Dawit Worku

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Addis Ababa University, college of health

sciences, school of medicine department


ofobstetrics and gynecology.

Screening for pelvic organ prolapsed without physical examination: Validation of the
pelvic organ prolapse simple screening inventory (POPSSI)

Investigator: - Dawit Worku (MD)

Advisor:Yirgu G/Hiwot (MD, MSc, Associate Prof. Obstetrics and gynecology)

A Research to Be Submitted to collage of Health Sciences, School of


Medicine, Department of Gynecology and Obstetrics, Addis Ababa
University , in partial fulfillment for the requirement of specialization
certificate in obstetrics and gynecology .

September, 2014

Addis Ababa, Ethiopia

i
Acknowledgment

First and most I am very grateful to my advisors Dr Yirgu G/Hiwot consultants in Obstetrics and
Gynecology for his unreserved guidance, constructive suggestions and comments in the selection
of the topic, development of the proposal and analysis.

My acknowledgment also goes to the two teaching hospitals, Zewditu memorial hospital and
Gandhi memorial Hospital where this study was conducted.

I would like to take this opportunity to extend my deepest gratitude to Lynsey Hayward for
donating POPstix and Fahimeh Ramezani for giving me the permission to use the POPSSI tool.

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Table of contents
ACRONYMS..................................................................................... ERROR! BOOKMARK NOT DEFINED.
INTRODUCTION .............................................................................. ERROR! BOOKMARK NOT DEFINED.
STATEMENT OF THE PROBLEM ...........................................................................................................1
SIGNIFICANCE OF THE STUDY .......................................................... ERROR! BOOKMARK NOT DEFINED.
RESEARCH QUESTION...................................................................... ERROR! BOOKMARK NOT DEFINED.
OBJECTIVE .........................................................................................................................................3
HYPOTHESIS.......................................................................................................................................3
LITERATURE REVIEW ..........................................................................................................................3
METHODS..........................................................................................................................................4
ETHICAL CONSIDERATIONS.................................................................................................................8
DATA ANALYSIS .................................................................................................................................9
RESULTS ............................................................................................................................................9
DISCUSSION.....................................................................................................................................14
CONCLUSION ...................................................................................................................................16
ACKNOWLEDGEMENTS ....................................................................................................................16
DECLARATION OF INTEREST..............................................................................................................16
REFERENCE ......................................................................................................................................16
APPENDIX........................................................................................................................................19
1. PARTICIPANTS’ INFORMATION SHEET ........................................................................................................ 19
2. PARTICIPANT CONSENT FORM ...................................................................................................................21
3. QUESTIONNAIRES ................................................................................................................................... 22
3.1. Socio-demographic data .............................................................................................................. 22
3.2. Patient health questionnaire -9-item version (PHQ-9)................................................................. 24
3.3. Kessler 10-item scale (k-10) ......................................................................................................... 26
3.4. Self-Reporting Questionnaire 20-item version (SRQ-20)..............................................................27
3.5. Mini-International Neuropsychiatric Interview (MINI) ................................................................28
3.6. WHO Disability Assessment Schedule, version 2 (WHODAS II) ....................................................34
3.7. To be filled from FMOH integrated antenatal, labor, delivery, newborn and postnatal care card
............................................................................................................................................................42
Acronyms
AA Addis Ababa
CI Confidence Interval
ETB Ethiopian birr
GMH Gandhi Memorial Hospital
OR Odds ratio
POP Pelvic Organ prolapse
POPSSI Pelvic organ prolapse simple screening inventory
PFDI pelvic floor disorder inventory
PPV Positive predictive value
ROC Receiver operating curve
SD Standard Deviation
SPSS Statistical package for social sciences
UVP Uterovaginal prolapse
ZMH Zewditu memorial hospital
INTRODUCTION
Pelvic organ prolapse occurs with descent of one or more pelvic structures: the
uterine cervix or vaginal apex, anterior vagina (usually with bladder, cystocele),
posterior vagina (usually with rectum, rectocele), or peritoneum of the cul-de-sac
(usually with small intestine, enterocele).However, a specific definition of what
constitutes clinically significant prolapse remains elusive[1].
POP results from relaxation of the pelvic floor muscle and is estimated to have a
prevalence of 30-50% among women aged 50 and over[1]. Although mortality
resulting from POP is not significant it has a huge impact on the daily activities of
women afflicted by this condition, often disrupting and decreasing their quality of
life[2].
POP and its complications impose a considerable economic burden on the person
and it has been estimated that about 11% of women undergo surgery for POP
before the age of 79 and with 29.2% require repeated surgery[3],[4],[5].
High parity is the single most important risk factor for prolapse in rich and poor
women in both more and less developed countries[6].
Many women with pelvic floor disorder do not seek medical advice and this
makes determining its incidence very difficult.
In 1996, International Continence Society defined a system of pelvic organ
prolapse quantification (POP-Q) demonstrating high inter and intra observer
reliability. It allows researchers to report findings in standardized, easily
reproducible fashion. Prolapse in each segment is measured relative to the
hymen, which is a fixed anatomic landmark that can be identified
consistently. Accordingly, it is stage one when the leading prolapsed part is
more than one centimeters above the hymenal ring; stage two when it is
between one centimeter above and one centimeter below the hymenal ring;
stage three when it is more than one centimeter below the hymenal ring
but less than total vaginal length (TVL) minus two centimeters, and stage four
if itis more than (TVL-2) cm below the hymenal ring [7].In Ethiopia, where access
to obstetric care is very limited (institutional delivery being only 10 %) and the
fertility rate is high (5.5 children per woman) little is known about the prevalence
and risk factors for pelvic floor disorders.

1
There are few community -based studies conducted to determine the prevalence

of pelvic organ prolapse. Requirement of a pelvic examination is a major


hindrance for such studies and needs considerable time, resources and costs[8].

The common patient history remains a cornerstone in everyday practice, yet its
diagnostic performance is essentially unexplored for many common conditions[9].

The aim of this study was to validate a short questionnaire that has the ability to
discriminate between women with and without genital organ prolapse.

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Objective
General objective
This objective of the present study wasto evaluate the validity of the PHQ-9, K-10, K-6 and SRQ-
20 as screening tools for depression during pregnancy among Ethiopian women attending
Butajira area health centers ANC clinics.

Specific objectives
Specific objectives of the study were

1) To evaluate criterion validity of the PHQ-9, K-10, k-6 and SRQ-20 against a gold standard.

2) To evaluate concurrent validity of the PHQ-9, K-10, K-6 and SRQ-20 with a measure of
disability.

3) To estimate the point prevalence of depression in pregnant women attending ANC follow
up in Butajira area health centres.

Hypothesis
The study will show that the PHQ-9, K-10, K-6 and SRQ-20 screening tools are valid instruments
to screen for antenatal depression in Ethiopia.

Literature review
In low-income and middle-income countries, the prevalence of perinatal depression is
somewhat higherthan in high-income countries (19, 20). Information drawn from scientific
literature underlines, in HICs, between 3% and 16% of pregnant women fulfill the diagnostic
criteria for unipolar major depression (21, 22). In specific populations, such as marginalized
minority groups and unmarried teenagers, the prevalence of clinically relevant mood symptoms
in pregnancy may be as high as 51%.In LMICs; the prevalence of antenatal depression is
estimated to be 33% (23).

In a cross sectional study at two peri-urban health clinics in Dar es Salaam, Tanzania, it was
found that there is a 39.5% prevalence of depression. Having a previous depressive episode
(Odds Ratio 4.35, P<0.01), low (OR 2.18, P<0.01) or moderate (OR 1.86, P=0.04) satisfaction
with ability to access basic needs, conflicts with the current partner (OR 1.89, P<0.01), or
booking earlier for antenatal care (OR 1.87, P=0.02) were independent predictors of antenatal
3
depression in the logistic regression model; together explaining 21% of variance in depression
scores (14).

Depressed mood in pregnancy was reported by 39% of mothers in peri-urban settlements,


South Africa. Factors which were significantly associated with depressed mood at a p < 0.05
level included being single as opposed to being married or cohabiting with a partner, being
unemployed, having a household income below 2000 rand per month, having less education,
smoking, alcohol use, experiencing intimate partner violence in the previous year, receiving
poorer social support from one's partner, mother and father, and receiving no financial support
from the baby's father (1). Another study in rural South Africa, an area where there is high
prevalence of HIV, showed a high numbers (47% confidence interval, CI: 37.2–56.3) of women
met the criteria for a major depressive episode (MDE) (5).

In Nigeria, among pregnant woman who were interviewed during their late pregnancy, 8.3%
women met the current (2 weeks) DSM-IV diagnosis of depressive disorder. The factors
independently associated with depression included being single [odds ratio (OR)=16.67, 95%
confidence interval (CI)=3.17-87.76], divorced/separated (OR=11.11, 95% CI=1.55-19.65),
polygamous (OR=3.92, 95% CI=0.94-16.33), and having a previous history of stillbirth (OR=8.00,
95% CI=1.70-37.57) and perceived lack of social support (OR=6.08, 95% CI=1.42-26.04) (16).

A systematic review of papers covering nine LMICs found a weighted mean prevalence of
common perinatal mental disorders in pregnant mothers to be 15.6% (95% CI: 15.4–15.9)(24).
Another systematic review on pre- and postnatal psychological wellbeing in Africa showed
prevalence rates of depression ranging between 4.3% and 17.4% during pregnancy, with a
mean prevalence of 11.3% (95% CI 9.5%–13.1%) (25).

Methods
Study design
The study design was a cross sectional study to evaluate the criterion and concurrent validity of
fourscreening instruments (PHQ-9, SRQ-20, K-10 and K-6) for depression in pregnant women in
a primary care setting in Ethiopia.

Study setting
The study was conducted in three health centers in the Butajira Demographic Surveillance Site,
southern Ethiopia,an area adjoining the PRIME Sodo site. These are Butajira, Enseno and Silte
health centers. Pregnant women both from urban and rural areas attended the health centers.

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Sampling
Study population

Reference populationswere all pregnant women who lived in the Butajira Demographic
Surveillance Site. The source populations were pregnant women attending ANC follow up in
Enseno, Butajira and Silte health centers.

Participant inclusion and exclusion criteria

A woman had to be pregnant and attend the health center for ANC visit to be included in the
study. Potential participants were excluded from the study If were acutely unwell and
neededemergency treatment, unable to converse in the official language of Ethiopia, Amharic,
or unable to communicate for different reasons.All eligible pregnant women of any gestational
age who came to ANC clinics at the health center were invited to participate in the study
following their consultation with a health worker.

