Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan

BACKGROUND: The signing of the Comprehensive Peace Agreement in January 2005 marked the end of the civil conflict in Sudan lasting over 20 years. The conflict was characterised by widespread violence and large-scale forced migration. Mental health is recognised as a key public health issue for conflict-affected populations. Studies revealed high levels of post-traumatic stress disorder (PTSD) amongst populations from Southern Sudan during the conflict. However, no studies have been conducted on mental health in post-war Southern Sudan. The objective of this study was to measure PTSD and depression in the population in the town of Juba in Southern Sudan; and to investigate the association ofdemographic, displacement, and past and recent trauma exposure variables, on the outcomes of PTSD and depression. METHODS: A cross-sectional, random cluster survey with a sample of 1242 adults (aged over 18 years) was conducted in November 2007 in the town of Juba, the capital of Southern Sudan. Levels of exposure to traumatic events and PTSD were measured using the Harvard Trauma Questionnaire (original version), and levels of depression measured using the Hopkins Symptom Checklist-25. Multivariate logistic regression was used to analyse the association ofdemographic, displacement and trauma exposure variables on the outcomes of PTSD and depression. Multivariate logistic regression was also conducted to investigate which demographic and displacement variables were associated with exposure to traumatic events. RESULTS: Over one third (36%) of respondents met symptom criteria for PTSD and half (50%) of respondents met symptom criteria for depression. The multivariate logistic regression analysis showed strong associations of gender, marital status, forced displacement, and trauma exposure with outcomes of PTSD and depression. Men, IDPs, and refugees and persons displaced more than once were all significantly more likely to have experienced eight or more traumatic events. CONCLUSION: This study provides evidence of high levels of mental distress in the population of Juba Town, and associated risk-factors. Comprehensive social and psychological assistance is urgently required in Juba

Conhecimento de mulheres de uma Unidade Básica de Saúde da cidade de Natal/RN sobre o exame de Papanicolau Conocimiento de mujeres de una Unidad Básica de Salud de la ciudad de Natal/RN sobre el examen de Papanicolau Knowledge of women about the Paptest in a Basica Unit of Health in Natal

Trata-se de uma pesquisa descritiva quantitativa, desenvolvida em uma Unidade Básica de Saúde em Natal/RN, objetivando identificar o conhecimento de mulheres quanto à importância, à freqüência do exame de Papanicolau, bem como seus cuidados antes de realizá-lo e causas que levam mulheres a não se submeterem a tal exame. Utilizou-se uma entrevista estruturada na coleta de dados antes da consulta ginecológica, com uma amostra intencional de 120 mulheres. Os resultados mostram que as pesquisadas conhecem a importância do exame, a maioria realiza-o anualmente e, no geral, apresentam conhecimento satisfatório sobre os cuidados antes do exame. A vergonha de fazer o exame de Papanicolau e o medo do seu resultado são as principais causas atribuídas para a sua não realização. Conclui-se que os projetos educativos sejam direcionados para a importância, a freqüência e os cuidados necessários antes do exame de Papanicolau, como também, para a interação profissional-cliente durante a consulta ginecológica, visando a reduzir a vergonha e o medo dessas mulheres.<br>Se trata de una investigación descriptiva cuantitativa, desarrollada en una Unidad Básica de Salud en Natal/RN, con el objetivo de identificar el conocimiento de las mujeres en cuanto a la importancia y frecuencia del examen de Papanicolau, así como sus cuidados antes de realizárselo y causas que las llevan a no someterse a tal examen. Se utilizó una entrevista estructurada en la recolección de datos antes de la consulta ginecológica, con una muestra intencional de 120 mujeres. Los resultados muestran que las investigadas conocen la importancia del examen, la mayoría lo realiza anualmente y, en general, presentan conocimiento satisfactorio sobre los cuidados antes del examen. La vergüenza de hacerse el examen de Papanicolau y el miedo de su resultado son las principales causas atribuídas para su no realización. Se concluye que los proyectos educativos estén orientados a la importancia, frecuencia y cuidados necesarios antes del examen de Papanicolau, así como también, a la interacción profesional-cliente durante la consulta ginecológica, visando reducir la vergüenza y el miedo de esas mujeres.<br>This is a descriptive quantitative research carried out at a Basic Health Unit in Natal, State of Rio Grande do Norte, aimed at measuring the knowledge that women have on the importance of the Pap test and the frequency in which they undertake it, as well as how they prepare themselves to undertake it and the causes that lead women to not submit to it. For data collection a structured interview prior to the gynecologic consultation was used, with an intentional sample of 120 women. The results show that the surveyed women are aware of the importance of the test, that most of them undertake it annually and that they generally have satisfactory knowledge as for the care they must take prior to undertaking it. Embarrassment and fear of the results are the main causes associated with the refusal to undertake the test. It can be concluded that the educative projects are to be focused on the importance, the frequency and the care that must be taken prior to the test, as well as on the professional-client interaction during the gynecologic consultation, with the aim of reducing women's embarrassment and fear

Exame Papanicolaou: sentimentos relatados por profissionais de enfermagem ao se submeterem a esse exame Pap smear screening: sensations reported by nursing professionals when submitted to this test

Objetivou-se conhecer os sentimentos de auxiliares e técnicas de enfermagem ao se submeterem ao exame Papanicolaou. Trata-se de um estudo descritivo com abordagem qualitativa realizado nos meses de setembro a outubro de 2006, com 35 servidoras de uma instituição governamental referência em ginecologia na cidade de Fortaleza (CE). Os dados foram coletados através de entrevista semiestruturada, contendo uma questão norteadora gravada e analisada de acordo com referencial teórico metodológico da fenomenologia social. Os relatos foram agrupados em três temáticas: um exame que causa incômodo, medo e vergonha; um exame que gera ansiedade quanto aos resultados; e um exame que "me deixa calma e tranquila". Apesar de as entrevistadas pertencerem a uma instituição que cuida de mulheres na prevenção do câncer cérvico-uterino, elas não deixaram de emitir sentimentos negativos relacionados ao exame. Concluiu-se a importância de realizar projetos educativos, enfatizando a importância do empoderamento das usuárias a fim de minimizar essas questões.<br>This work sought to record the impressions of nursing assistants and technicians after submitting to Pap smear screening. This is a descriptive study using a qualitative approach conducted in September and October of 2006 with 35 employees of a public institution, which is a benchmark in gynecology in Fortaleza in the State of Ceará (Brazil). The data was collected through semi-structured interviews containing a recorded leading question and analyzed according to the methodological-theoretical reference of social phenomenology. The testimonials were separated in three groups: an exam that causes discomfort, fear and shame; an exam that causes anxiety about the results; and an exam that "makes me calm and relaxed". Despite the interviewees being part of an institution that cares for the prevention of cervical-uterine cancer in women, negative feelings about the Pap smear test were nonetheless reported. The conclusion reached is that it is important to stage educational campaigns emphasizing the importance of empowerment of patients in order to minimize these aspects