Extent of alcohol use and mental health (depressive and post- traumatic stress disorder symptoms) in undergraduate univer- sity students from 26 low-, middle- and high-income countries

Objective. To estimate if there is a non-linear association between varying levels of alcohol use and poor mental health (depressive and post-traumatic stress disorder (PTSD) symptoms) in university students from low-, middle- and high-income countries.  Methods. Using anonymous questionnaires, data were collected from 19 238 undergraduate university students (mean age 20.8; standard deviation (SD) 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Alcohol use was assessed in terms of number of drinks in the past 2 weeks and number of drinks per episode, and measures of depression and PTSD symptoms were administered.  Results. The proportion of students with elevated depression scores was 12.3%, 16.9%, and 11.5% for non-drinkers, moderate drinkers, and heavy drinkers, respectively, while the proportion of students with high PTSD symptoms was 20.6%, 20.4% and 23.1% for non-drinkers, moderate drinkers, and heavy drinkers, respectively. Logistic regression found that non-drinkers and heavy drinkers had a lower odds than moderate drinkers to have severe depression, after adjusting for sociodemographic variables, social support and subjective health status. Further, heavy, more frequent drinkers and more frequent binge drinkers had a higher odds to have elevated PTSD symptoms than moderate and non-drinkers, after adjusting for sociodemographic variables, social support and subjective health status.  Conclusion. The results suggest a reverse U-shaped association between recent alcohol use volume and frequency and depressive symptoms (unlike that previously identified), and a J-shaped association between binge drinking frequency and depressive symptoms and alcohol use and PTSD symptoms

Helmet use and associated factors among motorcyclists in the Association of Southeast Asian Nations: Prevalence and effect of interventions

The Association of Southeast Asian Nations (ASEAN) is a collaborative group of 10 countries (Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam) located in South-East Asia. In most ASEAN countries, the majority of road users are motorcyclists. Globally, among the 20 countries with the greatest rate of motorcycle deaths per 100,000 population, six ASEAN countries are included. A review found that across ASEAN countries, a significant proportion of motorcycle drivers did not wear a helmet; this ranged from 11–20% in Indonesia, 35–66% in Cambodia, 25–97% in Laos, 24.2–67.2% in Malaysia, 44.2%–56.3% in Thailand, and 10–70.1% in Vietnam, while rates of non-use of helmets were higher in motorcycle passengers, ranging from 25% in Vietnam, 38.1% in Malaysia, 48–80% in Indonesia, 72–81% in Thailand, and 91% in Cambodia. The effect of the introduction of helmetuse legislation for drivers and passengers was evaluated in Thailand and Vietnam, and in both evaluations, significant increases in helmet use were found compared to prior the legislation in both countries. Multisectoral or community intervention programmes in localised areas and schools in Laos and Thailand also lead to significant increases in motorcycle helmet use. The effectiveness of the enforcement of helmet laws in ASEAN countries was rated an average of 7.2 (on a scale of 0 to 10, where 0 is not effective at all and 10 is highly effective), with the lowest (5) in Malaysia and the highest (10) in Brunei Duressalam. Stricter enforcement of mandatory helmet laws for two-wheeler riders (both drivers and pillion-riders) are needed. Keywords: helmet use, motorcycle, prevalence, interventions, Southeast Asia

The severity of violence against women by intimate partners and associations with perpetrator alcohol and drug use in the Vhembe district, South Africa

Substance use is cited as a major contributing factor to intimate partner violence in South Africa. The aim of the study was to assess the association between the frequency and severity of several types of intimate partner violence against women, who have been granted a protection order, and the use of alcohol and illicit drug use by perpetrators. Using systematic sampling, 268 women (18 years and older), who had consecutively received a protection order in the Vhembe district in South Africa, were assessed by a research assistant. The results indicate that these women reported perpetrators 34% of whom did not have a drinking problem and no drug use in the past three months, 31.3% with problem drinking only, 4.1% drug use only, and 30.6% with problem drinking and drug use in the past three months. Multivariate logistic regression found that having a partner with problem drinking only (OR = 4.14, CI = 2.02–8.51) and having a partner with problem drinking and drug use (OR = 2.77, CI = 1.36–5.65) were associated with greater physical intimate partner violence. Having a partner with problem drinking and drug use (OR = 2.80, CI = 1.35–5.79) was associated with an increased psychological intimate partner abuse. Problem drinking and drug use among male partners is a strong determinant of physical intimate partner violence among battered women in South Africa. Intimate partner violence prevention measures should address reduction of problem drinking and drug use among men.Keywords: physical violence, psychological abuse, stalking, intimate partner, problem drinking, drug use, South Afric

Knowledge, attitudes and management of alcohol problems in general practice in rural South Africa

