@article {Takahashi2018,
	title = {{Evaluation of alcohol screening and community-based brief interventions in rural western Kenya: A quasi-experimental study}},
	journal = {Alcohol and Alcoholism},
	volume = {53},
	number = {1},
	year = {2018},
	abstract = {{\textcopyright} 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{\textquoteright} effects on AUDIT scores were analysed using linear mixed models. Logistic regression was used to analyse the interventions{\textquoteright} 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.},
	issn = {14643502},
	doi = {10.1093/alcalc/agx083},
	author = {Takahashi, R. and Wilunda, C. and Magutah, K. and Mwaura-Tenambergen, W. and Atwoli, L. and Perngparn, U.}
}
@book {Braitstein2017,
	title = {{Child abuse and neglect in charitable children{\textquoteright}s institutions in Uasin Gishu County, Kenya: A challenge of context}},
	series = {Child Maltreatment in Residential Care: History, Research, and Current Practice},
	year = {2017},
	isbn = {9783319579900},
	doi = {10.1007/978-3-319-57990-0_16},
	author = {Braitstein, P. and Ayaya, S. and Ayuku, D. and DeLong, A. and Atwoli, L.}
}
@article {Fayyad2017,
	title = {{The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys}},
	journal = {ADHD Attention Deficit and Hyperactivity Disorders},
	volume = {9},
	number = {1},
	year = {2017},
	abstract = {{\textcopyright} 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.},
	keywords = {ADHD, Attention-deficit/hyperactivity disorder, Comorbidity, Disability epidemiology, Impairment, Prevalence, Treatment},
	issn = {18666647},
	doi = {10.1007/s12402-016-0208-3},
	author = {Fayyad, J. and Sampson, N.A. and Hwang, I. and Adamowski, T. and Aguilar-Gaxiola, S. and Al-Hamzawi, A. and Andrade, L.H.S.G. and Borges, G. and de Girolamo, G. and Florescu, S. and Gureje, O. and Haro, J.M. and Hu, C. and Karam, E. G. and Lee, S. and Navarro-Mateu, F. and O{\textquoteright}Neill, S. and Pennell, B.-E. and Piazza, M. and Posada-Villa, J. and ten Have, M. and Torres, Y. and Xavier, M. and Zaslavsky, A.M. and Kessler, R. C. and Adamowski, T. and Aguilar-Gaxiola, S. and Al-Hamzawi, A. and Al-Kaisy, M. and Subaie, A.A. and Alonso, J. and Altwaijri, Y. and Andrade, L.H. and Atwoli, L. and Auerbach, R.P. and Axinn, W.G. and Benjet, C. and Borges, G. and Bossarte, R.M. and Bromet, E.J. and Bruffaerts, R. and Bunting, B. and Caffo, E. and de Almeida, J.M.C. and Cardoso, G. and Cia, A.H. and Chardoul, S. and Chatterji, S. and Filho, A.C. and Cuijpers, P. and Degenhardt, L. and de Girolamo, G. and de Graaf, R. and de Jonge, P. and Demyttenaere, K. and Ebert, D.D. and Evans-Lacko, S. and Fayyad, J. and Fiestas, F. and Florescu, S. and Forresi, B. and Galea, S. and Germine, L. and Gilman, S.E. and Ghimire, D.J. and Glantz, M.D. and Gureje, O. and Haro, J.M. and He, Y. and Hinkov, H. and Hu, C.-Y. and Huang, Y. and Karam, A.N. and Karam, E. G. and Kawakami, N. and Kessler, R. C. and Kiejna, A. and Koenen, K.C. and Kovess-Masfety, V. and Lago, L. and Lara, C. and Lee, S. and Lepine, J.-P. and Levav, I. and Levinson, D. and Liu, Z. and Martins, S.S. and Matschinger, H. and McGrath, J.J. and McLaughlin, K. A. and Medina-Mora, M.E. and Mneimneh, Z. and Moskalewicz, J. and Murphy, S.D. and Navarro-Mateu, F. and Nock, M.K. and O{\textquoteright}Neill, S. and Oakley-Browne, M. and {Hans Ormel}, J. and Pennell, B.-E. and Piazza, M. and Pinder-Amaker, S. and Piotrowski, P. and Posada-Villa, J. and Ruscio, A. M. and Scott, K.M. and Shahly, V. and Silove, D. and Slade, T. and Smoller, J.W. and Stagnaro, J.C. and Stein, D. J. and Street, A.E. and Tachimori, H. and Taib, N. and Have, M. and Thornicroft, G. and Torres, Y. and Viana, M. C. and Vilagut, G. and Wells, E. and Williams, D.R. and Williams, M.A. and Wojtyniak, B. and Zaslavsky, A.M.}
}
@article {Degenhardt2017,
	title = {{Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys}},
	journal = {World Psychiatry},
	volume = {16},
	number = {3},
	year = {2017},
	abstract = {{\textcopyright} 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){\textquoteright}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 ({\textquotedblleft}minimally adequate treatment{\textquotedblright}). 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.},
	keywords = {alcohol, drugs, Substance use disorders, treatment coverage, United Nations Sustainable Development Goals, World Health Organization},
	issn = {20515545},
	doi = {10.1002/wps.20457},
	author = {Degenhardt, L. and Glantz, M. and Evans-Lacko, S. and Sadikova, E. and Sampson, N. and Thornicroft, G. and Aguilar-Gaxiola, S. and Al-Hamzawi, A. and Alonso, J. and {Helena Andrade}, L. and Bruffaerts, R. and Bunting, B. and Bromet, E.J. and {Miguel Caldas de Almeida}, J. and de Girolamo, G. and Florescu, S. and Gureje, O. and {Maria Haro}, J. and Huang, Y. and Karam, A. and Karam, E. G. and Kiejna, A. and Lee, S. and Lepine, J.-P. and Levinson, D. and {Elena Medina-Mora}, M. and Nakamura, Y. and Navarro-Mateu, F. and Pennell, B.-E. and Posada-Villa, J. and Scott, K. and Stein, D. J. and ten Have, M. and Torres, Y. and Zarkov, Z. and Chatterji, S. and Kessler, R. C. and Adamowski, T. and Aguilar-Gaxiola, S. and Al-Hamzawi, A. and Al-Kaisy, M. and Alonso, J. and Altwaijri, Y. and Andrade, L.H. and Atwoli, L. and Auerbach, R.P. and Axinn, W.G. and Benjet, C. and Borges, G. and Bromet, E.J. and Bruffaerts, R. and Bunting, B. and {Caldas de Almeida}, J.M. and Cardoso, G. and Chardoul, S. and Chatterji, S. and Filho, A.C. and Cia, A.H. and Cuijpers, P. and de Girolamo, G. and de Graaf, R. and de Jonge, P. and Ebert, D.D. and Evans-Lacko, S. and Fayyad, J. and Florescu, S. and Galea, S. and Germine, L. and Ghimire, D.J. and Gilman, S.E. and Glantz, M.D. and Gluzman, S. and Gureje, O. and Haro, J.M. and Harris, M.G. and He, Y. and Hinkov, H. and Hu, C.-Y. and Huang, Y. and Karam, A.N. and Karam, E. G. and Kawakami, N. and Kessler, R. C. and Kiejna, A. and Koenen, K.C. and Kovess-Masfety, V. and Lara, C. and Lee, S. and Lepine, J.-P. and Levav, I. and Levinson, D. and Liu, Z. and Martins, S.S. and McGrath, J.J. and McLaughlin, K. A. and Medina-Mora, M.E. and Mneimneh, Z. and Moskalewicz, J. and Navarro-Mateu, F. and Nock, M.K. and O{\textquoteright}Neill, S. and Ormel, J. and Pennell, B.-E. and Piazza, M. and Piotrowski, P. and Posada-Villa, J. and Ruscio, A. M. and Scott, K.M. and Slade, T. and Smoller, J.W. and Stagnaro, J.C. and Stein, D. J. and Street, A.E. and Tachimori, H. and ten Have, M. and Thornicroft, G. and Torres, Y. and Vilagut, G. and Viana, M. C. and Wells, E. and Williams, D.R. and Williams, M.A. and Wojtyniak, B. and Zaslavsky, A.M.}
}
@article {Koenen2017,
	title = {{Posttraumatic stress disorder in the World Mental Health Surveys}},
	journal = {Psychological Medicine},
	volume = {47},
	number = {13},
	year = {2017},
	abstract = {Copyright {\textcopyright} Cambridge University Press 2017. Background Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. Methods Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. Results The cross-national lifetime prevalence of PTSD was 3.9{\%} in the total sample and 5.6{\%} among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5{\%}) was roughly double that in low-lower middle income (22.8{\%}) and upper-middle income (28.7{\%}) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. Conclusions PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.},
	keywords = {epidemiology, International, Posttraumatic stress disorder (PTSD), trauma, Treatment},
	issn = {14698978},
	doi = {10.1017/S0033291717000708},
	author = {Koenen, K.C. and Ratanatharathorn, A. and Ng, L. and McLaughlin, K. A. and Bromet, E.J. and Stein, D. J. and Karam, E. G. and {Meron Ruscio}, A. and Benjet, C. and Scott, K. and Atwoli, L. and Petukhova, M. and Lim, C.C.W. and Aguilar-Gaxiola, S. and Al-Hamzawi, A. and Alonso, J. and Bunting, B. and Ciutan, M. and {De Girolamo}, G. and Degenhardt, L. and Gureje, O. and Haro, J.M. and Huang, Y. and Kawakami, N. and Lee, S. and Navarro-Mateu, F. and Pennell, B.-E. and Piazza, M. and Sampson, N. and {Ten Have}, M. and Torres, Y. and Viana, M. C. and Williams, D. and Xavier, M. and Kessler, R. C.}
}
@article {Kwobah2017,
	title = {{PREVALENCE of psychiatric morbidity in a community sample in Western Kenya}},
	journal = {BMC Psychiatry},
	volume = {17},
	number = {1},
	year = {2017},
	abstract = {{\textcopyright} 2017 The Author(s). Background: About 25{\%} of the worldwide population suffers from mental, neurological and substance use disorders but unfortunately, up to 75{\%} of affected persons do not have access to the treatment they need. Data on the magnitude of the mental health problem in Kenya is scarce. The objectives of this study were to establish the prevalence and the socio-demographic factors associated with mental and substance use disorders in Kosirai division, Nandi County, Western Kenya. Methods: This was a cross sectional descriptive study in which participants were selected by simple random sampling. The sampling frame was obtained from a data base of the population in the study area developed during door-to-door testing and counseling exercises for HIV/AIDS. Four hundred and twenty consenting adults were interviewed by psychologists using the Mini International Neuropsychiatric Interview Version 7 for Diagnostic and Statistical Manual 5th Edition and a researcher-designed social demographic questionnaire. Results: One hundred and ninety one (45{\%}) of the participants had a lifetime diagnosis of at least one of the mental disorders. Of these, 66 (15.7{\%}) had anxiety disorder, 53 (12.3{\%}) had major depressive disorder; 49 (11.7{\%}) had alcohol and substance use disorder. 32 (7.6{\%}) had experienced a psychotic episode and 69 (16.4{\%}) had a life-time suicidal attempt. Only 7 (1.7{\%}) had ever been diagnosed with a mental illness. Having a mental condition was associated with age less than 60 years and having a medical condition. Conclusion: A large proportion of the community has had a mental disorder in their lifetime and most of these conditions are undiagnosed and therefore not treated. These findings indicate a need for strategies that will promote diagnosis and treatment of community members with psychiatric disorders. In order to screen more people for mental illness, we recommend further research to evaluate a strategy similar to the home based counseling and testing for HIV and the use of simple screening tools.},
	keywords = {Mental disorders, Mini International Neuropsychiatry Interview, Prevalence, Western Kenya},
	issn = {1471244X},
	doi = {10.1186/s12888-017-1202-9},
	author = {Kwobah, E. and Epstein, S. and Mwangi, A. and Litzelman, D. and Atwoli, L.}
}
@article {Embleton2017,
