To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Globally, stigma associated with mental, neurological and substance use (MNS) disorders is rampant and a barrier to good health and overall well-being of people with these conditions. Person-centred digital approaches such as participatory video may reduce stigma, but evidence on their effectiveness in Africa is absent.
To evaluate the effectiveness of participatory video in reducing mental health-related stigma in a resource-limited setting.
We evaluated the effectiveness of using participatory video and face-to-face interaction between people with MNS disorders and a target audience in lowering stigma among 420 people living in Kilifi, Kenya. Changes in knowledge, attitudes and behaviour (KAB) were measured by comparing baseline scores with scores immediately after watching the participatory videos and 4 months after the intervention. Sociodemographic correlates of stigma scores were examined using multivariable linear regression models.
Compared with baseline, KAB scores significantly improved at both time points, suggesting reduced stigma levels. At 4 months, the changes in scores were: knowledge (β = 0.20, 95% CI 0.16–0.25; P < 0.01), liberal attitude (β = 1.08, 95% CI 0.98–1.17; P < 0.01), sympathetic attitude (β = 0.52, 95% CI 0.42–0.62; P < 0.01), tolerant attitude (β = 0.72, 95% CI 0.61–0.83; P < 0.01) and behaviour (β = 0.37, 95% CI 0.31–0.43; P < 0.01). Sociodemographic variables were significantly correlated with KAB scores; the correlations were not consistent across the domains.
Participatory video is a feasible and effective strategy in improving knowledge, attitudes and intended behaviour in a resource-limited setting. Further studies are required to understand the mechanisms through which it lowers stigma and to examine long-term sustainability and the effectiveness of multicomponent interventions.
The Mini International Neuropsychiatric Inventory 7.0.2 (MINI-7) is a widely used tool and known to have sound psychometric properties; but very little is known about its use in low and middle-income countries (LMICs). This study aimed to examine the psychometric properties of the MINI-7 psychosis items in a sample of 8609 participants across four countries in Sub-Saharan Africa.
We examined the latent factor structure and the item difficulty of the MINI-7 psychosis items in the full sample and across four countries.
Multiple group confirmatory factor analyses (CFAs) revealed an adequate fitting unidimensional model for the full sample; however, single group CFAs at the country level revealed that the underlying latent structure of psychosis was not invariant. Specifically, although the unidimensional structure was an adequate model fit for Ethiopia, Kenya, and South Africa, it was a poor fit for Uganda. Instead, a 2-factor latent structure of the MINI-7 psychosis items provided the optimal fit for Uganda. Examination of item difficulties revealed that MINI-7 item K7, measuring visual hallucinations, had the lowest difficulty across the four countries. In contrast, the items with the highest difficulty were different across the four countries, suggesting that MINI-7 items that are the most predictive of being high on the latent factor of psychosis are different for each country.
The present study is the first to provide evidence that the factor structure and item functioning of the MINI-7 psychosis vary across different settings and populations in Africa.
Little is known about the reasons for suicidal behaviour in Africa, and communities’ perception of suicide prevention. A contextualised understanding of these reasons is important in guiding the implementation of potential suicide prevention interventions in specific settings.
To understand ideas, experiences and opinions on reasons contributing to suicidal behaviour in the Coast region of Kenya, and provide recommendations for suicide prevention.
We conducted a qualitative study with various groups of key informants residing in the Coast region of Kenya, using in-depth interviews. Audio-recorded interviews were transcribed and translated from the local language before thematic inductive content analysis.
From the 25 in-depth interviews, we identified four key themes as reasons given for suicidal behaviour: interpersonal and relationship problems, financial and economic difficulties, mental health conditions and religious and cultural influences. These reasons were observed to be interrelated with each other and well-aligned to the suggested recommendations for suicide prevention. We found six key recommendations from our thematic content analysis: (a) increasing access to counselling and social support, (b) improving mental health awareness and skills training, (c) restriction of suicide means, (d) decriminalisation of suicide, (e) economic and education empowerment and (f) encouraging religion and spirituality.
The reasons for suicidal behaviour are comparable with high-income countries, but suggested prevention strategies are more contextualised to our setting. A multifaceted approach in preventing suicide in (coastal) Kenya is warranted based on the varied reasons suggested. Community-based interventions will likely improve and increase access to suicide prevention in this study area.
Problem Management Plus (PM+) is a psychological intervention that seeks to address common mental disorders among individuals exposed to adversity. Thus far, the potential for delivering PM+ by mobile phones has not been evaluated.
To adapt PM+ for telephone delivery (ten weekly sessions of about 45 min each) and preliminarily evaluate its acceptability and feasibility with young people living with HIV (YLWH) in coastal Kenya.
This was a mixed-method formative research. Qualitative data collection included consultations with stakeholders, conducting key informant interviews with HIV care providers and focus group discussions with potential end-users, i.e. YLWH. Moreover, brief exit interviews with recipients of the adapted PM+ were conducted. Quantitative acceptability and feasibility indicators and outcome measures were tracked/assessed during PM+ preliminary implementation involving 70 YLWH.
