Emergency mental health and psychosocial support for survivors of post-election violence in Eldoret, Kenya

Objective: To describe the design and delivery of emergency mental health and psychosocial support services for the survivors of Post-Election Violence in Eldoret, Kenya.Design: A longitudinal intervention.Setting: The North Rift Valley region in western Kenya.Subjects: A total of 80,772 survivors received mental health and psychosocial support services.Results: Counselling and Psychological First Aid services were successfully offered to most survivors in the North Rift Valley region. Common issues addressed included looking for lost relatives, sudden traumatic death of relatives, anger at their attackers, feelings of revenge, fear of seeing the corpse, loss of all property and source of livelihood and denial.Conclusion: It is possible and necessary to integrate a mental health and psychosocial support intervention into a disaster response even in limited resource settings. Further studies are recommended to evaluate the effectiveness of this approach

The Prevalence of Post-Traumatic Stress Disorder Among Sexually Abused Children at Kenyatta National Hospital in Nairobi, Kenya

Background: Post-Traumatic Stress Disorder (PTSD) develops following some stressful events. There has been increasing recognition that children who have been exposed to traumatic events like child sexual abuse can develop post-traumatic stress disorder just like adults.Objective: To determine prevalence of PTSD in sexually abused children seen at the Gender Based Violence Recovery Centre at Kenyatta National Hospital.Design: A cross sectional descriptive study.Setting: Gender Based Violence Recovery Centre – Kenyatta National Hospital. Subjects One hundred and forty-nine (n = 149) sexually abused children were recruited in the study.Results: The mean age 14.8%boys and 85.2% girls was 13.2 years (SD 4.2) the age at which sexual abuse most frequently (55%) occurred between 15-17 years. Sixty three percent of children reported that the perpetrator was known to them, and 76.5% of perpetrators used verbal or physical force during sexual assault. The prevalence of PTSD among the sexually abused children was 49%. PTSD was significantly associatedwith shorter duration of sexual abuse i.e. daily which is 67% as compared to months which is 4.7% (p = 0.005), Greater severity of injuries sustained during assault (p = 0.023), parent’s marital status those whose parents were married or cohabiting 40% were affected as compared to 52% whose parents were separated or divorced (p = 0.003) and the family's way of sorting out their disagreements was also significantly associated with PTSD. Parents who sorted their disagreement by talking was at 31% while thosewho sorted their disagreement by fighting was at 67% (p < 0.001).Conclusions: This study highlights the high prevalence of PTSD among sexually abused children presenting at Kenyatta National Hospital Nairobi-Kenya. PTSD is associated with the degree of physical or verbal abuse during sexual abuse, injuries during assault, and parent-child relationships. These findings are important in formulation of appropriate prevention and care interventions to be implemented by families and other stakeholders

The Impact of Health Workers' Strikes on Health Outcomes and Health Service Utilization in Low-and Middle-Income Countries: A Systematic Review

Background The impact of strikes by health workers in low- and middle-income countries (LMIC) is not well described. We systematically reviewed articles on the impact of health workers’ strikes on health outcomes or health service utilization in LMIC. Methods We searched PubMed, SCOPUS, Web of Science, and Google Scholar databases on May 27, 2019. To be included for review, articles met the following criteria: (1) reported on a strike that involved at least one cadre of health worker; (2) reported on a strike in a LMIC; (3) included at least one outcome related to patient or population health or health service utilization; and, (4) included a reference group or time period. There were no date or language restrictions. We modified the Newcastle-Ottawa Tool to appraise study quality. The review is registered with PROSPERO (CRD42019124989). Findings Among 5,123 articles, eleven articles met inclusion criteria. Studies examined 20 strikes in LMIC from 1991 to 2017 (average strike length of 32·9 days), with five studies from Kenya, two each from India and Nigeria, and one each from Malawi and South Africa. The majority of studies reported hospital admissions or inpatient mortality. Generally, health service utilization decreased during strike periods, but changes in patient mortality and other health outcomes varied. Study quality was heterogenous with most studies reporting from a single facility or medical department. Interpretation Compared to high-income settings, our study suggests a more complex picture of the effect of strikes by health workers on health and health service utilization outcomes in LMIC

Reliability and validity of the RS14 in orphaned and separated adolescents and youths in western Kenya

Purpose: The 14-item Resilience Scale (RS14) is a tool designed to measure psychological resilience. It has been used effectively in diverse populations. However, its applicability is largely unknown for Sub-Saharan adolescent populations and completely unknown for orphaned and separated adolescents and youths (OSAY), a highly vulnerable population for whom resilience may be critical. This study assesses the RS14\u27s psychometric properties for OSAY in Uasin Gishu County, Kenya. Methods: Survey responses from a representative sample of 1016 OSAY (51.3% female) aged 10-25 (mean = 16; SD = 3.5) living in institutional and home-based environments in Uasin Gishu County were analyzed. The RS14\u27s psychometric properties were assessed by examining internal consistency reliability, confirmatory factor analyses, and convergent validity using correlations between resilience and each of social support and depression. Sub-analyses were conducted by age and sex. Results: Resilience scores ranged from 14-98 (mean = 66; SD = 19) with no sex-based significant difference. Resilience was higher for those aged ≥18 (mean = 69; range = 14-98) versus age \u3c18 (mean = 65; range = 14-98). Internal consistency was good (Cronbach\u27s α = .90). Confirmatory factor analysis indicated a 1-factor solution, though the model fit was only moderate. Resilience was positively correlated with social support in all ages (.22; p \u3c .001) and negatively correlated with depression in individuals age \u3c18 (-.22; p \u3c .001). The relationship between resilience and depression in individuals age ≥18 was statistically significant only in females (-.17; p = .026). Conclusion: This study demonstrates reasonable evidence that the RS14 is both valid and reliable for measuring psychological resilience in the population of OSAY in western Keny

