Emmanuel Rudatsikira

Intimate partner violence among pregnant women in Rwanda

BackgroundIntimate partner violence (IPV), defined as actual or threatened physical, sexual, psychological, and emotional abuse by current or former partners is a global public health concern. The prevalence and determinants of intimate partner violence (IPV) against pregnant women has not been described in Rwanda. A study was conducted to identify variables associated with IPV among Rwandan pregnant women.MethodsA convenient sample of 600 pregnant women attending antenatal clinics were administered a questionnaire which included items on demographics, HIV status, IPV, and alcohol use by the male partner. Mean age and proportions of IPV in different groups were assessed. Odds of IPV were estimated using logistic regression analysis.ResultsOf the 600 respondents, 35.1% reported IPV in the last 12 months. HIV+ pregnant women had higher rates of all forms of IVP violence than HIV- pregnant women: pulling hair (44.3% vs. 20.3%), slapping (32.0% vs. 15.3%), kicking with fists (36.3% vs. 19.7%), throwing to the ground and kicking with feet (23.3% vs. 12.7%), and burning with hot liquid (4.1% vs. 3.5%). HIV positive participants were more than twice likely to report physical IPV than those who were HIV negative (OR = 2.38; 95% CI [1.59, 3.57]). Other factors positively associated with physical IPV included sexual abuse before the age of 14 years (OR = 2.69; 95% CI [1.69, 4.29]), having an alcohol drinking male partner (OR = 4.10; 95% CI [2.48, 6.77] for occasional drinkers and OR = 3.37; 95% CI [2.05, 5.54] for heavy drinkers), and having a male partner with other sexual partners (OR = 1.53; 95% CI [1.15, 2.20]. Education was negatively associated with lifetime IPV.ConclusionWe have reported on prevalence of IPV violence among pregnant women attending antenatal care in Rwanda, Central Africa. We advocate that screening for IPV be an integral part of HIV and AIDS care, as well as routine antenatal care. Services for battered women should also be made available.

Prevalence and determinants of adolescent tobacco smoking in Addis Ababa, Ethiopia.

BackgroundTobacco smoking is a growing public health problem in the developing world. There is paucity of data on smoking and predictors of smoking among school-going adolescents in most of sub-Saharan Africa. Hence, the aim of this study is to estimate the prevalence of smoking and its associations among school-going adolescents in Addis Ababa, Ethiopia.MethodsData from the Global Youth Tobacco Survey (GYTS) 2003 were used to determine smoking prevalence, determinants, attitudes to, and exposure to tobacco advertisements among adolescents.ResultsOf the 1868 respondents, 4.5% males and 1% females reported being current smokers (p < 0.01). Having smoking friends was strongly associated with smoking after controlling for age, gender, parental smoking status, and perception of risks of smoking (OR = 33; 95% CI [11.6, 95.6]). Male gender and having one or both smoking parents were associated with smoking. Perception that smoking is harmful was negatively associated with being a smoker (odds ratio 0.3; 95% confidence interval, 0.2–0.5)ConclusionPrevalence of smoking among adolescents in Ethiopia is lower than in many other African countries. There is however need to strengthen anti-tobacco messages especially among adolescents.

Prevalence and associated factors of physical fighting among school-going adolescents in Namibia.