Sampling technique
Consecutive sampling technique was used; i.e.allpregnant womenwere included as they come
until enough sample size was obtained.

Training
Two psychiatric nurses were given refresher training in administration of the criterion measure
(MINI). The nurses were trained for two days previously by an Ethiopian psychiatrist, with
emphasis on sociocultural factors affecting the presentation of depression in a rural Ethiopian
setting. Extensive role play and observed piloting of the gold standard assessment and
screening tools has already been carried out in a health center out-patient population. Inter-
rater reliability has already been evaluated on 15 patients (half identified as having depression
and half with no identified depression and agreement found to be excellent).

The screening instruments were administered by lay-interviewers, educated to the level of 10th
grade (high school completers), who have been working as data collectors with the mental
health research group for many years. Training was given until satisfactory level of rating
proficiency was achieved. Inter-rater reliability has been assessed previously for the screening
tools in 30 outpatient attendees of the Butajira hospital and was found to be very good.

Data collection procedure

5
After attending their ANC visit, the women were asked for consent. After giving informed
consent,socio-demographic data together withthe test assessments (SRQ-20, PHQ-9 and K-10
(in which K-6was also extracted)) were administered by trained data collectors with extensive
experience and the gold standard assessment (MINI)was administered by psychiatric
nurses.Orders of administration of each of the test assessment interviews were randomized
with resulting six different orders of administration. The psychiatric nurses conducting the
criterion assessment interviews were blinded to the results of the screening tests, and vice
versa.

Measures
Socio-demographic characteristics includedself-report of age, educational level, marital
status,occupation, residential place and relative wealth. They were also asked for the
gestational age of the current pregnancy in months and number of pregnancies they had
previous to the current one. Data collectorscheaked for any problem/risk for the pregnancy
from woman’s integrated antenatal, labor, delivery, newborn and postnatal care card.

Depression screening scales

Self-Reporting Questionnaire, 20-item version (SRQ-20)

The SRQ-20 is a 20-item scale developed by the World Health Organization as a screening tool
in primary care (26). The instrument establishes symptomatology in the preceding one month.
It was previously translated into the national language of the country, Amharic, and validated in
different settings in Ethiopia. We used the last validated version (27). Recommended cut-off
score varies from setting to setting between 3/4 and 11/12 (26) but cluster around 7/8 (28). In
Ethiopia, among convenience sample of postnatal and antenatal women optimal cut-off was
6/7 againstcomprehensive psychopathological rating scale (CPRS) case (27). All five
questionnaires used are found in the Appendix 3.

Kessler 10-item scale (K-10)

This 10-item scale is a widely used tool to assess non-specific psychological distress in the
previous one month (29). Each item is rated from 0 to 4, mainly based on the persistence of a
specific symptom, from “none at all” to “all the time”. The total score for the 10-item scale is 40
and the level of psychological distress ranges from minimal (score of 20 and above) to severe

6
distress (score of 30 and above).Both the 10- and 6-item versions were validated in Ethiopia,
with the 10-item version showing superior validity (30). We used the validated Amharic (the
official national language of Ethiopia) version of the K-10 in which K-6 was also extracted (30).

Patient Health Questionnaire, 9 item version (PHQ-9)

The Patient Health Questionnaire (PHQ)is a brief self-report questionnaire designed as a


screening tool for depression in primary care(31). The PHQ-9 has nine items and can be used to
rate symptom severity and monitor change over time (32, 33). An additional question (10th
question) for the evaluation of the clinical significance of the experienced symptoms, can allow
evaluation of DSM-IV depressive episode. The recommended cut-off score for major depressive
disorder is of ≥10 (32),and in a meta-analysis was found to have acceptable diagnostic
properties for detecting major depressive disorder for cut-off scores between eight and 11 (34).
A threshold score of ≥10 had a sensitivity of 88% and a specificity of 88% for major depression
(35).

Criterion measure of depression

The Mini-International Neuropsychiatric Interview (MINI)

The MINI is a brief diagnostic assessment scale that allows DSM-IV and ICD-10 diagnosis (36). It
is modularized and each major diagnostic condition is represented by a module, for example,
major depressive episode, mania/hypomania, psychotic disorders, etc. For this validation study,
the module on major depressive episode was used. The skip rules were ignored and the raters
were allowed to explore symptoms once the initial probe questions were asked to determine
the presence of a symptom, its clinical significance and overall presence of MDE. Based on the
principles of the MINI Plus, bereavement and organic exclusions were put in place.

Disability

WHO Disability Assessment Schedule

The full version (the 36-item) Disability Assessment Schedule, version 2, developed by the
World Health Organization (WHODAS-II), was used to establish level of impairment associated
with depression and other causes of mental distress. WHODAS assesses the level of disability
and the number of days lost from work in the previous 30 days. The instrument is considered
cross-culturally applicable (37). The Amharic version of the 36-item version, which was
previously validated in Ethiopia (38), formed the basis of the current validation study.

Sample size

7
We used a formula for calculating sensitivity and specificity for single tests by Buderer (39):
n=[Z2 1-α/2* SN×(1-SN)]/[L2×Prevalence]

Wheren = required sample size

S N = anticipated sensitivity,

α = size of the critical region (1 – α is the confidence level),

z 1-α/2 = standard normal deviate corresponding to the specified size of the critical region (α),
and

L = absolute precision desired on either side (half-width of the confidence interval) of sensitivity
or specificity.

Using the following assumptions:

Desired sensitivity fixed at 80%

α=0.05

L=0.1

Z2 1-α/2=3.84

Prevalence=20%

Loss due to incomplete information or other reasons=3%

The required sample size was 316. This sample size allows the sensitivity estimate within the
confidence limits of 75% and 84%.

Ethical considerations
Ethical permission was obtained from the Department of Psychiatry, College of Health Sciences,
Addis Ababa University. All participants who were included gave written, informed consent
before starting the interview. All pregnant women identified by the psychiatric nurses as
suffering from MDEwere offered appropriate treatment and follow-up with the existing Butajira
psychiatric service.All participants were given 30birr each as compensation for their time spent
during the interviews.

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Data analysis
Data was double entered by two data entry clerks and cleaned. We used STATA 11.0 for data
analysis. Samples were categorized into cases of MDE and non-cases based on the gold
standard (MINI) assessment. Optimal cut-off score was estimated at the cut-off score selected
for maximum specificity not exceeding sensitivity. Sensitivity, specificity, percentage of
correctly classified, positive and negative likelihood ratios and positive and negative predictive
values were estimated for the optimal cut-off scores of each of the screening tests against the
gold standard diagnosis of MDE. Sensitivity, specificity and positive predictive values were also
estimated for different cut-off scores of thescreening tests against the gold standard diagnosis
of MDE. To measure the overall predictive value of the instruments, Receiver operating
characteristic (ROC) curve was plotted for each instrument and area under the ROC curve
estimated. Internal consistency of each instrument was estimated using Cronbach's alpha (α).
The degree of correlation between each screening instrument and WHODAS was measured
using Spearman's rank correlation coefficient (Spearman's rho).

Results
Socio-demographic characteristics
Detail information on socio-demographic characteristics is presented on table 1. A total of 388
pregnant women were interviewed from three health centers (Butajira, Enseno and Silte). At
the time of adequate sample interview (n=316), there were high number of participants from
Silte health center and fewer from Enseno because of patient flow difference. Sowe were
forced to include more women from Enseno health center into the study to have a more
equivalent distribution of participants from the three health centers. Their age ranged from 15
to 40 years. Around 58% (n=224) were aged between 25 and 34 years. The majority of
participants (56.3%; n=218), were illiterate. Only 40.4% (n=153) had attended formal education.
Almost all (99.2%; n=385) were married. The majority of them (93.0%; n=361) were in
monogamous and few (6.2%; n=24) were in polygamous marriages. Over half (57.5%; n= 223)
resided in rural areas. The majority of the women were either housewives (62.9%; n= 242) or
merchants (26.8%; n=103). More than half (59.3%; n=230) claimed they have similar wealth
relative to others in their community while 36.9% (n=143) said less and 3.6% (n=14) said more.
The gestational age of the pregnancy in participating women ranged from two to ten (already
completed 9 months) months. For 30.0% (n=116) of women it was a first pregnancy and for the
rest it ranged from the second to twelfth pregnancy.

Distribution of scores of screening instruments


9
The frequency distribution of scores was not normally distributed for all screening instruments,
so median witn 25th and 75th percentiles were calculated instade of the mean. The results are
shown in table 2.The median PHQ-9 score was two with 25th and 75th percentiles being zero and
three respectively. For SRQ-20, the median score with 25th and 75th percentile were two, one
and four respectively. K-10 had a median score of zero, with a 25 th and 75th percentile being
zero and two. In K-6 all the three scores were same, zero.

Prevalence of depression
The prevalence of Major Depressive Episode (MDE)in pregnant women attending ANC follow up
using the gold standard measure was 3.9% (n=15). When cases in which organic causes cannot
be definitely ruled out were included, the prevalence estimate increased to 4.4% (n=17).

Criterion validity of the screening instruments against a gold standard


PHQ-9

At optimal cutoff score of greater than or equal to four, PHQ-9 had a sensitivity of 86.7% and
specificity of 80.4%. It had a positive predictive value (PPV) of 15.1% and negative predictive
value (NPV) of 99.3%. ROC curve was plotted for each instrument to measure the overall
predictive value of the instrument (see figure 1 and table 3). Area under the ROC curve was
highest for PHQ-9,0.91 (95%CI=0.86-0.96), showing the performance of the instrument is
excellent. Cronbach's α was 0.74, having good (acceptable) internal consistency. Comparison of
criterion validity of each instruments at optimal cutoff scores are shown at table 4. Also
sensitivity, specificity and positive predictive values of the four screening instruments at higher
cut-off scores are presented on table 5.

SRQ-20

SRQ-20, at optimal cutoff score of greater than or equal to five, had a sensitivity of 80.0% and
specificity of 79.6%. It had a PPV of 13.6% and NPV of 99.0%. Area under the ROC curve was
0.86 (95%CI=0.76-0.95), showing the performance of the instrument is good. Cronbach's α was
calculated to be 0.84, the highest of all, having good internal consistency.

Kessler-10

10
K-10, at optimal cutoff score of greater than or equal to two, had a sensitivity of 93.3% and
specificity of 69.4%. It had a PPV of 10.9% and NPV of 99.6%. Area under the ROC curve was
0.88 (95%CI=0.80-0.97), showing the performance of the instrument is good. Cronbach's α was
calculated to be 0.79, having good internal consistency.

