Geneva Health Forum Archive

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Psychosocial and Educational Support Programme for Tsunami-Affected Children: A Multi-Dimensional Model

Author(s): S. Mendis*1, S. Amarasena2
Affiliation(s): 1Physiology, 2Paediatrics, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
Keywords:

Tsunami, displaced, psychosocial support, poverty, multi-dimensional intervention, dysfunctional families, inter-ethnic harmony, education

Background:

In the morning of 26th December 2004, the Tsunami struck Sri Lanka causing unprecedented damage to life and property to most coastal areas. Of over 35,000 dead, the southern district of Galle accounted for nearly 9,000. A large number of survivors were destitute and displaced. Seeing the enormity of the resultant human suffering, we formed a Tsunami relief organization named the Southern Tsunami Trust (STT). Our scope was to reach affected children in 3 badly affected areas within the Galle District – one of which was a village with a Muslim population and two villages with predominantly Sinhala populations.

Summary/Objectives:

Interconnected multiple objectives: (i) to assist families financially by offering scholarships to the children to re-establish themselves in their educational pursuits in school; (ii) to give psychosocial support to children who were in differing states of psychological distress due to loss of one or more parents or siblings, displacement, destitution and grinding poverty; (iii) use this opportunity to establish a model multi-dimensional interventional approach to bring some equilibrium to dysfunctional families and (iii) develop unity in distress among Muslim and Sinhala ethnic groups and develop inter-ethnic harmony. The programme of activity commenced in July 2005. The project was to conduct a three year scholarship and psychosocial support programme to assist selected children (in 5 age groups – 6-7; 8-9; 10-11; 12-13; 14-16 years) by giving them psychosocial support and facilitating their education and related activities. The programme was to strengthen these children psychosocially who would otherwise have been in danger of post-traumatic stress disorder of differing magnitude and possibly developing into anti-social elements in adulthood. A Youth Centre was established for this purpose.

Results:

The following has been achieved during the past 30 months: (i) A small library of children’s books was established including daily newspapers. We have been successful in cultivating a ‘thirst’ for books and knowledge among children who have never read even a newspaper. The children were encouraged to purchase books from the scholarship funds and establish home libraries. (ii) Dysfunctional families – particularly due to alcoholic fathers and negligent mothers – have been brought in to the STT centre for counselling and support. ‘Incentive’ used was that the scholarship was tied to the acceptance of the fathers entering into a supervised drug/alcohol rehabilitation process. (iii) Medical and health monitoring of children and their families and referral to specialist centres when necessary. (iv) Computer awareness (IT) programme, developing skills in art and aesthetics (singing and dancing), improving language skills (English) have been established. (v) Sport and outdoor recreational activities, TV facilities and audio-visual educational programmes.

Lessons learned:

The change in the lives of these children and improvements in inter-relationships within previously dysfunctional families that we have observed have been a source of great satisfaction to us. We consider this a model for achieving simple goals for enhancing mental health and education of not only Tsunami or disaster-affected villages, but also as a strategy for public health intervention in a developing country.

Prehypertension: A warning signal for action! Prevalence of Hypertension and Prehypertension and Associated Modifiable Risk Factors among Women in Delhi

Author(s): M. Gupta*1, D. Taneja2, P. Lal2, M. Daga3, G. Ingle2
Affiliation(s): 1Community Medicine, Kasturba Medical College, Manipal, Karnataka, 2Community Medicine, 3Medicine, Maulana Azad Medical College, Delhi, India
Keywords: Hypertension, prehypertension, risk factors, stress, sedentary, women
Background:

The rising incidence of Hypertension is being recognized as a public health problem and is strongly related to the aging of the population, urbanization and socio-economic changes favouring sedentary life style ,obesity, alcohol and tobacco consumption, high salt intake and mental stress.

Summary/Objectives:

To study the prevalence of hypertension, prehypertension and associated modifiable risk factors among women 18-40 years in an urban resettlement colony of Delhi. Study design: Cross-sectional community based. Study period: March-May 2005. Study Area: Urban resettlement colony of Delhi. Study population: 18-40 year-old women. Sample size: 450. Data collection: A pre-designed and pre-tested semi-structured questionnaire was used to collect information on identification data, socio-demographic profile, presenting complaints, past history, assessment of risk factors including salt intake, physical activity, mental stress, alcohol and tobacco consumption. Weight, height and blood pressure were recorded.

