A critical review of the effectiveness of educational interventions applied in HIV/AIDS prevention.

OBJECTIVE: A critical review of issues around the effectiveness of educational approaches applied in the field of HIV/AIDS prevention. METHODS: Published papers, systematic reviews and technical reports were reviewed. RESULTS: The review has identified the large gap between the current state of the art and the ultimate goal of the education-based approaches contributing to the reduction of HIV incidence rates. Significant positive impact has been reported mainly on mediating factors to behavioural change (knowledge, attitude, and intentions). The reported impact on actual behaviour change has been weak and short-lived. Biological markers are not used in many studies as outcome measures and follow-up period is too short to facilitate the measurement of impact on behaviour change or biological markers. Several methodological flaws and cultural issues militate against effective programming. A guideline for standardising practice and research in school-based programme is available for use. CONCLUSION: There is only very modest evidence of the effectiveness of educational interventions as a result of several gaps in project design, implementation and follow-up. There is urgent need to raise practice and research standards. PRACTICE IMPLICATIONS: Educational interventions should utilise scientifically valid data gathering methods. Follow-up period should be long enough to allow for impact measurement.

Detecting maternal depression in a low-income country: comparison of the self-reporting questionnaire and the edinburgh postnatal depression scale.

OBJECTIVE: To validate the Self-Reporting Questionnaire (SRQ-20) and the Edinburgh Postnatal Depression Scale (EPDS) against the Clinical Interview Schedule-Revised (CIS-R). DESIGN: Two-phase design. SUBJECTS AND METHODS: 664 mothers were approached, 601 of them completed the EPDS and SRQ questionnaires. The CIS-R was administered to confirm the diagnosis for depression. The diagnostic accuracy was compared using the receiver operating characteristic analysis. RESULTS: At the threshold of 11, the SRQ had better sensitivity, negative predictive values and positive predictive values compared with the EPDS optimal threshold of 14. CONCLUSION: Both measures (EPDS and SRQ) have adequate validity to screen for depression in mothers in Pakistan. However, the SRQ performed better, with participants finding it easy to understand. The scales can be of great value to detect maternal depression in primary care and pediatric settings in low-income countries.

Six rapid assessments of alcohol and other substance use in populations displaced by conflict.

BACKGROUND: Substance use among populations displaced by conflict is a neglected area of public health. Alcohol, khat, benzodiazepine, opiate, and other substance use have been documented among a range of displaced populations, with wide-reaching health and social impacts. Changing agendas in humanitarian response-including increased prominence of mental health and chronic illness-have so far failed to be translated into meaningful interventions for substance use. METHODS: Studies were conducted from 2006 to 2008 in six different settings of protracted displacement, three in Africa (Kenya, Liberia, northern Uganda) and three in Asia (Iran, Pakistan, and Thailand). We used intervention-oriented qualitative Rapid Assessment and Response methods, adapted from two decades of experience among non-displaced populations. The main sources of data were individual and group interviews conducted with a culturally representative (non-probabilistic) sample of community members and service providers. RESULTS: Widespread use of alcohol, particularly artisanally-produced alcohol, in Kenya, Liberia, Uganda, and Thailand, and opiates in Iran and Pakistan was believed by participants to be linked to a range of health, social and protection problems, including illness, injury (intentional and unintentional), gender-based violence, risky behaviour for HIV and other sexually transmitted infection and blood-borne virus transmission, as well as detrimental effects to household economy. Displacement experiences, including dispossession, livelihood restriction, hopelessness and uncertain future may make communities particularly vulnerable to substance use and its impact, and changing social norms and networks (including the surrounding population) may result in changed - and potentially more harmful-patterns of use. Limited access to services, including health services, and exclusion from relevant host population programmes, may exacerbate the harmful consequences. CONCLUSIONS: The six studies show the feasibility and value of conducting rapid assessments in displaced populations. One outcome of these studies is the development of a UNHCR/WHO field guide on rapid assessment of alcohol and other substance use among conflict-affected populations. More work is required on gathering population-based epidemiological data, and much more experience is required on delivering effective interventions. Presentation of these findings should contribute to increased awareness, improved response, and more vigorous debate around this important but neglected area.

Sexual dysfunction among secondary school teachers in Ilorin, Nigeria.

INTRODUCTION: There is an increasing emphasis on human sexuality, which may reflect cultural and scientific development in recent years. AIM: To determine the prevalence, pattern of sexual dysfunction, and its associated factors among secondary school teachers in Ilorin, Kwara State, Nigeria. METHODS: Four hundred fifty consenting teachers were invited to complete an anonymous self administered questionnaire on demography as well as two to three other instruments for the assessment of human sexuality and general mental health status. This was thereafter collected by hand. MAIN OUTCOME MEASURES: The International Index of Erectile Function (IIEF), a modified Sexual Activity Questionnaire (SAQ) and the General Health Questionnaire-30 (GHQ-30). RESULTS: The following prevalence rates were found: female anorgasmia (40%), lubrication failure (30%); dyspareunia (12%); erectile dysfunction, premature ejaculation, and male orgasmic disorder (23% each); loss of sexual desire (24%); sexual life dissatisfaction and relationship dissatisfaction 6 months prior to interview (10% each). Age was a significant factor in sexual dysfunction in males (erectile dysfunction, premature ejaculation, and male anorgasmia), also in females (lubrication failure, superficial dyspareunia, anorgasmia). Marital status was found to be significant in relationship satisfaction, overall sexual satisfaction and presence of sexual dysfunctions whereas GHQ-30 scores were significant in sexual dysfunction in both genders, except for female anorgasmia and premature ejaculation in males. However, a presence of psychiatric "caseness" was significantly found in overall sexual life dissatisfaction as well as relationship dissatisfaction. CONCLUSION: The extent and pattern of sexual dysfunctions found in this study is comparable with those reported in earlier Nigerian studies. Despite this, there is apparently no health services specially designed to address sexual dysfunction among the teacher's group or the general population at large. This study thus draws attention to the urgent need for services geared towards alleviating sexual problems in our society.

Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian psychiatric hospital.

In low-income countries, clinicians must seek strategies to improve treatment adherence that are non-resource intensive and easily integrated into existing treatment structures. We conducted a prospective observational cohort study to investigate the relationship of family engagement in treatment during hospitalisation with post-discharge appointment and medication adherence in 81 patients from a Nigerian psychiatric hospital. After controlling for gender, diagnosis, mental state at discharge, and marital status, family involvement was significantly associated with appointment (P=0.047) but not medication adherence (P=0.590). Studies are needed to determine whether interventions based on engaging families in treatment can improve post-discharge adherence in this setting.