Detecting depressive disorder with the Hopkins Symptom Checklist-25 in Tanzania.

BACKGROUND: Assessment of the growing prevalence of depression in developing countries is hampered by a lack of valid diagnostic instruments for the local settings. AIM AND METHOD: This study attempted to examine the validity of the 25-item Hopkins Symptom Checklist (HSCL-25) in a special primary care population in Dar es Salaam, Tanzania. RESULTS: 787 antenatal participants were recruited, and their responses revealed good internal consistency, interrater reliability, and test-retest reliability, and the scale was validated using content, construct, and discriminant validation methods. Factor analysis of the depression subscale, however, confirmed the need for a locally developed scale. CONCLUSIONS: Integrating universalist and relativist approaches, through the validation and modification of scales, may help in the detection of depression in cross-cultural settings.

Detecting depressive disorder with a 19-item local instrument in Tanzania.

BACKGROUND: Based on experience with the Hopkins Symptom Checklist-25 (HSCL-25) in a Tanzanian population, this study attempted to develop a locally specific screen that employs indigenous expressions. AIM AND METHOD: Thirty ethnographically derived local idioms were added and the final 47-item questionnaire administered to 787 randomly selected antenatal clinic attendees. RESULTS: Logistic regression identified 19 items for the Dar-es-Salaam Symptom Questionnaire (DSQ), which demonstrated good internal consistency (Cronbach's alpha = 0.84), interrater reliability (intraclass r = 0.89), and test-retest reliability (intraclass r = 0.82). Positive endorsement overall increased only slightly, but the report of mild symptoms was more frequent with the DSQ (15.0%) than the HSCL-25 (10.8%). Content and discriminant validation of the local scale conformed to expectation, but depressed affect failed to emerge as an important feature. CONCLUSION: Locally derived expressions may aid in the reporting of illness and illness severity. Further studies are recommended to uncover universal aspects and culturally specific manifestations of illness expression. DECLARATION OF INTEREST: None to report.

Barriers to men who have sex with men attending HIV related health services in Dar es Salaam, Tanzania.

The HIV/AIDS disease burden is disproportionately high among men who have sex with men (MSM) worldwide. If this group will continue to be ignored they will continue to be the focus of HIV infection to the general population. This study explored barriers impeding MSM utilizing the HIV related health services currently available. The objectives of the study were to: (i) determine how stigma and discrimination affect MSM attendance to HIV related health services; (ii) determine how health care worker's (HCW's) practices and attitudes towards MSM affect their attendance to HIV related health service; (iii) learn MSM's perception towards seeking HIV related health services and other factors affecting accessibility of HIV related health services among MSM in Dar es Salaam, Tanzania. This was a descriptive study whereby qualitative methods were employed, using in-depth interviews for 50 individuals and focus group discussions for 5 groups which were conducted at PASADA premises, in Temeke district in 2012. After transcription data was read through, codes created were then collapsed into themes which were interpreted. The findings of this study show that majority of the study participants access HIV related health services in Dar es Salaam when they need to. However, they reported stigma and discrimination, lack of confidentiality and privacy, lack of availability and MSM friendly HIV related health services, financial challenges, poor practices and negative attitudes directed towards them by health workers, fears and lack of HIV knowledge among them as barriers for them to access these services. With these findings, there is an importance of enabling MSM to overcome the perceived stigma when seeking for HIV related health services. Also there is a need to conduct further research with regards to how HCW's treat this group and their understanding on same sex practices.

Flashblood: blood sharing among female injecting drug users in Tanzania.

AIMS: This study examined the association between the blood-sharing practice of 'flashblood' use and demographic factors, human immunodeficiency virus (HIV) status and variables associated with risky sex and drug behaviors among female injecting drug users. Flashblood is a syringe-full of blood passed from someone who has just injected heroin to someone else who injects it in lieu of heroin. DESIGN: A cross-sectional study. SETTING: Dar es Salaam, Tanzania. PARTICIPANTS: One hundred and sixty-nine female injecting drug users (IDUs) were recruited using purposive sampling for hard-to-reach populations. MEASUREMENTS: The association between flashblood use, demographic and personal characteristics and risky sex and drug use variables was analyzed by t-test and chi(2) test. The association between flashblood use and residential neighborhood was mapped. FINDINGS: Flashblood users were more likely to: be married (P = 0.05), have lived in the current housing situation for a shorter time (P < 0.000), have been forced as a child to have sex by a family member (P = 0.007), inject heroin more in the last 30 days (P = 0.005), smoke marijuana at an earlier age (P = 0.04), use contaminated rinse-water (P < 0.03), pool money for drugs (P < 0.03) and share drugs (P = 0.000). Non-flashblood users were more likely to live with their parents (P = 0.003). Neighborhood flashblood use was highest near downtown and in the next two adjoining suburbs and lowest in the most distant suburbs. CONCLUSIONS: These data indicate that more vulnerable women who are heavy users and living in shorter-term housing are injecting flashblood. The practice of flashblood appears to be spreading from the inner city to the suburbs.

Exposure to information and communication about HIV/AIDS and perceived credibility of information sources among young people in northern Tanzania.

Young people in sub-Saharan Africa constitute an important group for HIV prevention efforts. Determining their exposure to HIV/AIDS information and communication and their perceived credibility of information sources is imperative to the development of interventions. However, the majority of studies on this topic have been conducted among school-based populations, with few focused on those out of school or on comparing the two groups. A structured face-to-face interview was completed by 993 young people out of school, between the ages of 13 and 18, in Kilimanjaro, Tanzania; additionally, the questionnaire was self-administered by 1 007 students attending either their last year of primary or first year of secondary school. Significant factors associated with the frequency of exposure to HIV/AIDS information and frequency of communication about HIV/AIDS included urban/rural location, sex, socio-economic status, and educational attainment. Both groups ranked the radio as the most frequent source of HIV/AIDS information. The in-school group reported significantly more frequent exposure to all sources of HIV/ AIDS information and they communicated more frequently about the topic than did the out-of-school group. Among both groups, exposure to HIV/AIDS information occurred more frequently than discussing the topic. The in-school group gave high credibility ratings to medical doctors, the radio and parents as sources of information, while the out-of-school group attributed the most credibility to the mass media. Irrespective of school attendance, the young people ranked friends, parents and doctors as preferred communicators of sexual and reproductive health information. Interventions that address the determinants of educational attainment are needed, as well as ones specifically intended to reach girls or those out of school. The preferences and credibility rankings for sources of HIV/AIDS information suggest the need for evidence-based programmes that utilise peers and promote the involvement of parents or doctors. Particularly needed are interventions that explicitly aim to stimulate discussion among young people about HIV/AIDS and that foster the development of interpersonal skills.