Publications

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 'hidden' 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. © 2013 Kinyanjui and Atwoli; licensee BioMed Central Ltd.

It is a sine qua non that research and health care provided in international settings raise profound ethical questions when different cultural and political values are implicated. Yet ironically, as international health research expands and as research on ethical issues in international health research broadens and deepens, we appear to have moved away from discussing the moral foundations of these activities. For international health research to thrive and lead to the kind of benefits it is capable of, it is helpful to occasionally revisit the foundational premises that justify the enterprise as a whole. We draw on the experience of the Indiana University–Moi University Academic Research Ethics Partnership, an innovative bioethics training program co-located in Indianapolis and Eldoret, Kenya to highlight the changing nature of ethical issues in international health research and the ongoing practical challenges.

BACKGROUND: South Africa'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'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.

Background: South Africa'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'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. © 2013 Atwoli et al.; licensee BioMed Central Ltd.