Use of 'sense of coherence (SOC)' scale to measure resilience in Eritrea: interrogating both the data and the scale.

An adapted 'sense of coherence' scale short form (SOC-13) was administered in nine languages of Eritrea with a total of 265 participants (162 women and 103 men) in order to assess 'resilience' in quantitative terms. Statistical analysis yielded significant differences in SOC scores between the displaced and non-displaced: mean=54.84 (SD=6.48) in internally displaced person (IDP) camps, compared with mean=48.94 (SD=11.99) in urban and rural settlements (t=3.831, p<0.001). Post-hoc tests revealed that the main difference is between IDP camp dwellers and urban (non-displaced) residents. Those in rural but traditionally mobile (pastoralist or transhumant) communities scored more or less the same as the urban non-displaced - i.e. significantly higher than those in IDP camps (p<0.05). Analysis of variance showed that displacement has a significantly negative effect on women compared with men (RR=0.262, p<0.001). Repeating the analysis for the three groups confirmed that urban and pastoralist/transhumant groups are similar, while women in IDP camps are lower scoring (RR=0.268, p<0.001), Hamboka women being worst affected due to their experience of serial displacement. These findings are interpreted and discussed in the light of qualitative information gleaned from the study participants' interrogation of the content of the SOC scale; and in the wider context of historical, socio-political and cultural characteristics of Eritrea. The study's implications for humanitarian and public health policy are considered.

Postnatal salivary cortisol and sense of coherence (SOC) in Eritrean mothers.

This pilot study explores possible physiological correlates of maternal sense of coherence (SOC) by looking at salivary cortisol levels in Eritrean mothers during the immediate pre- and postnatal period. Samples of pre- and postnatal resting whole saliva were obtained from 19 mothers and from 31 controls in Ghinda. Radioimmunoassay results revealed no differences between prenatal and control concentrations of salivary cortisol, but postnatal levels were significantly lower (P < 0.014). Mothers who delivered in hospital had significantly higher SOC scores compared to those who opted for home birth (P < 0.045). This difference was particularly pronounced in the comprehensibility subscale of the SOC scores (P < 0.037). Moreover, mothers with higher comprehensibility scores showed significantly lower postnatal cortisol levels (P < 0.017). No associations were found between cortisol and age or parity. The implications of these findings for maternity health service policy and practice in Eritrea are considered.

Prolonged displacement may compromise resilience in Eritrean mothers.

OBJECTIVE: to assess the impact of prolonged displacement on the resilience of Eritrean mothers. METHODS: an adapted SOC scale (short form) was administered. Complementary qualitative data were gathered from study participants' spontaneous reactions to and commentaries on the SOC scale. RESULTS: Displaced women's SOC scores were significantly less than those of the non-displaced: Mean = 54.84; SD = 6.48 in internally displaced person (IDP) camps, compared to non-displaced urban and rural/pastoralist: Mean = 48. 94, SD = 11.99; t = 3.831, p < .001. Post hoc tests revealed that the main difference is between IDP camp dwellers and urban (non-displaced). Rural but traditionally mobile (pastoralist or transhumant) communities scored more or less the same as the urban non-displaced--i.e., significantly higher than those in IDP camps (p < 0.05). Analysis of variance confirmed that gender is critical: displacement has significantly negative effects on women compared to men: RR = .262, p < .001. SOC scores of urban and pastoralist/transhumant groups were similar, while women in IDP camps were lower scoring--RR = .268, p < .001. CONCLUSIONS: The implications of these findings for health policy are critical. It is incumbent on the international health institutions including the World Health Organization and regional as well as local players to address the plight of internally displaced women, their families and communities in Eritrea and other places of dire conditions such as, for example Darfur in the Sudan.

Maternal psychosocial well-being in Eritrea: application of participatory methods and tools of investigation and analysis in complex emergency settings.

OBJECTIVE: To establish the context in which maternal psychosocial well-being is understood in war-affected settings in Eritrea. METHOD: Pretested and validated participatory methods and tools of investigation and analysis were employed to allow participants to engage in processes of qualitative data collection, on-site analysis, and interpretation. FINDINGS: Maternal psychosocial well-being in Eritrea is maintained primarily by traditional systems of social support that are mostly outside the domain of statutory primary care. Traditional birth attendants provide a vital link between the two. Formal training and regular supplies of sterile delivery kits appear to be worthwhile options for health policy and practice in the face of the post-conflict challenges of ruined infrastructure and an overstretched and/or ill-mannered workforce in the maternity health service. CONCLUSION: Methodological advances in health research and the dearth of data on maternal psychosocial well-being in complex emergency settings call for scholars and practitioners to collaborate in creative searches for sound evidence on which to base maternity, mental health and social care policy and practice. Participatory methods facilitate the meaningful engagement of key stakeholders and enhance data quality, reliability and usability.