Content validation of educational materials on maternal depression in Nigeria.

BACKGROUND: This study describes the content validation process of the already developed English and Yoruba (poster and leaflet) and Yoruba (song) maternal depression educational materials in Nigeria. METHODS: This study is a cross sectional study which is a part of a larger study on training and supervision of Primary health care workers. Study utilized health professionals' judgement for content validation, and maternal-child health clients' evaluation for face validation with the use of Suitability Assessment of Materials (SAM). Six bilingual professionals validated both English and Yoruba version of materials (Song has only Yoruba version) and 50 clients evaluated each Yoruba material. Validity Index was calculated by formula and inter-rater agreement using intra-class coefficient (ICC) was analyzed on Professionals' ratings. ICC, 't' test and Pearson correlation were analyzed on professionals' rating versus randomly selected six clients' rating. Descriptive statistics, and fisher exact test were used for other statistical analysis with SPSS version 25. RESULTS: The mean age of the professionals for poster was 44.3 ± 6.0 years, for leaflet 39.8 ± 7.2 years, for song 43.8 ± 8.4 years. For maternal child health clients, mean age is: 30.7 ± 5.4 years for poster; 31.3 ± 5.2 for leaflet and 29.0 ± 5.1 for song. Outcomes of bilingual professionals' validation are validity index: English {leaflet (0.94), poster (0.94)}, and Yoruba {leaflet (0.94) poster (0.94) and song (1.00)}. More than 80% clients rated the suitability of each material as superior. There is no significant relationship between clients' sociodemographic characteristics and their ratings across content, literacy demand and cultural appropriateness domains of the three materials on fisher exact test. The inter-rater agreement among the professionals is excellent on leaflet and song ICC > 0.8, but it is weak on the poster ICC < 0.6. There is no inter-rater agreement on all the three Yoruba materials, but a negative linear correlation was found on the leaflet between the professionals' ratings and the randomly selected clients' ratings. 't' test found no statistical difference in the ratings of the professionals and clients only on song material. CONCLUSION: This study shows the process of validation of the English and Yoruba versions of the educational materials. This process should be leveraged in the content validation of other maternal-child health education materials in Africa.

The effect of training and supervision on primary health care workers' competence to deliver maternal depression inclusive health education in Ibadan, Nigeria: a quasi-experimental study.

BACKGROUND: Health workers lack the competence to address maternal depression in the routine health education in Nigeria. Hence, awareness among maternal-child health clients is low. We assessed the effect of training and supervision on knowledge, skills, and self-efficacy of primary healthcare workers in delivering health talks and the clients' knowledge on maternal depression. METHODS: A quasi-experimental study design was adopted. Five Local Government Area (LGAs) in the Ibadan metropolis were grouped according to geographical proximity and randomly assigned to experimental (Group A = two LGAs) and control (Group B = three LGAs) with 12 primary health centres in each group. All primary health care workers recruited in group A received a one-day training on maternal depression. Good Knowledge Gain (GKG), Good Skill Gain (GSG) and Self-Efficacy (SEG) were assessed in both groups. 1-week post-training, the knowledge of all the PHCs' attendees in the two groups was assessed. Two weeks post- training, a half of experimental group's PHCs received supportive supervision and a clinic-based health education delivery skill assessment was conducted. The knowledge of clients and their health seeking were also assessed. Fisher's exact test, independent t test and Poisson regression were used to analyze differences in percentages and mean/ factors associated with GKG, GSG and SE, using SPSS 25. RESULTS: Training improved gains in the experimental versus controls as follows: GKG (84.3% vs. 15.7%), GSG (90.7% vs 9.3%) and SEG (100% vs 0%). Training contributed to the good gain in knowledge (RR = 6.03; 95%CI =2.44-16.46; p < 0.01); skill (RR = 1.88; CI = 1.53-2.33; p < 0.01).) and self-efficacy (RR = 2.74; CI = 2.07-2.73; p < 0.01). Clients in the experimental group had higher knowledge gain score than in the control (7.10 ± 2.4 versus - 0.45 ± 2.37); p < 0.01). The rater supervisor observed better motivation in the supervised group than the not supervised. Forty clients sought help in the intervention group while none in the control group. Thirty-five clients sought help in the supervised group while only five did in the not supervised. CONCLUSIONS: Training followed by supervision improved the competence of health workers to transfer knowledge to clients. This intervention is recommended for primary healthcare settings to improve uptake of maternal mental health services.

HIV-1 transmission networks in high risk fishing communities on the shores of Lake Victoria in Uganda: A phylogenetic and epidemiological approach.

BACKGROUND: Fishing communities around Lake Victoria in sub-Saharan Africa have been characterised as a population at high risk of HIV-infection. METHODS: Using data from a cohort of HIV-positive individuals aged 13-49 years, enrolled from 5 fishing communities on Lake Victoria between 2009-2011, we sought to identify factors contributing to the epidemic and to understand the underlying structure of HIV transmission networks. Clinical and socio-demographic data were combined with HIV-1 phylogenetic analyses. HIV-1 gag-p24 and env-gp-41 sub-genomic fragments were amplified and sequenced from 283 HIV-1-infected participants. Phylogenetic clusters with ≥2 highly related sequences were defined as transmission clusters. Logistic regression models were used to determine factors associated with clustering. RESULTS: Altogether, 24% (n = 67/283) of HIV positive individuals with sequences fell within 34 phylogenetically distinct clusters in at least one gene region (either gag or env). Of these, 83% occurred either within households or within community; 8/34 (24%) occurred within household partnerships, and 20/34 (59%) within community. 7/12 couples (58%) within households clustered together. Individuals in clusters with potential recent transmission (11/34) were more likely to be younger 71% (15/21) versus 46% (21/46) in un-clustered individuals and had recently become resident in the community 67% (14/21) vs 48% (22/46). Four of 11 (36%) potential transmission clusters included incident-incident transmissions. Independently, clustering was less likely in HIV subtype D (adjusted Odds Ratio, aOR = 0.51 [95% CI 0.26-1.00]) than A and more likely in those living with an HIV-infected individual in the household (aOR = 6.30 [95% CI 3.40-11.68]). CONCLUSIONS: A large proportion of HIV sexual transmissions occur within house-holds and within communities even in this key mobile population. The findings suggest localized HIV transmissions and hence a potential benefit for the test and treat approach even at a community level, coupled with intensified HIV counselling to identify early infections.

Short communication: HIV type 1 transmitted drug resistance and evidence of transmission clusters among recently infected antiretroviral-naive individuals from Ugandan fishing communities of Lake Victoria.

Human immunodeficiency virus type 1 (HIV-1) prevalence and incidence in the fishing communities on Lake Victoria in Uganda are high. This population may play a role in driving the HIV epidemic in Uganda including the spread of transmitted drug resistance (TDR). We report data on TDR in this population among antiretroviral (ARV)-naive, recently infected individuals about 5 years after ARV scaling-up in Uganda. We identified phylogenetic transmission clusters and combined these with volunteer life histories in order to understand the sexual networks within this population. From a prospective cohort of 1,000 HIV-negative individuals recruited from five communities, 51 seroconverters were identified over a period of 2 years. From these, whole blood was collected and population sequencing of the HIV-1 pol gene (protease/reverse transcriptase) was performed from plasma. Drug resistance mutations (DRMs) were scored using the 2009 WHO list for surveillance of TDR. TDR prevalence categories were estimated using the WHO recommended truncated sampling technique for the surveillance of TDR for use in resource-limited settings (RLS). Of the samples 92% (47/51) were successfully genotyped. HIV-1 subtype frequencies were 15/47 (32%) A1, 20/47 (43%) D, 1/47 (2%) C, 1/47 (2%) G, and 10/47 (21%) unique recombinant forms. Nonnucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutation K103N was identified in two individuals and V106A in one (6%) suggesting that the level of TDR was moderate in this population. No nucleoside/tide reverse transcriptase inhibitor (NRTI) or protease inhibitor (PI) DRMs were detected. In this study, we identified five transmission clusters supported by high bootstrap values and low genetic distances. Of these, one pair included the two individuals with K103N. Two of the genotypic clusters corresponded with reported sexual partnerships as detected through prior in-depth interviews. The level of TDR to NNRTIs in these ARV-naive individuals was moderate by WHO threshold survey categorization. The transmission clusters suggest a high degree of sexual partner mixing between members of these communities.