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Self-administered HIV testing may be a promising strategy to improve testing in hard-to-reach young adults, provided they are aware of and willing to use oral HIV self-testing (HIVST). This study examined awareness of and willingness to use oral HIVST among 350 high-risk young adults, aged 18-22, living in Kenya's informal urban settlements. Bivariate and multivariate logistic regressions were used to examine differences in HIVST awareness and willingness by demographic and sexual risk factors. Findings showed that most participants were male (56%) and less than 20 years old (60%). Awareness of oral HIVST was low (19%). However, most participants (75%) were willing to use an oral HIV self-test in the future and ask their sex partner(s) to self-test before having sex (77%). Women (OR = 1.80, 95%CI:1.11, 2.92), older participants (aged 20+) (OR = 2.57, 95% CI:1.48, 4.46), and more educated participants (OR = 2.25, 95%CI:1.36, 3.70) were more willing to use HIVST as compared to men, teen-aged, and less educated participants, respectively. Young adults who reported recent engagement in high-risk sexual behaviors, such as unprotected sex, sex while high or drunk, or sex exchange, were significantly less likely to be willing to use an oral HIV self-test kit (OR = 0.34, 95%CI:0.13,0.86). Those with the highest monthly income (OR = 0.47, 95%CI: 0.25, 0.89) were also less willing to use HIVST. More community- and peer-based efforts are needed to highlight the range of benefits of HIVST (i.e., social, clinical, and structural) to appeal to various youth demographics, in addition to addressing concerns relating to HIVST.

Objective: The use of psychoactive substances increases university students’ general morbidity and mortality. Universities run programs to prevent psychoactive substance use since they are associat...

BACKGROUND: Mobile phone-based health (mHealth) interventions have the potential to improve HIV outcomes for high-risk young adults living in informal urban settlements in Kenya. However, less is known regarding young adults’ differential access to mobile phones and their willingness and use of mobile phone technologies to access HIV prevention, care, and treatment services. This is important as young adults make up the largest demographic segment of impoverished, informal urban settlements and are disproportionately impacted by HIV. METHODS: This study used observational survey data from 350 young adults, aged 18-22, who were living informal urban settlements in Nairobi, Kenya. Respondent driven sampling methods were used to recruit and enroll eligible youth. Using descriptive statistics and logistical regressions, we examined the prevalence of mobile phone access, willingness, and use for HIV services. We also assessed associated demographic characteristics in the odds of access, willingness, and use. RESULTS: The mean age of participants was 19 years (±1.3). 56% were male. Mobile phone coverage, including text messaging and mobile internet, was high (>80%), but only 15% of young adults had ever used mobile phones to access HIV services. Willingness was high (65%), especially among those who had individual phone access (77%) compared to lower willingness (18%) among those who shared a phone. More educated (OR=1.84, 95%CI:1.14-2.97) and employed (OR=1.70, 95%CI:1.02=2.83) young adults were also more willing to use phones for HIV services. In contrast, participants living in large households (OR=0.47, 95%CI:0.24-0.921), were religious minorities (OR=0.56, 95%CI:0.32-0.99), partnered/married (OR=0.30, 95%CI:0.10-0.91), or female (OR=0.29, 95%CI:0.16-0.55) were significantly less likely to have mobile phone access or usage, limiting their potential participation in HIV-related mHealth interventions. Given the low usage of mobile phones currently for HIV services, no differences in demographic characteristics were observed. CONCLUSION: Mobile health technologies may be under-utilized in HIV services for at-risk youth. Our findings highlight the importance of preliminary, formative research regarding population differences in access, willingness, and use of mobile phones for HIV services. More efforts are needed to ensure that mHealth interventions account for potential differences in preferences for mobile phone-based HIV interventions by gender, age, religion, education, and/or employment status.

Background Nearly three decades of conflict and frequent droughts and environmental hardships, have left 2.6 million of Somalis in displacement camps. Even though psychological impact of war and natural disasters are well documented, little is known about the unseen scars of psychological trauma in Internally displaced persons in Somalia. The purpose of the study was to determine the prevalence of post-traumatic stress disorder (PTSD) and depression amongst internally displaced persons (IDPs), and examine association between displacement and these psychiatric conditions. Methodology A cross-sectional quantitative study was conducted among 406 IDPs in Mogadishu. Harvard Trauma Questionnaire was used to determine levels of trauma exposure and PTSD, and Hopkins Symptom Checklist-25 was used to estimate prevalence of depression. Multivariate and bivariate analysis was conducted to analyze the association of demographic and displacement variables on the outcomes of PTSD and depression. Results More than half (59%) of participants met the symptom criteria of depression, and nearly one third (32%) of respondents met the symptom criteria for PTSD. The most prevalent traumatic event was lack of food or water (80.2%). Important predictive factors in development of psychiatric morbidity were unemployment, cumulative traumatic exposure, frequency and duration of displacement. Conclusion The study revealed high levels of Depressive disorder and Post-Traumatic Stress Disorder among internally displaced persons in Mogadishu. Furthermore, this study provided evidence to IDPs’ susceptibility to trauma exposure and lack of essential services and goods. Study also highlighted the importance of provision of Mental Health and Psychosocial Support (MHPSS) service in IDP camps.

Background Mental disorders are a leading cause of global disability, driven primarily by depression and anxiety. Most of the disease burden is in Low and Middle Income Countries (LMICs), where 75% of adults with mental disorders have no service access. Our research team has worked in western Kenya for nearly ten years. Primary care populations in Kenya have high prevalence of Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD). To address these treatment needs with a sustainable, scalable mental health care strategy, we are partnering with local and national mental health stakeholders in Kenya and Uganda to identify 1) evidence-based strategies for first-line and second-line treatment delivered by non-specialists integrated with primary care, 2) investigate presumed mediators of treatment outcome and 3) determine patient-level moderators of treatment effect to inform personalized, resource-efficient, non-specialist treatments and sequencing, with costing analyses. Our implementation approach is guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Methods/design We will use a Sequential, Multiple Assignment Randomized Trial (SMART) to randomize 2710 patients from the outpatient clinics at Kisumu County Hospital (KCH) who have MDD, PTSD or both to either 12 weekly sessions of non-specialist-delivered Interpersonal Psychotherapy (IPT) or to 6 months of fluoxetine prescribed by a nurse or clinical officer. Participants who are not in remission at the conclusion of treatment will be re-randomized to receive the other treatment (IPT receives fluoxetine and vice versa) or to combination treatment (IPT and fluoxetine). The SMART-DAPPER Implementation Resource Team, (IRT) will drive the application of the EPIS model and adaptations during the course of the study to optimize the relevance of the data for generalizability and scale –up. Discussion The results of this research will be significant in three ways: 1) they will determine the effectiveness of non-specialist delivered first- and second-line treatment for MDD and/or PTSD, 2) they will investigate key mechanisms of action for each treatment and 3) they will produce tailored adaptive treatment strategies essential for optimal sequencing of treatment for MDD and/or PTSD in low resource settings with associated cost information – a critical gap for addressing a leading global cause of disability. Trial registration ClinicalTrials.govNCT03466346, registered March 15, 2018.

Background:Universities have a student population in the age range of 17 to 25 years, 75 % of whom are sexually active, with the median age of sexual debut at age 18 years. About half of all students are involved in risky sexual behaviour. Many interventions have decreased sexual risk behaviour in the short-term, but there is need for multilevel prevention, including targeting improvements in family relationships for sustained change. Perceived positive family connectedness has been found to be related to reduced sexual risk-taking among adolescents and young adults. Methods:This cross-sectional study evaluated the family connectedness and sexual behaviour of students aged 18 to 24 years at the University of Nairobi. There were 904 participants, both male and female, who were registered students of the University of Nairobi. After institutional and individual consent were granted, participants completed a self-administered questionnaire within their classes. The family subscale of the Hemingway Measure of Adolescent Connectedness was used to evaluate connectedness, and a sexual behaviour questionnaire was used to evaluate sexual risk-taking behaviour. Results:Six hundred forty (70.8%) of the respondents were sexually active – 372 males and 268 females. High-risk sex was reported by 203 male respondents (54.6%) and 117 females (43.7%). Reportedly abstinent participants had higher family connectedness scores than those who were sexually active (P

INTRODUCTION: Studies have shown that a child’s learning in school is affected by several factors, some related to the school environment, others to the home and community while others are as a result of the individual characteristics of the child. This study sought to explore parents’ and teachers’ perceptions of factors that affect learning of children in primary schools in a rural County in Kenya. METHODS. This was a qualitative study that adopted the phenomenological approach. It was conducted with parents and teachers of 7 primary schools in rural and semi-rural areas of Kiambu County in Kenya. Using a researcher developed guide, data was collected using focus group discussion with parents and teachers. The discussions were conducted as follows-four were conducted in English language, two in Kiswahili language, and three were conducted in the local language and all were audio taped. Research assistants also took notes during the discussions. Results were transcribed verbatim and those that needed to be translated into English were translated. In analysis, MA, MM and MT read the transcripts and coded the major themes. RESULTS: Four themes perceived by both parents and teachers to affect a child’s learning emerged. These were; school environment, home, community and factors within the child. CONCLUSION: There is need for both teachers and parents to come together and discuss perceived factors that interfere with learning of the children. Those that form a consensus for both groups, means to address them be found for better academic success of the child.

