Subjective wellbeing in a sample of South African, Xhosa people with schizophrenia

Subjective well-being when on neuroleptic treatment (SWBN), has been established as a good predictor of adherence, early response and prognosis in patients with schizophrenia(1, 2). The 20-item subjective well-being under neuroleptic treatment scale (SWN-K 20) is a self-rating scale that has been validated to measure SWBN(3). However, the SWN-K20 has not been previously used in a Low- and Middle-income country (LMIC). Aims and Objectives: This study explored the psychometric properties of SWN-K20 in a sample of Xhosa speaking African patients with schizophrenia, and investigated factors associated with SWBN in this population. Methods: As a part of a large genetic study, 244 study participants with a confirmed diagnosis of schizophrenia completed the translated SWN-K 20 scale. Internal consistency analysis was performed, and convergent analysis and exploratory analysis were conducted using Principal Component Analysis (PCA).Varimax rotation method was selected as we did not assume any correlation of the factors(4). Linear regression methods were used to determine predictors of SWBN in the sample population. Results: The PCA extracted 4 components which cumulatively explained 52.21% of the total variance. The internal consistency of the SWN-K 20 was 0.86 and those of the sub-scales ranged between 0.47 and 0.59. The total scores of the SWN-K 20 demonstrated moderate correlation r= 0.44 with GAF scores. The sub-scale scores had lower correlations ranging between r=.41 and r=.30 with the GAF scores. The total scores on SWN-K20 scale were used to explore factors influencing SWBN. There was a significant correlation between overall subjective well-being score with higher education level, increased illness severity and GAF scores. Discussion and Conclusion: The isiXhosa version of the SWN-20 scale can be used for clinical and research purposes in LMICs but predictors of SWBN in this population differed from those previously established in (high income countries) HICs. The individual sub-scales of the SWN-K20 were less reliable when translated into isiXhosa and hence the subs-scales were not a meaningful measure of specific domains of wellbeing . These findings merit evaluation to determine whether cultural and linguistic specific sub-cales might provide further insight and recommendations for use in South African context. Predictors of SWBN in this LMICs population were not comparable to those in HICs setting(5, 6). Older patients with lower baseline level of education, poor global functioning and less severe symptoms were noted to have lower SWBN and hence at risk of poor compliance. This information could provide guidance for clinicians, researchers and interventions that aim at improving compliance and the treatment experiences of this patient group

Adolescent mental health research in Tanzania: a study protocol for a priority setting exercise and the development of an interinstitutional capacity strengthening programme

INTRODUCTION: Poor adolescent mental health is a barrier to achieving several sustainable development goals in Tanzania, where adolescent mental health infrastructure is weak. This is compounded by a lack of community and policy maker awareness or understanding of its burden, causes and solutions. Research addressing these knowledge gaps is urgently needed. However, capacity for adolescent mental health research in Tanzania remains limited. The existence of a National Institute for Medical Research (NIMR), with a nationwide mandate for research conduct and oversight, presents an opportunity to catalyse activity in this neglected area. Rigorous research priority setting, which includes key stakeholders, can promote efficient use of limited resources and improve both quality and uptake of research by ensuring that it meets the needs of target populations and policy makers. We present a protocol for such a research priority setting study and how it informs the design of an interinstitutional adolescent mental health research capacity strengthening strategy in Tanzania. METHODS AND ANALYSIS: From May 2021, this 6 month mixed-methods study will adapt and merge the James Lind Alliance approach and validated capacity strengthening methodologies to identify priorities for research and research capacity strengthening in adolescent mental health in Tanzania. Specifically, it will use online questionnaires, face-to-face interviews, focus groups, scoping reviews and a consensus meeting to consult expert and adolescent stakeholders. Key evidence-informed priorities will be collaboratively ranked and documented and an integrated strategy to address capacity gaps will be designed to align with the nationwide infrastructure and overall strategy of NIMR. ETHICS AND DISSEMINATION: National and institutional review board approvals were sought and granted from the National Health Research Ethics Committee of the NIMR Medical Research Coordinating Committee (Tanzania) and the Liverpool School of Tropical Medicine (United Kingdom). Results will be disseminated through a national workshop involving all stakeholders, through ongoing collaborations and published commentaries, reviews, policy briefs, webinars and social media

Eggs: clearing the charges, exploring the potential!

Of all the various kinds of foods, an egg is special for its combination of all essential food nutrients in one item. However for much of the past 40 years, the public has been warned away from eggs because of concerns that they increase the risk of coronary heart disease and stroke and a claim that they raise the blood pressure by causing vasoconstriction. In Tanzania, up to date there are some cultures that forbid women in general or pregnant women in particular from eating eggs due to a belief that they will get bald babies or have problems during delivery. Several studies over the years have examined egg intake and its relationship with coronary outcome. When dietary confounders were considered, no association was seen between egg consumption and the risk of coronary heart disease in non-diabetic men and women. Recent researches have not only linked eggs with biological functions beyond basic nutrition but to a huge potential in the medical field. Eggs are now linked to fetal brain development and boosting of the immune system thus consequently lowering the risk of getting breast cancer, colon and lung cancer. For already developed cancer, eggs show potential for the development of promising anticancer drugs through the production of Monoclonal antibodies. They are also proven to prevent cataract and macular degeneration and protect against heart attacks and strokes by preventing arteriosclerosis and facilitating fat metabolism. Moreover researchers now not only prove eggs do not increase your blood cholesterol, but also link eggs to lowering high blood pressure by acting like an antihypertensive through an ACEI like inhibiting mechanism. Components in eggs were also found to be active as anti-adhesives, microbiocidals and as chelators in metal poisoning. Good news to egg lovers again

A group-based mental health intervention for Tanzanian youth living with HIV: Secondary analysis of a pilot trial.

BACKGROUND: Youth living with human immunodeficiency virus (YLWH) are vulnerable to incomplete adherence to antiretroviral therapy in the context of stigma, decreased hope for future, and mental health challenges. Despite these challenges, few mental health interventions have been developed to support YLWH. Previous randomized results from the Sauti ya Vijana (SYV; The Voice of Youth) mental health intervention were indicative of the interventions benefits in promoting virologic suppression. METHODS: SYV is a group-based mental health and life skills intervention (pilot, individually randomized group treatment trial) developed alongside YLWH. SYV was comprised of 10, 90-minute sessions based on evidence-based treatment models designed to improve coping, social support, and hope for future as a pathway to improved adherence and virologic suppression. At baseline, YLWH 12 to 24 years of age were randomized to SYV or standard of care. Participants included in this secondary analysis were enrolled in SYVs crossover waves due to either being randomized to standard of care or inability to attend an earlier group, and therefore delayed intervention exposure. Measured outcomes included self-reported mental health measures, self-reported human immunodeficiency virus measures (stigma and adherence), and human immunodeficiency virus ribonucleic acid. Data was collected at baseline, preintervention, and postintervention timepoints. Participants were included if they attended a crossover wave and had data at all 3 timepoints. RESULTS: Twenty-one crossover participants met inclusion criteria. Mean scores of self-reported mental health questionnaires were in an asymptomatic range both pre- and postintervention. Viral suppression was N = 15 (71%) preintervention compared to N = 17 (81%) postintervention. The participants who became virologically suppressed had no change in antiretroviral therapy. CONCLUSIONS: Despite the small sample size, findings from this study demonstrate that mental wellbeing may be an important pathway to improved HIV outcomes for YLWH. The same trend toward virologic suppression pre- to postintervention was demonstrated in the randomized pilot trial and suggests that SYV holds promise to improve HIV outcomes. Data from this analysis support the fully powered trial that is now underway

"When a man drinks alcohol it's cool but when a woman drinks she is a hoe": A qualitative exploration of alcohol, gender, stigma, and sexual assault in Moshi, Tanzania.

Alcohol's ever-increasing global use poses a distinct threat to human well-being, with intake and associated burdens rising especially quickly in low- and middle-income countries like Tanzania. Prior research has shown alcohol use and related consequences differ by gender in Moshi, Tanzania, with important implications for both clinical care and future alcohol-reduction interventions. This study builds upon this knowledge by providing a deeper understanding of how gender differences affect alcohol-related stigma and sexual assault among Emergency Department (ED) and Reproductive Health Center (RHC) patients at Kilimanjaro Christian Medical Center (KCMC) in Moshi. In-depth interviews were conducted among ED and RHC KCMC patients (n = 19) selected for participation via purposive sampling. A mix of inductive and deductive coding schemes was used to identify themes and subthemes. All data were analyzed through a grounded theory approach. Gender roles that linked men with financial responsibilities and women with child caretaking led to different expectations on alcohol intake, with alcohol use encouraged for men but vilified for women. Women who drank, for example, were deemed poor mothers and undesirable spouses. Patients likewise emphasized that both alcohol-related stigma and sexual violence disproportionately impacted women, the latter fueled through alcohol use, with serious and lasting acts of discrimination and isolation from community members seen among women alcohol users but not for men. Women alcohol users in Moshi are subject to severe social consequences, facing disproportionate stigma and sexual violence as compared to men. Alcohol-related treatment for women should be mindful of the disproportionate burdens present in this context while treatment for men should be cognizant of the social pressures to drink. Strategies to address and/or mitigate these factors should be incorporated in subsequent care and interventions

