Adapting culturally appropriate mental health screening tools for use among conflict-affected and other vulnerable adolescents in Nigeria.

BACKGROUND: The Boko Haram insurgency has brought turmoil and instability to Nigeria, generating a large number of internally displaced people and adding to the country's 17.5 million orphans and vulnerable children. Recently, steps have been taken to improve the mental healthcare infrastructure in Nigeria, including revamping national policies and initiating training of primary care providers in mental healthcare. In order for these efforts to succeed, they require means for community-based detection and linkage to care. A major gap preventing such efforts is the shortage of culturally appropriate, valid screening tools for identifying emotional and behavioral disorders among adolescents. In particular, studies have not conducted simultaneous validation of screening tools in multiple languages, to support screening and detection efforts in linguistically diverse populations. We aim to culturally adapt screening tools for emotional and behavioral disorders for use among adolescents in Nigeria, in order to facilitate future validation studies. METHODS: We used a rigorous mixed-method process to culturally adapt the Depression Self Rating Scale, Child PTSD Symptom Scale, and Disruptive Behavior Disorders Rating Scale. We employed expert translations, focus group discussions (N = 24), and piloting with cognitive interviewing (N = 24) to achieve semantic, content, technical, and criterion equivalence of screening tool items. RESULTS: We identified and adapted items that were conceptually difficult for adolescents to understand, conceptually non-equivalent across languages, considered unacceptable to discuss, or stigmatizing. Findings regarding problematic items largely align with existing literature regarding cross-cultural adaptation. CONCLUSIONS: Culturally adapting screening tools represents a vital first step toward improving community case detection.

Seroprevalence of hepatitis B and C infection among the HIV-positive population in Abuja, Nigeria.

BACKGROUND: In Nigeria, it is estimated that 3.6% of the population were living with Human immunodeficiency virus in 2009, and the country had the world's second highest number of HIV/AIDS related deaths after South Africa. Viral hepatitis is also a major public health concern as hepatitis B virus (HBV) afflicts an estimated 350 million people, and hepatitis C virus (HCV) affects 150 million people worldwide. OBJECTIVES: We conducted a retrospective study of HBV and HCV seroprevalence among Nigerian population coming to our clinic in Abuja and receiving HIV/AIDS treatment. METHODS: In this cohort study, we collected medical data from 443 HIV-positive patients between September 2010 and May 2011. Standard enzyme immunoassays were used to determine the serological prevalence of hepatitis B (HBsAg) and C (anti-HCV antibody) among HIV-positive individuals. RESULTS: Among the HIV/AIDS positive individuals, we found that 35 patients were infected with hepatitis B virus (7.9%), 10 with hepatitis C virus (2.3%) and 3 with both hepatitis B and C viruses (0.7%). The overall hepatitis-HIV prevalence is 10.8%. The majority of the population infected was under 39 years of age (55%) and the same proportion of males and females was observed in all the studied categories (HIV, HIV + hepatitis B and/or C). Remarkably, an overall lower CD4 count was seen in the co-infected population (205 cells/µl versus 243 cells/µl), with the lowest seen for the triply infected individuals (97 cells/µl). CONCLUSIONS: Our findings underscore the importance of screening for hepatitis B and hepatitis C viruses in the HIV-infected population in developing countries, and particularly in sub-Saharan Africa, where the epidemics are still growing.

A problem-solving approach to nutrition education with Filipino mothers.

The study examined Filipino mothers' problem solving on issues related to child feeding, using a dyadic, peer-help approach. The participants were mothers of children under 6 yr of age from a village in the southern Philippines, where malnutrition among children is prevalent. Mothers were paired with a mutual friend (each nominated the other as a best friend) or a unilateral friend (only one nominated the other as a best friend) to discuss a feeding problem to which they initially gave similar solutions (agreed) and one to which they gave different solutions (disagreed). In the final step, they were asked to give privately the solutions they considered best for the problem. The number and quality of these final-step solutions were analyzed as a function of the friend relation, the level of initial agreement with their friend partner, and the source of the solution. Results indicated that the quantity and quality of solutions increased from before to after the dyadic discussion, especially among mothers paired with a mutual friend with whom they agreed. Most of their final-step solutions came from ones they themselves had generated during the discussion, not ones their friend partner had proposed. There was also evidence that high quality solutions were generated by mothers paired with a disagreeing unilateral friend. Implications for nutrition education concern the benefits of a peer-help, dyadic problem-solving approach, taking into account the role of a friend in facilitating a mother's production of new solutions to child feeding problems. The procedure may be used by health promoters who want to build capacities and self-reliance through collective problem solving.