BackgroundCriminal activity and social problems are recognized as important outcomes of substance use and abuse. Little research has been carried out on substance use among prison inmates in Kenya. General population surveys that have examined drug use usually omit this ‘hidden’ population which may offer insight into drug related morbidity and invaluable preventive measures. This study is set out to determine the lifetime prevalence and factors associated with substance use, including the most frequently used substances, among inmates at a government prison in Western Kenya.MethodsDesign: A cross-sectional descriptive study, using the WHO model questionnaire and an additional drug use and effects questionnaire among prisoners at the Eldoret Government of Kenya (GK) prison, Kenya.Setting: Study was carried out at the Eldoret G.K. prison, with a population of 1325 (1200 males and 125 females) inmates.Subjects: Three hundred and ninety five prisoners, who gave consent, were selected, consisting of 271 males (68.6%) selected by simple random sampling, and 124 females (31.4%) enrolled consecutively due to their small number. The mean age was 33.3 years (18–72, s.d. 9.8) while the mean number of years of formal education was 8.4 (0–15, s.d. 3.4).ResultsLifetime prevalence of substance use was 66.1%, while that of alcohol use was 65.1%. Both were significantly associated with male gender, urban residence and higher level of education. The lifetime prevalence of cigarette use was 32.7% while 22.5% admitted to chewing tobacco. Factors significantly associated with tobacco use were male gender, urban residence, being unmarried, younger age, lack of income in the past year. The prevalence of cannabis use was 21%, and this was associated with male gender, urban residence, being unmarried, and being a student in the past year. Other substances used included amphetamines (9.4%), volatile inhalants (9.1%), sedatives (3.8%), tranquillizers (2.3%), cocaine (2.3%), and heroine (1.3%). Users were commonly introduced to the habit by friends (70.8%), immediate family members (13.7%) and other close relatives (6.2%). Among those who reported lifetime substance use the common reasons attributed to the habit were the need to relax (26.5%), relieve stress (24.5%) and confidence to commit a crime (4.5%). Majority of those who reported alcohol use were already suffering ill effects.ConclusionsThere is a high prevalence of substance use among prisoners at the Eldoret G.K. prison. The increased morbidity and unpleasant psychosocial consequences of this habit suggest a need for establishment of substance use management programmes in Kenyan prisons.

BackgroundMost of the studies on epilepsy in Kenya and indeed the sub-Saharan region of Africa mainly focus on prevalence, psychiatric profile, and factors associated with increased seizure burden. This being the first Kenyan and sub-Saharan African study assessing quality of life among people living with epilepsy, it will identify their ‘intangible’ needs and enable evidence-based intervention that would ultimately lead to a comprehensive management and better outcome.MethodsDesign: A cross-sectional comparative study, using the World Health Organization Quality of Life questionnaire, a socio-demographic questionnaire, seizure burden and characteristics, drug and treatment profile questionnaires and the Mini-Mental state examination, among PLWE and those accompanying them, herein referred to as the normal healthy controls, attending the neurology clinic at Kenyatta National Hospital, Nairobi.Setting and subjects: Study was carried out between October 2006 and February 2007 at the neurology clinic in the hospital where three hundred consecutive subjects who satisfied the inclusion criteria and gave consent were recruited.Statistical tests used: Descriptive statistics were used to compute means, standard deviations as well as frequencies. Significance of associations was tested using the Chi square test statistic (x2), an independent samples t-test, analysis of variance (ANOVA) and a step-wise (forward) regression analysis. A p < 0.05 was considered statistically significant.ResultsThe mean quality of life among people living with epilepsy (49.90%) was significantly (p < 0.01) lower than that of the normal controls (77.60%) accompanying them and significantly impaired as compared to the hypothesized mean of 75±2.5%. Factors significantly (p < 0.05) associated with impairment of quality of life in those living with epilepsy were a low level of education, higher seizure burden, low annual income, unemployment, unskilled employment, and living in a rural residence.ConclusionsThe mean quality of life of people living with epilepsy at Kenyatta National Hospital was significantly impaired and lower than that of the normal controls accompanying them. A comprehensive epilepsy management program is recommended to address this problem and its associated risk factors for the people living with epilepsy in Kenya.

Background and aims Culturally relevant and feasible interventions are needed to address limited professional resources in sub‐Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder. This study tested the efficacy of a cognitive–behavioral therapy (CBT) intervention to reduce alcohol use among HIV‐infected outpatients in Eldoret, Kenya. Design Randomized clinical trial. Setting A large HIV outpatient clinic in Eldoret, Kenya, affiliated with the Academic Model Providing Access to Healthcare collaboration. Participants A total of 614 HIV‐infected outpatients [312 CBT; 302 healthy life‐styles (HL); 48.5% male; mean age: 38.9 years; mean education 7.7 years] who reported a minimum of hazardous or binge drinking. Intervention and comparator A culturally adapted six‐session gender‐stratified group CBT intervention compared with HL education, each delivered by paraprofessionals over six weekly 90‐minute sessions with a 9‐month follow‐up. Measurements Primary outcome measures were percentage of drinking days (PDD) and mean drinks per drinking day (DDD) computed from retrospective daily number of drinks data obtained by use of the time‐line follow‐back from baseline to 9 months post‐intervention. Exploratory analyses examined unprotected sex and number of partners. Findings Median attendance was six sessions across condition. Retention at 9 months post‐intervention was high and similar by condition: CBT 86% and HL 83%. PDD and DDD marginal means were significantly lower in CBT than HL at all three study phases. Maintenance period, PDD – CBT = 3.64 (0.696), HL = 5.72 (0.71), mean difference 2.08, 95% confidence interval (CI) = 0.13 – 4.04; DDD – CBT = 0.66 (0.96), HL = 0.98 (0.098), mean difference = 0.31, 95% CI = 0.05 – 0.58. Risky sex decreased over time in both conditions, with a temporary effect for CBT at the 1‐month follow‐up. Conclusions A cognitive–behavioral therapy intervention was more efficacious than healthy lifestyles education in reducing alcohol use among HIV‐infected Kenyan outpatient drinkers.

Background Human Immunodeficiency Virus (HIV) infection causes a myriad of neurological complications including cognitive deficits referred to as HIV-Associated Neurocognitive Disorders (HAND). With the introduction of combination antiretroviral therapy, there has been an epidemiological shift in cognitive disorders with a decline in the more severe HIV-Associated Dementia (HAD) to an increase in the less severe HAND: Asymptomatic Neurocognitive Impairment (ANI) and HIV-associated Mild Neurocognitive Disorder (MND). Central Nervous System (CNS) involvement in HIV interferes with cognitively demanding activities of daily living and hence a worse quality of life. Early diagnosis is delayed until symptoms are overt. Methods We conducted a cross sectional analytical study of HIV infected persons on antiretroviral therapy attending HIV clinic. A systematic random sampling was done to select 360 patients. An interviewer administered structured questionnaire was used to collect socio-demographic data while the CD4 count and viral load were retrieved from the Academic Model Providing Access to Healthcare (AMPATH) database. Pearson’s Chi Square test was used to compare proportions while independent sample t- test was used to compare continuous variables between the patients diagnosed with HAND and those without HAND. Logistic regression model was used to assess the factors associated with HAND. Results The mean age of the study participants was 40.2 years. The overall prevalence of HAND was (81.1%) N = 292. Mild HAND (ANI and MND) was present (78.6%) N = 283, Severe HAND (HAD) (2.5%) N = 9. The factors associated with HAND were older age OR: 1.06 (95% CI: 1.03, 1.10), male gender OR: 0.48 (95% CI: 0.24, 0.97), Advanced WHO clinical staging OR: 2.45 (95% CI: 1.20, 5.01) and a higher level of education; secondary/tertiary OR: 0.16 (95% CI: 0.07, 0.38); 0.11 (95% CI: 0.04, 0.35). Conclusion The prevalence of HAND in this study population was found to be high (81.1%). Older age and advanced WHO clinical staging were associated with an increased risk of hand while higher level of education and male gender were protective.

Background There is documented evidence of the increase of alcohol and substance use among college students globally. Increased morbidity and associated maladaptive socio-occupational outcomes of the habit with early dependence and mortality have also been reported. Majority of the substance use related studies conducted in low- and middle- income countries mainly look at health- related risk behaviour control mechanisms that focus on the social environment domain, with few or almost none focusing on those embedded within the person (self- control). This study focuses on the relationship between substance use and personality traits (in the self-control domain), among college students in a low- middle- income country. Methods Design. A cross- sectional descriptive study that used the self- administered WHO Model Core and the Big Five Inventory Questionnaires to collect information among students in Colleges and Universities in Eldoret town, Kenya. Setting. Four (1- university campus; 3- non- university) tertiary learning institutions were randomly selected for inclusion. Subjects. Four hundred students, 100 from each of the 4 institutions; selected through a stratified multi-stage random sampling, who gave consent to participate in the study. Associations between various variables, personality traits and substance use were tested using bivariate analysis, while the strength/ predictors of association with substance use was ascertained through multiple logistic regression analyses. A finding of p ≤ 0.05 was considered statistically significant. Results The median age was 21 years (Q1, Q3; 20, 23), approximately half 203 (50.8%) were male, with majority 335 (83.8%) from an urban residence and only 28 (7%) gainfully employed. The lifetime prevalence of substance use was 41.5%, while that of alcohol use was 36%. For both, a higher mean neuroticism score [substance use- (AOR 1.05, 95%CI; 1, 1.10: p = 0.013); alcohol use- (AOR 1.04, 95%CI; 0.99, 1.09: p = 0.032)] showed increased odds of lifetime use, while a higher mean agreeableness score [substance use- (AOR 0.99, 95%CI; 0.95, 1.02: p = 0.008); alcohol use- (AOR 0.99, 95%CI; 0.95, 1.02: p = 0.032)] showed decreased odds of lifetime use. A higher mean age (AOR 1.08, 95% CI; 0.99, 1,18: p = 0.02) of the students also showed an 8% increase in odds of lifetime alcohol use. The lifetime prevalence of cigarette use was 8.3%. Higher mean neuroticism (AOR 1.06, 95%CI; 0.98, 1.16: p = 0.041) and openness to experience (AOR 1.13, 95%CI; 1.04, 1.25: p = 0.004) scores showed increased odds of lifetime cigarette smoking, whereas being unemployed (AOR 0.23, 95%CI; 0.09, 0.64: p<0.001) had a decreased odd. Other substances reported included cannabis 28 (7%), sedatives 21 (5.2%), amphetamines 20 (Catha edulis) (5%), tranquilizers 19 (4.8%), inhalants 18 (4.5%), cocaine 14 (3.5%), with heroin and opium at 10 (2.5%) each. Among the 13 participants who reported injecting drugs, 10 were female and only 3 were male; this finding was statistically significant (p = 0.042). Conclusions The prevalence of substance use among college and university students in Eldoret is high and associated with high neuroticism and low agreeableness personality traits. We provide directions for future research that will examine and contribute to a deeper understanding of personality traits in terms of evidence- based approach to treatment.

Background Alcohol use disorder is prevalent globally and in Kenya, and is associated with significant health and socio-economic consequences. Despite this, available pharmacological treatment options are limited. Recent evidence indicates that intravenous (IV) ketamine can be beneficial for the treatment of alcohol use disorder, but is yet to be approved for this indication. Further, little has been done to describe the use of IV ketamine for alcohol use disorder in Africa. The goal of this paper, is to: 1) describe the steps we took to obtain approval and prepare for off-label use of IV ketamine for patients with alcohol use disorder at the second largest hospital in Kenya, and 2) describe the presentation and outcomes of the first patient who received IV ketamine for severe alcohol use disorder at the hospital. Case presentation In preparing for the off-label use of ketamine for alcohol use disorder, we brought together a multi-disciplinary team of clinicians including psychiatrists, pharmacists, ethicists, anesthetists, and members of the drug and therapeutics committee, to spearhead the process. The team developed a protocol for administering IV ketamine for alcohol use disorder that took into account ethical and safety issues. The national drug regulatory authority, the Pharmacy and Poison’s Board, reviewed and approved the protocol. Our first patient was a 39-year-old African male with severe alcohol use disorder and comorbid tobacco use disorder and bipolar disorder. The patient had attended in-patient treatment for alcohol use disorder six times and each time had relapsed between one to four months after discharge. On two occasions, the patient had relapsed while on optimal doses of oral and implant naltrexone. The patient received IV ketamine infusion at a dose of 0.71 mg/kg. The patient relapsed within one week of receiving IV ketamine while on naltrexone, mood stabilizers, and nicotine replacement therapy. Discussion & conclusions This case report describes for the first time the use of IV ketamine for alcohol use disorder in Africa. Findings will be useful in informing future research and in guiding other clinicians interested in administering IV ketamine for patients with alcohol use disorder.

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Substance use disorders (SUDs) are often under-diagnosed & undertreated among psychiatric in-patients, yet are frequent & associated with adverse outcomes 1,2 . This study examined the 12-month prevalence & clinical & socio-demographic factors associated with SUDs among inpatients at a psychiatric in-patient facility in western Kenya. This was a cross-sectional study. One hundred and thirty one consenting adult in-patients consecutively discharged from the facility between March 2015 & February 2016 were interviewed. The Mini International Neuropsychiatric Interview Version 7.0 for DSM-5 was used to assess for SUD and other mental disorder diagnoses. A researcher designed questionnaire was used to collect socio-demographic & clinical data. Descriptive statistics were used to explore the data while inferential statistics used to assess associations.