Harsh Physical Discipline: Prevalence and Associated Factors Among Primary Caregivers of Pre-school Children in Ethiopia.

Harsh parental discipline is ineffective and potentially harmful to children, yet it is still common, particularly in many African countries. Culturally responsive education programs are needed to shift parenting practices in African countries, but there is limited baseline research to inform such efforts. This study's objectives were to establish the baseline prevalence of harsh physical discipline practices among primary caregivers of pre-school children in Ethiopia and to identify associated factors to inform intervention efforts. The well-established Parent-Child Conflict Tactics Scale section on physical assault was translated and administered to primary caregivers of 1139 pre-school children aged 4-6 years sampled from four regions of Ethiopia. Trained interviewers also collected basic socio-demographic data. Based on caregiver report, 52.5% (n = 598) of the children had experienced harsh physical discipline and an additional 12.7% (n = 145) experienced moderate physical discipline in their lifetimes. After controlling for covariates, the factors significantly related to increased likelihood of harsh discipline were geographic region, female caregivers, lack of employment, at least moderate perceived social status, and non-Muslim religion. These data establish a baseline from which to evaluate the impact of future educational interventions designed to shift practices. Information about the correlates can be used to tailor such intervention efforts toward those most likely to use harsh discipline practices.

Epidemiological study of a developmentally and culturally sensitive preschool intervention to improve school readiness of children in Addis Ababa, Ethiopia.

BACKGROUND: Early childhood is a dynamic period of physical, psychosocial and cognitive development, where age appropriate intervention during the preschool years influences psychosocial, behavioural and academic achievement of children. This study evaluated the impact of a comprehensive preschool intervention on psychosocial, cognitive and behavioural school preparedness among children in Addis Ababa, Ethiopia. METHODS: Employing a cluster-sampling design, 150 preschool children who received the basic preschool curriculum (non-intervention) were compared with 100 randomly selected children who received a comprehensive preschool curriculum (intervention) using the Early Development Instrument (EDI) in five domains. Sample t-tests compared means of domain scores. Binary logistic regression analysed proportions of vulnerability in domains and overall. RESULT: There were no group differences in gender, age, special need status or child's first language. Intervention children had higher domain scores on social competence (mean difference 0.67 (SE=0.26)), emotional maturity (mean difference 0.77 (SE=0.29)), language and cognitive development (mean difference 0.67 (SE=0.40)), communication and general knowledge (mean difference 0.82 (SE=0.34)). Accounting for confounding variables, intervention children had a lower chance of overall vulnerability to domain problems (adjusted OR (AOR)=0.38; 95% CI 0.13 to 1.15), language and cognitive development (AOR=0.21; 95% CI 0.03 to 1.64), and social competence (AOR=0.20; 95% CI 0.08 to 0.45). CONCLUSION: The comprehensive intervention was associated with better outcomes on early childhood development across four domains. It is recommended to extend this programme to other areas of Ethiopia, where children do not have appropriate school preparation, to reduce risk of school dropout, negative personal and societal outcomes.

Use of the WHO's Perceived Well-Being Index (WHO-5) as an efficient and potentially valid screen for depression in a low income country.

Introduction: Depression is associated with negative social, economic, and family outcomes and the majority of individuals with depression in low and middle income countries (LMICs) are untreated. A critical first step in bridging the treatment gap is accurate, feasible, and culturally appropriate screening to identify those who need treatment. The WHO's Perceived Well-Being Index (WHO-5) well-being instrument can potentially meet the screening needs of LMICs in primary care and community-based settings. This study tested the feasibility and validity of this tool to identify depression among adult parents of young children in Addis Ababa, Ethiopia. Successful identification and treatment of depression in parents extends benefits to children and families. Method: The WHO-5 was translated to Amharic and administered to 849 adults and compared with simultaneous administration of the well-established PHQ-9 instrument. Feasibility was assessed and analyses evaluated frequency of positive screens for depression, internal consistency, sensitivity and specificity of the WHO-5, and sociodemographic correlates of depression. Results: The prevalence of probable depression was similar as assessed by the PHQ-9 (17.3%) and the WHO-5 (18.5%). The internal consistency of the WHO-5 was strong (Cronbach's alpha = .83). WHO-5 agreement with the PHQ-9 was moderate; sensitivity and specificity were strong. Correlates of depression included unemployment and financial status. Discussion: The study provides promising evidence to support use of the WHO-5 to identify depression in Ethiopia. Feasibility was good, and it was culturally and linguistically acceptable. The results suggest that minimally trained community health and education workers in countries like Ethiopia could use the WHO-5 effectively in primary health and education settings. (PsycINFO Database Record

Socio-demographic and psychopathologic correlates of enuresis in urban Ethiopian children.

AIM: To examine the association between enuresis and psychopathology in urban Ethiopian children. METHODS: A two-stage mental health survey of 5000 urban children found enuresis to be by far the most common disorder. Logistic regression modelling was carried out to determine the independent associations of a number of socio-demographic and psychopathological characteristics with enuresis. RESULTS: Male sex, younger age and lower achieved educational grade of the child were all independently associated with childhood enuresis. The odds of having enuresis were significantly higher for children in families with significant financial worries and in children from homes where parents were separated. Children with DSMIII-R anxiety disorders, especially simple phobia, or disruptive behaviour disorders were found to have significantly higher odds of having enuresis. CONCLUSION: Psychopathology, both anxiety and behavioural disorders, as well as family stressors in urban Ethiopian children were found to be risk factors for enuresis. Although a cause-effect relationship could not be ascertained, the findings of higher association of psychopathology with enuresis in this and other studies indicate that there is a need for evaluating children with enuresis for the presence of concurrent psychopathology, especially in traditional societies where undetected psychopathology may be more common.

Mental disorders among the Borana semi-nomadic community in Southern Ethiopia.

This study aimed to estimate the lifetime prevalence and socio-demographic correlates of psychiatric disorders among the Borana semi-nomadic community of the Oromia region of Ethiopia. 1854 people of both sexes, aged 15 years and above, were interviewed during the survey. The households were selected by using a cluster sampling method proportionate to population size. The interviews were conducted by trained high school graduates using the Oromiffa version of the Composite International Diagnostic Interview (CIDI). The lifetime prevalence of ICD-10 mental disorders, including substance abuse, was 21.6%. Affective disorders were found in 1.7% of the study population, whereas neurotic and somatoform disorders constituted 14%. No cases of schizophrenia were detected. The prevalence of substance use was 10.1%. Studies using other methods, including interview by clinicians, might shed more light on the nature of mental illness in this unique community.

Controlled trial of hydroxychloroquine in schizophrenia.

Hydroxychloroquine is widely employed for the treatment of rheumatological diseases. A preliminary pilot study suggested that hydroxychloroquine may be a useful adjunct for the treatment of schizophrenia, which has been associated with abnormalities in several proinflammatory cytokines. Sixty-one patients were randomized to receive 200 mg/ day hydroxychloroquine or placebo in addition to standard typical antipsychotic treatment. After 8 weeks of double-blind treatment, there was no significant interaction between treatment status and length of treatment for positive, negative, or general symptoms according to the Positive and Negative Syndrome Scale, despite a hydroxychloroquine-associated decrease in serum interferon-gamma levels. After completion of the 8-week study, all participants were offered open treatment with hydroxychloroquine for an additional 12 weeks. Open treatment produced no further improvement in Positive and Negative Syndrome Scale scores at weeks 12, 16, and 20. Further study will be required to determine the role of anti-inflammatory treatments for schizophrenia.