Integrating psychiatric basic care at Ruaraka Uhai

Neema Hospital: an evidence-based

approach.

Doct. Jean-Louis Aillon,

Nairobi 14-10-2010

Introduction

• Mental disorders: 12% of the global burden of disease

• LAMIC: more people than HIV/AIDS, tuberculosis, and malaria combined!!!

• Lack of structures and psychiatrists

• Kenya: 34 millions people & 68 psychiatrists (half actively involved in clinical work and mostly live in urban areas)

• Clinical trials: locally available, affordable interventions in community and primary care settings.

• The majority can recover• Efficacy and cost-effectiveness of treatments: huge

health and economic benefits to the entire society. • WHO advocates integrating mental health in primary

care,

however the limited evidence-based data have prevented efforts to develop such services

Ruaraka Huai Neema Hospital

• Integrated health centre (from 2009): out-patients clinics, casualty, laboratory, Xray, ultrasound, MCH, VCT, PMTCT and OPD  

• Promoted by Amici del Mondo - World Friends – Onlus, an NGO operating in Kenya since 2002

• Partnership with the Catholic Church

• Mission: to improve the quality of life and promote the right to health in the most marginalized areas of Nairobi, to increase the access to essential preventive, diagnostic and curative services for the patients of the slums of North Eastern Nairobi.

MATERIALS &

METHODS

Materials and Methods- Random selection of ordinary outpatients during 2 months (n.

300)- Written consent- Administration of 2 questionnaires by the author and 2 social

researchers:• Mini International Neuropsychiatric Interview Version 5.0.0

(DSM-IV)

• Questionnaire about traditional believes and mental/physical illness

English

Kiswahili

Mini International Neuropsychiatric Interview Version 5.0.0 (DSM-IV)

Y. Lecrubier, E. Weiller, T. Hergueta, P. Amorim, L.I. Bonora, J.P.Lépine. Hôpital de la Salpétrière - Paris - FRANCE.

20 Psychiatric Disorders

•Major Depressive Episode Current and past•Dysthymia current•Suicide risk current•Hypomanic episode current and past•Manic episode current and past•Panic Disorder lifetime and current•Panic Limited syntoms attack lifetime•Panic Disorder with Agoraphobia Current•Agoraphobia without panic disorder Current•Social phobia Current•Obsessive compulsive disorder current•Post traumatic Stress Disorder Current•Alcohol dependence Current•Alcohol abuse Current

•Drug (s) dependence Current•Drug(s) abuse current•Psychotic syndrome current•psychotic syndrome lifetime•Mood disorder with psychotic features current•Anorexia Nervosa current•Bulimia Nervosa current•Generalized Anxiety disoder current•Antisocial personality Disorder lifetime•Somatization Disorder Current•Hyphocondriasis Current•Pain Disorder Current •Pain Disorder associated with psychological factors Current•Pain Disorder associated with psychological factors and general medical condition Current

Traditional believes questionnaireI a) In your opinion what could be the cause of your mental problems?

I b) In your opinion what could be the cause of mental problems?

 

II) Do you think that your physical illness is caused by– a jini

– wicthcraft

– a spirit

– the evil

– curse

– ancestral curse

– badluck in all your life

– bad omen on the family

– someone looked you with bad eyes

III a) Do you think that your mental illness is caused by:

III b) Do you think that mental illness is caused by:

II b) If yes, What is the reason of that?

II c) What will you do to resolve this problem?

a) Pray

b) Speak with a priest, a pastor, a muezzin, …………………

c) Speak with friends, with the family or with the elders

d) Go to a Faith Healer

e) Go to a Traditional Healer

f) Go to a Muganga (witch doctor)

g) Do a sacrifice

h) Go to a professional mental health consultant

RESULTS

Sociodemographic Features

Site Ethnic community

Clinical Results1) prevalence of psychiatric disorders

Major Depressive Disorder: 79 28,3%

*We exclude Agoraphobia, social fobia, antisocial personality, acute and chronic pain disorder associated with medical factor, Acute pain disorder associated with psychological factors.

Depression how long? (n.44): 18,6 ± 33,9 months

Pain how long? (n.21): 29,2 ± 35,9 months

Mental disorder and sociodemographic features

Mental disorder and clinic features

Mental disorders and site

MD. and ethnic community

Depression and sociodemographic features

Mental illness and slum areas

p= 0,047

p= 1,00p= 0,50

Statistical difference only for suicide

What do you think is the cause of “your” mental illness?

Top Ten

What do you think is the cause of mental illness?

Top Ten

Prevalence of traditional believes in mental and physical

illness

a) a jini b) witchcraft c) a spirit d) the evil

e) curse f) ancestral curseg) badluck in all your life h) bad “omen” on the familyi) someone looked you with bad eye

Limits of our study

- Not cultural validation of MINI-plus

- Monocentric (only one hospital)

- Bias: more women

Conclusions• Mental illness is a common problem: 62,7 % during lifetime

• Need to recognize and treatment: 48,2% • Depression is the most common disorder: Bipolar vs MDD• A lot of different disorders (Pain disorder, PTSD, Panic Disorder, OCD,

suicidality, Alchol Dep.)

• Relevance of Traditional Believes:

• Importance of socio-economic context and lifestyle

12,5 % Physical24,4% Your mental 33,3% Mental

Need for some actions!!

• Training local staff: CMEs

The new Constitution gives to Kenians the right to health, nonetheless there will never be real health without mental health!

Utopia lies at the horizon. When I draw nearer by two steps, it retreats two steps. If I proceed ten steps forward, it swiftly slips ten steps ahead. No matter how far I go, I can never reach it. What, then, is the purpose of utopia? It is to cause us to advance.” Eduardo Hughes Galeano

Asante sana for your attention