We used a cohort study design to estimate the prevalence, incidence and correlates of significant postpartum depressive symptoms in Kenyan women. Methods We recruited adult women residing in an urban, resource-poor setting and attending maternal and child health clinics in two public hospitals in Nairobi, Kenya. A translated Kiswahili Edinburgh Postpartum Depression Scale was used to screen for depressive symptoms at baseline assessment in the 3rd trimester and follow up assessment at 6–10 weeks postpartum. Information was collected on potential demographic, psychosocial and clinical risk variables. Potential risk factors for postpartum depression were evaluated using multivariate logistic regression analysis. Results Out of the 171 women who were followed up at 6–10 weeks postpartum, 18.7% (95% CI: 13.3–25.5) were found to have postpartum depression using an EPDS cut off of 10. In multivariate analyses, the odds of having postpartum depression was increased more than seven-fold in the presence of conflict with partner (OR = 7.52, 95% CI: 2.65–23.13). The association between antepartum and postpartum depression was quite strong but did not reach statistical significance (OR = 3.37, 95% CI: 0.98–11.64). Conclusions The high prevalence of significant postnatal depressive symptoms among Kenyan women underscores the need for addressing this public health burden. Depression screening and psychosocial support interventions that address partner conflict resolution should be offered as part of maternal health care
Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey
No full textThis study aimed to assess the prevalence of probable post-traumatic stress disorder (PTSD), and its associated risk factors in a general household population in Kenya. Data were drawn from a cross-sectional household survey of mental disorders and their associated risk factors. The participants received a structured epidemiological assessment of common mental disorders, and symptoms of PTSD, accompanied by additional sections on socio-demographic data, life events, social networks, social supports, disability/activities of daily living, quality of life, use of health services, and service use. The study found that 48% had experienced a severe trauma, and an overall prevalence rate of 10.6% of probable PTSD, defined as a score of six or more on the trauma screening questionnaire (TSQ). The conditional probability of PTSD was 0.26. Risk factors include being female, single, self-employed, having experienced recent life events, having a common mental disorder (CMD)and living in an institution before age 16. The study indicates that probable PTSD is prevalent in this rural area of Kenya. The findings are relevant for the training of front line health workers, their support and supervision, for health management information systems, and for mental health promotion in state boarding schools
Patterns of self-harm presentations at a Tertiary Urban Hospital in Kenya: A retrospective 5-year study (2018–2022)
No full textIntroduction Self-harm represents a complex and multifaceted public health issue of global significance, exerting profound effects on individuals and communities alike. It involves intentional self-poisoning or self-injury with or without the motivation to die. Although self-harm is highly prevalent, limited research has focused on the patterns and trends of self-harm among hospital populations in low- and middle-income countries, particularly within Africa. This study aims to explore the socio-demographic and clinical profile of patients presenting with self-harm and determine the common self-harm patterns at a tertiary facility in Kenya.
Methodology We carried out a descriptive retrospective study and included patients from inpatient units and outpatient settings within the Secion of Psychiatry at the Aga Khan University Hospital, Nairobi from January 1st 2018 to December 31st 2022. A data abstraction tool was used to collect data from eligible files sourced from the medical records department for all patients who met the study criteria. Summary statistics were reported as frequencies and percentages for categorical data and as means and standard deviations for continuous data.
Results A total of 507 files were reviewed in the given timeframe and 497 patients were included in the analysis. Of these patients, 28.1% (n = 144) presented with self-harm. The mean age of the self-harm patients was 26.5 years (SD = 10.5) and a majority (74.3%) were female. The first point-of-contact was at the emergency department in 72.9% of the cases. A majority of them, i.e. 89.6%, reported a past psychiatric diagnosis. Based on the psychiatric diagnosis evaluation of the patients- depression was the most common diagnosis at 88.2%, followed by anxiety disorder at 27.8% and bipolar mood disorder at 17.4%. The majority of reported self-harm cases involved overdose incidents (68.8%), with self-injury accounting for 56.3% of cases. Analgesics were the most frequently reported type of overdose, followed by tricyclic antidepressants. In context of self-injury, cutting emerged as the predominant form of self-harm. Family conflict was reported to be the most common reason for self-harm at 39.6%.
Conclusion This study shows a high rate of self-harm among patients with mental illness in this facility, necessitating the development of self-harm prevention and management protocols. A national registry of self-harm behavior would also help further elucidate the occurrence and mechanisms of self-harm in the population, improving the possibility for early interventions and prevention
Prevalence of malaria parasites in adults and its determinants in malaria endemic area of Kisumu County, Kenya
No full textAbstract
Background
The prevalence of malaria parasites in adults in Africa is less well researched than in children. Therefore, a
demographic surveillance site was used to conduct a household survey of adults in the malaria endemic area of Maseno division in Kisumu County near Lake Victoria.
Methods
A random survey of 1,190 adults living in a demographic health surveillance site in a malaria endemic area of 70,805 population size was conducted, measuring presence of malaria parasites by slide microscopy. Data were analysed using STATA to calculate the prevalence of malaria and associated risk factors.
Results
The adult prevalence of presence of malaria parasites in Maseno was 28% (95% CI: 25.4–31.0%). Gender was a significant sociodemographic risk factor in both univariate (OR 1.5, p = 0.005) and multivariate (OR 1.4, p = 0.019) analyses. Females were 50% more likely to have malaria than men.
Conclusions
Presence of malaria parasites is common in the adult population of this endemic area, and the rate is greatly increased in women. The presence of such an adult pool of malaria parasites represents a key reservoir factor in transmission of parasites to children, and is relevant for plans to eradicate malaria
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