BYAMAH MUTAMBA, JAMES OKELLO,JANET NAKIGUDDE,SEGGANE MUSISI BUTABIKA HOSPITAL/MAKSPH

1. CHILDHOOD ADVERSITY AND ITS RELATIONSHIP TO PSYCHOLOGICAL TRAUMA IN NODDING SYNDROME (NS) AFFECTED CHILDREN BYAMAH MUTAMBA, JAMES OKELLO,JANET NAKIGUDDE,SEGGANE MUSISI BUTABIKA HOSPITAL/MAKSPH PCAF CONFERENCE;MBARARA JULY 2014

2. ACKNOWLEDGEMENTS • GCC/IPT-F Study team & communities • MaKSPH • MOH

3. OUTLINE • BACKGROUND • AIM • METHODS • FINDINGS • DISCUSSION • CONCLUSION/WAY FORWARD

4. 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)

5. 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 )

6. BACKGROUND • The link between childhood adversities, NS and psychological trauma not well understood NS Adverse events Psycho-trauma

8. AIM

9. To Investigate the relationship between childhood adversity and psychological trauma in children with NS (part of GCC/IPT-F study) • .

10. 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)

11. 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..

12. 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

13. Common adverse events

14. 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

15. RESULTS

16. 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)

17. 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

18. 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

19. Thank you for listening!!