Mathari Hospital Research Articles

Determinants for Utilization of Alcohol Use Screening Tool by Nurses at Mathari Hospital, Nairobi City County, Kenya

The purpose of this study was to evaluate determinants for utilization of alcohol use screening tools by nurses at Mathari Hospital. The study employed analytical cross sectional study design. Participants were practising nurses deployed at Mathari Hospital. 159 respondents formed the sample size. The study utilised simple random sampling. The average age for most nurses was 42 (±10.6) years, had 18 (±10.6) years’ experience in nursing profession, had 10 (±8.1) years’ experience in mental health and psychiatry nursing. Majority (98.1%, 156) of the nurses had cared for a patient with potentially harmful alcohol use and initiated screening for alcohol use on the patient (56.6%, 90). The findings revealed that majority of the nurses were female (76.1%), Christians (97.5%), diploma holders (47.8%), aged was 42 years, 18 years’ experience in nursing profession, and 10 years’ experience in mental health and psychiatry nursing. In addition, education level of nurses was positively and significantly (r=0.164, p=0.039) related with utilization of SBIRT screening tool. The respondents highlighted the following as key enabling factors: Management support (52.8%), motivation (51.6%), Champion (44.7%) and training (44.7%). Management support was positively and significantly (r=0.322, p=0.000) related with utilization of SBIRT screening tool. Identified barriers to utilization of the SBIRT screening tool were nurses’ own alcohol use (44%), competency gaps (32.7%) and lack of knowledge (49.7%). Nurse’s characteristics had a positive and significant influence on the utilization of alcohol use screening tool (β = 0.612, p= 0.000) at 95% confidence interval. Enabling factors had a positive and significant influence on utilization of alcohol use screening tool (β = 0.226, P= 0.061) at 90% confidence interval. Barriers had a negative and significant influence on utilization of alcohol use screening tool (β = -0.261, P= 0.065) at 95% confidence interval. The adjusted R squared (0.243) revealed that jointly, nurses’ characteristics, enabling factors and barriers explain 24.3% of variations in the utilization of alcohol use screening tool. Enabling factors were observed to have a positive and significant relationship with utilization of alcohol use screening tool (r=0.359, P=0.000) at 99% confidence interval. Barriers have a negative and significant relationship with utilization of alcohol use screening tool (r= -0.132, P=0.097) at 95% confidence interval. The three determinants (nurses’ characteristics, enabling factors, and barriers) only explained eighteen percent of changes in utilization of SBIRT suggesting the existence of other factors that may account for changes in utilization of the screening tool. Keywords: Screening tool, alcohol use, SBIRT, barriers, enabling factors, nurse’s characteristics

An Exploratory Study on the Psychological Experiences of Families of People Living with Schizophrenia under Forensic Care at Mathari Hospital, Nairobi County, Kenya

Family members of People living with schizophrenia under forensic care (PLWSUFC) find themselves in a multifaceted situation. Families are considered important in increasing the patients’ chances of living a well-functioning life after discharge from psychiatric facilities. In Kenya, scanty evidence exists on exploration of the psychological experiences of such families facing a paradox. The aim of this study was to explore the psychological experiences of families with a relative under forensic care in Mathari Hospital having committed a crime under the influence of schizophrenia. The study was guided by the Rational Emotive Behavioral Therapy. This qualitative study used phenomenology research design and recruited a sample size of 14 participants an open-ended question was asked during the semi-structured in-depth interviews and recorded. The audio recorded interviews were transcribed verbatim and data analyzed thematically. The findings from the study revealed that families of PLWSUFC at Mathari Hospital, suffered negative emotions which were: rejection, unresolved anger, ambivalence, denial, despair fear and unrequited love, The study recommends that counseling psychologists develop appropriate psycho education programs for families in this situation. Such programs are envisioned to improve families’ psychological well-being, better management of the patients and reduce recidivism.

