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The Impact of Post-Election Violence on HIV and Other Clinical Services and on Mental Health—Kenya, 2008

  • Sapna Bamrah (a1), Agneta Mbithi (a2), Jonathan H. Mermin (a3), Thomas Boo (a4), Rebecca E. Bunnell (a4), SK Sharif (a2) and Susan Temporado Cookson (a1)...
Abstract
AbstractIntroduction

In December 2007, civil disruption and violence erupted in Kenya following national elections, displacing 350,000 people and affecting supply chains and services. The Kenyan government and partners were interested in assessing the extent of disruption in essential health services, especially HIV treatment.

Methods

A two-stage cluster sampling for patients taking antiretroviral therapy (ART) was implemented ten weeks after elections, March 10-21, 2008, at twelve health facilities providing ART randomly selected in each of the three provinces most affected by post-election disruption—Rift Valley, Nyanza, and Central Provinces. Convenience samples of patients with tuberculosis, hypertension, or diabetes were also interviewed from the same facilities. Finally, a convenience sampling of internally displaced persons (IDPs) in the three provinces was conducted.

Results

Three hundred thirty-six IDPs in nine camps and 1,294 patients in 35 health facilities were interviewed. Overall, nine percent of patients reported having not returned to their routine health care facility; 9%-25% (overall 16%) reported a temporary inability for themselves or their children to access care at some point during January-February 2008. Less than 15% of patients on long-term therapies for HIV, tuberculosis, diabetes, or hypertension had treatment interruptions compared with 2007. The proportion of tuberculosis patients receiving a ≥45-day supply of medication increased from five percent in November 2007 to 69% in December 2007. HIV testing decreased in January 2008 compared with November 2007 among women in labor wards and among persons tested through voluntary counseling and testing services in Nyanza and Rift Valley Provinces. Patients and their family members witnessed violence, especially in Nyanza and Rift Valley Provinces (54%-59%), but few patients (2.5%-14%, 10% overall) personally experienced violence. More IDPs reported witnessing (80%) or personally experiencing (38%) violence than did patients. About half of patients and three-quarters of IDPs interviewed had anxiety or depression symptoms during the four weeks before the assessment. There was no association among patients between the presence of HIV, tuberculosis, diabetes, and hypertension and the prevalence of anxiety or depression symptoms.

Conclusion

More than 85% of patients in highly affected provinces avoided treatment interruptions; this may be in part related to practitioners anticipating potential disruption and providing patients with medications for an extended period. During periods of similar crisis, anticipating potential limitations on medication access and increased mental health needs could potentially prevent negative health impacts.

BamrahS, MbithiA, MerminJH, BooT, BunnellRE, SharifSK, CooksonST. The Impact of Post-Election Violence on HIV and Other Clinical Services and on Mental Health—Kenya, 2008. Prehosp Disaster Med. 2013;28(1):1-9.

