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Background: There are few psychometric instruments whose properties have been studied in a developing country's context. Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children, Kenya. Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools. Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample, which is similar to Western findings, and is hence a reliable tool for measuring anxiety in the study population. It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms, social anxiety, separation anxiety and harm avoidance. The correlation co-efficient with CDI was similar to Scandinavian findings. Conclusion: The MASC can be used in Kenyan children and, by extension, other Africa children. [ABSTRACT FROM AUTHOR]

Abstract Aim To document Beck Depression Inventory (BDI) II suicidal symptoms among patients admitted to Kenyan non-psychiatric general medical facilities Methods All consenting adults admitted within a period of 4 weeks at 10 general medical facilities in Kenya were interviewed for suicidal symptoms and depression using the BDI-II. Results In all, 2,780 patients responded to item 9 (suicidal symptoms of the BDI-II). The prevalence of all BDI-II suicidal symptoms combined was 10.5%. Thoughts of 'killing oneself but have not carried them out' accounted for 9% of the suicidal symptoms. The younger age group had the highest prevalence of suicidal symptoms and the oldest age group had the least prevalence of suicidal symptoms. The more depressed the patients were on the overall BDI-II score, the higher the prevalence of suicidal symptoms. Conclusion On average 1 out of 10 of the patients had suicidal symptoms, more so in younger than the older people and in the more depressed. These symptoms had not been clinically recognised and therefore not managed. This calls for clinical practice that routinely enquires for suicidal symptoms in general medical wards.

Abstract Background Physical disorders are commonly comorbid with depression in children attending general medical facilities. However, the depression component is rarely recognised. Methods A questionnaire on sociodemographics and history of presenting medical conditions was administered together with the Children's Depression Inventory (CDI) to all 11-year-old to 17-year-old children attending at nine medical facilities. Results In all, 408 children were recruited from 9 health facilities. Whereas the clinicians diagnosed a mental disorder in only 2.5% of the sample studied, 41.3% had CDI scores that suggested mild to moderate depression. The highest proportion of children with depressive symptomatology was found at the Kenyatta National and Teaching Referral Hospital. Conclusion Although prevalence rate for depression among children is high, detection rates remain low. This finding has clinical practice and policy implications within and outside Kenya.

Abstract Background The possibility that a significant proportion of the patients attending a general health facility may have a mental disorder means that psychiatric conditions must be recognised and managed appropriately. This study sought to determine the prevalence of common psychiatric disorders in adult (aged 18 years and over) inpatients and outpatients seen in public, private and faith-based general hospitals, health centres and specialised clinics and units of general hospitals. Methods This was a descriptive cross-sectional study conducted in 10 health facilities. All the patients in psychiatric wards and clinics were excluded. Stratified and systematic sampling methods were used. Informed consent was obtained from all study participants. Data were collected over a 4-week period in November 2005 using various psychiatric instruments for adults. Descriptive statistics were generated using SPSS V. 11.5. Results A total of 2,770 male and female inpatients and outpatients participated in the study. In all, 42% of the subjects had symptoms of mild and severe depression. Only 114 (4.1%) subjects had a file or working diagnosis of a psychiatric condition, which included bipolar mood disorder, schizophrenia, psychosis and depression. Conclusion The 4.1% clinician detection rate for mental disorders means that most psychiatric disorders in general medical facilities remain undiagnosed and thus, unmanaged. This calls for improved diagnostic practices in general medical facilities in Kenya and in other similar countries.

