Evaluation of Parenting Interventions to Prevent Violence Against Children in Colombia: A Randomized Controlled Trial.

The effects of the International Child Development Programme (ICDP) and the specific addition of a violence prevention module were observed in a preidentified population in Colombia where children are experiencing high levels of violence. Participants were 176 parents of 3- to 4-year-olds attending child centers who were randomly allocated to one of three conditions: organized Community Activities at child centers and ICDP (CA + ICDP), CA, ICDP, and a preventive Violence Curriculum (CA + ICDP + VC), or a comparison group with only CA. The parents completed questionnaires about corporal punishment, intimate partner violence, community violence, and mental health at baseline and at 6 months follow-up. Univariate logistic regressions were used to examine uses of child violence, predictors of intimate partner violence, and prevalence of mental health problems. McNemar tests were used to assess differences between intervention groups and comparison group at two different time points. Participants were mostly female (78.5%) and had an average age of 32 years. Among these, 58.5% had been exposed to community violence and 98.3% reported using physical assault to discipline their children. Reported prevalence of child violence decreased in all groups whereas the reduction of severe forms of violence was larger for the intervention groups, and especially for the CA + ICDP + VC group. There was a significant reduction of victimization of intimate partner violence in both intervention groups as well as a decrease in mental health problems, especially for the CA + ICDP group (from 22.4% to 5.1%). The general ICDP seems effective in reducing violence. The addition of a specific violence intervention component seemed to reduce intimate partner violence, but not violence related to children. The comparison group attending the child center and other social activities also reported reduced violence but to a lesser extent than the groups who attended specific interventions.

Sexual risk-taking behaviour among HIV outpatients in Argentina.

HIV prevention strategies must be based on evidence of risk behaviours among people with HIV infection. This study aimed to determine the demographic, behavioural and self-reported disease/treatment variables that predict sexual risk behaviour, defined as unprotected intercourse with a partner of unknown or negative HIV status, among HIV-infected outpatients in Buenos Aires, Argentina. Two hundred consecutive outpatients (response rate 76.5%) participated in a self-complete cross sectional survey. The majority (49.5%) identified as heterosexual, and most were on antiretroviral therapy (ART) (75.5%). Undetectable viral load was currently achieved by 63%. Unprotected intercourse with a person of unknown or discordant status in the previous three months was reported by 20%. In multivariate analysis, risk was associated with lower distress from physical symptoms (p=0.012), greater distress from psychological symptoms (p=0.038) and being on treatment had borderline association with risk (p=0.058). The data reveal an important link between self-reported experience of disease, and treatment, with risk. Secondary prevention, care and treatment should not be conducted in isolation from each other if outcomes are to be optimised.

Cash transfers and social vulnerability in Bosnia: a cross-sectional study of households and listed beneficiaries.

OBJECTIVE: Promoted as a means of fueling markets and encouraging economic growth or recovery, cash transfers have become a popular approach to international assistance. The literature recognizes potential problems such as insecurity, corruption, misuse, gender inequality, market inflation, and ineffective targeting. We carried out population and beneficiary surveys in 1997 to evaluate the targeting of cash transfers in Bosnia soon after the end of the conflict. METHODS: The population survey visited a random sample of clusters from population registers in Bosnia and Herzegovina (BiH) and Republika Srpska (RS). A directly administered questionnaire asked households whether they received any cash handouts from the Municipal Welfare Office in the last year, and, if so, for what purpose, the amount, and how they used the money. We calculated coverage and inclusion and exclusion errors of the program. The field team also identified cash transfers beneficiaries from official lists of the program and attempted to contact a random sample of them to ask about their experience. RESULTS: It was not possible to confirm receipts of cash in one third of the sample of 840 named beneficiaries; 19% could not be traced and 17% of those found denied receiving any cash. In the general population survey of 7182 households, coverage rates with cash assistance (11% in BiH, 3% in RS) were at least 44% lower than those declared by the distribution agencies, with considerable variation between cantons. Exclusion errors were high: 83% of those eligible according to the program's income criterion did not receive any cash. Although sufficient cash was dispensed to reach every United Nations High Commission for Refugees priority 1 (most needy) household, only 13% of these households (278/2125) admitted receiving any cash. Inclusion errors were also high: 60% of all of those who received cash were not in the priority 1 category and 46% were not eligible according to the program's income criterion. Extrapolating from the population survey findings, we could only account for a maximum of US$4 million received by households in BiH and RS up to May 1997, of the US$16 million dispersed by the program up to that time. CONCLUSIONS: Targeting of the cash transfers program was poor, with large inclusion and exclusion errors. Much of the disbursed cash apparently did not reach the intended beneficiaries and could not be accounted for. Agencies on the ground did not have the necessary skills to handle the disbursements or to train national organizations to do so.

Epidemiological assessment of food aid in the Bosnian conflict, 1994-97.

Surveys in emergency settings are important for the accountability of food aid. Four household surveys conducted between 1994 and 1997 measured the performance of the Bosnia food aid programme, covering a random sample of clusters in Bosnia and Herzegovina and the Republica Srpska. The team calculated coverage, exclusion and inclusion errors, programme misses, and under-supply. Despite intended universal coverage from 1994-96, 15, 19, and 31 per cent, respectively, did not receive food across the three-year time frame. Households categorised as vulnerable were somewhat more likely to receive food. Programme misses were rare, whereas under-supply fell from 30 per cent in 1994 to four per cent in 1997, as the availability of other food increased. Extrapolation suggested that 61 per cent of the food distributed did not reach households. The programme introduced priority categories for targeting in 1997, yet nearly one-half of the highest priority households did not receive food. Incomplete coverage and weak targeting were related to political constraints.

Breast-feeding in a complex emergency: four linked cross-sectional studies during the Bosnian conflict.

OBJECTIVE: To examine changes in breast-feeding and impacts on child health during the Bosnian conflict. DESIGN: Four linked representative cross-sectional household surveys, 1994 to 1997. SETTING: The countries of former Yugoslavia largely missed the international wave of enthusiasm for breast-feeding of the 1980s and early 1990s. The concern is that breast-feeding deteriorates during humanitarian emergencies, when children need it most. SUBJECTS: The four surveys visited a random sample of clusters from population registers in the Federation of Bosnia and Herzegovina (BiH) and the Republica Srpska (RS). Interviewers asked about breast-feeding and other factors related to child health, and measured mid upper-arm circumference in 1123 infants aged 1-12 months. RESULTS: One-fifth of infants were not breast-fed at all (220/1087). Muslim and displaced children were less likely to breast-feed; 59 % of Muslim displaced children never breast-fed. Among infants in sites visited by all four surveys, there was no change in the proportion ever breast-fed and a significant increase in duration of breast-feeding and exclusive breast-feeding between 1994 and 1997. Children were breast-fed for shorter durations in male absent households, in frontline communities, the RS, and households that did not receive remittances from abroad. Non-breast-fed children and those who breast-fed for less than 4 months were more likely to be malnourished, as were those with complementary foods added either before or after their sixth month of life. CONCLUSIONS: If relief agencies had promoted and supported breast-feeding, this might have avoided some of the increased malnutrition that occurred during the conflict.