childhood adversity and its relationship to psychological trauma in nodding syndrome (ns) affected...
TRANSCRIPT
CHILDHOOD ADVERSITY AND ITS RELATIONSHIP TO PSYCHOLOGICAL TRAUMA IN NODDING
SYNDROME (NS) AFFECTED CHILDREN
BYAMAH MUTAMBA, JAMES OKELLO,JANET NAKIGUDDE,SEGGANE MUSISI
BUTABIKA HOSPITAL/MAKSPHPCAF CONFERENCE;MBARARA
JULY 2014
ACKNOWLEDGEMENTS
GCC/IPT-F Study team & communitiesMaKSPHMOH
OUTLINE
• BACKGROUND• AIM• METHODS• FINDINGS• DISCUSSION• CONCLUSION/WAY FORWARD
BACKGROUND
• >3000 children and adolescents affected by Nodding Syndrome (NS) in post conflict Northern Uganda-mainly the Acholi sub region.
• Adverse childhood experiences occur in the post war situation( family context, including interpersonal trauma, poverty and deprivation)
BACKGROUND
• Children in post conflict situations have high rates of mental health problem.
• Co morbidity the norm: Major Depression, Generalised Anxiety disorder, PTSD (Derluyn 2004, Kohrt 2008, Moscardino 2008,Okello 2013)
• PTSD rates : Okello et al ,2007;26.8% (Abducted) vs 12.8% (Non
abducted), Klassen et al,2010: 33% in Child soldiers)
BACKGROUND
• The link between childhood adversities, NS and psychological trauma not well understood
NS
Adverse events Psycho-trauma
AIM
To Investigate the relationship between childhood adversity and psychological trauma in children with NS
(part of GCC/IPT-F study)
• .
METHODS
• 146 children with NS assessed during the GCC/IPT-F Baseline (cross sectional) study
• Study sites: Atanga (SC1) and Awere (SC2) subcounties • Ethical approval received• Socio-demographic questionnaires • Past childhood adverse events assessed using Adverse
Childhood Exposure (ACE) questionnaire ( Bruffaerts et al., 2010, J.Okello et al., 2013). :
• Determines type and number of traumatic events .• Total ACE scores was computed for each participant ; modeled
as a continuous variable in our analyses (mean cut off scores)
METHODS
• Level of psychological trauma assessed using The CHILDREN’S IMPACT OF EVENT SCALE (CRIES-13) (Weiss and Marmar (1997)
• Consists of three subscales : intrusion, avoidance and hyper arousal.
• Has been used in war-affected adolescent populations in Africa (Amone-P'olak et al., 2007; Mels et al., 2010, J.Okello et al., 2013).
• Total scores computed for each individual and a mean cut off score calculated to determine high and low levels of psychological trauma..
RESULTS
• Mean age: 13.7years • Females: 52.5%• 82.5% -lived with a parent/guardian• 71.7% -studied up to middle primary level (p5)• Majority of the children (82.2%) had a high
adverse events score• 48.6% had high levels of psycho trauma• No statistically significant difference between SC1
and SC2
Common adverse events Adverse events Subcounty 1 Subcounty 2 Total (%)
Has your child ever lived in an IDP camp 74 (97.4) 68 (100.0) 142 (98.6)
Duration while in IDP: mean (sd)7.1 (2.7) 6.8 (2.7) 7.0 (2.7)
During your child’s childhood was there ever a period of 6 months or more when your family or child received food or support from a government assistance program like World Food Program
65 (85.5) 66 (97.1) 131 (91.0)Was there a time during your child’s childhood when your child had less than one meal a day
55 (73.3) 54 (79.4) 109 (76.2)Has there been a time in the past 6 months when there was not enough money at home to buy food for your children/child
60 (79.0) 56 (82.3) 116 (80.6)Was there a time in the last 6 months when your child had less than one meal a day
47 (65.3) 51 (75.0) 98 (70.0)Has there been a time when you have had to cut your child/children’s meal size one or more times in the past 6 months
49 (64.4) 52 (76.5) 101 (70.1)
RESULTS
ADVERSE CHILDHOOD EVENTS Sub county 1 Sub county 2 Total
• During your child’s childhood was there ever a period of 6 months or more when your family or child received food or support from a government assistance program like World Food Program
No 11 (14.5) 2 (2.9) 13 (9.0) Yes 65 (85.5) 66 (97.1) 131(91.0)
p=0.019
• Other stressful events that your child experienced p=0.003
RESULTSRevised Child impact of events scale
Adverse childhood events
No Yes Total OR P 95% CI
low count:<4 17 (22.7) 9 (12.7) 26 (17.8)
high count:>=4 58 (77.3) 62 (87.3) 120 (82.2) 2 0.119 0.83-4.89
Current food securityNo 11 (14.7) 10 (14.1) 21 (14.4)
Yes 64 (85.3) 61 (85.9) 125 (85.6) 1 0.92 0.42-2.65
DISCUSSION
• High levels of trauma comparable to other studies (arousal symptoms more common in both SCs)…?scoring system
• More “chronic poverty” adversities• Levels of trauma not significantly associated
with Adversities experienced• Co-morbidity; depression and anxiety (Kohrt
2008,Klassen 2010,Okello 2013)
DISCUSSION
• Is it because of trauma that we can not find trauma?..sensitive questions?
• Small sample size• Cultural validation of instruments…Other
hidden stressors/adversities• Role of cumulative/developmental trauma
experiences???? (Klasen et al ..2013)
• Cross sectional design…no causality
CONCLUSION/WAY FORWARD
• NS affected children had high levels of psycho trauma and most have experienced childhood adversity..commonly deprivation
• Association with adversities experienced not statistically significantly.
• Further investigation of psycho trauma in NS ,using culturally validated methods ,to identify other hidden stressors required
• NS programme response to include psycho trauma specific interventions
Thank you for listening!!