BackgroundInterpersonal physical violence is an important global public health concern that has received limited attention in the developing world. There is in particular a paucity of data regarding physical violence and its socio-demographic correlates among in-school adolescents in Namibia.MethodsWe analysed cross-sectional data from the Namibia Global School-Based Health Survey (GSHS) conducted in 2004. We aimed to estimate the prevalence and socio-demographic correlates of physical fighting within the last 12 months. We obtained frequencies of socio-demographic attributes. We also assessed the association between self-reported history of having engaging in a physical fight and a selected list of independent variables using logistic regression analysis.ResultsOf the 6283 respondents, 50.6% (55.2% males and 46.2% females) reported having been in a physical fight in the past 12 months. Males were more likely to have been in a physical fight than females (OR = 1.71, 95% CI (1.44, 2.05)). Smoking, drinking alcohol, using drugs and bullying victimization were positively associated with fighting (OR = 1.91, 95% CI (1.49, 2.45); OR = 1.48, 95% CI (1.21, 1.81); OR = 1.55, 95% CI (1.22, 1.81); and OR = 3.12, 95% CI (2.62, 3.72), respectively). Parental supervision was negatively associated with physical fighting (OR = 0.82, 95% CI (0.69, 0.98)). Both male and female substance users (cigarette smoking, alcohol and drug use) were more likely to engage in physical fighting than non-substance users (OR = 3.53, 95% CI (2.60, 4.81) for males and OR = 11.01, 95% CI (7.25, 16.73) for females). Parental supervision was negatively associated with physical fighting (OR = 0.85, 95% CI (0.72, 0.99)).ConclusionPrevalence of physical fighting within the last 12 months was comparable to estimates obtained in European countries. We also found clustering of problem behaviours or experiences among adolescents who reported having engaged in physical violence in the past 12 months. There is a need to bring adolescent violent behaviour to the fore of the public health agenda in Namibia.

Variables associated with physical fighting among US high-school students

BackgroundViolence among adolescents is an important public health problem in the United States. This study was conducted to estimate the prevalence of having been engaged in physical fighting on school property and associated factors of the behavior among school-going adolescents in the United States.MethodsThis study was based on secondary analysis of the United States Youth Risk Behavior Survey (YRBS) conducted in 2005. The sampling frame included all private and public school in the country, stratified by region and urbanicity based on the US census bureau data. Frequencies and proportions were obtained for the outcome and explanatory variables. Logistic regression analysis was used to estimate the level of association between explanatory variables and the outcome (having been involved in a physical fight).ResultsOf the 13,857 respondents, 13.5% (18.2% for males and 8.8% for females) reported physical fighting onschool property in the last 12 months to the survey. Males were more likely to have been in a physical fight than females (OR = 2.23; 95% CI [1.89, 2.63]). Respondents aged 17 years or older were less likely to report physical fighting than those who were 14 years or younger. Compared to Whites, American Indians or Alaska Natives, Blacks, Native Hawaii or other Pacific Islanders, and Hispanics were more likely to report physical fighting on school property (OR = 2.11; 95% CI [1.22, 3.66], OR = 1.72; 95% CI [1.42, 2.0], OR = 2.18; 95% CI [1.01, 4.79], and OR = 1.74; 95% CI [1.41, 2.16] respectively). Physical fighting on school property was also positively associated with cigarette smoking (OR = 1.70; 95% CI [1.37, 2.10]), drinking alcohol (OR = 1.45; 95% CI [1.20, 1.76]), use of illegal drugs (OR = 1.73; 95% CI [1.42, 2.12]), having had property stolen or deliberately damaged on school property (OR = 2.06; 95% CI [1.74, 2.44]), having been threatened or injured with a weapon on school property (OR = 2.63; 95% CI [2.06, 3.34]), and playing videogame three or more hours a day (OR = 1.29; 95% CI [1.07, 1.56]).ConclusionThese findings suggest that physical fighting among US High School students is widespread and positively associated with victimization (having been threatened or injured with a weapon on school property) and other risky behaviors such as smoking, alcohol and drugs use. Intervention programs to prevent/control those risky behaviors as well as further attention on the association between physical fighting and victimization at school through longitudinal research are warranted.

