Measuring refugees' capabilities: translation, adaptation, and valuation of the OxCAP-MH into Juba Arabic for use among South Sudanese male refugees in Uganda

BACKGROUND

Forcibly displaced populations are highly vulnerable to psychosocial distress and mental disorders, including alcohol misuse. In an ongoing trial that seeks to develop a transdiagnostic intervention addressing psychological distress and alcohol use disorders among conflict-affected populations, we will carry out a cost-effectiveness evaluation using a capability-based Oxford Capabilities Mental Health (OxCAP-MH) measure. The OxCAP-MH is a 16-item questionnaire developed from the Capability Approach, that covers multiple domains of functioning and welfare. The aim of the current paper is to present the results of the translation, cultural adaptation and valuation of the OxCAP-MH into Juba Arabic for South Sudanese refugees living in Uganda. We adhered to the official Translation and Linguistic Validation process of the OxCAP-MH. To carry out the translation, the Concept Elaboration document, official English version of the OxCAP-MH, and the Back-Translation Review Template were used. Four independent translators were used for forward and back translations. The reconciled translated version was then piloted in two focus group discussions (N = 16) in Rhino refugee settlement. A most important to least important valuation of the sixteen capability domains covered in the OxCAP-MH was also done.

RESULTS

The Juba Arabic version of the OxCAP-MH was finalized following a systematic iterative process. The content of the Juba Arabic version remained unchanged, but key concepts were adapted to ensure cultural acceptability, feasibility, and comprehension of the measure in the local context of Rhino refugee settlement. Most participants had low levels of literacy and required support with filling in the tool. Participants suggested an additional capability that is currently not reflected in the OxCAP-MH, namely access to food. Furthermore, discussions around the valuation exercise of the sixteen domains led to two separate importance scales, which showed relevant differences.

CONCLUSIONS

In this context, the OxCAP-MH was considered culturally acceptable. The valuation exercise proved cognitively demanding. Participants voiced confusion over how to answer the questions on the OxCAP-MH instrument due to low levels of literacy. These concerns invite consideration for future research to consider how measures such as the OxCAP-MH can be made more accessible to individuals with low literacy rates in resource poor settings.

New evidence on the prevalence and risk of peripartum mental illness amongst migrant women: A global review of the literature

Migration is known to affect an individual's health and social status, and migrant women who are pregnant or postpartum are known to be at high risk of adverse health and social outcomes. They are at particularly high risk of mental disorders, especially perinatal depression (PND). Previous studies have demonstrated the prevalence of PND may be higher amongst migrant women when compared to the general population. The determinants of perinatal mental disorders amongst migrant women are complex and may include social isolation, discrimination, poor healthcare access, and low levels of emotional and practical support. The consequences of perinatal mental disorders include a high risk of suicidality and depression in the woman, as well as adverse outcomes for the child including a high risk of low birth weight, diarrhoeal disease, and poorer cognitive outcomes. We will present updated data on the prevalence and risk factors for perinatal mental illness (depression, anxiety, post-traumatic stress disorder, psychosis) amongst migrant women (refugee women, and internally displaced women) at a global level. We will synthesize the available evidence which is available to date, and create consensus on the prevalence and risk of perinatal mental illness amongst migrant women. We expect that migrant woman will be at significantly higher risk of perinatal mental illness when compared to the general population. We will discuss appropriate health system responses which may address the health care needs for migrant women in fragile or conflict-affected settings.

Altered breathing mechanics and ventilatory response during exercise in children born extremely preterm

Background

Extreme preterm birth confers risk of long-term impairments in lung function and exercise capacity. There are limited data on the factors contributing to exercise limitation following extreme preterm birth. This study examined respiratory mechanics and ventilatory response during exercise in a large cohort of children born extremely preterm (EP).

Methods

This cohort study included children 8–12 years of age who were born EP (≤28 weeks gestation) between 1997 and 2004 and treated in a large regionalised neonatal intensive care unit in western Canada. EP children were divided into no/mild bronchopulmonary dysplasia (BPD) (ie, supplementary oxygen or ventilation ceased before 36 weeks gestational age; n=53) and moderate/severe BPD (ie, continued supplementary oxygen or ventilation at 36 weeks gestational age; n=50). Age-matched control children (n=65) were born at full term. All children attempted lung function and cardiopulmonary exercise testing measurements.

Results

Compared with control children, EP children had lower airway flows and diffusion capacity but preserved total lung capacity. Children with moderate/severe BPD had evidence of gas trapping relative to other groups. The mean difference in exercise capacity (as measured by oxygen uptake (VO₂)% predicted) in children with moderate/severe BPD was −18±5% and −14±5.0% below children with no/mild BPD and control children, respectively. Children with moderate/severe BPD demonstrated a potentiated ventilatory response and greater prevalence of expiratory flow limitation during exercise compared with other groups. Resting lung function did not correlate with exercise capacity.

Conclusions

Expiratory flow limitation and an exaggerated ventilatory response contribute to respiratory limitation to exercise in children born EP with moderate/severe BPD.

[Stresses and health risks of farm women]

Women farmers have a specific profile both of illness and of complaints, exhibiting a higher frequency of diseases than women of other occupations but, at the same time, registering fewer complaints. Women farmers tend to consider their own state of health less satisfactory than do other women but demand medical attention less readily. This seemingly contradictory picture is discussed and interpreted, taking into consideration the special situation of these women and the stress factors to which they are subjected. The results were taken from an study conducted in southern Wuerttemberg in 1990 during the course of which 775 farmer's women were questioned about their state of health.