Background: There has been increasing emphasis on the role of primary health care in the prevention and management of alcohol-related harm. The aim of this study was to determine attitudes to and management of alcohol problems in general practice in rural South Africa. Methods: A total of 61 general practitioners (GPs) were interviewed with the aid of a structured questionnaire (response rate 50%) in two rural districts. Results: The results indicate that 51% of the GPs felt that alcohol is an important issue in general practice. GPs were able to discriminate accurately between cases of problem drinking and alcohol dependence. GPs who reported high levels of alcohol-related education and training were more prepared to counsel problem drinkers, expressed more therapeutic commitment in their role and reported more appropriate management of these patients than did GPs with lower levels of Continuing Medical Education (CME) experience. Alcohol problems are recognised as an important problem in general practice, and improved training could increase the identification and management of alcohol problems in primary care. GPs rated the most critical barriers to alcohol interventions as competency training, role endorsement, not being adequately reimbursed, health policy not supporting prevention and their own alcohol problem. Conclusion: Alcohol problems are recognised as an important problem in general practice, and improved training, adequate reimbursement and health policy support could increase the identification and management of alcohol problems in primary care. South African Family Practice Vol. 50 (1) 2008: pp. 66-66

HIV counselling and testing utilisation and attitudes of male inmates in a South African prison

The Department of Correctional Services Policy on the management of HIV and AIDS for offenders include voluntary counselling and testing (VCT) for HIV as one of the priorities in the rehabilitation of inmates. The aim of this study was to determine factors associated with the utilisation of VCT services in the correctional centres in terms of level of satisfaction, their experiences and expectations, and motivating factors and barriers for VCT utilisation at Losperfontein Correctional Centre, South Africa. This was a case control study (cases being those who underwent testing and controls those who did not) examining predictors of HIV VCT utilisation among 200male adult sentenced inmates serving medium and maximum sentences. Results indicate that a poor health system (OR=0.34, 95%CI:0.23 - 0.50) was inversely associated with HIV testing acceptance in prison, while age, educational level, population group, marital status, length of incarceration and access to HIV testing in prison were not associated with HIV testing acceptance in prison. Half of the participants (50%) agreed that VCT services are accessible and are promoted at their correctional centre. Most were satisfied with different components of VCT services, ranging from 79% (fair to very good) for ‘the way he/she received you’ to 62% ‘clarified all your concerns’. This study demonstrated some challenges and benefits to the field of health promotion and HIV prevention in the correctionalcentres especially with regard to VCT services

Mental health and HIV sexual risk behaviour among University of Limpopo students

Background. Little attention has been paid to the role of poor mental health among young people with regard to HIV risk behaviour and HIV prevention in Africa. Objective. To determine the association between mental health, substance use and HIV sexual risk behaviour among a sample of university students in South Africa. Methods. A cross-sectional survey was conducted among undergraduate students who were recruited conveniently from public campus venues at the University of Limpopo Medical University of Southern Africa (Medunsa) campus. The sample included 722 university students (57.6% men and 42.4% women) with a mean age of 21.7 years (standard deviation ±8.8). Results. Of the 722 students, 39.5% reported depression, 23.4% screened positive for post-traumatic stress disorder (PTSD), 22% reported hazardous or harmful alcohol use, 33% reported ≥2 sexual partners in the past 12 months, 50% reported inconsistent condom use, 46% reported unknown HIV status of a sexual partner and 20% reported alcohol use in the context of sex in the past 3 months. In multivariate analysis, HIV risk behaviour was associated with, among men, hazardous or harmful alcohol use and having screened positive for PTSD, and among women, being in the 4th or more year of study and current cannabis use. Conclusion. Poor mental health, including substance use, was found to be associated with HIV risk behaviour. Co-ordinated mental health and sexual and reproductive health services that meet the needs of university students would be desirable

Simulation of landsat thematic mapper imagery using AVIRIS hyperspectral imagery

In this paper we present a methodology for simulating multispectral imagery (MSI) using hyperspectral imagery (HSI), and present a validation of the technique using one nearly coincident Landsat TM and AVIRIS data set. Generation of MSI from HSI supports several investigations including selection of multispectral sensor band edges, and engineering trade studies related to on-board or ground-based aggregation of HSI to simulate MSI. In addition, the utility of this technique as a potential procedure for monitoring calibration changes in spaceborne instrument is also addressed

The social and clinical characteristics of patients on antiretroviral therapy who are ‘lost to follow-up’ in KwaZulu-Natal, South Africa: a prospective study

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms, quality of life, depression, herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naïve patients recruited from three (one urban, one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months’ follow-up. At 12-months follow-up 557 (75.9%) individuals continued active ART, 177 (24.1%)were all cause attrition, there were 82 deaths (13.8%), 58 (7.9%) transfers, 7 (1.0%) refused participation, 8 (1.1%) were not yet on ARTand 22 (3.0%) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio, RR=2.05, confidence intervals, CI=1.20 - 3.49) and higher depression levels (RR=1.05, CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme, such as delays in health care access (delayed health care seeking), health system delays, or inappropriate treatment criteria, need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome