Structure and process factors that influence patients' perception of inpatient psychiatric nursing care at Mathari Hospital, Nairobi.

To explore structure and process factors which influence patients' perception of quality inpatient psychiatric nursing care at Mathari hospital. This was a cross-sectional study of 236 inpatients selected by stratified random sampling. Competence to give consent was determined by a minimum score of 24 on Mini Mental State Examination. Patients were interviewed using a semi-structured questionnaire. Differences in proportions of variables were determined by calculating confidence interval and summary chi-squared statistics. P-values of < or =0.05 were considered significant. Majority of patients (87%) were aged 20-49 years with 43% having stayed in the ward for over a month. Structure factors related to patients' perception of care included physical environment, being happy with the way the ward looked was significantly related to satisfaction with care (chi(2) = 5.506, P = 0002). Process factors significantly related to patients' satisfaction with care included nurses providing patients with information on prescribed medicines (chi(2) = 10.50, P = 00012). Satisfaction with care was positively related to ability to recommend someone for admission in the same ward (chi(2) = 20.2, P = 00001). Structure and process factors identified as influencing patients' perception of care were physical environment and nurses' qualities that fit within the characteristics of Peplau's Interpersonal Relations Theory.

Body dysmorphic disorder: case report.

The desire for self-mutilation in the absence of any discernible psychopathology is relatively rare. Self-mutilation is most commonly a manifestation of an underlying psychopathology such as depression, schizophrenia, personality disorder, transexuality, body dysmorphic disorder and factitious disorder. In this article, a case in which a 29-year-old single Kenyan lady of African origin demanded a surgical operation to modify and reduce the size of her external genitalia is presented. Although female genital mutilation is still widespread in the country, this case is of interest in that the woman did not seek the usual circumcision but sought to specifically reduce the size of her labia minora so that she could feel like a normal woman. The unique challenges in her management are discussed. Possible aetiological factors in patients who demand surgical removal or modification of parts of their bodies without an obvious cause is discussed.

Psychiatric morbidity among convicted male sex offenders at Kamiti Prison, Kenya.

OBJECTIVES: To determine the prevalence and distribution of psychiatric morbidity among convicted male sex offenders and to establish factors associated with sexual offending. DESIGN: A Cross-sectional descriptive survey. SETTING: Kamiti Maximum Security Prison, Nairobi, Kenya. SUBJECTS: Seventy six male convicts. RESULTS: Forty seven (61.8%) had defilement-related convictions, 23 (30.3%) had rape-related, while six (7.9%) had other convictions. Twenty seven (35.5%) out of 76 had a DSM-IV Axis I disorder, majority of whom (71.1%) were dependent on or abused substances, and 26 (34.2%) had an Axis II disorder, most of whom had antisocial and impulsive personality disorders (46.2%). Of these 12 (15.8%) had an Axis I diagnosis alone, 11 (14.5%) had an Axis II diagnosis alone while 15 (19.7%) had both Axis I and II diagnoses, that is, co-morbidity. Exposure to erotica was statistically associated with both Axis I and II (p = 0.02 and p = 0.0003 respectively) and pre-occupation with thoughts about sex was associated with Axis II disorders (p = 0.01). CONCLUSIONS: Most of those with psychiatric morbidity targeted children and had antisocial or impulsive personality disorder. Awareness campaigns to enlighten the public of the fact that children are the most common victims and research to determine ways of treating and rehabilitating sexual offenders could reduce the vice.

Bullying in Public Secondary Schools in Nairobi; Kenya

Background: The prevalence and frequency of bullying in Nairobi public secondary schools in particular and in Kenyan schools in general is not known. Knowledge of the extent of the problem is essential in developing effective interventions. Aim: To study the prevalence and frequency of bullying in Nairobi public secondary schools; Kenya. Methods: A self-report sociodemographic questionnaire and the Olweus Bullying Questionnaire of 1991 were administered to 1 012 students from a stratified sample of public secondary schools in Nairobi. Results: Between 63.2(640) and 81.8(828) of students reported various types of bullying; both direct and indirect; with significant variations found for sex; age; class and year of study; whether in day or boarding school; and the place where bullied. Being bullied was significantly associated with becoming a bully; in turn. Discussion: Bullying is highly prevalent in Kenyan schools. Further studies are needed to characterise bullies and victims in terms of personality and environmental factors that may be associated with or conducive to bullying; as well as to determine the long-term prognosis for both bullies and victims. Further research is also required to determine the most appropriate intervention