This study estimated the prevalence and correlates of PTSD in Kenyan school children during a period of widespread post-election violence. The UCLA PTSD Reaction Index was administered to 2482 primary and secondary school students ages 11–17 from rural and urban communities. A high proportion of school children had witnessed people being shot at, beat up or killed (46.9%) or had heard about the violent death or serious injury of a loved one (42.0%). Over one quarter (26.8%, 95% CI = 25.1% - 28.7%) met criteria for PTSD. Correlates of PTSD included living in a rural (vs urban) area (AOR = 1.72, 95% CI = 1.41–2.11), attending primary (vs secondary) school (AOR = 2.25, 95% CI = 1.67–3.04) and being a girl (with girl as referent AOR = .70, 95% CI = .57–.86). We recommend training Kenyan teachers to recognize signs of emotional distress in school children and psychosocial counselors to adapt empirically-supported mental health interventions for delivery in primary and secondary school settings.

Background: Individuals with mental disorders are more susceptible to initiating and sustaining tobacco use; unfortunately, most do not get support to quit. Group behavioural counselling, an effective low-cost strategy for cessation has been shown to be effective, yet has not been studied among this population in Kenya.Methods: Mentally ill tobacco users at Mathari Referral and Teaching Hospital’s Clinic for Substance Abuse Treatment in Nairobi, were recruited from September 2017-March 2019. Participants were allocated into intervention and control groups (1:1). Intervention group participants met in groups of 10 over 24-weeks to participate in group behavioural counselling sessions using a structured curriculum to promote cessation. Control group participants received usual care. The primary outcome was tobacco cessation at 24-weeks measured through salivary cotinine strips. Secondary outcomes included self-reported number of cigarettes/sticks used daily and health-related quality of life (HRQoL), using the WHOQoL Brief Questionnaire at 24-weeks. Between-group event rates were compared using Cox proportional hazards models, while differences in HRQoL scores were analysed using paired t-tests.Results: Participants’ mean age was 35 (SD=9) years, 87% were male, and 42% had completed secondary education. Over half (65%) had substance use disorders (diagnosed) and 15% had major depressive disorders. Most participants (94%) used cigarettes at baseline and participants smoked for a mean of 13 (SD=11) years with an average of 14 (SD=7) sticks daily. Intervention group participants reported a higher cessation rate (15.2% vs. 0% at week 12;P=0.02 and 9.1% vs. 0%;P=0.10) at 24-weeks, with a lower number of sticks smoked (97% vs. 58.6%;PConclusion: The group behavioural intervention among tobacco using Kenyans with mental illness led to improved tobacco cessation outcomes. Trial registration number: NCT04013724

Introduction Quitting tobacco smoking is associated with improvements in mental health, including reductions in depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms. This study aimed to identify barriers and facilitators to successful cessation among tobacco using patients with concomitant mental illness undergoing a group tobacco cessation intervention program in Kenya. Methods This was a qualitative study embedded in a group behavioral tobacco cessation intervention trial in Nairobi, Kenya. Data were collected between March 2017 and August 2019. Group behavioral tobacco cessation meetings were held bimonthly for the first 3 months and monthly for the next 3 months for each intervention group. Field notes of group discussions were used to identify key themes using an inductive approach. Data were transcribed, coded, analyzed, interpreted and categorized by two team members. Results A purposive sample of 49 tobacco-using patients with concomitant mental illness participated in 5 focus groups. Mean (SD) age was 33.4 (6) years, 22.4% were women, 98% smoked cigarettes, and mean (SD) Fagerström score was 5.9 (1.5). Barriers experienced included: 1) peer influence, 2) withdrawal symptoms, 3) fear of complete cessation, 4) other substance use, and 5) end-of-month disputes. Facilitators used by participants included: 1) oral stimulation, and 2) spousal and friend support. Conclusions Tobacco users with concomitant mental illness face important barriers when trying to quit. Thus, more frequent and intensive tobacco cessation interventions may be needed, including supplementary group behavioral counseling by telephonic follow-up or online group sessions.