Cross-Cultural Adaptation and Psychometric Properties of the SF-8 Questionnaire in Tanzanian Swahili for Injury Population

Background: There is a lack of tools to screen for health-related quality of life (HRQoL) in acute injury patients, despite the critical need for having a good understanding of the characteristics of mental health during the rehabilitation process. The SF-8 instrument, a shorter version of the SF-36, is the most widely used patient-based assessment of HRQoL. The aim of this research is to adapt the psychometric properties of the SF-8 to Swahili. Methods: This study is a secondary data analysis of previously collected and psychometric evaluation of the culturally adapted and translated SF-8. A cross-cultural adaptation committee carried out the process of translation to provide validity evidence based on test content. Confirmatory factor analysis was used to test the internal structure-based evidence. The validity based on relation to other variables (discriminant evidence) was tested using polychoric correlation with PHQ-2 (Patient Health Questionnaire-2). The reliability was tested using Cronbach’s alpha, Omega McDonald, and Composite Reliability. Results: 1434 adults who suffered an acute injury and presented to the emergency department between April 2018 and August 2020 were included in the study. The instrument demonstrated language clarity and domain coherence, showing validity evidence based on test content. The CFA (Confirmatory Factor Analysis) analysis showed good fit indices for both models (one- and two-factor models) of the SF-8. The discriminant evidence showed that SF-8 scores correlate strongly with the PHQ-2 instrument. These results supported the validity evidence in relation to other variables. All analyses of reliability were considered adequate with values above 0.90 for both models of the SF-8. Conclusions: The results show that the SF-8 instrument can provide relevant information about the health-related quality of life of acute injury patients, and allow practitioners to gain a better understanding of mental health, improving the treatment and follow-up of injury patients within Tanzanian culture

Alcohol use among emergency medicine department patients in Tanzania: A comparative analysis of injury versus non-injury patients.

BackgroundAlcohol is a leading behavioral risk factor for death and disability worldwide. Tanzania has few trained personnel and resources for treating unhealthy alcohol use. In Emergency Medicine Departments (EMDs), alcohol is a well-known risk factor for injury patients. At Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania, 30% of EMD injury patients (IP) test positive for alcohol upon arrival to the ED. While the IP population is prime for EMD-based interventions, there is limited data on if non-injury patients (NIP) have similar alcohol use behavior and potentially benefit from screening and intervention as well.MethodsThis was a secondary analysis of a systematic random sampling of adult (≥18 years old), KiSwahili speaking, KCMC EMD patients surveyed between October 2021 and May 2022. When medically stable and clinically sober, participants provided informed consent. Information on demographics (sex, age, years of education, type of employment, income, marital status, tribe, and religion), injury status, self-reported alcohol use, and Alcohol Use Disorder (AUD) Identification Test (AUDIT) scores were collected. Descriptive statistics were analyzed in RStudio using frequencies and proportions.ResultsOf the 376 patients enrolled, 59 (15.7%) presented with an injury. The IP and NIP groups did not differ in any demographics except sex, an expected difference as females were intentionally oversampled in the original study design. The mean [SD] AUDIT score (IP: 5.8 [6.6]; NIP: 3.9 [6.1]), drinks per week, and proportion of AUDIT ≥8 was higher for IP (IP:37%; NIP: 21%). However, alcohol preferences, drinking quantity, weekly expenditure on alcohol, perceptions of unhealthy alcohol use, attempts and reasons to quit, and treatment seeking were comparable between IPs and NIPs.ConclusionOur data suggests 37% of injury and 20% of non-injury patients screen positive for harmful or hazardous drinking in our setting. An EMD-based alcohol treatment and referral process could be beneficial to reduce this growing behavioral risk factor in non-injury as well as injury populations