Supplementary Material for: Dementia screening in rural Kenya: The prevalence and impact of screening positive for dementia

Introduction: In Kenya, there is a lack of data on the number of people with dementia. In this article, we aim to estimate the number of community-dwelling older adults (aged 60 years and above) that are potentially living with dementia in rural Kenya. Methods: Recruitment of older adults occurred through adopting a convenience approach based on the catchment areas served by trained ten Community Health Workers (CHWs). Screening was conducted using the Brief Community Screening Instrument for Dementia (CSI-D), in which prevalence ratios were reported. Regression analyses were run to understand the association between screening outcome and wellbeing, social isolation, and employment status (adjusted for age, sex, literacy, geography, and social status). Results: Of the 3,546 older adults who were screened for dementia, 652 screened positive (PR = 0.18, 95%CIs 0.17 to 0.20). Back estimating screen positives based on established sensitivity and specificity of the tool against a gold standard (clinical diagnosis), yielded a prevalence of 9.4% (0.09, 95%CIs 0.08 to 0.11). Screening positive for dementia was associated with poorer quality of life (B =-0.17, p<0.001) and loneliness (B= 0.28, p<0.001). Conclusion: There is potentially 258,000 older adults living with dementia in Kenya, who likely have poorer outcomes. We need to encourage a timely diagnosis and develop better ways to support people living with dementia in Kenya and other resource-limited settings

Feasibility and effectiveness of nurses and clinical officers in implementing the WHO mhGAP intervention guide: Pilot study in Makueni County, Kenya

Objectives:(1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mentalhealth Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability,improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in aKenyan rural setting. (2) To identify any gaps that can be contributed towards future research.Methods:This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya.This county had a population of approximately one million people, with no psychiatrist or clinical psychologist.We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously beenexposed to the community mental health awareness campaigns, while being subjected to screening for themhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability usingWHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depressionusing Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using theWashington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure ques-tionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement ScreeningTest (ASSIST). These measurements were at the baseline, followed by the training for the health professionals onusing the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention.Results:Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months afollow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most dependingon condition also received medication. Overall, there was significant decline in disabilities, improvement inseizure control and improvement in clinical outcomes on the identified mental disorders.Conclusions:Trained, supervised and supported nurses and clinical officers can produce good outcomes using themhGAP-IG for mental health

Foliar diseases and the associated fungi in rice cultivated in Kenya

We conducted a survey to assess the occurrence and severity of rice blast and brown spot diseases on popular cultivars grown in the Busia, Kirinyaga, and Kisumu counties of Kenya in 2019. Working with agricultural extension workers within rice production areas, we interviewed farmers (n = 89) regarding their preferred cultivars and their awareness of blast disease, as this was the major focus of our research. We scored the symptoms of blast and brown spot and assessed the lodging, plant height, and maturity of the crops (days after planting). Furthermore, we collected leaf and neck tissues for the assessment of the prevailing fungal populations. We used specific DNA primers to screen for the prevalence of the causal pathogens of blast, Magnaporthe oryzae, and brown spot, Cochliobolus miyabeanus, on asymptomatic and symptomatic leaf samples. We also conducted fungal isolations and PCR-sequencing to identify the fungal species in these tissues. Busia and Kisumu had a higher diversity of cultivars compared to Kirinyaga. The aromatic Pishori (NIBAM 11) was preferred and widely grown for commercial purposes in Kirinyaga, where 86% of Kenyan rice is produced. NIBAM108 (IR2793-80-1) and BW196 (NIBAM 109) were moderately resistant to blast, while NIBAM110 (ITA310) and Vietnam were susceptible. All the cultivars were susceptible to brown spot except for KEH10005 (Arize Tej Gold), a commercial hybrid cultivar. We also identified diverse pathogenic and non-pathogenic fungi, with a high incidence of Nigrospora oryzae, in the rice fields of Kirinyaga. There was a marginal correlation between disease severity/incidence and the occurrence of causal pathogens. This study provides evidence of the need to strengthen pathogen surveillance through retraining agricultural extension agents and to breed for blast and brown spot resistance in popular rice cultivars in Kenya

Mental Health Outcomes of Psychosocial Intervention Among Traditional Health Practitioner Depressed Patients in Kenya

Task-shifting in mental health such as engaging Traditional Health Practitioners (THPs) in appropriate management of mental disorders is crucial in reducing global mental health challenges. This study aims to determine the outcomes of using evidence-based mental health Global Action Programme Intervention guide (mhGAP-IG) to provide psychosocial interventions among depressed patients seeking care from THPs. THPs were trained to deliver psychosocial interventions to their patients screening positive for mild to severe depression on Beck’s Depression Inventory (BDI). Assessments were conducted at 0, 6 and 12 weeks and Analysis of Variance (ANOVA) performed to determine the change in depression scores over the three time period. BDI mean score was 26.52 before intervention and reduced significantly at 6 (13%) and 12 (35%) weeks after intervention. 58 and 78% of patients showed reduction in symptoms of depression at 6 and 12 weeks. It is therefore crucial to engage THPs in the care of patients with depression and the need for inclusion of training packages; and other mental disorders in order to establish and maintain collaboration between THPs and conventional health workers and promote evidence-based care among marginalized populations. Moreover, further research on randomized control trials of mhGAP-IG intervention versus usual care is required