Copyright
Corresponding author
Correspondence: Susan T. Cookson, MD, MPH Centers for Disease Control and Prevention International Emergency and Refugee Health Branch 1600 Clifton Rd, NW, Atlanta, GA USA E-mail sgc0@cdc.gov
References
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1.Population Reference Bureau, Kenya. The demographics of a country in turmoil. January 2008. http://www.prb.org/Articles/2008/Kenya.aspx. Accessed September 18, 2009.
2.Data Exchange Platform for the Horn of Africa (DEPHA). Post election violence, Kenya. January 28, 2008. http://www.depha.org/Post_election_Violence.asp. Accessed September 18, 2009.
3.Consolidated Appeals Process. Kenya Emergency Humanitarian Response Plan 2008. January 16, 2008. http://ochaonline.un.org/humanitarianappeal/webpage.asp?Page=1650. Accessed September 18, 2009.
4.BBC. Key points. Kenya power-sharing deal. February 28, 2008. http://news.bbc.co.uk/2/hi/africa/7269476.stm. Accessed January 11, 2010.
5.Kenya Office of the President, National AIDS Control Council. United Nations General Assembly Special Session on HIV and AIDS. Country Report—Kenya. 2008. http://data.unaids.org/pub/Report/2008/kenya_2008_country_progress_report_en.pdf. Accessed September 18, 2009.
6.Republic of Kenya, Ministry of Health. ARV data. July 30, 2008. http://www.health.go.ke/. Accessed May 5, 2008.
7.Lopes Cardozo B, Talley L, Burton A, Crawford C. Karenni refugees living in Thai–Burmese border camps: traumatic experiences, mental health outcomes, and social functioning. Soc Sci Med. 2004;58:2637-2644.
8.Sabin M, Lopes Cardozo B, Nackerud L, Kaiser R, Varese L. Factors associated with poor mental health among Guatemalan refugees living in Mexico 20 years after civil conflict. JAMA. 2003;290:635-642.
9.Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL-25L): A self-report symptom inventory. Behav Sci. 1974;19:1-15.
10.Griensven F, Somchai Chakkraband ML, Thienkrua W, et al. Mental health problems among adults in tsunami-affected areas of southern Thailand. JAMA. 2006;296:537-548.
11.Lopes Cardozo B, Vergara A, Agani F, Gotway C. Mental health, social functioning, and attitudes of Kosovar Albanians following war in Kosovo. JAMA. 2000;284:569-577.
12.Mollica RF, Wyshak, de Marneffe G, et al. Indochinese versions of the Hopkins Symptom Checklist-25: A screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144:497-500.
13.Kagee A. Symptoms of depression and anxiety among a sample of South African patients living with a chronic illness. J Health Psychology. 2008;13:547-555.
14.Bolton P, Wilk CM, Ndogoni L. Assessment of depression prevalence in rural Uganda using symptom and function criteria. Soc Psychiatry Psychiatr Epidemiol. 2004;39:442-447.
15.Kaharuza FM, Bunnell R, Moss S, et al. Depression and CD4 cell count among persons with HIV infection in Uganda. AIDS Beha.v. 2006;10(supplement 1):105-111.
16.Monahan PO, Shacham E, Reece M, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. http://www.springerlink.com/content/2552544w54n23310/. Accessed September 18, 2009.
17.Kaaya SF, Fawzi MCS, Mbwambo JK, et al. Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand. 2002;106:9-19.
18.Lee B, Kaaya S, Mbwawbo JK, et al. Detecting depressive disorder with the Hopkins Symptom Checklist-25 in Tanzania. Intern J Soc Psychiatry. 2008;54(1):7-20.
19.Office of the United Nations Humanitarian Coordinator in Kenya. Humanitarian update vol. 20, 16-20 May 2008. http://ochaonline.un.org/OchaLinkClick.aspx?link=ocha&docId=1090089. Accessed September 18, 2009.
20.Office of the United Nations Humanitarian Coordinator in Kenya. Humanitarian update vol. 29, 17-23 July 2008. ochaonline.un.org/OchaLinkClick.aspx?link=ocha&docId=1092573. Accessed September 18, 2009.
21.Galea S, Nandi A, Vladov D. The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev. 2005;27:78-91.
22.Gettleman J. Ethnic Violence in Rift Valley Is Tearing Kenya Apart. The New York Times, January 27, 2008. http://www.nytimes.com/2008/01/27/world/africa/27/kenya.html. Accessed October 3, 2008.
23.Janssens B, Van Damme W, Raleigh B, et al. Offering integrated care for HIV/AIDS, diabetes and hypertension within chronic disease clinics in Cambodia. Bull World Health Organ. 2007;85:880-885.
24.Mashew M, MacPhil P, Menezes C, Rubel D. Lost to follow up: contributing factors and challenges in South African patients on antiretroviral therapy. S African Med J. 2007;97:853-857.
25.Philips M, Zachariah R, Venis S. Task shifting for antiretroviral treatment delivery in sub-Saharan Africa: not a panacea. Lancet. 2008;371:682-684.
26.Patel V, Araya R, Chatterjee S, et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet. 2007;370:991-1005.
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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
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