Reporting of sexual and gender-based violence and associated factors among survivors in Mayuge, Uganda

background: Reporting of Sexual and Gender-Based Violence (SGBV) allows survivors to access support services to minimize the impact of the violence on their lives. However, research shows that most SGBV survivors do not report. Objective: We aimed to determine the proportion of survivors of SGBV in Mayuge District, Uganda, who report SGBV, and the factors associated with reporting. Methods: Using a cross-sectional study design, we analyzed data of SGBV survivors in eight villages in Mayuge district collected in a baseline survey of a larger experimental study. Data were analyzed using Modified Poisson Regression. Results: Of the 723 participants, 65% were female. Only 31.9% had reported the SGBV experienced. Reporting was 43% lower among survivors aged 45 years and older (p-value = 0.003), and 41% lower among survivors with higher than a primary school education (p-value = 0.005). Likewise, reporting was 37% lower among survivors who relied on financial support from their partners (p-value = 0.001). Female survivors were also 63% more likely to report (p-value = 0.001), while survivors who were separated/widowed were 185% more likely to report than those who were never married (p-value = 0.006). Conclusions: Reporting of SGBV by survivors in Mayuge was found to below

Self-motivation, functional ability and participation among stroke survivors' resident in Ibadan metropolis, Nigeria

Background:Stroke is a leading cause of death both globally, and in Africa. The attendant effect of the stroke is disability, loss of function and psychosocial issues. Studies have been carried out on different rehabilitation outcomes such as participation, self-motivation and functional ability related to stroke survivors. There is however a dearth of studies exploring the relationships among self-motivation, functional ability and participation of stroke survivors, particularly in our African community.Objectives:Relationship among participation, self-motivation and functional ability of stroke survivors residing in Ibadan was investigated.Methods:This was a cross-sectional survey which involved 44 consenting stroke survivors. Clinical and demographic information were documented. Self-motivation, functional ability and participation of the stroke survivors were assessed with the Self-Motivation Inventory, Fugl-Meyer Assessment of Motor Recovery after Stroke; and London Handicap Scale respectively. Data was analysed with descriptive statistics and inferential statistics of Spearman Rank Correlation at p= 0.05.Results:There was a statistically significant positive correlation between the time since onset of stroke scores and participation (p= 0.02) and between the stroke survivors' functional ability and participation scores (p=0.001). Conversely there was no significant relationship between the participants' functional ability and time since onset of stroke scores (p= 0.62), between stroke survivors' self-motivation and time since onset of stroke scores (p= 0.41), between self-motivation and participation (p=0.80) and between self-motivation and functional ability scores (p= 0.80)Conclusions:Whereas self-motivation appeared non-related to functional ability and participation, a more exploration of the subject matter is still necessary for a conclusive inference to be drawn, especially in view of the sample size involved in this present study

Improving the quality of care for female rape survivors at Scottish Livingstone Hospital, Molepolole, Botswana: a quality improvement cycle

Background: Rape is prevalent in Botswana, but there has been limited research undertaken to improve the quality of healthcare for female rape survivors in this clinical setting. Research can not only influence the health outcomes of victims but also has the potential to inform policy. Aim: The aim of this study was to improve the quality of care for female rape survivors in Scottish Livingstone Hospital, Molepolole, Botswana. Setting: The setting is Scottish Livingstone Hospital, Molepolole, Botswana. Methods: This study was a qualitative cycle, using the normal steps of performing a baseline audit of clinical practice, planning and implementing changes and re-audit. Results: A total of 124 patient records were audited, comprising 62 patient records at baseline and re-audit. The mean age of victims was 23 years and the age category with the highest incidence of rape ranged between 12 and 20 years, constituting 47% of patients' records. During the baseline audit, only one out of 10 structural standards was met, while at re-audit eight structural standards were fully met. Although none of the process standards were met during both audits, statistically significant improvements in performance (p < 0.05) were shown in six out of 10 criteria at re-audit. Conclusion: The quality of care for female rape survivors is suboptimal in our setting. However, simple interventions to improve the structure in place for patients and upskilling the entire practice team to align care to current international standards can improve the overall quality of healthcare

