Stephen Lawoko

Distress and hopelessness among parents of children with congenital heart disease, parents of children with other diseases, and parents of healthy children

OBJECTIVE We examined differences in distress (i.e., depression, anxiety, and somatisation) and hopelessness (e.g., suicide ideation) among parents of congenital heart disease (CHD) children (PCCHD, n=1092), parents of children with other diseases (PCOD, n=112), and parents of healthy children (PHC, n=293). In addition, we determined the proportion of parents in each group whose scores in distress and hopelessness, respectively, exceeded norms for psychiatric outpatients (POPN) and depressed people, and identified determinants of distress and hopelessness among all parents, and the PCCHD. METHOD The parents completed a questionnaire about such areas as distress and hopelessness. The design was cross-sectional and data were collected during 20 consecutive days. RESULTS PCCHD were generally at higher risk of distress and hopelessness. A significant number of parents, in particular PCCHD, reported levels of distress and hopelessness within/above POPN and depressed people, respectively. Mothers within all parent groups had higher levels of distress and hopelessness than fathers, with the highest levels among mothers of children with CHD compared to mothers in the other groups. Fathers of children with CHD were doing worse than fathers belonging to the other groups. There were no differences between PCOD and PHC. Variables such as employment status and financial situation explained more of the variation in distress and hopelessness among parents than the diseases of their children. CONCLUSION We corroborated previous findings and provide new insights into the experiences of PCCHD that may be of importance when considering intervention. Further research concerning the parents, in particular PCCHD, at risk of developing psychosocial problems is needed.

The independent contribution of individual-, neighbourhood-, and country-level socioeconomic position on attitudes towards intimate partner violence against women in sub-Saharan Africa: a multilevel model of direct and moderating effects.

We examined associations between country, neighbourhood, and individual socioeconomic position (SEP) and attitudes towards intimate partner violence against women (IPVAW). We applied multivariable multilevel logistic regression analysis on Demographic and Health Survey data for 165,983 women and 68,501 men nested within 7465 communities from 17 countries in sub-Saharan Africa collected between 2003 and 2007. Contrary to expectation women were 34% more likely to justify IPVAW than men. We found that sex moderates associations of individual-, neighbourhood-, and country-level SEP with attitudes towards IPVAW. There was a significant positive interaction effect between sex and education attainment; women with no education were more likely to justify IPVAW than men with no education. Negative sex interaction with household wealth status indicates that differences in attitude are less pronounced among women. Unemployed men were more likely to justify IPVAW. Interaction effects indicate that the association of neighbourhood socioeconomic disadvantage with attitudes was more pronounced among women than among men. The association of country-level SEP with attitudes towards IPVWA was inconclusive. There was some evidence that neighbourhood modified the association between individual SEP and attitudes towards IPV. Also, there was cross-level interaction between country and neighbourhood SEP. Neighbourhood and individual SEP were independently associated with attitudes towards IPVAW. The relationship with country-level SEP was inconclusive. The findings underscore the need to implement public health prevention/intervention strategies not only at the level of individual SEP but also at the neighbourhood level.

Violence towards psychiatric staff: a comparison of gender, job and environmental characteristics in England and Sweden

Workplace violence is receiving increasing attention world-wide, and studies suggest that, for example, nurses and women may be more abused at work than psychiatrists and men. However, there is a lack of cross-cultural data on the topic. Further, relatively few studies have addressed the influence of environmental factors in the occurrence of violence and within a cross-cultural context. The present study compares among other things the nature of violence encountered by female/male staff (nurses and psychiatrists) in Sweden and England. Psychiatric personnel from England (301 nurses; 74 psychiatrists) and Sweden (745 nurses; 306 psychiatrists) were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. nature of violence). The univariate analyses showed an association between being abused and male gender, young age, being British and a nurse, physical and psychological strain. The multivariate logistic regression confirmed that British nurses and male nurses were the main risk group for exposure to violence. Further, the multivariate analysis indicated that the odds of being abused increased with increasing age, physical strain and dissatisfaction with quality of care. Interventions thus need to be sensitive to gender differences, societal context, professional roles and interactions between them. Further, clinical supervision and team functioning, organizational and environmentally friendly settings may help to reduce violence in mental health care.