Background: Task shifting is a well-tested implementation strategy within low- and middle-income countries that addresses the shortage of trained mental health personnel. Task shifting can increase access to care for patients with mental illnesses. In Kenya, community health workers (CHWs) are a combination of community health assistants and community health volunteers and have played a crucial role on this front. In our study, we seek to assess the acceptability and feasibility of Group Interpersonal Psychotherapy (IPT-G) delivered by CHWs among depressed postpartum adolescents (PPAs) living with human immunodeficiency virus (HIV)., Method: The study used theoretical framework of behaviour change including: Capability, Opportunity and Motivation (COM-B model) to help understand behavioural changes due to IPT-G intervention delivered by the CHWs. 24 PPAs were administered IPT-G by trained CHWs from two health centres. A two-arm study design (IPT-G intervention and treatment as usual) with an intent to treat was used to assess the acceptability and feasibility of IPT-G. With purposeful sampling, participants who scored > 10 on the Edinburgh postnatal depression scale and who were 6-12 weeks postpartum were eligible for the study. Participants were equally distributed into two groups: one group for intervention and another as a wait-listed group. This was achieved by randomly allocating numerical numbers and separating those with odd numbers (intervention group) and even numbers (wait-listed group). Focus group discussions and in-depth interviews ascertained the experiences and perceptions of the PPAs and the CHWs during IP-G delivery process. In addition to weekly face-to-face continuous supportive supervision for the CHWs, the researchers also utilized phone calls, short messages services and WhatsApp instant messaging services., Results: The CHWs found the intervention useful for their own knowledge and skill-set. With regards to participation, 21 out of the 24 adolescents attended all sessions. Most of the adolescents reported an improvement in their interpersonal relationships with reduced distress and lessening of HIV-related stigma. Primary healthcare workers embraced the intervention by accommodating the sessions in their routine clinic activities., Conclusion: Our study demonstrates the possible benefits of task shifting in addressing mental health problems within low-resource settings in Kenya, and IPT-G is demonstrated to be both acceptable and feasible by health workers and adolescents receiving care., (© 2022. The Author(s).)

Objective: The authors adopted a task-sharing strategy in which lay health workers delivered group interpersonal psychotherapy (IPT-G) in primary care clinics in Nairobi, Kenya, to young mothers with HIV and depression. The study examined the acceptability, feasibility, and effectiveness of IPT-G in improving depression and antiretroviral therapy adherence., Methods: Twenty-four mothers (ages 18-24 years and 6-12 weeks postpartum) participated. The women were randomly assigned to IPT-G or to a waitlist. Eight lay providers administered the IPT-G sessions across 8 weeks. The primary outcome was pre- to postintervention change in depression scores as measured on the Edinburgh Postnatal Depression Scale. The secondary outcome was antiretroviral therapy adherence. All waitlist participants subsequently received the intervention, and a secondary outcome, within-group analysis, was conducted and included those participants., Results: Participants' median age was 23.0 years, 17 (71%) lived with a partner, and 19 (79%) had fewer than two children. The intervention group had a mean±SD depression score of 15.9±4.3 at baseline and 6.8±7.0 postintervention. For the waitlist control group, the mean score was 17.3±5.9 at baseline and 13.2±6.6 at the first follow-up. Waitlist participants had significantly greater mean depression scores than did intervention group participants at the first follow-up (after the intervention group's 8-week IPT-G) (β=6.42, 95% confidence interval=1.17 to 11.66, p=0.017). No difference was observed between groups in antiretroviral therapy adherence., Conclusions: This study provides preliminary evidence that IPT-G led by community health workers may have benefits for postpartum depression among young mothers with HIV.

This paper describes a sustainable structure to deliver the World Health Organization (WHO) endorsed group Interpersonal Psychotherapy (IPT-G) for Postpartum Adolescent (PPA) mothers living with HIV in Nairobi. It documents the process of mobilizing, training, and engaging Community Health Workers (CHWs) and Key Informants (health facility staff) involved in the Prevention of Mother-To-Child Transmission (PMTCT) in two Primary Health Care (PHC) facilities from informal settlements of Nairobi County. Mainly reporting experiences from the training process utilizing focused group discussions and in-depth interviews involving participants, IPT-G therapists and supervisors we present process findings and acceptability of our IPT-G implementation.

