ECOCULTURAL PERSPECTIVES ON PROBLEMATIC CHILD BEHAVIOR: AN EXPLORATORY QUALITATIVE STUDY IN THE CONTEXT OF URBAN POVERTY IN EGYPT

Background: Disruptive behavioral problems (DBPs) are the most commonly identified mental health issues in children and have long-term health, social, and economic consequences. Community violence, lack of basic infrastructure, and inaccessibility to services in the context of urban poverty aggravate DBPs and their consequences. Most research around child behavior occurs in high-income countries and relies on a biomedical understanding of decontextualized disorders. Definitions and meaning ascribed to DBPs, however, vary by culture and context. In Egypt, child DBPs are a major reason for care-seeking. Like many developing countries, Egypt has an extremely low coverage of child psychiatric services, and limited research exists around the contextual influences on DBPs. This study addresses this gap in knowledge by examining how mothers in urban slums in Egypt define, describe causes of, and respond to DBPs. Methods: We qualitatively assessed the definitions, responses, and care-seeking patterns for DBPs in Alexandria, Egypt. Up to two qualitative in-depth interviews were carried out with a sample of 37 mothers of 6-11-year-old children with DBPs, 17 who sought medical care and 20 who did not. Transcribed audio-recordings of IDIs, field notes, and observational notes were thematically analyzed. Results: Thematic analysis of participants accounts indicate a constant negotiation of the meaning of DBPs and their attribution as medical or criminal issues. Participants linked their child’s DBPs in part to the extreme poverty and the physical and social environment where they live. This construction impacted their perception and response to their child’s problems and partially informed their care-seeking practices and expectations. Employing a gender lens, we found that perceptions of child DBPs were influenced by gender roles and expectations. Additionally, mothers described how maternal stressors, resulting from the burdensome expected gender roles and exposure to domestic violence, profoundly affected children’s behavioral problems. Conclusions: Our findings highlight the limitations of a western biomedical understanding and diagnosis of child DBPs. To design an intervention addressing DBPs in Egypt in urban slums, we need to consider the social construction of disruptive child behavior and the multifaceted influences at the environmental, cultural and structural levels that affect parents and children

Saving lives through road safety risk factor interventions: global and national estimates

Global road mortality is a leading cause of death in many low-income and middle-income countries. Data to support priority setting under current resource constraints are urgently needed to achieve Sustainable Development Goal (SDG) 3.6. This Series paper estimates the potential number of lives saved if each country implemented interventions to address risk factors for road injuries. We did a systematic review of all available evidence-based, preventive interventions for mortality reduction that targeted the four main risk factors for road injuries (ie, speeding, drink driving, helmet use, and use of seatbelt or child restraint). We used literature review variables and considered three key country-level variables (gross domestic product per capita, population density, and government effectiveness) to generate country-specific estimates on the potential annual attributable number of lives that would be saved by interventions focusing on these four risk factors in 185 countries. Our results suggest that the implementation of evidence-based road safety interventions that target the four main road safety risk factors could prevent between 25% and 40% of all fatal road injuries worldwide. Interventions addressing speed could save about 347 258 lives globally per year, and at least 16 304 lives would be saved through drink driving interventions. The implementation of seatbelt interventions could save about 121 083 lives, and 51 698 lives could be saved by helmet interventions. We identify country-specific estimates of the potential number of lives saved that would be attributable to these interventions. Our results show the potential effectiveness of the implementation and scaling of these interventions. This paper presents key evidence for priority setting on road safety interventions and shows a path for reaching SDG 3.6

Behavioural factors associated with fear of litigation as a driver for the increased use of caesarean sections: a scoping review

Objective To explore the behavioural drivers of fear of litigation among healthcare providers influencing caesarean section (CS) rates.Design Scoping review.Data sources We searched MEDLINE, Scopus and WHO Global Index (1 January 2001 to 9 March 2022).Data extraction and synthesis Data were extracted using a form specifically designed for this review and we conducted content analysis using textual coding for relevant themes. We used the WHO principles for the adoption of a behavioural science perspective in public health developed by the WHO Technical Advisory Group for Behavioural Sciences and Insights to organise and analyse the findings. We used a narrative approach to summarise the findings.Results We screened 2968 citations and 56 were included. Reviewed articles did not use a standard measure of influence of fear of litigation on provider’s behaviour. None of the studies used a clear theoretical framework to discuss the behavioural drivers of fear of litigation. We identified 12 drivers under the three domains of the WHO principles: (1) cognitive drivers: availability bias, ambiguity aversion, relative risk bias, commission bias and loss aversion bias; (2) social and cultural drivers: patient pressure, social norms and blame culture and (3) environmental drivers: legal, insurance, medical and professional, and media. Cognitive biases were the most discussed drivers of fear of litigation, followed by legal environment and patient pressure.Conclusions Despite the lack of consensus on a definition or measurement, we found that fear of litigation as a driver for rising CS rates results from a complex interaction between cognitive, social and environmental drivers. Many of our findings were transferable across geographical and practice settings. Behavioural interventions that consider these drivers are crucial to address the fear of litigation as part of strategies to reduce CS