Assessment of substance use among injured persons seeking emergency care in Nairobi, Kenya

ntroduction: Trauma is a leading cause of morbidity and mortality in Kenya. In many countries, substance use is common among patients presenting with injuries to an emergency center (EC). Objective: To describe the epidemiology of self-reported substance use among adult injured patients seeking ED care in Nairobi, Kenya. Methods: This prospective cross-sectional study, assessed patients presenting with injuries to the Kenyatta Na-tional Hospital ED in Nairobi, Kenya from March through June of 2021. Data on substance use, injury character-istics and ED disposition were collected. Substances of interest were alcohol, stimulants, marijuana, and opiates.The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) tool was used to characterize hazardous alcoholuse. Results: A total of 1,282 patients were screened for participation, of which 646 were enrolled. Among participants,322 (49.8%) reported substance use in the past month (AUDIT-C positive, stimulants, opiates, and/or marijuana). Hazardous alcohol use was reported by 271 (42.0%) patients who screened positive with AUDIT-C. Polysubstance use, (≥2 substances) was reported by 87 participants in the past month. Median time from injury to ED arrival was 13.1 h for all enrolees, and this number was significantly higher among substance users (median 15.4 h, IQR 5.5 - 25.5; p = 0.029). Conclusions: In the population studied, reported substance use was common with a substantial proportion of injured persons screening positive for hazardous alcohol use. Those with substance use had later presentations for injury care. These data suggest that ED programming for substance use disorder screening and care linkagecould be impactful in the study setting.

Determinants of the use of family planning methods among rural women in Plateau state, Nigeria

This study aimed at determining the factors that influence family planning practice among rural women of Pankshin district inPlateau state, Nigeria. A cross-sectional study using a simple random sampling method was conducted from October to December 2019. A self-administered questionnaire was used for data collection among 302 respondents. Among respondents, 48.3% had practised family planning and the most popular family planning method ever practised was injectables (57.5%). The determinants of family planning practice were age group 29-39 and 40-49 years old (AOR=4.373, p<0.001; AOR=5.862, p<0.001), discussion with partner (AOR=9.192, p<0.001) and partner's approval (AOR=2.791, p=0.007). Findings showed an encouraging family planning prevalence with the main determinants involving male partners. Further efforts need to be made to promote family planning practice among male partners and to empower women of all reproductive age groups by providing them with relevant information that is needed for them to make informed decisions. (Afr J Reprod Health 2022; 26[4]: 32-41).

Psychosocial determinants of depression and maladaptive behaviour in adolescence: two tested models

Objective: Self-esteem has been identified as a strong predictor of depression and maladaptive behaviours in adolescents. Two relational models (A and B) were tested on the antecedent and consequent variables of self-esteem.Methods: A representative sample of 610 Spanish adolescents (52% boys) ranging in age from 11 to 16 years of age (mean age = 13.38 years, SD = 1.70 years) was used. The participants completed a battery of instruments measuring self-esteem, self-concept, importance of self-concept domains, depression symptoms, and problem behaviour. Covariance structure analysis (path analysis) from LISREL 8.54 was employed.Results: Model B presented a better fit (χ2difference (A­B) = 160.29, p < 0.001). Perceived social support (parents and classmates), and perceptions of competence in domains deemed important were positively related to self-esteem. While both self-esteem and social support (parents and classmates) were negatively related to depression symptoms, only social support (parents and teacher) appeared negatively related to behavioural problems.Conclusions: While self-esteem constitutes a strong correlate of affective symptoms in Spanish adolescents, it is unrelated to maladaptive behaviour. Social support emerged as an important protective factor. Concrete proposals for future research and prevention are discussed

Forms and determinants of sexual abuse among female child hawkers in Uyo, Nigeria

