Serious life events and associated PTSD in Gambian girls exposed to female genital cutting.

Introduction: Poor mental health, such as post-traumatic stress disorder (PTSD), has been reported after female genital cutting (FGC). However, data documenting adverse consequences of FGC have insufficiently considered confounding factors, such as other traumatising events. Here, we examined the extent to which FGC versus other serious life events disturbed Gambian girls subjected to FGC. We additionally assessed the prevalence of PTSD and the extent to which it was attributed to FGC versus other serious life events. Methods: We conducted a cross-sectional study with a community-based sample of 12 years-old Gambian girls who had been subjected to FGC (N = 125). Using structured interviews, we assessed serious life events and probable PTSD related to the event that the girls cited as bothering them the most. Results: Most of the girls reported several serious life events in addition to FGC, such as witnessing violence, experiencing violence or assaults, death of a close relative, and being exposed to natural disasters or serious accidents, for an average 4.5 events per girl. Around one-sixth of the girls (16.8%) stated that FGC was the event that currently bothered them the most, whereas the majority (75.2%) emphasised other experiences. The girls who said they were most troubled by other events reported more impaired daily functioning than those most bothered by FGC. Overall, we found a prevalence of probable PTSD of 19.2%. Of 24 PTSD cases, one was attributed to the experience of FGC, and the remaining 23 were attributed to other events. Conclusion: Our findings indicate that FGC is less important than other serious life events in explaining high rates of PTSD in Gambian girls. Associations established in the field between FGC and adverse mental health must be interpreted with caution because girls who have undergone FGC may be severely exposed to other traumatising events.

Epidemiology of occupational hazards and injuries among fishermen at Tanji fishing site in The Gambia: an analytical cross-sectional study design.

Fishing is a well-known industry, and there are certain risks of work-related diseases and accidents, occupational hazards and safety issues. This study aimed at examining the determinants of occupational hazards and injuries among fishermen at Tanji fishing site, a major fish-landing site in the Gambia, West Africa. An analytical cross-sectional design was conducted in August to October 2019. Structured questionnaires were administered to fishermen at Tanji fishing site. A simple random sampling method was used to select fishermen in this study. Data entry and processing for preliminary data analysis was done using Stata version 15. Descriptive and bivariate analysis using chi-square/fisher exact test as well as binary logistics regression analysis were used. The adjusted risk ratios (aRRs) and confidence intervals of 95% were calculated. A P-value < .05 was considered for statistical significance. The proportion of occupational hazards were 95%, while reported injuries were 85%. Ergonomics, physical, and environmental/climatic hazards formed the majority at 25%, 23%, and, 21%, while muscle strains and falling formed the majority for types of injuries at 19% and 17%, respectively. Fishermen who used PPE (aRR: 0.12and 95% CI: 0.01-0.99) were less likely to have occupational hazards relative to those who did not use PPE. In terms of injuries, fishermen who were smokers (aRR: 3.18, 95% CI: 1.32-7.66), had chemical hazards (aRR: 3.14, 95% CI: 1.26-7.86) and had no fishing safety rules (aRR: 2.81, 95% CI: 1.15-6.85) were more likely to sustained injuries relative to other categories after controlling for confounders. This research found a high prevalence of OSH hazards and injuries among fishermen, highlighting the critical nature of strengthening safety regulatory services for this workforce.

Knowledge, Attitude, and Practice of Livestock Owners and Livestock Assistants towards African Trypanosomiasis Control in The Gambia.

BACKGROUND: In Africa, it has been estimated that 50 million cattle and 70 million sheep and goats are at risk of animal African trypanosomiasis, and three million cattle die annually. METHODS: This study was conducted in all the regions of The Gambia except Kombo Saint Mary Island (Banjul). Structured questionnaires were administered to 440 randomly selected livestock owners and 23 livestock assistants, and 7 focus group discussions were held for both livestock owners and livestock assistants. The data were analyzed mainly using descriptive statistics and content analysis methods. RESULTS: A total of 94.5% and 75% of livestock owners reported having seen tsetse and horse flies, respectively, while 100% of livestock assistants reported having seen tsetse flies. Forty-seven percent of the livestock owners indicated a positive attitude toward control measures, while 42% of them had no idea how to control tsetse flies. On the other hand, 57% of livestock assistants believe that tsetse and horse flies are the main reasons why AAT is still in their community. There was a statistically significant difference between all the respondents' characteristics and the practices done by livestock owners to prevent AAT vectors from biting their animals. CONCLUSION: This study shows that trypanosomiasis is still a major problem for livestock health and production in The Gambia, and it requires disease and vector control.

The association between physical complications following female genital cutting and the mental health of 12-year-old Gambian girls: A community-based cross-sectional study.

