Search

Depression is common among adolescents more so during the transition to secondary school, and the psychosocial and emotional changes that accompany adolescence. This study sought to assess the prevalence and predictors of depression among students joining public secondary schools in Nairobi County. The study was carried out at five selected public secondary schools in Nairobi County covering 539 students between the ages of 11 and 18 years. The Patient Health Questionnaire‐Adolescent version (PHQ‐A) was used to collect data on depression. For suicidal behavior, the Suicide Behavior Questionnaire‐revised version was used. The Adolescent Peer Relations Instrument was used to assess bullying victimization. These were augmented by a sociodemographic questionnaire. Depression prevalence rates were generated using a generalized linear model customized with a log link and a Poisson distribution for a common binary outcome. The prevalence of depression was found to be 14.5%, with a mean PHQ‐A score of 6.16 (SD = 3.16). Predictors of depression were suicide risk (adjusted prevalence ratio [aPR] = 3.07, confidence interval, CI [1.94–4.88]; p <.001) and lifetime alcohol use (aPR = 2.24, CI [1.36–3.68]; p =.001). Depression is prevalent among adolescents joining secondary schools in Nairobi County. Counselor‐led school‐based cognitive behavioral therapy could be a sustainable strategy for reducing depression symptoms and guiding preventive efforts among adolescents in this context. Practitioner points: Depression among adolescents joining public secondary schools in Nairobi, Kenya is lower than depression among ongoing students.Depression occurred at a higher rate among boys compared to girls.Lifetime alcohol use and risk of suicidal behavior significantly predicted depression. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 global pandemic exposed mental health gaps that have been salient among adolescents and young people. The glaring gaps include lack of information, undefined referral systems, and inadequate human resources for mental health. We aimed to develop a digital webbased platform to support young people's mental health and psychosocial needs during the COVID-19 pandemic. Methods: we adopted a mixed methods action research approach to design and pilot a digital mental health intervention for young people during the pandemic. We piloted the platform between Oct 2020 and July 2021, and recruited a sample of 150 young people through the community gathering spaces in three informal settlements in Nairobi City County using a convenient sampling method. Results: overall, participants reported that information provided to them via the platform was pertinent and beneficial, and that the self-assessments improved their mental health and psychosocial awareness and signposted them to available support and services. The support services consisted of informative weekly bulk emails and short motivational messages related to mental health, with a total of, 1343 short messages distributed through the short message service (SMS). Moreover, more than half the participants completed online self-assessments and participated in 19 online sessions. Conclusion: findings from this pilot study demonstrate that digital mental health systems are feasible and have the potential to improve access to mental health and psychosocial services. This is especially crucial during times of public health crisis, such as the COVID-19 pandemic. The realization of such systems requires swift multistakeholder partnership approach and investment. [ABSTRACT FROM AUTHOR]

Adolescents and young adults (15–24 yrs.) have poorer HIV clinical outcomes than adults. Despite this, there is minimal data on individual-level factors such as self-efficacy towards antiretroviral adherence among perinatally infected adolescents living with HIV in sub-Saharan Africa. Our study examined the interaction between antiretroviral treatment adherence self-efficacy and other psychosocial factors among adolescents receiving care in Nairobi, Kenya. We enrolled perinatally infected Adolescent Living with HIV (ALWHIV) 16–19 yrs. who were accessing care routinely at the HIV clinic. We measured self-reported ART adherence (7-day recall) and defined optimal adherence as >95%, and conducted a regression analysis to identify independently associated factors. Mediation analysis explored interactions between the psychosocial variables. We enrolled 82 ALWHIV median age 17 (IQR 16,18) who had been on ART for a median age of 11 yrs. (IQR 7,13). Sixty-four per cent (52) of the ALWHIV reported optimal adherence of >95%, and 15% reported missing doses for three or more months. After controlling for the other covariates, self-esteem, high viral load and an adherence level > 95% were significantly associated with adherence self-efficacy. Self-esteem was significantly associated with adherence self-efficacy and social support (p < 0.001 and p = 0.001), respectively. The paramed test indicated that the association between self-efficacy and adherence was mediated by self-esteem with a total effect of OR 6.93 (bootstrap 95% CI 1.99–24.14). Adherence self-efficacy was also mediated by self-esteem in developing adherence behavior. Interventions focused on increasing adherence among ALWHIV should include self-esteem building components.Key words : Adolescents, Adherence self -efficacy, Transition , perinatal, [ABSTRACT FROM AUTHOR]