Kessler-6

K-6, at optimal cutoff score of greater than or equal to one, had a sensitivity of 86.7% and
specificity of 80.8%. It has a PPV of 15.5% and NPV of 99.3%. Area under the ROC curve was
0.87 (95%CI=0.77-0.97), showing the performance of the instrument is good. Cronbach's α was
calculated to be 0.78, having good (acceptable) internal consistency.

Concurrent validity of the screening instruments with a measure of disability


(WHODAS II)
Spearman's rank correlation coefficient (Spearman's rho) is calculated to measure the degree of
correlation instruments have with measure of disability i.e. WHODAS II. In all four instruments a
positive correlation was found with rho p being 0.52 (p<0.001), 0.53 (p<0.001), 0.49 (p<0.001)
and 0.43 (p<0.001) for PHQ-9, SRQ-20, K-10 and K-6 respectively.

Table 1: Description of the socio-demographic characteristics of participants (n= 388)

Frequency(number) percent
Age in years 15-19 23 5.9
n= 387 20-24 99 25.6
25-29 132 34.1
30-34 92 23.8
35-39 39 10.1
40-44 2 0.5
Literacy Literate 169 43.7
n= 387 Illiterate 218 56.3
Education type Formal 2-4 46 30.1
n=379 (Grades 5-8 67 43.8
completed) 9-10 25 16.3
n= 153 >10 15 9.8
Informal 22 5.8
No education 204 53.8
Marital status Married only wife 361 93.0
Married 2nd or more 24 6.2
Separated 2 0.5
Single, never married 1 0.3
11
Residence place Urban 165 42.5
Rural 223 57.5
Occupation House wife 242 62.9
n= 385 Farmer 17 4.4
Merchant 103 26.8
Government 10 2.6
Student 1 0.3
Daily laborer 7 1.8
Unemployed 3 0.8
other 2 0.5
Relative wealth More 14 3.6
Similar 230 59.3
Less 143 36.9
Not happy to respond 1 0.3
Gestational age in month 2-3 28 7.2
n= 387 4-6 135 34.9
7-10 224 57.9
Number of previous pregnancies 0 (1st pregnancy) 116 30.0
n= 387 1-3 161 41.6
4-6 93 24.0
7-11 17 4.4
Prevalence of depression using the screening instruments
The prevalence of depression was 22.7% (n=88) by SRQ-20 with a cutoff score of greater than
or equal to five. It was 22.2% (n=86) on PHQ-9 with a cutoff score of greater than or equal to
four. When DSM-IV-TR criteria A of MDE are applied to PHQ-9, the prevalence significantly
drops to 0.5% (n=2). Using K-10 and 6, prevalence is 33.0% (n=128) and 21.7% (n=84), with a
cutoff score of greater than or equal to two and one respectively.

Table 2: Distribution of scores of screening instruments

Instrument Median 25th percentile 75thpercentile


PHQ-9 2 0 3
SRQ-20 2 1 4
K-10 0 0 2
K-6 0 0 0

Figure 1: ROC curves for PHQ-9, SRQ-20, Kessler-10 and Kessler-6 against gold standard (MINI)
diagnosis of MDE
12
1.00
0.75
Sensitivity
0.50
0.25
0.00

0.00 0.25 0.50 0.75 1.00


1-Specificity

PHQ-9 ROC area: 0.9069 SRQ-20 ROC area: 0.857


K-10 ROC area: 0.8845 K-6 ROC area: 0.8683
Reference

Table 3: Description of characteristics of the ROC curves

Instrument ROC area 95% confidence interval


PHQ-9 0.91 0.86-0.96
SRQ-20 0.86 0.76-0.95
K-10 0.88 0.80-0.97
K-6 0.87 0.77-0.97

Table 4: Comparison of Criterion validity of PHQ-9, SRQ-20, Kessler-10 and Kessler-6 at optimal
cut-off scores against gold standard (MINI) diagnosis of MDE

Instrument Optimal Sensitivity Specificity Correctly LR+ LR- PPV NPV Cronbach's
Cutoff % % classified % % α
>= %
PHQ-9 4 86.7 80.4 80.7 4.43 0.17 15.1 99.3 0.74
SRQ-20 5 80.0 79.6 79.6 3.93 0.25 13.6 99.0 0.84
K-10 2 93.3 69.4 70.4 3.05 0.10 10.9 99.6 0.79
K-6 1 86.7 80.9 81.2 4.55 0.16 15.5 99.3 0.78

13
Table 5: Sensitivity, specificity and positive predictive values of PHQ-9, SRQ-20, Kessler-10 and
Kessler-6 at higher cut-off scores

Instrument Cut-off (≥) Sensitivity (%) Specificity (%) PPV (%)


PHQ-9 6 53.3 92.5 22.4
7 40.0 94.6 23.3
SRQ-20 9 46.7 93.8 23.5
10 40.0 96.0 28.8
K-10 8 40.0 96.0 28.8
9 26.7 97.6 31.0
K-6 3 53.3 94.6 28.8
4 46.7 94.9 28.1

Discussion
In this study of the criterion validity of brief depression screening scales in antenatal clinics in
Ethiopia, the four scales (PHQ-9, SRQ-20, K-6 and 10) all showed very good criterion validity as
dimensional scales, PHQ-9 showing better criterion validity than the rest. However positive
predictive value was low which limits their clinical applicability. While all instruments have an
acceptable to good internal consistency, SRQ-20 had the highest result, and all four instruments
showed positive correlation with WHODAS II.

Strengths of the study include having a large sample size (n=388) which gives it a higher power.
Most validation studies have a fewer sample size (30, 40, 41). Pregnant women were included
consecutively into the sample and participants both from urban and rural areas were included
ensuring the representativeness. We also used instruments that were previously translated into
the national language (Amharic) and validated in different settings. Our data collectors were
with extensive data collection experience and data collectors and psychiatric nurses were given
refresher training on administration of screening tests and MINI. Inter-rater reliability was
already evaluated and was found to be excellent. In order to eliminate order effect, orders of
administration of each of the screening tests were randomized. MINIwas administered to all
participants to avoid selection bias. Data collectors and psychiatric nurses were blinded to the
results of criterion assessment and screening instruments.

There is no gold standard instrument for detection of depression in pregnancy. MINI is an


acceptable gold standard for validation studies. It is a semi-structured instrument,as psychiatric
nurses were allowed to ask additional questions to be certain about the presence of a
symptom. One limitation could be use of psychiatric nurses. Using psychiatrists would have
been the best alternative as our findings are heavily reliant upon the quality of the gold

14
standard diagnosis, but was not feasible. We also used only the depression section on MINI so
were not able to assess other common mental disorders (CMD). High scores may have
relationship with CMD other than depression. Restricting diagnoses to depression has a risk of
missing other CMD which might have a significant proportion.

The prevalence of depression in pregnant women in primary health care settings in our study
(3.9%)is much lower than what has been reported in other studies and systematic reviews (17,
24, 25, 42). We would have expected it to be higher than community samples but the result
was to the contrary. One explanation for this could be because of use of screening instruments
having lower PPV, which led to many false positives. But all cannot be explained this since using
the same diagnostic instrument (MINI), the prevalence of depressionin Nigeria in the third
trimester ranged from 8.3-17.4% (16, 43) and in Morocco in first, second and third trimester
was found to be 17.4%, 16.0% and 15.7% respectively (44). However in a previous community
study done in Ethiopia, if the same SRQ-20 cut-off (≥ 5) had been used, we would have CMD
estimated prevalence of 18.6% (18). This is lower than the prevalence of MDE by SRQ-20 in the
current study (22.7%).

When we see the case detection properties of the screening instruments, all were found to be
highly accurate. This finding is similar to other studies done in general primary care settings (30,
40, and 45). Similar findings are reported in postnatal women in Ethiopia using K-10 and 6 (30).
The area under the ROC curve (AUC) was above 0.85 for all instruments, highest being for PHQ-
9. The relatively good performance of PHQ-9 may be attributable to the fact that it contains
DSM-IV-TR criteria A symptoms of MDE. The fact that SRQ-20 and Kessler included anxiety
symptoms might have contributed partly to the relatively lower performance, but the same
reason might make them preferable in primary health care population because of the mixed
depression/anxiety/somatic presentation of cases.

To use the instruments in clinical setting, an optimal balance between sensitivity and PPV is
important. Minimum of 50% for both sensitivity and PPV is mandatory for an acceptable
instrument (45). But in all of the instruments, it was difficult to set that cut-off score because it
was not possible to get a higher PPV without sensitivity being significantly compromised. Thus
none of the instruments have higher sensitivity at an acceptable PPV.

The cut-off scores are much lower than what was reported in other studies and also from the
recommended thresholds (26, 27, 28, 34, 35). We normally would have expected it to be higher
because pregnancy by itself can have symptoms (change in energy level, appetite and sleep)
mimicking symptomatology of MDE, but was not the case in our study. Generally, lower cut-off
score means that the women had a high threshold for reporting symptoms.The Kessler-10 and

15
6 cut-off scores in our study areimplausibleand difficult to explain whyas a score of one on
Kessler scale means scoring positive on only a single symptom a little of the time.

Conclusion
The study shows that there is little difference between PHQ-9, SRQ-20, K-10 & 6 in their
criterion validity as dimensional scales, all showed good discriminating ability in relation to
MINI and have a positive correlation with WHODAS II. Previously recommended thresholds for
the PHQ-9 and SRQ-20 resulted in many undetected major depressive disorders. In addition, all
are poorly suited to be used as a screening instrument in clinical settings because of low PPV,
only can be used in selected occasions. If used at all in clinical settings, has to be combined with
mental health professional assessment of positives to reduce false positives.

Acknowledgements
This study was supported byC-MaMiE project. I would like to thank all the pregnant women for
giving us their time and for their willingness. I greatly appreciate the management team of the
three health centers for their cooperation and the psychiatric nurses, data collectors and their
coordinator for their dedication. I would also like to thank Dr. Charlotte Hanlon for her priceless
advice and support, Dr. Binyam Worku for helping with the trainings and Dr. Girmay Medihin
for coordinating staffs during data collection and all other supports.

Declaration of interest
None.

