Posttraumatic stress following childbirth in homelike- and hospital settings

Objective. To assess the prevalence of posttraumatic stress disorder (PTSD) following childbirth in homelike versus hospital settings and to determine risk factors for the development of posttraumatic stress symptoms. Methods. Multi-center cross-sectional study at midwifery practices, general hospitals and a tertiary (university) referral center. An unselected population of 907 women was invited to complete questionnaires on PTSD, demographic, psychosocial, and obstetric characteristics 2 to 6 months after delivery. Prevalence of PTSD was based on women who met all criteria of the diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV), whereas risk factors were determined using the severity (sum-score) of posttraumatic stress symptoms. Results. PTSD following childbirth was found in 1.2% of the respondents (5/428 women, response rate 47%), while 9.1% of women (39/428) had experienced the delivery as traumatic. Posttraumatic stress symptoms were associated with unplanned cesarean section, low sense of coherence (coping skills), and high intensity of pain. Initial differences in posttraumatic stress symptoms between home and hospital deliveries disappeared after taking into account the (by definition) uncomplicated nature of home births. Conclusion. In this Dutch study, 1 in 100 women had PTSD following childbirth, with no differences between home- and hospital deliveries after controlling for complications and interventions. Emergency cesarean section, severe labor pain, and poor coping skills were associated with more posttraumatic stress symptoms

Measuring posttraumatic stress following childbirth: a critical evaluation of instruments

OBJECTIVES: To evaluate instruments used to assess posttraumatic stress disorder (PTSD) following childbirth with both quantitative (reliability analysis and factor analysis) and qualitative (comparison of operationalization) techniques. METHODS: An unselected population of 428 women completed the Traumatic Event Scale-B (TES-B) and the PTSD Symptom Scale-Self Report (PSS-SR) 2-6 months after delivery. RESULTS: Assessment of internal consistency yielded similar results for the TES-B and PSS-SR (Cronbach's alpha = 0.87 and 0.82, respectively). Factor analysis revealed two rather than three DSM-IV symptom categories for both instruments: childbirth-related factors (re-experiencing/ avoidance) and symptoms of depression and anxiety (numbing/hyperarousal). Although the TES-B and the PSS-SR sum-scores show a strong relationship (Spearmans rho = 0.78), agreement between the instruments on the identification of PTSD cases is low (kappa = 0.24); discrepancy between TES-B and PSS-SR is largely due to differences in instruction to respondents, formulation of items, answer categories, and cut-off values. CONCLUSIONS: Large operationalization differences between TES-B and PSS-SR have been identified, i.e., in the formulation of questions, answer categories, cut-off values and instructions to respondents. Comparison between studies using different instruments for measuring PTSD following childbirth should be done with utmost caution

Challenges of Integrated Pest Management in Sub-Saharan Africa

a response to the negative side effects of chemical control in the developed world, Integrated Pest Management (IPM) developed with an emphasis on reducing the role of pesticides. Later the role of natural enemies was recognized as being the cornerstone for sustainable pest management strategies. The IPM concept initially stressed the combination of control tactics while afterwards the empowerment of farmers in managing their own agro-ecosystems became the focus. Reasons are given why integrated pest management has been instrumental in making the Farmer Field School (FFS) prominent in sectors such as nutrient management, animal husbandry and health. FAO started with an IPM project in subsistence crops in Africa, but because of its low impact on farmers’ livelihoods changed to crops with a higher consumption of pesticides such as cotton and rice. Some pests like locusts require the attention of the central government. The multiple dimensions of desert locust problems are highlighted, and the realization that its solution is more operational than technical. Invasive pests are a continuous threat, and classical biological attempts have been highly successful. Some examples of technical IPM components such as varietal resistance, the judicious use of chemicals, agronomic practices, and biological control are given. However, it appeared that the adoption rate by farmers of proposed technologies is low. It is argued that farmers face very small windows of opportunities. Therefore, institutional development needs as much attention as technological improvement. A number of examples are given to illustrate this poin