Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa.

Depression is often underdiagnosed and undertreated in primary care settings, particularly in developing countries. This is, in part, due to challenges resulting from lack of skilled mental health workers, stigma associated with mental illness, and lack of cross-culturally validated screening instruments. We conducted this study to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) as a screen for diagnosing major depressive disorder among adults in Ethiopia, the second most populous country in sub-Saharan Africa. A total of 926 adults attending outpatient departments in a major referral hospital in Ethiopia participated in this study. We assessed criterion validity and performance characteristics against an independent, blinded, and psychiatrist administered semi-structured Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. Overall, the PHQ-9 items showed good internal (Cronbach's alpha=0.81) and test re-test reliability (intraclass correlation coefficient=0.92). A factor analysis confirmed a one-factor structure. Receiver Operating Characteristics (ROC) analysis showed that a PHQ-9 threshold score of 10 offered optimal discriminatory power with respect to diagnosis of major depressive disorder via the clinical interview (sensitivity=86% and specificity=67%). The PHQ-9 appears to be a reliable and valid instrument that may be used to diagnose major depressive disorders among Ethiopian adults.

Community diagnosis of common skin diseases in the Zay community of the Zeway Islands, Ethiopia.

BACKGROUND: Skin diseases are common public health problems throughout the world. Studies on skin problems are rare in Ethiopia. Easy and cheap methods of identifying skin conditions in the community are poorly developed in the country. OBJECTIVES: (1) To assess whether the newly developed Dermatological Screening Questionnaire (DSQ) can be used to effectively screen for common skin diseases and (2) to estimate the prevalence of skin diseases in a rural community. METHODS: A cross-sectional survey was conducted in the rural community residing on the islands of Lake Zeway. A locally prepared nine-item questionnaire (the DSQ) was used by lay-interviewers to screen for common skin diseases. Any respondent giving one or more positive responses, and a further 104 people who had replied negatively, underwent confirmatory diagnosis by specialist dermatologists. RESULTS: A total of 4697 people were included in the survey. Of these, 992 (20.0%) respondents screened positive on the DSQ. Out of 62.5% (N = 620) examined by dermatologists, 98.6% (n = 611) were found to have one or more skin conditions. Amongst screen negatives, 10.6% had skin diseases. Sensitivity and specificity of the DSQ was found to be 98% and 91%, respectively. The weighted prevalence of clinically-confirmed skin disease was 22.5%. Scabies was the most common of all skin conditions, followed by fungal infections. CONCLUSION: Our survey revealed that easily preventable and treatable skin diseases are common in this rural community. Nearly all those who gave a positive response to the DSQ had one or more skin disease confirmed on clinical examination. This finding indicates that the DSQ is a useful instrument for identification of common skin diseases in the community.