Harmful lifestyles' clustering among sexually active in-school adolescents in Zambia

BackgroundHIV is a leading cause of morbidity and mortality in Zambia. Like many other African nations with high HIV burden, heterosexual intercourse is the commonest mode of HIV spread. The estimation of prevalence and factors associated with sexual intercourse among in-school adolescents has potential to inform public health interventions aimed at reducing the burden of sex-related diseases in Zambia.MethodsWe carried out secondary analysis of the Zambia Global School-Based Health Survey (GSHS) 2004; a cross sectional survey that aims to study health-related behaviors among in-school adolescents. We estimated frequencies of relevant socio-demographic variables. The associations between selected explanatory variables and self-reported history of sexual intercourse within the last 12 months were assessed using logistic regression analysis.ResultsData from 2136 in-school adolescents who participated in the Zambia Global School-Based Health Survey of 2004 were available for analysis. Out of these respondents, 13.4% reported that they had sexual intercourse in the past 12 months prior to the survey; 16.4% and 9.7% among males and females respectively. In multivariable logistic regression analysis, with age less than 15 years as the referent the adjusted odds ratio (AOR) of having engaged in sexual intercourse in adolescents of age 15 years, and those aged 16 years or more were 1.06 (95% CI 1.03–1.10) and 1.74 (95% 1.70–1.79) respectively. Compared to adolescents who had no close friends, adolescents who had one close friend were more likely to have had sexual intercourse, AOR = 1.28 (95% CI 1.24–1.32). Compared to adolescents who were not supervised by their parents, adolescents who were rarely or sometimes supervised by their parents were likely to have had sexual intercourse, and adolescents who were most of the time/always supervised by their parents were less likely to have had sexual intercourse; AORs 1.26 (95% CI 1.23–1.26) and 0.92 (95% CI 0.90–0.95) respectively. Compared to adolescents who did not smoke dagga, adolescents who smoked dagga 1 or 2 times, and those who smoked dagga 3 or more times in their lifetime were 70% and 25% more likely to have had sexual intercourse, respectively. Adolescents who drank alcohol in 1 or 2 days, and those who took alcohol in 3 or more days in a month preceding the survey were 12% and 9% more likely to have had sexual intercourse, respectively, compared to adolescents who did not drink alcohol in the 30 days prior to the survey. Furthermore, adolescents who had been drunk 1 or 2 times, and who had been drunk 3 or more times in a life time were 14% and 13% more likely to have had sexual intercourse compared to those who have never been drunk in their lifetime.ConclusionWe identified a constellation of potentially harmful behaviours among adolescents in Zambia. Public health interventions aimed at reducing prevalence of sexual intercourse may be designed and implemented in a broader sense having recognized that sexually active adolescents may also be exposed to other problem behaviours.

Mentoring Cambodian and Lao health professionals in tobacco control leadership and research skills

Design: The aim of the programme was to ultimately affect public health practice and policy in the Kingdom of Cambodia and Lao People’s Democratic Republic (Lao PDR) by training key health professionals to conduct tobacco control research. Setting: Encouraged by the World Health Organization’s Framework Convention on Tobacco Control, a global partnership formed to build effective leadership to develop and guide national tobacco control agendas. The partners were the Ministries of Health (Cambodia and Lao PDR), non-government organisations (Adventist Development and Relief Agency in Cambodia and Laos) and an academic institution (Loma Linda University, Loma Linda, California, USA). Subjects: 16 health professionals, 10 from Cambodia and 6 from Lao PDR, were selected by local advisory committees to enter a two-year, intensive tobacco research graduate certificate and research training programme. Intervention: We developed a “Global Tobacco Control Methods” (GTCM) 28 unit certificate programme that was offered in five sessions from September 2003 to September 2005 at the National Institute of Public Health, Phnom Penh, Cambodia. As part of their coursework, the 16 trainees actively participated in the development and implementation of two research projects. In the first project, “Healthy Doc Healthy Patient” (HDHP), trainees adapted an existing, self-administered questionnaire designed to assess health practices and beliefs of medical students in Cambodia and Lao PDR. The second project involved the design of a national prevalence of tobacco use and health beliefs study in Cambodia using a multi-stage, cluster sample method. Trainees were sponsored to attend and present at international tobacco control conferences to enhance their awareness of the tobacco epidemic. Results: As of September 2005, 14 trainees (8 from Cambodia and 6 from Lao PDR) completed the courses in the GTCM certificate programme. The HDHP study sampled four medical school classes (years 3, 4, 5 and 6) in both Cambodia (n  =  330, 71.1% response rate) and Lao PDR (n  =  386, 87.3% response rate). As part of the Cambodian adult tobacco prevalence study in Cambodia, 13 988 adults (ages ⩾ 18 years) were interviewed from all 22 provinces during the summer of 2005. Over the two years, more than half of the trainees participated substantially in local and regional tobacco control and research activities. Programme challenges included the trainees’ limited English language and computer proficiency skills, both of which improved during the two years. Conclusions: With the successful completion of the certificate programme, the remaining two years of the grant will be used to prepare the trainees for positions of leadership within their Ministries of Health and other agencies to implement effective tobacco control policies based on locally-derived research findings.