The relationships between resilience, care environment, and social-psychological factors in orphaned and separated adolescents in Western Kenya

The relationships between care environment, resilience, and social factors in orphaned and separated adolescents and youths (OSAY) in western Kenya are complex and under-studied.Survey responses from OSAY living in Charitable Children’s Institutes (CCI) and family-based care settings (FBS) in Uasin Gishu County, Kenya were used to examine the associations between 1) care environment and resilience; 2) care environment and factors thought to promote resilience (e.g. social, family, and peer support); and 3) resilience and these same resilience-promoting factors, using multivariable linear and logistic regressions. This cross-sectional study included 1202 OSAY (50.4% female) aged 10–26 (mean = 16; SD = 3.5). The mean resilience score in CCIs was 71 (95%CI = 69–73) vs. 64 (95%CI = 62–66) in FBS. OSAY in CCIs had higher resilience (β = 7.67; 95%CI = 5.26–10.09), social support (β = 0.26; 95%CI = 0.14–0.37), and peer support (β = 0.90; 95%CI = 0.64–1.17) than those in FBS. OSAY in CCIs were more likely to volunteer than those in FBS (OR = 3.72; 95%CI = 1.80–7.68), except in the male subgroup. Family (β = 0.42; 95%CI = 0.24–0.60), social (β = 4.19; 95%CI = 2.53–5.85), and peer (β = 2.13; 95%CI = 1.44–2.83) relationships were positively associated with resilience in all analyses. Volunteering was positively associated with resilience (β = 5.85; 95%CI = 1.51–10.19). The factor most strongly related to resilience in both fully adjusted models was peer support. This study found a strong relationship between care environment and resilience. Care environment and resilience each independently demonstrated strong relationships with peer support, social support, and participating in volunteer activities. Resilience also had a strong relationship with familial support. These data suggest that resilience can be developed through strategic supports to this vulnerable population

Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis

The burden of HIV/AIDS and other transmissible diseases is higher in prison and jail settings than in the non-incarcerated communities that surround them. In this comprehensive review, we discuss available literature on the topic of clinical management of people infected with HIV, hepatitis B and C viruses, and tuberculosis in incarcerated settings in addition to co-occurrence of one or more of these infections. Methods such as screening practices and provision of treatment during detainment periods are reviewed to identify the effect of community-based treatment when returning inmates into the general population. Where data are available, we describe differences in the provision of medical care in the prison and jail settings of low-income and middle-income countries compared with high-income countries. Structural barriers impede the optimal delivery of clinical care for prisoners, and substance use, mental illness, and infectious disease further complicate the delivery of care. For prison health care to reach the standards of community-based health care, political will and financial investment are required from governmental, medical, and humanitarian organisations worldwide. In this review, we highlight challenges, gaps in knowledge, and priorities for future research to improve health-care in institutions for prisoners

Posttraumatic stress disorder in the World Mental Health Surveys

Background: Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. Methods: Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. Results: The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. Conclusions: PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD

COP27 climate change conference: Urgent action needed for Africa and the world

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The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas

Although earlier trauma exposure is known to predict posttraumatic stress disorder (PTSD) after subsequent traumas, it is unclear whether this association is limited to cases where the earlier trauma led to PTSD. Resolution of this uncertainty has important implications for research on pretrauma vulnerability to PTSD. We examined this issue in the World Health Organization (WHO) World Mental Health (WMH) Surveys with 34 676 respondents who reported lifetime trauma exposure. One lifetime trauma was selected randomly for each respondent. DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) PTSD due to that trauma was assessed. We reported in a previous paper that four earlier traumas involving interpersonal violence significantly predicted PTSD after subsequent random traumas (odds ratio (OR)=1.3-2.5). We also assessed 14 lifetime DSM-IV mood, anxiety, disruptive behavior and substance disorders before random traumas. We show in the current report that only prior anxiety disorders significantly predicted PTSD in a multivariate model (OR=1.5-4.3) and that these disorders interacted significantly with three of the earlier traumas (witnessing atrocities, physical violence victimization and rape). History of witnessing atrocities significantly predicted PTSD after subsequent random traumas only among respondents with prior PTSD (OR=5.6). Histories of physical violence victimization (OR=1.5) and rape after age 17 years (OR=17.6) significantly predicted only among respondents with no history of prior anxiety disorders. Although only preliminary due to reliance on retrospective reports, these results suggest that history of anxiety disorders and history of a limited number of earlier traumas might usefully be targeted in future prospective studies as distinct foci of research on individual differences in vulnerability to PTSD after subsequent traumas.The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123, and EAHC 20081308), (the Piedmont Region (Italy)), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline