Psychiatric morbidity and care among children and adolescents with HIV infection at Moi Teaching and Referral Hospital Eldoret, Kenya

Abstract

Background: Psychiatric disorders and Human Immunodeficiency Virus (HIV) have been closely interlinked with a causal relationship having been demonstrated. Among children, mental disorders are a significant public health concern due to the rising prevalence. The effects of HIV and mental disorders are pervasive and have far reaching implications that impact on communities not only psychologically but also economically and socially. However, little is known about the prevalence of mental disorders among children/adolescents with HIV-infection and no studies have been done on the integration of mental health services in HIV programs in our setting. This will be the first study in our setting to give a baseline of prevalence of psychiatric disorders among children and adolescents living with HIV while assessing the integration of mental health services in the HIV program. Objective: This study investigated the prevalence, patterns and factors associated with psychiatric morbidity, while assessing models of mental health care of HIV-infected children and adolescents between 6 and 17 years of age at Moi Teaching and Referral Hospital (MTRH). Methods: This was a descriptive cross-sectional study. Systematic sampling was applied for children and adolescent group while a census was done for health workers group. Mini Neuropsychiatric Interview for children and adolescents (MINI Kid) was used for measuring psychiatric morbidity among children and adolescents with HIV infection. Researcher designed questionnaires were used to obtain sociodemographic data, clinical information and assess the models of mental health care. The study was carried out at MTRH - Academic Model Providing Access to Healthcare (AMPATH) Paediatric/Adolescent HIV clinics. Approval to conduct the study was given by Institutional Research and Ethics Committee. A total of 391 children/adolescents with HIV infection and 18 health workers at the AMPATH Paediatric/Adolescent HIV clinics were interviewed. Descriptive statistics were used to explore the data while Chi-square test, Fishers exact test and logistic regression were used to assess associations. Associations with p value less than 0.05 were considered statistically significant. Results The median age of the children/adolescents was 13 years (Interquartile range 11 - 15 years) with a female to male ratio of 1:1. The prevalence of psychiatric morbidity among children/adolescents with HIV infection was 57.5%. The most prevalent disorders were Anxiety 53.8%, Suicidality 10.4% and Attention Deficit Hyperactivity Disorder 10%. Only 1.7 % of those who screened positive for psychiatric disorders had ever been diagnosed or received treatment. Compared to those less than 12 years, children older than 12 years had 36.3% reduced odds of having anxiety (O.R=0.637 C.I [0.425 - 0.953]; p value=0.028). Majority of the health workers were nurses and clinical officers and half of them were below 35 years of age. Only 38.9% of them had any mental health training. Mental health services available at the clinics were psychological counselling, group therapy and review by a psychiatrist once a week. There was ongoing screening for mental disorders and referral to appropriate mental health services. Conclusion There was a high prevalence of psychiatric disorders among children/adolescents with HIV infection. Most of the disorders were undiagnosed and therefore not treated despite there being mental health services at the AMPATH Pediatrics/Adolescent HIV clinics. Recommendations Due to the high prevalence, screening for psychiatric disorders should be enhanced at the AMPATH Paediatric/Adolescent HIV clinics. Secondly, health care providers should have regular training on basic mental health care. Finally, further research needs to be done to determine the barriers to access and uptake of mental health services at the AMPATH Paediatric/Adolescent HIV clinics.