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Assessment of condom use acceptability, Hoima district, Uganda, July 1996
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“A CROSS-CULTURAL DECISION INSTRUMENT FOR SCREENING MAMMOGRAPHY.” Vakrie A. Lawrence, A. Gufni, H. Hawda, D. Streiner, N. Hudepohl, R. Naylor, N. Place, C. deMoor, and G. Clark. University of Texas Health Science Center at San Antonio, San Antonio, U.S.A. Objective: Previous research has examined the roles of sociocultural status (ethnicity, socioeconomic level) and psychosocial variables (e.g., health beliefs) in women’s decisions about screening mammography (SM). The missing link in understanding decisions is information: 1) risk/benefit information about breast cancer and SM is given in ways that generate inaccurate understanding; 2) the relative roles of information, sociocultural status and psychosocial variables in decisions are unknown. We developed a crosscultural decision instrument about SM that is interactive and uses simple graphics: 1) for SO-70-year-old Anglo or Mexican American (MA) women; 2) to present standardized, unbiased, understandable and culturally relevant information; 3) to enable women to express an informed preference about SM. Design, Participants, Setting: Iterative construction: medical school; 12 participants (5 men, 7 women; 3 MDs (internal medicine, oncology), 6 PhDs (sociology, psychology, biostatistics, economics, education), 2 lay women, 1 graphics artist. Reliability and validity: focus groups of 50-70-year-old women volunteers: 26 Anglo, 26 Mexican American (MA); broad educational/socioeconomic spectrum. To test reliability, true risk/benefit probabilities were given and preferences elicited twice, 1 week apart. To test validity, probabilities were then changed to see if preferences changed predictably. Cross-cultural adaptation (Spanish): 12 member established bilingual multidisciplinary team. Intervention: Decision instrument. Main Outcome Measure(s): Decision about having screening mammog raphy. Results: Test-retest reliability was perfect. For validity, 23 of 26 Angles (88%) changed preference as predicted. We confirmed validity in 26 MAs with focus groups using bilingual facilitators. Conclusion: This cross-cultural consumer instrument appears reliable and valid for a planned cohort study of MA and Anglo women’s decisions and behavior about SM.
“MOTHERS’ ‘DIAGNOSIS’ AND TREATMENT OF CHILDREN’S FEVER IN A MALARIA ENDEMIC AREA OF UGANDA: IMPLICATIONS FOR THE MALARIA CONTROL PROGRAM.” Rosalind G. Lubanga, S. Norman, D. Ewbnnk, and C. Karumagi. CEU, Makerere University, Kampala, Uganda. Objectives: To determine: (1) mothers’ interpretation of the cause of fever in children under five years; (2) agreement between mothers’ diagnosis and clinical and laboratory evidence of malaria; (3) drugs given to febrile children before they were brought to the health center. Design: Cross-sectional study. Setting: An outpatient pediatric clinic of Old Mulago Hospital, Kampala, a tertiary health care unit. Participants: Mothers accompanying under-five children who had fever as a major complaint. A sample of 439 mothers were interviewed and the children were physically examined and their blood tested for malaria parasites. Mothers’ diagnosis was compared with clinical and laboratory diagnosis of malaria. Intervention: N/A. Results: Thirty-nine percent of the mothers associated the fevers with malaria. Doctors diagnosed 92% of the children to have malaria. The prevalence of malaria parasites as determined by laboratory tests was 64%. The sensitivity of mothers’ perception of malaria was 37%, specificity was 58%, false positive rate was 42% and false negative rate was 63%. Their predictive value negative was 34%. This was in contrast to clinical diagnosis which was 82%. Ninety percent of the mothers (CI: 88%-92%) administered drugs before visiting the health unit; 76% gave modern medicines, 3% herbs only, and 21% a mixture of both. Mothers administered antimalarials to children irrespective of the perceived cause of fever. Fifty percent of mothers who suspected malaria gave an antimalarial. Conclusions: The majority of the mothers do not associate fever with malaria. Since malaria is a common cause of fever in children, it is recommended that mothers give antimalarials as a first aid measure.
HEALTH
SOCIAL
SCIENCE
“FEMALE CIRCUMCISION IN KENYA.” Enos H. N. Njeru. CEU, University of Nairobi, Kenya. Objectives: To establish the social and cultural factors that contribute to both persistence and abandonment of female circumcision. Design: Qualitative study: Key informant interviews, focus group discussions, case studies, in-depth interviews. Setting: Nyeri, Embu, and Murang’a, in rural areas of Kenya. Participants: Mothers and fathers, schoolboys and girls, circumcisers, educators, religious leaders, community opinion leaders. Intervention: Not Applicable. Main Outcome Measure(s): Reasons for persistence and abandonment of female circumcision. Results: Persistence explained by social and cultural beliefs promoting women’s humility, good health, wisdom, attractiveness. Abandonment explained by modernization, Christianization, education, and increased awareness of disadvantages. Conclusion: There is a lot of disinformation and cultural bias regarding advantages of female circumcision. The health-related effects of female circumcision are well-known. Community-based approaches are needed to stem female circumcision.
“ASSESSMENT OF CONDOM USE ACCEPTABILITY, HOIMA DISTRICT, UGANDA, JULY 1996.” D. C. Okumu, L. Korukiiko, G. Outdo, 0. Okui, and M. E. White. Uganda Public Health Schools Without Walls, Kampala, Uganda. Introduction: Hoima is a rural District in western Uganda with a population of 222,364. HIV/AIDS, transmitted through heterosexual intercourse, is a major health problem. About 5% of adults acquire ulcerative STDs every year, a condition associated with increased HIV/AIDS transmission. Despite high knowledge about HIV transmission among the population and the good availability of condoms, condom use rate is still approximately 10%. Obiective: To orovide information for social marketine of condoms in Hoima District. Main Outcome Measure(s): A cross sectional studv. Qualitative methods of focus group discussions. (FGD) and key informant interviews (KI) were used. FGD participants were purposively selected and stratified by sex, residence (urban and rural) and age group. Four FGD were held in Hoima town, 8 in two rural subcounties with adolescents and adults of both sexes. Three Kl were held with: the Catholic Bishop, district women leader and head of a local AIDS NGO. Focus group discussion guide and questionnaire guide were used for collecting information. Notes were taken verbatim and FGD tape recorded. Tapes were transcribed and analysis was done with the master sheet. Results: Condom acceptance was high among urban males and used for prevention of HIV/STD. Adults mainly used them outside marriage. There was low acceptance of condoms among urban adolescent females, but the urban adult females mainly accepted condom use for family planning. In the rural areas, there was poor acceptance in both sexes for adults and adolescents, more pronounced among the females. Key informants observed that condoms were mainly used in the urban area by males while in rural areas the acceptance was still low. Reasons for poor condom acceptance were: fear of condoms remaining inside a woman, requiring operation for removal, fear of condom bursting, public ridicule, husband was against it, condom promotes promiscuity, they are not fully safe. Conclusion: Health education to counteract fears related to condom use prioritizing urban females and rural areas. r
I
“A CROSS-CULTURAL DECISION INSTRUMENT FOR SCREENING MAMMOGRAPHY.” Vakrie A. Lawrence, A. Gufni, H. Hawda, D. Streiner, N. Hudepohl, R. Naylor, N. Place, C. deMoor, and G. Clark. University of Texas Health Science Center at San Antonio, San Antonio, U.S.A. Objective: Previous research has examined the roles of sociocultural status (ethnicity, socioeconomic level) and psychosocial variables (e.g., health beliefs) in women’s decisions about screening mammography (SM). The missing link in understanding decisions is information: 1) risk/benefit information about breast cancer and SM is given in ways that generate inaccurate understanding; 2) the relative roles of information, sociocultural status and psychosocial variables in decisions are unknown. We developed a crosscultural decision instrument about SM that is interactive and uses simple graphics: 1) for SO-70-year-old Anglo or Mexican American (MA) women; 2) to present standardized, unbiased, understandable and culturally relevant information; 3) to enable women to express an informed preference about SM. Design, Participants, Setting: Iterative construction: medical school; 12 participants (5 men, 7 women; 3 MDs (internal medicine, oncology), 6 PhDs (sociology, psychology, biostatistics, economics, education), 2 lay women, 1 graphics artist. Reliability and validity: focus groups of 50-70-year-old women volunteers: 26 Anglo, 26 Mexican American (MA); broad educational/socioeconomic spectrum. To test reliability, true risk/benefit probabilities were given and preferences elicited twice, 1 week apart. To test validity, probabilities were then changed to see if preferences changed predictably. Cross-cultural adaptation (Spanish): 12 member established bilingual multidisciplinary team. Intervention: Decision instrument. Main Outcome Measure(s): Decision about having screening mammog raphy. Results: Test-retest reliability was perfect. For validity, 23 of 26 Angles (88%) changed preference as predicted. We confirmed validity in 26 MAs with focus groups using bilingual facilitators. Conclusion: This cross-cultural consumer instrument appears reliable and valid for a planned cohort study of MA and Anglo women’s decisions and behavior about SM.