BackgroundRespondent-driven sampling (RDS) is a peer-referral sampling methodology used to estimate characteristics of underserved groups that cannot be randomly sampled. RDS has been implemented in several settings to identify hidden populations at risk for HIV, but few studies have reported the methodological lessons learned on RDS design and implementation for assessing sexual risk behaviors in marginalized youth.MethodsWe used RDS to recruit N = 350 young adults, aged 18 to 22, who were living in urban slum settlements in Nairobi, Kenya. A structured survey was used to assess sexual risk behaviors. Twenty seeds were selected and asked to recruit up to three eligible peers. We used small monetary incentives and a three-day recruitment coupon with sequential numbers linking recruiters to their recruits.ResultsData collection was completed in 8 days with a maximum chain length of 6 waves. Each seed yielded 16 to 21 eligible recruits. Three (15%) seeds were unproductive and were replaced. RDS benefits were high identification rates (90% coupons returned per coupons given), high eligibility rates (100% eligible recruits per coupons returned), and high efficiency (~39 eligible recruits per day). 44% of the sample was female. Most recruits (74%) reported being "friends" for 7+ years with their recruiter. RDS overcame feasibility concerns of household-, clinic-, and school-based sampling methodologies in that underserved youth who were unemployed (68%), out of school (48%), ethnic minorities (26%), and having prior residential instability (≥2 moves in the past year) (20%) were successfully recruited, based on weighted analyses. Youth reporting HIV risk behaviors, including unprotected sex (38%), sex while high/drunk (35%), and sex exchange for pay (14%), were also enrolled. However, 28% were not sexually active within the last 6 months. Challenges included managing wait times during peaks and participant referral expectations. Community engagement, use of study-stamped coupons, broad inclusion criteria, incentives, and study sites within walking distances all contributed to the successful implementation of the sampling methodology.ConclusionRDS is an important tool in reaching a diverse sample of underserved and at-risk young adults for study participation. Implications for optimizing RDS for behavioral studies in this population are discussed.

Background The rate of tobacco use among people with mental illness is nearly twice that of the general population. Psychotropic medications for tobacco cessation are relatively expensive for most Kenyans. Behavioral counseling and group therapy are effective lower cost strategies to promote tobacco cessation, yet have not been studied in Kenya among individuals with concomitant mental illness. Methods/design One hundred tobacco users with mental illness who were part of an outpatient mental health program in Nairobi, Kenya were recruited and allocated into intervention and control groups of the study (50 users in intervention group and 50 users in control group). Participants allocated to the intervention group were invited to participate in 1 of 5 tobacco cessation groups. The intervention group received the 5As (Ask, Advise, Assess, Assist and Arrange) and tobacco cessation group behavioral intervention, which included strategies to manage cravings and withdrawal, stress and anxiety, and coping with depression due to withdrawal; assertiveness training and anger management; reasons to quit, benefits of quitting and different ways of quitting. Individuals allocated to the control group received usual care. The primary outcome was tobacco cessation at 24 weeks, measured through cotinine strips. Secondary outcomes included number of quit attempts and health-related quality of life. Discussion This study will provide evidence to evaluate the efficacy and safety of a tobacco cessation group behavioral intervention among individuals with mental illness in Kenya, and to inform national and regional practice and policy. Trial registration Trial registration number: NCT04013724. Name of registry: ClinicalTrials.gov. URL of registry: https://register.clinicaltrials.gov Date of registration: 9 July 2019 (retrospectively registered). Date of enrolment of the first participant to the trial: 5th September 2017. Protocol version: 2.0.

AimsThe main objective was to determine whether quality of sleep is associated with burnout among undergraduate medical students at the University of Nairobi.The null hypothesis in our study population was; 'There is no significant association between poor sleep quality and burnout'.BackgroundIn a pressure prevailing environment, medical students find themselves in a vicious cycle of cutting down on sleep in attempts to cope and adjust to increasing workloads. Students with poor sleep quality have been found to perform worse in their board exam and have strained social engagements. Ultimately, this chronic sleep deprivation may lead to burnout which may cause diminished sense of accomplishment and impaired professional conduct, that may be carried on to the career as a physician. High levels of burnout have been associated with suicides.MethodThe sample size obtained was 384 and participants were selected by a mixed sampling method. Data collection was through self-administered questionnaires. Scales used for this study were the Pittsburg Sleep Quality Index(PSQI) and the Oldenburg Burnout Inventory(OLBI).Ethical considerations were adhered to and approval obtained from the Kenyatta National Hospital-University of Nairobi(KNH-UON) Ethics Board. Data entry and analysis was by SPSS v23. Data from 336 questionnaires were deemed fit for analysis.ResultWith a response rate of 87.5%, the prevalence of poor sleep quality and burnout were 69.9% and 74.7% respectively. There was a significant positive association between poor sleep quality and female gender, clinical years of study, living with family, poorly perceived socio-economic state and poor subjective academic performance. In addition, being female, younger, pre-clinical years, living independently off-campus and poor subjective academic performance were significantly associated with higher levels of burnout.Burnout had a significant correlation with poor sleep quality. Daytime functioning, a component of sleep quality had the highest correlation with components of burnout, disengagement and exhaustion. Overall, 57% of the respondents had both poor sleep quality &burnout, while only 12% were good sleepers with no burnout. Furthermore, having poor sleep increased the risk of having burnout by 2.8times. It is crucial that students adopt better sleeping habits to reduce the risk of burnout.ConclusionWith the high prevalence of poor sleep quality and burnout, peer-support groups and peer-led mentorship programs are recommended within this population to help deal with expectations, challenges and difficulties encountered within the course of medical education, in addition to preparing for the early future careers.

Mothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) among women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending prevention of mother-to-child transmission (PMTCT) clinic at Kenyatta National Hospital located in Nairobi, Kenya. We used the Edinburgh Postnatal Depression Scale and HIV/AIDS Stigma Instrument - PLWHA (HASI - P). Forty-eight percent (N = 59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR = 0.14, 95% CI [0.04-0.46], p = .001) and lack of family support (OR = 2.49, 95% CI [1.14-5.42], p = .02) were associated with the presence of elevated depressive symptoms. The presence of stigma implied more than ninefold risk of development of PPD (OR = 9.44, 95% CI [1.132-78.79], p = .04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother-baby dyad.

This paper describes a mental health capacity-building partnership between the University of Nairobi (UON) and the University of Washington (UW) that was built upon a foundational 30-year HIV/AIDS research training collaboration between the two institutions. With funding from the US National Institute of Mental Health Medical Education Program Initiative (MEPI), UW and UON faculty collaborated to develop and offer a series of workshops in research methods, grant writing, and manuscript publication for UON faculty and post-graduate students committed to mental health research. UON and UW scientists provided ongoing mentorship to UON trainees through Skype and email. Three active thematic research groups emerged that focused on maternal and child mental health, gender-based violence, and HIV-related substance abuse. Challenges to conducting mental health research in Kenya included limited resources to support research activities, heavy teaching responsibilities, clinical duties, and administrative demands on senior faculty, and stigmatization of mental health conditions, treatment, and research within Kenyan society. The partnership yielded a number of accomplishments: a body of published papers and presentations at national and international meetings on Kenyan mental health topics, the institution of systematic mental health data collection in rural clinics, funded research proposals, and a mental health research resource centre. We highlight lessons learned for future mental health research capacity-building initiatives.

Background Few longitudinal studies have examined associations between risk factors during pregnancy and mental health outcomes during the postpartum period. We used a cohort study design to estimate the prevalence, incidence and correlates of significant postpartum depressive symptoms in Kenyan women. Methods We recruited adult women residing in an urban, resource-poor setting and attending maternal and child health clinics in two public hospitals in Nairobi, Kenya. A translated Kiswahili Edinburgh Postpartum Depression Scale was used to screen for depressive symptoms at baseline assessment in the 3rd trimester and follow up assessment at 6–10 weeks postpartum. Information was collected on potential demographic, psychosocial and clinical risk variables. Potential risk factors for postpartum depression were evaluated using multivariate logistic regression analysis. Results Out of the 171 women who were followed up at 6–10 weeks postpartum, 18.7% (95% CI: 13.3–25.5) were found to have postpartum depression using an EPDS cut off of 10. In multivariate analyses, the odds of having postpartum depression was increased more than seven-fold in the presence of conflict with partner (OR = 7.52, 95% CI: 2.65–23.13). The association between antepartum and postpartum depression was quite strong but did not reach statistical significance (OR = 3.37, 95% CI: 0.98–11.64). Conclusions The high prevalence of significant postnatal depressive symptoms among Kenyan women underscores the need for addressing this public health burden. Depression screening and psychosocial support interventions that address partner conflict resolution should be offered as part of maternal health care.

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Background Preterm birth occurs among 9.6% of births worldwide and is the leading cause of long-term neurodevelopmental disabilities among children and also responsible for 28% of neonatal deaths. No single etiological factor is responsible for preterm birth, but various risk factors have been identified. Prior studies have reported that compromised maternal mental health occurring during pregnancy may lead to various adverse obstetric outcomes. Objective To determine whether antenatal depression is significantly associated with preterm delivery in a low resource hospital sample from the suburbs of Nairobi. Methods 292 women attending the antenatal clinic at Pumwani Maternity Hospital in Nairobi meeting the study criteria were recruited. The Edinburgh Postnatal Depression Scale was administered to screen for depression. A clinical cutoff score of 10 and above was regarded as possible depression. Thereafter, a clinical interview together with the Patient Health Questionnaire-9 was administered to evaluate the participants on DSM-V criteria for major depressive disorder. Only 255 of the women were successfully followed-up to delivery with an attrition rate of 12.7%. Records of gestation at delivery and birth weight were collected at second contact. Data analysis Preterm birth was associated with various demographic, psychosocial and medical variables. Relative risks were estimated via log binomial regression analysis to determine whether depression was a risk factor for preterm birth. Results Of the 255 participants, 98(38.4%) found to have depressive symptoms and 27(10.7%) delivered preterm. The risk of delivering preterm was 3.8 times higher among those with depressive symptoms. Conclusion There is a positive association between antenatal depression and preterm delivery. This highlights the importance of screening for mental health disorders in the antenatal period as a means to reduce adverse obstetric outcomes.

Background Psychiatric morbidity is commonly associated with HIV disease and may have adverse effects. This aspect may be overlooked at comprehensive HIV care centers in Low and Middle-Income Countries. Objectives The aim of this study was to determine the prevalence of undetected psychiatric morbidity among HIV/AIDS adult patients attending Comprehensive Care Centre in a semi-urban clinic, in Nairobi, Kenya. Design Descriptive cross-sectional study of adult HIV patients not receiving any psychiatric treatment was conducted. Participants/methods The participants consisted of consecutive sample of adults (n = 245) attending HIV Comprehensive Care Clinic at Kangemi Health Centre, Nairobi. The Mini International Neuropsychiatric Interview (MINI) was administered to screen for undetected psychiatric morbidity. Socio-demographic characteristics were recorded in a questionnaire. Sample descriptive analysis was performed and prevalence of undetected psychiatric morbidity calculated. Chi-square test for independence was used to examine the associations between patient characteristics and undetected morbidity. Multivariable logistic regression analysis was performed to determine independent predictors of undetected psychiatric morbidity. Results The mean age of our participants was 37.3 years (SD 9.2) Three-quarters (75.9%) of participants were females and median duration of HIV illness was 5 years. The prevalence of (previously undetected) psychiatric morbidity was 71.4% (95% CI 65.3–77). The leading psychiatric disorders were MDD (32.2%), PTSD (18.4%), Dysthymia (17.6%), and OCD (17.6%). Overall psychiatric morbidity was associated with low income (

Children who experience sexual abuse often meet the criteria of Post-Traumatic Stress Disorder and other psychiatric disorders. This article examines Post-Traumatic Stress Disorder and their educational status among children who have been sexually abused and its effects on the children's educational status. The study was carried out between June 2015 and July 2016. The study adopted a longitudinal study design. The study was conducted at Kenyatta National Teaching and Referral Hospital and Nairobi Women's Hospitals in Kenya. The children who had experienced sexual abuse and their parents/legal guardians were followed up for a period of one year after every four months interval. One hundred and ninety one children who had experienced sexual abuse and their parents/legal guardians were invited to participate in the study. Findings indicate that the children continued to experience PTSD one year after the sexual abuse incidence. PTSD was associated with the length of time taken to receive medical attention (p

Defilement is traumatic and often associated with psychosocial problems in children, parental distress and significant social strain on family relationships and well-being. This study aimed at examining psychosocial outcomes in defiled children and their caregivers’ perceptions of the children’s trauma after defilement. The study was carried out between June 2015 and July 2016 at Kenyatta National Hospital and Nairobi Women’s Hospital. It adopted a qualitative descriptive design using interviews to obtain information from six purposely selected caregivers comprising of four mothers, one father and one grandmother. All the perpetrators were adult males and two of the defiled children were male and 5 were female. Two of the children were siblings; a brother and his sister. Five of the perpetrators were known to the children and one of these was the child’s biological father. The defiled children had negative outcomes in terms of poor academic performance, low self esteem, depression and poor social relationships. In addition one of the children contracted HIV/AIDS, two became pregnant, one was used to traffic drugs, and another had mental retardation. The caregivers felt significant psychosocial distress. There is therefore, need to routinely screen for psychological, social and physical outcomes of children exposed to defilement trauma and to always consider caregiver distress when treating these children.

