Ouma Sarah Atieno, Frey Florina, Ganda Gregory, Arogo Beryl Annie, Otieno Douglas Onyango, Andrä Paul, Wolthusen Rick Peter Fritz
School of Medicine Maseno University Kisumu Kenya.
School of Medicine University Hospital Düsseldorf Düsseldorf Germany.
Public Health Chall. 2023 Jul 31;2(3):e112. doi: 10.1002/puh2.112. eCollection 2023 Sep.
Suicide prevention is a complex and context-dependent challenge. About 75% of deaths by suicide occur in low- and middle-income countries; yet, most current suicide prevention strategies build upon data from high-income countries (HIC). The Kisumu County Government (KCG) in Kenya recognized the need for a suicide prevention action plan. In the absence of a Kenyan national suicide strategy, it also did not solely depend on recommendations from HIC. The KCG therefore convened a multidisciplinary workgroup with stakeholders from various sectors that led the development of the Kisumu County Suicide Prevention Action Plan (KCSPAP). The team utilized a mixed-method approach (literature review, a desk review of mental health indicators and death certificates, focus group discussions, and key informant interviews) identifying the following: (a) magnitude and variations of suicide cases (higher number of suicide completions compared to attempts; the leading method was organophosphate poisoning though the suicide method often was not specified); (b) protective and risk factors (male gender, being between 19 and 45 years of age, and being married); (c) community perceptions of suicide (taboo topic; associated with negative spirits; community members were divided on suicide decriminalization); (d) potential solutions (need for data collection, awareness creation; scale-up of traditional and nontraditional mental health approaches). Given the importance of a public health perspective on suicide prevention, the data in the KCSPAP are organized in a public health prevention framework that builds on a data collection framework. The KCSPAP was handed over to the KCG in mid-2020; different recommendations have been implemented since. The KCSPAP is an example of policymaking based on local knowledge. This homegrown policymaking approach has multiple benefits and can be used by stakeholders locally and in other countries.
预防自杀是一项复杂且因具体情况而异的挑战。约75%的自杀死亡事件发生在低收入和中等收入国家；然而，当前大多数预防自杀策略都是基于高收入国家的数据制定的。肯尼亚的基苏木县政府认识到需要制定一项预防自杀行动计划。由于肯尼亚没有国家自杀预防战略，该计划也并非完全依赖高收入国家的建议。因此，基苏木县政府召集了一个由来自各个部门的利益相关者组成的多学科工作组，负责制定《基苏木县预防自杀行动计划》（KCSPAP）。该团队采用了混合方法（文献综述、对心理健康指标和死亡证明的案头审查、焦点小组讨论以及关键 informant 访谈），确定了以下内容：（a）自杀案例的规模和差异（自杀既遂的数量高于自杀未遂；主要方法是有机磷中毒，尽管自杀方法通常未明确说明）；（b）保护因素和风险因素（男性、年龄在19至45岁之间、已婚）；（c）社区对自杀的看法（禁忌话题；与邪灵有关；社区成员在自杀非罪化问题上存在分歧）；（d）潜在解决方案（需要进行数据收集、提高认识；扩大传统和非传统心理健康方法的规模）。鉴于从公共卫生角度预防自杀的重要性，KCSPAP中的数据是按照基于数据收集框架的公共卫生预防框架进行组织的。KCSPAP于2020年年中移交给基苏木县政府；自那以后，已实施了不同的建议。KCSPAP是基于当地知识制定政策的一个例子。这种本土制定政策的方法有多重益处，可供当地和其他国家的利益相关者使用。