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Appendix
1. Participants’ Information Sheet
የጥናት ተሳታፊዎች መረጃ ቅፅ
Detecting depression

በዚህ የጥናት እንዲሳተፉ ተጋብዘዋል፡፡ ተሳትፎዎት በፍላጎት ላይ ብቻ የተመሰረተ መሆን አለበት፣ በጥናቱ ላለመሳተፍ
ከመረጡ የሚያስከትለው ችግር የለም፡፡ በጥናቱ ለመሳተፍ ከመወሰንዎ በፊት ጥናቱ ለምን እንደሚሰራና የእርስዎ ተሳትፎ
ምን እንደሚያካትት መረዳቱ አስፈላጊ ነው፡፡ እባክዎ ከዚህ በታች የተሰጡ መረጃዎችን በጥንቃቄ ያዳምጡ፡፡ ግልጽ ያልሆነ
ነገር ካለና የበለጠ መረጃ ከፈለጉ ሊጠይቁን ይችላሉ፡፡

የምርምሩ አላማ
19
የዚህ ጥናት አላማ የድብርት ህመም መለኪያ መሣሪያዎች በነፍሰ ጡር እናቶች ላይየድብርት ህመምን እንደሚለኩ ማጥናት
ነው፡፡

በጥናቱ እንዲሳተፉ የሚመረጡት እነማን ናቸው

ከላይ በተጠቀሰው ርእስ ላይ መረጃ ሊሰጡን እንደሚችሉ የምናስባቸው ለእርግዘና ክትትል ወደ ጤና ጣቢያ የሚመጡ
ነፍሰ ጡር እናቶችን ቃለ መጠይቅ እናደርግላቸዋለን፡፡

በጥናቱ ለመሳተፍ ቢስማሙ ምን ይደረጋል፡፡

ከመረጃ ሰብሳቢዎቻችን አንዱ በጤና ጣቢያ ውስጥ የመጡበትን ምርመራ ካደረጉ (ከጨረሱ) በሁዋላ አንዳንድ ጥያቄዎች
ይቀርብሎታል ፡፡ ቃለ መጠይቁ ወደ አርባ ደቂቃ ገደማ ይወስዳል፡፡ ለጊዜዎ ማካካሻ 30ብርክፍያ ይኖረዋል፡፡

በጥናቱ መሳተፍ ምን ጉዳት ይኖረዋል?

በቃለመጠይቁ መሳተፍ የሚያስከትለው ችግር የለም፡፡ እርስዎ በጥያቄዎቹ ደስተኛ ካልሆኑ መልስ ይሰጡ ዘንድ
አይገደዱም፡፡ ቃለ መጠይቁም ዕዚሁ ላይ መቆም ይችላል፡፡የጊዜ ጫናውን ለማሳጠር እንሞክራለን፡፡

የሚገኘው መረጃ በኢትዮጵያም ሆነ በሌሎች ሀገሮች ያለውን የአእምሮ ጤና አገልግሎት እንደሚያሻሽለው ተስፋ
እናደረጋለን፡፡

በሰጡን ቅድመ መረጃ ምን እናደርግበታለን?

ጥያቄዎቹ የእርስዎን ስም እንዲሁም ማንነት አያካትቱም፡፡ ስለዚህ ከፕሮጀክቱ አስተባባሪዎች እና የፕሮጀክቱ የመረጃ
ሰራተኞች ውጪ ማንም ሌላ ሰው መረጃው የእርስዎ ስለመሆኑ የሚያውቀው አይኖርም ፡፡

የመረጃ ሰነዶቹን በሚቆለፉ መሳቢያ / መደርደርያ / እናስቀምጣለን፡፡ከጥናቱ ማለቅ በኋላ የሰጡን መረጃ ሌሎች
ተመራማሪዎች ይጠቀሙበት ይሆናል፡፡ ግን በማንኛውም መንገድ መረጃ የሰጠውን ሰው መለየት እናዳይችሉ ይደረጋል፡፡

ዋና አጥኚዎች

ዶ/ር ሻርሎት ሃንሎን እና ዶ/ር ግርማይ መድህን፡፡ ሊያገኙን ከፈለጉ የቡታጅራ ፕሮጀክት ቢሮ ስልክ ቁጥር 046 115 15
95 በመጠቀም በስራ ቀኖች በሥራ ሰአት ሊደውሉልን ይችላሉ ፡፡

በጥናቱ መሳተፍ የእርስዎ ውሳኔ ጉዳይ ይሆናል፡፡ በጥናቱ ላለመሳተፍ ከወሰኑ በማንኛውም ሰአት ምክንያት መስጠት
ሳይጠበቅብዎት በነጻነት ተሳትፎውን ማቋረጥ ይችላሉ፡፡

ይህ ጥናት በማንኛውም መንገድ ጉዳት ካደረሰብዎት የአ.አ ዩኒቨርሲቲ የህክምና ፋኩልቲ የስነምግባር (ኢቲክስ) ተቋማዊ
የክለሳ ቦርድን ከዚህ በታች በተጠቀሰው አድራሻ ማነጋገር ይችላሉ፡፡

- ስልክ ቁጥር 0115-553 87 34

ማስታወሻ

ወደ መጨረሻ ሪፖርትነት እስኪቀየር ድረስ በፈለጉት ሰአት መረጃዎን ከፕሮጀክቱ ሊያወጡ ይችላሉ፡፡

በጥናቱ ለመሳተፍ ከወሰኑ ይህን የመረጃ ቅጽ ይሰጥዎትና ስምምነት ግን በፊርማ እንዲያረጋግጡ ይጠየቃሉ፡፡

20
የመረጃ ወረቀቱን ካነበቡ እና ወይም ስለምርምሩ የተሰጠውን መግለጫ ካዳመጡ በኋላ እባክዎን ይህን የፈቃደኝነት
መግለጫ ቅጽ ይሙሉ፡፡

የአ.አ.ዩ የምርምር ስነ-ምግባር ኮሚቴ መለያ ቁጥር ………………….

በዚህ ምርምር ለመሳተፍ ስላሰቡ እናመሰግናለን፡፡ በምርምሩ ለመሳተፍ ከመወሰንዎ በፊት ምርምሩን የሚመራው ሰው
ስለፕሮጀክቱ ማብራሪያ ሊሰጥዎ ይገባል፡፡ እባክዎ ከመረጃው ወረቀት ወይም ከተደረገልዎት ገለጻ የመነጨ ጥያቄ ካለዎት
በምርምሩ ለመሳተፍ ከመወሰንዎ በፊት ጥናቱን የሚያካሂደውን ግለሰብ ይጠይቁ፡፡ በእጅዎ ይኖር ዘንድ እና በፈለጉ ጊዜ
እንዲያመሳክሩበት የዚህ የስምምነት ቅጽ ግልባጭ ይሰጥዎታል፡፡

በማንኛውም ጊዜ በምርምሩ ላለመሳተፍ ከወሰንኩኝ ለምርምሩ ለሚያካሂዱት ወይም ወኪሎቻቸው ማሳወቅ እንደምችልና
ምንም ምክንያት ሳላቀርብ ከምርምሩ እራሴን ላገል እንደምችል ተረድቻለሁ፡፡ ከዚህም ባሻገር ጥናቱ እስኪታተም ድረስ
የሰጠሁትን ቅጽ መረጃዎች ማውጣት እንደምችል ተረድቻለሁ፡፡

የሰጠሁት የግል መረጃ ለተገለፀልኝ አላማ ጥቅም ላይ ይውል ዘንድ ተስማምቻለሁ፡፡

የሰጡን መረጃ እንደ ሪፖርት ይታተማል፡፡ የሚሰጡን መረጃ ሚስጥራዊነት እንደሚጠበቅና ከሚወጡትም ሪፖርቶች
ማንነቶንለማወቅ እንደማይቻል ልናረጋግጥ እንወዳለን፡፡

የምርመራ ቡድኑ ቅድመ መረጃውን ለወደፊት ምርምር ሊጠቀም እንደሚችል እስማማለሁ፡፡

2. Participant consent form


የተሳታፊዎች የፈቃደኝነት መግለጫ ቅፅ
የተሳታፊው መግለጫ

እኔ ____________________________________________________________

____________________________________________________________

ከላይ የተጠቀሰው የምርምር ፕሮጀክት በበቂ ሁኔታ ተብራርቶልኝ በጥናቱ ለመሳተፍ ተስማምቻለሁ፡፡ ከላይ የተጻፉትን
ማሳሰቢያዎች አና ስለፕሮጀክቱ የሚገልጽ የመረጃ ወረቀት አንብቤ ጥናቱ የሚያካትተውን ተረድቻለሁ፡፡

ፊርማ ____________ ቀን ____________


21
የምስክር ቃል(ተሳታፊው ያልተማረ ከሆነ )

እኔ____________________________________________________________

____________________________________________________________

ከላይ የተጠቀሰው የምርምር ፕሮጀክት በበቂ ሁኔታ ለ _____________________ ተብራርቶላቸው በምርምሩ ለመሳተፍ
ተስማምተዋል፡፡ ከላይ የተጻፉ ማሳሰቢያዎች እና ስለፕሮጀክቱ የሚገልጽ የመረጃ ወረቀት የተነበበላቸው ሲሆን ጥናቱ
የሚያካትታቸውንም ጉዳዮች ተረድተዋል፡፡

ፊርማ ____________ ቀን ____________

የቃለ መጠይቅ አቅራቢ ቃል፡-

እኔ_____________________________________________________ የጥናቱን ምንነት የሚፈልጋቸውን ነገሮችና በጥናቱ መሳተፍ ሊያከትል


የሚችለውን ጉዳዮች ለተሳታፊው በጥንቃቄ አብራርቻለሁ፡፡

ፊርማ ____________ ቀን ____________

3. Questionnaires
3.1. Socio-demographic data
መጠይቁ የተሞላበት ቀን [ ][ ]/[ ][ ]/[ ][ ][ ][ ]

የተጠያቂው ቁጥር [ ][ ][ ][ ]

የጠያቂው ቁጥር [ ][ ][ ]

የታዩበት የጤና ጣቢያ ስም

22
የግለሰቡ መረጃ
በቅድሚያ ስለእርስዎ አጠቃላይ መረጃ እጠይቃለሁ፡፡ በአብዛኛው ማወቅ የምፈልገው አሁን ስላሉበት ሁኔታ ነው፡፡
101 እድሜዎትስንትነው? [ ] [ ] AGE

102 ማንበብና መጻፍ ይችላሉ? እችላለሁ 1 LIT

አልችልም 2

103 ምን አይነት ትምህርት ተምረዋል? ምንም አልተማሩም 1 EDUTYPE

መደበኛ ያልሆነ ትምህርት 2

መደበኛ ትምህርት 3

መልስ መስጠት አልፈለጉም 99

104 የጥያቄ 102 [ ][ ] ክፍል EDUGRAD

መልስመደበኛትምህርትከሆነስንተኛክፍልአጠናቅቀዋል?

105 የጋብቻ ሁኔታ (በአሁኑ ወቅት የትዳር ሁኔታ እንዴት ያገባ፣ ብቸኛ ሚስት 1 MARISTAT
ነው?)
ያገባ፣ ሁለትና ከዚያ በላይ ሚስት 2

የተፋቱ 3

የተለያዩ (ከባል ጋር በጥል የተለያዩ) 4

ባል የሞተባቸው 5

ያላገቡ 6

106 የመኖሪያ ቦታ (የሚኖሩት ቀበሌ ከተማ ነው ወይስ ከተማ 0 RES


ገጠር?)
ገጠር 1

107 ስራ (ገቢ የሚያገኙበት ስራዎ ምንድነዉ?) የቤት እመቤት 1 EMP

አርሶ አደር 2

ነጋዴ 3

ተማሪ 4

የመንግስት ሰራተኛ 5

የቀን ስራ (የጉልበት ሰራተኛ) 6

23
ስራ አጥ 7

ሌላ__________________ 8

108 በቀበሌዎ ውስጥ ካሉ ሰዎች ጋር ራስዎን ሲያወዳድሩ ያነሰ 1 RELWEAL


ያለዎት ሃብት እኩል ነው፤ ይበልጣል፤ ወይንስ ያንሳል
ብለው ይገምታሉ? የበዛ 2

ተመሳሳይ 3

አላውቅም /አላስታውስም 88

መልስ መስጠት አልፈለጉም 99

109 የስንት ወር እርጉዝ ነዎት? [ ] [ ] ወር GEST

110 ያሁኑ እርግዝናዎ የመጀመሪያ ነው? አዎ 1 PRIMIP

አይደለም 2

የ109 መልስ አይደለም ከሆነ ወደ 110 ይለፊ

111 ከዚህ በፊት ስንት ጊዜ አርግዘዋል? [ ][ ] PREVPR

3.2. Patient health questionnaire -9-item version (PHQ-9)


PHQ-9 Code
ማስታወሻ፡አልፎአልፎብቻ (2-6 ቀናት)፣በዛላለጊዜ (7-11 ቀናት)፣ከሞላ ጎደል በየቀኑ (12-14
ቀናት)መሆኑንይግለፁ፡፡

ላለፉት ሁለት ሳምንታት ከነዚህ ከምዘረዝራቸው ችግሮች ውስጥ፤ የትኞቹ


ደርስውብዎት (በየትኞቹ ተቸግረው) እንደነበር እጠይቅዎታለሁ።
1. የእለትተእለትተግባርዎንለማከናወን (ለመስራት) ያለዎት ተነሳሽነት ወይም አዎ 1 PHLI
ፍላጎት በጣም ቀንሶ ነበር? የለም 0
24
መልሱአዎከሆነበሁለቱሳምንታትዉስጥለምንያህልጊዜተሰማዎት? አልፎአልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
2. የመከፋት፣ የመደበት ወይም ተስፋ የመቁረጥ ስሜት ይሰማዎት ነበር? አዎ 1 PHFS
የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ተሰማዎት? አልፎአልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
3.1 እንቅልፍ አልወስድ ብሎዎት ወይም በደንብ መተኛት አቅትቶዎት ይቸገሩ ነበር? አዎ 1 PHIS
የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ተቸገሩ? አልፎአልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
3.2 እንቅልፍ በዝቶብዎት ይቸገሩ ነበር? አዎ 1 PHOS
የለም 0
አልፎአልፎ ብቻ 1
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ተቸገሩ? በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
4. የድካም ወይም የአቅም ማነስ ስሜት ይሰማዎት ነበር? አዎ 1 PHLE
የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ተሰማዎት? አልፎአልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
5.1 የምግብ ፍላጎትዎ ቀንሶ ነበር? አዎ 1 PHLR
የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ቀንሶ ነበር? አልፎአልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
5.2 የምግብ ፍላጎትዎ ከተለመደው በላይ ጨምሮ ነበር? አዎ 1 PHLA
የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ጨምሮ ነበር? አልፎአልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
6. ራስዎን የመጥላት ወይም ዋጋ የለኝም የማለት ወይም ራሴንም ሆነ ቤተሰቤን አዎ 1 PHFH
አሳዝኛለሁ የሚል ስሜት ተሰምቶዎት ነበር? የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ተሰማዎት? አልፎአልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
7. በሚሰሩት ስራ ላይ ሃሳብዎን ለመሰብሰብ/ትኩረት መስጠት አስቸግርዎት ነበር? አዎ 1 PHDC
(ለምሳሌ፣ ከሰዎች ጋር ሲጨዋወቱ ትኩረት ሰጥቶ ማዳመጥ?) የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ተቸግረው ነበር? አልፎአልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
8.1 ለሌሎች ሰዎች እስከሚታወቅ ድረስ በእንቅስቃሴዎ ወይም በንግግርዎ በጣም አዎ 1 PHDT
ቀስ ብለው ነበር? የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ተቸግረው ነበር? አልፎ አልፎ ብቻ 1
በዛ ላለ ጊዜ 2

25
ከሞላ ጎደል በየቀኑ 3
8.2 ለሌሎች ሰዎች እስከሚታወቅ ድረስ መረጋጋት አቅቶዎት፣ አንድ ቦታ አርፎ አዎ 1 PHDS
መቀመጥ ወይም መቆም እስከማይችሉ ሆነው ነበር? የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ተቸግረው ነበር? አልፎ አልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
9. ከምኖር ብሞት ይሻላል ብለው አስበው ወይም ራስዎን በሆነ መንገድ ሊጎዱ አዎ 1 PHWD
አስበው ነበር? የለም 0
መልሱ አዎ ከሆነ በሁለቱ ሳምንታት ዉስጥ ለምን ያህል ጊዜ ተሰምቶዎት ነበር? አልፎ አልፎ ብቻ 1
በዛ ላለ ጊዜ 2
ከሞላ ጎደል በየቀኑ 3
10. ከተዘረዘሩት ችግሮች ለአንዳቸውም አዎ የሚል መልስ ከተሰጠ የሚከተለውን በጭራሽ 1 PHDR
ይጠይቁ። አልተቸገርኩም
በእነዚህ ችግሮች ምክንያት ስራዎን ለመስራት፣ የቤት ሓላፊነትዎን ለመወጣት በመጠኑ ተቸግሬ 0
ወይም ከሰዎች ጋር ተስማምተው ለመኖር ምን ያህል አስቸጋሪ ሆኖብዎት ነበር? ነበር
በጣም ተቸግሬ 1
ነበር
እጅግ በጣም 2
ተቸግሬ ነበር

3.3. Kessler 10-item scale (k-10)


ኬስለር 10
አሁን ደግሞ ባለፈው አንድ ወር ስለነበረዎት ስሜት እጠይቅዎታለሁ፡፡ ለእያንዳንዱ ጥያቄ አምስት ምርጫዎች
ይቀርብልዎታል፤ አንዱን ብቻ ይምረጡ፡፡

ለጠያቂ ማስታወሻ፡ ተጠያቂው ማብራሪያ ካስፈለጋቸው፡ እምብዛም (2-7 ቀናት) አልፎ አልፎ ብቻ (8-15 ቀናት)፣ በዛ
ላለ ጊዜ (16-24 ቀናት)&ሁልጊዜ (ከ25 ቀናት በላይ) መሆኑን ይግለፁ፡፡
ተ.ቁ ጥያቄ ነጥብ
1. ባለፉት 30 ቀናት ውስጥ የመደበር (የመተከዝ) ስሜትይሰማዎት ነበር? አዎ 1 KTIRED
የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4
2. ባለፉት 30 ቀናት ውስጥ በጣም ከመደበትዎ (ከመከፋትዎ) የተነሳ ምንም ነገር አዎ 1 KNERV
ሊያስደስትዎ ያልቻለበት ወቅትነበር? የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4
3. ባለፉት 30 ቀናት ውስጥ የመረበሽ ስሜት ይሰማዎት ነበር? አዎ 1 KNERC
የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4
4. ባለፉት 30 ቀናት ውስጥ ውስጥዎ እጅግ ከመረበሹ የተነሳ ምንም ነገር ሊያረጋጋዎት አዎ 1 KHOPE
26
ያልቻለበት ወቅትነበር? የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4
5. ባለፉት 30 ቀናት ውስጥ እረፍት የማጣት ወይም የመቁነጥነጥ ስሜት ይሰማዎት አዎ 1 KREST
ነበር? የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4
6. ባለፉት 30 ቀናት ውስጥ እጅግ ከመቁነጥነጥዎ የተነሳ አንድ ቦታ አርፎ መቀመጥ አዎ 1 KPROB
ያልቻሉበት ወቅት ነበር? የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4
7. ባለፉት 30 ቀናት ውስጥ ለምንም አልጠቅምም (ዋጋ የለኝም) የሚል ስሜት አዎ 1 KDEPR
ይሰማዎት ነበር? የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4
8. ባለፉት 30 ቀናት ውስጥ ምንም ሳይሰሩ ይደክምዎት ነበር? አዎ 1 KEFFO
የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4
9. ባለፉት 30 ቀናት ውስጥ ተስፋ የመቁረጥ ስሜት ይሰማዎት ነበር? አዎ 1 KCHEE
የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4
10. ባለፉት 30 ቀናት ውስጥ ሁሉንም ነገር የግድዎን ያደርጉ ነበር? (ለምሳሌ መናገር፣ አዎ 1 KWOTH
መነሳት፣ መሄድ፣ የመሳሰሉትን) የለም 0
መልሱ አዎ ከሆነ፤ በአንድ ወር ዉስጥ ለምን ያህል ጊዜይሰማዎት ነበር? እምብዛም 1
አልፎ አልፎ ብቻ 2
በዛ ላለ ጊዜ 3
ሁልጊዜ 4

3.4. Self-Reporting Questionnaire 20-item version (SRQ-20)


አዎን 1 SRHA
1 ባለፉት 30 ቀናት ብዙ ጊዜ ራስ ምታት ያምዎታል?
የለም 0
2 ባለፉት 30 ቀናት የምግብ ፍላጎትዎ ቀንሷል? አዎን 1 SRAP

