Publications

Copyright © 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.

Background: Fasciolosis is known globally to be an important helminthic disease of ruminants caused by liver
fluke species of the genus Fasciola, and it is one of the most neglected tropical zoonotic diseases that can lead to
human infection. It has the widest geographic spread of any emerging zoonotic disease, and it occurs in many
countries of the world. Objectives: The study aimed at determining the prevalence of fasciolosis in ruminants
slaughtered in Trans-Nzoia West. Specific objectives were to establish the trend of fasciolosis in ruminants,
ascertain the relationship between fasciolosis prevalence and rainfall patterns and assess the knowledge of meat
sellers and farmers about fasciolosis. Methodology: A 5-year secondary data retrospective study was carried out
in Trans-Nzoia West, Trans-Nzoia County. The study population consisted of ruminants slaughtered, meat
sellers and livestock farmers.Results: A total of 104,221 cattle, sheep and goats were slaughtered in the five-year
period in which 6,098 (5.85%) were infested with fasciolosis with a prevalence of 6.52%, 6.08% and 4.1 0% in
cattle, sheep, and goats respectively. Most meat sellers (72.2%) were able to identify fasciolosis in infested livers,
88.9% reported liver flukes infestation resulted in the loss of income while 58.3% were not aware of nutrition
depletion associated with fasciolosis. Of the farmers interviewed, 52.9% grazed in swampy areas, 66.7%
dewormed after 3 months, 78.4% had heard about fasciolosis and 80.0% did not know the cause of fasciolosis.
The majority (95.0%) were not aware of the snail species spreading liver flukes while 77.5% did not know that
fasciolosis was a zoonotic disease.Conclusion: Fasciolosis was prevalent in the area and caused great economic
loss to the meat sellers. Most farmers were not aware of its cause and zoonotic nature. Recommendations:
Fasciolosis control should be approached from a multidisciplinary angle and farmers should be educated on it
and its zoonotic nature.

Background: Fasciolosis is known globally to be an important helminthic disease of ruminants caused by liver
fluke species of the genus Fasciola, and it is one of the most neglected tropical zoonotic diseases that can lead to
human infection. It has the widest geographic spread of any emerging zoonotic disease, and it occurs in many
countries of the world. Objectives: The study aimed at determining the prevalence of fasciolosis in ruminants
slaughtered in Trans-Nzoia West. Specific objectives were to establish the trend of fasciolosis in ruminants,
ascertain the relationship between fasciolosis prevalence and rainfall patterns and assess the knowledge of meat
sellers and farmers about fasciolosis. Methodology: A 5-year secondary data retrospective study was carried out
in Trans-Nzoia West, Trans-Nzoia County. The study population consisted of ruminants slaughtered, meat
sellers and livestock farmers.Results: A total of 104,221 cattle, sheep and goats were slaughtered in the five-year
period in which 6,098 (5.85%) were infested with fasciolosis with a prevalence of 6.52%, 6.08% and 4.1 0% in
cattle, sheep, and goats respectively. Most meat sellers (72.2%) were able to identify fasciolosis in infested livers,
88.9% reported liver flukes infestation resulted in the loss of income while 58.3% were not aware of nutrition
depletion associated with fasciolosis. Of the farmers interviewed, 52.9% grazed in swampy areas, 66.7%
dewormed after 3 months, 78.4% had heard about fasciolosis and 80.0% did not know the cause of fasciolosis.
The majority (95.0%) were not aware of the snail species spreading liver flukes while 77.5% did not know that
fasciolosis was a zoonotic disease.Conclusion: Fasciolosis was prevalent in the area and caused great economic
loss to the meat sellers. Most farmers were not aware of its cause and zoonotic nature. Recommendations:
Fasciolosis control should be approached from a multidisciplinary angle and farmers should be educated on it
and its zoonotic nature.

© 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.

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

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