brain

BRAIN AND MENTAL HEALTH

10% of global disease burden is attributable to mental health

The burden of mental, neurological and substance use disorders, otherwise referred to as brain and mental health conditions is enormous. and contributes to over 10% of global burden of disease.

The Mental health burden in LMIC is underestimated

There are few empirical studies from low- and middle-income countries (LMIC) on the epidemiology of brain and mental health conditions. which may bias estimates downwards. However, accumulating evidence suggests that the burden of these disorders is increasing in LMIC because of population growth, increase in the aging population, urbanization, adoption of western lifestyles, and epidemiological transitions e.g. those with neuroinfections surviving with brain and mental health conditions.

Research Gaps
Serious challenges and gaps remain with regard to:
  • Incomplete understanding of epidemiology and nature of brain and mental health disorders.
  • Capacity of health care systems to deliver care.
  • Prioritization and investment in care and research.
  • Extent and consequences of stigma and discrimination.
  • Violation of human rights and mitigation strategies, among others.
Opportunities in research
To address these gaps, future efforts should be dedicated towards sensitizations for raising prioritization of brain and mental health disorders by policy makers and increasing awareness among the public, conduct of properly designed research on these conditions and their comorbidities to inform planning of care and policy, strengthening of health care systems capacity to provide high-quality care and implementation and evaluation of cost-effective interventions to improve outcomes.
An eye on the future
These future plans should be premised on principles of universal health coverage such as multisectoral collaboration, people-centeredness, public health or primary health care approach, accessibility and quality, equity, transparency, and sustainability.
Project Title
Project Description
Demographic, psychosocial and clinical factors associated with postpartum depression in Kenyan women We conducted a study on maternal depression in women living in an urban, poor resource community and attending maternal and child health clinics. We recruited 188 women in their 3rd trimester and followed them up to 6-10 weeks in the postpartum period to determine the rates and risk factors of antepartum depression and postpartum depression. We also evaluated the feasibility of integrating a screening tool, the Edinburgh PostNatal Depression Scale (EPDS), into primary care. Prior to commencing the study, our team translated, back translated and adapted the EPDS screening tool into Kiswahili.
Interpersonal psychotherapy for depression and posttraumatic stress disorder among HIV-positive women in Kisumu, Kenya (MIND study) Gender-Based Violence is a key concern due to its enormous contribution to depression and PTSD. We conducted a pilot study for a randomized controlled trial that sought to investigate the role that Interpersonal Psychotherapy Treatment (IPT) can play for HIV-positive women diagnosed with both depression and PTSD and history of gender-based violence. In the study we trained lay therapists to deliver IPT.
Khat use and health effects in a rural Khat growing population in Kenya: a household survey Khat use has been at the forefront of national and regional political debates as stakeholders attempt to weigh the negative health effects of the stimulant versus the economic value the plant commissions in the form of foreign exchange. This study was designed to assess the negative and positive effects of Khat use using a Concurrent Parallel Mixed Methods design. The main objective of the study was to investigate the safety, health effects and factors associated with, experiences and perceptions of Khat growing and chewing in selected areas of Kenya.
Infectious diseases, mental health and immunity This was the first research study in the region to examine the impact that an infectious disease like malaria has on the immune system and mental health, specifically depression. In this community-based household survey, we assessed the point prevalence of adult malaria in a malaria endemic area (Western Kenya) and evaluated the prevalence of common mental illnesses in the study population: depression, psychosis, suicidal behavior, substance abuse and related these to cytokine and CD4 cell levels. Overall, 1,190 randomly sampled participants were recruited in the survey using the Walter Reed, Kombewa Health Demographic Survey System.
A Sequential, Multiple Assignment Randomized Trial (SMART) For Non-Specialist Treatment of Common Mental Disorders in Kenya: Leveraging The Depression And Primary-Care Partnership For Effectiveness-Implementation Research (DAPPER) Project (SMART-DAPPER) We partnered with local and national mental health stakeholders in Kenya to evaluate: (1) non-specialist delivery of evidence-based depression and/or PTSD treatment integrated within an existing healthcare center in regard to clinical effectiveness and implementation parameters; including (2) costs and cost-benefit ratios for depression and/or PTSD care. Given that evidence-based psychotherapy and second-generation antidepressants are the two leading first-line treatments for depression and/or PTSD and are feasible to deliver in Kenya, our goal was to test an implementation strategy for improving equitable access to these treatments by integrating them within primary care.
Epilepsy Pathway Innovation in Africa

 

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This is a multisite study in 4 countries namely Kenya, Ghana and Tanzania and leverages on innovative approaches to reduce the diagnostic and treatment gaps for epilepsy. We partner with multiple stakeholders to create awareness and raise prioritization of epilepsy, train health workers in increasing detection and management of epilepsy, develop and test apps to improve epilepsy diagnosis and use of short message reminders to reduce nonadherence to anti-seizure medication.
Deployment of high-density portable EEG system and computer modelling of EEG signals in rural Kenya.

 

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The standard EEG commonly used in low- and middle-income countries is fraught with limitations, such as low sensitivity; time consuming process of recording and preparation; technical challenges of deployment in the field; and lack of human expertise for interpretation. aims to develop and deploy a high-density portable EEG system for use in Africa. The proposed work will inform feasibility and intervention studies on utility of technological solutions in reducing diagnostic and treatment gap for epilepsy in Kilifi, Kenya.
Project Title Project description
Integrating tobacco use cessation in Family AIDS Care and Education Services (FACES) in Kisumu, Kenya. (IN-TOUCH study)

 

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The study evaluates if a tobacco use cessation program focusing on breadth (brief intervention) or depth (intensive intervention) would be more cost-effective in supporting Kenyans living with HIV to quit tobacco use.  In addition, we assess barriers to and facilitators of integrating tobacco dependence treatment within HIV care to inform policy.
Genetics of PTSD in African Ancestry Populations: Enhancing discovery by addressing inequality

 

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The broad goal is to advance PTSD genetic discovery and address inequity in PTSD genetics research by leveraging a partnership between the PGC – PTSD and a network of African investigators, including the Neuropsychiatric Genetics in African Populations (NeuroGAP) program
Integration of a collaborative care model for mental health services into HIV care for pregnant and postpartum women in Kenya (the Tunawiri Study) To integrate proven mental health services using a collaborative care model, combined with a low intensity evidence-based intervention (problem solving therapy, while targeting known social determinants of HIV-related health for PPWH (stigma and IPV)
Integration of stepped care for Perinatal Mood and Anxiety Disorders among Women Living with HIV in Kenya (IPMH study) To develop and evaluate a stepped care model (Integrated Perinatal Mental Health Program) for promoting mental health among pregnant and postpartum women in Kenya. We integrate three evidence-based interventions (1) universal mental health screening, (2) the Problem Management Plus (PM+) counseling intervention for women experiencing PMAD, and (3) telepsychiatry for women with severe symptoms and evaluate effectiveness and implementation outcomes of the package in a Hybrid Type II cluster-randomized trial in 20 healthcare facilities in Western Kenya
Caring for Providers to Improve Patient Experience (CPIPE) Study To assess the effectiveness of the CPIPE intervention on person-centered maternity care and examine mechanisms of impact.It targets health care providers, managing stress and burnout in these providers. This is a pragmatic multicountry trial ongoing in Kenya and Ghana.
Suicide Bereavement and Impact of Stigma on help-seeking behaviour in Kiambu and Nairobi counties. We investigate depression and suicidal thoughts among individuals who have experienced the loss of a loved one by suicide. Additionally, the cultural underpinnings that create and exacerbate stigmatizing behaviors towards suicide will be explored. Study findings will be used to highlight the mental health needs of those who are bereaved by suicide and how stigma affects help-seeking behavior.
Mental Health Needs Assessment among Kenyan athletes: A mixed methods study To better understand the burden of mental illness, risk and protective factors associated, barriers to access and mental health service utilization. Findings from this study will 1) give us a baseline data on existing mental health burden, 2) identify the gaps between the current state of mental health support and services and what is required to meet the needs of the athletes 3) help prioritize resources, shape mental health policies, and tailor interventions to improve the overall well-being of the athletes.
Burden of suicide and suicidal behaviour: A scoping review This scoping review study aims to map the available evidence on the burden of suicide and suicidal behavior in Kenya. It will investigate patterns and trends across various demographics, explore risk and protective factors, and assess existing prevention and intervention strategies. The review will identify knowledge gaps and provide insights to guide policy development and implementation of Kenya’s suicide prevention strategies.
Epilepsy Pathway Innovation in Africa