27
የለም 0
አዎን 1 SRIS
3 ባለፉት 30 ቀናት የእንቅልፍ ችግር አለብዎት?
የለም 0
አዎን 1 SRFR
4 ባለፉት 30 ቀናት በቀላሉ<ይደነግጣሉ (ይበረግጋሉ)?
የለም 0
አዎን 1 SRTR
5 ባለፉት 30 ቀናትእጅዎ ይንቀጠቀጣል?
የለም 0
ባለፉት 30 ቀናት መረበሽ፣ መጠበብ ወይም በሚረባውም አዎን 1 SRWO
6
በማይረባውም ሐሳብ ይበዛብዎታል? የለም 0
ባለፉት 30 ቀናት ምግብ ከበሉ በኅላ ሆድዎን ይከብድዎታል (ሆድዎን አዎን 1 SRID
7 ይነፋዎታል)?
የለም 0
ባለፉት 30 ቀናት በትክክል ማሰብ ይቸግርዎታል (ሀሳብዎ እየተዘራረቀ አዎን 1 SRDT
8
ያስቸግርዎታል)? የለም 0
አዎን 1 SRSA
9 ባለፉት 30 ቀናት ደስታ የማጣት ስሜት አለዎት?
የለም 0
10 ባለፉት 30 ቀናት ከወትሮው በላይ ያስለቅስዎታል? አዎን 1 SRWC
የለም 0
11 ባለፉት 30 ቀናት በየቀኑ በሚሠሯቸው ሥራዎች መደሰት አዎን 1 SRLH
ይቸግርዎታል? የለም 0
12 ባለፉት 30 ቀናት በእለት ተእለት ጉዳይዎ (ተግባርዎ) ላይ ውሳኔ አዎን 1 SRPDM
መወሰን ያስቸግርዎታል? የለም 0
13 አዎን 1 SRDFW
ባለፉት 30 ቀናት የእለት ተእለትሥራዎችተበድሏል(ተስተጓጉሏል)?
የለም 0
14 ባለፉት 30 ቀናትበእለትተእለትኑሮላይ ጠቃሚ አስተዋጽኦ አዎን 1 SRSCO
(ተሳትፎ)ማበርከትአልቻልኩምይላሉ? የለም 0
15 አዎን 1 SRWS
ባለፉት 30 ቀናትለተለያዩ ነገሮች የነበረዎት ፍላጎት/ስሜት/ጠፍቷል?
የለም 0
16 አዎን 1 SRFWL
ባለፉት 30 ቀናት የማልጠቅመ ወይም ዋጋ ቢስ ነኝ ብለው ያስባሉ<?
የለም 0
17 ባለፉት 30 ቀናት ውስጥ፤ ራስዎትን የማጥፋት ሐሳብ መጥቶብዎት አዎን 1 SRWTD
ያውቃል? የለም 0
18 አዎን 1 SRFTIR
ባለፉት 30 ቀናት ሁልጊዜ ድካም ይሰማዎታል?
የለም 0
19 ባለፉት 30 ቀናት ሆድዎ ይረበሻል (ሆድዎ ውስጥ ያለመመቸት ስሜት አዎን 1 SRFDIS
ይሰማዎታል)? የለም 0
20 አዎን 1 SREGR
ባለፉት 30 ቀናት በቀላሉ ይደክማሉ?
የለም 0

3.5. Mini-International Neuropsychiatric Interview (MINI)

28
መጠይቁ የተሞላበት ቀን [ ][ ]/[ ][ ]/[ ][ ][ ][ ]

የተጠያቂው ቁጥር [ ][ ][ ][ ]

የተጠያቂው ስም

የተጠያቂው ዕድሜ [ ][ ]

የተጠያቂው ቀበሌ

መጠይቁ የተሞላበት ቀን [ ][ ]/[ ][ ]/[ ][ ][ ][ ]

የተጠያቂው ቁጥር [ ][ ][ ][ ]

የተጠያቂው ዕድሜ [ ][ ]

የተጠያቂው ቀበሌ

M.I.N.I

የመጠይቁ የአሞላል መመሪያ (RATING INSTRUCTIONS)፤

ሁሉም ጥያቄዎች መመለስ ይኖርባቸዋል፡፡ የለም ወይም አዎን የሚለውን አማራጭ አክብቡ፡፡
ምላሹን ለመሙላት የሙያ ግምገማችሁንም ተጠቀሙ፡፡ አስፈላጊ ሆኖ ሲገኝ፤ ምላሹ ትክክለኛ
መሆኑን ለማረጋገጥ ምሳሌ እንዲሰጥ ጠይቁ፡፡ ህመምተኛው ያልተረዷቸው ነገሮች ካሉ
ማብራሪያ እንዲጠይቁ አበረታቱ፡፡

ጠያቂ ባለሙያዎች፤ እያንዳንዱ የጥያቄ ክፍል በትክክል መመለሱን ማረጋገጥ ይኖርባቸዋል


(ለምሳሌ፤ ምልክቱ ምን ያህል ጊዜ እንደቆየ፤ ድግግሞሹ፤የህመሙ ብርታት፤ እንዲሁም
አማራጮች)

በሌላ ህመም ሳቢያ ወይም በመጠጥ እና በእፅ ምክንያት የተከሰተ የአእምሮ ሀመም ምልክት፤
በ M.I.N.I.ላይ መሞላት የለበትም፡፡

A.የአባች ድባቴ ህመም ክስተት

29
ማስታወሻ፤ የለም ወይም አዎን የሚለውን አማራጭ አከብቡ፡፡

A1 a. ላለፉት ሁለት ተከታታይ ሳምንታት የመደበር ወይም የማዘን የለም አዎን


(የመከፋት) ስሜት ነበረዎት ወይ?

A1 a አዎን ከሆነb.ን ጠይቁ፤ A1 aየለም ከሆነወደ A2እለፉ

b. የቀኑን አብዛኛውን ጊዜ እና ከሞላ ጎደል በየእለቱይህ የመደበር የለም አዎን


ወይም የማዘን (የመከፋት) ስሜት ነበረወይ?

A2 ላለፉት ሁለት ሳምንታት አብዛኛውን ጊዜ ለብዙ ነገሮች የለም አዎን


ፍላጎት ማጣት ወይም በፊት ያስደስትዎት ለነበሩት ነገሮች
ስሜት ማጣት ነበረዎት?

A1 b. ወይም A2 መልስ አዎን ነው? የለም አዎን

A3 ባለፉት ሁለት ሳምንታት

a a.1 ከሞላ ጎደል በየቀኑ የምግብ ፍላጎትዎ ከወትሮው ቀንሶ የለም አዎን
ነበር?

a.2 ከሞላ ጎደል በየቀኑ የምግብ ፍላጎትዎ ከወትሮው የለም አዎን


ጨምሮ ነበር?

a.3 ሆን ብለው ሳይሞክሩ ክብደትዎ ቀንሶ ነበር (ከሰውነት የለም አዎን


ክብደት ቢያንስ አምስት ከመቶ ያህሉን መቀነስ)?

a.4 ሆን ብለው ሳይሞክሩ ክብደትዎ ጨምሮ ነበር (ከሰውነት የለም አዎን


ክብደት ቢያንስ አምስት ከመቶ ያህል)?

b b.1 ከሞላ ጎደል በየቀኑ እንቅልፍ እንቢ ብሎዎት ነበር? የለም አዎን
(ማለትም፤እንቅልፍ አልዎስድ ማለት፤ ሌሊት
መንቃት/የእንቅልፍ መቆራረጥ/፤ ጠዋት ማልዶ
መንቃት)

b.2 ከሞላ ጎደል በየቀኑ እንቅልፍ እየበዛብዎት ተቸግረው የለም አዎን


ነበር?

c c.1 ከሞላ ጎደል በየቀኑ ንግግርዎ ወይም እንቅስቃሴዎ የለም አዎን

30
ከተለመደው በላይ ቀስ ብሎ ነበር?

c.2 ከሞላ ጎደል በየቀኑ መቅበጥበጥ፤ አርፎ አለመቀመጥ የለም አዎን


እና እረፍት ማጣት ነበረዎት?

d ከሞላ ጎደል በየቀኑ ድካምና ጉልበት ማነስ ነበረዎት? የለም አዎን

e ከሞላ ጎደል በየቀኑ ዋጋ ቢስነት፣ የበታችነት ወይም የለም አዎን


የጥፋተኝነት ስሜት ይሰማዎት ነበር?

A3e አዎን ከሆነ ምሳሌ ይጠይቁ፡፡

ምሳሌው ከእውነት የራቀ ሃሳብ (delusional idea)


ይመስላል?

0 የለም 1 አዎን

f ከሞላ ጎደል በየቀኑ ሃሳብዎት እየተበተነ ወይም ዉሳኔ የለም አዎን


ላይ ለመድረስ እየተቸገሩ ነበር?

g በተደጋጋሚ ራስዎትን ለመጉዳት አስበው፣ ራስዎትን የለም አዎን


ለማጥፋት ስሜት አድሮብዎት ወይም ሞቼ ባረፍኩት
ብለው ያውቃሉ?

n ከተለመደው በላይ ወይም በትንሹም በትልቁም የለም አዎን New


እየተበሳጩ ተቸግረዋል? item

A4 3 ወይም ከዛ በላይ የሆኑ የA3 ጥያቄዎች አዎን የሚል የለም አዎን


መልስ ተሰጥቷቸዋል? (ወይምA1 ወይምA2የለም የሚል መልስ
ከተሰጣቸው ፤4 የA3 ጥያቄዎች አዎን የሚል መልስ
ተሰጥቷቸዋል?)

ማስታዎሻ፡ a.1.-a.4.=1, b.1.-b.2.=1, c.1.-c.2.=1


(ለእያንዳንዳቸው አንዳንድ ነጥብ ብቻ ይሰጥ)

ማስታዎሻ፤ ለ A4መልሱ የለም ከሆነ፤ ወደ መጠይቅ B እለፉ፡፡


31
A5. የነበረዎት የመደበት ስሜት በኑሮዎ ላይ ጫና ፈጠረብዎት?
ወይም በስራዎ፣በማህበራዊ ህይወትዎ እንዲሁም በሌላ መልኩ
የለም አዎን
ያለዎትን ኃላፊነት እንዳይወጡ አደረገዎት ወይ?

A6.1. የሚወዱትን ሰው በሞት አጥተዋል? የለም አዎን

A6.1.a. ለጥያቄ A6.1. መልሳቸው አዎን ከሆነ፤ "የሚወዱትን ሰው በሞት ከተለዩ ስንት ጊዜ
ሆነው?" ብለው ይጠይቁ:: [ ][ ] ወራት፡፡

A6.2. ለጥያቄ A6.1. መልሳቸው አዎ ከሆነ፤ የሚከተለውን ጥያቄ አቅርቡ፡፡

ከላይ የተዘረዘሩት ምልክቶች ሙሉ በሙሉ፤ የሚወዱትን ሰው በሞት ከማጣት የተነሳ የመጡ


ናቸው? ከሆነስ እነዚህ ምልክቶች፣ በክብደታቸው፣ በእለት ተእለት ተግባርዎት እና ኑሮዎት
ላይ ባደረሱት መስተጓጓል፤ እንዲሁም ከጊዜው ርዝመት አንጻር ከሌሎች ሃዘን ከደረሰባቸው
ሰዎች ጋር ሲወዳደር ጋር ተመሳሳይነት አለው?