'No one prepared me to go home': Cerebrovascular accident survivors' experiences of community reintegration in a peri-urban context

Background: The South African health system has policies and strategies to ensure effective rehabilitation and reintegration of individuals who have survived a cerebrovascular accident into their respective communities. However, implementation of such guidelines remains an issue. Aim: This study sought to explore cerebrovascular accident (CVA) survivors' experiences of community integration. Setting: The study was located in a peri-urban community within the KwaZulu-Natal Province, South Africa. Methods: An explorative qualitative study with eight purposively selected CVA survivors was conducted via semi-structured individual interviews. Data were audio-recorded and manually transcribed prior to thematic analysis. Trustworthiness of the study was maintained by strategies such as analyst triangulation, an audit trail and use of thick descriptions. Ethical principles of autonomy, informed consent, confidentiality and privacy were also maintained in the study. Results: Six themes emerged that highlighted (1) loss of autonomy and roles, (2) barriers to community reintegration, (3) social isolation of participants, (4) finding internal strength, (5)enablers of community reintegration including the positive influence of support and the benefits derived from rehabilitation and (6) recommendations for rehabilitation. Conclusion: The study revealed both positive and negative influences that impact CVA survivors' ability to effectively reintegrate into their respective communities following a CVA. Recommendations include the need for education and awareness around access to rehabilitation services for CVA survivors, advice on how to improve CVA survivors' ability to mobilise in the community and make environmental adaption to facilitate universal access, provision of home programmes and caregiver training for continuity of care and for inclusion of home-based rehabilitation into current models of care

A community-based intervention for improving utilization of medical services by rape survivors in refugee camps in Zambia

Background: Rape is the most common form of violence in conflict and refugee situations but because of the associated stigma few cases are reported. This study assessed the outcome of an intervention targeted at women groups on the utilization of medical services by rape survivors in refugee camps in Zambia.Methods: A prospective quasi-experimental community-based intervention study was carried out in two refugee camps allocated into intervention and comparison areas. The intervention was participatory education sessions for women groups. Data was collected using the clinic records and the main outcome was the number of rape survivors who utilized and completed medical services provided at the camp clinics. Univariate, bivariate and multivariate analyses were carried out with level of significance set at 5%.Results: The proportion of the rape survivors who accessed medical care within 72 hours increased significantly from 41.2% to 84.8% in the intervention area but from 31.1% to 38.9% in the comparison area, (p=0.005). Those who completed their medical treatment and the follow-up visits increased significantly from 42.8% to 94.8% in intervention area but reduced from 38.5% to 21.4% in the comparison area, (p=0.002). Being resident in the intervention area predicted the utilization of medical services, [OR: 3.15; 95%CI: 1.955-5.681], p=0.002. Conclusion: Community-based intervention using participatory women's group discussion had a significant impact on increasing the utilization of medical services by rape survivors and should be considered for scaling up as a key intervention for increasing utilization of medical services for rape survivors especially in refugee situations

A community-based intervention for improving utilization of medical services by rape survivors in refugee camps in Zambia

