{Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings}

Citation:

Embleton L, Nyandat J, Ayuku D, Sang E, Kamanda A, Ayaya S, Nyandiko W, Gisore P, Vreeman R, Atwoli L. {Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings}. Journal of Adolescent Health. 2017;60.

Abstract:

© 2016 Society for Adolescent Health and Medicine Purpose This study sought to assess whether risky sexual behaviors and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya. Methods We analyzed baseline data from a cohort of orphaned adolescents aged 10–18 years living in 300 randomly selected households and 19 charitable children's institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariate logistic regression compared these between participants in institutional care and family-based care while adjusting for age, sex, orphan status, importanc e of religion, caregiver support and supervision, school attendance, and alcohol and drug use. Results This analysis included 1,365 participants aged ≥10 years: 712 (52{%}) living in institutional environments and 653 (48{%}) in family-based care. Participants in institutional care were significantly less likely to report engaging in transactional sex (adjusted odds ratio,.46; 95{%} confidence interval,.3–.72) or to have experienced forced sex (adjusted odds ratio,.57; 95{%} confidence interval,.38–.88) when controlling for age, sex, and orphan status. These associations remained when adjusting for additional variables. Conclusions Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities through the provision of basic material needs and adequate standards of living that influence adolescents' sexual risk-taking behaviors. The use of single items to assess outcomes and nonexplicit definition of sex suggest the findings should be interpreted with caution.

Recent Publications

Takahashi R, Wilunda C, Magutah K, Mwaura-Tenambergen W, Atwoli L, Perngparn U. {Evaluation of alcohol screening and community-based brief interventions in rural western Kenya: A quasi-experimental study}. Alcohol and Alcoholism. 2018;53.Abstract

© The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved. Aims: To assess the effectiveness of community-based alcohol brief interventions (ABI) implemented by community-health workers with and without motivational talks (MT) by former drinkers, in reducing harmful and hazardous alcohol consumption.Methods: We conducted a three-arm quasi-experimental study (one control and two intervention groups) between May and December 2015 in Kakamega County, Kenya. Participants were hazardous or harmful alcohol drinkers with an Alcohol Use Disorders Identification Test (AUDIT) score of 8-19 at baseline. One intervention group received only ABI while the other received ABI + MT. The interventions' effects on AUDIT scores were analysed using linear mixed models. Logistic regression was used to analyse the interventions' effects on low-risk drinking (AUDIT score {\textless} 8) after 6 months.Results: The study included 161 participants: 52 in the control group, 52 in the only ABI group and 57 in the ABI + MT group. The mean AUDIT scores were lower in the intervention groups at 1, 3 and 6 months post-intervention; the ABI + MT group showed a greater reduction. The mean AUDIT scores over a 6-month period were lower in both intervention groups compared with the control group. The odds of low-risk drinking were almost two times higher in both intervention groups than in the control group, although the effect of only ABI on low-risk drinking was not significant.Conclusions: ABI + MT and only ABI were associated with a reduced mean AUDIT score among hazardous and high-risk drinkers in this resource-limited setting. ABI + MT was also associated with low-risk drinking in this population.Short summary: Community-based alcohol brief interventions implemented by community-health workers accompanied by motivational talks by former drinkers were associated with reduced hazardous and harmful alcohol consumption in a rural setting in western Kenya.

Degenhardt L, Glantz M, Evans-Lacko S, Sadikova E, Sampson N, Thornicroft G, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, {Helena Andrade} L. {Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys}. World Psychiatry. 2017;16.Abstract

© 2017 World Psychiatric Association Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality (“minimally adequate treatment”). Among the 70,880 participants, 2.6{%} met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3{%}) than in high-income (2.6{%}) and low/lower-middle income (2.0{%}) countries. Overall, 39.1{%} of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1{%}) than in upper-middle (35.6{%}) and low/lower-middle income (31.5{%}) countries. Among those who recognized treatment need, 61.3{%} made at least one visit to a service provider, and 29.5{%} of the latter received minimally adequate treatment exposure (35.3{%} in high, 20.3{%} in upper-middle, and 8.6{%} in low/lower-middle income countries). Overall, only 7.1{%} of those with past-year substance use disorders received minimally adequate treatment: 10.3{%} in high income, 4.3{%} in upper-middle income and 1.0{%} in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.

Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LHSG, Borges G, de Girolamo G, Florescu S. {The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys}. ADHD Attention Deficit and Hyperactivity Disorders. 2017;9.Abstract

© 2016, Springer-Verlag Wien. We previously reported on the cross-national epidemiology of ADHD from the first 10 countries in the WHO World Mental Health (WMH) Surveys. The current report expands those previous findings to the 20 nationally or regionally representative WMH surveys that have now collected data on adult ADHD. The Composite International Diagnostic Interview (CIDI) was administered to 26,744 respondents in these surveys in high-, upper-middle-, and low-/lower-middle-income countries (68.5{%} mean response rate). Current DSM-IV/CIDI adult ADHD prevalence averaged 2.8{%} across surveys and was higher in high (3.6{%})- and upper-middle (3.0{%})- than low-/lower-middle (1.4{%})-income countries. Conditional prevalence of current ADHD averaged 57.0{%} among childhood cases and 41.1{%} among childhood subthreshold cases. Adult ADHD was significantly related to being male, previously married, and low education. Adult ADHD was highly comorbid with DSM-IV/CIDI anxiety, mood, behavior, and substance disorders and significantly associated with role impairments (days out of role, impaired cognition, and social interactions) when controlling for comorbidities. Treatment seeking was low in all countries and targeted largely to comorbid conditions rather than to ADHD. These results show that adult ADHD is prevalent, seriously impairing, and highly comorbid but vastly under-recognized and undertreated across countries and cultures.

Lukoye Atwoli

Associate Professor of Psychiatry

{Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings}

Citation:

Abstract:

Recent Publications