Development of a screening tool to identify female survivors of gender-based violence in a humanitarian setting:qualitative evidence from research among refugees in Ethiopia.

PMC3695841BACKGROUND: High levels of gender-based violence (GBV) persist among conflict-affected populations and within humanitarian settings and are paralleled by under-reporting and low service utilization. Novel and evidence-based approaches are necessary to change the current state of GBV amongst these populations. We present the findings of qualitative research, which were used to inform the development of a screening tool as one potential strategy to identify and respond to GBV for females in humanitarian settings. METHODS: Qualitative research methods were conducted from January-February 2011 to explore the range of experiences of GBV and barriers to reporting GBV among female refugees. Individual interview participants (n=37) included female refugees (≥15 years), who were survivors of GBV, living in urban or one of three camps settings in Ethiopia, and originating from six conflict countries. Focus group discussion participants (11 groups; 77 participants) included health, protection and community service staff working in the urban or camp settings. Interviews and discussions were conducted in the language of preference, with assistance by interpreters when needed, and transcribed for analysis by grounded-theory technique. RESULTS: Single and multiple counts of GBV were reported and ranged from psychological and social violence; rape, gang rape, sexual coercion, and other sexual violence; abduction; and physical violence. Domestic violence was predominantly reported to occur when participants were living in the host country. Opportunistic violence, often manifested by rape, occurred during transit when women depended on others to reach their destination. Abduction within the host country, and often across borders, highlighted the constant state of vulnerability of refugees. Barriers to reporting included perceived and experienced stigma in health settings and in the wider community, lack of awareness of services, and inability to protect children while mothers sought services. CONCLUSIONS: Findings demonstrate that GBV persists across the span of the refugee experience, though there is a transition in the range of perpetrators and types of GBV that are experienced. Further, survivors experience significant individual and system barriers to disclosure and service utilization. The findings suggest that routine GBV screening by skilled service providers offers a strategy to confidentially identify and refer survivors to needed services within refugee settings, potentially enabling survivors to overcome existing barriers.JH Libraries Open Access Fun

Reliability of the Marlowe-Crowne social desirability scale in Ethiopia, Kenya, Mozambique, and Uganda

<p>Abstract</p> <p>Background</p> <p>Studies of HIV often use self-reported surveys to measure sexual knowledge, attitudes, and practices. However, the self-reported data are vulnerable to social desirability (SD), a propensity of individuals to report favorable responses. The Marlowe-Crowne Social Desirability Scale (MC-SDS) was developed as a measure of the effect of social desirability, but it has not been adapted for or used in Africa. This study aimed to apply the MC-SDS nested in an HIV behavioral intervention program and to measure its reliability in four African countries.</p> <p>Methods</p> <p>The MC-SDS was adapted based on consultations with local stakeholders and pilot tested in Ethiopia, Kenya, Mozambique, and Uganda. Trained interviewers administered the modified 28-item MC-SDS survey to 455 men and women (ages 15-24 years). The scores for the social desirability scales were calculated for all participants. An analysis of the internal consistency of responses was conducted using the Cronbach's α coefficient. Acceptable internal consistency was defined as an α coefficient of ≥ 0.70.</p> <p>Results</p> <p>Mean social desirability scores ranged from a low of 15.7 in Kenya to a high of 20.6 in Mozambique. The mean score was 17.5 for Uganda and 20.6 for Mozambique. The Cronbach's α coefficients were 0.63 in Kenya, 0.66 in Mozambique, 0.70 in Uganda, and 0.80 in Ethiopia.</p> <p>Conclusions</p> <p>The MC-SDS can be effectively adapted and implemented in sub-Saharan Africa. The reliability of responses in these settings suggest that the MC-SDS could be a useful tool for capturing potential SD in surveys of HIV related risk behaviors.</p

THE USE OF GEOGRAPHIC INFORMATION SYSTEMS AND SPATIAL ANALYSIS IN DESCRIBING PATTERNS OF PREHOSPITAL RESPONSE TO HIGH-ACUITY TRAUMA IN HOWARD COUNTY, MARYLAND

Background: For many patients, prehospital care is the first contact with the healthcare system in a medical emergency. When traumatic injuries are involved, timely response is particularly important as increased time to definitive care is associated with worsened health outcomes. This dissertation focuses on the prehospital response to high-acuity trauma patients in Howard County, Maryland, and describes the spatial distribution of the ambulance calls with a particular examination of the timeliness of response and socioeconomic factors of the location of the traumas. Methods: Data was obtained in collaboration with the Howard County Department of Fire and Rescue Services and encompassed all ambulance calls to high-acuity trauma cases from May 2013 – May 2020. For spatial information on census tracts and data on socioeconomic indicators, information was obtained from the United States Census Bureau. Calls were categorized into “delayed” or “non-delayed” responses based on national published guidelines, and the location of the calls were geocoded. We performed spatial analyses to explore the spatial distribution of both delayed and non-delayed calls and to identify any statistically significant clustering. Calls were also cross tabulated with socioeconomic data on census tracts to identify any association between delayed prehospital responses and the general household income of a tract. Results: The overwhelming majority of responses to high-acuity traumas in Howard County were delayed during the time period. More traumas occurred in the eastern, more urbanized area of the county. There was clustering of all high-acuity traumas, whether they were delayed or non-delayed. The eastern part of the county also had more census tracts with lower socioeconomic indicators, although the county as a whole is relatively affluent compared to the rest of the United States. There was not a higher proportion of delayed calls in lower income tracts compared to higher income tracts. Conclusions: Trauma calls in a high-income county tended to have delayed responses and spatially cluster together. Delayed calls did not occur more commonly in lower income areas in Howard County than in higher income areas. The dissertation also used spatial analytical techniques that have not been previously employed in prehospital care research

Comparison of Respiratory Virus Detection Rates for Infants and Toddlers by Use of Flocked Swabs, Saline Aspirates, and Saline Aspirates Mixed in Universal Transport Medium for Room Temperature Storage and Shipping▿

A nylon flocked swab/universal transport medium collection method developed for bacterial sexually transmitted infections was adapted to detect respiratory viruses in infants and toddlers. This method significantly outperformed the traditional use of nasal aspirates in terms of PCR-based virus detection (P = 0.016), and the samples were easier for clinicians to evaluate, store, and transport