Results:

The mean age of the study participants was 27.54 + 6.9 years. The prevalence of hypertension in the study group was 9.4% (CI: 6.7-12.1) while almost half (48.2%) fell under the category of prehypertensives. Out of the total 42 screened hypertensive patients in our study 11 were unaware of their condition (26.2%). A statistically significant rising trend of BP was observed with age .The prevalence of risk factors of hypertension among the study subjects was as follows: High salt intake (10.9%), BMI> 25.0 (17.3%), BMI >30.0 (5.1%), central obesity (11.1%), mental stress (6.4%) and sedentary lifestyle (55.8%). Smoking was reported in 1.5% study subjects while none of the women in our sample reported alcohol consumption.

Lessons learned:

The prevalence of prehypertension in the study sample was reported to be high. Thus emphasis should be laid on those with BP in the pre hypertensive stage as they are the ones most predisposed to develop hypertension in future and prevention at this step can prevent a major financial burden for the nation. Almost a quarter of screened hypertensives were unaware of their BP status. The results of the present study indicate the need to plan and implement actions on prevention, detection and treatment of hypertension as a part of a comprehensive programme of hypertension control in the community. Only a comprehensive strategy based upon the public health approach will be able to stem the increasing prevalence of risk factors of hypertension.

Assessing Hand Hygiene Perception: Compliance and Structures in a University Hospital in Mali

Author(s): B. Allegranzi*1, L. Bengaly2, D. K. Minta3, A. Traoré2, H. Richet1, P. Bonnabry4, D. Pittet5
Affiliation(s): 1World Alliance for Patient Safety, World Health Organization, Geneva, Switzerland, 2Pharmacie, 3Maladies Infectieuses, Centre Hospitalier Universitaire du Point G, Bamako, Mali, 4Hospital Pharmacy, 5Infection Control Programme, University Hospitals of Geneva, Switzerland
Keywords: Hand hygiene, healthcare-associated infections, prevention
Background:

Optimal compliance with hand hygiene (HH) during healthcare delivery is the most effective measure to prevent healthcare-associated infections (HAI), but compliance remains unacceptably low in many healthcare settings worldwide. New Guidelines on HH in Health Care have been developed by the WHO, including a multimodal strategy and tools to translate recommendations into practice at facility level.

Summary/Objectives:

A project to implement the WHO multimodal HH improvement strategy is ongoing at the University Hospital Point G in Bamako, Mali. Actions to improve HH were planned following a baseline survey conducted from June to August 2007 in the following services: two surgical units; urology; nephrology and dialysis; obstetrics and gynaecology; internal medicine, infectious diseases, intensive care and emergency. The perception of HH and its impact on HAI among senior managers and healthcare workers (HCWs) were assessed by two targeted questionnaires. HCW HH compliance with five main indications was measured using the WHO method of direct observation. A survey of the availability of products and structures to enable staff to perform HH was also conducted.

Results:

Questionnaires were completed by 27 senior managers and 163 HCWs. Senior managers ranked the impact of HAI on morbidity and mortality and healthcare costs as ‘high’ and ‘very high’ (86.4% and 86.9%, respectively), whereas only 49% of HCWs gave the same score to HAI impact. Both senior managers and HCWs rated the importance of HH to prevent HAI as “high” and “very high” (65.4% and 81.4%, respectively). According to the opinion of 66.6% of senior managers and 71.7% of HCWs, HH compliance rates in their institution were high (40-60% and >70%, respectively). During healthcare delivery, 1927 HH opportunities were directly observed by a trained and validated observer and overall compliance rate was as low as 8%. Compliance was higher among physicians and medical students (20.2% and 13.6%, respectively) than among midwives, nurse students and nurses (7.1%, 6.4% and 4.3%, respectively). Higher compliance was observed with the indications “after patient contact” (16.3%) and “after exposure to body fluid” (15.4%). HH was performed by handwashing in 68.1% of actions or by rubbing with ethanol 90% v/v. The structure survey showed that alcohol-based handrub formulations are never available at the point of care in this hospital. Sinks are installed in only 14.3% (10/70) patient rooms, and soap and towels are available at only 47.4% of sinks.