Mental Health Implications of COVID-19 in Kenya

Dear Editor,
 As the COVID-19 pandemic continues to spread rapidly worldwide, it is certainly having an immense effect on the mental wellbeing of people thereby increasing the number of people with elevated levels of stress, depression, or anxiety.1 Developing countries will undoubtedly have serious mental health implications due to the poor or almost non-existent mental health services.
 In Kenya, mental health is still somewhat neglected mainly because only 0.05% of the Governments’s health budget allocation goes to mental health.2 The allocated health budget largely focuses on communicable diseases despite the impact of mental health on the Kenyan population. Although there are no accurate data on the prevalence of mental disorders in Kenya, various studies have shown that the prevalence of depression generally varies from 19% in household review studies2 to 42% among the general population visiting the health facilities.3 Similar to other African countries, Kenya has a shortage of mental health professionals. Mathari hospital is the country’s only mental referral facility where one nurse handles up to 150 patients.4 In a country with only approximately 100 psychiatrists serving a population of 45 million, only a third of the psychiatrists work in the government health facilities.5 The rest of the psychiatrists work in private health facilities that are generally more expensive making them inaccessible to the majority of the population due to the unaffordable consultation fees.

Effect of Mental Illness on the Primary Care Givers: A Case Study of Mathari Hospital, Kenya

Effect of Mental Illness on the Primary Care Givers: A Case Study of Mathari Hospital, Kenya

A Cross-Sectional Study on Factors Associated with Relapse in Patients with Schizophrenia at Mathari Hospital, Nairobi Kenya

Schizophrenia is a chronic and disabling mental disorder with a high prevalence rate of 1.4-4.6 per a thousand populations. Schizophrenia is often accompanied by relapses even while on treatment. Relapse rate vary from 50%-92% and are similar in both developed and developing countries, despite the former having well established Mental health services. This was a crosssectional descriptive study of 209 family members or significant others accompanying patients to Mathari Hospital. Patients were selected by random sampling and the study was carried out between June and July 2011. Schizophrenia was diagnosed using Diagnostic and statistical manual of mental disorder, 4th edition text revision (DSM-IV-TR) criteria. Data was collected using semi-structured questionnaire and analyzed using Statistical package for social science (SPSS) and presented in frequency tables, bar graphs and pie charts. Relationship between independent and dependent variables was determined by calculating confidence interval and summary Chi-square statistics. P-value of < 0.05 was considered significant. The findings indicated that majority of patients (81.8%) were aged between 17-46 years with (54%) of patients having had their first episodes of schizophrenia between ages 17-26 years. The results showed that factors associated with relapse in schizophrenia in Mathari hospital included, non-drug compliance and failure to attend follow-up clinic (67.9%), stressful life events (17.3%), and substance abuse (14.8%). Relapse rate was found to be 58%-97%. This calls for intensified Psycho education to both patients and family members for early recognition of signs of relapse and drug compliance. Improvement of community mental health services will reach more family members in their homes, encourage drug compliance and community involvement in understanding schizophrenia to reduce stigma. Health policy makers will avail atypical antipsychotic drugs with minimal side effects to reduce the high relapse rate. Future research should focus on clinical factors associated with relapse in schizophrenia.

EVALUATION OF THE NURSING CARE ADMINISTERED TO PSYCHOACTIVE SUBSTANCE DEPENDENT PATIENTS MATHARI HOSPITAL IN NAIROBI- KENYA

Different nursing care approaches have been used in the care of psychoactive substance dependent patients as shown by literature. Nurses form a core component of many healthcare systems so their role in responding to problems related to psychoactive substance use is crucial (Murray &amp; Andrews, 2002). The aim of the study was to evaluate the nursing Care approach administered to Psychoactive Substance Dependent Patients admitted in substance dependence rehabilitation unit at Mathari hospital in Nairobi. This was a cross sectional descriptive study conducted in November 2010. 22 nurses taking care of psychoactive substance depedend patients were purposively included. Pretest was done in Asumbi rehabilitation centre in Nairobi. Data analysis methods included use of descriptive and inferential statistics. The findings were presented using charts, tables, and narrative form. Results indicated that 45% manage withdrawal symptoms, while 41% do routine nursing care to the psychoactive substance dependent patient. The nurses could not identify exactly their role in the care of psychoactive substance dependent patients after detoxification period. Therefore it was recommended that psychoactive substance dependent patients and their relatives should be actively involved in the plan of care.