Background: Female hawkers are exposed to numerous hazards including sexual abuse. This study aimed at assessing the prevalence, forms and determinants of sexual abuse among female child hawkers in Uyo, Nigeria. Methods: This was a cross-sectional descriptive study carried out among female child hawkers in Uyo, Nigeria. Data was collected using an interviewer-administered structured questionnaire and was analyzed with IBM SPSS Statistics 20.0 software. Level of significance was set at 0.05. Result: A total of 172 respondents participated in the study. The mean age was 12.9±2.3 years. School dropout rate was 11.6% among respondents. Commonest reasons for hawking included family support (66.8%), feeding (22.1%) and generating school fees (11.1%). Prevalence of any form of sexual abuse was 76.2%. Forms of sexual abuse reported included verbal abuse (54.1%), inappropriate touching (56.4%), kissing (14.5%), intercourse due to enticement (18.0%) and rape (12.2%). The commonest reason for sexual act among those enticed was monetary gains, (64.5%). Consequences of sexual abuse included STI (13.5%), pregnancy (5.8%) and abortion (5.8%) respectively. Predictors of any form of sexual abuse included being aged 14-17 years (OR =14.70, 95%CI=2.05-105.14, p=0.007), being a dropout (OR=7.37, 95%CI=2.21-24.59, p=0.001) and being from social class V (OR=23.44, 95%CI=1.13-401.67, p=0.031). Conclusion: There was high prevalence of sexual abuse ranging from inappropriate touching to rape. Predictors of sexual abuse included age, being a dropout and of low socio economic class. Enlightenment campaigns on risks of female child hawking, establishment of skill acquisition centres and free education to secondary level are advocated

Socio-demographic determinants of body mass index among school children in Ebonyi State, Nigeria

Background: African specific studies on the factors associated with the growth pattern of children are needed to guide evidence and develop effective population-based interventions that can be tailored to the unique African context. Purpose: The purpose of this study was to determine the socio-economic correlates of body mass index (BMI) of primary and secondary school children in Ebonyi State, which is situated in south-eastern Nigeria. Methodology: This was a quantitative, cross-sectional study that utilised clustering and stratified sampling techniques to select 1000 learners from primary and secondary schools located in Abakaliki local government area. Apart from a questionnaire, a Mettler weighing scale was also used for data collection. A generalised linear model was used to test the association between the participants' socio-demographic characteristics and their BMI.Result: BMI was positively related to female gender but negatively related to age and level of education. The mode of cooking, who the participants live with and how they get to school also predicted changes in BMI. Other variables like mother's occupation and family's mode of transport were also associated with BMI changes while father's level of education, mother's level of education, father's occupation and the type of residence did not have any statistical relationship with BMI. Conclusion: The present study shows that the BMI of school children is influenced by the socio-demographic characteristics surrounding them. Therefore, efforts should be made to improve the socio-economic standing of families in this community

Les impacts des déterminants sociaux de la santé sur la santé publique : Cas de la région sanitaire Est de l'Algérie

Cette recherche a pour objet de : mettre l'accent sur les déterminants sociaux de la santé comme ceux qui sont les plus prégnants pour la santé dans les sociétés pauvres ou modernes, comme : l'obésité, la sédentarité, la pratique du sport, l'alimentation, la dépendance, etc.Parmi les résultats de notre étude de cas sur les établissements publics de soins de proximité/EPSP des 7 wilayas de l'Est algérien, nous relevons des inégalités concernant les besoins de santé d'une part, et d'autre part, les moyens alloués pour couvrir ces besoins dans les communes d'une même wilaya et entre les wilayas elles-mêmes. Comme nous sommes arrivés à une certitude que la transition économique et sociale des années 90e, a engendré plus tard une transition épidémiologique vers des maladies chroniques (maladies cardiovasculaires, diabète, cholestérol, HTA …) à cause des nouvelles habitudes individuelles, collectives ou des politiques générales de l'Etat

National policy framework and strategy on palliative care 2017-2022

Palliative care is a multidisciplinary approach to the holistic care and support for patients and families facing a life-threatening illness, improving quality of life while maintaining dignity from the time of diagnosis until death. For children, the spectrum of illness includes life limiting illnesses/conditions which may progress to death or may be severely disabling. Palliative care should be available to all patients as needed from birth until death and should be accessible at all levels of the health care service. Palliative care cuts across all health programs in the delivery of services. With the quadruple burden of disease in South Africa, an estimated 50% of all people who die in South Africa could benefit from palliative care services. While there are health system challenges to providing equitable access to quality palliative care services, there are available resources as well as existing legislation and policies which support the principles of palliative care and will enable the implementation of the palliative care policy and strategy using the existing service delivery platform. With guiding principles such as the right to health, patient centred and ethical care, equitable access, and quality evidence-based care, the vision of this policy is that all adults and children, including their families, facing the problems associated with life-threatening or life limiting illness will receive palliative care to maintain quality of life, dignity and comfort as well as manage pain throughout the course of the illness. The needs of palliative care patients at different stages of the illness trajectory are described. Referral pathways have been identified. The services available will range from a palliative care approach in the community and clinics to a generalist palliative care service at district hospitals to a specialist palliative care service at regional and tertiary hospitals. Centres of excellence will be established at academic hospitals to support education and research in palliative care. Access to hospices or sub-acute facilities will be availablefrom all levels of the health service. Packages of care for patients at different stages of the trajectory as well as at different levels of the service have been described. Training in palliative care is essential and includes in-service training of existing health care workers in the palliative approach, undergraduate training, postgraduate training and the development of a palliative care specialty to support the need for the different levels of services and to provide a career path for interested health professionals, ensuring sustainability of services. The goals and objectives have been developed based on the WHO health system building blocks for health services. The responsibilities of the National Department of Health are outlined with activities and targeted outcomes, which then guide the implementation plan for the provinces. The costs of setting up the service as well as of continued service delivery have been estimated, although ongoing mapping of services within provinces is required. The National Policy Framework and Strategy for Palliative Care is intended to assist policy makers, all relevant health programmes, professionals and workers in the health department as well as NGOs to understand the need for palliative care and to provide a guide to providing such care so that patients will experience a greater quality of life with less suffering while retaining their dignity when faced with a life-threatening illness.

