Validation of a Swahili version of the World Health Organization 5-item well-being index among adults living with HIV and epilepsy in rural coastal Kenya

Objective:The purpose of this study was to evaluate the psychometric properties of the World Health Organization’s five item well-being index(WHO-5)when administered to adults living with HIV or epilepsy in a rural setting at the coast of Kenya.Methods:A case control study design was conducted among 230 adults aged 18-50 years,who comprised 147 cases(63 living with epilepsy and 84 living with HIV)and 83 healthy controls.The participants were administered to a faceto-face interview during which they completed the Swahili version of WHO-5 well-being index,the Major Depression Inventory(MDI)and responded to some items on their socio-demographic characteristics.Analysis to assess internal consistency,construct validity,discriminant validity,and convergent validity of the Swahili version of WHO-5 well-being index was conducted.A multivariate regression was carried out to assess the association between psychological wellbeing(assessed using Swahili version of WHO-5 well-being index)and having a chronic illness(HIV or epilepsy).Results:The Swahili version of WHO-5 well-being index demonstrated good internal consistency with Cronbach alpha ranges of 0.86-0.88 among the three study groups.The tool had good discriminant validity.A one factor structure of the tool was obtained from confirmatory factor analysis(overall Comparative Fit Index=1.00,Tuckler Lewis Index=1.01,Root Mean Square of Error Approximation=0.00).Living with HIV or epilepsy in comparison to being a healthy control was significantly associated with greater odds of having sub-optimal psychological wellbeing.Conclusion:Our findings demonstrate that the Swahili version of WHO-5 well-being index has good psychometric properties and is appropriate for use to evaluate psychological well-being among adults living with chronic conditions such as HIV or epilepsy from a rural low resource setting in Kenya.Given its brevity and ease of use,the Swahili version of WHO-5 well-being index could potentially be used by lay workers and other paraprofessional to monitor psychological well-being among chronically ill adults in resource poor settings.

对肯尼亚农村住院患儿群体重度营养不良症的评估:身高别体重与中上臂围的比较研究

Context: Severe malnutrition has a high mortality rate among hospitalized children in sub-Saharan Africa. However, reports suggest that malnutrition is often poorly assessed. The World Health Organization recommends using weight for height, but this method is problematic and often not undertaken in practice. Mid upper arm circumference (MUAC) and the clinical sign “ visible severe wasting” are simple and inexpensive methods but have not been evaluated in this setting. Objectives: To evaluate MUAC and visible severe wasting as predictors of inpatient mortality at a district hospital in sub-Saharan Africa and to compare these with weight for height z score (WHZ). Design, Setting, and Participants: Cohort study with data collected at admission and at discharge or death. Predictive values for inpatient death were determined using the area under receiver operating characteristic curves. Participants were children aged 12 to 59 months admitted to a district hospital in rural Kenya between April 1, 1999, and July 31, 2002. Main Outcome Measure: MUAC,WHZ, and visible severewasting as predictors of inpatient death. Results: Overall, 4.4% (359) of children included in the study ded while in the hospital. Sixteen percent (1282/8190) of admitted children had severe wasting (WHZ≤ -3) (n=756), kwashiorkor (n=778), or both. The areas under the receiver operating characteristic curves for predicting inpatient death did not significantly differ (MUAC: 0.75 95% confidence interval, 0.72-0.78 ; WHZ: 0.74 95% confidence interval, 0.71-0.77 ) (P=.39). Although sensitivity and specificity for subsequent inpatient death were 46% and 91% , respectively, for MUAC less than or equal to 11.5 cm, 42% and 92% for WHZ less than or equal to -3, and 47% and 93% for visible severe wasting, the 3 indices identified different sets of children and were independently associated with mortality. Clinical features of malnutrition were significantly more common among children with MUAC less than or equal to 11.5 cm than among those with WHZ less than or equal to -3. Conclusions: MUAC is a practical screening tool that performs at least as well as WHZ in predicting subsequent inpatient mortality among severely malnourished children hospitalized in rural Kenya. Visible severe wasting is also a potentially useful sign at this level, providing appropriate training has been given.

Co-morbidity of malnutrition with falciparum malaria parasitaemia among children under the aged 6-59 months in Somalia:a geostatistical analysis

Background:Malnutrition and malaria are both significant causes of morbidity and mortality in African children.However,the extent of their spatial comorbidity remains unexplored and an understanding of their spatial correlation structure would inform improvement of integrated interventions.We aimed to determine the spatial correlation between both wasting and low mid upper arm circumference(MUAC)and falciparum malaria among Somalian children aged 6-59 months.Methods:Data were from 49227 children living in 888 villages between 2007 to 2010.We developed a Bayesian geostatistical shared component model in order to determine the common spatial distributions of wasting and falciparum malaria;and low-MUAC and falciparum malaria at 1×1 km spatial resolution.Results:The empirical correlations with malaria were 0.16 and 0.23 for wasting and low-MUAC respectively.Shared spatial residual effects were statistically significant for both wasting and low-MUAC.The posterior spatial relative risk was highest for low-MUAC and malaria(range:0.19 to 5.40)and relatively lower between wasting and malaria(range:0.11 to 3.55).Hotspots for both wasting and low-MUAC with malaria occurred in the South Central region in Somalia.Conclusions:The findings demonstrate a relationship between nutritional status and falciparum malaria parasitaemia,and support the use of the relatively simpler MUAC measurement in surveys.Shared spatial distribution and distinct hotspots present opportunities for targeted seasonal chemoprophylaxis and other forms of malaria prevention integrated within nutrition programmes.