Secure attachment in childhood and adolescence protects children from engagement in high risk behaviors and development of mental health problems over the life span. Poverty has been shown to create impoverishment in certain aspects of caregiving and correspondingly to compromise development of secure attachment in children. Nineteen children 8 to 14 years old from two schools in a middle income area and an urban informal settlement area of Nairobi were interviewed using an adapted Child Attachment Interview (CAI) protocol. CAI was developed to provide a glimpse into the 'meta-theories' children have about themselves, parents, parenting and their attachment ties with parents and extended family members. Narratives obtained with the CAI were analyzed using thematic analysis. Both Bowlby's idea of 'secure base' as well as Bronfrenbrenner's 'ecological niche' are used as reference points to situate child attachment and parenting practices in the larger Kenyan context. We found that with slight linguistic alterations CAI can be used to assess attachment security of Kenyan children in this particular age range. We also found that the narration ability in both groups of children was generally good such that formal coding was possible, despite cultural differences. Our analysis suggested differences in narrative quality across the children from middle class and lower socio-economic class schools on specific themes such as: sensitivity of parenting (main aspects of sensitivity were associated with disciplinary methods and child's access to education), birth order, parental emotional availability, and severity of inter-parental conflicts and child's level of exposure. The paper puts in context a few cultural practices such as greater household responsibility accorded to the eldest child and stern to harsh disciplinary methods adopted by parents in the Kenyan setting.

It has been established that sexual abuse against children is a global problem and quite widespread. Sexual abuse against children is a public health concern given that its outcomes are not only detrimental to the health of children, but also to the health of their families and society. Often, poor mental health functioning among children is identified late and in very low numbers by health professionals. In view of the fact that children exposed to sexual abuse are one group in Sub-Saharan Africa that exhibits serious mental health problems, this article examined self-esteem among children exposed to sexual abuse in Kenya. The study used data collected between June 2015 and July 2016 from 191 children and their legal parents/guardians. Specifically, the study adopted a longitudinal research design. Children who had experienced sexual abuse and their parents/legal guardians were followed up for a period of 1 year and interviewed at 4-month intervals. Participants were recruited from the Kenyatta National Teaching and Referral Hospital and Nairobi Women’s Hospital in Kenya. Findings indicated that low and average self-esteem was significantly associated with frequency of abuse (p

Background Children who experience sexual abuse undergo various negative psychosocial outcomes such as depressive symptoms. Unfortunately, not many studies have been conducted on the incidence of depressive symptoms among sexually abused children in Kenya. This study sought to ascertain the incidence of depressive symptoms among children who have experienced sexual abuse in Kenya. Methods This was a longitudinal study design. It was conducted at Kenyatta National Teaching and Referral Hospital and Nairobi Women’s Hospitals in Kenya. One hundred and ninety-one children who had experienced sexual abuse and their parents/legal guardians were invited to participate in the study. The study administered the Becks Depression Inventory and the Child Depression Inventory to the children. Results The incidence of depressive symptoms after 1 month of sexual abuse revealed that amongst children who were below 16 years old, 14.6% had minimal-mild depressive symptoms while 85.4% had moderate-severe depressive symptoms. In comparison, children who were 16 years or older, 6.4% had minimal-mild depressive symptoms while 93.6% had moderate-severe depressive symptoms. Children below 16 years old whose parents were separated were found to have depressive symptoms (p

Urban slum adolescents and young adults have disproportionately high rates of HIV compared to rural and non-slum urban youth. Yet, few studies have examined youth’s perceptions of the economic drivers of HIV. Informed by traditional and behavioral economics, we applied a scarcity theoretical framework to qualitatively examine how poverty influences sexual risk behaviors among adolescents and young adults. Focus group discussions with one hundred twenty youth in Kenyan’s urban slums were transcribed, coded, and analyzed using interpretive phenomenology. Results indicated that slum youth made many sexual decisions considered rational from a traditional economics perspective, such as acquiring more sex when resources were available, maximizing wealth through sex, being price-sensitive to costs of condoms or testing services, and taking more risks when protected from adverse sexual consequences. Youth’s engagement in sexual risk behaviors was also motivated by scarcity phenomena explained by behavioral economics, such as compensating for sex lost during scarce periods (risk-seeking), valuing economic gains over HIV risks (tunneling, bandwidth tax), and transacting sex as an investment strategy (internal referencing). When scarcity was alleviated, young women additionally described reducing the number of sex partners to account for non-economic preferences (slack). Prevention strategies should address the traditional and behavioral economics of the HIV epidemic.

