Psychiatric morbidity among patients attending a primary health care centre in a deprived community in Nairobi
Abstract
Studies done in recent years have shown that previous
estimates of the prevalence of psychological disorders
have had to be revised upwards, the majority of this
evidence emanating from the West (Reeler, 1987).
Research conducted in developing countries has shown
that the prevalence of psychiatric disorders is high
contrary to earlier reports during colonial era
(Carothers, 1947).
Gillis et al (1968) reported more psychiatric disturbance
amongst people living in overcrowded conditions and those
with least education. With this in mind, the author
commenced this study with the aim of finding out whether
the prevalence of psychiatric morbidity in a deprived
community was high. The follOwing hypotheses were tested:
(i) The prevalence of psychiatric morbidity in patients
from a deprived community is substantial.
(ii) Majority of patients with psychiatric morbidity
present predominantly with physical symptoms
rather than psychological symptoms.
The study was set out to:
(i) Find out the prevalence of psychiatric morbidity
among patients from a deprived community.
(ii) Attempt to identify any factors that may be
associated with psychiatric morbidity.
(iii) To make recommendations towards integration of
mental health care into existing primary health
care service in the area.
(iv) To gather any other useful information about
.. psychiatric morbidity.
The study was carried out in a city health centre
(Kariobangi) in Nairobi. A sample was selected using
systematic random sample method. A two-stage procedure
was used to detect and confirm patients with psychiatric
disorders. A locally validated version of the Self-
Rating Questionnare (SRQ) was used for screening and
standardised psychiatric interview (SPI) for confirmation
of the "Cases". ICD-9 was used for basing the psychiatric
diagnosis.
201 patients above 15 years of age were selected randomly
and interviewed. They were all physically examined,
managed and disposed of appropriately. For all cases,
infonnation on oocio-derrographic data, health, drug use and
abuse and mental state assessment data were collected.
Confirmed psychiatric cases were termed as PM (Psychiatric
Morbidity). The non-psychiatric cases were designated as
NPM (Non-Psychiatric Morbidity). Using the "SIM' corputer
analysis the data was analysed.
The significant findings were as follows:
(i) Of the 201 patients interviewed, 90 met the preestablished
criteria for.. psychiatric cases (PM = 44.8
per cent).
(ii) Psychoneuroses were the commonest group of disorders
(41.8 per cent of total sample) and consisted of
neurotic depression and anxiety neurosis.
(iii) 6 patients (3%) of the total sample had psychosis,
4 of whan had Manic-depressive psychosis (depressed)
and 2 had SChizophrenia.
(iv) 61.1% of the PM cases did not have any discernible
organic illness.
The implications of these findings are discussed.
Citation
Degree of Master of MedicinePublisher
School of Medicine
Description
This dissertation is presented in part
fulfilment for the Degree of Master of
Medicine in the
University of Nairobi