Lessons learned:

Collected data and correlation between the different surveys were carefully scrutinized and openly discussed by a committee representing all professional categories. The discussion was invaluable to understand deficiencies and responsibilities and to identify solutions for improvement. Despite senior managers’ and HCWs’ high awareness of the preventive value of optimal HH, its practice in the facility was greatly overestimated compared with actual compliance rates which were abysmally low. These aspects led to a clear acknowledgment of the need to improve staff motivation and knowledge and to catalyze advocacy by senior managers and key role players. The structure survey allowed for understanding that poor compliance in this hospital is partly due to a huge lack of products for HH. Local production of a WHO-recommended alcohol-based handrub was undertaken by the hospital pharmacy. A massive HH promotion campaign focused on data feedback, staff education and the distribution of pocket bottles of alcohol-based handrubs to HCWs was launched in November 2007. The impact of these activities will be measured after 5 months by the same surveys undertaken for baseline assessment.

A Follow Up Study on the Quality of Alcohol Dependence Related Information on the Web

Author(s): Y. Khazaal*1, O. Coquard2, D. Zullino3
Affiliation(s): 1Psychiatry, University Hospitals of Geneva, Switzerland, 2Lausanne University Hospital, 3University Hospitals of Geneva, Switzerland
Keywords: Internet, quality indicators, healthcare, alcohol, addiction
Background:

Internet is frequently used as a source of information on health issues. This makes it is particularly important for websites to present high quality and accurate information on a health-related topic such as alcohol dependence. However, there has been a general concern about the quality of web-based health information designed for consumers. In a review evaluating the quality of consumer health information on the Internet, most papers conclude that quality was a problem. This finding holds true in the area of mental health. Most available studies on this topic have however a cross sectional design and little is now about the evolution of the quality of web-sites over time.

Summary/Objectives:

The objective of the present study is to evaluate a one year evolution of web-based information on alcohol dependence. Sites assessed in June 2006 were re-assessed in July 2007 using the same evaluation procedure. Websites were assessed with a standardized pro-forma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality. ‘Health on the Net’ (HON) quality label, and DIS- CERN scale were also used.

Results:

Of the 45 websites identified in June 2006, 38 were still existed. A high reliability of scores was found for all components of the pro-forma (r= 0.77 to 0.95 p<0.01). By ANOVA for repeated measures, there was no time effect, no interaction between time and scale, no interaction between time and group (affiliation categories), and no interaction between time, group and scale. Distribution of the sites in term of affiliations remained exactly the same (government: 2.6%; non profit organization: 47.40%; University: 7.90%; individual: 21.2; unknown: 2.10%). Conclusions: The study highlights lack of evolution of web pages across a one year follow-up.

Lessons learned:

Despite some limitations, this study brings to evidence lack of evolution of web pages across a one year follow-up and highlight the good test-retest properties of the evaluating instruments used in the present study. Furthermore it seems that Universities and governments are poorly involved in the development of websites for general consumer.

African Partnership For Patient Safety in Cameroon: The Story So Far

Author(s): V. Djientcheu1
Affiliation(s): 1Department of Neurosurgery, Yaoundé Central Hospital, Yaoundé, Cameroon
Keywords: Hospitals, Patient Safety, Developing Countries, Cameroon, Africa
Background:

Safe effective care is a WHO priority. In May 2004, the WHO World Alliance was created to act as a major force for improvement internationally and to mobilize efforts to protect patients from adverse effects of care in health systems across the world. In Cameroon, momentum on patient safety has been gradually increasing. In September 2008, 27 African Health Ministers as well as their homologue Cameroonian signed their support for action on health care-associated infections at a special ceremony that was part of the WHO AFRO Regional Committee Meeting. Also in September 2008, a scientific day on hand hygiene took place at the Central Hospital of Yaoundé (CHY) and was transmitted through the Francophone African Network (RAFT). The expert lead of the First Global Patient Safety Challenge visited the 4 University Hospitals of Yaoundé, a district (Effoulan) and a Regional Hospital (Bafoussam) as proposed by the Minister of Public Health. All these events were critical to laying the foundation for APPS in Cameroon.

