Trends in suicide, parasuicide and accidental poisoning in Children in Addis Ababa, Ethiopia

Abstract: Due to lack of compiled data on suicide, parasuicide and accidental poisoning (AP) in under-fifteens in Addis Ababa, Ethiopia, it was essential to prepare and analyze these basic data. By using estimated mid-year population for 0-4 and 5-14 years age groups and fiscal year morbidity and mortality data reports, age and sex-specific suicide, parasuicide, and AP rates (per 100,000) are, calculated for 1981/82-1995/96. No suicide deaths or ‘undetermined’ deaths were reported in underfifteens, but 12 deaths were recorded in the two pediatrics hospitals of Addis Ababa following admissions for AP. Out of 479 reported parasuicide cases, 402(83.9%) were in the age group of 514 years and the average parasuicide rate for the same age group was 6.74 and 5.32 for boys and girls, respectively. The trends of the reported parasuicide rates showed small peaks initially in 1981/82 in both age groups, but after 1990/91 only the age group of 5-14 showed peaks. Out of 939 cases of AP,533 (56.8%) were in the age group of 0-4 years and the rest in the age group of 5-14. Males in the age group of 0-4 have the highest AP rate (19.91%) followed by females (12.60%) of the same age group. Possible reasons for changes in trends and preventive measure are discussed. [Ethiop. J. Health Dev. 1999;13(3):263-269

Morbid grief III: The influence of variables on the degree of grief reaction, depression and anxiety among close relatives of the "red-terror" victims

Abstract: To analyze some of the variables of the bereaved and of the victims that could significantly influence the degree of grief reaction, depression and anxiety, 91 randomly selected close relatives of victims of the ‘red-terror’ have completed the ETIG (Expanded Texas Inventory of Grief), BDI (Beck Depression Inventory), and SAI (State Anxiety Inventory) 18 years after the loss. All these questionnaires are self-rating, Amharic-translated and with acceptable face validity, but they are not yet concurrently validated with their corresponding English versions. The results have shown that the older age group (60-79 yrs) had a mean score of (131.63) on ETIG which is significantly higher (P<0.05) than that (118.56) of the youngest age group (20-39 yrs). The widows/ers had the highest mean score (139.95) on ETIG which is significantly higher (P<0.01 and P<0.001) than those of married (124.83) and singles (117.61), respectively. They were also found to have a mean score of 56.62 on SAI which is significantly higher (P<0.05) than that of singles (47.70) only. Parents who lost son(s) had a mean score of 132.26 on ETIG which is significantly higher (P<0.01) than those who lost brother(s) (118.93). Among the variables of the victims, where the dead body was given to relatives for funeral services, the mean score on the ETIG was 109.2 and this was found to be significantly lower (P<0.02 and P<0.001) than where the dead body was left on the street and not given to relatives (127.89) or where the dead body was neither left on the street nor given to relatives (129), respectively. It was recommended that the older age group, widows/ers, parents who lost son(s) and those who could not confirm the death of the victim by seeing the dead body, should get priority for counselling. [Ethiop. J. Health Dev. 1997;11(3):257-261

Morbid grief I: Are close relatives of the "redterror" victims of Addis Ababa still suffering from a morbid grief and other complications of bereavement?

Abstract: To assess whether close relatives of the "red-terror" victims of the Ethiopian revolution of late 1970's are still suffering from a morbid grief and other complications of bereavement, a study was carried out in Addis Ababa, Ethiopia, between February and May 1995. Ninety one close relatives (sample I ) have rated themselves with the Texas Inventory of Grief 18 years after bereavement and 89(97.8%) of them were found to have a profound grief reaction. Compared to 87 non-bereaving control group (sample II), they have scored significantly higher (P <0.001) on the General Health Questionnaire-30 items version (GHQ-30), Beck Depression Inventory (BDI) and State Anxiety Inventory (SAI). The correlation (r=+0.843, P<0.001) between the brief (BTIG) and the expanded (ETIG) forms of Texas Inventory of Grief has indicated that the two forms are equally reliable and useful in measuring grief reaction. All the rating scales are self-rating, Amharic translated with acceptable face validity, but they are not yet concurrently validated with their corresponding English versions. BTIG was recommended as a useful paper-and-pencil screening instrument with an arbitrary cut-off point of 16.24 (i.e. - 1.96 Z- score) for this particular group and it was suggested that respondents scoring 16.24 and above which amounts to 89(97.8%) be considered as probable cases of morbid grief and as candidates for bereavement counselling. [Ethiop. J. Health Dev. 1997;11(3):241-249

Morbid grief II: The phenomenology of pathologic grief process, depression and anxiety among close relatives of ‘red-terror’ victims

