Nurses’ perceptions of mental healthcare in primary-care settings in Kenya

Kenya maintains an extraordinary treatment gap for mental health services because the need for and availability of mental health services are extraordinarily misaligned. One way to narrow the treatment gap is task-sharing, where specialists rationally distribute tasks across the health system, with many responsibilities falling upon frontline health workers, including nurses. Yet, little is known about how nurses perceive task-sharing mental health services. This article investigates nurses’ perceptions of mental healthcare delivery within primary-care settings in Kenya. We conducted a cross-sectional study of 60 nurses from a public urban (n?=?20), private urban (n?=?20), and public rural (n?=?20) hospitals. Nurses participated in a one-hour interview about their perceptions of mental healthcare delivery. Nurses viewed mental health services as a priority and believed integrating it into a basic package of primary care would protect it from competing health priorities, financial barriers, stigma, and social problems. Many nurses believed that integrating mental healthcare into primary care was acceptable and feasible, but low levels of knowledge of healthcare providers, especially in rural areas, and few specialists, would be barriers. These data underscore the need for task-sharing mental health services into existing primary healthcare in Kenya.     

Hospitalizations and Costs Incurred at the Facility Level after Scale-up of Malaria Control: Pre-Post Comparisons from Two Hospitals in Zambia

There is little evidence on the impact of malaria control on the health system, particularly at the facility level. Using retrospective, longitudinal facility-level and patient record data from two hospitals in Zambia, we report a pre-post comparison of hospital admissions and outpatient visits for malaria and estimated costs incurred for malaria admissions before and after malaria control scale-up. The results show a substantial reduction in inpatient admissions and outpatient visits for malaria at both hospitals after the scale-up, and malaria cases accounted for a smaller proportion of total hospital visits over time. Hospital spending on malaria admissions also decreased. In one hospital, malaria accounted for 11% of total hospital spending before large-scale malaria control compared with < 1% after malaria control. The findings demonstrate that facility-level resources are freed up as malaria is controlled, potentially making these resources available for other diseases and conditions.     

Clinical characteristics and outcomes of atrial fibrillation and flutter at the Aga Khan University Hospital,Nairobi

Introduction

Scant data exist on the epidemiology and clinical characteristics of atrial fibrillation in Kenya. Traditionally, atrial fibrillation (AF) in sub-Saharan Africa is as a result of rheumatic valve disease. However, with the economic transition in sub-Saharan Africa, risk factors and associated complications of this arrhythmia are likely to change.

Methods

A retrospective observational survey was carried out between January 2008 and December 2010. Patients with a discharge diagnosis of either atrial fibrillation or flutter were included for analysis. The data-collection tool included clinical presentation, risk factors and management strategy. Follow-up data were obtained from the patients’ medical records six months after the index presentation.

Results

One hundred and sixty-two patients were recruited (mean age 67 ± 17 years, males 56%). The distribution was paroxysmal (40%), persistent (20%) and permanent AF (40%). Associated co-morbidities included hypertension (68%), heart failure (38%) diabetes mellitus (33%) and valvular abnormalities (12%). One-third presented with palpitations, dizziness or syncope and 15% with a thromboembolic complication as the index AF presentation. Rate-control strategies were administered to 78% of the patients, with beta-blockers and digoxin more commonly prescribed. Seventy-seven per cent had a CHA₂DS₂VASC score ≥ 2, but one-quarter did not receive any form of oral anticoagulation. At the six-month follow up, 6% had died and 12% had been re-admitted at least once. Of the high-stroke risk patients on anticoagulation, just over one-half were adequately anticoagulated.

Conclusion

Hypertension and diabetes mellitus, not rheumatic valve disease were the more common co-morbidities. Stroke risk stratification and prevention needs to be emphasised and appropriately managed.     

