Effectiveness of emergency obstetric care training at the regional level in Ukraine: a non-randomized controlled trial.

BACKGROUND: Emergency obstetric care training, using Advances in Labour and Risk Management (ALARM) International Program (AIP) was implemented in Ukraine, a country with universal access to skilled perinatal and obstetric care but restricted resources. A total of 577 providers (65.5% of total) from 28 maternal clinics attended a 5-day training session focused on the five main causes of maternal mortality, with hands-on skill workshops, pre- and post- tests, and an objective structured clinical examination. The effects of this emergency obstetric care training on maternal outcomes is the subject of this paper. METHODS: A non-randomized controlled trial was conducted. The pilot areas where the training was implemented consisted of 64 maternity clinics of which 28 were considered as cases and 36 non-participating clinics were the referents. Data on maternal outcomes were collected for a 2-year span (2004-2005) prior to the trainings, which took place 2006-2007 and again after implementation of the trainings, from 2008 to 2009. Information was collected from 189,852 deliveries. Outcomes for the study were incidences of operative delivery and postpartum hemorrhage. Non-parametric statistics, meta-analyses, and difference in difference (DID) estimation were used to assess the effect of the AIP on maternal indices. RESULTS: DID analysis showed that after the training, compared to the referents, the cases had significant reduction of blood transfusions (OR: 0.56; 95%CI: 0.48-0.65), plasma transfusions (OR: 0.70; 95%CI: 0.63-0.78), and uterus explorations (OR: 0.64; 95%CI: 0.59-0.69). We observed a non-significant reduction of postpartum hemorrhage ≥1000 ml (OR: 0.92; 95%CI: 0.81-1.04; P = 0.103). Utilization of vacuum extraction for vaginal delivery increased (OR: 2.86; 95%CI: 1.80-4.57), as well as forceps assisted delivery (OR: 1.80; 95%CI: 1.00-3.25) and cesarean section (OR: 1.11; 95%CI: 1.06-1.17). There was no change in the occurrence of postpartum hysterectomy and maternal mortality. CONCLUSIONS: After one week of Emergency Obstetrics Care training of the obstetric staff in a setting with universal access to perinatal and obstetric care but restricted resources, an association with the reduction of postpartum hemorrhage related interventions was observed. The effects on the use of vacuum extraction and cesarean section were minimal. TRIAL REGISTRATION: Retrospectively registered 071212007807 from 07/12/2012.

Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study.

BACKGROUND: We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities. METHODS: In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios. RESULTS: From May 1, 2010, to Dec 31, 2011, we included 314,623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23,015 (7.3%) women had potentially life-threatening disorders and 3024 (1.0%) developed an SMO. 808 (26.7%) women with an SMO had post-partum haemorrhage and 784 (25.9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0.826 [95% CI 0.802-0.851]). INTERPRETATION: High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy. FUNDING: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects.

Young people, sexuality, and HIV prevention within Christian faith communities in South Africa: a cross-sectional survey.

Faith communities exert a powerful influence on the life of their members, and studies are needed about how they may be able to influence young people's attitudes regarding sexuality and HIV prevention. Data were collected through a self-administered questionnaire from young people (811), aged 15-24 years, affiliated to the Roman Catholic Church, the Lutheran Church and the Assemblies of God. The majority of participants perceived themselves at risk of HIV infection (53 %). Premarital sexual abstinence was the most frequently (88 %) reported prevention message, followed by faithfulness (23 %), HIV testing (18 %) and condom use (17 %). Furthermore, religious affiliation was associated with education on sexuality and HIV in youth groups, with better information given to members of the Lutheran and Catholic churches. Faith communities need to strengthen their capacity to educate young people in a more holistic way about sexuality and HIV prevention.

Faith, premarital sex and relationships: are church messages in accordance with the perceived realities of the youth? A qualitative study in KwaZulu-Natal, South Africa.

Since religious messages on life style have a strong impact in South Africa, it is important to assess how they relate to the situation for young people at risk of HIV infection. Nine focus group discussions were conducted with youth (n = 62), aged 13-20 years, from the Roman Catholic Church, the Lutheran Church, and the Assemblies of God. Young people were ambivalent toward sexual contacts since these generally were expected to be part of a relationship even though the church condemns premarital sex. Girls perceived the moral norms to concern them more than the boys for whom sexual needs were more accepted. These moral barriers lead to lack of information about protection and may increase the risk of HIV. The realities young people facing should be a major concern for the faith communities.

Executive functions and child problem behaviors are sensitive to family disruption: a study of children of mothers working overseas.

Mothers in Sri Lanka are increasingly seeking overseas employment, resulting in disruption of the childcare environment. The present study was designed to evaluate the effects of maternal migration on executive function (EF) and behavior, thereby also contributing to the scientific understanding of environmental effects--or more specifically family effects--on children's neurocognitive functioning. A sample of 60 healthy 11-year-old children whose mothers had been working overseas for more than 1 year formed the study group, and a comparison group was recruited from the same schools. Evaluations were made twice over a 1-year interval with regard to the EF components inhibition and working memory as well as teacher ratings of internalizing and externalizing behavior. The children in the study group were found to have poorer EF and higher levels of externalizing behaviors. A composite score of inhibition partially mediated the group effect on externalizing behavior. Current home environment was assessed using the HOME scale, was poorer for the study group and was related to EF, but not to behavior problems. Keeping in mind the correlational nature of the present data, our results were discussed in relation to studies showing cognitive effects of stress.

How good is the quality of antenatal care in the Colombo district of Sri Lanka in diagnosing and treating anaemia?

BACKGROUND: Sri Lanka has shown relatively good maternal outcome indicators for a developing country. However, high maternal deaths from haemorrhage and anaemia raise questions about the quality of detection and treatment of anaemia at field antenatal clinics, which is the primary care setting for pregnant women. AIM: The aim of the study was to assess the quality of facilities and services and how satisfactory antenatal care is with regard to diagnosis and treatment of anaemia. METHODS: This study was set in field antenatal clinics and conducted in two stages based on the Lot Quality Assurance Sampling method. In the first stage 55 antenatal clinics were selected, and in the second stage 275 pregnant women were recruited from these 55 clinics. Quality of services and quality of facilities were assessed using observation, and an interviewer administered questionnaire was used to measure client satisfaction. The validity of haemoglobin colour scale results was investigated by comparing them with results from a quality assured laboratory. RESULTS: Eleven health areas, other than the seven areas which had the haemoglobin investigated, were unacceptable as regards the quality of services. The quality of facilities was better than the quality of services in the Colombo district. Information and counselling was provided for only 4% of women in the clinics. The sensitivity and the specificity for the haemoglobin colour scale was 62% (95% CI: 52.9%-71.1%) and 86% (95% CI: 79.6%-93.0%) respectively. CONCLUSION: Urgent steps should be taken to improve the quality of care in the health areas where care is substandard, in order to reduce morbidity and mortality due to anaemia.

Successful implementation of evidence-based routines in Ukrainian maternities.

OBJECTIVE: To describe the process of change and assess compliance and effect on maternal and infant outcome when the WHO package Effective Perinatal Care (EPC) was implemented at maternities in Ukraine. DESIGN: Intervention study comparing outcomes before and during 2.5 years after training. SETTING: Three maternities in Donetsk, Lutsk and Lviv 2003-2006. POPULATION: Baseline data were collected for 652, 742 and 302 deliveries and 420, 381 and 135 infants, respectively, in Donetsk, Lutsk and Lviv. Follow-up data included 4,561, 9,865 and 7,227 deliveries and 3,829, 8,658 and 6,401 infants. METHODS: Staff training on evidence-based guideline. MAIN OUTCOME MEASURES: Interventions during labor, maternal outcomes and hypothermia in the infants. RESULTS: EPC procedures were successfully implemented and adherence to the protocols was excellent. For most variables, the change occurred during the first three months but was well sustained. The use of partogram increased fourfold in Donetsk and from 0% to 60% in Lviv. Induction and augmentation of labor decreased to less than 1% and less than 5%, respectively. Cesarean section rate dropped significantly in two of the maternities. The proportion of hypothermic infants decreased from 60% (Donetsk), 85% (Lutsk) and 77% (Lviv) to 1% in all three maternities during the first three months and was stable throughout the study period. Admission to Neonatal Intensive Care Unit decreased significantly in two of the maternities and there was no effect on early neonatal mortality. CONCLUSIONS: The process of education and change was well anchored in the organization, and implementation of new procedures was quick and successful.

Quality of antenatal care in rural Tanzania: counselling on pregnancy danger signs.

BACKGROUND: The high rate of antenatal care attendance in sub-Saharan Africa, should facilitate provision of information on signs of potential pregnancy complications. The aim of this study was to assess quality of antenatal care with respect to providers' counselling of pregnancy danger signs in Rufiji district, Tanzania. METHODS: A cross-sectional study was conducted in 18 primary health facilities. Thirty two providers were observed providing antenatal care to 438 pregnant women. Information on counselling on pregnancy danger signs was collected by an observer. Exit interviews were conducted to 435 women. RESULTS: One hundred and eighty five (42%) clients were not informed of any pregnancy danger signs. The most common pregnancy danger sign informed on was vaginal bleeding 50% followed by severe headache/blurred vision 45%. Nurse auxiliaries were three times more likely to inform a client of a danger sign than registered/enrolled nurses (OR = 3.7; 95% CI: 2.1-6.5) and Maternal Child Health Aides (OR = 2.3: 95% CI: 1.3-4.3) and public health nurses (OR = 2.5; CI: 1.4-4.2) were two times more likely to provide information on danger signs than registered/enrolled nurses. The clients recalled less than half of the pregnancy danger signs they had been informed during the interaction. CONCLUSION: Two out of five clients were not counselled on pregnancy danger signs. The higher trained cadre, registered/enrolled nurses were not informing majority of clients pregnancy danger signs compared to the lower cadres. Supportive supervision should be made to enhance counselling of pregnancy danger signs. Nurse auxiliaries should be encouraged and given chance for further training and upgrading to improve their performance and increase human resource for health.

Effectiveness of maternal referral system in a rural setting: a case study from Rufiji district, Tanzania.

BACKGROUND: The functional referral system is important in backing-up antenatal, labour and delivery, and postnatal services in the primary level of care facilities. The aim of this study was to evaluate the effectiveness of the maternal referral system through determining proportion of women reaching the hospitals after referral advice, appropriateness of the referral indications, reasons for non-compliance and to find out if compliance to referrals makes a difference in the perinatal outcome. METHODS: A follow-up study was conducted in Rufiji rural district in Tanzania. A total of 1538 women referred from 18 primary level of care facilities during a 13 months period were registered and then identified at hospitals. Those not reaching the hospitals were traced and interviewed. RESULTS: Out of 1538 women referred 70% were referred for demographic risks, 12% for obstetric historical risks, 12% for prenatal complications and 5.5% for natal and immediate postnatal complications. Five or more pregnancies as well as age <20 years were the most common referral indications. The compliance rate was 37% for women referred due to demographic risks and more than 50% among women referred in the other groups. Among women who did not comply with referral advice, almost half of them mentioned financial constraints as the major factor. Lack of compliance with the referral did not significantly increase the risk for a perinatal death. CONCLUSION: Majority of the maternal referrals were due to demographic risks, where few women complied. To improve compliance to maternal referrals there is need to review the referral indications and strengthen counseling on birth preparedness and complication readiness.

Ambivalence, silence and gender differences in church leaders' HIV-prevention messages to young people in KwaZulu-Natal, South Africa.

A series of semi-structured interviews on HIV prevention were conducted with South African clergy with pastoral and liturgical responsibilities from the Roman Catholic Church, the Lutheran Church and the Assemblies of God. The interviews were tape-recorded, transcribed verbatim and analysed by interpretive descriptive analysis. Three themes indicative of church leaders' approach to HIV prevention among youth emerged: dilemmas in breaking the silence on HIV and AIDS; ambivalent HIV-prevention messages from church leaders to young people; and gender differences in HIV-prevention messages. While church leaders had taken steps to overcome the stigma, the dilemmas of balancing theological understanding with resistance from their congregations presented a complex scenario. Ambivalence to HIV prevention concerned whose responsibility it was to educate young people about HIV; talking about sexuality in public; pre-marital abstinence and condom use; and resistance from congregation members towards HIV prevention. Finally, findings indicated a discrepancy between church leaders' belief in gender equality and the HIV-prevention messages they verbalised, which appears to burden girls.

Effect of supporter characteristics on expression of negative social reactions toward rape survivors in Dar Es Salaam, Tanzania.