Gendered childcare norms ­ evidence from rural Swaziland to inform innovative structural HIV prevention approaches for young women

Addressing discriminatory gender norms is a prerequisite for preventing HIV in women, including young women. However, the gendered expectation that women will perform unpaid childcare-related labour is rarely conceptualised as influencing their HIV risk. Our aim was to learn from members of a rural Swazi community about how gendered childcare norms. We performed sequential, interpretive analysis of focus group discussion and demographic survey data, generated through participatory action research. The results showed that gendered childcare norms were firmly entrenched and intertwined with discriminatory norms regarding sexual behaviour. Participants perceived that caring for children constrained young women's educational opportunities and providing for children's material needs increased their economic requirements. Some young women were perceived to engage in "transactional sex" and depend financially on men, including "sugar daddies", to provide basic necessities like food for the children they cared for. Our results suggested that men were no longer fulfilling their traditional role of caring for children's material needs, despite women's traditional role of caring for their physical and emotional needs remaining firmly entrenched. The results indicate that innovative approaches to prevent HIV in young women should incorporate structural approaches that aim to transform gendered norms, economically empower women and implement policies guaranteeing women equal rights

Social models of HIV risk among young adults in Lesotho

Extensive research over the past 30 years has revealed that individual and social determinants impact HIV risk. Even so; prevention efforts focus primarily on individual behaviour change; with little recognition of the dynamic interplay of individual and social environment factors that further exacerbate risk engagement. Drawing on long-term research with young adults in Lesotho; I examine how social environment factors contribute to HIV risk. During preliminary ethnographic analysis; I developed novel scales to measure social control; adoption of modernity; and HIV knowledge. In survey research; I examined the effects of individual characteristics (i.e.; socioeconomic status; HIV knowledge; adoption of modernity) and social environment (i.e.; social control) on HIV risk behaviours. In addition; I measured the impact of altered environments by taking advantage of an existing situation whereby young adults attending a national college are assigned to either a main campus in a metropolitan setting or a satellite campus in a remote setting; irrespective of the environment in which they were socialised as youth. This arbitrary assignment process generates four distinct groups of young adults with altered or constant environments. Regression models show that lower levels of perceived social control and greater adoption of modernity are associated with HIV risk; controlling for other factors. The impact of social control and modernity varies with environment dynamics

Determinants of health insurance ownership among South African women

Background: Studies conducted in developed countries using economic models show that individual- and household- level variables are important determinants of health insurance ownership. There is however a dearth of such studies in sub-Saharan Africa. The objective of this study was to examine the relationship between health insurance ownership and the demographic, economic and educational characteristics of South African women. Methods: The analysis was based on data from a cross-sectional national household sample derived from the South African Health Inequalities Survey (SANHIS). The study subjects consisted of 3,489 women, aged between 16 and 64 years. It was a non-interventional, qualitative response econometric study. The outcome measure was the probability of a respondent's ownership of a health insurance policy. Results: The χ2 test for goodness of fit indicated satisfactory prediction of the estimated logit model. The coefficients of the covariates for area of residence, income, education, environment rating, age, smoking and marital status were positive, and all statistically significant at p ≤ 0.05. Women who had standard 10 education and above (secondary), high incomes and lived in affluent provinces and permanent accommodations, had a higher likelihood of being insured. Conclusion: Poverty reduction programmes aimed at increasing women's incomes in poor provinces; improving living environment (e.g. potable water supplies, sanitation, electricity and housing) for women in urban informal settlements; enhancing women's access to education; reducing unemployment among women; and increasing effective coverage of family planning services, will empower South African women to reach a higher standard of living and in doing so increase their economic access to health insurance policies and the associated health services