Ayalew Tegegn

Food insecurity, stressful life events and symptoms of anxiety and depression in east Africa: evidence from the Gilgel Gibe growth and development study

Objectives: Common mental disorders are a major contributor to the burden of disease in developing countries. An assessment was carried out of whether food insecurity and exposure to stressful life events, two common features of life in sub-Saharan Africa (SSA), are associated with symptoms of mental disorders among adults. Methods: The Gilgel Gibe Growth and Development Study (GGGDS) is an ongoing cohort study in rural Ethiopia. Participants of the GGGDS were randomly selected from households from a complete census of persons living in the area. The Hopkins Symptom Checklist and the Harvard Trauma Questionnaire were used to assess anxiety and depression and post-traumatic stress symptoms. Results: Among 902 adult participants, food insecurity, stressful life events and symptoms of common mental disorders were highly prevalent. In separate multivariate models adjusting for potential confounders, food insecurity and stressful life events were independently associated with high symptoms of depression, anxiety and post-traumatic stress. Conclusions: Potentially modifiable stressors may influence variation in common mental disorders in Ethiopia, and SSA more generally. These findings suggest that the negative effects of food insecurity extend beyond nutritional outcomes and that interventions that promote food security may also positively influence adult mental health in the region.

Women’s preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery

Background Delivery attended by skilled professionals is essential to reducing maternal mortality. Although the facility delivery rate in Ethiopias rural areas is extremely low, little is known about which health system characteristics most influence womens preferences for delivery services. In this study, womens preferences for attributes of health facilities for delivery in rural Ethiopia were investigated. Methods A population-based discrete choice experiment (DCE) was fielded in Gilgel Gibe, in southwest Ethiopia, among women with a delivery in the past 5 years. Women were asked to select a hypothetical health facility for future delivery from two facilities on a picture card. A hierarchical Bayesian procedure was used to estimate utilities associated with facility attributes: distance, type of provider, provider attitude, drugs and medical equipment, transport and cost. Results 1006 women completed 8045 DCE choice tasks. Among them, 93.8% had delivered their last child at home. The attributes with the greatest influence on the overall utility of a health facility for delivery were availability of drugs and equipment (mean β=3.9, p<0.01), seeing a doctor versus a health extension worker (mean β=2.1, p<0.01) and a receptive provider attitude (mean β=1.4, p<0.01). Conclusion Women in rural southwest Ethiopia who have limited personal experience with facility delivery nonetheless value health facility attributes that indicate high technical quality: availability of drugs and equipment and physician providers. Well-designed policy experiments that measure the contribution of quality improvements to facility delivery rates in Ethiopia and other countries with low health service utilisation and high maternal mortality may inform national efforts to reduce maternal mortality.

Parental symptoms of common mental disorders and children's social, motor, and language development in sub-Saharan Africa

Background: There is increasing interest in the social determinants of childrens developmental outcomes in developing countries because of the links with schooling, behavioral, and employment outcomes. Yet, little is known about the impact of household and caretaker variables in influencing developmental outcomes in rural, developing country settings. Aim: The study examined the relative impact of individual and household variables and caretaker symptoms of common mental disorders on childrens personal–social, fine and gross motor, and language development. Subjects and methods: A total of 431 children aged 3–24 months in a rural Ethiopian setting were studied. Children underwent a developmental assessment and parents independently provided information on household characteristics and were administered anxiety and depression symptom inventories. Results: In adjusted multivariable models, maternal symptoms of mental disorders were associated with both global development and most developmental sub-scales (p < 0.01) except language developmental; there was no consistent relation between paternal symptoms of mental disorders and child development. Nutritional stunting was generally a risk factor for lower developmental scores but few household-level variables were associated with child development. Conclusion: Child development in this setting is strongly associated with child age and maternal depression. If these findings are replicated elsewhere, they may suggest that interventions aimed at improving maternal depression may have an important role to play in efforts to improve child development and to mitigate the intergenerational transmission of poor health in sub-Saharan Africa.