Using a community representative sample of 1,505 adults we examined interpretations of rape situations in order to establish attitudes toward rape. We assessed their intentions to express negative social reactions (NSRs) toward rape survivors. We then determined effects of attitudinal and sociodemographic characteristics in logistic regression models assessing the odds of expressing NSRs. Being old, male, and Muslim, and failing to interpret the legal circumstances of rape increased their risks of expressing NSRs. The degree of interpretation of lack of consent as rape affected their intentions to express NSRs, but not how they responded to survivors of different social status.

Struggling with growing bodies within silence and denial: Perspectives of HIV and AIDS among youth in Rural Zimbabwe.

Concerns regarding HIV and AIDS were elicited from 546 school youth (51% female, age range 9-25 years) in a Zimbabwean rural district, through a self-generated question writing process. Concerns emerged around how to avoid infection at a time when they were undergoing secondary sexual development, had growing feelings for love and were even engaging in sexual activity, but had limited access to preventive methods due to denial by the adult world. Fears were expressed regarding how to tell one's HIV status, even just after sex. HIV and AIDS were visualised in terms of suffering, loneliness, quarantine and death. The youth stressed they would have difficulties communicating with other people should they suspect or find they are infected with HIV, as this would imply they had been sexually active. They seemed to have knowledge around HIV and AIDS that either was incomplete, or they could not apply given a context of silence and denial around their sexuality. Some of the knowledge was coloured with misconceptions, suggesting contradictory information from multiple sources. After more than two decades, the scenario portrayed raises questions about interventions targeting young people. The question is why is their situation in this state when several stakeholders are actively participating in debates and interventions around their well-being? Campaigns and interventions may need to consider young people's complex social contexts, the factors generating and sustaining their situation, and what role diverse actors and social change processes play in this.

Perceptions of child sexual abuse-a qualitative interview study with representatives of the socio-legal system in urban Tanzania.

Through in-depth interviews, this study explored perceptions and experiences of key players handling child sexual offense cases in Dar es Salaam, Tanzania. The informants included public police investigators, magistrates, legal workers, and social workers working with nongovernmental organizations. The interviews were recorded, transcribed verbatim, and analyzed using qualitative content analysis. Five themes emerged summarizing factors associated with sexual offenses, including community passivity, legal system weaknesses, legal framework inadequacy, and key players' vulnerabilities. Addressing the identified weaknesses may promote justice, while changes in attitudes and norms are needed for the prevention of sexual offenses to children.

Rural Tanzanian women's awareness of danger signs of obstetric complications.

BACKGROUND: Awareness of the danger signs of obstetric complications is the essential first step in accepting appropriate and timely referral to obstetric and newborn care. The objectives of this study were to assess women's awareness of danger signs of obstetric complications and to identify associated factors in a rural district in Tanzania. METHODS: A total of 1118 women who had been pregnant in the past two years were interviewed. A list of medically recognized potentially life threatening obstetric signs was obtained from the responses given. Chi-square test was used to determine associations between categorical variables and multivariate logistic regression analysis was used to identify factors associated with awareness of obstetric danger signs. RESULTS: More than 98% of the women attended antenatal care at least once. Half of the women knew at least one obstetric danger sign. The percentage of women who knew at least one danger sign during pregnancy was 26%, during delivery 23% and after delivery 40%. Few women knew three or more danger signs. According to multivariate logistic regression analysis having secondary education or more increased the likelihood of awareness of obstetric danger signs six-fold (OR = 5.8; 95% CI: 1.8-19) in comparison with no education at all. The likelihood to have more awareness increased significantly by increasing age of the mother, number of deliveries, number of antenatal visits, whether the delivery took place at a health institution and whether the mother was informed of having a risks/complications during antenatal care. CONCLUSION: Women had low awareness of danger signs of obstetric complications. We recommend the following in order to increase awareness of danger signs of obstetrical complications: to improve quality of counseling and involving other family members in antenatal and postnatal care, to use radio messages and educational sessions targeting the whole community and to intensify provision of formal education as emphasized in the second millennium development goal.

Criteria-based audit on management of eclampsia patients at a tertiary hospital in Dar es Salaam, Tanzania.

BACKGROUND: Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care. METHODS: We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH), Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. RESULTS: Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73%) preterm whereas the majority (71%) of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75%) of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. CONCLUSION: Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff.

Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania.

BACKGROUND: Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR). METHODS: From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133) with birth weight 1500 g or more at Muhimbili National Hospital (MNH). The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care). The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. RESULTS: The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. CONCLUSION: There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.

Paramedic-conducted mental health counselling for abused women in rural Bangladesh: an evaluation from the perspective of participants.

This paper reports on evaluation of an initiative to use paramedics as the first-level mental health counsellors of abused women in rural Bangladesh (2003-2004) from the perspective of the abused women who participated in one or more counselling sessions. Thirty in-depth interviews, followed by a survey(n=372), targeted to cover all participants, were conducted in 2006. Overall, the arrangement, management of ethical issues, and skills of paramedics were rated favourably. Most (89%) abused women (n=372) considered the session useful; one-fourth of these women considered it very useful; and only a few abused women considered the session useless. Usefulness of the session was expressed mostly in terms of relief attained after talking about the issue. Most (87%) women reported being encouraged to be self-confident. In a context characterized by low self-confidence of women, lack of opportunity to talk about violence, and absence of professional mental health counselling services, this initiative is sufficiently promising to warrant further testing.

Social reactions to rape: experiences and perceptions of women rape survivors and their potential support providers in Dar es Salaam, Tanzania.

Social reactions to rape are socioculturally determined and have a strong influence on the coping and recovery of the survivor. The existing knowledge on social reactions emanates from Western countries with limited research attention on non-Western populations, particularly sub-Saharan Africa. We aimed to establish the types and perceptions of social reactions that are expressed to rape survivors and people's intentions to express them to survivors of varied social backgrounds in Tanzania. Using triangulation of research methods, experiences of social reactions among rape survivors (n = 50) and nurses (n = 44) from a community in Tanzania were explored, and the intentions to express typical social reactions to rape survivors of different social backgrounds were established from a representative community sample (n = 1,505). Twelve typical social reactions were identified with the positive reactions more commonly mentioned than the negative reactions. Nondisclosure of rape events and distracting the survivor from the event were perceived as both positive and negative. A commercial sex worker was most vulnerable to negative reactions. The cultural influences of social reactions and implications for practical applicability of the results are discussed.

Striving to make a difference: health care worker experiences with intimate partner violence clients in Tanzania.

In this article we describe health care workers' (HCWs') experiences and perceptions of meeting clients exposed to intimate partner violence (IPV). Qualitative content analysis of in-depth interviews from 16 informants resulted in four main themes. The first, "internalizing women's suffering and powerlessness," describes HCWs' perceptions of violence, relating it to gender relations. The second, "caught between encouraging disclosure and lack of support tools," refers to views on possibilities for transparency and openness. The third, "Why bother? A struggle to manage with limited resources," illustrates the consequences of a heavy workload. Last; "striving to make a difference," emphasizes a desire to improve abilities to support clients and advocate for prevention.

Validity and reliability of Tamil version of Strengths and Difficulties Questionnaire self-report.

BACKGROUND: Child and adolescent mental health services are scarce in Sri Lanka. Moreover there are no validated instruments to measure the mental health problems of Tamil speaking adolescents in Sri Lanka. Hence, strengths and difficulties questionnaire (SDQ) self-report was translated into Tamil and validated in the District of Jaffna, Sri Lanka. SDQ self-report was translated from English to Tamil using standard translation and back translation method. The Tamil version of the SDQ self-report was validated against a gold standard (ie. diagnosis made by a consultant psychiatrist). Both clinic and community samples were included in the validation study. Thirty-five adolescents (11-16 years) attending a psychiatric clinic and 91 adolescents from the community were included. The consultant psychiatrist made the diagnosis independent of the SDQ responses. Receiver operating characteristics (ROC) curve was used to measure the validity of SDQ. Reliability was measured using internal consistency. RESULTS: The ROC curve indicated high validity for the identification of adolescents with mental health problems: area under the curve 0.87 (95% - CI = 0.79-0.93). International cut-off point of 15 gave a sensitivity of 69.4% and specificity of 92.2%. Cronbach's alpha values (0.67-0.78) were good in all subscales and total difficulties scale. CONCLUSION: The SDQ self-report Tamil version can be used effectively for screening of adolescents to identify mental health problems as well as for research purposes.