From the qualitative inquiries, the adapted PM+ emerged as contextually appropriate, acceptable and feasible for mobile phone delivery, despite some concerns around missing nonverbal cues and poor network connectivity. High recruitment (85%) and fair programme retention (69%) were observed. Intervention sessions over the telephone lasted 46 min on average (range 42–55 min). Preliminary feasibility data indicated that the adapted PM+ has the potential of reducing common mental disorders among YLWH from the Kenyan coast.
PM+ is acceptable and can feasibly be delivered via mobile phone to YLWH in coastal Kenya. This study sets the stage for a future fully powered, randomised controlled trial assessing the efficacy of the adapted PM+ in this or a similar setting.
Stigma against persons with mental illness is a universal phenomenon, but culture influences the understanding of etiology of mental illness and utilization of health services.
We validated Kiswahili versions of three measures of stigma which were originally developed in the United Kingdom: Community Attitudes Toward the Mentally Ill Scale (CAMI), Reported and Intended Behaviors Scale (RIBS) and Mental Health Awareness Knowledge Schedule (MAKS) and evaluated their psychometric properties using a community sample (N = 616) in Kilifi, Kenya.
Confirmatory factor analysis confirmed the one-factor solution for RIBS [root mean-squared error of approximation (RMSEA) < 0.01, comparative fit index (CFI) = 1.00, Tucker–Lewis index (TLI) = 1.01] and two-factor solution for MAKS (RMSEA = 0.04, CFI = 0.96, TLI = 0.95). A 23-item, three-factor model provided the best indices of goodness of fit for CAMI (RMSEA = 0.04, CFI = 0.90, TLI = 0.89). MAKS converged with both CAMI and RIBS. Internal consistency was good for the RIBS and acceptable for CAMI and MAKS. Test–retest reliabilities were excellent for RIBS and poor for CAMI and MAKS, but kappa scores for inter-rater agreement were relatively low for these scales. Results support validity of the original MAKS and RIBS scale and a modified CAMI scale and suggest that stigma is not an enduring trait in this population. The low kappa scores are consistent with first kappa paradox which is due to adjustment for agreements by chance in case of marginal prevalence values.
Kiswahili versions of the MAKS, RIBS and a modified version of the CAMI are valid for use in the study population. Stigma against people with mental illness may not be an enduring trait in this population.
Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya.
Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test.
Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4–70.8) v. 76.6% (95% CI 71.6–79.2) (p < 0.001).
The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.
Fetal studies show that a specific malformation, e.g., polymicrogyria or cobblestone cortex, may be the end point of disruption of one of a number of developmental pathways and may have more than one etiology. Histology of the cerebral hemispheres showed, apart from necrosis, failure of neuronal migration with subcortical heterotopia, polymicrogyria, overmigration into the leptomeninges, transmantle dysplasia, and schizencephaly. Malformations resulting from undermigration may be generalized, as in type 1 lissencephaly and subcortical band (double cortex) syndromes, or focal as represented by subcortical and periventricular heterotopias. Focal cortical dysplasia and tuberous sclerosis are lesions restricted to a small region of the cortex and are thought to result from early abnormalities in cell growth and proliferation. Cobblestone cortex (type 2 lissencephaly), bilateral frontoparietal polymicrogyria, MARCKS deficiency, TUBB2B mutation, polymicrogyria and schizencephaly are some of the over migration syndromes.
The bed-forming brittlestars Ophiothrix fragilis, Ophiocomina nigra and Amphiura chiajei from Oban Bay, Scotland were studied using methods previously employed to study chemoautotrophic symbioses. Ophiothrix fragilis and A. chiajei both contain symbiotic bacteria (SCB) while Ophiocomina nigra is non-symbiotic. Samples were taken of Ophiothrix fragilis at approximately two-week intervals for one year. Symbiotic bacteria numbers were determined by direct counting of homogenates of the arms of 50 individual brittlestars. Water samples were analysed for chlorophyll content. Stable isotope ratios for carbon and nitrogen were determined for each homogenate sample. Regular SCB counts were made on the infaunal brittlestar A. chiajei. Homogenate samples of Ophiothrix fragilis, A. chiajei and the non-symbiotic Ophiocomina nigra were analysed to produce fatty acid profiles for each species. Symbiotic bacteria count varied by up to one order of magnitude in both Ophiothrix fragilis and A. chiajei with no evidence of seasonality in this variation. Symbiotic bacteria number was inversely correlated with δ15N but no relationship was established with δ13C. 16:1ω7 and 18:1.ω7 fatty acids were used as putative bacterial markers. Both symbiotic species had higher percentages of 16:1ω7 than the non-symbiotic Ophiocomina nigra. However, only Ophiothrix fragilis appeared to receive appreciable quantities of 18:1ω7 from its SCB. The SCB are heterotrophic and may contribute to the nitrogen budget of the host. The two symbiotic species studied here derive the bulk of their nutrition from conventional feeding but SCB make significant, additional contributions.
Email your librarian or administrator to recommend adding this to your organisation's collection.