“MOTHERS’ ‘DIAGNOSIS’ AND TREATMENT OF CHILDREN’S FEVER IN A MALARIA ENDEMIC AREA OF UGANDA: IMPLICATIONS FOR THE MALARIA CONTROL PROGRAM.” Rosalind G. Lubanga, S. Norman, D. Ewbnnk, and C. Karumagi. CEU, Makerere University, Kampala, Uganda. Objectives: To determine: (1) mothers’ interpretation of the cause of fever in children under five years; (2) agreement between mothers’ diagnosis and clinical and laboratory evidence of malaria; (3) drugs given to febrile children before they were brought to the health center. Design: Cross-sectional study. Setting: An outpatient pediatric clinic of Old Mulago Hospital, Kampala, a tertiary health care unit. Participants: Mothers accompanying under-five children who had fever as a major complaint. A sample of 439 mothers were interviewed and the children were physically examined and their blood tested for malaria parasites. Mothers’ diagnosis was compared with clinical and laboratory diagnosis of malaria. Intervention: N/A. Results: Thirty-nine percent of the mothers associated the fevers with malaria. Doctors diagnosed 92% of the children to have malaria. The prevalence of malaria parasites as determined by laboratory tests was 64%. The sensitivity of mothers’ perception of malaria was 37%, specificity was 58%, false positive rate was 42% and false negative rate was 63%. Their predictive value negative was 34%. This was in contrast to clinical diagnosis which was 82%. Ninety percent of the mothers (CI: 88%-92%) administered drugs before visiting the health unit; 76% gave modern medicines, 3% herbs only, and 21% a mixture of both. Mothers administered antimalarials to children irrespective of the perceived cause of fever. Fifty percent of mothers who suspected malaria gave an antimalarial. Conclusions: The majority of the mothers do not associate fever with malaria. Since malaria is a common cause of fever in children, it is recommended that mothers give antimalarials as a first aid measure.
HEALTH
SOCIAL
SCIENCE
“FEMALE CIRCUMCISION IN KENYA.” Enos H. N. Njeru. CEU, University of Nairobi, Kenya. Objectives: To establish the social and cultural factors that contribute to both persistence and abandonment of female circumcision. Design: Qualitative study: Key informant interviews, focus group discussions, case studies, in-depth interviews. Setting: Nyeri, Embu, and Murang’a, in rural areas of Kenya. Participants: Mothers and fathers, schoolboys and girls, circumcisers, educators, religious leaders, community opinion leaders. Intervention: Not Applicable. Main Outcome Measure(s): Reasons for persistence and abandonment of female circumcision. Results: Persistence explained by social and cultural beliefs promoting women’s humility, good health, wisdom, attractiveness. Abandonment explained by modernization, Christianization, education, and increased awareness of disadvantages. Conclusion: There is a lot of disinformation and cultural bias regarding advantages of female circumcision. The health-related effects of female circumcision are well-known. Community-based approaches are needed to stem female circumcision.
“ASSESSMENT OF CONDOM USE ACCEPTABILITY, HOIMA DISTRICT, UGANDA, JULY 1996.” D. C. Okumu, L. Korukiiko, G. Outdo, 0. Okui, and M. E. White. Uganda Public Health Schools Without Walls, Kampala, Uganda. Introduction: Hoima is a rural District in western Uganda with a population of 222,364. HIV/AIDS, transmitted through heterosexual intercourse, is a major health problem. About 5% of adults acquire ulcerative STDs every year, a condition associated with increased HIV/AIDS transmission. Despite high knowledge about HIV transmission among the population and the good availability of condoms, condom use rate is still approximately 10%. Obiective: To orovide information for social marketine of condoms in Hoima District. Main Outcome Measure(s): A cross sectional studv. Qualitative methods of focus group discussions. (FGD) and key informant interviews (KI) were used. FGD participants were purposively selected and stratified by sex, residence (urban and rural) and age group. Four FGD were held in Hoima town, 8 in two rural subcounties with adolescents and adults of both sexes. Three Kl were held with: the Catholic Bishop, district women leader and head of a local AIDS NGO. Focus group discussion guide and questionnaire guide were used for collecting information. Notes were taken verbatim and FGD tape recorded. Tapes were transcribed and analysis was done with the master sheet. Results: Condom acceptance was high among urban males and used for prevention of HIV/STD. Adults mainly used them outside marriage. There was low acceptance of condoms among urban adolescent females, but the urban adult females mainly accepted condom use for family planning. In the rural areas, there was poor acceptance in both sexes for adults and adolescents, more pronounced among the females. Key informants observed that condoms were mainly used in the urban area by males while in rural areas the acceptance was still low. Reasons for poor condom acceptance were: fear of condoms remaining inside a woman, requiring operation for removal, fear of condom bursting, public ridicule, husband was against it, condom promotes promiscuity, they are not fully safe. Conclusion: Health education to counteract fears related to condom use prioritizing urban females and rural areas. r
I