KENYA PSYCHITRIC ASSOCIATION 5 TH ANNUAL SCIENTIFIC CONFRENCE

1. KENYA PSYCHITRIC ASSOCIATION 5TH ANNUAL SCIENTIFIC CONFRENCE 13TH 15TH JUNE 2013 VENUE LA MADA HOTEL; NAIROBI

2. SUBTHEME • PSYCHOTRUAMA AND GENDER ISSUES

3. ABSTRACT TITLE • POST TRAUMATIC STRESS DISORDER AMONG WIDOW SURVIVORS OF THE 1994 RWANDESE GENOCIDE (2009) AUTHORS • DR.NGAMIJE K SHADRCK • PROF,NDETEI D.M. • DR.MBURU. J.M • DR WANGARI KURIA

4. INTRODUCTION • LARGEST GENOCIDE IN AFRICA BY 1994 • AFFECTED THE WHOLE POPULATION • ONE MILLION WERE KILLED(NEARLY 15% OF THE POPULATION) • TWO MILLION REFUGEES CREATED • RESULTED IN GREAT SUFFERING

5. RESEARCH QUESTION • WHAT IS THE PREVALENCE OF PTSD AMONG WIDOW SURVIVORS OPF RWANDESE GENOCIDE 14 YRS AFTER THE EVENT

6. RESEARCH HYPOTHESIS • NULL HYPOTHESIS • THERE IS NO PTSD AMONG WIDOW SURVIVORS OPF RWANDESE GENOCIDE 14 YRS AFTER THE EVENT • ALTERNATIVE HYPOTHESIS • THERE IS PTSD AMONG WIDOW SURVIVORS OPF RWANDESE GENOCIDE 14 YRS AFTER THE EVENT

7. OBJECTIVES • DETERMINE PTSD AMONG WIDOWS SURVIVORS OF 1994 RWANDESE GENOCIDE 14 YRS AFTER EVENT • CORRELATE SOCIO DEMOGRAPHIC PATTERNS AND PTSD • DETERMINE ASSOCIATED PSYCHIATRIC MORBIDITY

8. LITERATURE REVIEW • THE YOUNGER THE WOMAN IS WIDOWED THE MORE INTENSE HER GRIEF(HAGENGIMAN A.NDETEI D.M,MBURU. J.M, KANGETHE ,R. 1996) • WOMEN AND YOUNG PERSONS AND THOSE WITH LOW LEVEL OF EDUCATION ARE MORE SUSECPTIBLE TO PTSD(CREAMER .M. et al 2001) • WOMEN WHO EXPERIENCED PTSD HAD DOUBLE RISK OF DEVELOPING A DEPRESSIVE DISORDER AND THREE TIMES THE RISK OF DEVELOPING ALCOHOL RELATED PROBLEMS IN FUTURE(KILONZO G. et al 2006)

9. EPIDEMIOLGY OF PTSD IN NON POST CONFLICT SOCIETIES OVERALL 7.8% IN (USA) • 10.4 % IN WOMEN • 5 % IN MEN IN MEN (KESSLER R.C. ET AL 1995) 7.4% HOSPITALIZED PATIENTS AT MATHATHARI HOSPITAL (NDETEI ET AL 2008)

10. EPIDEMIOLGY OF PTSD IN POST CONFLICT SOCIETIES SOUTH LEBANON • 29.3% IN CIVILIAN POPULATION(FARHOOD. L ET AL 2006) WEST NILE REGION • 31.6 % OF MALE.40.1%OF FEMALE(NEUNER F ET AL 2004)

11. EPIDEMIOLGY OF PTSD-3 UGANDA • 39.9% PTSD, 52% DEPRESSION 60% SOMATIZATION DISORDER AT 72.2% SUICIDE 22.7% ALCHOL ABUSE 18.2% (MUSISI S. 2005) • 26.8% IN ABUCTED ADOLESENTS IN GULU DISTRICT (OKELLO.J.ET AL 2007) RWANDA • 20.3%((HAGENGIMAN A.NDETEI D.M, KANGETHE ,R. 1996) WHOLE POULATION • 35.5% HIV INFECTED WOMEN SURVIVORS(FABRIC M ,KOVLER M 2007)

12. EPIDEMIOLGY OF PTSD-4 KENYA • 33.8% SEXUALLY ABUSED WOMEN(ONYANCHA N 2004) • 52.5% WOMEN SURVIVORS OF DOMESTIC VIOLENCE(HINGA ,S . 2006) • 65.7% IN SURVIVORS OF MAU MAU CONCENTRATION CAMPS(lUKOYE.A 2006) • 80.2 % IN INTERNALLY DISPLACED POPULATIONS IN RIFT VALLEY (NJAU J.W. 2005)

13. METHODOLGY • CROSS-SECTIONAL DESCRIPTIVE STUDY • SAMPLE INCLUDED 110 WIDOW SURVIVORS WHO COSENTED • ALL REGISTERED WITH EVEGA (ASSOCITION DES VEUVES DU GENOCIDE)AGAHOZO IE WIDOWS ASSOCIATION OF GENOCIDE SURVIVORS • SELECTED RANDOMLY IN 5 DIFFERENT SITES(PROVINCES IN RWANDA)

