Reexamining epilepsy-associated stigma: validation of the Stigma Scale of Epilepsy in Zambia.

Purpose: Epilepsy-associated stigma is an important patient-centered outcome, yet quantification remains challenging. Jacoby's 3-item Stigma Scale is commonly used to assess felt stigma among people with epilepsy (PWE) yet has ceiling effects. The Stigma Scale of Epilepsy (SSE) is a 24-item instrument that measures felt stigma among PWE and stigmatizing attitudes among others.

Stigma and psychiatric morbidity among mothers of children with epilepsy in Zambia.

Background: Epilepsy-associated stigma contributes substantially to the social, medical, and economic burden of disease for people with epilepsy (PWE), but little is known about its impact on caregivers of PWE.

Methods: To better understand stigma experienced by caregivers of PWE, factors that influence caregiver stigma, and the effect of stigma on a caregiver's psychologic well being, we interviewed 100 caregivers of children with epilepsy in Zambia. Questions assessed maternal knowledge, attitudes, and practices related to epilepsy, maternal stigma, mother's proxy report of child stigma, and maternal psychiatric morbidity.

Peer support groups as an intervention to decrease epilepsy-associated stigma.

Eighty percent of people with epilepsy (PWE) reside in low-income countries where stigma contributes substantially to social and medical morbidity. Peer support groups (PSGs) are thought to be beneficial for people with stigmatized conditions, but little data exist regarding PSG effectiveness. We facilitated monthly PSG meetings for men, women, and youth from three Zambian clinics for one year.

The cost of implementing a nationwide program to decrease the epilepsy treatment gap in a high gap country.

Healthcare systems in many low income countries have evolved to provide services for acute, infections and are poorly structured for the provision of chronic, non-communicable diseases which are increasingly common. Epilepsy is a common chronic neurologic condition and antiepileptic drugs are affordable, but the epilepsy treatment gap remains >90% in most African countries. The World Health Organization has recently released evidence-based guidelines for epilepsy care provision at the primary care level.

The influence of informed consent content on study participants' contraceptive knowledge and concerns.

Little is known about how the information presented in the informed consent process influences study outcomes among participants. This study examines the influence of informed consent content on reported baseline contraceptive knowledge and concerns among two groups of HIV-serodiscordant and seroconcordant HIV-positive couples enrolled in research projects at an HIV research center in Lusaka, Zambia. We found significant differences in the reporting of contraceptive knowledge and concerns between couples viewing consent materials that included detailed information about contraception and those viewing consent materials that lacked the detailed information.

Epilepsy-associated stigma in Zambia: what factors predict greater felt stigma in a highly stigmatized population?

Epilepsy-associated stigma in Africa has been described largely in terms of enacted stigma or discrimination. We conducted a study of 169 adults with epilepsy attending epilepsy clinics in Zambia's Lusaka or Southern province using a three-item instrument (maximum score = 3). Potential determinants of felt stigma including age, gender, education, wealth, disclosure status (meaning whether or how their community members knew of their condition), seizure type (generalized vs partial), seizure frequency, the presence of visible epilepsy-associated stigmata, personal contagion beliefs, and community contagion beliefs.

The current availability of antiepileptic drugs in Zambia: implications for the ILAE/WHO "out of the shadows" campaign.

Recent concerns regarding antiepileptic drug (AED) availability in Zambia led us to conduct a study in the Lusaka and Southern Provinces to quantify the availability and cost of AEDs and assess determinants. Among 111 pharmacies, almost one-half did not carry AEDs (N = 54; 49.1%).

Integration of services for victims of child sexual abuse at the university teaching hospital one-stop centre.

Objective. To improve care of sexually abused children by establishment of a "One Stop Centre" at the University Teaching Hospital. Methodology.

Closing gaps in antiretroviral therapy access: human immunodeficiency virus-associated dementia screening instruments for non-physician healthcare workers.

Human immunodeficiency virus-associated dementia (HIV-D) is an indication for antiretroviral therapy (ART), but HIV-D is not routinely screened for in ART clinics in sub-Saharan Africa. Given the dearth of physicians in sub-Saharan Africa, enabling non-physician healthcare workers to identify HIV-D is crucial for early treatment initiation and preventing chronic neurologic disability. Non-physician healthcare workers administered locally adapted screening instruments to 48 persons living with acquired immunodeficiency syndrome (PLWAs), and 15 healthy comparison persons provided normative data.

What the better half is thinking: A comparison of men's and women's responses and agreement between spouses regarding reported sexual and reproductive behaviors in Rwanda.

Objective: To compare responses to a sexual behavioral survey of spouses in cohabiting heterosexual relationships in Kigali, Rwanda.

Design: Cross-sectional survey.

Methods: Husbands and wives in 779 cohabiting couples were interviewed separately with parallel questionnaires.

Women's experiences living with epilepsy in Zambia.

Epilepsy-associated stigma is a well-recognized phenomenon that adversely impacts the lives of people with epilepsy (PWE). The burden of stigma follows power differentials, with socially and economically disenfranchised groups being particularly susceptible. To guide instrument development for quantitative studies, we conducted a series of focus group discussions among PWE and found that women with epilepsy experienced especially adverse social and economic problems because of epilepsy-associated stigma.

The socioeconomic status of children with epilepsy in Zambia: implications for long-term health and well-being.

Epilepsy is a highly stigmatized disorder in Zambia. Studies indicate that adults with epilepsy in many regions have significantly lower socioeconomic status (SES) than their peers. We conducted a case-control study of Zambian children with epilepsy (CWE) to assess their SES.