Perceived economic and behavioural effects of the mentally ill on their relatives in Kenya: a case study of the Mathari Hospital

There is no documented evidence in Kenya on relatives' perceptions of economic and behavioural effects of the mentally ill patients and their coping mechanisms. To document what relatives of mentally ill patients perceive to be the economic effects of the patients on the family and how they are affected by and cope with the disturbed behaviours of the patients. This was a cross-sectional descriptive study conducted at the Mathari Psychiatric Hospital. Informed consent was obtained from both the relatives and the patients admitted at the hospital. Data on socio-demographic and economic profiles were obtained from the patients and their relatives. The relatives were interviewed using a structured questionnaire to determine what they perceived to be the economic effects of the mental illness, how the various disturbed behaviours of the mentally ill affected them, and how they coped. The data were analysed using SPSS version 11.5 and results are presented in narratives and tables. One hundred and seventy-five relatives and 107 patients were recruited and interviewed. The patients were younger and better educated but economically less well off than their relatives. The relatives perceived that the mentally ill patients caused financial constraints and that various disturbed behaviours, particularly, verbal and physical aggression and refusal of the patient to take medicine or go to hospital, affected the family in different ways. Different coping mechanisms were used, depending on whether or not the behaviours were intrusive. Mentally ill patients adversely affect their families in diverse ways. There is need for appropriate policy to address the needs of families with mentally ill patients at the family and community levels. However, these must be evidence-based and this calls for further research.

Substance abuse and psychiatric co-morbidities: a case study of patients at Mathari Psychiatric Hospital, Nairobi, Kenya

Substance abuse co-morbidity with psychiatric disorders is common and has been widely reported, except in Kenya. This study aimed to determine the prevalence, pattern and socio-economic burden of a dual diagnosis of substance abuse disorder and other psychiatric conditions. This was a cross-sectional descriptive study of 691 patients admitted at Mathari hospital. Only 42 patients had a first working diagnosis of substance abuse but nearly thirty-five percent of the patients scored for a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of alcohol dependance/abuse. There was high co-morbidity of alcohol abuse/dependence with opiate, sedative and 'khat' use, as well as with mood and other psychotic disorders. Substance abuse disorders correlated significantly with other psychiatric disorders. Only 12 patients were in a drug rehabilitation unit, all of whom had a dual psychiatric diagnosis of affective disorder. There were high co-morbidity rates of substance abuse in both general psychiatric wards and drug rehabilitation units. KEY WORDS: substance abuse, co-morbidity, psychiatric disorders, Kenya

A Cross-Sectional Study of Co-Occurring Suicidal and Psychotic Symptoms in Inpatients at Mathari Psychiatric Hospital, Nairobi, Kenya

To investigate the prevalence of suicidal symptoms and their co-occurrence with psychotic symptoms in patients at Mathari Hospital. A descriptive cross-sectional study was conducted in June 2004 on inpatients at Mathari Hospital, the national psychiatric teaching and referral hospital. Data on sociodemographic characteristics and clinical diagnoses of inpatients were extracted from their clinical notes. The Structured Clinical Interview for DSM-IV (SCID) Screening Module was used to elicit information on psychotic and suicidal symptoms. A total of 691 patients were interviewed, of whom 308 (44.6%) had suicidal symptoms. There were significant positive correlations (p < .05) between psychotic and suicidal symptoms diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) suggesting co-existence of these 2 sets of disorders. There is a high prevalence of suicidal symptoms in the patients admitted at Mathari Hospital with predominantly psychotic disorders. Although these prevalence rates are much lower than those reported elsewhere, especially for schizophrenia, they are still a cause for concern given that these suicidal symptoms were not being managed.

Obsessive-compulsive (oc) symptoms in psychiatric in-patients at Mathari hospital , Kenya

To document the prevalence of obsessive-compulsive disorders (OCD) among patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya. This was a descriptive cross-sectional study conducted at the Mathari Hospital. Out of 691 patients interviewed, 84 (12.2%) had symptoms which met the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) criteria for OCD, which started early in life. The clinicians had not recognized the OC symptoms/disorder. There were high co-morbidities between OCD and other Structured Clinical Interview for DSM-IV (SCID) core syndromes as well as psychotic symptoms often associated with schizophrenia. OC symptoms are common in psychiatric patients admitted at Mathari Hospital although such symptoms were clinically undetected and therefore not managed. The high co-morbidities between OCD, other psychiatric disorders and other psychiatric symptoms pose clinical challenges in differentiating between psychotic symptoms perceived by the patients to have an external locus and OC symptoms perceived to have an internal locus. A more systematic clinical procedure for assessing all DSM-IV symptoms should be adapted as standard quality control practice in all patients, particularly those with psychotic symptoms.