ለጠያቂው፡ ይህ ከሆነ ግለሰቡ ያላቸው አግባብ ያለው ሃዘን (uncomplicated bereavement) ነው፡፡ አግባብ
ያለው ሃዘን (uncomplicated bereavement) አለመሆኑን አረጋግጠዋል?

የለም አዎን

A7. a. እነዚህ ምልክቶች ከመጀመራቸው በፊት የሚወስዷቸው መድሃኒቶች ወይም

ለሱስ የሚዳርጉ እጾች ይወስዱ ነበር?


የለም አዎን

b. እነዚህ ምልክቶች ከመጀመራቸው በፊት ዘዎትር ከሚዎስዱት በላይ አልኮል

ወይም ጫት ይጠቀሙ ነበር?


የለም አዎን

c. እነዚህ ምልክቶች ልክ ከመጀመራቸው በፊት አካላዊ ህመም ነበረዎት?

የለም አዎን

በጠያቂው አስተያየት፡- የድባቴ ህመሙ ከላይ ከተጠቀሱት ምክንያቶች በአንዱ የመጣ ሊሆን ይችላል
ብለው ያምናሉ? አስፈላጊ ከሆነ ሌሎች ተጨማሪ የማብራሪያ ጥያቄዎችን ይጠይቁ፡፡

A7(ማጠቃለያ) ድባተቴው ከሌላ በሽታ የመጣ(organic) እንዳልሆነ ተረጋግጧል?

የለም አዎን አጠራጣሪ ነው

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የለምአዎን
A8. የA7(ማጠቃለያ) መልስ አዎ ወይም አጠራጣሪ ከሆነ አዎን ይምረጡ፡፡
የአባች ድባቴ ህመም ክስተት

የስሜት መታወክ

A9. A7c. መልስ አዎን ከሆነና፡ የA7(ማጠቃለያ) መልስየለም ከሆነ አዎን ይምረጡ፡፡ የለምአዎን

ከአካላዊ ህመም የተነሳ


የስሜት መታወክ
A10. A7a ወይምb መልስ አዎን ከሆነና፡ የA7 (ማጠቃለያ) መልስ የለም
የለምአዎን
ከሆነ አዎን ይምረጡ፡፡
በሱስ አስያዥ ንጥረ ነገሮች
የተነሳ የስሜት መታወክ

A10 PAST: ከአሁን በፊት ተመሳሳይ የሆነ የድባቴ ህመም አጋጥሞዎት ያውቃል?

የለም አዎን

ቅደም ተከተል

A11. በመጀመሪያ የድባቴ ህመም ምልክቶች ሲጀምርዎ ዕድሜዎ ስንት ነበር?[ ][ ] ዓመት

A12. በእድሜዎ ሁሉ እነደዚህ አይነት የድባቴ ህመም ስንት ጊዜ ተመላልሶብዎታል? [ ][ ] ጊዜ

A13. ተመሳሳይ ወይም ተቃራኒ የሚመስል በሽታ ያለበት ወይም ለአእምሮ መታወክ
መደሃኒት የሚጠቀም ዘመድ አለዎት? የለም አዎን

B.
1. እስካሁን ስለድባቴ ወይም ስለመተከዝ ስሜቶች አነጋግሬዎታለሁ፡፡ ከዚህ ውጭ የሆነ የሚነግሩኝ
የአእምሮ መታወክ ወይም ጭንቀት አለ?

ማስታወሻ፡ briefly explore anxiety symptoms and describe the symptoms and the likely
diagnosis

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2. ሐኪም ወይም አዋቂ አላወቅልኝም የሚሉት ህመም አለ?

ማስታወሻ፡ briefly explore somatoform symptoms and describe the symptoms and the
likely diagnosis

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3.6. WHO Disability Assessment Schedule, version 2 (WHODAS II)


መግቢያ

ለጠያቂ ማስታወሻ፡ካርድ ቁጥር 1ን ለተጠያቂ ስጥ እና የሚከተለውን ማብራሪያ ስጥ።

ይህ ቃለመጠይቅ ሰዎች በጤና እክል ምክንያት ስለሚኖራቸው ችግር ይሆናል።

የጤናእክል ስል በሽታ ወይም ህመም፣ ሌሎች ለአጭር ወይም ለረዥም ጊዜ የሚቆዩ የጤና ችግሮች፣ ጉዳቶች፣ የአእምሮ
ወይም የመንፈስ መታወክ እንዲሁም ከመጠጥ እና ከዕጽ ጋር የተናኙ ችግሮችን ይሆናል።

ቃለመጠይቁን ሲመልሱ ሁሉንም የጤና ችግርዎን እንዲያስቡ እፈልጋለሁ።


ለጠያቂ ማስታወሻ፡ ካርድ ቁጥር 1ን አመልክት ወይም ለተጠያቂዉ አንብብእና የሚከተለውንማብራሪያ ስጥ።

"አንድን ተግባር ለማከናወንመቸገር"ማለት፤

ስራውን ለማከናወን ተጨማሪ ጥረትሲያስፈልግ

ስራውን ማከናወን አለመመቸት ወይም የህመምስሜት ሲፈጥር

ስራውን ለማከናወን ብዙ ጊዜ ሲፈጅ

ስራዉን ለማከናወን ቀድሞ ከሚሰሩበት ሌላ መንገድለመጠቀም ሲገደዱ ማለት ነው፡፡ እንግዲህ አንድን ተግባር ለማከናወን
ስለሚገጥምዎት ችግር ስጠይቆትእነዚህን እያሰቡ መልስ ይስጡ፡፡

ለጠያቂ ማስታወሻ፡ለተጠያቂዉየሚከተለውን ተጨማሪ ማብራሪያ ስጥ፡፡

ጥያቄዎቹን ሲመልሱ የያለፉትን 30 ቀነቀት እያስታወሱ ይሁን። እንዲሁም እነዚህን ጥያቄዎች ሲመልሱ በአማካይ ባለፉት
30 ቀናት ብዙ ጊዜ የሚያከናውኑትን ስራ ለመፈፀም ምን ያህል ችግር ይገጥምዎት እንደነበር እያሰቡ ይሁን።

34
ካርድ ቁጥር 2ን ለመላሹ ስጥና ድምፅህን ከፍ አድርገህ መስፈርቶቹን አንብብላቸው። በመቀጠልም የሚከተለውን ተጨማሪ
ማብራሪያ ስጥ፡፡

ጥያቄዎቹን ሲመልሱ እነዚህን 5 የችግር ወይም የእክል ደረጃዎች ይጠቀሙ፣

1. ምንም ችግር የለም2. አነስተኛ ችግር3.መካከለኛ ችግር 4.ከፍተኛ ችግር 5.በጣም ከፍተኛ ችግር ወይምፈጽሞ መስራት
አለመቻል::

ለጠያቂ ማስታወሻ፤ መጠይቁ እስኪጠናቀቅ ድረስ ካርድ ቁጥር 1እና ካርድ ቁጥር 2 ለመላሹ እንደሚታዩ መሆን
አለባቸው።

የመረዳት ብቃት
ለጠያቂ ማስታወሻ፤ ለመላሹ ካርድ ቁጥር 1እና ካርድ ቁጥር 2 አሳይ።

ነገሮችን ሰለመረዳትእናከሰዎች ጋር ያለዎትን መግባባት በተመለከተ አንዳንድ ጥያቄዎች አቀርብልዎታለሁ።

ጥያቄዎቹን ሲመልሱ ከላይ የጠቀስኩልዎትን 5ቱን የችግር ወይም የእክል ደረጃዎች ይጠቀሙ፣ እነዚህም፣

ምንም ችግር የለም2.አነስተኛ ችግር 3.መካከለኛ ችግር 4. ከፍተኛ ችግር5.በጣም ከፍተኛ ችግር ወይምፈጽሞ መስራት
አለመቻል

ባለፉት 30 ቀናት ምንም አነስተኛ መካከለኛ ከፍተኛ በጣም


ከፍተኛ

D1.1 በሚóሰሩት ሥራ ላይ ሀሳብዎንለጥቂትጊዜ (ለ10 1 2 3 4 5


ደቂቃ)ያህልመሰብሰብ ይቸገሩነበር?

D1.2 አስፈላጊ የሆኑ ነገሮችን አስታዉሰዉለማድረግይቸገሩነበር? 1 2 3 4 5

D1.3 በእለት ተእለት ህይወትዎ ውስጥ 1 2 3 4 5


የሚገጥሙችግሮችንመንስኤለማወቅእናመፍትሄ ለመፈለግ
ይቸገሩነበር?

D1.4 አዲስ ነገር ወይምሥራ ለመማር ይቸገሩነበር? 1 2 3 4 5


(ለምሳሌየእርሻስራ፣ባልትና፣የእጅስራ፣የሞባይልአጠቃቀምወዘ
ተ...)

D1.5 በአጠቃላይ ሰዎች የሚሉትን መረዳት ይቸገሩነበር? 1 2 3 4 5

D1.6 ከሰዎች ጋር ንግግርጀምሮመጨረስይቸገሩነበር? 1 2 3 4 5

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2.እንቅስቃሴ
ለመላሹ ካርድ ቁጥር 1እና ካርድ ቁጥር 2 አሳይ።

አሁን ከእንቅስቃሴ ጋር ስለሚያያዙ ችግሮች እጠይቅዎታለሁ።

ባለፉት 30 ቀናት ምንም አነስተኛ መካከለኛ ከፍተኛ በጣም


ከፍተኛ

D2.1 ረዘም ላለ ጊዜ መቆም ምን ያህል ይቸግሮት ነበር? ለምሳሌ 1 2 3 4 5


ግማሽሰአት

D2.2 ከተቀመጡበት ለመነሳትምን ያህል ይቸግሮት ነበር? 1 2 3 4 5

D2.3 እቤትዎ ውስጥ መዘዋወር ምን ያህል ይቸግሮት ነበር? 1 2 3 4 5

D2.4 ከቤትዎ ለመውጣት ምን ያህል ይቸግሮት ነበር? 1 2 3 4 5

D2.5 ረዘም ያለ ርቀት ለመጓዝ ምን ያህል ይቸግሮት ነበር? 1 2 3 4 5


ለምሳሌ የሩብሰአትመንገድ (1ኪ.ሜትር)

3 . እራስን መንከባከብወይም መጠበቅ


አሁን እራስዎን ለመንከባከብ የሚገጥምዎትን ችግር እጠይቆታለሁ።

ባለፉት 30 ቀናት ምንም አነስተኛ መካከለኛ ከፍተኛ በጣም


ከፍተኛ

D3.1 ሰውነትዎን መታጠብ ምን ያህል ይቸግሮት ነበር? 1 2 3 4 5

D3.2 ልብስዎትንለመልበስ ምን ያህል ይቸግሮት ነበር? 1 2 3 4 5

D3.3 ምግብለመመገብ ምን ያህል ይቸግሮት ነበር? 1 2 3 4 5

D3.4 ያለሰዉብቻዎትንለተወሰኑ ቀናት መቆየት ምን ያህል 1 2 3 4 5


ይቸግሮት ነበር?

