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

Airway microbiome-immune crosstalk in chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) has significantly contributed to global mortality, with three million deaths reported annually. This impact is expected to increase over the next 40 years, with approximately 5 million people predicted to succumb to COPD-related deaths annually. Immune mechanisms driving disease progression have not been fully elucidated. Airway microbiota have been implicated. However, it is still unclear how changes in the airway microbiome drive persistent immune activation and consequent lung damage. Mechanisms mediating microbiome-immune crosstalk in the airways remain unclear. In this review, we examine how dysbiosis mediates airway inflammation in COPD. We give a detailed account of how airway commensal bacteria interact with the mucosal innate and adaptive immune system to regulate immune responses in healthy or diseased airways. Immune-phenotyping airway microbiota could advance COPD immunotherapeutics and identify key open questions that future research must address to further such translation

Biophysical interactions in tropical agroforestry systems

sequential systems, simultaneous systems Abstract. The rate and extent to which biophysical resources are captured and utilized by the components of an agroforestry system are determined by the nature and intensity of interac-tions between the components. The net effect of these interactions is often determined by the influence of the tree component on the other component(s) and/or on the overall system, and is expressed in terms of such quantifiable responses as soil fertility changes, microclimate modification, resource (water, nutrients, and light) availability and utilization, pest and disease incidence, and allelopathy. The paper reviews such manifestations of biophysical interactions in major simultaneous (e.g., hedgerow intercropping and trees on croplands) and sequential (e.g., planted tree fallows) agroforestry systems. In hedgerow intercropping (HI), the hedge/crop interactions are dominated by soil fertility improvement and competition for growth resources. Higher crop yields in HI than in sole cropping are noted mostly in inherently fertile soils in humid and subhumid tropics, and are caused by large fertility improvement relative to the effects of competition. But, yield increases are rare in semiarid tropics and infertile acid soils because fertility improvement does not offse

Improving adherence to ante-retroviral treatment for people with harmful alcohol use in Kariobangi, Kenya through participatory research and action

<p>Abstract</p> <p>Background</p> <p>Harmful alcohol use has been linked to the spread of HIV in Kenya. It also adversely affects those on antiretroviral (ARV) treatment through poor compliance. This study using participatory research and action (PRA) methods sought to understand factors related to alcohol abuse and non-adherence and to formulate appropriate interventions in a sample of people living with HIV and AIDS (PLWHA) who were also abusing alcohol, at Kariobangi in Nairobi, Kenya.</p> <p>Methods</p> <p>Entry into the community was gained through previous PRA work in that community and PLWHA were recruited through snowballing. Working together with the community members, the researchers explored the participants’ understanding of alcohol use problem, its effects on compliance to ARV treatment and discussed possible action areas through PRA techniques that included focus group and market place discussions; visual aids such as spider diagrams, community mapping and ranking. Follow-up meetings were held to discuss the progress.</p> <p>Results</p> <p>By the final meeting, 67 PLWHA and 19 community members had been recruited. Through discussions, misconceptions regarding alcohol use were identified. It emerged that alcohol abuse was poorly recognised among both the community and health workers. Screening for alcohol use was not routinely done and protocols for managing alcohol related disorders were not available at the local health centres providing ARVs. The study participants identified improving communication, psychoeducation and screening for alcohol use as possible action areas. Poverty was identified as a major problem but the interventions to mitigate this were not easy to implement.</p> <p>Conclusion</p> <p>We propose that PRA could be useful in improving communication between the health workers and the clients attending primary health care (PHC) facilities and can be applied to strengthen involvement of support groups and community health workers in follow up and counselling. Integrating these features into primary health care (PHC) would be important not only to PLWHA but also to other diseases in the PHC setting . Longer term follow up is needed to determine the sustained impact of the interventions. Problems encountered in the PRA work included great expectations at all levels fostered by handouts from other donors and cognitive impairment that interfered with constructive engagement in some of the PLWHA.</p