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Depression in an Ethiopian rural community

This project seeks to find out the risk factors for and impact of major depression in the Meskan and Mareko district of Ethiopia. Risk factor measures include poverty and khat consumption; impact measures include mortality, days lost from work and use of health services.

Most of the available information on the course, outcome and impact of depression is from developed nations. Many studies from developed countries have shown that low education, unemployment and low income are risk factors. However, the incidence and course of major depression have not been adequately researched in areas of the world where poverty and illiteracy are major social characteristics.

The Ethiopian economy is based on agriculture: this accounts for 80 per cent of total employment. About 64 per cent of people live below the poverty line and adult literacy is around 40 per cent. Only 45 per cent of the total population has access to health care (there is only one psychiatric hospital in the country): most Ethiopians use traditional methods.

The chewing of khat leaf, an amphetamine-like stimulant, is common practice in some parts of Ethiopia and other east African countries: its main constituents are phenylpropylamines (alkaloids) structurally related to amphetamine and adrenaline. Users report increased levels of energy, alertness and self-esteem and improved ability to communicate and concentrate. Insomnia and anorexia are common effects of khat use, but little is known about its role in the course of depression.

Participants were recruited from an existing population-based study on the course and outcome of severe mental illness at the Butajira Demographic Surveillance Site. An initial screening survey for this study had contacted 68,378 individuals aged 15-49, between 1998 and 2001.

300 people who were identified as having major depression in the last 12 months at the time of this survey were recruited. Another 300 who did not have depression were also recruited as a comparison group.

The participants were interviewed using the Composite International Diagnostic Interview (CIDI), translated into Amharic, and asked about their use of khat, about anxiety and depression, days off work and contact with health services. Interviewers also collected information about their education, occupation and income. Both groups were followed over a four year period to ascertain recovery rates in those with depression and incidence rates in the comparison group.

Butajira is the town of Meskan and Mareko district, 135 km south of Ethiopia’s capital city Addis Ababa. Pepper and khat are the main cash crops in the area.

This project was directed by Dr Souci Mogga Frissa as a PhD project supervised by Dr Robert Stewart and Professor Martin Prince, in collaboration with Dr Atalay Alem and Derege Kebede at Addis Ababa University.

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