Bullying in Public Secondary Schools in Nairobi; Kenya

Background: The prevalence and frequency of bullying in Nairobi public secondary schools in particular and in Kenyan schools in general is not known. Knowledge of the extent of the problem is essential in developing effective interventions. Aim: To study the prevalence and frequency of bullying in Nairobi public secondary schools; Kenya. Methods: A self-report sociodemographic questionnaire and the Olweus Bullying Questionnaire of 1991 were administered to 1 012 students from a stratified sample of public secondary schools in Nairobi. Results: Between 63.2(640) and 81.8(828) of students reported various types of bullying; both direct and indirect; with significant variations found for sex; age; class and year of study; whether in day or boarding school; and the place where bullied. Being bullied was significantly associated with becoming a bully; in turn. Discussion: Bullying is highly prevalent in Kenyan schools. Further studies are needed to characterise bullies and victims in terms of personality and environmental factors that may be associated with or conducive to bullying; as well as to determine the long-term prognosis for both bullies and victims. Further research is also required to determine the most appropriate intervention

Psychometric properties of an African symptoms check list scale: the Ndetei-Othieno-Kathuku scale.

OBJECTIVES: To profile and quantify the psychometric properties of the NOK (Ndetei-Othieno-Kathuku) scale against internationally used Gold-standards and benchmarks for mild psychiatric disorders and post-traumatic stress disorders and to provide a potential easy to administer culture sensitive instrument for screening and assessing those with possible psychiatric disorders for the Kenyan and similar social-cultural situations. DESIGN: Cross-Sectional quantitative study. SETTING: A psychiatric clinical consultation setting and Kyanguli Secondary School psychotrauma counselling clinical set-up. SUBJECTS: Survivors of the Nairobi USA Embassy bombing who were referred for psychiatric treatment and survivors of a fire disaster from a rural Kenyan school (Kyanguli School fire disaster) including students, parents of the diseased children and staff members. RESULTS: Positive correlation was found between the NOK and all the instruments. The highest correlations were between the NOK and the BDI and SCL-90 (r = 0.557 to 0.786). The differences between the NOK scores among the different groups were statistically significant (F ratio = 13.54 to 160.34, p < 0.01). The reliability coefficient (internal consistency) of the scale, alpha = 0.9733. Other item statistics and correlations of the scale are discussed. CONCLUSION: It is concluded that the NOK has high concurrent and discriminant validity as well as a high internal consistency and that it can be used for the rapid assessment of psychotrauma victims of all age groups; and stress in general in similar age groups in the local setting. It is culture appropriate and sensitive.

Consultation liaison psychiatry at Kenyatta National Hospital, Nairobi.

OBJECTIVES: To describe the psychiatric services offered at Kenyatta National Hospital and the types of patients and cases seen at Kenyatta National Hospital. DESIGN: A retrospective study based on case notes and other hospital records. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: All patients seen in the various psychiatric clinics and those who attended the Patient Support Centre Unit in the hospital in the year 2002. RESULTS: In the year 2002, 598,119 patients were treated at KNH out of which 6,878 (1.15%) were seen in the psychiatric clinics: 1,709 adults and 1,412 children were referred to the various psychiatric clinics. At the hospital's Patient Support Centre (PSC) 3,454 patients were seen, mostly for pre and post-HIV test counselling. Consultations from the wards accounted for 332 (9.6%) of the cases referred to PSC. The main diagnoses among the latter in order of frequency were alcohol related psychiatric disorders, acute and transient psychoses, depressive disorders, dissociative and conversion disorders and dementia. CONCLUSION: In view of the high load of acute and transient psychotic states, as well as substance related disorders, it is recommended that the hospital should establish acute wards for the comprehensive management of such patients. An alcohol and drug detoxification and rehabilitation centre should also be developed at the hospital. Services to those with HIV related disorders should also be improved.

Psychiatric morbidity among leprosy patients in Teso and Busia districts of Western Kenya.

OBJECTIVE: To establish the magnitude of psychiatric disorders among leprosy patients in western Kenya. DESIGN: A cross-sectional descriptive study. SETTING: Busia and Teso districts in western Kenya. SUBJECTS: A sample of 152 male and female, adult leprosy patients. RESULTS: The prevalence of psychiatric morbidity (PM) was 53.29%. The PM was positively correlated with physical disability and marital status but not with age, sex, education, type of leprosy, or duration of the illness. The prevalence of psychiatric morbidity was lower among Kenyan leprosy patients compared to studies carried out in India (56% to 78%). It was high compared to the rate of psychiatric morbidity in those seeking medical help in primary health care centres in Kenya, which was recently estimated to be 10%. CONCLUSION: The prevalence of PM in leprosy patients in western Kenya was lower than that in studies carried out in India. This could be attributed to de-institutionalisation and re-integration of leprosy sufferers back into their local communities. Since the rate was more than double that in the general Kenyan population and seemed to be related to presence of physical disability, an appraisal of psychiatric services offered to these patients is needed.

Post traumatic stress disorder among motor vehicle accident survivors attending the orthopaedic and trauma clinic at Kenyatta National Hospital, Nairobi.