Intimate partner violence and reproductive health of women in Kenya.

BACKGROUND Reproductive age represents an augmented risk of intimate partner violence (IPV) despite its occurrence in women of all ages. IPV has been associated with various reproductive health outcomes (e.g. terminated pregnancies and infant mortality), although multi-country studies indicate that the findings may not be consistent across all cultures. STUDY AIM AND METHOD: The current work describes the association between IPV and reproductive health of women in Kenya using the Demographic and Health Survey of 2003. RESULTS A significant association between physical/emotional/sexual abuse of women and negative reproductive health outcomes such as terminated pregnancies and infant mortality was identified. In addition, IPV exposure was associated with use of family planning methods and high fertility. CONCLUSION AND RECOMMENDATIONS Practitioners in the healthcare sector should inquire about abuse. Provision of counselling services and information regarding IPV effects on reproductive outcomes as well as referring abused women to relevant institutions is recommended in secondary prevention of IPV and to improve the reproductive health status of abused women.

Predictors of Attitudes Toward Intimate Partner Violence A Comparative Study of Men in Zambia and Kenya

Attitudes toward intimate partner violence (IPV) were compared between Zambian and Kenyan men on sociodemographic, attitudinal, and structural predictors of such attitudes. Data were retrieved from the latest Demographic and Health Surveys in each country. The results showed that many men in Zambia (71%) and Kenya (68%) justified IPV to punish a woman for transgression from normative domestic roles. In priority order, sociodemographic, autonomy, and access-to-information indicators predicted attitudes toward IPV in both countries. Whereas in Kenya, education reduced the likelihood of justifying IPV, the reverse was observed in Zambia. Access to information reduced the likelihood of justifying IPV among men in Zambia but not in Kenya. Mens positive attitudes toward womens autonomy reduced the likelihood of justifying IPV in Kenya but not in Zambia. Differences in specific predictors between the countries demonstrate the significance of capitalizing on need-adapted interventions tailored to fit conditions in each country.

Social inequalities in intimate partner violence: A study of women in Kenya

This study examines social inequalities in intimate partner violence (IPV) among women of reproductive age in Kenya. A sample comprising 3,696 women was retrieved from the Kenyan Demographic and Health Survey of 2003. The study design was cross-sectional. Chi-square tests and logistic regression were used to analyze the data. Results indicated that while high education among women reduced the risk of IPV exposure, both being employed and having a higher education/occupational status than her partner increased a woman’s vulnerability to IPV. Age differences between the partners, illiteracy, and lack of autonomy and access to information increased the likelihood of IPV. Finally, being in polygamous relationships was associated with IPV exposure. The findings indicate demographic, social, and structural differences in exposure to IPV with important implications for interventions.

Sex disparities in attitudes towards intimate partner violence against women in sub-Saharan Africa: a socio-ecological analysis.

BackgroundAttitudes towards intimate partner violence against women (IPVAW) has been suggested as one of the prominent predictor of IPVAW. In this study, we take a step back from individual-level variables and examine relationship between societal-level measures and sex differences in attitudes towards IPVAW.MethodsWe used meta-analytic procedure to synthesize the results of most recent data sets available from Demographic and Health Survey (DHS) of 17 countries in sub-Saharan Africa conducted between 2003 and 2007. Pooled odds ratio (OR) and 95% confidence intervals (CI) were computed for all countries. Test of heterogeneity, sensitivity analysis, and meta-regression were also carried out.ResultsWomen were twice as likely to justify wife beating than men (pooled OR = 1.97; 95% CI 1.53- 2.53) with statistically significant heterogeneity. The magnitude in sex disparities in attitudes towards IPVAW increased with increasing percentage of men practicing polygamy in each country. Furthermore, magnitude in sex disparities in attitudes towards IPVAW decreased monotonically with increasing adult male and female literacy rate, gender development index, gross domestic product and human development index.ConclusionThis meta-analysis has provided evidence that women were more likely to justify IPVAW than men in sub-Saharan Africa. Our results revealed that countrys socio-economic factors may be associated with sex differential in attitudes towards IPVAW.

