Background: Major Depression is the presence of sadness, empty or irritable mood, accompanied by somatic and cognitive changes. It is often unrecognized and untreated among patients with breast cancer, which causes amplification of physical symptoms, increased functional impairment, and poor treatment outcome. Factors associated with having depression among patients with breast cancer include age at diagnosis, tumor stage, surgery, and chemotherapy. There is limited data on depression among patients with breast cancer at Moi Teaching and Referral Hospital (MTRH). Objective: To determine the factors associated with depression among patients with breast cancer at MTRH. Methods: A cross-sectional study, in which Hamilton Depression Rating Scale (HAM-D) was used to diagnose and measure the severity of depression. A researcher-designed questionnaire was used to obtain socio-demographic and clinical information. The study was done at the breast cancer clinic, medical and surgical wards of MTRH, in which seventy-nine random consenting patients were interviewed from January to December 2017. Descriptive statistics were used for continuous data and categorical data. Chi-square and Fisher's exact tests were used to measuring for associations. Multivariate analysis by logistic regression was used to measure an independent association. Results: A total of seventy-nine patients were interviewed, 98% of them were females. The mean age was 40±7.8 years. The prevalence of depression among patients with breast cancer was 59.5%. Those who were employed were 3 times more likely to have depression compared to the unemployed (AOR=3.7, 95% CI: 1.07, 17.27; p=0.047). Patients on neo-adjuvant and palliative therapy were 9 times more likely to have depression (AOR=9.43, 95% CI: 1.5, 185.32; p=0.044 and AOR=9.5, 95% CI: 1.62, 181.81; p=0.039) respectively than those on adjuvant therapy. Patients with late-stage breast cancer had 61% increased odds of having depression (AOR=1.61, 95% CI: 0.63, 4.17; p=0.319) than patients with early-stage breast cancer. Conclusion: Being employed, the use of chemotherapy, and the late stage of cancer were significantly associated with having depression. Recommendation: Screening and interventions for depression should be initiated for all patients with breast cancer especially late stages of cancer, those on chemotherapy, and employed.

Background: Both patients and health care providers working in mental health facilities witness high rates of incidents that have the potential to jeopardize their safety. Despite this, there are few studies that have documented the kind of incidents that are experienced, or explored the potential contributors to these incidents, and solutions that would result in better safety. This study explored various types of safety related incidents occurring in mental facilities in Kenya, perceived contributing factors, and recommendations for improve. Methods: This mixed methods descriptive study was carried out betweenDecember 2019 – February 2020. It included 28 mental health staff across 14 mental health unit spread across the country. Results: All the participants reported having personally experienced an incident that threatened their safety or that of the patients. Most of the respondents (24/26. 91.67%) admitted to have experienced verbal aggression while 54.17%, (n=24) had experienced physical assault. Participating health care workers attributed the safety incidents to poor infrastructure, limited human resources, and inadequate medication to calm down agitated patients. Suggested solutions to improve patient safety included; improving surveillance systems, hiring more specialized healthcare workers, and provision of adequate supplies such as short-acting injectable psychotropic. Conclusion: Incidents that threaten patient and staff safety are common in mental health facilities in Kenya. There is need to strengthen staff capacity and reporting mechanisms, as well as invest in infrastructural improvements, to safeguard patient and staff safety in mental health facilities in Kenya.

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