1. Integrating psychiatric basic care at Ruaraka Uhai Neema Hospital:
an evidence-based approach.
Doct. Jean-Louis Aillon,
Nairobi

2. 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)

3. 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

4. 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.

5. MATERIALS & METHODS

6. 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 (DSM-IV)
Questionnaire about traditional believes and mental/physical illness
Admistered by me and 2 social researcher trained by me and amhf
English
Kiswahili

7. Mini International Neuropsychiatric Interview Version 5. 0 (DSM-IV) Y
Mini International Neuropsychiatric Interview Version (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
1 h to administer

8. Traditional believes questionnaire
I 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:

9. II b) If yes, What is the reason of that?
II c) What will you do to resolve this problem?
Pray
Speak with a priest, a pastor, a muezzin, …………………
Speak with friends, with the family or with the elders
Go to a Faith Healer
Go to a Traditional Healer
Go to a Muganga (witch doctor)
Do a sacrifice
Go to a professional mental health consultant

10. RESULTS

11. Sociodemographic Features

12. Site
Ethnic community

13. Clinical Results 1) prevalence of psychiatric disorders
Major Depressive Disorder: ,3%
*We exclude Agoraphobia, social fobia, antisocial personality, acute and chronic pain disorder associated with medical factor, Acute pain disorder associated with psychological factors.

14. Depression how long? (n.44): 18,6 ± 33,9 months
Pain how long? (n.21): 29,2 ± 35,9 months

17. Mental disorder and sociodemographic features

20. Mental disorder and clinic features

22. Mental disorders and site

23. MD. and ethnic community

24. Depression and sociodemographic features

26. Mental illness and slum areas
p= 0,50
p= 1,00
Statistical difference only for suicide
p= 0,047

27. What do you think is the cause of “your” mental illness?
Top Ten

28. What do you think is the cause of mental illness?
Top Ten

29. Prevalence of traditional believes in mental and physical illness
a jini
witchcraft
a spirit
the evil
e) curse
f) ancestral curse
g) badluck in all your life
h) bad “omen” on the family
i) someone looked you with bad eye

32. Limits of our study Not cultural validation of MINI-plus
Monocentric (only one hospital)
Bias: more women

33. 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
To summarize
12,5 % Physical
24,4% Your mental
33,3% Mental

34. 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!

35. Asante sana for your attention
Deeply thank
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