ABSTRACT
The rising number of patients with Covid-19 as well as the infection control measures have affected healthcare service delivery, including mental healthcare. Mental healthcare delivery in low and middle income countries where resources were already limited are likely to be affected more during this pandemic. This paper describes the efforts of ensuring mental healthcare delivery is continued in a referral hospital in Kenya, Moi Teaching and Referral hospital, as well as the challenges faced. These efforts are guided by the interim guidelines developed by the Kenyan ministry of health. Some of the adjustments described includes reducing number of patients admitted, shortening the stay in the inpatient setting, using outdoors for therapy to promote physical distancing, utilization of electronic platforms for family therapy sessions, strengthening outpatient services, and supporting primary care workers to deliver mental health care services. Some of the challenges include limited ability to move about, declining ability for patients to pay out of pocket due to the economic challenges brought about by measures to control Covid-19, limited drug supplies in primary care facilities, inability to fully implement telehealth due to connectivity issues and stigma for mental health which results in poor social support for the mentally ill patients. It is clear that current pandemic has jeopardized the continuity of usual mental healthcare in many settings. This has brought to sharp focus the need to decentralize mental health care and promote community based services. Meanwhile, there is need to explore feasible alternatives to ensure continuity of care.
ABSTRACT
Background: The on-going COVID-19 pandemic has resulted in a major negative impact on public mental health particularly among health care workers. Alcohol use is a common maladaptive response to stress that is associated with adverse health consequences and that could impair productivity in the workplace for the health workforce. The aim of this study is to document the burden and factors associated with harmful alcohol use among health care workers at the beginning of the COVID-19 pandemic in Kenya.Methods: This study was a cross-sectional analysis of data obtained from a parent online survey that investigated the prevalence and factors associated with mental disorders among healthcare workers during the COVID-19 pandemic in Kenya. Analyses for this study were conducted to examine the burden and factors associated with harmful alcohol use among a sub-group of 887 participants who completed the Alcohol Use Disorder Identification Test (AUDIT) questionnaire.Results: Three hundred and eighty nine (43.9%) participants reported harmful alcohol use. The factors significantly associated with increased odds of endorsing harmful alcohol use were: being male (AOR= 1.56; 95% CI=1.14, 2.14; p=0.006), being not married (AOR= 2.06; 95% CI=1.48, 2.89; p<0.001), having 11-20 years of experience as compared to having 20+ years of experience (AOR= 1.91; 95% CI=1.18, 3.12; p=0.009), and being a specialist (AOR=2.78; CI=1.64, 4.78; P=<0.001) or doctor (AOR= 2.82; 95% CI=1.74, 4.63; p<0.001) as compared to being a nurse. Conclusions: A high proportion of health care workers reported harmful alcohol use at the beginning of the COVID-19 pandemic in Kenya. Males, the unmarried, those with 11-20 years of experience in the health field, doctors and specialists were more likely to report harmful alcohol use. These findings highlight the need to institute interventions for harmful alcohol use targeting these groups of health care workers in Kenya during the COVID-19 pandemic.