POST-TRAUMATIC STRESS DISORDER AMONG SOMALI GIRLS LIVING IN EASTLEIGH, NAIROBI, WHO HAVE

UNDERGONE FEMALE GENITAL CUTTING.

Presnters: Maimuna Mohamud Isse, Muthoni Mathai, John Mburu

PCAF Regional Psychotrauma Conference: 13th to 16th July

Venue: Nairobi

University of Nairobi ISO 9001:2008 1 Certified http://www.uonbi.ac.ke

Objective

The purpose of this presentation is to highlight the problem of Female Genital Cutting among the Somali in Kenya based on a study done for a Post Graduate Diploma in Psychotrauma at the department of Psychiatry University of Nairobi in 2014

Introduction and background

Female genital mutilation/cutting (FGM)/C is defined as comprising all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

FGM/C is recognized internationally as a violation of the human rights of girls and women and is a violation of the rights of children (Who 2010).

The practice is widespread in Africa. Associated with severe health and psychosocial

consequences

Classification of FGM

(WHO, UNICEF, UNFPA, 1997). Type I FGM,

Type II female genital mutilation,

(WHO, UNICEF, UNFPA, 1997). Type II FGM,

Type III female genital mutilation

(WHO, UNICEF, UNFPA, 1997). Type III FGM,

Prevalence of FGM in the world

An estimated 100 to 140 million girls and women in the world today have undergone some form of female genital mutilation/Cutting.

An est. 2 million girls are at risk from the practice each year.

The great majority of affected women live in sub-Saharan Africa, but the practice is also known in parts of the Middle East and Asia.

As a result of migration the practice has spread to other western countries.

FGM/C in Africa and Middle East

Percentage of girls and women aged 15 to 49 who have undergone FGM/C by Country (2013)http://www.undispatch.com/map-of-the-day-the-countries-where-female-genital-mutilation-is-rampant/

FGM in Africa

Most women who have experienced FGM live in one of the 28 countries in Africa or the Middle East where FGM is practiced.

Recent survey data, available for 18 of these countries, show the prevalence of FGM to range from 5% to 97% of the female population.

FGM in Kenya

The prevalence of FGM in girls and women (aged 15-49 years) is est. at 27.1%. (KDHS 2008/2009)

There is a wide regional and ethnic difference

nearly universal among Somali at 98%

Ethnic group Prevalence

Somali 98%

Abagusii 96%

Maasai 94%

Taita Taveta 62%

Kalenjin 49%

Embu 43%

Meru 41%

Kikuyu 33%

Mijikenda/Swahili <5%

PTSD and FGM

Research suggests that women who have undergone FGM/C are at an increased risk of developing psychological and emotional health problems

In a study in Senegal more than 90% of circumcised subjects described severe pain and feeling of intense fear helplessness, and horror at time of the trauma and more than 80% continued to have flash backs (Stotland 2005).

Review of literaturecont……………

Another study found that the severity of psychological problems was related to the severity of mutilation. Women who had undergone Types I and II showed lesser adverse psychological effects compared to those who had undergone Type III, which has been linked with post-traumatic stress disorder (Behrendit and Moritz S.)

Study objectives

Overall objective The study aimed at establishing the psychological

impact of FGM among Somali girls in Kenya.   Specific objectives1. To establish the demographic profile of Somali girls

who have undergone FGM. 2. To establish the prevalence of PTSD among Somali

girls who have undergone FGM.3. To explore girls attitudes towards FGM

Study Method

Study Design: A descriptive cross- sectional study

 Study Sites: An Educational Centre in Eastleigh. This school is predominantly attended by Somali ethnic students and as such, was purposively selected for this study

  Sampling and sample The study sampled all female students at the

Educational Centre in Eastleigh from form 1 to 4

Study Populationaccording to the 2009 census the Somali ethnic

groups in Kenya are 2,385,572 people

University of Nairobi ISO 9001:2008 15 Certified http://www.uonbi.ac.ke

Data Collection Instruments

1. Social demographic data instrument. Researcher designed- was used to collect data on age, class,

ethnic group, nationality, political status, type of FGM if known and age at which FGM was performed and if girls would choose to have their daughters cut in future

2. The impact of Event Scale-R (IES-R) Is a self administered report scale designed to measure the

intensity of trauma- related symptoms on 3 separate dimensions: Hyper-arousal, intrusive thoughts and behavioral avoidance. It yields a total score from the summation of the Hyper-arousal, intrusion and avoidance subscale scores.

Ethical approval and Study limitation

  Study proposal was reviewed and approved

by ERC KNH/UON The study was limited in scope and time

since. It only looked at one school in Eastleigh and one ethnic group.

 

Socio Demographic Profile of Somali girls in the study

50.9% (n=172) were Kenyan Somalis 49.1% (n=166) were Somali refugees Average age was 19.64 ±3.229 years. Majority of the girls were in the age bracket

15 to 24 years Ranging from 15 to34 years

Socio Demographic Profile of Somali girls in the study

50.9% (n=172) were Kenyan Somalis

49.1% (n=166) were Somali refugees

Average age was 19.64 ±3.229 years.

Majority of the girls were in the age bracket 15 to 24 years

Ranging from 15 to34 years

0

10

20

30

40

50

6051.2

40.8

7.4

0.600000000000001

Distribution of Somali girls by age

Series1

Age in Years

Pro

port

ion

of g

irls

(%)

Distribution by FGC status of the Somali Girls

85.8% (n=429) of the girls sampled had undergone FGM/C/Circumcision.

14.2% (n=71) of the girls had not been undergone FGC.

Every 4 in 5 Somali girls sampled in the study had undergone FGC.

86%

14%

FGC Status of the Somali girls

CircumcisedUncircumcised

Age at which FGC done

18.9% (n=81) had undergone FGM between 0 and 5 years

68.8% (n=295) 6 – 10 years

11.9% (n=51) 11 – 15 years

0.5% (n=2) 16 -20

0

10

20

30

40

50

60

70

18.9

68.8

11.9

0.5

Distribution of Somali girls by age at circum-cision

Series1

Age at circumcision

Pro

port

ion

of g

irls

(%)

Year of High school study

There was no significant relationship between FGM and current year of study. (p=0.288).

Form of study Proportion

Circumcised

Form 1 87.6% (78)

Form 2 80.0% (64)

Form 3 86.4% (89)

Form 4 89.0% (130)

Parents level of education

The study analysed the Mother and father level of education in association to whether girls had undergone FGC

There was no significant relationship between level of education of fathers and their daughters’ circumcision status. ( p=0.950).

There was no significant relationship between level of education of mothers and their daughters circumcision (p=0.230)

Attitude towards FGM

34.8% (n=168) of the girls said they approved of it- as it was culturally acceptable and a normal occurrence among the Somali community

65.2% (n=315) disapproved as- an archaic and backward cultural practice that denied women of their peace during delivery.

35%

65%

Approves

Disapproves

Desire by girls to circumcise their daughters in

the future

28% (n=135) girls said they would Circumcise their daughters- of these 92.6% (125) were circumcised and 7.4% (10) were not.

72% (n=341) girls said they would not circumcise their daughters- of these 83.0% (283) were circumcised and 17.0% (58) were not

Girls who had been cut were significantly more likely to express a desire to cut their daughters in future (p=0.004)

Distribution of PTSD Symptoms

Evaluation based on the scores of IES-r, 21.7% (n=107) of the girls did not show any

signs of Post traumatic stress 33.6% (n=166) of the girls exhibited several

symptoms of post traumatic stress 44.7% (n=221) had scores above the cut off

point for PTSD

Distribution of PTS Symptoms

21.7% (n=107) did not show any signs of Post traumatic stress

33.6% (n=166) exhibited several symptoms of post traumatic stress

44.7% (n=221) had scores above the cut off point for PTSD

0

5

10

15

20

25

30

35

40

45

21.7

33.6

44.7

Distribution of Somali girls by PTS symptoms

Series1

PTS Symptoms

Pro

por

tion

of

girl

s (%

)

PTSD prevalence by Circumcision Status

PTSD prevalence among the girls who had gone through FGM is more than twice the prevalence of PTSD among the uncircumcised Somali girls.

Circumcised girls - 49.1%, n=209), Uncircumcised girls – (17.6%, n=12) PTSD was significantly Associated with FGC-

(p=0.001)

Current age and age at “cut” and PTSD

Age specific PTSD prevalence among Somali girls

Age in Years PTSD Cases

15 – 19 41.5% (105)

20 – 24 48.5% (98)

25 – 29 44.4% (16)

30 – 34 66.7% (2)

PTSD prevalence specific to age at “cut” of Somali Girls

Age in years PTSD Cases0 – 5 46.9% (38)6 – 10 50.0% (146)11 – 15 47.1% (24)16 – 20 50.0% (1)

No significant Association between age at “cut” and PTSD

No significant Association between current age and PTSD

Discussion

A huge proportion of the population in the study were or still are Somali refugees who lost many years in the anarchy of their country, with an average age higher than the school age in Nairobi

Discussion ct

The prevalence of FGC in the community is high and concordant to the Kenya Demographic and Health Survey 2008/9 (38).

FGC is not associated with a specific age cohort but high across all age cohorts because circumcision in Somali culture is not a rite of passage to womanhood as in other Kenyan ethnic groups.

Discussion Ct

The prevalence of PTSD among girls who had undergone FGC is higher than in the general population but lower than that found by Ndiema among Maasai girls (37).

However Ndiema’s study was done in a rescue home where the girls had recently under gone FGC and had had the added trauma of early forced marriage and dislocation to a rescue home.

The risk of perpetuation of FGC is particularly high among girls who had undergone the cut in this community.

Conclusion

Despite the current legislation banning the practice in Kenya, Somali girls are at high risk of undergoing FGC which is associated with the high prevalence of PTSD, irrespective of the level of education of the parents.

Recommendations

Based on the findings above, the following recommendations are hereby made:-

Somali parents through available channels such as the religious meeting places or Caucasus organized for purposes of community empowerment should be educated on the effects, both physical and psychological, of Female Genital Mutilation especially among young girls.

There is need for Intervention measures to treat the survivors

Vision: A world-class university committed to scholarly excellence

The University of

Nairobi

University of Nairobi ISO 9001:2008 36 Certified http://www.uonbi.ac.ke