Introduction: This qualitative study, conducted in public primary and secondary schools, sought teachers' perceptions of mental health concerns that are relevant in school settings. Based on the phenomenological theory, the study aimed to understand the teachers experiences of mental health problems in the schools and how they handled them., Method: The schools sampled represented rural, suburban and urban sections of Kiambu County in Kenya. Data were collected through Focus Group Discussions (FGDs). The researcher made summary notes from both audio taped interviews and notes made by the research assistants and summarized the major themes., Results: Teachers reported that they were aware that students suffered from mental health problems. They recognized learning difficulties, externalizing problems, internalizing problems, bizarre behavior, and problem substance use among students. Teachers reported that lack of skills and time were challenges in dealing with student mental health problems., Conclusion: Teachers perceive presence of mental health problems among the students. There is need for in- service training for identification and referral and that school psychologists be employed to deal with student mental health problems., Competing Interests: Conflict of Interest: On behalf of all authors, the corresponding author states that there is no conflict of interest

Background: Children who experience sexual abuse undergo various negative psychosocial outcomes such as depressive symptoms. Unfortunately, not many studies have been conducted on the incidence of depressive symptoms among sexually abused children in Kenya. This study sought to ascertain the incidence of depressive symptoms among children who have experienced sexual abuse in Kenya., Methods: This was a longitudinal study design. It was conducted at Kenyatta National Teaching and Referral Hospital and Nairobi Women's Hospitals in Kenya. One hundred and ninety-one children who had experienced sexual abuse and their parents/legal guardians were invited to participate in the study. The study administered the Becks Depression Inventory and the Child Depression Inventory to the children., Results: The incidence of depressive symptoms after 1 month of sexual abuse revealed that amongst children who were below 16 years old, 14.6% had minimal-mild depressive symptoms while 85.4% had moderate-severe depressive symptoms. In comparison, children who were 16 years or older, 6.4% had minimal-mild depressive symptoms while 93.6% had moderate-severe depressive symptoms. Children below 16 years old whose parents were separated were found to have depressive symptoms (p < 0.001) as well as those who were presented early for medical care (p < 0.004), while children aged 16 years and above who were abused by strangers were more likely to have depressive symptoms (p < 0.024) and those who were not attending school (p < 0.002)., Conclusion: Sexual abuse of children is world-wide and the Kenyan situation is comparable. Being the victim of sexual abuse as a child has major psychological and emotional sequlae which need to be addressed in Kenya. Children who experience sexual abuse have very high incidence of developing depressive symptoms. All the sexually abused children studied suffered from depressive symptoms and a large majority suffered from major depressive symptoms that should be promptly and effectively addressed to ameliorate psychological suffering among children.

Purpose: To estimate the prevalence, types and comorbidity of the most common mental disorders and the spread of suicide risk in a primary care practice in Kenya., Methods: This was a cross-sectional descriptive study. A total of 300 adult outpatients were randomly selected while they were consulting their general practitioner. The M.I.N.I. Plus interview five was used to diagnose psychiatric disorders and suicide risk., Results: Thus, 56.3 % of the sample (n = 169) presented one or more psychiatric disorders. The most prevalent disorders were Affective (39.0 %), Anxiety (31.3 %), and Somatoform (13.0 %). Regarding specific disorders, the most common were Major Depressive Disorder (26.3 %), Agoraphobia (16.7 %), Pain Disorder (12.5 %), Generalized Anxiety Disorder (9.3 %) and Bipolar Disorder (9 %). We found three cases of Bulimia Nervosa (1 %); 29.7 % had more than one current mental disorder. Suicide risk was present in 12.7 % of participants. No associations were identified between socio-demographic factors and the presence of mental disorder. Suicide risk was higher in women and in patients who came from slum areas. Gastric pain was positively associated with presence of mental disorder., Conclusion: High prevalence of mental disorders and suicide risk calls for integrating mental health services in primary health care; in particular, this study highlights the importance of differentiating between specific types of mental disorders (which require different therapeutic approaches), and of diagnosing comorbidities.

Objective: The study aimed to investigate the types of mental illnesses treated by traditional healers, and their methods of identifying and treating mental illnesses in their patients., Method: In urban informal settlements of Kibera, Kangemi and Kawangware in Nairobi, Kenya, we used opportunistic sampling until the required number of traditional healers was reached, trying as much as possible to represent the different communities of Kenya. Focus group discussions were held with traditional healers in each site and later an in-depth interview was conducted with each traditional healer. An in-depth interview with each patient of the traditional healer was conducted and thereafter the MINIPLUS was administered to check the mental illness diagnoses arrived at or missed by the traditional healers. Quantitative analysis was performed using SPSS while focus group discussions and in-depth interviews were analysed for emerging themes., Results: Traditional healers are consulted for mental disorders by members of the community. They are able to recognize some mental disorders, particularly those relating to psychosis. However, they are limited especially for common mental disorders., Conclusion: There is a need to educate healers on how to recognize different types of mental disorders and make referrals when patients are not responding to their treatments.

Defining the prepsychotic state in an effort to prevent illness progression and the development of disorders such as schizophrenia is a rapidly growing area of psychiatry. The presentation of psychotic symptoms can be influenced by culture; however, there has not been any previous assessment of psychosis risk symptoms in the continent of Africa. Our study aimed to measure the prevalence of psychosis risk in a community sample in Nairobi, Kenya, and to evaluate the effects of key demographic variables. A culturally modified version of the 12-item PRIME-Screen (mPRIME) was self-administered by 2758 youth (aged 14-29 years) recruited through house-to-house visits in Nairobi, Kenya. The prevalence and severity of psychosis risk items from the mPRIME and the effects of sex and age on symptoms were evaluated. k-Means cluster analysis was used to identify symptom groups. Depending on the mPRIME item, 1.8% to 19.5% of participants reported certainty of having had a psychosis risk symptom. Overall, 45.5% reported having had any psychosis risk symptom. Females had a significantly higher mean severity score on items evaluating persecutory ideation and auditory hallucinations. Symptom severity on 5 items showed a modest (R = 0.09-0.13) but significant correlation with age. Cluster analysis identified 4 groups of participants: normative (55%), high symptom (11%), intermediate symptom (19%), and grandiose symptom (15%). Psychosis risk symptoms appear to be highly prevalent in Kenyan youth. Longitudinal studies are needed to determine the correlation of identified symptoms with transition to psychotic illness, as well as the associated functionality and distress, to develop appropriate intervention strategies., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: Depression in adolescents is a matter of concern because of its high prevalence, potential recurrence and impairment of functioning in the affected individual. The study sought to determine the prevalence of depressive symptoms among adolescents in Nairobi (Kenya) public secondary schools; make a comparison between day and boarding students; and identify associated factors in this population., Method: A random sample of school going adolescents was taken from a stratified sample of 17 secondary schools out of the 49 public secondary schools in Nairobi province. The sample was stratified to take into account geographical distribution, day and boarding schools, boys only, girls only and mixed (co-education) schools in the capital city of Kenya. Self administered instruments (EMBU and CDI) were used to measure perceived parental behaviour and levels of depression in a total of 1,276 students excluding those who had no living parent., Results: The prevalence of clinically significant depressive symptoms was 26.4%. The occurrence was higher in girls than it was in boys p<0.001. Students in boarding schools had more clinically significant depressive symptoms compared to day students (p=0.01). More girls exhibited suicidal behaviour than boys (p<0.001). There was a significant correlation between depressive symptoms and suicidal behaviour (p<0.001). CDI scores correlated positively with age (p<0.001) with an increase in CDI score with unit increase in age among students 14-17 years old, perceived rejecting maternal parenting behaviour (p<0.001), perceived no emotional attachment paternal behaviour (p<0.001), perceived no emotional attachment maternal behaviour (p<0.001), and perceived under protective paternal behaviour (p=0.005)., Conclusion: Perceived maladaptive parental behaviours are substantially associated with the development of depressive symptoms and suicidal behaviour in children.

