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13 TH 15 TH JUNE 2013 VENUE LA MADA HOTEL; NAIROBI.

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Presentation on theme: "13 TH 15 TH JUNE 2013 VENUE LA MADA HOTEL; NAIROBI."— Presentation transcript:

1 13 TH 15 TH JUNE 2013 VENUE LA MADA HOTEL; NAIROBI

2  PSYCHOTRUAMA AND GENDER ISSUES

3 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  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  WHAT IS THE PREVALENCE OF PTSD AMONG WIDOW SURVIVORS OPF RWANDESE GENOCIDE 14 YRS AFTER THE EVENT

6  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  DETERMINE PTSD AMONG WIDOWS SURVIVORS OF 1994 RWANDESE GENOCIDE 14 YRS AFTER EVENT  CORRELATE SOCIO DEMOGRAPHIC PATTERNS AND PTSD  DETERMINE ASSOCIATED PSYCHIATRIC MORBIDITY

8  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 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 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 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 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  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 INSTRUMENTS 1. RESEARCHER DESIGNED SOCIODEMOGRAPHIC QUESWTIONNAIRE 2. THE HARVARD TRAUMA QUESTIONNNAIRE 3. THE ALCOHOL SMOKING AND SUBSTANCE INVOLVEMENT SCREENING TEST(ASSIST) 4. THE STRUCTURED CLINICAL INTERVIEW FOR THE DIAGNOSTIC AND STATISTICAL MANUAL IV

15  N=11O  AGE ; YRS  LIFETIME PTSD; 53.2%  CURRENT PTSD; 28.2%

16 SIGNIFICATNON SIGNIFICAT 1. RAPE(P=0.02) 2. FORCED SEPARTION FROM FAMILY MEMBERS(P=0.002) 3. MURDER OF A FAMILY MEMBER OR FRIEND(P=0.00) 4. BEING SLASHED (P=0.001) 5. BEING TIED UP(P=0.032) 6. INABILITY TO HELP RELATIVE(P=) (P=0.018) 7. SUICIDE IDEATION(P=) 8. SATISFACTION WITH ASSISTANCE(P=0.001) 9. BEING ILL AND INACCESSSIBILITY TO CARE(P=0.011) 10. BEING SHOT(P=0.000) 11. BEING SEVERLY WOUNDED(P=0.00) 12. MURDER OF A FAMILY OR FRIEND(P=0.001) 1. AGE(P=0.5) 2. NO. OF CHILDREN((P=0.126) 3. LEVEL OF EDUCATION(P=0.627) 4. OCCUPATION(P=0.218) 5. RELIGION(P=0.610) 6. BEING BEATEN(P=0.110) 7. NO WHERE TO HIDE(P=0.074) 8. MONTHLY INCOME(P=0.082) 9. BEING TRATED WITH ANOTHER MENTAL ILLNES(P=0.258) 10. FAMILY HX OF MENRTAL ILLNESS(P=0.66) 11. MATERIAL ASSISTANCE(P=0.06) 12. SATISFACTION WITH TRIAL OF GENOCIDE PERPETRATORS((P=0.87) 13. BEING FORCED TO KILL(P=0.069) 14. HIDING FOR A LONG TIME(P=0.209) 15. BEING BURIED ALIVE(P=0.161) 16. DENYING YOUR TRIBE RELATIVES,ORIGIN(P= LYING AMONG CORPSES(P=0.794)

17  SIGNIFICANT  ALCOHOL(P=0.014)  SUCIDALITY(P=0.00 2)  NON SIGNIFICANT  SMOKING(P=0.082)  SUICIDE PLAN(P= )

18 SIGNIFICANTNON SIGNIFICANT  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%)

19 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 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

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

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  ENHANCE MENTAL HEALTH SERVICES TO SCREEN GENOCIDE SURVIVORS FOR PTSD AND OTHER CO-MORBIDITIES

23  SENSITIVE AREA OF STUDY  GUARDED INFORMATION  FUNDING AND SCALE OF THE STUDY  LIMITING MAKING GENERALIZTIONS

24  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


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