Suchergebnisse

Developing effective place-based health interventions requires understanding of the dynamic between place and health. The therapeutic landscape framework explains how place-based social processes and physical geography interact and influence health behavior. This study applied this framework to examine how venues, or social gathering places, influenced HIV risk behavior among young, urban men in Tanzania. Eighty-three public venues where men ages 15–19 met new sexual partners were identified by community informants in one city ward. The majority (86%) of the venues were called 'camps', social gathering places that had formal leaders and members. Observations were conducted at 23 camps and in-depth interviews were conducted with 36 camp members and 10 camp leaders in 15 purposively selected camps. Geographic and social features of camps were examined to understand their contributions to men's behaviors. Camps were characterized by a geographic space claimed by members, a unique name and a democratic system of leadership and governance. Members were mostly men and socialized daily at their camp. They reported strong social bonds and engaging in health-promoting activities such as playing sports and generating income. Members also engaged in HIV risk behaviors, such as meeting new sexual partners and having sex in or around the camp at night. Some members promoted concurrent sexual partnerships with their friends and resisted camp leaders' efforts to change their sexual risk behavior.

Background: Assessment of the growing prevalence of depression in developing countries is hampered by a lack of valid diagnostic instruments for the local settings. Aim and method: This study attempted to examine the validity of the 25-item Hopkins Symptom Checklist (HSCL-25) in a special primary care population in Dar es Salaam, Tanzania. Results: 787 antenatal participants were recruited, and their responses revealed good internal consistency, interrater reliability, and test-retest reliability, and the scale was validated using content, construct, and discriminant validation methods. Factor analysis of the depression subscale, however, confirmed the need for a locally developed scale. Conclusions: Integrating universalist and relativist approaches, through the validation and modification of scales, may help in the detection of depression in cross-cultural settings.

Background: Based on experience with the Hopkins Symptom Checklist-25 (HSCL-25) in a Tanzanian population, this study attempted to develop a locally specific screen that employs indigenous expressions.Aim and method: Thirty ethnographically derived local idioms were added and the final 47-item questionnaire administered to 787 randomly selected antenatal clinic attendees.Results: Logistic regression identified 19 items for the Dar-es-Salaam Symptom Questionnaire (DSQ), which demonstrated good internal consistency (Cronbach's α = 0.84), interrater reliability (intraclass r = 0.89), and test-retest reliability (intraclass r = 0.82). Positive endorsement overall increased only slightly, but the report of mild symptoms was more frequent with the DSQ (15.0%) than the HSCL-25 (10.8%). Content and discriminant validation of the local scale conformed to expectation, but depressed affect failed to emerge as an important feature.Conclusion: Locally derived expressions may aid in the reporting of illness and illness severity. Further studies are recommended to uncover universal aspects and culturally specific manifestations of illness expression.Declaration of interest: None to report.

The International Center for Research on Women, the Muhimbili University College of the Health Sciences, the Population Council, and Family Health International conducted an evaluation of a community-based effort to reduce stigma surrounding HIV infections in a peri-urban community in Tanzania. Results presented a mixed, but hopeful, picture for a way forward in tackling stigma at the community level. Tackling stigma requires that the individuals tasked with doing this undergo personal change. Programs can start by focusing stigma-reduction efforts on a smaller, more manageable geographical area and adding specific anti-stigma components to their portfolio of activities. Engaging community opinion leaders (e.g., political, religious, and youth leaders, and healthcare workers) is a promising way forward for scaling up stigma-reduction at the community level.

There is considerable variation in the presentation of mental health problems across cultural contexts. Most screening and assessment tools do not capture local idioms and culturally specific presentations of distress, thus introducing measurement error and overlooking meaningful variation in mental health. Before applying screening and assessment tools in a particular context, a qualitative exploration of locally salient idioms and expression of distress can help assess whether existing measures are appropriate in a specific context as well as what adaptations may improve their construct validity. We aimed to employ a mixed-methods approach to describe and measure cultural concepts of distress among female Congolese survivors of intimate partner violence in Nyarugusu refugee camp, Tanzania. This sequential study used data from 55 qualitative (free-listing and in-depth) interviews followed by 311 quantitative interviews that included assessments of symptoms of common mental disorder to explore whether the symptom constellations were consistent across these methodologies. Results from thematic analysis of qualitative data and exploratory factor analysis of quantitative data converged on three concepts of distress: huzuni (deep sadness), msongo wa mawazo (stress, too many thoughts), and hofu (fear). The psychometric properties of these constructs were comparable to those of the three original common mental disorders measured by the quantitative symptom assessment tools—anxiety, depression, and post-traumatic stress disorder—adding weight to the appropriateness of using these tools in this specific setting. This mixed-methods approach presents an innovative additional method for assessing the local "cultural fit" of globally used tools for measuring mental health in cross-cultural research.