Engaging community voices to assess Kenya's strengths and limitations to support a child maltreatment prevention program

Adverse childhood experiences and cognition: A cross-sectional study in Xhosa people living with schizophrenia and matched medical controls

BACKGROUND

Adverse childhood experiences (ACEs) are associated with impaired cognitive function in adult life in the general population as well as in people living with schizophrenia (PLS). Research on cognitive function in PLS in low- and middle-income countries (LMIC) is, however, limited. The objectives of this study were to investigate the association between ACE types and various cognitive domains in a sample of PLS and matched medical controls, and to determine the moderating effect of group membership (PLS vs. medical controls) on these associations, in the South African setting.

METHODS

Participants (n PLS = 520; n medical controls = 832) completed the Childhood Trauma Questionnaire-Short Form, the Structured Clinical Interview for DSM-IV (SCID-I), and the University of Pennsylvania Computerized Neurocognitive Battery (PennCNB). An efficiency or speed score was used to assess performance across 9 cognitive domains. The association between exposure to different ACE types and 9 cognitive domains was examined using partial correlations and multiple linear regression models, adjusting for sex, age and education years. Finally, potential moderating effects of group membership (PLS vs. medical controls) on the association between ACEs and cognitive domains were tested.

RESULTS

In the entire sample, emotional and physical abuse predicted worse performance on sensorimotor and emotion identification domains. Also, emotional abuse was negatively associated with motor function, physical abuse was negatively associated with spatial processing, and physical neglect was negatively associated with face memory and emotion identification. In contrast, emotional neglect was related to better performance on abstraction and mental flexibility. No moderating effect of group membership was found on any of these associations.

CONCLUSION

Exposure to ACEs was associated with social and non-social cognition in adulthood, although the magnitude of these relationships was small and similar between PLS and matched medical controls. The nature of these associations differed across ACE subtype, suggesting the need for a nuanced approach to studying a range of mechanisms that may underlie different associations. However, a number of ACE subtypes were associated with worse performance on emotional identification, indicating that some underlying mechanisms may have more transversal impact. These findings contribute to the sparse body of literature on ACEs and cognition in PLS in LMIC.

Preventing Alcohol-Related Harm in East Africa: Stakeholder Perceptions of Readiness across Five Countries

OBJECTIVE

While alcohol-related harm is a recognized public health priority, the capacity to address and mitigate its harm is lacking, primarily in low-income countries. Recent developments including new tools that can assess readiness for preventing alcohol-related harm, specifically in low-resource settings, can be used to determine strengths and opportunities for supporting, planning, and resource allocation. In this study, we determined the perceptions of readiness and capacity for the prevention of alcohol-related harm across East Africa among stakeholders engaged in such work.

METHODS

We conducted a cross-sectional survey in 2020, distributed by the East Africa Alcohol Policy Alliance to their member alliances and stakeholders across five countries in East Africa (i.e., Burundi, Kenya, Rwanda, Tanzania, and Uganda). The survey included modified measures from the Readiness Assessment for the Prevention of Child Maltreatment (RAP-CM) short form, organizational size and funding, research capacity and priorities, and perceptions related to alcohol prevention and harm both locally and in the region. Analyses were computed based on 142 persons/organizations completing the survey.

RESULTS

In terms of general readiness, the overall adjusted aggregate score for East Africa was 39.70% (ranging from 30.5% in Burundi to 47.0% in Kenya). Of the 10 domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol prevention (8.43), institutional links and resources (6.15) and legislation, mandates and policies (5.46) received the highest scores. In contrast, measures pertaining to resources (i.e., material, human, technical, and informal) received the lowest score.

CONCLUSIONS

Our results demonstrate substantial variability in the readiness to address alcohol-related harm across East Africa. The highest capacity was noted for knowledge towards alcohol prevention, institutional links, and legislative mandates and policies. However, important gaps were noted in terms of attitudes towards alcohol prevention, the will to address the problem, as well as material, human, and informal resources, which need to be urgently addressed to strengthen capacity for addressing and mitigating the significant toll of alcohol-related harm in the region.

A readiness assessment for the prevention of alcohol-related harm in West Africa: A new methodological approach to inform practice and policy

OBJECTIVE

Alcohol-related harm is a growing concern globally and particularly in West Africa. However, tools for assessing the readiness for prevention of alcohol-related harm in low-resource settings have been lacking. We modified the WHO tool, the Readiness Assessment for the Prevention of Child Maltreatment Short Form (RAP-CM), to assess readiness for the prevention of alcohol-related harm across West Africa.

METHODS

We conducted a cross-sectional survey in the fall of 2020, distributed by the West Africa Alcohol Policy Alliance to their member alliances and stakeholders, predominantly community-based organizations (CBOs) and non-governmental organizations (NGOs), across 7 countries in West Africa (N = 140). The survey included modified measures from the RAP-CM short form.

RESULTS

In terms of general readiness, the overall adjusted aggregate score for West Africa was 45.0% (ranging from 42.9% in Liberia to 52.7% in Senegal). Of the ten domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol-related harm prevention (8.3) and legislation, mandates, and policies (6.7) received the highest readiness scores. The lowest readiness scores were observed for human and technical resources (2.5), attitudes toward preventing alcohol-related harm (2.7), and the will to address the problem (2.9).

CONCLUSIONS

Our results demonstrate substantial variability across domains in the readiness to address alcohol-related harm with clear strengths and limitations for future priority setting and capacity building. The barriers to progress include attitudes toward alcohol-related harm prevention, lack of willingness to address the problem, and limited human and technical resources available. These barriers need to be mitigated to address the high burden of alcohol-related harm in the region and to inform both practice and policy.

The Prevention of Child Maltreatment: Using SafeCare® to Highlight Successes and Needs for Improvement in Prevention Efforts

Child maltreatment is a public health problem of considerable magnitude. Though substantial progress has been made in the prevention of child maltreatment, one incident of maltreatment is one too many. Intervention and/or prevention efforts must always be dynamic. In this commentary, we highlight recent prevention and policy efforts in the United States, using SafeCare, an evidence-based parent support program with a focus on the prevention of neglect, as an example. We describe broad-scale implementation efforts and offer a vision for what the field must do to realize public heath impact, highlighting recent advances of parent support models in policy, advocacy, and programs. Strategies that might improve current efforts are suggested to ensure the field not become static.

Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach: a study protocol

BACKGROUND

Delivering evidence-based interventions to refugee and immigrant families is difficult for several reasons, including language and cultural issues, and access and trust issues that can lead to an unwillingness to engage with the typical intervention delivery systems. Adapting both the intervention and the delivery system for evidence-based interventions can make those interventions more appropriate and palatable for the targeted population, increasing uptake and effectiveness. This study focuses on the adaptation of the SafeCare© parenting model, and its delivery through either standard implementation methods via community-based organizations (CBO) and a task-shifted implementation in which members of the Afghans, Burmese, Congolese community will be trained to deliver SafeCare.

METHOD

An adaptation team consisting of community members, members of CBO, and SafeCare experts will engage a structured process to adapt the SafeCare curriculum for each targeted community. Adaptations will focus on both the model and the delivery of it. Data collection of the adaptation process will focus on documenting adaptations and team member's engagement and satisfaction with the process. SafeCare will be implemented in each community in two ways: standard implementation and task-shifted implementation. Standard implementation will be delivered by CBOs (n = 120), and task-shifted implementation will be delivered by community members (n = 120). All interventionists will be trained in a standard format, and will receive post-training support. Both implementation metrics and family outcomes will be assessed. Implementation metrics will include ongoing adaptations, delivery of services, fidelity, skill uptake by families, engagement/completion, and satisfaction with services. Family outcomes will include assessments at three time points (pre, post, and 6 months) of positive parenting, parent-child relationship, parenting stress, and child behavioral health.

DISCUSSION

The need for adapting of evidence-based programs and delivery methods for specific populations continues to be an important research question in implementation science. The goal of this study is to better understand an adaptation process and delivery method for three unique populations. We hope the study will inform other efforts to deliver health intervention to refugee communities and ultimately improve refugee health.