Introduction: Longitudinal studies that assess antepartum risk factors and outcome in the postpartum period can help provide a wealth of information in understanding maternal depression. In addition to collecting information on prevalence and correlates of antepartum depression, such studies reveal postpartum outcomes of depression as well as its risk factors while avoiding recall bias, a limitation frequently seen in cross sectional postpartum studies. Methodology: We consecutively recruited 188 adult women residing in an urban, resource poor setting and attending maternal and child health clinics in 2 major public hospitals in Nairobi, Kenya. A translated Kiswahili EPDS was used to screen for depressive symptoms at baseline assessment in the 3rd trimester and a follow up assessment at 6-10 weeks post-partum. A different questionnaire was administered at baseline to collect information on potential socio demographic and clinical antepartum risk variables. Study results: At a cut off of 13 or more on the EPDS, our study found a prevalence of 18% for antepartum depression. Associated correlates of antepartum depression were partner current alcohol use and partner wanting current pregnancy. Out of the 171 women we followed up at 6-12 weeks postpartum, 21% were found to have postpartum depression. Antenatal depression and conflict with partner were the strongest independent predictors of postpartum depression. In the adjusted analysis, the risk of having postpartum depression is increased six-fold in the presence of antepartum depression and ten times in the presence of conflict with partner. Conclusion: High rates of perinatal depression among women residing in Africa underscore the need for addressing this public health burden. Despite the comparably little emphasis on antenatal depression, antenatal depressive symptoms appear to be as common as postnatal depressive symptoms. Depression screening and psychosocial support that especially addresses conflict resolution during pregnancy should therefore be targeted for future interventions.

The period of adolescence is characterized by physical, psychological, emotional and personality change. During this period the adolescents are in schools and are expected to complete their schooling successfully. These can overwhelm the adolescents with some developing hopelessness and conduct problems. This study aimed to find out if Hopelessness was a predictor of conduct problems among the school going youth. It was conducted in eight public rural and urban schools among youth aged between 11 and 17 years. Eight schools, four primary schools and four secondary schools, took part in the study. Hopelessness was measured using the Hopelessness Scale for Children by Kazdin while. Conduct problems was measured using the Strength and Difficulty Questionnaire youth version. Data of 2439 students was analyzed. The prevalence of high hopelessness was 20.7% while the prevalence of conduct problems was 15.7%. At Bivariate analysis, only age, with the OR of having conduct problems if one was 11-13 years age group being 1.520 at 95% Cl (1.217-1.897), P

There are two medical schools training doctors in Kenya: the Moi University established in 1984 and the University of Nairobi established in 1967. The University of Nairobi has so far produced the majority of Kenyan doctors. Both are public universities with the Government being the main financier. The increased demand for university education and the inability to meet these demands has led to the introduction of a system of training self-sponsored medical students alongside Government-subsidised students. One other public university has started a medical school. The pressure to increase the number of schools and students in the absence of increased resources poses a particular challenge to the country.

The need for a suitable tool for assessing postpartum depression in Kenya led to the process of translation of the 10 items Edinburgh Postnatal Scale into Kiswahili. The idea was to seek semantic, conceptual as well as normative equivalence in this translation. The paper discusses issues and the process of translation and provides in depth discussions around translation from the point of view of cross-cultural mental health research and practice. The English version of the EPDS screening tool was finally successfully translated into Kiswahili and the translated version is attached with this paper.

BACKGROUND: Sub-Saharan Africa bears the greatest burden of cervical cancer. Human papillomavirus (HPV) vaccination programmes to prevent the disease will need to reach vulnerable girls who may not be able access health and screening services in the future. We conducted formative research on facilitators and barriers to HPV vaccination and potential acceptability of a future HPV vaccination programme amongst girls living in hard-to-reach populations in Kenya. METHODS: Stakeholder interviews with Ministry of Health staff explored barriers to and support for the uptake of HPV vaccination. A situation assessment was conducted to assess community services in Maasai nomadic pastoralist communities in Kajiado County and in Korogocho informal settlement in Nairobi city, followed by focus group discussions (n=14) and semi-structured interviews (n=28) with health workers, parents, youth, and community and religious leaders. These covered marriage, knowledge of cervical cancer and HPV, factors that might inhibit or support HPV vaccine uptake and intention to accept HPV vaccine if a programme was in place. RESULTS: Reported challenges to an HPV vaccination programme included school absenteeism and drop-out, early age of sex and marriage, lack of parental support, population mobility and distance from services. Despite little prior knowledge of cervical cancer and HPV, communities were interested in receiving HPV vaccination. Adequate social mobilisation and school-based vaccination, supplemented by out-reach activities, were considered important facilitating factors to achieve high coverage. There was some support for a campaign approach to vaccine delivery. CONCLUSIONS: Given the high level of support for a vaccine against cervical cancer and the experience of reaching pastoralist and slum-dwellers for other immunizations, implementing an HPV vaccine programme should be feasible in such hard-to-reach communities. This may require additional delivery strategies in addition to the standard school-based delivery, with vaccine offered at multiple venues, potentially through a campaign approach.

Worldwide, mental disorders affect 450 million people and account for 15% of the overall burden of diseases from all causes (World Health Organization, 2001). Two-thirds of those affected do not receive adequate care owing to stigma, discrimination, neglect and poverty. The World Health Organization (2001) found that only 1% of the total health expenditure went to mental health in most countries.