Promotion of couples' voluntary counselling and testing for HIV through influential networks in two African capital cities.

Background: Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples' Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. We present our experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia.

Enrollment and retention of HIV discordant couples in Lusaka, Zambia.

Background: Biased enrollment and attrition compromise the power of clinical trials and limit generalizability of findings. We identify predictors of enrollment and retention for HIV-discordant couples enrolled in prospective studies in Zambia.

Principal Findings: A total of 1995 discordant couples were invited to enroll.

Evolution of couples' voluntary counseling and testing for HIV in Lusaka, Zambia.

Background: : We describe promotional strategies for couples' voluntary HIV counseling and testing (CVCT) and demographic risk factors for couples in Lusaka, Zambia, where an estimated two thirds of new infections occur in cohabiting couples.

Principal Findings: : CVCT attendance as a function of promotional strategies is described over a 6-year period. Cross-sectional analyses of risk factors associated with HIV in men, women, and couples are presented.

Contraception among HIV concordant and discordant couples in Zambia: a randomized controlled trial.

Objectives: This study examines the impact of an intervention to promote dual-method contraceptive use among HIV concordant and discordant couples already using condoms for HIV prevention.

Methods: A three-armed randomized, controlled trial was conducted at a voluntary HIV testing and counseling clinic in Lusaka, Zambia; 251 couples were randomized. Control couples received family planning education and referral to an outside clinic for nonbarrier contraceptives, intervention 1 couples received education and offer of contraceptives at the research clinic, and intervention 2 couples received intervention 1 plus a presentation designed to reduce outside pressures to conceive.

The relationship between alcohol consumption and unprotected sex among known HIV-discordant couples in Rwanda and Zambia.

Although alcohol abuse is highly prevalent in many countries in sub-Saharan Africa, little is known about the relationship between alcohol consumption and risky sexual behavior in these settings. An understanding of this relationship is particularly important given the high prevalence of HIV that exists in many of these countries. This study analyzes data collected from members of cohabiting HIV-discordant couples regarding alcohol consumption and self-reported condom use.

Epilepsy-related knowledge, attitudes, and practices among Zambian police officers.

Objective: In Zambia, where emergency medical services are very limited, the police are frequently called to the scene for unaccompanied people experiencing seizures or exhibiting disturbed behaviors during a seizure. Police officers receive no formal medical training to manage such encounters. We developed and administered a police-specific survey to assess knowledge, attitudes, and practices (KAP) regarding epilepsy among police officers in Zambia.

The social and economic impact of epilepsy in Zambia: a cross-sectional study.

Background: Among the 40 million people with epilepsy worldwide, 80% reside in low-income regions where human and technological resources for care are extremely limited. Qualitative and experiential reports indicate that people with epilepsy in Africa are also disadvantaged socially and economically, but few quantitative systematic data are available. We sought to assess the social and economic effect of living with epilepsy in sub-Saharan Africa.

Zambian health care workers' knowledge, attitudes, beliefs, and practices regarding epilepsy.

Objective: Zambia suffers from a physician shortage, leaving the provision of care for those with epilepsy to nonphysician health care workers who may not be adequately trained for this task. These individuals are also important community opinion leaders. Our goal in this study was to determine the knowledge, attitudes, beliefs, and practices of these health care workers with respect to epilepsy.

Violence and abuse among HIV-infected women and their children in Zambia: a qualitative study.

HIV and violence are two major public health problems increasingly shown to be connected and relevant to international mental health issues and HIV-related services. Qualitative research is important due to the dearth of literature on this association in developing countries, cultural influences on mental health syndromes and presentations, and the sensitive nature of the topic. The study presented in this paper sought to investigate the mental health issues of an HIV-affected population of women and children in Lusaka, Zambia, through a systematic qualitative study.

Zambian teachers: what do they know about epilepsy and how can we work with them to decrease stigma?

Purpose: Teachers play a central role in determining access to education and may mediate epilepsy-associated stigma. We developed and administered a teacher-specific survey to assess teachers' knowledge, attitudes, behaviors, and practices (KABPs) regarding epilepsy in Zambia and social and demographic determinants of KABPs.

Methods: In 2004, we surveyed 171 teachers in urban and rural regions using a 46-item questionnaire.

Clinical and demographic features of treated first-episode psychotic disorders: a Zambian study.

Background: There is a relative lack of information about the epidemiology of psychotic disorders in the developing world. The aim of this pragmatic study was to describe the correlates of first-episode psychosis in the central African nation of Zambia.

Method: Selected clinical and demographic variables were collected on patients with psychotic disorders presenting for the first time at the only psychiatric hospital in Zambia (Chainama Hills College Hospital, Lusaka).

Traditional psychiatric practices in Africa.

Many leaders in Africa bemoan the disappearance of African culture, including the use of traditional medicines, and there have been numerous calls for recognition of their value and for the integration of these treatments into orthodox medicine. This is especially so with regard to psychiatric disorders. The literature on psychiatric practice in Africa contains very few references to herbal treatments, however, and more is to be learnt about the use of herbs as adjuvants in the solution of psychosocial problems from the anthropological literature.

Sexual behavior of HIV discordant couples after HIV counseling and testing.

Background And Objectives: Sexual behavior following voluntary HIV counseling and testing (VCT) is described in 963 cohabiting heterosexual couples with one HIV positive and one HIV negative partner ('discordant couples'). Biological markers were used to assess the validity of self-report.

Methods: Couples were recruited from a same-day VCT center in Lusaka, Zambia.