 

Learn More

This is a multisite study in 4 countries namely Kenya, Ghana and Tanzania and leverages on innovative approaches to reduce the diagnostic and treatment gaps for epilepsy. We partner with multiple stakeholders to create awareness and raise prioritization of epilepsy, train health workers in increasing detection and management of epilepsy, develop and test apps to improve epilepsy diagnosis and use of short message reminders to reduce nonadherence to anti-seizure medication.
Deployment of high-density portable EEG system and computer modelling of EEG signals in rural Kenya.

 

Learn More

The standard EEG commonly used in low- and middle-income countries is fraught with limitations, such as low sensitivity; time consuming process of recording and preparation; technical challenges of deployment in the field; and lack of human expertise for interpretation. aims to develop and deploy a high-density portable EEG system for use in Africa. The proposed work will inform feasibility and intervention studies on utility of technological solutions in reducing diagnostic and treatment gap for epilepsy in Kilifi, Kenya.
The UZIMA-DS (UtiliZe health Information for Meaningful impact in East Africa through Data Science)

 

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Aims to create a scalable and sustainable platform to apply novel approaches to data assimilation and advanced artificial intelligence/machine learning-based methods to serve as early warning systems to:

 

(i) Improve health outcomes for at-risk mothers and children

(ii)  Improve mental health outcomes for at-risk adolescents and young adults in Kenya.

 

Dr. Linnet Ongeri

Research Scientist


Dr. Ongeri is a researcher in the field of mental health working at the Centre for Clinical Research in the Kenya Medical Research Institute (KEMRI) and a current postdoctoral fellow in the Global Initiative for Neuropsychiatric Genetics Education in Research (GINGER) program, hosted jointly by the Harvard T.H. Chan School of Public Health and the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard.

Having worked in Kenya for the last 10 years as a medical doctor and later as a psychiatrist, Dr. Ongeri has gained meaningful experience and understanding of the dire needs of the mentally ill in my country. A key challenge that stands out in both her clinical and research experience is the growing burden of mental illnesses. Mental disorders are not only highly prevalent but also highly disabling if left untreated. Despite the existence of effective treatment, 75% of people with serious mental illness in the region do not receive any treatment. Inaccessibility of mental health treatment is a key contributor to the large treatment gap.

The country and region grapple with inadequate financial and human resource allocation to mental health. Innovative programs that tap into already existing physical and human resources can go a long way to addressing this gap. It is for this same reason that she has been drawn to research approaches that strive to design culturally and regionally appropriate models of integrating mental health care in primary health care at community level.

Dr. Simon Kariuki


Ms. Tele Kapkirwok


Ms. Christine Njambi


Yvonne Anyango Ochieng

Research Scientist


Ms. Yvonne is a healthcare research scientist and a registered public health nutritionist with expertise in knowledge synthesis, sharing, and translation. As a member of the Academia and Research Network’s Scaling Up Nutrition (SUN) initiative, Ms. Yvonne focuses on the intersection of mental health, nutrition, and public health, aiming to drive improvements in health outcomes through integrated, evidence-based.