Comorbid psychopathology and everyday functioning in a brief intervention study to reduce khat use among Somalis living in Kenya: description of baseline multimorbidity,its effects of intervention and its moderation effects on substance use

Background and aims

Migration and khat use were found to correlate with high rates of psychopathology. In this paper we aimed for assessing baseline multimorbidity and its interactions with a Brief Intervention.

Methods

In the RCT, 330 male Somali khat users were assigned to treatment conditions (khat use is a predominantly male habit). The ASSIST-linked BI for khat users was administered. Using the TLFB Calendar, the PHQ-9, a Somali short version of the PDS and parts from the CIDI, khat use and comorbidity was assessed. With a regression analysis we tested for the influence of comorbidity and with mixed effect models group differences over time in sleep duration, khat use-time and everyday functioning.

Results

We found high rates of baseline multimorbidity: 51% (N?=?168) for depression, 22% (N?=?74) for PTSD and 23% (N?=?73) for khat-psychotic symptoms. Depression and khat-psychotic symptoms, but not PTSD symptoms decreased without group differences. Khat use-time decreased and functional time increased with significant time?×?group interactions (p?≤?0.046). Depression and PTSD did not influence therapy success but in participants without comorbid psychopathology, more khat use reduction after the intervention was found (p?=?0.024).

Conclusion

Somali khat users in Kenya are highly burdened by multimorbidity of depression, PTSD and khat-psychotic symptoms. The main effects for time and differences in healthy vs. mentally ill khat users indicate potential of unspecific support and the specific need for mental health care in combination with substance abuse treatment. The increase of everyday functioning promises more options for alternative activities, preventing excessive use and addiction.

     

Ethnobotanical survey of biopesticides and other medicinal plants traditionally used in Meru central district of Kenya

Ethnopharmacological relevance

The purpose of this study was to carry out a survey and document plants used in Meru-central district by traditional healers with emphasis on those used as biopesticides.

Materials and methods

The study was carried out at Igane and Gatuune sub-locations, Abothuguchi East division of Meru-Central district, Kenya. The data collection involving 23 traditional healers was done using semi-structured questionnaire, focused group discussion and transect walks. Plants samples were collected and botanically identified at the herbarium of the Department of Land Resource Management and Agriculture Technology in the University of Nairobi.

Results

The results of the ethnobotanical survey revealed that herbalists belonged to both gender with the majority being male (82.6%) and female (17.4%). Their ages ranged from 28 to 82 years. Seventy (70) plant species, belonging to 35 families, were identified as being used as biopesticides and also as medicinal. The families encountered were Asteraceae (10%), Euphorbiaceae (8.6%), Lamiaceae (8.6%), Fabaceae(8.6%), Caesalpiniaceae (5.7%), Rubiaceae (5.7%), Liliaceae (4.3%), Apocynaceae (2.9%), Flacourtiaceae (2.9%), Verbenaceae (2.9%) and the rest of the 24 families had 1.4% each. These medicinal plants were used to treat and manage a wide range of diseases and conditions including parasitic, microbial, helminthosis, protozoa, cuts and wounds, fractures, dental, arthritis, allergic, snake bites, reproductive as well as metabolic. Among the plants used, shrubs were the commonest at 42.8%; trees were 32.9%, while herbs and liana were at 22.9% and 1.4%, respectively. Majority of the respondents used leaves, roots and bark to make their herbal preparations with only a few using seeds, flowers, whole plant, flower sap and pods. The plants that were cited by the respondents to be used as biopesticides were Prectranthus barbatus Andr. (47.8%), Tephrosia vogelii Hookf. (39.1%), Ocimum gratissimum L (34.7%), Vernonia lasiopus O.Hoffm. (8.7%), Cascabella thevetia( L.)Lippold (4.3%) and Oncoba routledgei Sprague (4.3%).

Conclusion

Meru central district is rich in biodiversity of biopesticides and other medicinal plants and there is need for further pharmacological studies to validate their use as potential drugs for pests and disease control.