14. METHODOLOGY INSTRUMENTS • RESEARCHER DESIGNED SOCIODEMOGRAPHIC QUESWTIONNAIRE • THE HARVARD TRAUMA QUESTIONNNAIRE • THE ALCOHOL SMOKING AND SUBSTANCE INVOLVEMENT SCREENING TEST(ASSIST) • THE STRUCTURED CLINICAL INTERVIEW FOR THE DIAGNOSTIC AND STATISTICAL MANUAL IV

15. RESULTS - • N=11O • AGE ; 36-65 YRS • LIFETIME PTSD; 53.2% • CURRENT PTSD; 28.2%

16. PTSD VS VARIABLE STATISTICAL FINDINGS • RAPE(P=0.02) • FORCED SEPARTION FROM FAMILY MEMBERS(P=0.002) • MURDER OF A FAMILY MEMBER OR FRIEND(P=0.00) • BEING SLASHED (P=0.001) • BEING TIED UP(P=0.032) • INABILITY TO HELP RELATIVE(P=) (P=0.018) • SUICIDE IDEATION(P=) • SATISFACTION WITH ASSISTANCE(P=0.001) • BEING ILL AND INACCESSSIBILITY TO CARE(P=0.011) • BEING SHOT(P=0.000) • BEING SEVERLY WOUNDED(P=0.00) • MURDER OF A FAMILY OR FRIEND(P=0.001) • AGE(P=0.5) • NO. OF CHILDREN((P=0.126) • LEVEL OF EDUCATION(P=0.627) • OCCUPATION(P=0.218) • RELIGION(P=0.610) • BEING BEATEN(P=0.110) • NO WHERE TO HIDE(P=0.074) • MONTHLY INCOME(P=0.082) • BEING TRATED WITH ANOTHER MENTAL ILLNES(P=0.258) • FAMILY HX OF MENRTAL ILLNESS(P=0.66) • MATERIAL ASSISTANCE(P=0.06) • SATISFACTION WITH TRIAL OF GENOCIDE PERPETRATORS((P=0.87) • BEING FORCED TO KILL(P=0.069) • HIDING FOR A LONG TIME(P=0.209) • BEING BURIED ALIVE(P=0.161) • DENYING YOUR TRIBE RELATIVES ,ORIGIN(P=0.812 • LYING AMONG CORPSES(P=0.794) SIGNIFICAT NON SIGNIFICAT

17. PTSD VS ASSIT • NON SIGNIFICANT • SMOKING(P=0.082) • SUICIDE PLAN(P=0.0.3239) • SIGNIFICANT • ALCOHOL(P=0.014) • SUCIDALITY(P=0.002)

18. PTSD AND PSYCHIATRIC MORBIDITY • MAJOR DEPRESSIVE DISORDER(N 12 =10.8%) • GENERALIZED ANXIETY DISORDER(N 25=22.7%) • DEPRESSIVE DISORDER NOT OTHERWISE CLASSIFIED • CYLOTHYMIC DISORDER • DYSTHYMIC DISORDER(N7=6.4%) • SOMATIZATION DISODER(N3=2.7%) SIGNIFICANT NON SIGNIFICANT

19. DISCUSSION LOWER THAN • 35.5% HIV INFECTED WOMEN SURVIVORS(FABRIC M ,KOVLER M 2007) • THE SURVIVORS DON’T HAVE SERIOUS ILLNESS LIKE HIV INFECTION WHICH MAY BE EXTRA SOURCE OF TRAUMA RESULTS • PTSD=28.2% HIGHER THAN • 20.3%((HAGENGIMAN A.NDETEI D.M, KANGETHE ,R. 1996) WHOLE POULATION • THIS IS SPECIAL POPULATION UNLIKE HAGENGIMANA’S WHICH INCLUDED GENERAL POPULATION

20. DISCUSSION • IN 1996 PSYCHIATRIC MORBIDITY WAS 50.3% WHICH INCLUDED ABNORMAL GRIEF REACTION FOLLOWED BY MAJOR DEPRESSSION AND THEN PTSD PSCHIATRIC MORBIDITY • PTSD IS ASSOCITED WITH • MAJOR DEPRESSIVE DISORDER(N 12 =10.8%) • GENERALIZED ANXIETY DISORDER(N 25=22.7%)

21. THE STUDY DEMOSTRATED THAT WAR RELATED VICTIMS ARE AT RISK OF DEVELOPING PROLONGED SYMPTOMS OF PTSD • FORTY YEARS FOLLOW UP STUDIES OF FORMER WORLD WAR 11 PRISONERS OF WAR INDICATED THAT SEVERE TRAUMATIZATION CAN PRODUCE PERSITENT PTSD (BLANK 1989)

22. RECOMMENDATIONS • ENHANCE MENTAL HEALTH SERVICES TO SCREEN GENOCIDE SURVIVORS FOR PTSD AND OTHER CO-MORBIDITIES

23. LIMITATIONS • SENSITIVE AREA OF STUDY • GUARDED INFORMATION • FUNDING AND SCALE OF THE STUDY • LIMITING MAKING GENERALIZTIONS

24. CONCLUSION • 14 YRS AFTER THE 1994 RWANDESE GENOCIDE,WIDOW SURVIVORS ARE STILL SUFFERING FROM PTSD AND OTHER PSYCHIATRIC MORBIDITIES. • ACCEPT THE ALTERNATIVE NULL HYPOTHESIS • PTSD RUNS A LONGITUDINAL COURSE