Methods:

In early 2008, the Central Hospital of Yaoundé (CHY) was designated as the Cameroonian first wave hospital to accompany the 5 other first wave hospitals in Africa (3 francophone and 3 Anglophone). The local focal point was appointed and participated in a workshop in Geneva in May 2009 to shape the programme with all other APPS focal points. The APPS programme was defined and the model of partnership working between CHY and Hôpitaux Universitaires de Genève (HUG) was adopted. The situational analysis was conducted in the CHY in June 2009. In October 2009, the Uganda Workshop allowed the CHY-HUG action plan to be finalized based on the situational analysis. The CHY-HUG action plan focused on hand hygiene and the control of health care associated infections, knowledge and learning on patient safety and the protection of health care personnel. The different members of the CHY APPS team were assigned to a specific task including continuous training (nurse), infection control (nurse), control of hospital waste (nurse), production of alcohol based hand rub (pharmacist), protection of health care personnel (nurse) and communication (CHY focal person). A member of the community was designated to develop the hospital-community interface on patient safety. Local implementation has already started with continuous training and sensitization of personnel. Two nurses will be trained on ABHR production in Mali in April 2010. Enquiries on health worker immunization status has also started.

Results/Conclusions:

Safe care will become a reality in the CHY through continuous learning and improvement in key action areas. The sustainability of this program will be achieved by ensuring mechanisms for the ongoing training of health professionals for infection control, continued sensitization and through integrating patient safety activities within the CHY care environment.

Terror as a Bargaining Instrument: How Violence against Women Relates to Health Hazards Due to Dowry Practices in a Developing Country

Author(s): B. Joshi*1, D. D. Bajgai2
Affiliation(s): 1Rural Development, Tribhuwan University, ktm, 2Community Health, Women Health and Environmental Society Nepal, DHI, Nepal
Keywords: Health crisis, violence, women, dowry, reproductive health, Nepal
Background:

At least one woman in every twelve has been beaten, coerced into sex, may death or otherwise abused in her own family. Increasingly, violence against women is recognized as a major public health concern and a violation of human-rights. In poor developing communities this may be due to either for dowry system, gender-inequality, illiteracy, multimarriage, poverty, early-forced marriage, alcohol and drug abuse, girls trafficking. This creates fatal outcomes such as suicide, homicide, abortion, injury, handicapped, family broken, infectious diseases, prostitution, mental and reproductive health problem.

Methods:

Epidemiological survey and counseling in a random samples of families, factory workers and hospital female patients, adolescents students, clients of rehabilitation centre with females(n=1508) from different communities and caste were interview and taken the both qualitative and quantitative data(Feb. 2007- October 2009), so were analyzed and edited in EPI info program.

Results/Conclusions:

The analysis showed the violence due to poverty and illiteracy is 47 %, domestic violence because of dowry system is 39 %,abused by their own family or husband(drug and alcohol) is 11 %, other causes is 3% including girls trafficking and in streets. This study revealed the need to develop appropriate intervention program would be emphasing the target communities. Due to illiteracy, poverty, gender inequality women and girls are facing with spousal battering , sexual abuse of female children, dowry related violence, rape including marital rape, traditional practices harmful to female, no spousal violence, sexual harassment and intimidation at work and in school, trafficking of women, forced prostitution, rape in war, female infanticide, constant belittling includes controlling behaviors such as isolation from family and friends, monitoring her movements, restrict her access to resources.
Healthcare providers can minimize these issues by giving empathy and psychosocial support, change behaviors and attitude providing medical treatment, offer counseling ,documents injuries and refer their clients to legal assistance and support services, family planning and other mental and reproductive healthcare. Peer-educators (healthcare workers and medical students) approach for prevention of violence are cost effective, sustainable, easy access to-hard-to reach groups. Govenment,NGOs,INGOs also have crucial role to work hand to hand in this issues by empowering female, law and policy, equal education and economic opportunities to female.

Are Social and Economic Factors Associated with Cognitive Impairment in Patients Attending an HIV/AIDS Treatment Centre in Yaoundé, Cameroon?

Author(s): D. M. Njamnshi*1, J. Y. Fonsah2, C. Kouanfack1, A. K. Njamnshi3, E. N. Tabah4
Affiliation(s): 1Day Care unit, 2Neurology Unit, Central Hospital Yaounde, 3Neurology Unit, FMBS, UYI/ Central Hospital Yaounde, 4Disease control, MINSANTE, Yaounde, Cameroon
Keywords: HIV/AIDS, Socio-economic status, ARV, cognitive impairment, Cameroon
Background:

HIV-associated cognitive impairment (HACI) describes difficulties with thinking, problem-solving and concentration in addition to memory impairment that is not severe enough to fulfill the DSM-IV criteria for dementia. HACI is a frequent complication of HIV/AIDS not often diagnosed in poor context. Poverty and overcrowding in homes for example have clearly been associated with HIV transmission1. However, the impact of social and economic factors on the cognitive status of HIV-AIDS patients has been examined only by few studies in Cameroon. We hypothesized that the social and economic status of patients may affect access to Anti-Retroviral (ARV) drugs, treatment compliance and adherence, and subsequently predispose them to cognitive impairment in Yaoundé, Cameroon.

Methods:

Patients who signed a consent form were interviewed and examined for possible cognitive impairment at the Day-Care Hospital, Yaoundé Central Hospital between October and December 2006. Possible cognitive impairment was measured using the international HIV dementia Scale – IHDS with a cut-off score of < 10 [1 and 2Administrative authorisation and ethical clearance for research were obtained prior to recruitment.

Results/Conclusions:

The female to male ratio was 2.4:1%, n = 94. The mean age of the sample was 37.3 ± 8.9 years. The mean age of the males was 41.52 ± 8.99 years; that of females was 35.5 ± 8.38 years, p = 0.003. Concerning marital status, 50 (54.3%) of the patients were currently married while 21.7% were single. Fifteen (16.3%) were widowed and 7 (7.6%) were divorced. Of those once married, 76.2% were involved in monogamous relationships and 23.8% were in polygamous relationships. For the patients with stable relationships, their partners were mainly housewives (25.4%), farmers (10.2%), or uniformed men/women (10.2%). A high percentage of the whole sample consisted of housewives (22.8%), followed by individuals in business (17.4%) and then the unemployed (14.1 %). Half of the patients (50.0%) had up to secondary school level education, while 38.0% had primary education and 9.8% had attended university; 2.2% never had any formal education. Considering risk behaviour assessment, all the respondents were sexually active, 65.8% having multiple sexual partners. Only 12.0% reported regular use of condom against 25.0% that never used one (p = 0.007). Marital status did not seem to affect condom use significantly. Cognitive impairment was not determined by the number of current and/or past sex partners; X2 = 19.38, p = 0.15. Almost half (42.4%) of the patients were occasional consumers of alcohol. Alcohol consumption was significantly associated with the availability of a stable source of income; p = 0.007, but did not influence cognitive status assessment outcome; X2 = 5.12, p = 0.64. We did not find any IV drug users nor homosexuals in the sample. Concerning tobacco smoking, 4.3% of the respondents accepted being smokers. None of the respondents had tattoos but up to 81.5% of them had scarifications. All the respondents were socially independent with respect to the basic social functions such as the ability to cook, clothe oneself, buy and sell without difficulties of calculation and finding oneself in and out of the home. More than half (55.4%) of the respondents had a stable source of income. Up to 25.5% of these lived on < $20 US per month; 23.5% declared an income of > $200 US/month, and 5.9% an income between 100 and $200US. The payment for the ARV treatment was afforded by 52.2% of patients themselves while the rest received help from family members (30.4%), husband (9.8%), and NGOs (7.6%).

Frequency of Road Accidents in Prishtina in the Period 2005-2008

Author(s): B. Z. Lenjani*1, B. S. H. Gjikolli2
Affiliation(s): 1Emergency Center, University Clinical Center of Kosova, Prishtine, Republic of Kosova, Bosnia and Herzegovina, 2Institute of Radiology, Institute of Radiology, Prishtine, Republic of Kosova
Keywords: Emergency center, traffic accident
Background:

On the basis of data, approximately 15,000-17,000 thousand people die worldwide in traffic accidents as a consequence of all types of injuries. Body injuries comprise 12% of the specific weight of diseases. The traffic accidents are ranked in the third group as a main cause of death for the age 1-40 years (1,3,5). Following the 1999 war, many radical social-economic changes have happened in Kosovo, accompanied by a very rapid dynamic development in the field of road transport. Within the shortest time, there was an enormous increase in number of vehicles in our country. This increase was also accompanied with an increase in the number of accidents on the streets of Kosovo. According to WHO, deaths from road accidents compose 23-25% of all deaths from injuries (2,4,6). Approximately 85% of deaths in the world-wide road traffic happen in the streets, 90 to 96% of children are threatened by death as a result of road accidents occurring in countries with a low or medium economic level.

Methods:

This study is descriptive. Data are used from the treatment database of the Emergency Center. The period January 2005-December 2008 has been considered for this paper. The used criterion for this research was the distribution of vehicle accidents on a yearly basis, injuries based on systems, vehicle drivers based on their sex, age, causes, accident location, road type, accident type and presence of driving permit.

Results/Conclusions:

The injured in traffic accidents who have sought emergency medical assistance in the Emergency Center within the period January 2005-December 2008. The total number of of patients in the Emergency Center within the period January to December 2005 was 44,111, from which 2,235 or 5.06% were from road traffic accidents. From this number Pristina had 772 accidents, Pudujeva 241, Drenas 13s, Lipjan 132, F. Kosovo 104. Total deaths in road traffic accidents were 41 or 1.83%. In the period January to December 2006 the total number of patients in the Emergency Center was 43,610, with a total number of 915 or 2.09% injured in road traffic accidents. Pristina had 324 accidents, Podujeva 87, Lipjan 58. Total deaths in road traffic accidents were 16 or 1.74%. In the period January to December 2007 the total number of patients in the Emergency Center was 44,228, and the total number of injured from road traffic accidents was 2,774, or 6.27%. Pristina had 1,071 accidents, Pudujeva 309, Drenas 184, Lipjan 170, F. Kosovo 171, Obiliqi 104. Total deaths in road traffic accidents were 28 or 1.00%. In the period January to December 2008 the total number of patients in the Emergency Center was 41,614, and injured from road traffic accidents were 2,384, or 5.72%. Pristina had 849 accidents, Pudujeva 277, Drenas 149, Lipjan146, F. Kosovo 110. Total deaths in road traffic accidents were 32 or 1.43%. The results of the research conducted in the Emergency Center during the period 2005-2008 are showing an enormous increase in the number of road traffic accidents. In this increase, except reasons mentioned above and among others, the following factors have contributed: enormous increase of number of persons equipped with driving license (5,6), driving speeds above permitted norms are considered a primary cause of road traffic accidents. An important factor that has influenced the cause of accidents was the consumption of alcohol before or during driving the vehicle, non-wearing of seat belts and protective helmets. The worldwide data show that the role of the safety belts enables a reduction of health consequences (1,2,3). We don’t have any precise data from the Kosovo police service in regard to the existing correlation between wearing the safety belt and the degree of damage to the injured, as these data are not taken by the traffic police when an accident happens. The negligence of pedestrians continues to remain a matter of concern and the pedestrians are considered as a vulnerable group (7.8).

Prevalence of Alcohol Problems in a Teaching Hospital in Eastern Nepal

Author(s): B. Pradhan*1, S. Chaudhary1, S. Rijal1, P. Karki1, F. Chappuis2, A. Hadengue3, P. Gache4
Affiliation(s): 1Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal, 2International and Humanitarian Medicine, 3Gastroenterology and Hepatology, 4Médecine Communautaire et de premier recours, University Hospitals of Geneva, Geneva, Switzerland
Keywords: AUDIT questionnaire, SCID for DSM IV, Alcohol problems
Background:

Drinking alcohol is a very common habit in Nepal. Nepali people drink homemade alcoholic beverages as well as alcohol commercially available. Alcohol problems are a major health issue in Nepal and remain under-diagnosed. Screening for alcohol problems is particularly challenging in the busy outpatient clinic and in the inpatient wards. Reliable epidemiological data about alcohol consumption and problems are missing in Eastern Nepal.