The nature, extent and determinants of violence against psychiatric personnel

Violence against psychiatric staff seems to be on the increase. Such abuse can lead to mental health consequences for the staff and a reluctance to be closely involved with patients. Few Swedish investigations have examined violence against mental nurses and psychiatrists, or undertaken comparative studies between them. In this study we examined the extent, nature and determinants (i.e. risk factors) of violence against psychiatric nurses (n = 731) and psychiatrists (n = 320) working in the eight health care districts of Stockholm. These caregivers were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. violence and work environment). The majority of the participants (85%) reported having been exposed to violence during their careers, with 57% being victimized in the past 12 months. Physical violence was common, and factors such as negative attitudes to work and diminished sense of autonomy were associated with an increased vulnerability to violence. Nurses and psychiatrists did not differ in violence variables. In spite of the weaknesses of the design (cross-sectional self-selecting sample), this study corroborates previous findings and identifies personal factors associated with violence that have received little attention in the literature (e.g. lack of respect for the organization of care).

Contraception, reproductive health and pregnancy outcomes among women exposed to intimate partner violence in Nigeria

Objectives To examine the association between reproductive health practices/outcomes and exposure to intimate partner violence (IPV) among women in Nigeria. More specifically, the association between IPV and use of contraception; miscarriages,induced abortions, stillbirths, and infant mortality; and having many children, was assessed. Methods Data on studied variables were retrieved from the Demographic and Health Surveys of Nigeria 2008, a nationally representative sample of 33,385 women of reproductive age. IPV was defined as exposure to physical, sexual or emotional abuse. The association between contraception use, pregnancy outcomes and infant mortality, and exposure to IPV was assessed using the chi-square test for unadjusted analyses. To control for potential confounding, socio-demographic variables were adjusted for using multiple logistic regression. Results Compared with women not exposed to IPV, those who were, exhibited a higher likelihood of using modern forms of contraception; having a history of miscarriages, induced abortions, stillbirths, or infant mortality; and having many children. The aforementioned observations still stood after adjustment for potential confounders (e.g., demographic and socioeconomic factors). Conclusion Though causal inference cannot be drawn due to the cross-sectional design, the study has important implications for incorporation of IPV detection and management in initiatives aimed at improving womens reproductive health.

Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis

Background High maternal mortality continues to be a major public health problem in most part of the developing world, including Nigeria. Understanding the utilization pattern of maternal healthcare services has been accepted as an important factor for reducing maternal deaths. This study investigates the effect of neighborhood and individual socioeconomic position on the utilization of different forms of place of delivery among women of reproductive age in Nigeria. Methods A population-based multilevel discrete choice analysis was performed using the most recent population-based 2008 Nigerian Demographic and Health Surveys data of women aged between 15 and 49 years. The analysis was restricted to 15,162 ever-married women from 888 communities across the 36 states of the federation including the Federal Capital Territory of Abuja. Results The choice of place to deliver varies across the socioeconomic strata. The results of the multilevel discrete choice models indicate that with every other factor controlled for, the household wealth status, women’s occupation, women’s and partner’s high level of education attainment, and possession of health insurance were associated with use of private and government health facilities for child birth relative to home delivery. The results also show that higher birth order and young maternal age were associated with use of home delivery. Living in a highly socioeconomic disadvantaged neighborhood is associated with home birth compared with the patronage of government health facilities. More specifically, the result revealed that choice of facility-based delivery is clustered around the neighborhoods. Conclusion Home delivery, which cuts across all socioeconomic strata, is a common practice among women in Nigeria. Initiatives that would encourage the appropriate use of healthcare facilities at little or no cost to the most disadvantaged should be accorded the utmost priority.