Aims Dual epidemics of HIV and alcohol use disorders, and a dearth of professional resources for behavioral treatment in sub-Saharan Africa, suggest the need for development of culturally relevant and feasible interventions. The purpose of this study was to test the preliminary efficacy of a culturally adapted 6-session gender-stratified group cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. Design Randomized clinical trial comparing CBT against a usual care assessment only control Setting A large HIV outpatient clinic in Eldoret, Kenya, part of the Academic Model for Providing Access to Healthcare collaboration Participants 75 HIV-infected outpatients who were antiretroviral (ARV)-initiated or ARV-eligible and who reported hazardous or binge drinking Measurements Percent drinking days (PDD) and mean drinks per drinking days (DDD) measured continuously using the Timeline Followback Findings There were 299 ineligible and 102 eligible outpatients with 12 refusals. Effect sizes of the change in alcohol use since baseline between the two conditions at the 30-day follow-up were large (d=.95, p=.0002, mean difference=24.93 (95% CI: 12.43, 37.43) PDD; d=.76, p=.002, mean difference=2.88 (95% CI: 1.05, 4.70) DDD). Randomized participants attended 93% of the 6 CBT sessions offered. Reported alcohol abstinence at the 90-day follow-up was 69.4% (CBT) and 37.5% (usual care). Paraprofessional counselors achieved independent ratings of adherence and competence equivalent to college-educated therapists in the U.S. Treatment effect sizes were comparable to alcohol intervention studies conducted in the U.S. Conclusions Cognitive-behavioral therapy can be successfully adapted to group paraprofessional delivery in Kenya and may be effective in reducing alcohol use among HIV-infected Kenyan outpatients.

Two-thirds of those with HIV worldwide live in sub-Saharan Africa. Alcohol use is associated with the HIV epidemic through risky sex and suboptimal ARV adherence. In western Kenya, hazardous drinking was reported by HIV (53%) and general medicine (68%) outpatients. Cognitive behavioral treatment (CBT) has demonstrated strong efficacy to reduce alcohol use. This article reports on a systematic cultural adaptation and pilot feasibility study of group paraprofessional-delivered CBT to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. Following adaptation and counselor training, five pilot groups were run (n=27). Overall attendance was 77%. Percent days abstinent from alcohol (PDA) before session 1 was 52%-100% (women) and 21-36% (men), and by session 6 was 96%-100% (women) and 89%-100% (men). PDA effect sizes (Cohen's d) between first and last CBT session were 2.32 (women) and 2.64 (men). Participants reported treatment satisfaction. Results indicate feasibility, acceptability and preliminary efficacy for CBT in Kenya.

Procurement of pharmaceutical drugs plays a crucial role in management of health. It was observed there was lack of some drugs in Narok County Referral Hospital (NCRH) and it caused a strain on the patients. The patients have to buy the prescribed medication from chemists and pharmacies outside the hospital which is very expensive. The availability of drugs is crucial in the functioning of any hospital. For there to be continuity of flow of drugs, their procurement procedure is essential and objectives should be considered in the procurement of pharmaceutical drugs. The objective of this study was to determine the factors affecting the procurement of pharmaceutical drugs in Narok County Referral Hospital. Descriptive crosssectional study was carried out at NCRH. Key personnel strategically positioned to integrate with the procurement process of pharmaceutical drugs were included in the study. Data was collected using semi-structured interviews and later transcribed to notes. Themes were deductively analysed before being presented in prose. The study revealed that the procurement procedures in NCRH followed the recommended guidelines. Major challenges included bureaucracy, poor quantification, inadequate transportation options and lack of skilled personnel. The main factors facing the procurement of drugs in NCRH were inadequate funding resulting in delay in paying the suppliers and poor quantification. The study recommended that checks and measures should be included, thorough auditing to avoid misappropriation of funds and provide accountability and transparency. Inventory management training by government is needed to equip the staff with knowledge and skills on use and management of the various registers and forms for proper quantification.

Despite electronic medical record (EMR) systems being in existence since 1972, it's only recently that governments worldwide have begun to encourage digitalization of medical records (Agency for Healthcare Research and Quality, n.d.). With EMR systems being the current way of hospital management and also delivering healthcare in Kisii Teaching and Referral Hospital (KTRH), there is need for a review of their impact and to understand the challenges faced in their adaptation and use. The objective of the study was to determine the impact of EMR on healthcare delivery in KTRH. A cross-sectional qualitative study was carried out in KTRH among healthcare providers. An interview guide was used to collect data which was coded and analyzed using content analysis. The study revealed that the EMR systems have led to an increase in the productivity of healthcare delivery, better clinical decision making and better collaboration between healthcare providers. The major challenges identified were shortage of funding for the adaptation and utilization of the EMR systems, computer illiteracy among staff and shortage of ICT staff in the facility. The EMR systems in KTRH have had a great impact on health care delivery system by increasing collaboration between personnel, increased productivity of health care providers bringing about patient and provider satisfaction. There is need to increase the amount of funding for the utilization of the systems, to employ more ICT staff and carry out refresher training to the staff so as to increase the benefits of the EMR systems and tackle the shortcomings.

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.

Bipolar causes significant psychosocial morbidity, because it frequently affects patients' relationships with family members and colleagues at work (Vornik& Hirschfeld, 2005). It also leads to increased family burden due to the increased cost of care and need for monitoring and support. This research thus aims to identify the effects that lead to relapse in bipolar patients and inform management interventions that will help reduce the rate of relapse. JustificationThis study is of significance to health workers, informal caregivers, families, colleagues, relatives and friends of those with bipolar so as to create awareness about the effects of bipolar among all those affected. It will also be important to other research as an inclusion to current literature. Research Objectives A. Broad objectiveTo determine effects of bipolar relapse on the patient. B. Specific objectives i.To determine the effects of bipolar on patients' work ii.To determine the effects of bipolar on patients' family iii. To determine the effects of Bipolar on school iv. To determine the effects of bipolar on patients' relationships

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Mental health problems are one of the main causes of the burden of disease worldwide [1]. Mental health problems constitute the largest single source of world economic burden, with an estimated global cost of £1.6 trillion (or US$2.5 trillion) -greater than cardiovascular disease, chronic respiratory disease, cancer, and diabetes on their own [2]. Mental illness is projected to