integrating psychiatric basic care at ruaraka uhai neema hospital: an evidence-based approach. doct....
TRANSCRIPT
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