Presentation on theme: "Integrating psychiatric basic care at Ruaraka Uhai Neema Hospital:"— Presentation transcript:
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 psychiatristsKenya: 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 recoverEfficacy 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 2002Partnership with the Catholic ChurchMission: 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.
6 Materials and MethodsRandom selection of ordinary outpatients during 2 months (n. 300)Written consentAdministration of 2 questionnaires by the author and 2 social researchers:Mini International Neuropsychiatric Interview Version (DSM-IV)Questionnaire about traditional believes and mental/physical illnessAdmistered by me and 2 social researcher trained by me and amhfEnglishKiswahili
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 DisordersMajor Depressive Episode Current and pastDysthymia currentSuicide risk currentHypomanic episode current and pastManic episode current and pastPanic Disorder lifetime and currentPanic Limited syntoms attack lifetimePanic Disorder with Agoraphobia CurrentAgoraphobia without panic disorder CurrentSocial phobia CurrentObsessive compulsive disorder currentPost traumatic Stress Disorder CurrentAlcohol dependence CurrentAlcohol abuse CurrentDrug (s) dependence CurrentDrug(s) abuse currentPsychotic syndrome currentpsychotic syndrome lifetimeMood disorder with psychotic features currentAnorexia Nervosa currentBulimia Nervosa currentGeneralized Anxiety disoder currentAntisocial personality Disorder lifetimeSomatization Disorder CurrentHyphocondriasis CurrentPain Disorder CurrentPain Disorder associated with psychological factors CurrentPain Disorder associated with psychological factorsand general medical condition Current1 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 bya jiniwicthcrafta spiritthe evilcurseancestral cursebadluck in all your lifebad omen on the familysomeone looked you with bad eyesIII 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?PraySpeak with a priest, a pastor, a muezzin, …………………Speak with friends, with the family or with the eldersGo to a Faith HealerGo to a Traditional HealerGo to a Muganga (witch doctor)Do a sacrificeGo to a professional mental health consultant
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
26 Mental illness and slum areas p= 0,50p= 1,00Statistical difference only for suicidep= 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 jiniwitchcrafta spiritthe evile) cursef) ancestral curseg) badluck in all your lifeh) bad “omen” on the familyi) 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 MDDA lot of different disorders (Pain disorder, PTSD, Panic Disorder, OCD, suicidality, Alchol Dep.)Relevance of Traditional Believes:Importance of socio-economic context and lifestyleTo summarize12,5 % Physical24,4% Your mental33,3% 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 thankUtopia 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