BACKGROUND: Female genital cutting (FGC) involve an acute physical trauma that hold a potential risk for immediate and long-term complications and mental health problems. The aim of this study was to examine the prediction of depressive symptoms and psychological distress by the immediate and current physical complications following FGC. Further, to examine whether the age at which 12-year-old Gambian girls had undergone the procedure affected mental health outcomes. METHOD: This cross-sectional study recruited 134 12-year-old girls from 23 public primary schools in The Gambia. We used a structured clinical interview to assess mental health and life satisfaction, including the Short Mood and Feeling Questionnaire (SMFQ), the Symptom check list (SCL-5) and Cantril's Ladder of Life Satisfaction. Each interview included questions about the cutting procedure, immediate- and current physical complications and the kind of help and care girls received following FGC. RESULTS: Depressive symptoms were associated with immediate physical health complications in a multivariate regression model [RR = 1.08 (1.03, 1.12), p = .001], and with present urogenital problems [RR = 1.19 (1.09, 1.31), p < .001]. The girls that received medical help following immediate complications had a lower risk for depressive symptoms [RR = .73 (.55, .98), p = .04]. Psychological distress was only associated with immediate complications [RR = 1.04 (1.01, 1.07), p = .004]. No significant differences in mental health outcomes were found between girls who underwent FGC before the age of four in comparison to girls who underwent FGC after the age of four. CONCLUSION: Our findings indicate that the immediate and long-term complications following FGC have implications for psychological health. Only a minimal number of girls received medical care when needed, and the dissemination of health education seems crucial in order to prevent adverse long-term physical and psychological health consequences.

The Impact of the Presidential Alternative Treatment Program on People Living with HIV and the Gambian HIV Response.

In January 2007, former president of The Gambia Yahya Jammeh created the Presidential Alternative Treatment Program (PATP), which introduced a fraudulent "HIV cure." PATP and the fraudulent HIV herbal cure (PATP cure) were widely advertised in state media through patient testimonials and specially produced broadcasts of Jammeh administering treatment, enticing people living with HIV to join the program. Jammeh faced little to no opposition from within The Gambia. Due to the great power and influence he wielded, PATP was nothing short of a health dictatorship. This paper argues that PATP and the PATP cure violated the human rights of people living with HIV in The Gambia and compromised HIV health service delivery. In addition, during PATP's 10-year operation, the global health community was derelict in its duty to stop Jammeh's promotion and use of the PATP cure and to protect people living with HIV.

Environmental and occupational health needs assessment in West Africa: opportunities for research and training.

OBJECTIVES: Data are lacking on environmental and occupational health risks and resources available for the prevention of related diseases in the West African subregion. METHODS: A needs assessment survey was conducted to identify environmental and occupational health concerns, and needs and strategies for skills training in the region. The survey was followed by a consensus-building workshop to discuss research and training priorities with representatives from countries participating in the study. RESULTS: Two hundred and two respondents from 12 countries participated in the survey. Vector-borne diseases, solid waste, deforestation, surface and ground water contamination together with work-related stress, occupational injury and pesticide toxicity were ranked as top environmental and occupational health priorities, respectively, in the region. Top training priorities included occupational health, environmental toxicology and analytic laboratory techniques with semester-long Africa-based courses as the preferred type of training for the majority of the courses. Major differences were found between the subregion's three official language groups, both in perceived health risks and training courses needed. CONCLUSIONS: The study results have implications for regional policies and practice in the area of environmental and occupational health research and training.

Participatory approach to identify interventions to improve the health, safety, and work productivity of smallholder women vegetable farmers in the Gambia.

OBJECTIVE: This paper describes the qualitative, community-based participatory approach used to identify culturally-acceptable and sustainable interventions to improve the occupational health, safety, and productivity of smallholder women vegetable farmers in The Gambia (West Africa). MATERIALS AND METHODS: This approach was used to conduct: 1) analysis of the tasks and methods traditionally used in vegetable production, and 2) selection of interventions. RESULTS: The most arduous garden tasks that were amenable to interventions were identified, and the interventions were selected through a participatory process for further evaluation. CONCLUSIONS: Factors contributing to the successful implementation of the participatory approach used in this study included the following: 1) ensuring that cultural norms were respected and observed; 2) working closely with the existing garden leadership structure; and 3) research team members working with the subjects for an extended period of time to gain first-hand understanding of the selected tasks and to build credibility with the subjects.

Evaluation of long- and short-handled hand hoes for land preparation, developed in a participatory manner among women vegetable farmers in The Gambia.