Background: Scaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets. This paper describes the experiences and outcomes related to implementing CQI processes to help reach these targets, with particular focus on clinical and programmatic settings in 6 countries from the global south.Methods: The HIV program at the University of Maryland, Baltimore (UMB) implemented an adapted CQI model in Kenya, Tanzania, Botswana, Zambia, Nigeria and Rwanda that included the following steps: (1) analysing the problem to identify goals and objectives for improvement; (2) developing individual changes or 'change packages', (3) developing a monitoring system to measure improvements; and (4) implementing and measuring changes through continuous 'plan-do-study-act' (PDSA) cycles. We describe country-level experiences related to implementing this adaptive design, a collaborative learning and scale-up/sustainability model that addresses the 95:95:95 global HIV targets via a CQI learning network, and mechanisms for fostering communication and the sharing of ideas and results; we describe trends both before and after model implementation.Results: Our selected country-level experiences based on implementing our CQI approach resulted in an increased partner testing acceptance rate from 21.7 to 48.2 % in Rwanda, which resulted in an increase in the HIV testing yield from 2.1 to 6.3 %. In Botswana, the overall linkage to treatment improved from 63 to 94 %, while in Kenya, the viral load testing uptake among paediatric and adolescent patients improved from 65 to 96 %, and the viral load suppression improved from 53 to 88 %.Conclusions: Adopting CQI processes is a useful approach for accelerating progress towards the attainment of the global 95:95:95 HIV targets. This paper also highlights the value of institutionalizing CQI processes and building the capacity of Ministry of Health (MoH) personnel in sub-Saharan Africa for the effective quality improvement of HIV programs and subsequent sustainability efforts. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is not only a fundamental violation of human rights but also a major public health problem. IPV is the most predominant form of violence committed by men against women. Therefore, our study sought to determine the prevalence of IPV and other moderating factors associated with IPV among these women. This study utilized data from the 2014 Kenya Demographic and Health Survey (KDHS), a nationally representative household-based survey that utilizes a two-stage sampling design. Data was weighted and analyzed using Stata 12 for Windows. A total of 3,028 women were interviewed for the analysis. A majority of the women were aged between 20 and 29 years (1,305; 43.1%), with a greater proportion married (2,329; 76.9%) and identified as Protestant (2,181; 72.1%). On adjusted analysis, factors associated with experiencing IPV included women who: were aged between 40 and 49 years belonging to religions other than Catholic, Protestant, or practiced no religion, resided in urban areas, were currently working, had a poor Wealth Index, were not sexually assertive, had one sexual partner other than their husband/spouse, received money, gifts, or favors in return for sex, had no knowledge on HIV, had husbands/partners aged above 50 years, experienced an early sexual debut of less than 18 years and felt that their partners were justified in beating them. Gender-based violence is complex and multifaceted affecting individuals, families, and society at large and should be addressed from different spectrums of intervention. There is a need for interventions that reduce and prevent IPV through empowering women, creating jobs to accumulate wealth, creating a conducive environment within workplaces for those employed, educating women, and empowering school-aged children to avert IPV. [ABSTRACT FROM AUTHOR]

Building capacity in implementation science within health programs is dependent on training in theory and practice of epidemiology, statistics, and research in addition to high self-efficacy toward application of training. This article describes a training program providing technical assistance to more than 300 health facilities in Kenya and Tanzania, its evaluation results, and its ability to improve participants' knowledge, competencies, and self-efficacy on data management, analysis, and dissemination among health care professionals. Two months prior to the training, participants (n = 98) were emailed a pre-course survey including 19 questions using a Likert-type response for planning the content of the workshop. Six to 12 weeks after the training, a post-course survey was emailed to all participants. Five different trainings were conducted indicating 5 participant cohorts. The questions posed involved course satisfaction, course impact on knowledge and skills, and self-efficacy in data analysis and utilization. Post-course survey results revealed that the participants had confidence in data analysis, which was significantly different from the pre-test results (0.05 α). Qualitative commentary complemented the findings of the impact of the workshop. Four manuscripts and 13 abstracts have been submitted post training. Results suggest that a short-term training program can achieve immediate gains in data and research self-efficacy among health care professionals. Although increasing self-efficacy is a necessary first step in developing skills, educators should engage in continuing education for sustainable dissemination practices. There is an urgent need to determine the current infrastructure to promote scientific dissemination. This will assist countries to produce better evidence to support their programs, policies, and overall health programs. [ABSTRACT FROM AUTHOR]

Background: We examine the uptake of HIV Testing and Counselling (HTC) and linkage into care over one year of providing HTC through community and health facility testing modalities among people living in Kibera informal urban settlement in Nairobi Kenya.Methods: We analyzed program data on health facility-based HIV testing and counselling and community- based testing and counselling approaches for the period starting October 2013 to September 2014. Univariate and bivariate analysis methods were used to compare the two approaches with regard to uptake of HTC and subsequent linkage to care. The exact Confidence Intervals (CI) to the proportions were approximated using simple normal approximation to binomial distribution method.Results: Majority of the 18,591 clients were tested through health facility-based testing approaches 72.5 % (n = 13485) vs those tested through community-based testing comprised 27.5 % (n = 5106). More clients tested at health facilities were reached through Provider Initiated Testing and Counselling PITC 81.7 % (n = 11015) while 18.3 % were reached through Voluntary Counselling and Testing (VCT)/Client Initiated Testing and Counselling (CITC) services. All clients who tested positive during health facility-based testing were successfully linked to care either at the project sites or sites of client choice while not all who tested positive during community based testing were linked to care. The HIV prevalence among all those who were tested for HIV in the program was 5.2 % (n = 52, 95 % CI: 3.9 %-6.8 %). Key study limitation included use of aggregate data to report uptake of HTC through the two testing approaches and not being able to estimate the population in the catchment area likely to test for HIV.Conclusion: Health facility-based HTC approach achieved more clients tested for HIV, and this method also resulted in identifying greater numbers of people who were HIV positive in Kibera slum within one year period of testing for HIV compared to community-based HTC approach. Linking HIV positive clients to care proved much easier during health facility- based HTC compared to community- based HTC. [ABSTRACT FROM AUTHOR]

Objective. To assess the prevalence and identified associated risk factors for precancerous cervical cancer lesions among HIV-infected women in resource-limited settings in Kenya. Methods. HIV-infected women attending the ART clinic at the Nazareth Hospital ART clinic between June 2009 and September 2010. Multivariate logistic regression model with odds ratios and 95% confidence intervals (CI) were estimated after controlling for important covariates. Result. A total of 715 women were screened for cervical cancer. The median age of the participants was 40 years (range 18-69 years). The prevalence of precancerous lesions (CINI, CINII, CIN III, ICC) was 191 (26.7%). After controlling for other variables in logistic regression analysis, cervical precancerous lesions were associated with not being on ART therapy; whereby non-ART were 2.21 times more likely to have precancerous lesions than ART patients [(aOR) = 2.21, 95% CI (1.28-3.83)]. Conclusion. The prevalence of precancerous cervical lesions was lower than other similar settings. It is recommended that cancer screening of HIV-infected women should be an established practice. Availability and accessibility of these services can be done through their integration into HIV. Prompt initiation of HAART through an early enrollment into care has an impact on reducing the prevalence and progression of cervical precancerous lesions. [ABSTRACT FROM AUTHOR]

Introduction: adolescence is a transitory stage in the lives of young people. The transition from primary to secondary school among adolescents is associated with suicidal behavior but is not well characterized in the Kenyan context. This study sought to elucidate factors associated with the risk of suicidal behavior among adolescents aged 11-18 years in transition to secondary school. Methods: a cross-sectional design was employed in the study that was conducted among adolescents in 5 randomly selected secondary schools in Nairobi County. The study involved 539 students who had joined form 1 in January 2020. Data were collected using the suicide behavior questionnaire-revised (SBQ-R) in March 2020. Factors associated with suicidal behavior were assessed using a generalized linear model (GLM), using a poisson distribution with a log-link function to estimate adjusted prevalence ratios (aPR), and a significance level of p=.05. Results: one-fifth (20.04%) of adolescents with a median age of 14 years were at risk of suicidal behavior. Depression (aPR=3.16, C.I {1.85, 5.41}, p=0.001) and lifetime alcohol use (aPR=1.87, C.I {1.17, 2.97}, p=0.009) were found to be significant factors for suicidal behavior. Conclusion: depression and lifetime alcohol use are associated with the risk of suicidal behavior among adolescents transitioning from primary to secondary school. Interventions may need to be targeted at the pre-secondary or primary school level to prevent underage alcohol use and enhancement of social support to prevent depression in this demographic of the population. [ABSTRACT FROM AUTHOR]

Background: Climate change has psychological impacts but most of the attention has been focused on the physical impact. This study was aimed at determining the association of climate change with adolescent mental health and suicidality as reported by Kenyan high school students., Methods: This was a cross sectional study with a sample size of 2,652. The participants were high school students selected from 10 schools in 3 regions of Kenya. A questionnaire was used to assess climate change experiences, mental health problems, and suicidality of the youth. Data were analyzed descriptively and with logistic regression to determine various associations of the different variables and the predictors of the various scores of SDQ and suicidality at 95% CI., Results: Significant differences were observed between gender and two of the threats of climate change - worry and being afraid as subjectively experienced by the participants. Females were more worried and afraid of climate change than males. On univariate and multivariate logistic regression, we found that various experiences of climate change were significantly associated with various scores of SDQ and much fewer of the experiences predicted SDQ scores. The same pattern was reflected in suicidality., Conclusion: Climate change appears to be associated with mental health concerns and suicidality according to Kenyan high school students' reports with gender differences in some associations., (© 2024. The Author(s).)

Studies including adolescents and young people (AYP) enhance the relevance of research results, benefit stakeholders, and inform future research. There exists a mental health gap in services for AYP living in low and middle-income countries. This study aims to identify mental health challenges faced by adolescents and young people in Kenya, develop practical recommendations to mitigate these issues, and reduce the mental health burden among this population. We convened an AYP-led meeting that involved 41 participants. The meeting objectives were to (1) identify efforts to support existing national and regional strategic priorities and review goals for addressing mental health needs among AYPs, (2) develop immediate action plans for strengthened mental health services, (3) review and strengthen country-level coordination mechanisms, and (4) identify how participating county experiences can inform mental health services in Kenya. Ministry of Health (MoH) officials from national and county levels, academic experts, and implementing partner agencies involved in mental health services participated in the meeting. The team, including AYP representatives, identified various mental health challenges among the AYA and recommended interventions aimed towards improving their mental health situation in the country. The challenges were clustered into three themes and comprehensively reviewed to establish the precipitating factors to mental health outcomes among AYPs in Kenya and provide recommendations. The themes included (1) legislative, (2) service provider/Ministry of Health, and (3) adolescent/individual-level factors. To bridge the mental health gap in the country and scale up mental health outcomes, the stakeholders recommended interventions within the context of the three clusters. The key suggestions included an increase in insurance financing, acceleration of community health interventions, the establishment of adolescent-friendly spaces, the training of adolescent youth champions, interactive service provision models, implementation of the existing mental health policies and structures, the development of comprehensive assessment tools, well equipped mental health departments in health facilities, the enhancement of telehealth services and digital villages, the mobilization of a functional mental health response team, and the development of a mental health database.

Introduction: intimate partner violence (IPV) is a global concern not only among adults but also adolescents. It has been reported that 35% of adolescent women have ever experienced IPV - occuring more so in non-industrialized countries. This study sought to understand the correlates associated with experiencing IPV among adolescent women between the ages 15 and 24 in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda., Methods: this was a secondary analysis of Demographic and Health Survey (DHS) data on adolescent women aged 15-24 years in five East African countries. IPV was measured as a composite variable of emotional, physical, and sexual violence. Other sociodemographic, income, maternal, sexual, knowledge, behavioral, and partner-related variables were included in the analysis., Results: the prevalence of ever experiencing IPV was 45.1% (n=2380). A higher proportion of women who reported experiencing IPV had their first sexual encounter when they were less than 18 years of age (p<0.001). The adjusted odds ratio (aOR) of experiencing IPV increased almost two times for women who were aged 18-24 years (aOR: 1.7; CI: 1.3-2.3), almost four times (aOR 3.8; CI: 1.7-8.3) for those who had two or more children, and two-fold for women who had ever terminated a pregnancy compared to those who had not (aOR 2.2; CI: 1.0-4.9). Additionally, there was a higher odds (aOR: 1.5 (1.0-2.3)) of experiencing IPV if the respondent believed their husband/spouse´s abuse was justified., Conclusion: raising early awareness and educating both the young males and females appropriately to mitigate contributing factors to IPV could ensure stable, healthy relationships free of domestic violence in the future., Competing Interests: The authors declare no competing interests., (Copyright: Peter Memiah et al.)

The study sought to determine the impact of COVID-19 on HIV/AIDS programming in the Kibera informal settlement and COVID-19 hotspot counties during the first wave of the pandemic. The study was conducted in two phases. The first phase entailed the analysis of HIV care and treatment secondary data (2018-2020) from the Kenya Health Information System. In the second phase, a prospective cohort study was conducted among people living with HIV in the Kibera informal settlement. A total of 176 participants aged 18 years and above accessing HIV services at selected healthcare facilities in Kibera were randomly sampled from facility electronic medical records and followed up for three months. Socio-demographics and contact details were abstracted from the records and telephone interviews were conducted with consenting participants. Results from the retrospective review of HIV program data indicated a 56% ( p < 0.000, 95% CI: 31.3%-62.8%) reduction in uptake of HIV services. Clients starting antiretroviral therapy (ART) reduced significantly by 48% ( p < 0.001, 95% CI: 35.4%-77%) in hotspot counties. However, pre-exposure prophylaxis uptake increased significantly by 24% ( p < 0.019, 95% CI: 4%-49%). In Kibera, 14% reported missing medications at the onset of the COVID-19 pandemic because of lack of food (38%) and government measures (11%), which affected ART access; 11% did not access health facilities due to fear of contracting COVID-19, government regulations and lack of personal protective equipment. Socioeconomic factors, food insecurity and government measures affected uptake of HIV/AIDS services; hence, the need for scaling up measures to increase access to HIV/AIDS services during the onset of pandemics.