Methods:

During the 6 month-inclusion period (15th March to 15th September 2009), we randomly included one fifth of the patients attending the department of internal medicine who were over 18 years, were in a stable medical condition and signed the informed consent . During the study period, two trained clinical nurses interviewed each included subject with the Nepali version of AUDIT (a ten-item self report questionnaire on alcohol intake and alcohol related problems) and the CAGE questionnaires. The medical alcohol history was then completed with the Structured Clinical Interview for DSM IV for alcohol abuse and dependence and the timeline follow-up questionnaire

Results/Conclusions:

1332 individuals aged from 18 to 91 years (53.6% males) completed the evaluation, out of which 89.5% were out-patients; Mean age was 53.22 +/-15.20 years for males and 50.48 +/-15.11 years for females. 96.6% were married and Hinduism was the most prevalent religion (83.2%). In our sample 89.2% were drinkers. Among drinkers two thirds drank daily. The prevalence of alcohol dependence (32.3%) and abuse (11.8%) were very high. The CAGE and AUDIT questionnaires confirm the high prevalence of alcohol problems in this population, with respectively 52.8% and 45.4% positive results. Positive AUDIT questionnaires show the severity of alcohol problems in our studied population. Nepali version of the AUDIT was well accepted by included patients. Conclusion: In accordance with the few previous findings, our study confirms the high prevalence of alcohol dependence. Specifically, our study reveals high prevalence of alcohol abuse and excessive consumption in Nepal. Intervention studies are needed to decrease the burden of alcohol issues in Nepal. The widespread use of simple and locally validated screening tools such as the CAGE and AUDIT would improve patients’ access to appropriate management of alcohol dependence and abuse.

Participatory Learning: An Approach for Empowering Vulnerable in Drug Infested Settings

Author(s): K. K. Ganguly*1
Affiliation(s): 1Reproductive Health and Nutrition, ICMR, New Delhi, India
Keywords: Community Participation, Participatory Learning, State Health Care, Drug
Background:

Participatory Learning and Action (PLA) is an umbrella term for a wide range of qualitative methods of process oriented, participant evaluative research. The evaluations have been organized as action research, (Cornwall & Jewkes (1995), Hart & Bond (1995), aiming at facilitating the participants’ own analysis, planning and ongoing evaluation of the process. The interactive involvement of many people in differing institutional contexts has promoted innovation and ownership, with many variations in the way that systems of learning have been put together. 1-Creating participation and empowerment among the dependents of the addicts 2-Creating more flexibility and co-operation within the system to make the process participatory.

Methods:

The methodology is concerned with the transformation of existing activities to try to bring about changes which people in the situation regard as improvements. The role of the «expert» is best thought of as helping people in their situation carry out their own study and so achieve something. These facilitating experts may be stakeholders themselves, leading to sustained action. The learning process leads to debate about change, and debate changes the perceptions of the actors and their readiness to contemplate action. Action is agreed upon, and implementable changes will therefore represent an accommodation among the different conflicting views. The debate or analysis both defines changes which would bring about improvement and seeks to motivate people to take action to implement the defined changes. This action includes local institution building or strengthening, thus increasing the capacity of people to initiate action on their own.

Results/Conclusions:

The spouses and children of alcoholics /drug addicts are the silent sufferers and feel the negative effects of the presence of drugs or alcohol dependent persons in the family. These include inappropriate coping mechanisms, co-dependency, self neglect and denial, which are manifested in day to day life.The NGO, chalked out vocational rehabilitation programme on need based assessment while working with the help of resource persons from the community and other volunteers (mainly the dependents of addicts). More than 200 alcohol/ drug affected individuals and their families joined, the study. A government department provided funds to run vocational programmes in various handicrafts for these families. In a span of five years (1993-1998), four batches of trainees (including 40 trainees in each batch) in ethnic and traditional crafts were produced by the programme with the help of the dependents of the addicts in cooperation with the NGO and the funding agency.Siblings, who mostly performed the role of garcon in their father’s drinking, changed his way after training with minimum domestic violence became minimum and addicts hospitalization was possible. In the present programme, out conclusion is that the concept of intermingling training, social empowerment, and enhancement of coping skills to deal with alcohol/drug problem at family levels is worth emulating. The group sessions, disseminating information on their day to day problems as well as specific issues raised by them, helped these young trainees to cope with the conflict and crisis. The low self esteem, feeling of helplessness and indifferent attitude towards life as a direct and indirect result of alcohol/drug problem in their respective families made the rehabilitation process a daunting task. The induction of community members, parents and at times addicts was a welcome move and appreciated by all.