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!!