OBJECTIVES: To determine the prevalence rate of post traumatic stress disorder (PTSD) and associated risk factors among motor vehicle accident (MVA) survivors attending the orthopaedic and trauma clinic at Kenyatta National Hospital, Nairobi. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: One hundred and ninety seven adult males and sixty seven female patients. METHOD: The 264 patients were interviewed using a questionnaire to collect the socio-demographic data, the Self Rating Questionnaire (SRQ) and the Impact of Event Scale-Revised (IES-R). Diagnosis was made using the Diagnostic and Statistical Manual (DSM-IV). RESULTS: The mean age was 34.63+/-12.71 years (range 18-65). Overall, the prevalence rate of PTSD was 13.3%. None of the cases had been previously diagnosed as having PTSD. Females had a higher rate of 17.9% (n = 67), compared to the males 11.7% (n=197). The majority of those with PTSD (42.9%) were young, 20 - 29 years. Other risk factors were having post-primary education (62.9%), experiencing the first motor vehicle accident (14.1%), previous psychiatric illness, and other medical illnesses. The type of accident, role/status and immediate reactions to the accident were not significant. CONCLUSIONS: PTSD following motor vehicle accidents is common. Although the MVA survivors do develop significant rates of PTSD, it is not easy to identify those at risk but some of the parameters documented in this study may help. A multi disciplinary approach is therefore essential in the management of the RTA survivors at the orthopaedic and trauma clinics if their physical and psychological needs are to be adequately addressed

Prevalence of tardive dyskinesia among psychiatric in-patients at Mathari Hospital, Nairobi.

OBJECTIVE: To determine the prevalence of tardive dyskinesia among psychiatric in-patients. DESIGN: A cross-sectional survey. SETTING: Mathari Hospital, Nairobi, the main psychiatric referral hospital in Kenya. SUBJECTS: Two hundred and two randomly selected in-patients seen in the hospital between January and April 2000. RESULTS: The prevalence of tardive dyskinesia was 11.9%. Neither the psychiatric diagnosis nor the sex was significantly associated with tardive dyskinesia. The antipsychotic dosage was also not associated with tardive dyskinesia but an increase in age was significantly associated with the abnormal movements. CONCLUSION: The prevalence rate of tardive dyskinesia among patients at Mathari Hospital is much lower than that found in western countries but similar to that from Asian studies. These findings indicate the possibility of racial differences in the aetiology of TD. Prospective cross-racial studies are necessary to confirm these findings.

How Kenyan physicians treat psychiatric disorders.

OBJECTIVES: To determine the psychological problems the non-psychiatric doctors commonly encounter, the treatment offered and/or referrals made and to determine any obstacles met in providing psychiatric treatment or making referrals. DESIGN: Cross-sectional survey. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Doctors working at Kenyatta National Hospital. RESULTS: One hundred and thirty (94 males and 36 females) doctors submitted usable questionnaires. Seventy eight per cent of the respondents were below 35 years and 57 had less than five years experience. The commonest psychiatric disorders seen by doctors were anxiety, depression, psychosomatic disorders and organic psychoses similar to findings in previous prevalence studies. Drugs therapy with anxiolytics antidepressants and antipsychotics were commonly utilised. Brief counselling was the verbal form of treatment most commonly used. Referral to mental health workers was less often done. Obstacles cited by the doctors were the patients' resistance to referral, lack of coordination and insufficient knowledge to treat the disorders. CONCLUSION: The doctors recognise that psychiatric disorders are common among their patients but they have major obstacles in managing them. These findings are discussed and remedial measures suggested.

Substance abuse in outpatients attending rural and urban health centres in Kenya.

OBJECTIVES: To estimate the prevalence and pattern of substance use among patients attending primary health centres in urban and rural areas of Kenya. DESIGN: A descriptive cross-sectional prevalence survey. SETTING: Urban health centres of Jericho and Kenyatta University (KU) and rural health centres in Muranga district. SUBJECTS: One hundred and fifty adult patients (seventy eight males and seventy two females) were included in the study. INTERVENTION: Semi-structured questionnaires and the DSM IV diagnostic criteria were used to record the socio-demographic data and to determine substance dependence or abuse. RESULTS: The substances commonly used in descending order of frequency were alcohol, tobacco, khat and cannabis. Only alcohol and tobacco were extensively used. Lifetime prevalence rates of alcohol use for the two urban health centres were 54% and 62% compared to 54% for the rural health centres. For tobacco the lifetime prevalence rates were 30% for Jericho, 28% for KU and 38% for Muranga. The differences between the rural and urban samples were not statistically significant. More males than females had used alcohol (average lifetime use 80.8% for males compared to 30.6% for females: p<0.05) and tobacco (average lifetime use 56.4% for males compared to 5.6% for females p<0.05). CONCLUSION: The rates of substance abuse were generally low with the exception of alcohol and tobacco. Socio-cultural factors might be responsible for the differences noted. It is suggested that preventive measures and education should be emphasised at the primary care level.