Background: Rape is the most common form of violence in conflict and refugee situations but because of the associated stigma few cases are reported. This study assessed the outcome of an intervention targeted at women groups on the utilization of medical services by rape survivors in refugee camps in Zambia. Methods: A prospective quasi-experimental community-based intervention study was carried out in two refugee camps allocated into intervention and comparison areas. The intervention was participatory education sessions for women groups. Data was collected using the clinic records and the main outcome was the number of rape survivors who utilized and completed medical services provided at the camp clinics. Univariate, bivariate and multivariate analyses were carried out with level of significance set at 5%. Results: The proportion of the rape survivors who accessed medical care within 72 hours increased significantly from 41.2% to 84.8% in the intervention area but from 31.1% to 38.9% in the comparison area, (p=0.005). Those who completed their medical treatment and the follow-up visits increased significantly from 42.8% to 94.8% in intervention area but reduced from 38.5% to 21.4% in the comparison area, (p=0.002). Being resident in the intervention area predicted the utilization of medical services, [OR: 3.15; 95%CI: 1.955-5.681], p=0.002. Conclusion: Community-based intervention using participatory women's group discussion had a significant impact on increasing the utilization of medical services by rape survivors and should be considered for scaling up as a key intervention for increasing utilization of medical services for rape survivors especially in refugee situations

Fournier's gangrene: outcome analysis and prognostic factors

Background: Fournier's gangrene is an infective necrotising fasciitis of the external genitalia and perineum associated with significant morbidity and mortality. The factors associated with non survival have been described but are not universally accepted. The identification of prognostic factors remains critical to improve outcomes.Objectives: To determine the hospital based mortality and factors associated with non-survival among subjects with a clinical diagnosis of Fournier's gangrene. Methods: A prospective hospital based observational study on 51patients with a clinical diagnosis of Fournier's gangrene over a 2-year period. A comparison was made between survivors and non-survivors to establish prognostic factors associated with non survival.Results: The disease related hospital mortality was 27% (14/51). The mean age of the 51, all male patients was 47 years. An older age was significantly associated with non-survival (p=0.02). The presence of renal dysfunction (p=0.001), severe sepsis (p=0.000), delay in surgical debridment (p=0.04), urogenital source of infection (p=0.01), a body surface area involvement of greater than 5% (p=0.006), abdominal wall involvement (p=0.02) on admission were significant factors associated with mortality. The presence of either HIV infection or diabetes mellitus was not a prognostic indicator of mortality. The clinical and biochemical parameters on admission associated with non survival were a high respiratory rate (p=0.03), a low hemoglobin(p=0.0001), an elevated blood urea nitrogen (p=0.005) and creatinine (p=0.01). Multivariate logistic regression analysis did not show any independent factors associated with non survival.Conclusion: Fournier's gangrene remains a fatal condition with a hospital mortality of 27%. Prognostic factors for non survival include an advanced age, a urogenital source of infection, abdominal involvement, severe sepsis and renal dysfunction

Comparison of Trauma on Survivors of Sexual Assault and Intimate Partner Violence in Limpopo

Background: Gender-based violence is a challenge in South Africa; despite available interventions. Caring for the survivors of both forms of violence is critical for ensuring their speedy recovery. Objectives: To compare the effects of trauma on female survivors of sexual assault versus those experienced by survivors of physical assault by their intimate partners.Method: A quantitative cross-sectional comparative study design was used to compare 30 sexually-assaulted women and 30 physically-assaulted women regarding depressive symptoms; posttraumatic stress disorder and coping styles three months after the incident. Semi-structured interviews were conducted with the survivors of both types of assault and the Beck Depression Inventory posttraumatic stress disorder checklist and Brief COPE Inventory were administered in order to obtain quantitative data. Both parametric and non-parametric statistics were employed. Ethical measures were adhered to throughout the research process.Results: A significantly-higher proportion of sexually-assaulted women disclosed the incident to family (p = 0.021). The majority of sexually- (90) and physically- (86) assaulted women were likely to recall the incident. Sexually-assaulted women had a significantly-higher mean for avoidance/numbness (p 0.001) and physical-assaulted women in arousal (p 0.051). About 41 of sexually-assaulted participants reported severe depression. Findings confirmed that sexual assault is more personal whilst physical assault is more interpersonal. If physically-assaulted women were removed from the perpetrators they recovered faster than sexually-assaulted women. Their stay with the perpetrators may perpetuate the violence.Conclusion: The need for counselling and support for the survivors of both traumas was recommended. All stakeholders should be educated to provide support to survivors of both traumas