Suicidal ideation and associated factors among school-going adolescents in rural Uganda

BackgroundMental health is a neglected area of health research and practice in most of sub-Saharan African countries where the largest burden of morbidity is from infectious diseases. This even occurs despite the fact that some mental health problems may arise from infectious diseases.MethodsWe conducted secondary analysis of the Uganda Global School-Based Health Survey-2003 to obtain the prevalence of, and assess factors that may be associated with suicidal ideation among school-going adolescents in rural Uganda. Assessment of association was conducted through both bi-variate and multivariate logistic regression analysis.ResultsAltogether 21.6% of the study participants, 21.3% males and 23.5% females had seriously considered committing suicide within the past 12 months. Loneliness, worry were positively associated with suicide ideation after adjusting for age, gender, smoking, drinking, and experience of having been bullied (OR = 1.59; 95% CI [1.12, 2.26] and OR = 1.19; 95% CI [1.12, 2.25]) respectively. Males were less likely to seriously consider committing suicide than females (OR = 0.70; 95% CI [0.50, 0.98]).ConclusionAdolescent suicidal ideation is a major public health issue in rural Uganda. Measures aimed to prevent adolescent suicides in Uganda should incorporate our understanding of factors that are associated with suicide in rural Uganda such the gender disparity and the association observed with substance use.

Prevalence and correlates of being bullied among in-school adolescents in Beijing: results from the 2003 Beijing Global School-Based Health Survey

BackgroundBullying has public health importance. It has been reported that both the victims and perpetrators of bullying are more likely to have suicidal ideation and other suicidal behaviours. Moreover, bullying can be a precursor for school violence and can contribute to poor academic performance. The purpose of the study was to raise awareness on the subject in China. We, therefore conducted an analysis of secondary data to determine the prevalence and correlates of having been bullied among in-school adolescents.MethodsThe data was taken from the Beijing Global School-Based Health Survey conducted in 2003. A weighted analysis to reduce bias due to differing patterns of non-response was conducted using statistical software (SPSS version 14.0). We conducted a backward logistic regression analysis to determine independent predictors for being bullied.ResultsOut of a total of 2,348 in-school adolescents who participated in the survey, 20% (23% males, and 17% females) reported having been bullied. Risk factors for having been bullied were loneliness (adjusted odds ratio (AOR) = 1.44; 95% confidence interval (CI) 1.42–1.45), being worried (AOR = 1.30; 95% CI 1.29–1.32), being sad or having feelings of hopelessness (AOR = 1.21; 95% CI 1.19–1.22), smoking cigarettes (AOR = 1.09; 95% CI 1.08–1.11), drinking alcohol (AOR = 1.31; 95% CI 1.29–1.32), and being truant (AOR = 1.24; 95% CI 1.22–1.27). Meanwhile protective factors were having close friends (AOR = 0.84; 95% CI 0.83–0.86), receiving parental supervision (AOR = 0.80; 95% CI 0.80–0.81), and ever been drunk (AOR = 0.86; 95% CI 0.84–0.87).ConclusionWe believe the results of this study will raise awareness among school health practitioners and administrators, paediatric psychiatrists and psychologists on the prevalence and correlates of bullying among adolescents in Beijing, China.