Back and neck pain and psychopathology in rural sub-Saharan Africa: Evidence from the Gilgel Gibe Growth and Development Study, Ethiopia

Study Design. Community-based cross-sectional analysis of the relation between symptoms of psychopathology and back pain (BP) or neck pain (NP) in rural southwest Ethiopia. Objective. Using data from a community-based sample, we assessed the prevalence and psychopathologic correlates of BP or NP in rural sub-Saharan Africa. Summary of Background Data. BP and NP are among the most prevalent pain conditions. Psychopathology has been shown to be associated with both BP and NP in developed and urban developing contexts. Little is known about the relation between psychopathology and BP or NP in the rural, developing context. Methods. Data on self-reported BP and NP, symptoms of depression, anxiety, and post-traumatic stress (PTS), gender, age, and socioeconomic status were collected from a representative cohort sample (N = 900) in rural southwest Ethiopia. We calculated univariate statistics to assess the prevalence of BP and NP. We used bivariate &khgr;2 tests and multivariate logistic regression models to assess the relation between psychopathology and BP and NP. Results. The prevalence of BP was 16.7%; that of NP was 5.0%. In &khgr;2 analyses, symptoms of depression, anxiety, and PTS were significantly associated with increased risk for each outcome. In models adjusted for age, household assets, and gender, depression symptomatology was associated with increased risk for BP (OR = 3.44, 95% CI: 2.37–5.00) and NP (OR = 4.92, 95% CI: 2.49–9.74). Anxiety symptomatology was also associated with increased risk for BP (OR = 2.88, 95% CI: 1.98–4.20) and NP (OR = 2.67, 95% CI: 1.41–5.09). PTS symptomatology was associated with increased risk for BP (OR = 2.89, 95% CI: 1.78–4.69). Conclusion. In the first known study about the relation between psychopathologic symptomatology and BP and NP in a rural context in a developing country, the prevalence of BP and NP were comparable to published data in developed and developing countries. Symptoms of depression and anxiety were correlates of BP and NP, and symptoms of PTS were a correlate of BP. Comparative studies about the relation between psychopathology and chronic pain conditions between rural and urban contexts in the global south are needed.

Food insecurity, childhood illness and maternal emotional distress in Ethiopia.

OBJECTIVE The relationship between food insecurity, maternal emotional distress and childhood morbidity in resource-poor settings is not well clarified. The present study aimed to assess independent associations between household food insecurity and childhood morbidity and potential modifications by maternal emotional distress. DESIGN A cross-sectional survey. A food security scale was used to assess household food insecurity; maternal reports were used to assess recent childhood illness; and the Hopkins Symptom Checklist was used to assess symptoms of emotional distress among mothers. SETTING The Oromia Region, Ethiopia (rural area). SUBJECTS A total of 936 mother-child pairs. RESULTS Of 936 children assessed, 22·4% had experienced diarrhoea, 20·7% had cough and 21·5% had fever in the 2 weeks preceding the interview. Household food insecurity was reported by 39% of mothers. Greater food insecurity and greater maternal emotional distress were each independently associated with higher prevalence of cough and fever. Among mothers with low emotional distress, food insecurity was associated with a 2·3 times greater odds of diarrhoea in their children. CONCLUSIONS Household food insecurity may increase the risk of childhood illness in rural Ethiopia, and children having mothers with greater emotional distress may be at highest risk. These findings highlight the importance of strengthening policy initiatives aimed at reducing the high prevalence of food insecurity and emotional distress in Ethiopia.

Depressive Symptoms and Posttraumatic Stress Disorder as Determinants of Preference Weights for Attributes of Obstetric Care among Ethiopian Women

Background Mental health, specifically mood/anxiety disorders, may be associated with value for health care attributes, but the association remains unclear. Examining the relation between mental health and attributes in a context where quality of care is low and exposure to suboptimal health conditions is increased, such as in Sub Saharan Africa (SSA), may elucidate the association. Methodology/Principal Findings We assessed whether preference weights for obstetric care attributes varied by mental health among 1006 women from Jimma Zone, Ethiopia, using estimates obtained through a discrete choice experiment (DCE), a method used to elicit preferences. Facilities were described by several attributes including provider attitude and performance and drug/equipment availability. Mental health measures included depressive symptoms and posttraumatic stress disorder (PTSD). We used Bayesian models to estimate preference weights for attributes and linear models to investigate whether these weights were associated with mental health. We found that women with high depressive symptoms valued a positive provider attitude [β = −0.43 (95% CI: −0.66, −0.21)] and drug/equipment availability [β = −0.43 (95% CI: −0.78, −0.07)] less compared to women without high depressive symptoms. Similar results were obtained for PTSD. Upon adjusting for both conditions, value for drug/equipment availability was lower only among women with both conditions [β = −0.89 (95% CI −1.4, −0.42)]. Conclusions/Significance We found that women with psychopathology had lower preference weights for positive provider attitude and drug/equipment availability. Further work investigating why value for obstetric care attributes might vary by psychopathology in SSA is needed.