	title = {{Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings}},
	journal = {Journal of Adolescent Health},
	volume = {60},
	number = {4},
	year = {2017},
	abstract = {{\textcopyright} 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{\textendash}18~years living in 300 randomly selected households and 19 charitable children{\textquoteright}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{\textendash}.72) or to have experienced forced sex (adjusted odds ratio,.57; 95{\%} confidence interval,.38{\textendash}.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{\textquoteright} 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.},
	keywords = {Family-based care, Institutional care, Kenya, Orphans, Sexual behavior, Transactional sex},
	issn = {18791972},
	doi = {10.1016/j.jadohealth.2016.11.015},
	author = {Embleton, L. and Nyandat, J. and Ayuku, D. and Sang, E. and Kamanda, A. and Ayaya, S. and Nyandiko, W. and Gisore, P. and Vreeman, R. and Atwoli, L. and Galarraga, O. and Ott, M.A. and Braitstein, P.}
}
@article {Shangani2017,
	title = {{Unconditional government cash transfers in support of orphaned and vulnerable adolescents in western Kenya: Is there an association with psychological wellbeing?}},
	journal = {PLoS ONE},
	volume = {12},
	number = {5},
	year = {2017},
	abstract = {{\textcopyright} 2017 Shangani et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Orphaned and vulnerable adolescents (OVA) in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs) have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA. Objective Among OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing. Methods We examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS) and positive future outlook among 655 OVA aged between 10 and 18 years who lived in 300 randomly selected households in western Kenya that either received or did not receive unconditional monthly CTs. Results The mean age was 14.0 (SD 2.4) years and 329 (50.2{\%}) of the participants were female while 190 (29.0{\%}) were double orphans whose biological parents were both deceased. After adjusting for socio-demographic, caregiver, and household characteristics and accounting for potential effects of participant clustering by sub-location of residence, OVA living in CT households were more likely to have a positive future outlook (odds ratio [OR] 1.47, 95{\%} confidence interval [CI] 1.08, 1.99), less likely to be anxious (OR 0.57, 95{\%} CI 0.42, 0.78), and less likely to have symptoms of post-traumatic stress (OR 0.50, 95{\%} CI 0.29, 0.89). We did not find statistically significant differences in odds of depression by CT group. Conclusion OVA in CT households reported better psychological wellbeing compared to those in households not receiving CTs. CT interventions may be effective for improving psychological wellbeing among vulnerable adolescents in socioeconomically deprived households.},
	issn = {19326203},
	doi = {10.1371/journal.pone.0178076},
	author = {Shangani, S. and Operario, D. and Genberg, B. and Kirwa, K. and Midoun, M. and Atwoli, L. and Ayuku, D. and Gal{\'a}rraga, O. and Braitstein, P.}
}
@article {Atwoli2016a,
	title = {{Associations between lifetime potentially traumatic events and chronic physical conditions in the South African Stress and Health Survey: A cross-sectional study}},
	journal = {BMC Psychiatry},
	volume = {16},
	number = {1},
	year = {2016},
	abstract = {{\textcopyright} 2016 The Author(s).Background: This study examined the association between the type, and cumulative number of lifetime potentially traumatic events (PTEs), and chronic physical conditions, in a South African sample. PTE exposures have been associated with an increased risk for a wide range of chronic physical conditions, but it is unclear whether psychiatric disorders mediate this association. Given the established differences in trauma occurrence, and the epidemiology of posttraumatic stress disorder (PTSD) in South Africa relative to other countries, examining associations between PTEs and chronic physical conditions, particularly while accounting for psychiatric comorbidity is important. Methods: Data were drawn from the South African Stress and Health Study, a cross-sectional population-representative study of psychological and physical health of South African adults. Twenty-seven PTEs, based on the World Health Organization Composite International Diagnostic Interview Version 3.0, DSM-IV PTSD module were grouped into seven PTE types (war events, physical violence, sexual violence, accidents, unexpected death of a loved one, network events, and witnessing PTEs). Five clusters of physical conditions (cardiovascular, arthritis, respiratory, chronic pain, and other health conditions) were examined. Logistic regressions assessed the odds of reporting a physical condition in relation to type and cumulative number of PTEs. Cochran-Armitage test for trend was used to examine dose-response effect of cumulative PTEs on physical conditions. Results: After adjusting for sociodemographic variables and psychiatric disorders, respondents with any PTE had increased odds of all assessed physical conditions, ranging between 1.48 (95 {\%} CI: 1.06-2.07) for arthritis and 2.07 (95 {\%} CI: 1.57-2.73) for respiratory conditions, compared to those without PTE exposure. Sexual violence, physical violence, unexpected death of a loved one, and network PTEs significantly increased the odds of all or nearly all the physical conditions assessed. There was a dose-response relationship between number of PTEs and increased odds of all physical conditions. Conclusions: Results from this study, the first in an African general population, are consistent with other population-based studies; PTEs confer a broad-spectrum risk for chronic physical conditions, independent of psychiatric disorders. These risks increase with each cumulative PTE exposure. Clinically, comprehensive evaluations for risk of mental and physical health morbidities should be considered among PTE survivors.},
	keywords = {Posttraumatic stress disorder, S, [Physical health},
	issn = {1471244X},
	doi = {10.1186/s12888-016-0929-z},
	author = {Atwoli, L. and Platt, J.M. and Basu, A. and Williams, D.R. and Stein, D. J. and Koenen, K.C.}
}
@article {Rich2016,
	title = {{Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis}},
	journal = {The Lancet},
	volume = {388},
	number = {10049},
	year = {2016},
	abstract = {{\textcopyright} 2016 Elsevier LtdThe burden of HIV/AIDS and other transmissible diseases is higher in prison and jail settings than in the non-incarcerated communities that surround them. In this comprehensive review, we discuss available literature on the topic of clinical management of people infected with HIV, hepatitis B and C viruses, and tuberculosis in incarcerated settings in addition to co-occurrence of one or more of these infections. Methods such as screening practices and provision of treatment during detainment periods are reviewed to identify the effect of community-based treatment when returning inmates into the general population. Where data are available, we describe differences in the provision of medical care in the prison and jail settings of low-income and middle-income countries compared with high-income countries. Structural barriers impede the optimal delivery of clinical care for prisoners, and substance use, mental illness, and infectious disease further complicate the delivery of care. For prison health care to reach the standards of community-based health care, political will and financial investment are required from governmental, medical, and humanitarian organisations worldwide. In this review, we highlight challenges, gaps in knowledge, and priorities for future research to improve health-care in institutions for prisoners.},
	issn = {1474547X 01406736},
	doi = {10.1016/S0140-6736(16)30379-8},
	author = {Rich, J.D. and Beckwith, C.G. and Macmadu, A. and Marshall, B.D.L. and Brinkley-Rubinstein, L. and Amon, J.J. and M-J Milloy and King, M.R.F. and Sanchez, J. and Atwoli, L. and Altice, F.L.}
}
@article {Stein2016,
	title = {{Post-traumatic stress disorder associated with life-threatening motor vehicle collisions in the WHO World Mental Health Surveys}},
	journal = {BMC Psychiatry},
	volume = {16},
	number = {1},
	year = {2016},
	abstract = {{\textcopyright} 2016 The Author(s).Background: Motor vehicle collisions (MVCs) are a substantial contributor to the global burden of disease and lead to subsequent post-traumatic stress disorder (PTSD). However, the relevant literature originates in only a few countries, and much remains unknown about MVC-related PTSD prevalence and predictors. Methods: Data come from the World Mental Health Survey Initiative, a coordinated series of community epidemiological surveys of mental disorders throughout the world. The subset of 13 surveys (5 in high income countries, 8 in middle or low income countries) with respondents reporting PTSD after life-threatening MVCs are considered here. Six classes of predictors were assessed: socio-demographics, characteristics of the MVC, childhood family adversities, MVCs, other traumatic experiences, and respondent history of prior mental disorders. Logistic regression was used to examine predictors of PTSD. Mental disorders were assessed with the fully-structured Composite International Diagnostic Interview using DSM-IV criteria. Results: Prevalence of PTSD associated with MVCs perceived to be life-threatening was 2.5 {\%} overall and did not vary significantly across countries. PTSD was significantly associated with low respondent education, someone dying in the MVC, the respondent or someone else being seriously injured, childhood family adversities, prior MVCs (but not other traumatic experiences), and number of prior anxiety disorders. The final model was significantly predictive of PTSD, with 32 {\%} of all PTSD occurring among the 5 {\%} of respondents classified by the model as having highest PTSD risk. Conclusion: Although PTSD is a relatively rare outcome of life-threatening MVCs, a substantial minority of PTSD cases occur among the relatively small proportion of people with highest predicted risk. This raises the question whether MVC-related PTSD could be reduced with preventive interventions targeted to high-risk survivors using models based on predictors assessed in the immediate aftermath of the MVCs.},
	keywords = {Posttraumatic stress dis, [Motor vehicle collision},
	issn = {1471244X},
	doi = {10.1186/s12888-016-0957-8},
	author = {Stein, D. J. and Karam, E. G. and Shahly, V. and Hill, E.D. and King, A. and Petukhova, M. and Atwoli, L. and Bromet, E.J. and Florescu, S. and Haro, J.M. and Hinkov, H. and Karam, A. and Medina-Mora, M.E. and Navarro-Mateu, F. and Piazza, M. and Shalev, A. and Torres, Y. and Zaslavsky, A.M. and Kessler, R. C.}
}
@article {Bromet2016,
	title = {{Post-traumatic stress disorder associated with natural and human-made disasters in the World Mental Health Surveys}},
	journal = {Psychological Medicine},
	year = {2016},
	abstract = {Copyright {\textcopyright} Cambridge University Press 2016Background: Research on post-traumatic stress disorder (PTSD) following natural and human-made disasters has been undertaken for more than three decades. Although PTSD prevalence estimates vary widely, most are in the 20{\textendash}40{\%} range in disaster-focused studies but considerably lower (3{\textendash}5{\%}) in the few general population epidemiological surveys that evaluated disaster-related PTSD as part of a broader clinical assessment. The World Mental Health (WMH) Surveys provide an opportunity to examine disaster-related PTSD in representative general population surveys across a much wider range of sites than in previous studies. Method: Although disaster-related PTSD was evaluated in 18 WMH surveys, only six in high-income countries had enough respondents for a risk factor analysis. Predictors considered were socio-demographics, disaster characteristics, and pre-disaster vulnerability factors (childhood family adversities, prior traumatic experiences, and prior mental disorders). Results: Disaster-related PTSD prevalence was 0.0{\textendash}3.8{\%} among adult (ages 18+) WMH respondents and was significantly related to high education, serious injury or death of someone close, forced displacement from home, and pre-existing vulnerabilities (prior childhood family adversities, other traumas, and mental disorders). Of PTSD cases 44.5{\%} were among the 5{\%} of respondents classified by the model as having highest PTSD risk. Conclusion: Disaster-related PTSD is uncommon in high-income WMH countries. Risk factors are consistent with prior research: severity of exposure, history of prior stress exposure, and pre-existing mental disorders. The high concentration of PTSD among respondents with high predicted risk in our model supports the focus of screening assessments that identify disaster survivors most in need of preventive interventions.},
	keywords = {post-traumatic stress disorder, PTSD], [Disaster},
	issn = {14698978 00332917},
	doi = {10.1017/S0033291716002026},
	author = {Bromet, E.J. and Atwoli, L. and Kawakami, N. and Navarro-Mateu, F. and Piotrowski, P. and King, A.J. and Aguilar-Gaxiola, S. and Alonso, J. and Bunting, B. and Demyttenaere, K. and Florescu, S. and de Girolamo, G. and Gluzman, S. and Haro, J.M. and de Jonge, P. and Karam, E. G. and Lee, S. and Kovess-Masfety, V. and Medina-Mora, M.E. and Mneimneh, Z. and Pennell, B.-E. and Posada-Villa, J. and Salmer{\'o}n, D. and Takeshima, T. and Kessler, R. C.}
}
@article {Atwoli2016,
	title = {{Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys Jose Posada-Villa 24 Margreet ten Have}},
	journal = {Depress Anxiety},
	volume = {00},
	year = {2016},
	pages = {1{\textendash}12},
	abstract = {Background: Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about posttraumatic stress disorder (PTSD) after this experience. The WHO World Mental Health (WMH) survey ini-tiative provides a unique opportunity to address these issues. Methods: Data from 19 WMH surveys (n = 78,023; 70.1{\%} weighted response rate) were collated. Potential predictors of PTSD (respondent sociodemographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk. Results: PTSD prevalence after UD averaged 5.2{\%} across surveys and did not differ signifi-cantly between high-income and low-middle income countries. Significant multivariate predictors included the deceased being a spouse or child, the respondent being female and believing they could have done something to prevent the death, prior trauma exposure, and history of prior men-tal disorders. The final model was strongly predictive of PTSD, with the 5{\%} of respondents having highest estimated risk including 30.6{\%} of all cases of PTSD. Positive predictive value (i.e., the pro-portion of high-risk individuals who actually developed PTSD) among the 5{\%} of respondents with highest predicted risk was 25.3{\%}. Conclusions: The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and sug-gests that screening assessments might be useful in identifying high-risk individuals for preventive interventions.},
	keywords = {epidemiology, International, K E Y W O R D S cross-national, life events/stress, PTSD, trauma},
	doi = {10.1002/da.22579},
	author = {Atwoli, Lukoye and Stein, Dan J and King, Andrew and Petukhova, Maria and Aguilar-Gaxiola, Sergio and Alonso, Jordi and Bromet, Evelyn J and {De Girolamo}, Giovanni and Demyttenaere, Koen and Florescu, Silvia and Haro, Josep Maria and Karam, Elie G. and Kawakami, Norito and Lee, Sing and Lepine, Jean-Pierre and Navarro-Mateu, Fernando and Neill, Siobhan O {\textquoteright} and Pennell, Beth-Ellen and Piazza, Marina and Sampson, Nancy A and Zaslavsky, Alan M and Kessler, Ronald C.}
}
@article {Atwoli2015,
	title = {{Epidemiology of posttraumatic stress disorder}},
	journal = {Current Opinion in Psychiatry},
	year = {2015},
	month = {jul},
	doi = {10.1097/yco.0000000000000167},
	author = {Atwoli, Lukoye and Stein, Dan J and Koenen, Karestan C and McLaughlin, Katie A}
}
@article {Olaya2015,
	title = {{Association between traumatic events and post-traumatic stress disorder: Results from the ESEMeD-Spain study}},
	journal = {Epidemiology and Psychiatric Sciences},
	volume = {24},
	number = {2},
	year = {2015},
	abstract = {Copyright {\textcopyright} Cambridge University Press 2014.Background. The relative importance of traumatic events (TEs) in accounting for the social burden of post-traumatic stress disorder (PTSD) could vary according to cross-cultural factors. In that sense, no such studies have yet been conducted in the Spanish general population. The present study aims to determine the epidemiology of trauma and PTSD in a Spanish community sample using the randomly selected TEs method. Methods. The European Study of the Epidemiology of Mental Disorders (ESEMeD)-Spain is a cross-sectional household survey of a representative sample of adult population. Lifetime prevalence of self-reported TEs and lifetime and 12-month prevalence of PTSD were evaluated using the World Health Organization (WHO) Composite International Diagnostic Interview. Reports of PTSD associated with randomly selected TEs were weighted by the individual-level probabilities of TE selection to generate estimates of population-level PTSD risk associated with each TE. Results. Road accident was the most commonly self-reported TE (14.1{\%}). Sexual assault had the highest conditional risk of PTSD (16.5{\%}). The TEs that contributed most to societal PTSD burden were unexpected death of a loved one (36.4{\%} of all cases) and sexual assault (17.2{\%}). Being female and having a low educational level were associated with low risk of overall TE exposure and being previously married was related to higher risk. Being female was related to high risk of PTSD after experiencing a TE. Conclusions. Having an accident is commonly reported among Spanish adults, but two TE are responsible for the highest burden associated with PTSD: the unexpected death of someone close and sexual assault. These results can help designing public health interventions to reduce the societal PTSD burden.},
	keywords = {post-traumatic stress disorder, PTS, [Epidemiology},
	issn = {20457979 20457960},
	doi = {10.1017/S2045796014000092},
	author = {Olaya, B. and Alonso, J. and Atwoli, L. and Kessler, R. C. and Vilagut, G. and Haro, J.M.}
}
@article {Atwoli2015a,
	title = {{Association between witnessing traumatic events and psychopathology in the South African Stress and Health Study}},
	journal = {Social Psychiatry and Psychiatric Epidemiology},
	volume = {50},
	number = {8},
	year = {2015},
	abstract = {{\textcopyright} 2015, Springer-Verlag Berlin Heidelberg.Background: The high burden of witnessing traumatic events has been demonstrated in previous research in South Africa. However, previous work has focused on PTSD rather than a broader range of psychopathological outcomes. This study examined the association between witnessing trauma and multiple outcomes including mood, anxiety, and substance use disorders. Methods: Regression models measured the odds of mood, anxiety, and substance use disorders among those who reported witnessing in the South African Stress and Health Study. Discrete-time survival analysis was used to examine whether witnessing was associated with earlier onset of mental disorders. Results: Witnessing trauma was more commonly reported among males and those with low-average education. Posttraumatic stress disorder, mood, and anxiety disorders varied significantly with witnessing status, and witnessing was associated with exposure to a higher number of traumatic events compared to other types of traumatic events. Respondents reporting witnessing trauma had elevated odds of mood and anxiety disorders, but not substance use disorders. Conclusion: Witnessing trauma is common in the South African population and results in increased risk of mood and anxiety disorders. Interventions aimed at reducing the burden of trauma and its outcomes must now increase their focus on bystanders and other observers, rather than just focusing on those directly affected.},
	keywords = {Anxiety disorders, Mood disorders, trauma, [Africa},
	issn = {09337954},
	doi = {10.1007/s00127-015-1046-x},
	author = {Atwoli, L. and Platt, J. and Williams, D.R. and Stein, D. J. and Koenen, K.C.}
}
@book {Were2015,
	title = {{Building Comprehensive and Sustainable Health Informatics Institutions in Developing Countries: Moi University Experience}},
	series = {Studies in Health Technology and Informatics},
	volume = {216},
	year = {2015},
	abstract = {{\textcopyright} 2015 IMIA and IOS Press.Current approaches for capacity building in Health Informatics (HI) in developing countries mostly focus on training, and often rely on support from foreign entities. In this paper, we describe a comprehensive and multidimensional capacity-building framework by Lansang {\&} Dennis, and its application for HI capacity building as implemented in a higher-education institution in Kenya. This framework incorporates training, learning-by-doing, partnerships, and centers of excellence. At Moi University (Kenya), the training dimensions include an accredited Masters in HI Program, PhD in HI, and HI short courses. Learning-by-doing occurs through work within MOH facilities at the AMPATH care and treatment program serving 3 million people. Moi University has formed strategic HI partnerships with Regenstrief Institute, Inc. (USA), University of Bergen (Norway), and Makerere University (Uganda), among others. The University has also created an Institute of Biomedical Informatics to serve as an HI Center of Excellence in the region. This Institute has divisions in Training, Research, Service and Administration. The HI capacity-building approach by Moi provides a model for adoption by other institutions in resource-limited settings.},