Abstract: To study the phenomenology of morbid grief and it's association to general distress, depression and anxiety, 91 randomly selected close relatives of the ‘red-terror’ victims completed four sets of questionnaires. All the questionnaires are self-rating, Amharic translated and with acceptable face validity, but not yet concurrently validated with their corresponding English versions. The percentage of positive endorsement and the mean score of each of the 34-items of ETIG (Expanded Texas Inventory of Grief) has ranged from 85.7% to 100% and from 1.71 to 4.81 respectively, indicating high degree of morbid grief. Items indicating ‘good outcome’ were found to show the opposite, i.e. ‘bad outcome’ even 18 years after the bereavement. The syndromes that belong to the complications of grief reaction are vivid and circumscribed. The magnitudes of endorsement and the mean scores of some of the items appear to be characteristic of the nature and circumstances of the loss and appropriate interpretation is necessary. The correlations between BTIG mean scores and the mean scores of GHQ-30 (General Health Questionnaire-30 item version), BDI (Beck Depression Inventory), and SAI (State Anxiety Inventory) were found to be weak, but significant. The GHQ-30, the BDI, and the SAI mean scores were found to have moderate to strong positive correlation coefficient to one another indicating common linkage they have to the pathologic grief reaction. [Ethiop. J. Health Dev. 1997;11(3):251-256

The effect of maternal common mental disorders on infant undernutrition in Butajira, Ethiopia: The P-MaMiE study

BACKGROUND: Although maternal common mental disorder (CMD) appears to be a risk factor for infant undernutrition in South Asian countries, the position in sub-Saharan Africa (SSA) is unclear METHODS: A population-based cohort of 1065 women, in the third trimester of pregnancy, was identified from the demographic surveillance site (DSS) in Butajira, to investigate the effect of maternal CMD on infant undernutrition in a predominantly rural Ethiopian population. Participants were interviewed at recruitment and at two months post-partum. Maternal CMD was measured using the locally validated Self-Reported Questionnaire (score of > or = six indicating high levels of CMD). Infant anthropometry was recorded at six and twelve months of age. RESULT: The prevalence of CMD was 12% during pregnancy and 5% at the two month postnatal time-point. In bivariate analysis antenatal CMD which had resolved after delivery predicted underweight at twelve months (OR = 1.71; 95% CI: 1.05, 2.50). There were no other statistically significant differences in the prevalence of underweight or stunted infants in mothers with high levels of CMD compared to those with low levels. The associations between CMD and infant nutritional status were not significant after adjusting for pre-specified potential confounders. CONCLUSION: Our negative finding adds to the inconsistent picture emerging from SSA. The association between CMD and infant undernutrition might be modified by study methodology as well as degree of shared parenting among family members, making it difficult to extrapolate across low- and middle-income countries

Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale.

BACKGROUND: The cultural validity of instruments to detect perinatal common mental disorders (CMD) in rural, community settings has been little-investigated in developing countries. METHODS: Semantic, content, technical, criterion and construct validity of the Edinburgh Postnatal Depression Scale (EPDS) and Self-Reporting Questionnaire (SRQ) were evaluated in perinatal women in rural Ethiopia. Gold-standard measure of CMD was psychiatric assessment using the Comprehensive Psychopathological Rating Scale (CPRS). Community-based, convenience sampling was used. An initial validation study (n=101) evaluated both EPDS and SRQ. Subsequent validation was of SRQ alone (n=119). RESULTS: EPDS exhibited poor validity; area under the receiver operating characteristic (AUROC) curve of 0.62 (95%CI 0.49 to 0.76). SRQ-20 showed better validity as a dimensional scale, with AUROC of 0.82 (95%CI 0.68 to 0.96) and 0.70 (95%CI 0.57 to 0.83) in the two studies. The utility of SRQ in detecting 'cases' of CMD was not established, with differing estimates of optimal cut-off score: three and above in Study 1 (sensitivity 85.7%, specificity 75.6%); seven and above in Study 2 (sensitivity 68.4%, specificity 62%). High convergent validity of SRQ as a dimensional measure was demonstrated in a community survey of 1065 pregnant women. LIMITATIONS: Estimation of optimal cut-off scores and validity coefficients for detecting CMD was limited by sample size. CONCLUSIONS: EPDS demonstrated limited clinical utility as a screen for perinatal CMD in this rural, low-income setting. The SRQ-20 was superior to EPDS across all domains for evaluating cultural equivalence and showed validity as a dimensional measure of perinatal CMD

Sociocultural practices in Ethiopia: association with onset and persistence of postnatal common mental disorders

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