Objective: To determine the knowledge, attitudes and beliefs about mental illness among staff in general hospitals., Method: A descriptive cross-sectional study conducted on staff in ten medical facilities in Kenya on their socio-demographic characteristics, professional qualifications and knowledge, attitudes and practice (KAP) toward mental illness., Results: A total of 684 general hospital staff: nurses (47.8%); doctors (18.1%); registered clinical officers (5.1%); students (9.5%) and support staff (19.5%) were recruited. About three quarters were under 40 years of age; most thought mental illness could be managed in general hospital facilities; the older the doctors were (age 40 years and older) the more they were aware of and positive towards mental illness. Most of the workers did not suspect any psychiatric symptoms among the patients they treated resulting in low referral rates for psychiatric services., Conclusion: There are gaps in knowledge on mental illness which could be constructively filled with Continued Medical Education (CME).

The global burden of neuropsychiatry diseases and related mental health conditions is enormous, underappreciated and under resourced, particularly in the developing nations. The absence of adequate and quality mental health infrastructure and workforce is increasingly recognized. The ethical implications of inequalities in mental health for people and nations are profound and must be addressed in efforts to fulfil key bioethics principles of medicine and public health: respect for individuals, justice, beneficence, and non-malfeasance. Stigma and discrimination against people living with mental disorders affects their education, employment, access to care and hampers their capacity to contribute to society. Mental health well-being is closely associated to several Millennium Development Goals and economic development sectors including education, labour force participation, and productivity. Limited access to mental health care increases patient and family suffering. Unmet mental health needs have a negative effect on poverty reduction initiatives and economic development. Untreated mental conditions contribute to economic loss because they increase school and work absenteeism and dropout rates, healthcare expenditure, and unemployment. Addressing unmet mental health needs will require development of better mental health infrastructure and workforce and overall integration of mental and physical health services with primary care, especially in the developing nations.

Objective: 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., Method: 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., Results: 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., Conclusion: 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.

Background: Knowledge of types and co-morbidities of disorders seen in any facility is useful for clinical practice and planning for services., Aim: 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., Study Design: Cross-sectional., Methods: 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., Results: 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., Conclusion: 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.

Objective: As there are no data on burnout in staff in Kenyan psychiatric hospitals, this study sought to document the level of burnout among the staff at the Mathari Psychiatric Hospital., Method: This was a cross sectional descriptive study of staff working at Mathari Psychiatric Hospital. The hospital staff completed self-administered questionnaires on socio-demographic characteristics and work environment and the Maslach Burnout Inventory - Human Services and General Survey. Analysis of the data was undertaken using the Statistical Package for the Social Sciences (SPSS) version 11.5., Results: Ninety-five percent of the respondents reported low to high emotional exhaustion while 87.8% reported depersonalization. Low accomplishment was reported by only 38.6% while 61.4% reported average to high personal accomplishment. Several work- and non-work-related factors including young age, number of own children, number of years worked, heavy workload and low morale were positively associated with various syndromes of burnout. Relationships at work, with family and society were generally rated as average. The staff made recommendations on how to improve the social support system and work performance., Conclusion: High levels of burnout were reported. These should be addressed at individual, collective and institutional levels.

Objective: To document the prevalence of obsessive-compulsive disorders (OCD) among patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya., Method: This was a descriptive cross-sectional study conducted at the Mathari Hospital., Results: 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., Conclusion: 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.

Background: Malaria is a major cause of morbidity and mortality in early childhood, yet its consequences for health and education during the school-age years remain poorly understood. We examined the effect of intermittent preventive treatment (IPT) in reducing anaemia and improving classroom attention and educational achievement in semi-immune schoolchildren in an area of high perennial transmission., Methods: A stratified, cluster-randomised, double-blind, placebo-controlled trial of IPT was done in 30 primary schools in western Kenya. Schools were randomly assigned to treatment (sulfadoxine-pyrimethamine in combination with amodiaquine or dual placebo) by use of a computer-generated list. Children aged 5-18 years received three treatments at 4-month intervals (IPT n=3535, placebo n=3223). The primary endpoint was the prevalence of anaemia, defined as a haemoglobin concentration below 110 g/L. This outcome was assessed through cross-sectional surveys 12 months post-intervention. Analysis was by both intention to treat, excluding children with missing data, and per protocol. This study is registered with ClinicalTrials.gov, number NCT00142246., Findings: 2604 children in the IPT group and 2302 in the placebo group were included in the intention-to-treat analysis of the primary outcome; the main reason for exclusion was loss to follow-up. Prevalence of anaemia at 12 months averaged 6.3% in the IPT group and 12.6% in the placebo group (adjusted risk ratio 0.52, 95% CI 0.29-0.93; p=0.028). Significant improvements were also seen in two of the class-based tests of sustained attention, with a mean increase in code transmission test score of 6.05 (95% CI 2.83-9.27; p=0.0007) and counting sounds test score of 1.80 (0.19-3.41; p=0.03), compared with controls. No effect was shown for inattentive or hyperactive-compulsive behaviours or on educational achievement. The per-protocol analysis yielded similar results. 23 serious adverse events were reported within 28 days of any treatment (19 in the IPT group and four in the placebo group); the main side-effects were problems of balance, dizziness, feeling faint, nausea, and/or vomiting shortly after treatment., Interpretation: IPT of malaria improves the health and cognitive ability of semi-immune schoolchildren. Effective malaria interventions could be a valuable addition to school health programmes.

Background: There is no information on the socio-demographic variations and determinants of Trauma and Post-Traumatic Stress Disorder (PTSD) in Kenyan adolescents., Objectives: To describe the traumatic experiences of Kenyan high school students and to determine the levels of Post-traumatic Stress Disorder (PTSD) among them, and in relation to sociodemographic variables., Design: A cross-sectional study of 1 110 students (629 males and 481 females), aged 12 to 26 years, using self-administered questionnaires., Method: The students completed questionnaires on sociodemographic data followed by the Trauma Checklist and the Child PTSD Checklist., Results: Being confronted with bad news was the most common type of trauma encountered in 66.7% of the subjects, followed by witnessing a violent crime and domestic violence; 23.2% and 16.5% of the subjects reported physical abuse and sexual abuse respectively. PTSD symptoms were common; avoidance and re-experiencing occurred in 75% of the students and hyperarousal was reported by over 50%. The number of traumatic events was positively correlated with the occurrence of PTSD. The prevalence of full PTSD was 50.5%, while partial PTSD was 34.8%. Male and female subjects were equally affected but the boarders were more affected (p < 0.05) and the differences between the schools were statistically significant (p = 0.000)., Conclusions: Kenyan secondary school students commonly experience traumatic events and have high rates of PTSD. Further studies are needed to determine the implications of these findings for their health and performance in school. The coping mechanisms need to be delineated and interventions put in place. Long-term studies are required to determine the role of such events in the causation of mental illness.

Background: The prevalence and frequency of bullying in Nairobi public secondary schools in particular and in Kenyan schools in general is not known. Knowledge of the extent of the problem is essential in developing effective interventions., Aim: To study the prevalence and frequency of bullying in Nairobi public secondary schools, Kenya., Methods: A self-report sociodemographic questionnaire and the Olweus Bullying Questionnaire of 1991 were administered to 1 012 students from a stratified sample of public secondary schools in Nairobi., Results: Between 63.2% (640) and 81.8% (828) of students reported various types of bullying, both direct and indirect, with significant variations found for sex, age, class and year of study, whether in day or boarding school, and the place where bullied. Being bullied was significantly associated with becoming a bully, in turn., Discussion: Bullying is highly prevalent in Kenyan schools. Further studies are needed to characterise bullies and victims in terms of personality and environmental factors that may be associated with or conducive to bullying, as well as to determine the long-term prognosis for both bullies and victims. Further research is also required to determine the most appropriate intervention.