	keywords = {Developing Countries, Health I, [Capacity Building},
	isbn = {9781614995630},
	issn = {18798365 09269630},
	doi = {10.3233/978-1-61499-564-7-520},
	author = {Were, M.C. and Siika, A. and Ayuo, P.O. and Atwoli, L. and Esamai, F.}
}
@article {Atwoli2015b,
	title = {{Epidemiology of posttraumatic stress disorder: Prevalence, correlates and consequences}},
	journal = {Current Opinion in Psychiatry},
	volume = {28},
	number = {4},
	year = {2015},
	abstract = {Copyright {\textcopyright} 2015 Wolters Kluwer Health, Inc. All rights reserved.Purpose of review This review discusses recent findings from epidemiological surveys of traumatic events and posttraumatic stress disorder (PTSD) globally, including their prevalence, risk factors, and consequences in the community. Recent findings A number of studies on the epidemiology of PTSD have recently been published from diverse countries, with new methodological innovations introduced. Such work has not only documented the prevalence of PTSD in different settings, but has also shed new light on the PTSD conditional risk associated with specific traumatic events, and on the morbidity and comorbidities associated with these events. Summary Recent community studies show that trauma exposure is higher in lower-income countries compared with high-income countries. PTSD prevalence rates are largely similar across countries, however, with the highest rates being found in postconflict settings. Trauma and PTSD-risk factors are distributed differently in lower-income countries compared with high-income countries, with sociodemographic factors contributing more to this risk in high-income than low-income countries. Apart from PTSD, trauma exposure is also associated with several chronic physical conditions. These findings indicate a high burden of trauma exposure in low-income countries and postconflict settings, where access to trained mental health professionals is typically low.},
	keywords = {epidemiology, Posttraumatic stres, [DSM-5 criteria},
	issn = {14736578 09517367},
	doi = {10.1097/YCO.0000000000000167},
	author = {Atwoli, L. and Stein, D. J. and Koenen, K.C. and McLaughlin, K. A.}
}
@article {Benjet2015,
	title = {{The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium}},
	journal = {Psychological Medicine},
	year = {2015},
	abstract = {Copyright {\textcopyright} Cambridge University Press 2015Background: Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. Method: General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. Results: Over 70{\%} of respondents reported a traumatic event; 30.5{\%} were exposed to four or more. Five types {\textendash} witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury {\textendash} accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. Conclusions: Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.},
	keywords = {epidemiology, injury, revictimization, [Disasters},
	issn = {14698978 00332917},
	doi = {10.1017/S0033291715001981},
	author = {Benjet, C. and Bromet, E. and Karam, E. G. and Kessler, R. C. and McLaughlin, K. A. and Ruscio, A. M. and Shahly, V. and Stein, D. J. and Petukhova, M. and Hill, E. and Alonso, J. and Atwoli, L. and Bunting, B. and Bruffaerts, R. and Caldas-de-Almeida, J. M. and de Girolamo, G. and Florescu, S. and Gureje, O. and Huang, Y. and Lepine, J. P. and Kawakami, N. and Kovess-Masfety, V. and Medina-Mora, M.E. and Navarro-Mateu, F. and Piazza, M. and Posada-Villa, J. and Scott, K.M. and Shalev, A. and Slade, T. and ten Have, M. and Torres, Y. and Viana, M. C. and Zarkov, Z. and Koenen, K.C.}
}
@article {Dalvie2015,
	title = {{Large Scale Genetic Research on Neuropsychiatric Disorders in African Populations is Needed}},
	journal = {EBioMedicine},
	volume = {2},
	number = {10},
	year = {2015},
	issn = {23523964},
	doi = {10.1016/j.ebiom.2015.10.002},
	author = {Dalvie, S. and Koen, N. and Duncan, L. and Abbo, C. and Akena, D. and Atwoli, L. and Chiliza, B. and Donald, K.A. and Kinyanda, E. and Lochner, C. and Mall, S. and Nakasujja, N. and Newton, C.R. and Ramesar, R. and Sibeko, G. and Teferra, S. and Stein, D. J. and Koenen, K.C.}
}
@article {Shirey2015,
	title = {{Symptoms of depression among patients attending a diabetes care clinic in rural western Kenya}},
	journal = {Journal of Clinical and Translational Endocrinology},
	volume = {2},
	number = {2},
	year = {2015},
	abstract = {{\textcopyright} 2015 The Authors.Abstract Objective The prevalence of diabetes in sub-Saharan Africa is rising, but its relationship to depression is not well-characterized. This report describes depressive symptom prevalence and associations with adherence and outcomes among patients with diabetes in a rural, resource-constrained setting. Methods In the Webuye, Kenya diabetes clinic, we conducted a chart review, analyzing data including medication adherence, hemoglobin A1c (HbA1c), clinic attendance, and PHQ-2 depression screening results. Results Among 253 patients, 20.9{\%} screened positive for depression. Prevalence in females was higher than in males; 27{\%} vs 15{\%} (p = 0.023). Glycemic control trends were better in those screening negative; at 24 months post-enrollment mean HbA1c was 7.5 for those screening negative and 9.5 for those screening positive (p = 0.0025). There was a nonsignificant (p = 0.269) trend toward loss to follow-up among those screening positive. Conclusions These findings suggest that depression is common among people with diabetes in rural western Kenya, which may profoundly impact diabetes control and treatment adherence.},
	keywords = {Diabetes, Kenya, Resource-constrained, [Depression},
	issn = {22146237},
	doi = {10.1016/j.jcte.2015.02.002},
	author = {Shirey, K. and Manyara, S.M. and Atwoli, L. and Tomlin, R. and Gakinya, B. and Cheng, S. and Kamano, J. and Laktabai, J. and Pastakia, S.}
}
@article {Atwoli2014a,
	title = {{Association between parental psychopathology and suicidal behavior among adult offspring: Results from the cross-sectional South African Stress and Health survey}},
	journal = {BMC Psychiatry},
	volume = {14},
	number = {1},
	year = {2014},
	abstract = {Background: Prior studies have demonstrated a link between parental psychopathology and offspring suicidal behavior. However, it remains unclear what aspects of suicidal behavior among adult offspring are predicted by specific parental mental disorders, especially in Africa. This study set out to investigate the association between parental psychopathology and suicidal behavior among their adult offspring in a South African general population sample.Method: Parental psychopathology and suicidal behavior in offspring were assessed using structured interviews among 4,315 respondents from across South Africa. The WHO CIDI was used to collect data on suicidal behavior, while the Family History Research Diagnostic Criteria Interview was used to assess prior parental psychopathology. Bivariate and multivariate survival models tested the associations between the type and number parental mental disorders (including suicide) and lifetime suicidal behavior in the offspring. Associations between a range of parental disorders and the onset of subsequent suicidal behavior (suicidal ideation, plans, and attempts) among adult offspring were tested.Results: The presence of parental psychopathology significantly increased the odds of suicidal behavior among their adult offspring. More specifically, parental panic disorder was associated with offspring suicidal ideation, while parental panic disorder, generalized anxiety disorder and suicide were significantly associated with offspring suicide attempts. Among those with suicidal ideation, none of the tested forms of parental psychopathology was associated with having suicide plans or attempts. There was a dose-response relationship between the number of parental disorders and odds of suicidal ideation.Conclusions: Parental psychopathology increases the odds of suicidal behavior among their adult offspring in the South African context, replicating results found in other regions. Specific parental disorders predicted the onset and persistence of suicidal ideation or attempts in their offspring. Further research into these associations is recommended in order to determine the mechanisms through which parent psychopathology increases the odds of suicidal behavior among offspring. {\textcopyright} 2014 Atwoli et al.; licensee BioMed Central Ltd.},
	keywords = {South Africa, Suicide], [Parental psychopathology},
	issn = {1471244X},
	doi = {10.1186/1471-244X-14-65},
	author = {Atwoli, L. and Nock, M.K. and Williams, D.R. and Stein, D. J.}
}
@article {Stein2014,
	title = {{DSM-5 and ICD-11 definitions of posttraumatic stress disorder: Investigating "narrow" and "broad" approaches}},
	journal = {Depression and Anxiety},
	volume = {31},
	number = {6},
	year = {2014},
	abstract = {Background: The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10. Methods: WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSMIV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview (CIDI). DSM-5 and proposed ICD-11 criteria were approximated. Associations of the different criteria sets with indicators of clinical severity (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate the implications of using the different systems. Results: A total of 5.6{\%} of respondents met criteria for "broadly defined" PTSD (i.e., full criteria in at least one diagnostic system), with prevalence ranging from 3.0{\%} with DSM-5 to 4.4{\%} with ICD-10. Only one-third of broadly defined cases met criteria in all four systems and another one third in only one system (narrowly defined cases). Between-system differences in indicators of clinical severity suggest that ICD-10 criteria are least strict and DSM-IV criteria most strict. The more striking result, though, is that significantly elevated indicators of clinical significance were found even for narrowly defined cases for each of the four diagnostic systems. Conclusions: These results argue for a broad definition of PTSD defined by any one of the different systems to capture all clinically significant cases of PTSD in future studies. {\textcopyright} 2014 Wiley Periodicals, Inc.},
	keywords = {DSM-IV, epidemiology, ICD-10, ICD-11, Noso, [DSM-5},
	issn = {15206394 10914269},
	doi = {10.1002/da.22279},