Human resources requirements for highly active antiretroviral therapy scale-up in Malawi

BackgroundTwelve percent of the adult population in Malawi is estimated to be HIV infected. About 15% to 20% of these are in need of life saving antiretroviral therapy. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and distribution of health professionals.MethodsWe obtained data on the total number of patients on highly active antiretroviral treatment program from the Malawi National AIDS Commission and Ministry of Health, HIV Unit, and the number of registered health professionals from the relevant regulatory bodies. We also estimated number of health professionals required to deliver highly active antiretroviral therapy (HAART) using estimates of human resources from the literature. We also obtained data from the Ministry of Health on the actual number of nurses, clinical officers and medical doctors providing services in HAART clinics. We then made comparisons between the human resources situation on the ground and the theoretical estimates based on explicit assumptions.ResultsThere were 610 clinicians (396 clinical officers and 214 physicians), 44 pharmacists and 98 pharmacy technicians and 7264 nurses registered in Malawi. At the end of March 2007 there were 85 clinical officer and physician full-time equivalents (FTEs) and 91 nurse FTEs providing HAART to 95,674 patients. The human resources used for the delivery of HAART comprised 13.9% of all clinical officers and physicians and 1.1% of all nurses. Using the estimated numbers of health professionals from the literature required 15.7–31.4% of all physicians and clinical officers, 66.5–199.3% of all pharmacists and pharmacy technicians and 2.6 to 9.2% of all the available nurses. To provide HAART to all the 170,000 HIV infected persons estimated as clinically eligible would require 4.7% to 16.4% of the total number of nurses, 118.1% to 354.2% of all the available pharmacists and pharmacy technicians and 27.9% to 55.7% of all clinical officers and physicians. The actual number of health professionals working in the delivery of HAART in the clinics represented 44% to 88.8% (for clinical officers and medical doctors) and 13.6% and 47.6% (for nurses), of what would have been needed based on the literature estimation.ConclusionHAART provision is a labour intensive exercise. Although these data are insufficient to determine whether HAART scale-up has resulted in the weakening or strengthening of the health systems in Malawi, the human resources requirements for HAART scale-up are significant. Malawi is using far less human resources than would be estimated based on the literature from other settings. The impact of HAART scale-up on the overall delivery of health services should be assessed.

Prevalence and associated factors of suicidal ideation among school-going adolescents in Guyana: results from a cross sectional study

BackgroundAdolescent suicidal behaviour is a neglected public health issue especially in middle- and low-income countries. Informed policy decision-making on suicidal behaviour will need reliable information on the prevalence and correlates of suicidal ideation which is a determinant of suicidal behaviour.MethodsWe estimated the prevalence and associated factors of suicidal ideation among school-going adolescents using data from the Global School-Based Health Survey conducted in 2004 in Guyana.ResultsOf the 1197 respondents, 18.4% (14.9% males and 21.6% females)reported having seriously considered committing suicide in the last12 months. Males were less likely to seriously consider committingsuicide than females (OR = 0.45; 95% CI [0.30, 0.67]). Subjects whoreported having been bullied were more than twice as likely tocontemplate committing suicide as those who had not been bullied (OR = 2.46 [1.71, 3.54]). History of depression was positivelyassociated with suicidal ideation (OR = 2.67; 95% [1.87, 3.81] whilehaving close friends and understanding parents were negativelyassociated with suicide ideation (OR = 0.51; 95% CI [0.28, 0.94] and OR = 0.51; 95% CI [0.35, 0.76] respectively).ConclusionSuicidal ideation is a significant public health issue among in-school adolescents in Guyana that requires attention. The design, implementation and evaluation of suicidal behaviour interventions should incorporate our knowledge of these associated factors.