PROF. KURIA MARY WANGARI

Knowledge of factors associated with relapse and remission after treatment for alcohol dependence en-
ables the clinician to offer better individualized treatment. It also enables the clinician to predict which
patients are likely to relapse and therefore offer appropriate and effective treatment to prevent relapse.
Objective: This study sought to determine the factors associated with remission and relapse in a group of
alcohol dependent persons undergoing Community Based Detoxification and Rehabilitation of alcohol
dependent persons. Method: One hundred and eighty eight (188) persons with Alcohol Use Disorder Identi-
fication Test (AUDIT) positive were subjected to outpatient detoxification for 10 days using a pair of
ampoules of high potency Vitamin B and C intravenously daily for 3 consecutive days, diazepam 5 mg
and carbamazepine 200 mg for 5 and 10 consecutive nights respectively on an outpatient basis. The par-
ticipants were visited twice a week (at home) by the community based health workers and reviewed once
a week by the principal investigator and attended a bimonthly group therapy session conducted in groups
of 20 s as part of the rehabilitation process. The groups were converted to self-help groups after 4
months to generate income for the participants. Results: Factors significantly associated with relapse to
alcohol use included severity of alcohol use and craving for alcohol at intake and the age of onset of alco-
hol drinking. Further there was a statistically significant predictive value in the mean score of alcohol re-
lated problems in the community based group (health,social, financial and legal). Conclusion: Identifying
factors that are associated with relapse after alcoholdependence treatment is likely to improve the effec-
tiveness of treatment and prevent relapse in persons at risk.

The course of HIV/AIDS in children has been transformed from an acute to a chronic one with the advent of
Anti-Retroviral Therapy. The aim of this study was to determine the prevalence and pattern of psychiatric
morbidity in HIV-infected children and adolescents between 6 and 18 years of age and the relationship between
their socio-demographic factors, immune suppression and psychiatric morbidity. The study was conducted at a
paediatric HIV clinic in Nairobi, between February and April 2010. One hundred and sixty-two HIV-infected
childrenandadolescentsagedbetween6and18yearsandtheirguardianswereinterviewed.Seventy-nine(48.8%)
of the study participants were found to have psychiatric morbidity. The most prevalent Diagnostic Statistical
Manual, 4th Edition TR psychiatric disorders were: Major depression (17.8%), Social phobia (12.8%),
Oppositional Defiant Disorder (12.1%) and Attention Deficit Hyperactivity Disorder (12.1%). Twenty-five
per cent of the study participants had more than one psychiatric disorder. The prevalence of psychiatric
morbidity in HIV-infected children ishigher than that found in children in the general population. There is
therefore a need to integrate psychiatric services into the routine care of HIV-infected children.

Affordability and availability of alcohol are factors that have been associated with alcohol dependence.
Ethanol content in the alcoholic beverages is an important determinant in alcohol dependence. Quality
control of alcoholic beverages available in the market is important in safeguarding the health of alcohol
consumers. Few studies in Kenya have determined the chemical composition of alcohol used by the study
participants. Objective: To determine the chemicalcomposition of alcoholic beverages used by a group of
alcohol dependent study participants. Design: The study was a clinical trial with pre and post measure-
ments. Method: The CIDI and WHO-ASSIST were administered to 188 alcohol-dependent persons at
intake and after six months. A researcher-designed socio demographic questionnaire was also adminis-
tered at intake. Alcohol beverages were randomly collected from the location of the study area and their
chemical composition analyzed using gas chromatography. Results: The mean AUDIT score of the par-
ticipant was 28.6 for male and 26.6 for females. Three of the alcohol samples collected was illicit brews col-
lected while 11 were licit. Four out of the eleven licit brews had ethanol levels that did not complied with
the set government standards. Conclusion: Illicit brews with high ethanol content are available in the
Kenyan market, while some of the manufacturers of the licit brew do not comply with government set
content recommendations.

The presence of depression in alcohol-dependent persons is likely to influence treatment process and outcomes. Identification of depression is important though not every depressed alcohol-dependent person requires treatment with antidepressants. Understanding the association between depression and alcohol dependence is essential for proper management of alcohol dependence. Objectives. To determine the prevalence of depression among alcohol-dependent persons before and after alcohol detoxification and rehabilitation. Design. Clinical trial with pre-/postmeasurements. Method. The CIDI and WHO-ASSIST were administered to 188 alcohol-dependent persons at intake and after six months. A researcher-designed sociodemographic questionnaire was also administered at intake. Results. The prevalence of depression among alcohol-dependent persons is high (63.8%) with a significant association between depression and the mean AUDIT score. At posttest, depressed participants had a statistically significant craving for alcohol. Conclusion. Alcohol dependence is associated with major depression.