The Lived Experiences of Late-Adolescent Female Suicide Survivors: 'A Part of Me Died'

People's thoughts often focus on the suicide victim immediately after a completed suicide. Yet; the real victims of such an event are those individuals who are left behind to cope with the aftermath of the suicide. This phenomenological psychological study explored the lived experiences of lateadolescent suicide survivors; particularly those negative experiences that seemed to worsen in the weeks and months after a significant other's completed suicide. The research participants were five female late-adolescents (aged 17-22 years) who were recruited by means of purposive sampling at a South African tertiary institution and at youth camps. Data collection consisted of collagefacilitated; face-to-face phenomenological interviews. In addition; some participants provided documentary material in the form of personal diaries; letters and poems. The data analysis was conducted according to Giorgi's phenomenological method. The following salient experiences emerged during the data analysis: guilt; self-blame; blaming others or God; anger; loss or restriction of 'self'; depression; suboptimal behavioural coping patterns; changes in relationship dynamics; and suicidality. The results of this study can be used by mental health professionals and caregivers to support adolescent suicide survivors effectively; in the midst of their mourning

Seizure Activity and Neurological Sequelae in Ugandan Children who have Survived an Episode of Cerebral Malaria

Background: Seizures are a common presenting feature in children with cerebral malaria (CM) and neurologic deficits have been described in survivors of CM. However few prospective studies have described the frequency of seizure activity and neurologic deficits in survivors of CM over time. Methods: Eighty-two children aged 3 to 12 years who survived an episode of CM were followed up and monitored for seizure activity and neurologic deficits at discharge; 3; 6 and 24 months. Seventy six children with uncomplicated malaria (UM) and 105 healthy community controls (CC) age 3 to 12 years were recruited as comparison groups and the frequency of seizures in the 6 to 24 month follow-up period was compared in the 3 groups. Results: Cumulative incidence of seizures increased over time in children with CM; with a total of 2 of 76 children (2.6) reporting seizures at 3 months; 3 of 74 children (4.1) at 6 months and 11 of 68 children (16.2) at 24 months (Chi square for trend = 9.36; P=0.002). In contrast; neurologic deficits almost completely resolved over time; occurring in 19 of 76 children with CM (25) at discharge; 2 of 74 children (2.7) at 6 months; and 1 of 68 (1.5) children at 24 months. Conclusions: During the 24 months following a CM episode; neurologic deficits resolve but the cumulative incidence of seizures increases in children with CM. Neurologic impairment after an episode of CM may not be limited to the neurologic deficits seen at discharge

Where the Streets Have No Names:Factors Associated With the Provision of Counselling and Social Work Services for Child Rape Survivors in Kwazulu-Natal; South Africa

Objective:The aim of this study was to audit the provision of state-assisted counselling and social work services to child rape survivors presenting for medico-legal assessment at a state hospital in KwaZulu-Natal; South Africa. Method: A prospective design was used to collect data from the social and medical case files of 200 consecutive cases of child rape referred for medico-legal assessment to a state hospital located to the north of the City of Durban (South Africa). For each case; information was obtained regarding survivor and offender demographics; the nature and duration of abuse; and the extent and nature of counselling and social work services provided. Results: Only 49of survivors benefited from state-supported counselling and social work services; with the provision of such services being frequently delayed (by periods of up to six months); and with service provision being restricted to a single intake interview in all but one case. Social work service provision was significantly less likely in cases where the survivor resided in an informal dwelling (OR = 0.507) and where the child presented for medico-legal assessment outside of normal working hours (OR = 0.625). From observations made during the study; it would appear that patterns of professional collaboration in relation to service provision for child rape survivors falls somewhat short of the ideal of effective multi-sectoral engagement. Conclusions: Levels of service provision observed in the study are unacceptably low; with there being a clear need for the development and implementation of carefully considered multi-sectoral protocols which are designed to effectively meet the needs of all child rape survivors