OBJECTIVE: This study evaluated land preparation interventions (new short- and long-handled hoes), developed in a participatory manner with women vegetable farmers in West Africa, and identified indicators of long-term adoption of these interventions. METHODS: Subjects (n = 48) engaged in timed trials, alternating between using an intervention tool and their traditional hand hoe to till specified plots of land. Heart rates were measured and subjects reported the relative ergonomic comfort and safeness of the tool after each trial. Follow-up interviews and focus groups were held one, two, and three months after the trials. RESULTS: Compared to the traditional hoe, the new long-handled hoe required 22% less time (p = 0.01), while the new short hoe took 20% more time (p = 0.05) to till the standard plots in this study. Two months after the initial trials, 94% of subjects preferred the new hoes over the traditional hoe. Most subjects (75%) preferred the new short hoe over the new long hoe and thought it was faster (81%), despite measurements to the contrary. CONCLUSIONS: While the new long-handled hoe performed better in the timed trials in this study, most subjects preferred the new short-handled hoe. Subjects should be sensitized on the benefits of the long-handled hoe.

Agricultural-related injury and illness in The Gambia: a descriptive survey of a rural nursing service and area farmers.

This is an exploratory, descriptive study based on a convenience sample from a rural nursing service and in-country area farmers from The Gambia. The purpose of the study was to provide descriptive information about agricultural-related injury and illness from area farmers and to obtain data from rural nurses about the time they spent caring for and treating farmers. Employees of the nursing service could read and write English fluently and thus completed a written questionnaire; the area farmers were unable to read and write English so they were interviewed by farm extension workers in their own tribal language. The most alarming findings were the nursing respondents' report of farm workers using pesticides in their homes, the poor condition of pesticide sprayers, and the lack of personal protective equipment. Despite their claim of following pesticide instructions, farm workers reported a surprisingly high number of respiratory and neurological signs and symptoms.

Pesticide handling and exposures among cotton farmers in the gambia.

OBJECTIVES: There are substantial health hazards to farmers and the environment associated with pesticide use in developing countries. Based on observations by the authors and previous reports, most previous studies in Africa are descriptive in nature. The aim of this study was to investigate how cotton farmers are exposed to pesticides in The Gambia and quantify their pesticide exposures and provide information for the formulation of a policy on pesticide safety for the country. METHODS: A representative sample of 20 cotton farmers in the Central and Upper River Divisions (CRD and URD) of The Gambia were surveyed by questionnaires. Dermal pesticide exposures among a subset of 10 farmer/pesticide applicators were assessed by dermal patch samples, observation, and postapplication questionnaires. RESULTS: The study revealed that a toxic organochlorine insecticide, Callisulfan (endosulfan), is frequently sprayed on cotton plants by the farmers. The farmers wore no protective equipment and were inadequately dressed for work with this pesticide. Laboratory analysis of the mixed formulation showed a wide range in the concentration of the pesticide solution among the farmer/pesticide applicators and dermal patch samples showed very high residues of endosulfan analytes on their body surfaces. CONCLUSIONS: A low level of awareness of pesticide toxicity prevails amonsg cotton farmers in The Gambia. There is a less than adequate control of pesticides and other hazardous agrichemicals in the country.

Agricultural health in The Gambia I: Agricultural practices and developments.

This manuscript reports results of our study to characterize the historical developments of agricultural practices in The Gambia and related health risks of farm workers. It surveys the various factors that shape production agriculture in the country and examines the degrees to which hand tools, animal traction, motorized traction and manual labour all contribute to the inherent hazards of farm work. The principal objective of this study is to lay the ground work for detailed research of occupational health hazards in Gambian agriculture; and development of policies and programmes to promote the health of Gambian farmers. The authors of this paper assume the belief that one must first understand the industry and its people before effective policies and programmes can be developed. The study concludes by highlighting the need for the integration of epidemiological investigations in the country's agricultural research programme.

Agricultural health in The Gambia II: A systematic survey of safety and injuries in production agriculture.

This study was undertaken to provide baseline information on the injuries and health and safety conditions in Gambian agriculture. The objective was to produce information to guide the formulation of an agricultural health and safety policy for the country, future investigations, prevention and surveillance of the adverse health effects in agriculture. A cross-sectional survey of 20 farmers, 20 nurses, and 20 agricultural extension workers was conducted in the Central and Upper River Divisions of The Gambia. The survey was implemented by the means of questionnaires, walk-through survey and hazard checklist. Seventy percent of farms reported an injury during the past year. Major sources and contributing factors for the injuries were characterized. Predisposing factors to the injuries were climatic conditions, working in static positions, bending and twisting and carrying heavy objects. Cuts and lacerations were identified as the commonest injury types and the most common sources were hand tools (hand hoe, cutlass, axe and knife) and animal-powered carts. A workshop for the major stake holders in the country's agriculture was also held to identify problems and possible solutions for health promotion of Gambian farmers.