	author = {Stein, D. J. and McLaughlin, K. A. and Koenen, K.C. and Atwoli, L. and Friedman, M.J. and Hill, E.D. and Maercker, A. and Petukhova, M. and Shahly, V. and {Van Ommeren}, M. and Alonso, J. and Borges, G. and {De Girolamo}, G. and {De Jonge}, P. and Demyttenaere, K. and Florescu, S. and Karam, E. G. and Kawakami, N. and Matschinger, H. and Okoliyski, M. and Posada-Villa, J. and Scott, K.M. and Viana, M. C. and Kessler, R. C.}
}
@article {Ayuku2014,
	title = {{The government of Kenya cash transfer for orphaned and vulnerable children: Cross-sectional comparison of household and individual characteristics of those with and without}},
	journal = {BMC International Health and Human Rights},
	volume = {14},
	number = {1},
	year = {2014},
	abstract = {{\textcopyright} 2014 Ayuku et al.; licensee BioMed Central Ltd.Background: The {\textquoteright}Cash Transfer to Orphans and Vulnerable Children{\textquoteright} (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people{\textquoteright}s health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT.Methods. This project analyzes baseline data from a cohort of orphaned and separated children aged {\textless}19 years and non-orphaned children living in 300 randomly selected households (HH) in 8 Locations of Uasin Gishu County, Kenya. Baseline data were analyzed using multivariable logistic and Poisson regression comparing children in CT-HH vs. non-CT HH. Odds ratios are adjusted (AOR) with 95{\%} confidence intervals (CI) for guardian age and sex, child age and sex, and intra-HH correlation.Results: Included in this analysis were data from 1481 children and adolescents in 300 HH (503 participants in CT, 978 in non-CT households). Overall there were 922 (62.3{\%}) single orphans, 324 (21.9{\%}) double orphans, and 210 (14.2{\%}) participants had both parents alive and were living with them. Participants in CT-HH were less likely to have >=2 pairs of clothes compared to non-CT HH (AOR: 0.32, 95{\%} CI: 0.16-0.63). Those in CT HH were less likely to have missed any days of school in the preceding month (AOR: 0.62, 95{\%} CI: 0.42-0.94) and those aged {\textless}1-18 years in CT-HH were less likely to have height stunting for their age (AOR: 0.65, 95{\%} CI: 0.47-0.89). Participants aged at least 10 years in CT-HH were more likely to have a positive future outlook (AOR: 1.72, 95{\%} CI: 1.12-2.65).Conclusions: Children and adolescents in households receiving the CT-OVC appear to have better nutritional status, school attendance, and optimism about the future, compared to those in households not receiving the CT, in spite of some evidence of continued material deprivation. Consideration should be given to expanding the program further.},
	keywords = {Cash transfer, Food security, Mental heal, [Africa},
	issn = {1472698X},
	doi = {10.1186/1472-698X-14-25},
	author = {Ayuku, D. and Embleton, L. and Koech, J. and Atwoli, L. and Hu, L. and Ayaya, S. and Hogan, J. and Nyandiko, W. and Vreeman, R. and Kamanda, A. and Braitstein, P.}
}
@article {Atwoli2014,
	title = {{Impact of domestic care environment on trauma and posttraumatic stress disorder among orphans in Western Kenya}},
	journal = {PLoS ONE},
	volume = {9},
	number = {3},
	year = {2014},
	abstract = {Objective: The aim of this study was to determine the impact of the domestic care environment on the prevalence of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) among orphaned and separated children in Uasin Gishu County, western Kenya. Methods: A total of 1565 (55.5{\%} male) orphaned and separated adolescents aged 10-18 years (mean 13.8 years, sd 2.2), were assessed for PTSD and PTEs including bullying, physical abuse and sexual abuse. In this sample, 746 lived in extended family households, 746 in Charitable Children{\textquoteright}s Institutions (CCIs), and 73 on the street. Posttraumatic stress symptom (PTSS) scores and PTSD were assessed using the Child PTSD Checklist. Results: Bullying was the commonest PTE in all domestic care environments, followed by physical and sexual abuse. All PTEs were commonest among the street youth followed by CCIs. However, sexual abuse was more prevalent in households than in CCIs. Prevalence of PTSD was highest among street youth (28.8{\%}), then households (15.0{\%}) and CCIs (11.5{\%}). PTSS scores were also highest among street youth, followed by CCIs and households. Bullying was associated with higher PTSS scores and PTSD odds than either sexual or physical abuse. Conclusion: This study demonstrated differences in distribution of trauma and PTSD among orphaned and separated children in different domestic care environments, with street youth suffering more than those in CCIs or households. Interventions are needed to address bullying and sexual abuse, especially in extended family households. Street youth, a heretofore neglected population, are urgently in need of dedicated mental health services and support. {\textcopyright} 2014 Atwoli et al.},
	issn = {19326203},
	doi = {10.1371/journal.pone.0089937},
	author = {Atwoli, L. and Ayuku, D. and Hogan, J. and Koech, J. and Vreeman, R.C. and Ayaya, S. and Braitstein, P.}
}
@article {Embleton2014,
	title = {{Models of care for orphaned and separated children and upholding children{\textquoteright}s rights: Cross-sectional evidence from western Kenya}},
	journal = {BMC International Health and Human Rights},
	volume = {14},
	number = {1},
	year = {2014},
	abstract = {Background: Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children{\textquoteright}s basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. Methods. The Orphaned and Separated Children{\textquoteright}s Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged <=18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher{\textquoteright}s exact test was also used if some cells had expected value of less than 5. Results: Included in this analysis are data from 300 households, 19 Charitable Children{\textquoteright}s Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI{\textquoteright}s and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as {\textquoteright}Pure CCI{\textquoteright} for those only providing residential care, {\textquoteright}CCI-Plus{\textquoteright} for those providing both residential care and community-based supports to orphaned children, and {\textquoteright}CCI-Shelter{\textquoteright} which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95{\%}) were significantly (p {\textless} 0.0001) more likely to have their basic material needs met in comparison to those in family-based care (17{\%}) and institutions were better able to provide an adequate standard of living. Conclusions: Each model of care we identified has strengths and weaknesses. The orphan crisis in sub-Saharan Africa requires a diversity of care environments in order to meet the needs of children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately care for children. {\textcopyright} 2014Embleton et al.; licensee BioMed Central Ltd.},
	keywords = {Kenya, Orphans, Street childre, [Children{\textquoteright}s rights},
	issn = {1472698X},
	doi = {10.1186/1472-698X-14-9},
	author = {Embleton, L. and Ayuku, D. and Kamanda, A. and Atwoli, L. and Ayaya, S. and Vreeman, R. and Nyandiko, W. and Gisore, P. and Koech, J. and Braitstein, P.}
}
@inbook {89,
	title = {Sleep and Sleep Disorders},
	booktitle = {In Your A-Z on Mental Health},
	year = {2014},
	publisher = {Acrodile Publishing Ltd},
	organization = {Acrodile Publishing Ltd},
	edition = {2nd  Revised Edition},
	address = {Nairobi},
	author = {Atwoli, L.},
	editor = {DM Ndetei and VN Mutiso}
}
@article {Ombok2013,
	title = {{THE PREVALENCE OF POST-TRAUMATIC STRESS DISORDER AMONG SEXUALLY ABUSED CHILDREN AT KENYATTA NATIONAL HOSPITAL IN NAIROBI, KENYA.}},
	year = {2013},
	month = {oct},
	url = {http://europepmc.org/abstract/med/26862643},
	author = {Ombok, C A and Obondo, A and Kangethe, R and Atwoli, L.}
}
@article {Kamanda2013,
	title = {{Harnessing the power of the grassroots to conduct public health research in sub-Saharan Africa: a case study from western Kenya in the adaptation of community-based participatory research (CBPR) approaches.}},
	journal = {BMC public health},
	volume = {13},
	year = {2013},
	abstract = {Community-based participatory research (CBPR) is a collaborative approach to research that involves the equitable participation of those affected by an issue. As the field of global public health grows, the potential of CBPR to build capacity and to engage communities in identification of problems and development and implementation of solutions in sub-Saharan Africa has yet to be fully tapped. The Orphaned and Separated Children{\textquoteright}s Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. This paper will describe how CBPR approaches and principles can be incorporated and adapted into the study design and methods of a longitudinal epidemiological study in sub-Saharan Africa using this project as an example. The CBPR framework we used involves problem identification, feasibility and planning; implementation; and evaluation and dissemination. This case study will describe how we have engaged the community and adapted CBPR methods to OSCAR{\textquoteright}s Health and Well-being Project{\textquoteright}s corresponding to this framework in four phases: 1) community engagement, 2) sampling and recruitment, 3) retention, validation, and follow-up, and 4) analysis, interpretation and dissemination. To date the study has enrolled 3130 orphaned and separated children, including children living in institutional environments, those living in extended family or other households in the community, and street-involved children and youth. Community engagement and participation was integral in refining the study design and identifying research questions that were impacting the community. Through the participation of village Chiefs and elders we were able to successfully identify eligible households and randomize the selection of participants. The on-going contribution of the community in the research process has been vital to participant retention and data validation while ensuring cultural and community relevance and equity in the research agenda. CBPR methods have the ability to enable and strengthen epidemiological and public health research in sub-Saharan Africa within the social, political, economic and cultural contexts of the diverse communities on the continent. This project demonstrates that adaptation of these methods is crucial to the successful implementation of a community-based project involving a highly vulnerable population.},
	issn = {14712458},
	doi = {10.1186/1471-2458-13-91},
	author = {Kamanda, A. and Embleton, L. and Ayuku, D. and Atwoli, L. and Gisore, P. and Ayaya, S. and Vreeman, R. and Braitstein, P.}
}
