Coronary artery disease and symptoms of depression in a Kenyan population.

BACKGROUND: Depression and heart disease are replacing the traditional enemies of Africa such as infectious diseases and malnutrition as the increasing causes of disability and premature death. Little is known about the co-morbidity of heart disease and depression in Africa. OBJECTIVE: To describe the prevalence of depression in Black Africans with and without Coronary Artery Disease as documented on coronary angiography at the Nairobi Hospital. DESIGN: Prospective comparative study. SETTING: A private not for Profit 210 bed hospital, catering for fee paying middles class clintele. RESULTS: Of the eighteen patients with an abnormal angiogram, the highest score on the BDI was 9 while the average was 2.11. Of the seven with normal angiograms, the highest BDI was 5, and the average was 1.71. There was no statistical significance in these differences. CONCLUSION: While African scientists must continue to concentrate on the urgent medical priorities of today (AIDS, malaria, measles, etc), cognisance has to be made of the other emerging epidemic, of the co-morbidity of coronary artery disease and depression. That no significant difference in depression score between the two groups was found could be due to a number of reasons including the small sample size achieved in this first study of its kind in Kenya.

Anorexia nervosa in Kenya.

BACKGROUND: Anorexia nervosa is a rare disorder in Africans, inspite of posing a serious public health hazard in the West. Whereas it is possible that African psychiatrists lack the skills to diagnose the disorder, other possible explanations for its apparent rarity must be sought in view of emerging evidence, which suggests a real lack of occurrence. OBJECTIVES: To establish the knowledge of practicing Kenyan psychiatrists about the signs, symptoms and management of anorexia nervosa and to establish the number of cases they had seen during all their years of practice of psychiatry. DESIGN: Telephone survey and data collection: case-finding approach. SETTING: Kenya, June 2001 METHODS: Forty seven psychiatrists registered to practice in Kenya as of June 2001 qualified for inclusion. The respondents were interviewed on the same day, to reduce the likelihood of cross checking between colleagues. RK called each one, (all knew her) explained the nature of the survey and obtained verbal consent to administer the brief (10 minutes) questionnaire, developed by the authors for the purpose. RESULTS: Twenty seven of all those eligible were reached on the day. All but one gave consent for the interview (55% response rate). The 20 who were not reached were similar to the respondents with regard to experience in psychiatry, (mean duration 11.4 versus 10.9 yrs) but differed in their place of residence, the majority of those not reached resided out of Nairobi (60% versus 26%). In a cumulative total of 320 years of practice, they had seen 16 cases of which seven were of African origin. The rest were Caucasian or of Asian origin. The psychiatrists demonstrated adequate skill in recognising anorexia nervosa. CONCLUSION: Kenyan psychiatrists can recognise cases of anorexia nervosa. The condition is rare in Kenya. The reasons for this remain unclear and traditional explanations for its cause as due to pressure for thinness may not be adequate for the Kenyan case.

Terrorist bombing at the USA Embassy in Nairobi: the media response.

BACKGROUND: On 7th August 1998, a terrorist bomb destroyed the American Embassy in Nairobi, killing and injuring thousands of people. OBJECTIVES: To describe the media component of the (larger) mental health response, and evaluate the impact of the intervention. DESIGN: Descriptive cross sectional study. SETTING: Nairobi, three months after the explosion. SUBJECTS: Residents of Nairobi and outlying areas, exposed to the bomb blast and who received Radio and TV coverage about the explosion. INTERVENTIONS: Radio and TV broadcasts, starting hours after the explosion and continuing for two weeks thereafter. RESULTS: Of a sample of 400 respondents interviewed, 172 reported they were affected by the bomb blast, either directly or through friends and relatives. TV and radio had the highest reach, (89% and 85%) respectively. Seventy per cent felt the programmes gave victims hope and 90% felt the programmes should continue, as they were helpful to the needy. CONCLUSION: The media is a controversial, sometimes overused and at times underused resource in Disaster Management. Judicious use of the media was shown to be helpful in this study. Literature supports media interventions in disaster. Doctors working in disaster areas need to understand the media and to prepare for its use as it compliments other interventions.

Africa: the traumatised continent, a continent with hope.

Many African countries gained political independence in the 1960s and 1970s and went through difficult times in economic, political and security terms in the 1980s and early 1990s. Mental health services and research were not spared and stagnated or deteriorated during this period. The effects of poor governance, inequitable distribution of resources and environmental degradation conspired with natural and man-made disasters (wars in particular) to drive Africa into an abyss of despair.

Post-traumatic stress disorder: case report.

Following exposure to a major traumatic event like the August seventh 1998 Nairobi bomb blast various reactions occur, some of which result in stress-related psychiatric disorders. We have described one such case, and used it to illustrate the salient features of post-traumatic stress disorder. We have outlined the diagnostic categories of the post-traumatic disorders and discussed the different treatment modalities applicable.