Clients' returning for cervical screening results : a focus group study exploring the reasons why women spontaneously return for their results at the Khayelitsha Cervical Cancer Screening Project

Bibliography: leaves 112-123.Cervical cancer is integrally associated with the problems of poverty in the developing world. It is the most common cancer cause of death among women in these regions. In South Africa, the lifetime risk for black African women developing this cancer is 1 in 26. Rates for white women are 1 in 80. Cervical cancer is largely preventable by screening for its precursor stages. However, cervical cancer screening in low-resource settings has only rarely been initiated and sustained. There are many barriers to the establishment of mass, organised screening programmes. This study focuses on one aspect of the screening process: the clients' receiving of their screening results. For the most part, health providers in resource-poor settings rely on the clients themselves to return to the health service to receive their results and consequent arrangements for further care. Understanding those factors that impact upon clients' returning is therefore crucial to the success of the screening. The Khayelitsha Cervical Cancer Screening Project (KCCSP) was established in 1996 to evaluate alternative screening tests to cytology. In addition, the Project has evaluated alternative screening algorithms to the traditional approach of cytology, colposcopy, biopsy and treatment, specifically, a "screen and treat" approach. This approach is expected to overcome some of the many barriers to women participating in screening programmes. This study aims to investigate the phenomenon of the high spontaneous return rate in the setting of the KCCSP. Motivating and deterring factors are sought, both logistical and psychological, in the clients' personal contexts, as well as those related to their experiences of the Project. Exploratory study in the interpretive research paradigm located in a peri-urban informal settlement outside Cape Town, South Africa. Volunteer sample of women enrolled in the KCCSP returning for their first set of screening results. Four focus groups were conducted in Xhosa, facilitated by a Xhosa-speaking social worker from Khayelitsha who has experience in focus group work. Discussion guidelines were followed. The discussions were tape recorded and later transcribed before being translated into English by the facilitator. Analysis of the data draws on elements of both the grounded theory and the systems theory paradigms. The findings reveal that, for the most part, women present to the KCCSP in order to have general gynaecological problems addressed. Returning for results represents an extension of this need. Obstacles to returning include problems with access to the clinic, the need to care for dependents at home and the competing priorities of housework and generating income. Factors that promote the returning for results are the imperative to understand the cause of, and have treatment for pre-existing gynaecological symptoms which cause high levels of anxiety. Related to this, women are motivated to have confirmed or refuted the diagnosis of a fatal disease, including cancer and HIV. Certain qualities and design features of the KCCSP facilitate women returning fOr their results. These include the perceived superior quality of interpersonal communication between Project staff and clients and the efficient manner in which results are made available to clients. Other promotive or obstructive factors that playa role in cervical screening service utilisation include; client attitudes towards traditional healers, a prevalent fear of hysterectomy, concern about privacy and gossip and a suspicious attitude toward caring health workers. Women enrolled in the KCCSP have a personal health agenda with a different focus to that of the Project. Chronic gynaecological problems are frequently experienced and give rise to levels of anxiety about their being signs of serious pathology. Women have not had these fears or the symptoms adequately addressed at other health services. The need to have these issues properly managed represents a large enough motivating force to overcome many of the practical and psychological obstacles to utilisation of the KCCSP. The Project represents for women a general women's health service

Image data processing system requirements study. Volume 2: Appendixes

Supporting information for the ERS loading study contains computer simulation loading output including printout description, and similar output representing data that include night station contacts

HIV-infected infants born to women who tested HIV-negative during pregnancy

The prevention of mother-to-child transmission (PMTCT) programme in the Western Cape is said to have achieved 100% coverage.1 This implies that all pregnant women who attend an antenatal health care facility in the public sector are offered voluntary counselling and testing (VCT). Uptake varies but has been reported to be as high as 90% in the Guguletu district.1 Currently, women who test HIV-positive qualify for the nevirapine-based PMTCT programme. Transmission rates below 10% have been achieved in some health districts (Médecins sans Frontières — unpublished research). Mothers of several perinatally infected infants recently diagnosed in our institution have indicated that they tested HIV-negative during their pregnancy. In some cases we have verified their statements with clinical and laboratory documentation. There is a need to determine the frequency of this phenonomen. Pregnant women are encouraged to book at their nearest antenatal clinic before 5 months’ gestation, although this frequently does not occur. We are concerned about women who do book early and test HIV-negative. Some may be in the ‘window period’ of the infection or become infected from a sexual partner during the latter stages of pregnancy. At present, there is no provision within the PMTCT programme for repeat HIV testing during pregnancy. Some women may, therefore, be denied the benefits of prevention measures including counselling on infant feeding options

Image data processing system requirements study. Volume 1: Analysis

Digital image processing, image recorders, high-density digital data recorders, and data system element processing for use in an Earth Resources Survey image data processing system are studied. Loading to various ERS systems is also estimated by simulation

EOS image data processing system definition study

The Image Processing System (IPS) requirements and configuration are defined for NASA-sponsored advanced technology Earth Observatory System (EOS). The scope included investigation and definition of IPS operational, functional, and product requirements considering overall system constraints and interfaces (sensor, etc.) The scope also included investigation of the technical feasibility and definition of a point design reflecting system requirements. The design phase required a survey of present and projected technology related to general and special-purpose processors, high-density digital tape recorders, and image recorders

Perinatal suicidal ideation and behaviour: psychiatry and adversity

Pregnant women are at increased risk for suicidal ideation and behaviours (SIB) compared to the general population. To date, studies have focused on the psychiatric correlates of SIB with lesser attention given to the associated contextual risk factors, particularly in low- and middle-income countries. We investigated the prevalence and associated psychiatric and socio-economic contextual factors for SIB among pregnant women living in low resource communities in South Africa. Three hundred seventy-six pregnant women were evaluated using a range of tools to collect data on socio-economic and demographic factors, social support, life events, interpersonal violence and mental health diagnoses. We examined the significant risk factors for SIB using univariate, bivariate and logistic regression analyses (p ≤ 0.05). The 1-month prevalence of SIB was 18%. SIB was associated with psychiatric illness, notably major depressive episode (MDE) and any anxiety disorder. However, 67% of pregnant women with SIB had no MDE diagnosis, and 65% had no anxiety disorder, while 54% had neither MDE nor anxiety disorder diagnoses. Factors associated with SIB included lower socio-economic status, food insecurity, interpersonal violence, multiparousity, and lifetime suicide attempt. These findings focus attention on the importance of socio-economic and contextual factors in the aetiology of SIB and lend support to the idea that suicide risk should be assessed independently of depression and anxiety among pregnant women

Perinatal mental health around the world: priorities for research and service development in Africa

Africa is a diverse and changing continent with a rapidly growing population, and the mental health of mothers is a key health priority. Recent studies have shown that: perinatal common mental disorders (depression and anxiety) are at least as prevalent in Africa as in high-income and other low- and middle-income regions; key risk factors include intimate partner violence, food insecurity and physical illness; and poor maternal mental health is associated with impairment of infant health and development. Psychological interventions can be integrated into routine maternal and child healthcare in the African context, although the optimal model and intensity of intervention remain unclear and are likely to vary across settings. Future priorities include: extension of research to include neglected psychiatric conditions; large-scale mixed-method studies of the causes and consequences of perinatal common mental disorders; scaling up of locally appropriate evidence-based interventions, including prevention; and advocacy for the right of all women in Africa to safe holistic maternity care

Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

Background: Evidence-based brief psychological interventions are safe and effective for the treatment of antenatal depressive symptoms. However, the adaptation of such interventions for low- and middle-income countries has not been prioritised. This study aimed to select and adapt a brief psychological intervention for women with antenatal depressive symptoms attending primary healthcare (PHC) in rural Ethiopia. Methods: We employed the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. Alongside this, we used the ADAPT-ITT model of process adaptation and the ecological validity model (EVM) to guide content adaptation. We conducted formative work, comprising a qualitative study, a series of three participatory theories of change workshops and an expert adaptation workshop to assess the needs of the target population and to select an intervention for adaptation. The adaptation process followed a series of steps: (1) training Ethiopian mental health experts in the original South African problem-solving therapy (PST version 0.0) and an initial adaptation workshop leading to PST Version 1.0. (2) Version 1.0 was presented to perinatal women and healthcare professionals in the form of a ‘theatre test’, leading to further adaptations (version 2.0). (3) Local and international stakeholders reviewed version 2.0, leading to version 3.0, which was used to train 12 PHC staff using clinical cases. (4) Finally, feedback about PST version 3.0 and its delivery was obtained from PHC staff. Results: In the first step, we modified case examples and terminology from the South African model, introduced an in-session pictorial flipchart for this low literacy setting, and added strategies to facilitate women’s engagement before translating into Amharic. In the second step, adaptations included renaming of the types of problems and inclusion of more exercises to demonstrate proposed coping strategies. In the third step, the components of motivational interviewing were dropped due to cultural incongruence. In the final step, refresher training was delivered as well as additional training on supporting control of women’s emotions to address PHC staff training needs, leading to the final version (version 4.0). Conclusion: Using a series of steps, we have adapted the content and delivery of brief PST to fit the cultural context of this setting. The next step will be to assess the feasibility and acceptability of the intervention and its delivery in antenatal care settings

Maternal mental health and the first 1 000 days

Even though maternal mental health receives low priority in healthcare, it is a vital component for the developing fetus and the raising of healthy children who are able to contribute meaningfully to society. This article explores risk factors for common mental illnesses and treatment options available in under-resourced settings

Abuse in South African maternity settings is a disgrace: Potential solutions to the problem

Abuse of mothers in maternity settings is widespread globally. In South Africa, this human rights violation has been documented by many sources. Particular factors relating to health workers’ professional and personal contexts contribute to the problem and need to be addressed if it is to be solved. Several local and international initiatives are discussed as possible solutions