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4. ከሰዎች ጋር መግባባት
አሁን ከሰዎች ጋር ለመግባባት የሚኖሮትን ችግር እጠይቆታለሁ። ያስታውሱ በጤና መታወክ ምክንያት የተፈጠሩ ችግሮችን
ብቻ ነው የምጠይቀው። ይህም ማለት:- በሽታ ወይም ህመም፣ ሌሎች ለአጭር ወይም ረዘም ጊዜ የሚቆዩ የጤና ችግሮች፣
ጉዳቶች፣ የአእምሮ ወይም የመንፈስ መታወክ እንዲሁም ከመጠጥ እና ከዕጽ ጋር የተገናኙ ችግሮችን ይሆናል።

ካርድ ቁጥር 1እና ካርድ ቁጥር 2 አሳይ/አንብብ።

ባለፉት 30 ቀናት ምንም አነስተኛ መካከለኛ ከፍተኛ በጣም


ከፍተኛ

D4.1 ከማያውቋቸው ሰዎች ጋር ተግባብቶጉዳይመፈጸምምን ያህል 1 2 3 4 5


ይቸግሮት ነበር?
D4.2 በጓደኝነት መቆየት ምን ያህል ይቸግሮት ነበር? 1 2 3 4 5

D4.3 ቅርብ ከሆኑ ሰዎች ጋር ተግባብቶመኖርምን ያህል ይቸግሮት 1 2 3 4 5


ነበር?
D4.4 አዲስ ጓደኝነትመጀመርምን ያህል ይቸግሮት ነበር? 1 2 3 4 5
D4.5 ወሲባዊ ግንኙነት ማድረግምን ያህል ይቸግሮት ነበር? 1 2 3 4 5

5. የኑሮ እንቅስቃሴ
5(1) የቤት ውስጥ ሥራዎች
የሚከተሉት ጥያቄዎች እቤትዎ ውስጥ ስላሎት እንቅስቃሴ እንዲሁም አብረዎት የሚኖሩ ወይም ቅርብ የሆኑ ሰዎችን
ስለመንከባከብ ይሆናል። ስራዎቹ ምግበ ማብሰል፣ ፅዳት፣ ሱቅ ወይም ገበያ መሄድ እንዲሁም ሌሎች ሰዎችን መንከባከብ
እና ንብረትዎን መጠበቅ ናቸው።

ካርድ ቁጥር 1እና ካርድ ቁጥር 2 አሳይ/አንብብ።

ባለፉት 30 ቀናት የሚከተሉትን ማድረግ ምን ያህል ይቸግሮት ነበር? ምንም አነስተኛ መካከለኛ ከፍተኛ በጣም
ከፍተኛ
D5.1 የቤት ውስጥ ሃላፊነቶችን መወጣት ምን ያህል ይቸግሮት ነበር? 1 2 3 4 5
D5.2 ቅድሚያየሚሰጧቸዉንየቤት ውስጥ ሥራዎች በደንብ መስራት ምን 1 2 3 4 5
ያህል ይቸግሮት ነበር?
D5.3 መስራት ያለብዎትን የቤት ውስጥ ሥራዎች በሙሉ ሰርቶለመጨረስምን 1 2 3 4 5

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ያህል ይቸግሮት ነበር?
D5.4 የቤት ውስጥ ሥራዎን በሚፈለገው ፍጥነት ለመስራት ምን ያህል 1 2 3 4 5
ይቸግሮት ነበር?

ከD5.1 – D5.4 ውስጥ የችግሩደረጃከምንም በላይ (ከ1 በላይ) ምላሽ የተሰጠበት ካለ የሚከተሉትን ጠይቅ።

D5.01 ባለፉት 30 ቀናት በጤናዎ ችግር የተነሳ ለስንት ቀናት የቤት ውስጥ የቀናት ብዛት ይመዝግቡ _______________
ሥራዎን መስራት ቀነሱ ወይም ሙሉ ለሙሉ ሳይሰሩቀሩ? ቀናት

መላሹ ሠራተኛ (በክፍያ፣ በነፃ፣ በግል የሚሰራ ከሆነ) ወይም ተማሪ ከሆነ
ከD5.5 –D5.10 ያለዉንሙላ። ካልሆነ ግን ወደ D6.1እለፍ።
5(2) ስራ ወይም ትምህርት

አሁን ስለሥራዎ ወይም ስለትምህርትዎ እጠይቅዎታለሁ።

ካርድ ቁጥር 1እና ካርድ ቁጥር 2 አሳይ/አንብብ።

ባለፉት 30 ቀናት ምንም አነስተኛ መካከለኛ ከፍተኛ በጣም


ከፍተኛ

D5.5 የዕለት ተዕለት ሥራዎን 1 2 3 4 5


ወይምትምህርትዎንለማከናወንምን ያህል ይቸግሮት
ነበር?

D5.6 ቅድሚያየሚሰጡትንሥራወይምትምህርትበደንብመስራትምን 1 2 3 4 5
ያህል ይቸግሮት ነበር?

D5.7 መስራት ያለብዎትን ሥራ ወይምትምህርትበሙሉð 1 2 3 4 5


ሰርቶለመጨረስምን ያህል ይቸግሮት ነበር?

D5.8 ሥራወይምትምህርትዎንበሚፈለገው ፍጥነት ለመስራት ምን 1 2 3 4 5


ያህል ይቸግሮት ነበር?

D5.9 በጤናዎ ምክንያት ከሚጠበቅብዎወይምከወትሮደረጃዎዝቅብለዉእንዲሰሩ ተገደዋል? የለም 1


አዎን 2
D5.10 በጤናዎ ምክንያት ገቢዎ ቀንሷል? የለም 1
አዎን 2

ከD5.5 – D5.8 ውስጥ የችግሩደረጃከምንም በላይ (ከ1 በላይ) ምላሽ (ምላሾች) የተሰጠበት ካለ የሚከተሉትን ጠይቅ።

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D5.02 ባለፉት 30 ቀናት በጤናዎ ችግር የተነሳ ለግማሽ ቀንወይምከዚያበላይ የቀናት ብዛት ይመዝግቡ _______________
ሥራ ሳይሰሩየቀሩትለምንያህልቀናትነበር? ቀናት

ማህበራዊ ተሳትፎ
አሁን በህበረተሰብ ውስጥ ለለዎት ተሳትፎ እንዲሁም የጤና ችግር በራስዎ እና በቤተሰብዎ ላይ ስላስከተለው ችግር
እጠይቅዎታለሁ። አንዳንዶቹ ችግሮች ከ30 ቀናት በላይ የቆዩ ሊሆኑ ይችላሉ፡፡ ሆኖም ግን፣ የሚከተሉትን ጥያቄዎች
ሲመልሱ እባክዎ ባለፉት 30 ቀናት ላይ ብቻ ያተኩሩ። እነዚህን ጥያቄዎች ሲመልሱ ስለጤናዎ ችግር እያሰቡ እንዲሆን
በድጋሚ አሳስብዎታለሁ።

ካርድ ቁጥር 1እና ካርድ ቁጥር 2 አሳይ።

ባለፉት 30 ቀናት ምንም አነስተኛ መካከለኛ ከፍተኛ በጣም


ከፍተኛ

D6.1 በማህበራዊእንቅስቃሴ ውስጥ (ለምሳሌ:- ዓመት በዓል፣ ድግስ፣ 1 2 3 4 5


ለቅሶ፣እድር፣ሊቃ..ወዘተ) ልክ እንደሌላው ሰውመሳተፍምን
ያህል ይቸግሮት ነበር?

D6.2 በአካባቢዎባሉ መሰናክሎችና ምቹያልሆኑሁኔታዎችምክንያትምን 1 2 3 4 5


ያህል ይቸግሮት ነበር?

D6.3 ሰዎች ባላቸው መጥፎ (አሉታዊ) አመለካከትና 1 2 3 4 5


ተገቢያልሆኑድርጊቶችየተነሳ ክብርዎተጠብቆልዎትለመኖር ምን
ያህል ተቸገሩ?

D6.4 በጤናዎመታወክወይምየጤናዎመታወክባስከተለዉችግርምክንያት 1 2 3 4 5
ምን ያህል ጊዜአጥፍተዋል?

D6.5 በጤናዎ ችግርምክንያት መንፈስዎ ምን ያህል ተረብሿል? 1 2 3 4 5

D6.6 የጤናችግርዎየእርስዎንናየቤተሰብዎን ሀብትእናንብረትምን ያህል 1 2 3 4 5


አራቆተ?

D6.7 በእርስዎ የጤና ችግር ምክንያት ቤተሰንዎ ምን ያህል ተቸግሯል? 1 2 3 4 5

D6.8 ራስዎትንችለዉለመዝናናት ወይም ለመደሰት ለመዝናናትወይም 1 2 3 4 5


ለመደሰት ሲሉነገሮችንማድረግምን ያህል ይከብድዎታል?

H1 በአጠቃላይ ባለፉት 30 ቀናት ዉስጥ እነዚህ ችግሮች ለምን ያህል ቀናት ነበሩ? የቀናት ብዛት ይግለፁ_______________

39
H2 ባለፉት 30 ቀናት ዉስጥ፣ በማንኛዉም የጤና ችግር ምክንያት፣ የተለመደ ስራ የቀናት ብዛት ይግለፁ_______________
ወይም እንቅስቃሴዎትን ሙሉ በሙሉ ማድረግ ያልቻሉት ለምን ያህል ቀናት
ነበር?

H3 ባለፉት 30 ቀናት ዉስጥ፣ በማንኛዉም የጤና ችግር ምክንያት፣ ሙሉ በሙሉ የቀናት ብዛት ይግለፁ_______________
ምንም ስራ መስራት ያልቻሉባቸዉን ