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

Published online by Cambridge University Press:  26 November 2012

Sapna Bamrah ,
Agneta Mbithi ,
Jonathan H. Mermin ,
Thomas Boo ,
Rebecca E. Bunnell ,
SK Sharif  and
Susan Temporado Cookson
Sapna Bamrah
Affiliation:
International Emergency and Refugee Health Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia USA
Agneta Mbithi
Affiliation:
Kenya Ministry of Health, Nairobi, Kenya
Jonathan H. Mermin
Affiliation:
Kenya Coordinating Office for Global Health, CDC, Nairobi, Kenya
Thomas Boo
Affiliation:
Global AIDS Program, CDC, Nairobi, Kenya
Rebecca E. Bunnell
Affiliation:
Global AIDS Program, CDC, Nairobi, Kenya
SK Sharif
Affiliation:
Kenya Ministry of Health, Nairobi, Kenya
Susan Temporado Cookson*
Affiliation:
International Emergency and Refugee Health Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia USA
*
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
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Abstract

Introduction

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.

Keywords

anti-HIV agentsdelivery of health careHIV infectionKenyamental healthviolence
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 1 , February 2013 , pp. 43 - 51
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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References

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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
6.Republic of Kenya, Ministry of Health. ARV data. July 30, 2008. http://www.health.go.ke/. Accessed May 5, 2008.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
21.Galea, S, Nandi, A, Vladov, D. The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev. 2005;27:78-91.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed