Non-fatal suicidal behaviour in rural Ethiopia: a cross-sectional facility- and population-based study

BACKGROUND

Injury related to self-harm is one of the leading causes of global disease burden. As a formative work for a programme to implement comprehensive mental healthcare in a rural district in Ethiopia, we determined the 12-month prevalence of non-fatal suicidal behaviour as well as factors associated with this behaviour to understand the potential burden of the behaviour in the district.

METHOD

Population-based (n = 1485) and facility-based (n = 1014) cross-sectional surveys of adults, using standardised, interview-based measures for suicidality (items on suicide from the Composite International Diagnostic Interview), depressive symptoms (the Patient Health Questionnaire) and alcohol use disorders (Alcohol Use Disorder Investigation Test; AUDIT).

RESULTS

The overall 12-month prevalence of non-fatal suicidal behaviour, consisting of suicidal ideation, plan and attempt, was 7.9 % (95 % Confidence Interval (CI) = 6.8 % to 8.9 %). The prevalence was significantly higher in the facility sample (10.3 %) compared with the community sample (6.3 %). The 12-month prevalence of suicide attempt was 4.4 % (95 % CI = 3.6 % to 5.3 %), non-significantly higher among the facility sample (5.4 %) compared with the community sample (3.8 %). Over half of those with suicidal ideation (56.4 %) transitioned from suicidal ideation to suicide attempt. Younger age, harmful use of alcohol and higher depression scores were associated significantly with increased non-fatal suicidal behaviours. The only factor associated with transition from suicidal ideation to suicide attempt was high depression score. Only 10.5 % of the sample with suicidal ideation had received any treatment for their suicidal behaviour: 10.8 % of the community sample and 10.2 % of the facility sample. Although help seeking increased with progression from ideation to attempt, there was no statistically significant difference between the groups.

CONCLUSION

Non-fatal suicidal behaviour is an important public health problem in this rural district. A more in-depth understanding of the context of the occurrence of the behaviour, improving access to care and targeting depression and alcohol use disorder are important next steps. The role of other psychosocial factors should also be explored to assist the provision of holistic care.

Surface glass transition in bimodal polystyrene mixtures

Using the cluster-embedding method of V. Zaporojchenko et al. (Macromolecules 34, 1125 (2000)), we measured the glass transition temperature T (g) at the polystyrene/vacuum interface of bimodal mixtures of monodisperse polystyrenes of 3.5k and 1000k. Embedding of approximately 1 nm Au clusters was monitored in situ by X-ray photoelectron spectroscopy (XPS). The clusters were formed by evaporation of Au onto the polymer surface. Only one glass transition was observed in the mixtures. The surface glass transition temperatures are correlated to but are below the bulk values of the mixtures and obey the Gordon-Taylor equation. The results suggest that the earlier reported molecular-weight dependence of the surface glass transition is not due to segregation of short chains to the surface.

Confidence intervals and sample-size calculations for the sisterhood method of estimating maternal mortality

The sisterhood method is an indirect method of estimating maternal mortality that has, in comparison with conventional direct methods, the dual advantages of ease of use in the field and smaller sample-size requirements. This report describes how to calculate a standard error to quantify the sampling variability for this method. This standard error can be used to construct confidence intervals and statistical tests and to plan the size of a sample survey that employs the sisterhood method. Statistical assumptions are discussed, particularly in relation to the effective sample size and to effects of extrabinomial variation. In a worked example of data from urban Pakistan, a maternal mortality ratio of 153 (95 percent confidence interval between 96 and 212) deaths per 100,000 live births is estimated.

Oestrous synchronisation in Ethiopian highland zebu cattle by means of intravaginal cloprostenole administration

Two series were used in studying the use of a low dose of intravaginal cloprostenole in oestrous synchronisation of zebu cows. In series I, 39 cows were given 175 mcg of cloprostenole with a plastic catheter in the anterior vagina twice, with a 12-day interval. After treatment, 61.5% of these cows came into heat, were inseminated and 70 days later pregnancies were confirmed in 66.6% of inseminated cows. In series II, intravaginal treatment (40 cows) was compared with intramuscular administration (33 cows) of 500 mcg of cloprostenole. After treatment the cows were checked for silent heat in addition to visible heat. The overall oestrous response, for both visible and silent heat, was 62.6% and 60.6% after the intravaginal and the intramuscular treatments respectively, and there was no statistical difference between the 2 treatments. Unfortunately the pregnancy of the cows could not be checked. Intravaginal administration of 175 mcg of cloprostenole resulted in good oestrous synchronisation and pregnancy rate. For zebu cattle, the oestrous synchronisation response was similar to that reached with 500 mcg of cloprostenole administered intramuscularly.

Illness burden and use of health services in a rural community, southwestern Ethiopia

An interview-survey of perceived morbidity in a rural community in south-western Ethiopia was conducted in partial fulfillment of the phased teaching objectives of the under graduate community-based medical education in Jimma. Institute of Health Sciences. Two hundred and seventy household heads were randomly selected to participate in the study, to examine the recall of recent health problems during a two-week period and actions sought for. Of the respondents, 65% reported illness which varied with age and sex. From those reporting illness, 55.4% did not take any action while 30.3% applied to health institutions. Self care and use of traditional healers were reported to be 9.2% and 5.2% respectively. The survey demonstrated a huge burden of perceived morbidity in a rural community for which the sick did nothing much indicating a large amount to unmet needs for the health delivery system, and further study on patterns of illness behaviour.

Maternal mortality in rural communities of Illubabor, southwestern Ethiopia: as estimated by the "sisterhood method"

In this study, the "sisterhood method", a new indirect technique, utilizing a cross-sectional survey by retrospective recall for deriving population-based estimates of maternal mortality for rural communities, was used in rural Illubabor region, Southwestern Ethiopia, in December 1991. The findings indicate a lifetime risk of maternal mortality of 0.0426, or 1 in 23 women; approximating a maternal mortality ratio of 570 per 100,000 live-births. The communities experience high maternal mortality which is compounded by high fertility as reflected by the total fertility rate of 7.6. The method can readily be applied to our settings to estimate the lifetime risk of maternal mortality and derive the maternal mortality ratio. In order to generate awareness, support planning and intervention strategies, community-based estimates of maternal mortality will remain a priority where vital events registration is non-existent and health service statistics are not reliable.