Clinical epidemiology in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya

Knowledge of types and co-morbidities of disorders seen in any facility is useful for clinical practice and planning for services. To study the pattern of co-morbidities of and correlations between psychiatric disorders in in-patients of Mathari Hospital, the premier psychiatric hospital in Kenya. Cross-sectional. All the patients who were admitted at Mathari Hospital in June 2004 and were well enough to participate in the study were approached for informed consent. Trained psychiatric charge nurses interviewed them using the Structured Clinical Interview for DSM-IV Axis I disorders Clinical Version (SCID-I). Information on their socio-demographic profiles and hospital diagnoses was extracted from their clinical notes using a structured format. Six hundred and ninety-one patients participated in the study. Sixty-three percent were male. More than three quarters (78%) of the patients were aged between 21 and 45 years. More than half (59.5%) of the males and slightly less than half (49.4%) of the females were single. All the patients were predominantly of the Christian faith. Over 85% were dependents of another family member and the remainder were heads of households who supported their own families. Schizophrenia, bipolar I disorder, psychosis, substance use disorder and schizo-affective disorder were the most common hospital and differential diagnoses. Of the anxiety disorders, only three patients were under treatment for post-traumatic stress disorder (PTSD). Nearly a quarter (24.6%) of the patients were currently admitted for a similar previous diagnosis. Schizophrenia was the most frequent DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-fourth edition) diagnosis (51%), followed by bipolar I disorder (42.3%), substance use disorder (34.4%) and major depressive illness (24.6%). Suicidal features were common in the depressive group, with 14.7% of this group reporting a suicidal attempt. All DSM-IV anxiety disorders, including obsessive-compulsive disorders, were highly prevalent although, with the exception of three cases of PTSD, none of these anxiety disorders were diagnosed clinically. Traumatic events were reported in 33.3% of the patients. These were multiple and mainly violent events. Despite the multiplicity of these events, only 7.4% of the patients had a PTSD diagnosis in a previous admission while 4% were currently diagnosed with PTSD. The number of DSM-IV diagnoses was more than the total number of patients, suggesting co-morbidity, which was confirmed by significant 2-tailed correlation tests. DSM-IV substance use disorders, major psychiatric disorders and anxiety disorders were prevalent and co-morbid. However, anxiety disorders were hardly diagnosed and therefore not managed. Suicidal symptoms were common. These results call for more inclusive clinical diagnostic practice. Standardized clinical practice using a diagnostic tool on routine basis will go a long way in ensuring that no DSM-IV diagnosis is missed. This will improve clinical management of patients and documentation.

The Prevalence of Personality Disorders in A Kenyan Inpatient Sample

DSM-IV Axis I and II comorbidities and the pattern of Axis II diagnoses in patients admitted at Mathari (Psychiatric) Hospital, Nairobi, Kenya are unknown. To determine DSM-IV Axis I and II comorbidities and patterns of Axis II diagnoses in patients admitted at Mathari Hospital. Cross-sectional study on 148 randomly sampled patients. Twenty percent of the patients were confirmed for an Axis II diagnosis. Eighty-seven percent of the Axis II disorders were Cluster B Personality Disorders of various types. Using chi2 tests, significant associations were found between Axis I and II diagnoses and substance use/dependence (p < 0.001; 66.7%), mood disorder (p = 0.002; 46.7%) and schizophrenia (p < 0.001; 23.3%). The prevalence of personality disorders was lower than that reported in psychiatric patients in USA and Europe. The results are likely to be a true reflection of the actual epidemiological situation, but cannot be generalized to outpatient or general populations.

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.

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

To determine the prevalence of tardive dyskinesia among psychiatric in-patients. A cross-sectional survey. Mathari Hospital, Nairobi, the main psychiatric referral hospital in Kenya. Two hundred and two randomly selected in-patients seen in the hospital between January and April 2000. 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. 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.

INTERVIEW: Mathari Hospital, Nairobi, Kenya

INTERVIEW: Mathari Hospital, Nairobi, Kenya