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Global Mental Health

Presentation to the 9/11 Trauma Team

Contemporary Methodologies in Psychotherapy

A Key Informant Study and Community Readiness Survey in the Village of Kalenga, Iringa District, Tan

Investigating suicide among the Wahehe of Iringa District, Tanzania. A Participatory Action research project.

 

Objective

Following anecdotal reports to this writer of frequent suicidality in the village of Kalenga, Iringa District, Tanzania (population 2,025), village elders (self-selected, all male) were asked to complete a rudimentary and retrospective survey[1] to measure the extent of the problem. Results of this survey show a disturbingly high rate of suicide for this village.  

Findings:

·      The Village of Kalenga has a suicide rate of approximately one hundred per hundred thousand of population

·      Ten suicides (six female, four male) reported in the period 2006/10

·      All six female suicides were reported as married.

·      One of four male suicide was reported as married.

·      2 males were age 15 – 20 and 2 aged  over 50.

·      1 Female was aged 10 – 15 yrs, 1 aged 25 - 35 yrs, 3 over 50, 1 age not recorded  

 Survey respondents report the causes of suicide as:

·      extra-marital pregnancy

·      promiscuity and marital discord

·      social humiliation

·      alcohol abuse

Discussion:

Tanzania has a per-capita income of $164 of which $4 is spent on health, (not including mental health) and the rest on subsistence.[2] The vast majority of people in the village of Kalenga live in conditions of hard-core poverty and the rudimentary nature of this survey reflects the paucity of resources in the area to examine urgent socio-psychological and epidemiological concerns for mental health.

 

The size of the survey's targeted population, the anomalies both in it’s completion by local stakeholders and in the metrics it produces, all suggest further research is needed. If accurate, however, this survey puts the village of Kalenga at the top of the world-wide suicide rate. (U.S has a rate of 17.7 per 100,000, U.K 10.4 and the highest known rate overall (74) is in Belarus .[3] It should be noted that the Kalenga survey may be statistically anomalous to Tanzania as a whole and even in the immediate vicinity because of micro-cultural variations between villages.

The WHO can provide no reliable statistics on suicide for the sub-Saharan Africa region but a recent study in Dar-es-Salam[4] does support the opinions of Kalenga's village elders with regard to causes. In that study, acute marital and family conflicts, disappointments of partners in love affairs, and unwanted pregnancies were cited as causative in 57.3% of cases where cause was established. (One hundred cases were studied)

 

Distribution of suicide by gender in Kalenga (six female, four male) is not in line with global statistics which trend toward higher numbers of male suicides by a factor of roughly one and a half to five times. (Only Tajikistan and China show more or less equality in the number of suicides across the genders[5], the previously cited study from Dar-es Salaam does conform to global trends) This suggests that the women of Kalenga may tend to carry an unequal share of the burden of poverty [6] and are at higher risk than men in situations of domestic conflict.

Conclusion and Proposals

Suicide is symptomatic of extreme mental distress. It is associated with trauma, chronic physical and mental illness, alcohol and substance abuse and socio economic despair. The World Health Organization[7] suggests that on average, more than 90% of mental, neurological and substance abuse (MNS) disorders go untreated in poor Countries. The Village of Kalenga appears to be a singular example that supports this assertion.

Further study should aim to: 

•  Expand the suicide survey to include the villages of Mkoga, (pop. 1,137) Isakalilo (pop. 866) and Tosamaganga (pop. 5,246) (the Ward of Kalenga, total pop. approx 9, 274)
•  Establish a suicide monitoring and 'gate-keeper' prevention program in the villages which will include female elders  
•  Establish contact with NGO's in the Iringa area with a view to developing appropriate partnerships.
•  Complete a pycho-social evaluation and resource inventory of the villages

 

John T. McInerney LCSW

24 East 12^th Street Suite #503

New York NY 10003

(212) 645 8059

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