D. Kiima

Background: There has been no previous household population study of suicidal ideation and attempts in Kenya.
Therefore this study aimed to establish the prevalence of suicidal ideation and attempts in a rural population in
Kenya, and to assess risk factors.
Methods: An epidemiological survey of a household population, using standardised structured interviews. We
examined the prevalence of suicidal ideation and suicide attempts and the predictors of suicidal thoughts and
attempts, using STATA to calculate unadjusted and adjusted odds ratios.
Results: A quarter of the sample (24.1 %) had thought that life was not worth living (tedium vitae) at some point
in their lives, while a fifth had experienced death wishes at some stage. About 7.9 % reported suicidal thoughts and
1.9 % had made actual suicide attempts at some point in their lives. It can be seen that the prevalence of suicidal
thoughts was 0.7 %, 4.2 %, 3.7 % and 7.9 % for last week, last year, at some other time, and lifetime respectively,
while the prevalence of suicidal attempts was 0.5 %, 1.2 %, 0.7 and 1.9 % respectively.
In the adjusted analysis of factors associated with suicidal thoughts, being female (OR 1.8, p = 0.017), having CMD
(OR 2.7, p = 0.001), having a number of recent life events (OR 2.3, p = 0.001 for 2–3 life events and OR 2.6, p = 0.004
for 4 or more life events), and having a large social group size (OR 7.7, p = 0.006 for social group size of 4–8 and OR
9.1, p = 0.003 for social group size of 9 or more) were all associated with increased rates of life time suicidal
thoughts, but psychotic symptoms were no longer significant after adjustment for the other variables. In the
adjusted analysis of suicide attempts, having any psychotic symptoms (OR 5.1, p = 0.001) was the only factor
associated with suicide attempts after adjustment for other factors significant at the bivariate level.
Conclusion: Suicidal ideation and attempts pose a significant public health burden in this poor rural area of Kenya.
The findings are relevant for mental health promotion and prevention programmes, public education and
professional training programmes in relevant sectors, especially in front line health workers and social workers.

There have been few epidemiological surveys to establish prevalence and associated risk factors of psychosis in Sub-Saharan Africa. This paper reports a population-based epidemiological survey in rural Kenya of the prevalence of psychotic symptoms and their relationship with demographic, socio-economic and other risk factors. A random sample of 2% of all adults living in Maseno, Kisumu District of Nyanza province, Kenya (50,000 population) were studied, aiming for a sample size of 1,000 people. The psychosis screening questionnaire was used to assess the prevalence of psychotic symptoms in the preceding twelve months. The response rate was 87.6%. The prevalence of single psychotic symptoms in rural Kenya was 8% of the adult population, but only 0.6% had two symptoms and none had three or more psychotic symptoms in this sample size. Psychotic symptoms were evenly distributed across this relatively poor rural population and were significantly associated with presence of common mental disorders, and to a lesser extent with poor physical health and housing type. We conclude that single psychotic symptoms are relatively common in rural Kenya and rates are elevated in those with CMD, poor physical health and poor housing.

Introduction Sri Lanka has one of the highest suicide rates in the world, with recent protracted conflict and the tsunami aggravating mental health needs. This paper describes a project to establish a systematic "train the trainers" programme to integrate mental health into primary care in Sri Lanka's public health system and private sector.Methods A 40 hour training programme was delivered to curriculum and teaching materials were adapted for Sri Lanka, and delivered to 45 psychiatrists, 110 medical officers of mental health and 95 registered medical practitioners, through five courses, each in a different region (Colombo, Kandy, Jaffna, Galle and Batticola). Participants were selected by the senior psychiatrist of each region, on the basis of ability to conduct subsequent roll out of the training. The course was very interactive, with discussions, role plays and small group work, as well as brief theory sessions.Results Qualitative participant feedback was encouragin...

Mental disorders tend to be seen first in primary care settings around the world. To be helpful, classifications of mental disorders for primary care need to be simple. In response to these basic observations and requirements, a primary care version of the mental disorder section of ICD-10 has been developed by the WHO (ICD-10-PHC). This classification version has been used quite extensively internationally. The results of field trials with ICD-10-PHC are summarised here along with recommendations to make classifications and information systems more helpful to upgrade primary care of mental disorders around the world.

This article synthesizes the views of participants in two roundtables that were convened in Nairobi (March 2007) and London (July 2008) to identify key challenges to the prioritization of mental health in Africa and possible solutions. Participants included leading development experts and policy makers from head and country offices of international donors, national directors of mental health for several African countries, key mental health and public health professionals, epidemiologists, and an international nongovernmental organization. The challenges they identified to mainstreaming mental health include lack of understanding of the contribution of mental disorders to morbidity and mortality, competition for limited resources within health reform efforts, poor distribution of interventions and lack of inclusion of mental health among core generic health indicators, lack of economic research evidence, lack of a strategic approach to human resources planning, lack of partnerships with the social development sector, and mental health professionals' need for public health skills to effectively conduct national advocacy. Potential solutions include further investment in economic research, better strategic identification of the levers and entry points for integrating mental health into health sector reform plans, more vigorous engagement of mental health professionals in general health sector reforms, strengthening the linkage between mental health and social development, and intensive resource mobilization. In summary, partnerships, underpinned by collaborative training, research, and mutual dialogue with other health and nonhealth sectors, are needed.

... oriGiNal PaPer Traditional health practitioners and mental health in Kenya Marx Okonji, 1 Frank Njenga, 2 David Kiima, 3 James ... disorders commonly consult traditional health practitioners (THPs) in African countries, including South Africa (Zabow, 2007), Nigeria (Olugbile et al ...

Integration of mental health into primary care is essential in Kenya, where there are only 75 psychiatrists for 38 million population, of whom 21 are in the universities and 28 in private practice. A partnership between the Ministry of Health, the Kenya Psychiatric Association and the World Health ...