@article {Embleton2013,
	title = {{The Journey of Addiction: Barriers to and Facilitators of Drug Use Cessation among Street Children and Youths in Western Kenya}},
	journal = {PLoS ONE},
	volume = {8},
	number = {1},
	year = {2013},
	abstract = {This mixed-methods study examined barriers to and facilitators of street children{\textquoteright}s drug use cessation in Eldoret, Kenya utilizing a cross-sectional survey and focus group discussions with a community-based sample of street-involved children and youth. The primary objective of this study was to describe factors that may assist or impede cessation of drug use that can be utilized in developing substance use interventions for this marginalized population. In 2011, 146 children and youth ages 10-19 years, classified as either children on the street or children of the street were recruited to participate in the cross-sectional survey. Of the 146 children that participated in the survey 40 were invited to participate in focus group discussion; 30 returned voluntarily to participate in the discussions. Several themes were derived from children{\textquoteright}s narratives that described the barriers to and facilitators of drug cessation. Specifically, our findings reveal the strength of the addiction to inhalants, the dual role that peers and family play in substance use, and how the social, cultural, and economic context influence or impede cessation. Our findings demonstrate the need to integrate community, family and peers into any intervention in addition to traditional medical and psychological models for treatment of substance use dependence. {\textcopyright} 2013 Embleton et al.},
	issn = {19326203},
	doi = {10.1371/journal.pone.0053435},
	author = {Embleton, L. and Atwoli, L. and Ayuku, D. and Braitstein, P.}
}
@article {Braitstein2013,
	title = {{Nutritional Status of Orphaned and Separated Children and Adolescents Living in Community and Institutional Environments in Uasin Gishu County, Kenya}},
	journal = {PLoS ONE},
	volume = {8},
	number = {7},
	year = {2013},
	abstract = {Objective: To describe the nutritional status of orphaned and separated children and adolescents (OSCA) living in households in the community (HH), on the street, and those in institutional environments in western Kenya. Methods: The study enrolled OSCA from 300 randomly selected households (HH), 19 Charitable Children{\textquoteright}s Institutions (CCIs), and 100 street-involved children. Measures of malnutrition were standardized with Z-scores using World Health Organization criteria; Z-scores <=-2 standard deviations (sd) were moderate-severe malnutrition. Data were analyzed using multivariable logistic regression adjusting for child age, sex, HIV status, whether the child had been hospitalized in the previous year, time living with current guardian, and intra-household clustering for adequacy of diet and moderate-severe malnutrition. Results: Included are data from 2862 participants (1337 in CCI{\textquoteright}s, 1425 in HH{\textquoteright}s, and 100 street youth). The population was 46{\%} female with median age at enrolment of 11.1 years. Only 4.4{\%} of households and institutions reported household food security; 93{\%} of children in HH reported an adequate diet vs. 95{\%} in CCI{\textquoteright}s and 99{\%} among street youth. After adjustment, OSCA in HH were less likely to have an adequate diet compared to those in CCI{\textquoteright}s (AOR 0.4, 95{\%} CI 0.2-1.0). After adjustment, there were no differences between the categories of children on weight-for-age, weight-for-height, or BMI-for-age. Children living in HH (AOR 2.6, 95{\%} CI: 2.0-3.4) and street youth (AOR: 5.9, 95{\%} CI: 3.6-9.5) were more likely than children in CCI{\textquoteright}s to be low height-for-age. Conclusion: OSCA in HH are less likely to have an adequate diet compared to children in CCI{\textquoteright}s. They and street children are more likely to be moderately-severely low height-for-age compared to children in CCI{\textquoteright}s, suggesting chronic malnutrition among them. {\textcopyright} 2013 Braitstein et al.},
	issn = {19326203},
	doi = {10.1371/journal.pone.0070054},
	author = {Braitstein, P. and Ayaya, S. and Nyandiko, W.M. and Kamanda, A. and Koech, J. and Gisore, P. and Atwoli, L. and Vreeman, R.C. and Duefield, C. and Ayuku, D.O.}
}
@article {Kinyanjui2013,
	title = {{Substance use among inmates at the Eldoret prison in Western Kenya}},
	journal = {BMC Psychiatry},
	volume = {13},
	year = {2013},
	abstract = {Background: Criminal activity and social problems are recognized as important outcomes of substance use and abuse. Little research has been carried out on substance use among prison inmates in Kenya. General population surveys that have examined drug use usually omit this {\textquoteright}hidden{\textquoteright} population which may offer insight into drug related morbidity and invaluable preventive measures. This study is set out to determine the lifetime prevalence and factors associated with substance use, including the most frequently used substances, among inmates at a government prison in Western Kenya.Methods: Design: A cross-sectional descriptive study, using the WHO model questionnaire and an additional drug use and effects questionnaire among prisoners at the Eldoret Government of Kenya (GK) prison, Kenya.Setting: Study was carried out at the Eldoret G.K. prison, with a population of 1325 (1200 males and 125 females) inmates.Subjects: Three hundred and ninety five prisoners, who gave consent, were selected, consisting of 271 males (68.6{\%}) selected by simple random sampling, and 124 females (31.4{\%}) enrolled consecutively due to their small number. The mean age was 33.3 years (18-72, s.d. 9.8) while the mean number of years of formal education was 8.4 (0-15, s.d. 3.4).Results: Lifetime prevalence of substance use was 66.1{\%}, while that of alcohol use was 65.1{\%}. Both were significantly associated with male gender, urban residence and higher level of education. The lifetime prevalence of cigarette use was 32.7{\%} while 22.5{\%} admitted to chewing tobacco. Factors significantly associated with tobacco use were male gender, urban residence, being unmarried, younger age, lack of income in the past year. The prevalence of cannabis use was 21{\%}, and this was associated with male gender, urban residence, being unmarried, and being a student in the past year. Other substances used included amphetamines (9.4{\%}), volatile inhalants (9.1{\%}), sedatives (3.8{\%}), tranquillizers (2.3{\%}), cocaine (2.3{\%}), and heroine (1.3{\%}). Users were commonly introduced to the habit by friends (70.8{\%}), immediate family members (13.7{\%}) and other close relatives (6.2{\%}). Among those who reported lifetime substance use the common reasons attributed to the habit were the need to relax (26.5{\%}), relieve stress (24.5{\%}) and confidence to commit a crime (4.5{\%}). Majority of those who reported alcohol use were already suffering ill effects.Conclusions: There is a high prevalence of substance use among prisoners at the Eldoret G.K. prison. The increased morbidity and unpleasant psychosocial consequences of this habit suggest a need for establishment of substance use management programmes in Kenyan prisons. {\textcopyright} 2013 Kinyanjui and Atwoli; licensee BioMed Central Ltd.},
	issn = {1471244X},
	doi = {10.1186/1471-244X-13-53},
	author = {Kinyanjui, D.W.C. and Atwoli, L.}
}
@article {Atwoli2013a,
	title = {{Trauma and posttraumatic stress disorder in South Africa: Analysis from the South African Stress and Health Study}},
	journal = {BMC Psychiatry},
	volume = {13},
	year = {2013},
	abstract = {Background: South Africa{\textquoteright}s unique history, characterised by apartheid, a form of constitutional racial segregation and exploitation, and a long period of political violence and state-sponsored oppression ending only in 1994, suggests a high level of trauma exposure in the general population. The aim of this study was to document the epidemiology of trauma and posttraumatic stress disorder (PTSD) in the South African general population.Methods: The South African Stress and Health Study is a nationally representative survey of South African adults using the WHO{\textquoteright}s Composite International Diagnostic Interview (CIDI) to assess exposure to trauma and presence of DSM-IV mental disorders.Results: The most common traumatic events were the unexpected death of a loved one and witnessing trauma occurring to others. Lifetime and 12-month prevalence rates of PTSD were 2.3{\%} and 0.7{\%} respectively, while the conditional prevalence of PTSD after trauma exposure was 3.5{\%}. PTSD conditional risk after trauma exposure and probability of chronicity after PTSD onset were both highest for witnessing trauma. Socio-demographic factors such as sex, age and education were largely unrelated to PTSD risk.Conclusions: The occurrence of trauma and PTSD in South Africa is not distributed according to the socio-demographic factors or trauma types observed in other countries. The dominant role of witnessing in contributing to PTSD may reflect the public settings of trauma exposure in South Africa and highlight the importance of political and social context in shaping the epidemiology of PTSD. {\textcopyright} 2013 Atwoli et al.; licensee BioMed Central Ltd.},
	keywords = {South Africa, Trau, [Posttraumatic stress disorder},
	issn = {1471244X},
	doi = {10.1186/1471-244X-13-182},
	author = {Atwoli, L. and Stein, D. J. and Williams, D.R. and McLaughlin, K. A. and Petukhova, M. and Kessler, R. C. and Koenen, K.C.}
}
@article {Atwoli2013,
	title = {{Trauma and posttraumatic stress disorder in South Africa: analysis from the South African Stress and Health Study.}},
	journal = {BMC psychiatry},
	year = {2013},
	abstract = {BACKGROUND: South Africa{\textquoteright}s unique history, characterised by apartheid, a form of constitutional racial segregation and exploitation, and a long period of political violence and state-sponsored oppression ending only in 1994, suggests a high level of trauma exposure in the general population. The aim of this study was to document the epidemiology of trauma and posttraumatic stress disorder (PTSD) in the South African general population.$\backslash$n$\backslash$nMETHODS: The South African Stress and Health Study is a nationally representative survey of South African adults using the WHO{\textquoteright}s Composite International Diagnostic Interview (CIDI) to assess exposure to trauma and presence of DSM-IV mental disorders.$\backslash$n$\backslash$nRESULTS: The most common traumatic events were the unexpected death of a loved one and witnessing trauma occurring to others. Lifetime and 12-month prevalence rates of PTSD were 2.3{\%} and 0.7{\%} respectively, while the conditional prevalence of PTSD after trauma exposure was 3.5{\%}. PTSD conditional risk after trauma exposure and probability of chronicity after PTSD onset were both highest for witnessing trauma. Socio-demographic factors such as sex, age and education were largely unrelated to PTSD risk.$\backslash$n$\backslash$nCONCLUSIONS: The occurrence of trauma and PTSD in South Africa is not distributed according to the socio-demographic factors or trauma types observed in other countries. The dominant role of witnessing in contributing to PTSD may reflect the public settings of trauma exposure in South Africa and highlight the importance of political and social context in shaping the epidemiology of PTSD.},
