A. Ko

C. Gonçalves

J. Croda

L. Da Silva

R.M. Rohrbaugh

T. Lazzarini

W. Benites

Annals of Global Health

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114 S o c i a l a n d Env i r o nmen t a l D e t e rm i nan t s o f H ea l t hhealth seeking behavior with those in the highest wealth index being
4.11 times (95% CI: 1.86-9.11; p < 0.000) more likely to achieve the
recommended level of care and 3.13 times (95% CI: 1.57-6.25; p <
0.001) more likely to achieve the middle level than the lowest level.
Interpretation: By determining differences between mothers
achieving the full recommended maternal health visits versus those
achieving less optimal levels, we recommend that maternal health
interventions target multigravida and low-income mothers to achieve
the greatest impact in increasing achievement of all recommended
maternal health visits along the continuum of care in rural Tanzania.
Funding: The study was funded by Doris Duke Charitable Foun-
dation and Comic Relief.
Abstract #: 01SEDH019Adolescent suicide among the Guarani-Kaiowá in
Dourados, Mato Grosso do Sul, Brazil
T. Lazzarini1, R.M. Rohrbaugh2, J. Croda3, C. Gonçalves3, A. Ko4,
W. Benites5, L. Da Silva6; 1Yale School of Medicine, New Haven, CT/
US, 2Yale University School of Medicine, New Haven, CT/US, 3Uni-
versidade Federal da Grande Dourados Faculdade de Ciencias da Saude,
Dourados, Brazil, 4Yale School of Public Health, New Haven, CT/US,
5Distrito Sanitario Especial Indigena - Polo Base Dourados, Mato Grosso
do Sul, Dourados, Brazil, 6Distrito Sanitario Especial Indigena - Polo Base
Dourados, Mato Grosso do Sul, Dourados, Brazil
Background: Suicide is a major global public health problem, and
the burden of suicide is unevenly distributed across societies and
ethnic groups; high rates of suicide among indigenous populations
and especially among indigenous young adults have been docu-
mented in many different societies. Previous studies have demon-
strated a very high burden of adolescent suicide among the Guarani-
Kaiowá in Mato Grosso do Sul Brazil. The purpose of this study was
to establish the current suicide epidemiology, perform in-depth
stratified analysis, and to conduct focus group interviews with
different segments of the Guarani-Kaiowá community to learn more
about possible risk and protective factors.
Methods: The study was conducted in indigenous reservations in
Dourados and Itaporã, Mato Grosso do Sul. Two different ap-
proaches were taken to further investigate this phenomenon: (1) an
epidemiological study of suicide rates in the local indigenous
healthcare office catchment area that consisted of village and house-
hold-level risk stratification in this population for the first time and (2)
a community-based qualitative study consisting of 15 focus group
interviews with community health workers, community leaders, and
young adults (aged 16-22) designed to develop an understanding of
community perceptions of suicide as well as to identify possible risk
and protective factors. Community participants were volunteers who
fit the following criteria: (1) were Identified as a community leader by
the village chief; (2) work as a community health agent or health
worker; or (3) is a Guarani-Kaiowá adolescent aged 16-22 years. The
primary outcome for the epidemiological study was suicide mortality,
and stratified analysis was performed based on important de-
mographic variables including age, sex and village of residence. This
study was approved by the Yale University IRB, the ethical review
board at Universidade Federal da Grande Dourados, and the village
chiefs. All participants signed a written consent form and for par-
ticipants under 18, guardian consent as well as participant assent was
required.
Findings: This study confirmed a high rate of overall and
adolescent suicide among the Guarani-Kaiowá, and also provided
new insight into differential suicide mortality rates amongdifferent neighboring villages, differential age of peak risk between
men and women, and a dramatically heightened risk among those
living in households with a previous suicide case. Additionally, in
the qualitative component, familial dysfunction, marginalization,
lack of access to educational and employment opportunities, and
alcohol use were identified as possible risk factors, whereas
attending school and an intact family structure were identified as
possible protective factors.
Interpretation: The results of the study have important public
health implications and will be utilized by the local indigenous health
care office (DSEI - Polo Base Dourados) to develop and improve
targetted suicide intervention and prevention strategies.
Funding: Nones.
Abstract #: 01SEDH020Sexual communication self-efficacy (SCSE) mediates
relationship power and consistent condom use among
heterosexual couples in Soweto, South Africa
A. Leddy1, D. Chakravarty2, S. Dladla3, L. Darbes4; 1Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD/US, 2University of
California, San Francisco, Center For AIDS Prevention Studies, San
Francisco, CA/US, 3Center for Disease Control and Prevention (CDC),
South Africa, Johannesburg, ZA, 4University of California, San
Francisco, Center For AIDS Prevention Studies, San Francsisco, CA/US
Background: Heterosexual couples in primary relationships are
one of the most at-risk groups for HIV in South Africa. Evidence
suggests that women with greater power in their sexual relation-
ships are more likely to engage in HIV prevention behaviors such
as consistent condom use. However, few studies examine the
mechanisms through which this occurs. Drawing from the Social
Cognitive Theory, we aimed to test the hypothesis that sexual
communication self-efficacy (SCSE) mediates the association be-
tween relationship power and consistent condom use among
couples in Soweto, South Africa.
Methods: Heterosexual couples (N¼208) from Soweto, South
Africa participated in a cross-sectional study on HIV risk behavior
and relationship dynamics. Couples were recruited from commu-
nity and clinic settings using non-probability, venue-based sam-
pling. Couples were eligible if both partners were 18 years or older,
and had been in the relationship for at least three months. Each
partner was individually consented, and completed an interviewer-
administered survey that assessed condom use, relationship power,
and SCSE. The proportion of protected sex acts in the last 30 days
was calculated for each partner, scores were averaged to obtain the
outcome measure of couple-level consistent condom use. The SCSE
scale assessed participants’ confidence in their ability to commu-
nicate about sex. Partners’ scores were averaged to obtain the
couple-level SCSE score. The Sexual Relationship Power Scale
(SRPS) assessed relationship power among female participants.
SRPS scores were trichotomized (0¼Low power, 1¼Moderate po-
wer, 2¼High power). Bivariate logistic regressions assessed whether
SCSE and relationship power were each associated with consistent
condom use (0¼ < 100% condom use; 1¼100% condom use).
Binary mediation analysis was conducted to assess whether SCSE
mediated the association between relationship power and consis-
tent condom use.
Findings: The average age was 34 years (men) and 31 years
(women), and average relationship length was 5.5 years. The majority
of couples were unmarried but in a committed relationship (86%).
Overall, 37% of the couples reported consistent condom use in the


Adolescent suicide among the Guarani-Kaiowá in Dourados, Mato Grosso do Sul, Brazil

http://www.annalsofglobalhealth.org/articles/10.1016/j.aogh.2015.02.763/galley/1778/download/

Adolescent suicide among the Guarani-Kaiowá in Dourados, Mato Grosso do Sul, Brazil

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