Mental disorders are estimated to account for 12% of the global burden of disease, but only a minority of persons affected receive basic treatment. It is sufficient to say that, in some developing countries, debilitating traumatic depression affects more people than HIV/AIDS, tuberculosis, and malaria combined. Clinical trials demonstrate that locally available, affordable interventions in community and primary care settings are effective for the management of mental disorders and that with a good therapy mostly of these people can return to productive lifes. To address this problem, WHO advocates integrating mental health in primary care; however the limited evidence-based datas have prevented efforts to develop such services.

Filling this gap was the aim of a collaboration research project between the University of Turin (Italy), the Africa Mental Health Foundation (AMHF), World Friends Onlus (an italian NGO) and Ruaraka Uhai Neema Hospital (an integrated health centre realized and supported by World Friends, located in Nairobi North District, that works mostly with patients from slums): to assess the prevalence of the most common psychiatric disorders present on the field in order to plan the training of the local staff on how to recognize and treat these diseases. This project is a part of a more comprehensive survey that AMHF is carrying out in slum areas: “Baseline Study on the situation and governance of Mental Health and Services in Kenya”.

We found that 57% of the outpatients of Neema hospital currently suffer of a psychiatric disorder, mainly Major Depressive Disorder, Bipolar Disorder, Pain Disorder, Generalized Anxiety Disorder and Post Traumatic Stress Disorder.

Prof. David Ndetei (director of AMHF and Professor of Psychiatry at Nairobi University) and Jean-louis Aillon (the Italian doctor, intern in the research, in the picture) will present and discuss the results of the study on:


The evidence-based growth of the efficacy and cost-effectiveness of treatments for these disorders raises the possibility of delivering huge health and economic benefits to the entire society. Our experience could be the first step for the development of an integrate care system for treating mental ilness in Kenya.
The new constitution gives to Kenian people the right to health, nonetheless there will never be real health without mental health!


Prof. David M. Ndetei, Professor of Psychiatry University of Nairobi and Director of Africa Mental Health Foundation (AMHF)

Doct. Jean-louis Aillon, intern in the research project (University of Turin and European Social fund).     Jean.84@libero.it / 0735525429

People in the western world tent to identify cancer as the worst enemy of healthy “developed” nations and in fact it is. However, not many people are aware that the face of the disease is now changing. Rates around the world are dramatically increasing, effecting very badly developing countries, which are not yet prepared to face it. Prevalence of the disease has risen significantly over the past two decades. In Kenya it numbers among the top 10 causes of mortality. In 2004, the mortality rate for cancer was 129/100,000 people which is similar to that in high income countries although Kenya has a much lower incidence rate. Over 90% of all cancers are identified late, in clinical stages III and IV, when treatment is very difficult, if not impossible.

Against this background, there are no specialised health facilities to deal with treatment of cancers in the country. Due to various reasons, including lack of funds available for the provision of health care, cancer is not on the MOH list of priorities. Topping the public health agenda are HIV/AIDS, reproductive health, maternal & child health, malaria control, environmental health, sexually transmitted infections (STI), TB control, and an expanded program for immunization, among others.

The situation of breast cancer is particularly serious. It is the most common malignancy in women, both in developed and developing countries, where it is constantly increasing.  By the end of 2020, 70% of cases will occur in the developing world. At present, 45% of new cases and 69% of deaths caused by this type of tumour occur in developing countries. Kenya is no exception. Data from Nairobi Cancer Registry show that breast cancer is the first tumour in women, consisting of 23.3% of all cases and immediately followed by cancer of the cervix. Those female types of cancer together consist of 43.3% of all cancer cases in the country. It seems then that the burden of cancer weighs particularly on women. In addition, the disease is rising prominently: from 20% of all cases in 2006, to 23.3% in 2009.

Compared to developed countries, the incidence of cancer within Kenya shows a different but nonetheless threatening aspect. Whereas cancer is generally a disease of the elderly population, due to increased susceptibility as duration of exposure to carcinogens increases, the relatively younger age distribution in the country is a reflection of higher frequency of early occurring female gender cancers. Against all western countries’ statistics, breast cancer is mostly found in women of a premenopausal age and it is more aggressive, presenting with metastases in 88% of cases. To avoid the worst outcomes of the disease, it is therefore necessary to act at a very early stage of prevention, starting from schools.

Guidelines of the World Health Organization (WHO) identify early diagnosis as the pillar of prevention in order to control the spread of breast cancer and reduce mortality rates.  The two main aspects of prevention are:

1. Awareness. Information about the risk factors related to the development of the disease. Knowing and acting on modifiable factors can reduce the impact of breast cancer, while awareness of non-modifiable factors (family history etc...) gives rise to an increase in attendance to medical examinations.

2. Early diagnosis. It is life-saving in most cases. An early diagnosis strategy is made up of the following steps:
a) Breast Self Examination (BSE). On a monthly base, it is necessary for the women to gain awareness of the body’s features and eventual changes, in order to empower them and communicate to the doctor any unusual finding.
b) Clinical breast exam performed by a doctor. On a yearly base.
c) Mammogram and ultrasound screening.

BSE and breast exams are of fundamental importance both in western countries and Africa, while the application of mammography in developing countries is more problematic. Due to the young age of the patients and given the woeful lack of resources in these countries, a screening-based anti-tumour programme would not be effective, where the remaining two elements cannot be lacking.
The severity of breast cancer cases in Kenya is partially due to lack of information, especially among poor women, who have no access to the health system and are not even included in official statistics about cancer incidence. 

At World Friends’ Ruaraka Uhai Neema Hospital of Nairobi, the motto is “Early Detection is a Woman’s Best Protection”. Nearly 97% of women who are diagnosed with breast cancer at an early stage survive for more than 5 years.
For the whole month of October, qualified doctors will perform clinical breast examinations free of charge, so that even the poorest women of Nairobi’s slums will have access to prevention.
This month World Friends will have a special focus on the issue, implementing a comprehensive breast cancer prevention programme, not only in the hospital but also in various schools of Nairobi’s slums, where a Safe Motherhood programme is ongoing and where pupils are receptive to public health notions. Health and social workers from World Friends and Neema Hospital will introduce the main themes of breast cancer prevention (description of the disease, definitions, BSE, nutritional behaviour etc...) to the teachers, the students and their families. Some meetings with the community will be held by health professionals, at World friends/ ACREF centre in Babadogo slum.

Helena Pes
World Friends Kenya 

Sources:
• World Health Organization (WHO)
• KEMRI – Kenya Medical Research Institute
• East African Medical Journal – vol. 87 n.1
• World Friends