	keywords = {80 and over, Adolescent, Adult, Aged, Diagnostic and Statistical Manual of Mental Disord, Female, Health Surveys, Humans, Life Change Events, Male, Middle Aged, Post-Traumatic, Post-Traumatic: diagnosis, Post-Traumatic: epidemiology, Prevalence, Psychological, Psychological: epidemiology, South Africa, South Africa: epidemiology, Stress, Stress Disorders, Violence, Violence: statistics {\&} numerical data, War},
	isbn = {10.1186/1471-244X-13-182},
	issn = {1471-244X},
	doi = {10.1186/1471-244X-13-182},
	author = {Atwoli, Lukoye and Stein, Dan J and Williams, David R. and McLaughlin, Katie A and Petukhova, Maria and Kessler, Ronald C. and Koenen, Karestan C}
}
@article {Vreeman2012,
	title = {{Community perspectives on research consent involving vulnerable children in Western Kenya}},
	journal = {Journal of Empirical Research on Human Research Ethics},
	volume = {7},
	number = {4},
	year = {2012},
	abstract = {INVOLVING VULNERABLE PEDIATRIC populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers, community leaders, and even community assemblies could participate in the consent process. Community members believed research involving orphans and street children could benefit these vulnerable populations, but would require special processes for consent. {\textcopyright} 2012 by Joan Sieber. All Rights Reserved.},
	keywords = {Ethics, Informed consen, [Community-based research},
	issn = {15562646 15562654},
	doi = {10.1525/jer.2012.7.4.44},
	author = {Vreeman, R. and Kamaara, E. and Kamanda, A. and Ayuku, D. and Nyandiko, W. and Atwoli, L. and Ayaya, S. and Gisore, P. and Scanlon, M. and Braitstein, P.}
}
@article {Embleton2012,
	title = {{Knowledge, attitudes, and substance use practices among street children in Western Kenya}},
	journal = {Substance Use and Misuse},
	volume = {47},
	number = {11},
	year = {2012},
	abstract = {The study describes the knowledge of and attitudes toward substance use among street-involved youth in Kenya, and how they relate to their substance use practices. In 2011, 146 children and youth ages 1019 years, classified as either children on the street or children of the street were recruited to participate in a cross-sectional survey in Eldoret, Kenya. Bivariate analysis using $\chi$ 2 or Fisher{\textquoteright}s Exact Test was used to test the associations between variables, and multiple logistic regression analysis was used to identify independent covariates associated with lifetime and current drug use. The study{\textquoteright}s limitations and source of funding are noted. {\textcopyright} 2012 Informa Healthcare USA, Inc.},
	keywords = {Inhalants, Knowledge, Resource-constra, [Attitudes},
	issn = {10826084 15322491},
	doi = {10.3109/10826084.2012.700678},
	author = {Embleton, L. and Ayuku, D. and Atwoli, L. and Vreeman, R. and Braitstein, P.}
}
@article {Kamau2012,
	title = {{Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community}},
	journal = {AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV},
	volume = {24},
	number = {7},
	year = {2012},
	abstract = {The course of HIV/AIDS in children has been transformed from an acute to a chronic one with the advent of Anti-Retroviral Therapy. The aim of this study was to determine the prevalence and pattern of psychiatric morbidity in HIV-infected children and adolescents between 6 and 18 years of age and the relationship between their socio-demographic factors, immune suppression and psychiatric morbidity. The study was conducted at a paediatric HIV clinic in Nairobi, between February and April 2010. One hundred and sixty-two HIV-infected children and adolescents aged between 6 and 18 years and their guardians were interviewed. Seventy-nine (48.8{\%}) of the study participants were found to have psychiatric morbidity. The most prevalent Diagnostic Statistical Manual, 4th Edition TR psychiatric disorders were: Major depression (17.8{\%}), Social phobia (12.8{\%}), Oppositional Defiant Disorder (12.1{\%}) and Attention Deficit Hyperactivity Disorder (12.1{\%}). Twenty-five per cent of the study participants had more than one psychiatric disorder. The prevalence of psychiatric morbidity in HIV-infected children is higher than that found in children in the general population. There is therefore a need to integrate psychiatric services into the routine care of HIV-infected children. {\textcopyright} 2012 Taylor {\&} Francis.},
	keywords = {AIDS, children, DSM-IV, HIV, Kenya, [adolescents},
	issn = {09540121 13600451},
	doi = {10.1080/09540121.2011.644234},
	author = {Kamau, J.W. and Kuria, W. and Mathai, M. and Atwoli, L. and Kangethe, R}
}
@article {Vreeman2012a,
	title = {{A qualitative study using traditional community assemblies to investigate community perspectives on informed consent and research participation in western Kenya}},
	journal = {BMC Medical Ethics},
	volume = {13},
	number = {1},
	year = {2012},
	abstract = {Background: International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings. Methods. We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on biomedical research and informed consent within a collaborative, multinational research network in western Kenya. Analyses included manual, progressive coding of transcripts from mabaraza to identify emerging central concepts. Results: Our findings from two mabaraza with 108 community members revealed that, while participants understood some principles of biomedical research, they emphasized perceived benefits from participation in research over potential risks. Many community members equated health research with HIV testing or care, which may be explained in part by the setting of this particular study. In addition to valuing informed consent as understanding and accepting a role in research activities, participants endorsed an increased role for the community in making decisions about research participation, especially in the case of children, through a process of community consent. Conclusions: Our study suggests that international biomedical research must account for community understanding of research and informed consent, particularly when involving children. Moreover, traditional community forums, such as mabaraza in East Africa, can be used effectively to gather these data and may serve as a forum to further engage communities in community consent and other aspects of research. {\textcopyright} 2012 Vreeman et al.; licensee BioMed Central Ltd.},
	keywords = {Ethics, Informed consen, [Community-based research},
	issn = {14726939},
	doi = {10.1186/1472-6939-13-23},
	author = {Vreeman, R. and Kamaara, E. and Kamanda, A. and Ayuku, D. and Nyandiko, W. and Atwoli, L. and Ayaya, S. and Gisore, P. and Scanlon, M. and Braitstein, P.}
}
@article {Atwoli2012,
	title = {{Short-term diagnostic stability among re-admitted psychiatric in-patients in Eldoret, Kenya}},
	journal = {African Journal of Psychiatry (South Africa)},
	volume = {15},
	number = {2},
	year = {2012},
	abstract = {Objective: To determine the prospective and retrospective consistency of diagnoses among readmitted psychiatric in-patients at the Moi Teaching and Referral Hospital in Eldoret, Kenya. Method: Admission and discharge diagnoses among a consecutive sample of 114 psychiatric in-patients readmitted at the Moi Teaching and Referral Hospital between August and December 2009 were compared. Results: The commonest diagnoses at admission were schizophrenia spectrum disorders (47.4{\%}) and bipolar spectrum disorders (30.7{\%}). Overall diagnostic stability as measured by prospective consistency in this study was 72.8{\%}.The most stable diagnostic category was Major Depressive Disorder (100{\%} prospective and retrospective consistency), followed by Bipolar Disorders (91.4{\%} prospective consistency, 69.6{\%} retrospective consistency) and Substance-related disorders (87.5{\%} prospective consistency, 50{\%} retrospective consistency). Schizophrenia-spectrum disorders had a prospective consistency of 75.9{\%} and a retrospective consistency of 87.2{\%}. {\textquoteright}Other Psychotic Disorders{\textquoteright} (acute psychotic episode and psychotic disorder not otherwise specified) had the lowest diagnostic stability, with both prospective and retrospective consistency being 0{\%}. Conclusion: Mood disorders and substance-related disorders have the highest diagnostic stability among readmitted psychiatric inpatients in a low-income country.},
	keywords = {Low and Middle income count, [Diagnostic stability},
	issn = {19948220},
	doi = {10.4314/ajpsy.v15i2.15},
	author = {Atwoli, L. and Ndambuki, D. and Owiti, P and Manguro, G and Omulimi, N}
}
@article {Atwoli2011a,
	title = {{Attention deficit hyperactivity disorder symptom self-report among medical students in Eldoret, Kenya}},
	journal = {African Journal of Psychiatry (South Africa)},
	volume = {14},
	number = {4},
	year = {2011},
	abstract = {Objective: To determine the prevalence of self-reported attention deficit hyperactivity disorder (ADHD) symptoms among medical students in Eldoret, Kenya. Method: A cross-sectional descriptive study of all medical students who gave consent to participate in the study. Undertaken at Moi University{\textquoteright}s School of Medicine in Eldoret, Kenya. Comprising two hundred and fifty three (253) undergraduate medical students, with a mean age of 23.7 years (19-42, s.d. 4.1), of whom 51{\%} were female. Measuring ADHD symptomatology using the Adult ADHD Self-Report Scale (ASRS v1.1). Results: The prevalence rate of self-reported ADHD symptoms using the ASRS screener was 23.7{\%}. This was significantly associated with being in the age-group 17-20 years compared (p{\textless}0.05). The prevalence rate was higher among females (25.6{\%}) than among males (21.8{\%}), but this difference was not statistically significant. Preclinical students had a higher prevalence rate of ADHD symptoms (28.7{\%}) compared to clinical students (19.6{\%}), but this was also not statistically significant. Using a modification of the ASRS full symptom checklist to approximate a Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) ADHD diagnosis yielded a {\textquoteright}possible ADHD{\textquoteright} prevalence rate of 8.7{\%}. Of these, the inattentive type was the most common (40.9{\%}). Conclusion: The prevalence rate of self-reported ADHD symptoms among medical students in Eldoret is very high and possibly interferes with the students{\textquoteright} social and academic functioning. Further studies are suggested to generate information on the real ADHD prevalence in the general population and in special populations such as schools and colleges.},
	keywords = {[Attention deficit hyperactivity disorder (ADHD)},
	issn = {19948220},
	doi = {10.4314/ajpsy.v14i4.5},
	author = {Atwoli, L. and Owiti, P and Manguro, G and Ndambuki, D.}
}
@inbook {90,
	title = {An overview of suicidal behaviour in Africa},
	booktitle = {Contemporary Psychiatry in  Africa},
	year = {2011},
	pages = {375-396},
	publisher = {Acrodile Publishing Ltd},
	organization = {Acrodile Publishing Ltd},
	edition = { A Review of Theory, Practice and Research},
	address = {Nairobi},
	author = {Atwoli, L.},
	editor = {DM Ndetei and C. Szabo}
}
@article {Atwoli2011,
	title = {{Prevalence of substance use among college students in Eldoret, western Kenya}},
	journal = {BMC Psychiatry},
	volume = {11},
	year = {2011},
	abstract = {Background: Substance use among college and university students predicts substance related problems in later life. Few studies on this phenomenon have been carried out in low income countries, and most focus on primary and secondary school students. This study therefore aimed to establish the prevalence and factors associated with drug use among university and college students in a low income country.Methods: Design: A descriptive cross-sectional survey using the Self-Administered WHO Model Core Questionnaire to collect information on use of various drugs among students in colleges and university campuses within Eldoret Municipality in Western Kenya. Setting: Four tertiary learning institutions in Eldoret Municipality were randomly selected for inclusion in the study- three tertiary level non-university institutions and one university campus. Subjects: Five hundred students who gave consent to participate in the study, 125 from each of the four participating institutions. The mean age was 22.9 years (18-32, s.d. 2.5), and males made up 52.2{\%} of the sample.Results: Lifetime prevalence rate of any substance use was 69.8{\%}, and none of the socio-demographic factors was significantly associated with this. Lifetime prevalence rate of alcohol use was 51.9{\%}, and 97.6{\%} of alcohol users had consumed alcohol in the week prior to the study. The prevalence rate of cigarette use was 42.8{\%}, with males having statistically significantly higher rates than females (p {\textless} 0.05). Other substances used were cannabis (2{\%}) and cocaine (0.6{\%}). Among those who admitted to using substances, 75.1{\%} were introduced by a friend while 23.5{\%} were introduced by a relative other than a member of the nuclear family. Majority of those using substances wanted to relax (62.2{\%}) or relieve stress (60.8{\%}). Problems associated with alcohol use included quarrelling and fights, loss and damage to property, problems with parents, medical problems and unplanned unprotected sex.Conclusion: The prevalence of substance use among college and university students in Eldoret is high and causes significant physical and psychosocial problems in this population. A large proportion of those using alcohol reported serious adverse effects, raising the necessity of targeted interventions to reduce the risk of subsequent substance dependence and other deleterious consequences. {\textcopyright} 2011 Atwoli et al; licensee BioMed Central Ltd.},
	issn = {1471244X},
	doi = {10.1186/1471-244X-11-34},
	author = {Atwoli, L. and Mungla, P.A. and Ndung{\textquoteright}u, M.N. and Kinoti, K.C. and Ogot, E.M.}
}
@article {Atwoli2010a,
	title = {{Emergency mental health and psychosocial support for survivors of post-election violence in Eldoret, Kenya.}},
	journal = {East African medical journal},
	volume = {87},
	number = {11},
	year = {2010},
	abstract = {To describe the design and delivery of emergency mental health and psychosocial support services for the survivors of Post-Election Violence in Eldoret, Kenya. A longitudinal intervention. The North Rift Valley region in Western Kenya. A total of 80,772 survivors received mental health and psychosocial support services. Counselling and Psychological First Aid services were successfully offered to most survivors in the North Rift Valley region. Common issues addressed included looking for lost relatives, sudden traumatic death of relatives, anger at their attackers, feelings of revenge, fear of seeing the corpse, loss of all property and source of livelihood and denial. It is possible and necessary to integrate a mental health and psychosocial support intervention into a disaster response even in limited resource settings. Further studies are recommended to evaluate the effectiveness of this approach.},
	issn = {0012835X},
	author = {Atwoli, L.}
}
@article {Atwoli2010b,
	title = {{General medical conditions among patients with mental illness.}},
	journal = {East African medical journal},
	volume = {87},
	number = {9},
	year = {2010},
	issn = {0012835X},
	author = {Atwoli, L.}
}
@inbook {91,
	title = {A radical proposal to deal with our prejudices},
	booktitle = {Oxford Transitional Justice Research},
	year = {2010},
	pages = {117-118},
	publisher = {The Foundation for Law, Justice and Society \& The Centre for Socio-Legal Studies, University of Oxford},
	organization = {The Foundation for Law, Justice and Society \& The Centre for Socio-Legal Studies, University of Oxford},
	edition = {Debating International Justice in Africa (OTJR Collected Essays 2008-2010)},
	address = {Oxford},
	author = {Atwoli, L.}
}
@article {Atwoli2010,
	title = {{Self-reported attention deficit and hyperactivity disorder symptoms among university students in Eldoret, Kenya.}},
	journal = {East African medical journal},
	volume = {87},
	number = {5},
	year = {2010},
	abstract = {To determine the prevalence of self-reported attention deficit and hyperactivity disorder (ADHD) symptoms among university students in Eldoret, Kenya. A cross-sectional descriptive study of all students who gave consent to participate in the study. Moi University{\textquoteright}s Town Campus, comprising the Schools of Medicine, Dentistry and Public Health. Four hundred and fifty eight undergraduate students, with a mean age of 23.7 years (17-46, S.D. 4.1), of whom 236 (51.5{\%}) were male. Presence of ADHD symptoms as measured by the adult ADHD self-report scale (ASRS versus 1.1). The prevalence rate of self-reported ADHD symptoms was 21.8{\%}. This was significantly associated with belonging to a younger age-group (17-20 years) compared to the older age-groups (p{\textless}0.05). The prevalence was higher among females (25.2{\%}) than among males (18.6{\%}), but this was not statistically significant. There was no significant association between a positive ASRS screen and course of study. Using a modification of ASRS full symptom checklist to approximate a DSM IV TR ADHD diagnosis yielded a prevalence of ADHD symptoms of 9.2{\%} in this cohort. The prevalence rate of ADHD symptoms among university students in Eldoret, Kenya is significantly higher than that reported in other studies. Further studies are needed to generate more information about this condition in the low-income countries, especially in college and university populations.},
	issn = {0012835X},
	author = {Atwoli, L. and Owiti, P and Manguro, G and Ndambuki, D.}
}
@article {Atwoli2009,
	title = {{Neuroleptic induced tardive dyskinesia in a patient on treatment for schizophrenia: Case report}},
	journal = {East African Medical Journal},
	volume = {86},
	number = {7},
	year = {2009},
	abstract = {In this case, a thirty six year old patient on treatment for schizophrenia is described with severe tardive dyskinesia. The most likely cause is long term treatment with two highly potent typical antipsychotic medications. The patient was initially treated with Benzhexol, an anticholinergic agent with the potential to induce or aggravate the disorder. This case discusses the common presentation and management of neuroleptic induced tardive dyskinesia.},
	issn = {0012835X},
	author = {Atwoli, L. and Manguro, G and Owiti, P and Ndambuki, D.}
}
@article {Atwoli2006,
	title = {{Post traumatic stress disorder among Mau Mau concentration camp survivors in Kenya}},
	journal = {East African Medical Journal},
	volume = {83},
	number = {7},
	year = {2006},
	abstract = {Background: A decade before Kenya{\textquoteright}s independence in 1963 thousands of {\textquoteright}Mau Mau{\textquoteright} fighters were arrested and incarcerated in concentration camps where many underwent torture and inhuman treatment. No studies have been done to establish the presence of post traumatic stress disorder (PTSD) and other psychiatric morbidity among the survivors of those concentration camps. Objectives: To establish the prevalence of PTSD and other psychiatric morbidity and associated factors among the Mau Mau Concentration Camp survivors. Design: A cross-sectional, descriptive study of all consecutive concentration camp survivors included in the study. Setting: Mau Mau War Veterans{\textquoteright} Association (MMWVA) headquarters at Mwea House, Nairobi, Kenya Human Rights Commission headquarters in Nairobi, Tumaini House (Venue of MMWVA elections, 2005) and the MMWVA branch office in Kajiado District, Rift Valley Province, Kenya. Subjects: One hundred and eighty one Mau Mau Concentration Camp Survivors who gave consent to participate in the study. Main outcome measures: Lifetime and Current PTSD, IES-R score and other Psychiatric Morbidity as measured using the SCID and the IES-R. Results: A DSM-IV-TR diagnosis of current PTSD was made in 65.7{\%} of the survivors. Current PTSD was associated with higher IES-R scores and older age, lower income, non-Catholic religion, larger household size, older age at incarceration, greater length of incarceration, incarceration in two or more camps, experiencing other traumatic events, family history of mental illness and having other psychiatric illness. Conclusions: Similar to other former Prisoners of War (POWs) elsewhere, these survivors suffer high PTSD prevalence rates and a special veterans{\textquoteright} service is recommended to address this problem and its associated factors among these and other veterans in Kenya.},
	issn = {0012835X},
	author = {Atwoli, L. and Kathuku, D. M. and DM Ndetei}
}