Sexual dysfunction can impact a person’s ability to form or sustain intimate relationships and co morbidity between sexual dysfunction and anxiety as well as depression has been reported. Yet epidemiological, etiological, and health association to sexual dysfunction has only begun to be explored in Kenya. To determine the prevalence, types of sexual dysfunction and their socio demographic correlate in diabetic patients. Descriptive cross- sectional study The study was conducted at the outpatient diabetic clinic of Kenyatta National Hospital. This is the main referral hospital in Kenya. A total of 350 participants were enrolled in the study. The Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) questionnaires were used to evaluate sexual dysfunctions in female and male patients respectively. The participants were composed of 164 females aged between 18-74 years and 186 males aged between 19- 100 years. In males, prevalence of sexual dysfunctions were: erectile dysfunction (68.8%); orgasmic dysfunction (48.4%); sexual desire (81.7%); intercourse satisfaction (86.6%) and overall satisfaction (68.4%).The female sexual dysfunction was 36.6% and was categorized as mild (17.1%); moderate (18.3%) and severe (1.2%). Diabetic patients have a high prevalence of sexual dysfunction

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Caregivers of children with intellectual disability have a great responsibility that may be stressful. The psychological well-being of
the care giver may affect the quality of care given to children with intellectual disability. Objective. The objective of the study was
todeterminetheriskofdepressionincaregiversofchildrenwithintellectualdisability.Setting.ThestudywasconductedatGachie
Catholic Parish, Archdiocese of Nairobi (Kenya). Design. Cross sectional, descriptive study. Method. The study was conducted
among 114 caregivers registered at the Gachie Parish program (in Kenya) for the intellectual disabled children. A researcher-designed
social demographic questionnaire and the Beck depression inventory were administered to those that met the inclusion
criteria. Results. Seventy-nine percent (79%) of the caregivers were at risk of clinical depression. Conclusion. Majority of the caregiversofchildrenwithintellectualdisabilitywereatriskofdevelopingclinicaldepression

DSM-IV Axis I and II comorbidities and the pattern of Axis II diagnoses in patients admitted at Mathari (Psychiatric) Hospital, Nairobi, Kenya are unknown. To determine DSM-IV Axis I and II comorbidities and patterns of Axis II diagnoses in patients admitted at Mathari Hospital. Cross-sectional study on 148 randomly sampled patients. Twenty percent of the patients were confirmed for an Axis II diagnosis. Eighty-seven percent of the Axis II disorders were Cluster B Personality Disorders of various types. Using chi2 tests, significant associations were found between Axis I and II diagnoses and substance use/dependence (p < 0.001; 66.7%), mood disorder (p = 0.002; 46.7%) and schizophrenia (p < 0.001; 23.3%). The prevalence of personality disorders was lower than that reported in psychiatric patients in USA and Europe. The results are likely to be a true reflection of the actual epidemiological situation, but cannot be generalized to outpatient or general populations.

The desire for self-mutilation in the absence of any discernible psychopathology is relatively rare. Self-mutilation is most commonly a manifestation of an underlying psychopathology such as depression, schizophrenia, personality disorder, transexuality, body dysmorphic disorder and factitious disorder. In this article, a case in which a 29-year-old single Kenyan lady of African origin demanded a surgical operation to modify and reduce the size of her external genitalia is presented. Although female genital mutilation is still widespread in the country, this case is of interest in that the woman did not seek the usual circumcision but sought to specifically reduce the size of her labia minora so that she could feel like a normal woman. The unique challenges in her management are discussed. Possible aetiological factors in patients who demand surgical removal or modification of parts of their bodies without an obvious cause is discussed.

The desire for self-mutilation in the absence of any discernible psychopathology is relatively rare. Self-mutilation is most commonly a manifestation of an underlying psychopathology such as depression, schizophrenia, personality disorder, transexuality, body dysmorphic disorder and factitious disorder. In this article, a case in which a 29-year-old single Kenyan lady of African origin demanded a surgical operation to modify and reduce the size of her external genitalia is presented. Although female genital mutilation is still widespread in the country, this case is of interest in that the woman did not seek the usual circumcision but sought to specifically reduce the size of her labia minora so that she could feel like a normal woman. The unique challenges in her management are discussed. Possible aetiological factors in patients who demand surgical removal or modification of parts of their bodies without an obvious cause is discussed.

The desire for self-mutilation in the absence of any discernible psychopathology is relatively rare. Self-mutilation is most commonly a manifestation of an underlying psychopathology such as depression, schizophrenia, personality disorder, transexuality, body dysmorphic disorder and factitious disorder. In this article, a case in which a 29-year-old single Kenyan lady of African origin demanded a surgical operation to modify and reduce the size of her external genitalia is presented. Although female genital mutilation is still widespread in the country, this case is of interest in that the woman did not seek the usual circumcision but sought to specifically reduce the size of her labia minora so that she could feel like a normal woman. The unique challenges in her management are discussed. Possible aetiological factors in patients who demand surgical removal or modification of parts of their bodies without an obvious cause is discussed.