The work was carried out at Kenyatta National Hospital, which is Kenya's main referral hospital & also the teaching hospital for University of Nairobi.
INTRODUCTION Quitting tobacco smoking is associated with improvements in mental health, including reductions in depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms. This study aimed to identify barriers and facilitators to successful cessation among tobacco using patients with concomitant mental illness undergoing a group tobacco cessation intervention program in Kenya. METHODS This was a qualitative study embedded in a group behavioral tobacco cessation intervention trial in Nairobi, Kenya. Data were collected between March 2017 and August 2019. Group behavioral tobacco cessation meetings were held bimonthly for the first 3 months and monthly for the next 3 months for each intervention group. Field notes of group discussions were used to identify key themes using an inductive approach. Data were transcribed, coded, analyzed, interpreted and categorized by two team members. RESULTS A purposive sample of 49 tobacco-using patients with concomitant mental illness participated in 5 focus groups. Mean (SD) age was 33.4 (6) years, 22.4% were women, 98% smoked cigarettes, and mean (SD) Fagerström score was 5.9 (1.5). Barriers experienced included: 1) peer influence, 2) withdrawal symptoms, 3) fear of complete cessation, 4) other substance use, and 5) end-of-month disputes. Facilitators used by participants included: 1) oral stimulation, and 2) spousal and friend support. CONCLUSIONS Tobacco users with concomitant mental illness face important barriers when trying to quit. Thus, more frequent and intensive tobacco cessation interventions may be needed, including supplementary group behavioral counseling by telephonic follow-up or online group sessions.
BackgroundThe rate of tobacco use among people with mental illness is nearly twice that of the general population. Psychotropic medications for tobacco cessation are relatively expensive for most Kenyans. Behavioral counseling and group therapy are effective lower cost strategies to promote tobacco cessation, yet have not been studied in Kenya among individuals with concomitant mental illness.Methods/designOne hundred tobacco users with mental illness who were part of an outpatient mental health program in Nairobi, Kenya were recruited and allocated into intervention and control groups of the study (50 users in intervention group and 50 users in control group). Participants allocated to the intervention group were invited to participate in 1 of 5 tobacco cessation groups. The intervention group received the 5As (Ask, Advise, Assess, Assist and Arrange) and tobacco cessation group behavioral intervention, which included strategies to manage cravings and withdrawal, stress and anxiety, and coping with depression due to withdrawal; assertiveness training and anger management; reasons to quit, benefits of quitting and different ways of quitting. Individuals allocated to the control group received usual care. The primary outcome was tobacco cessation at 24 weeks, measured through cotinine strips. Secondary outcomes included number of quit attempts and health-related quality of life.DiscussionThis study will provide evidence to evaluate the efficacy and safety of a tobacco cessation group behavioral intervention among individuals with mental illness in Kenya, and to inform national and regional practice and policy.Trial registrationTrial registration number: NCT04013724.Name of registry: ClinicalTrials.gov.URL of registry: https://register.clinicaltrials.govDate of registration: 9 July 2019 (retrospectively registered).Date of enrolment of the first participant to the trial: 5th September 2017.Protocol version: 2.0.
Background Tobacco use is associated with exacerbation of tuberculosis (TB) and poor TB treatment outcomes. Integrating tobacco use cessation within TB treatment could improve healing among TB patients. The aim was to explore perceptions of health workers on where and how to integrate tobacco use cessation services into TB treatment programs in Uganda. Methods Between March and April 2019, nine focus group discussions (FGDs) and eight key informant interviews were conducted among health workers attending to patients with tuberculosis on a routine basis in nine facilities from the central, eastern, northern and western parts of Uganda. These facilities were high volume health centres, general hospitals and referral hospitals. The FGD sessions and interviews were tape recorded, transcribed verbatim and analysed using content analysis and the Chronic Care Model as a framework. Results Respondents highlighted that just like TB prevention starts in the community and TB treatment goes beyond health facility stay, integration of tobacco cessation should be started when people are still healthy and extended to those who have been healed as they go back to communities. There was need to coordinate with different organizations like peers, the media and TB treatment supporters. TB patients needed regular follow up and self-management support for both TB and tobacco cessation. Patients needed to be empowered to know their condition and their caretakers needed to be involved. Effective referral between primary health facilities and specialist facilities was needed. Clinical information systems should identify relevant people for proactive care and follow up. In order to achieve effective integration, the health system needed to be strengthened especially health worker training and provision of more space in some of the facilities. Conclusions Tobacco cessation activities should be provided in a continuum starting in the community before the TB patients get to hospital, during the patients’ interface with hospital treatment and be given in the community after TB patients have been discharged. This requires collaboration between those who carry out health education in communities, the TB treatment supporters and the health workers who treat patients in health facilities.
The harmful effects of sexual abuse are long lasting. Sexual abuse when associated with violence is likely to impact negatively on the life of the victim. Anecdotal reports indicate that there was an increase in the number of cases of sexual violence following the 2007 post election conflict and violence in Kenya. Although such increases in sexual abuse are common during war or conflict periods the above reports have not been confirmed through research evidence. The purpose of the current study is to establish the trend in numbers of reported cases of sexual abuse at Kenyatta National Hospital over a 4-year period (2006-2009). Data on sexually abused persons for the year 2006-2009 was retrieved from the hospitals record. A researcher designed questionnaire was used to collect relevant data from the completed Post Rape Care (PRC) form. The PRC-Ministry of Health no. 363 (MOH363) form is mandatorily completed by the physician attending the sexually abused patient. There was an increase in the number of cases of sexual abuse reported in 2007 election year in Kenya, with a statistically significant increase in the sexually abused male cases. Sexual crime is more prevalent when there is war or conflict.
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