1. CHILDHOOD ADVERSITY AND ITS RELATIONSHIP TO PSYCHOLOGICAL TRAUMA IN NODDING SYNDROME (NS) AFFECTED CHILDREN BYAMAH MUTAMBA, JAMES OKELLO,JANET NAKIGUDDE,SEGGANE MUSISI BUTABIKA HOSPITAL/MAKSPH PCAF CONFERENCE;MBARARA JULY 2014

2. ACKNOWLEDGEMENTS  GCC/IPT-F Study team & communities  MaKSPH  MOH

3. OUTLINE BACKGROUND AIM METHODS FINDINGS DISCUSSION CONCLUSION/WAY FORWARD

4. BACKGROUND >3000 children and adolescents affected by Nodding Syndrome (NS) in post conflict Northern Uganda-mainly the Acholi sub region. Adverse childhood experiences occur in the post war situation( family context, including interpersonal trauma, poverty and deprivation)

5. BACKGROUND Children in post conflict situations have high rates of mental health problem. Co morbidity the norm: Major Depression, Generalised Anxiety disorder, PTSD (Derluyn 2004, Kohrt 2008, Moscardino 2008,Okello 2013) PTSD rates : Okello et al,2007;26.8% (Abducted) vs 12.8% (Non abducted), Klassen et al,2010: 33% in Child soldiers )

6. BACKGROUND The link between childhood adversities, NS and psychological trauma not well understood NS Adverse events Psycho-trauma

8. AIM

9. To Investigate the relationship between childhood adversity and psychological trauma in children with NS (part of GCC/IPT-F study ).

10. METHODS 146 children with NS assessed during the GCC/IPT-F Baseline (cross sectional) study Study sites: Atanga (SC1) and Awere (SC2) subcounties Ethical approval received Socio-demographic questionnaires Past childhood adverse events assessed using Adverse Childhood Exposure (ACE) questionnaire ( Bruffaerts et al., 2010, J.Okello et al., 2013). : Determines type and number of traumatic events. Total ACE scores was computed for each participant ; modeled as a continuous variable in our analyses (mean cut off scores)

11. METHODS Level of psychological trauma assessed using The CHILDREN’S IMPACT OF EVENT SCALE (CRIES-13) (Weiss and Marmar (1997) Consists of three subscales : intrusion, avoidance and hyper arousal. Has been used in war-affected adolescent populations in Africa (Amone-P'olak et al., 2007; Mels et al., 2010, J.Okello et al., 2013). Total scores computed for each individual and a mean cut off score calculated to determine high and low levels of psychological trauma..

12. RESULTS Mean age: 13.7years Females: 52.5% 82.5% -lived with a parent/guardian 71.7% -studied up to middle primary level (p5) Majority of the children (82.2%) had a high adverse events score 48.6% had high levels of psycho trauma No statistically significant difference between SC1 and SC2

13. Common adverse events Adverse eventsSubcounty 1Subcounty 2Total (%) Has your child ever lived in an IDP camp 74 (97.4)68 (100.0)142 (98.6) Duration while in IDP: mean (sd) 7.1 (2.7)6.8 (2.7)7.0 (2.7) During your child’s childhood was there ever a period of 6 months or more when your family or child received food or support from a government assistance program like World Food Program 65 (85.5)66 (97.1)131 (91.0) Was there a time during your child’s childhood when your child had less than one meal a day 55 (73.3)54 (79.4)109 (76.2) Has there been a time in the past 6 months when there was not enough money at home to buy food for your children/child 60 (79.0)56 (82.3)116 (80.6) Was there a time in the last 6 months when your child had less than one meal a day 47 (65.3)51 (75.0)98 (70.0) Has there been a time when you have had to cut your child/children’s meal size one or more times in the past 6 months 49 (64.4)52 (76.5)101 (70.1)

14. RESULTS ADVERSE CHILDHOOD EVENTS Sub county 1 Sub county 2 Total During your child’s childhood was there ever a period of 6 months or more when your family or child received food or support from a government assistance program like World Food Program No 11 (14.5) 2 (2.9) 13 (9.0) Yes 65 (85.5) 66 (97.1) 131(91.0) p=0.019 Other stressful events that your child experienced p=0.003

15. RESULTS Revised Child impact of events scale Adverse childhood events NoYesTotalORP95% CI low count:<417 (22.7)9 (12.7)26 (17.8) high count:>=458 (77.3)62 (87.3)120 (82.2)20.1190.83-4.89 Current food security No11 (14.7)10 (14.1)21 (14.4) Yes64 (85.3)61 (85.9)125 (85.6)10.920.42-2.65

16. DISCUSSION High levels of trauma comparable to other studies (arousal symptoms more common in both SCs)…?scoring system More “chronic poverty” adversities Levels of trauma not significantly associated with Adversities experienced Co-morbidity; depression and anxiety (Kohrt 2008,Klassen 2010,Okello 2013)

17. DISCUSSION Is it because of trauma that we can not find trauma?..sensitive questions? Small sample size Cultural validation of instruments…Other hidden stressors/adversities Role of cumulative/developmental trauma experiences???? (Klasen et al..2013) Cross sectional design…no causality

18. CONCLUSION/WAY FORWARD NS affected children had high levels of psycho trauma and most have experienced childhood adversity..commonly deprivation Association with adversities experienced not statistically significantly. Further investigation of psycho trauma in NS,using culturally validated methods,to identify other hidden stressors required NS programme response to include psycho trauma specific interventions

19. Thank you for listening!!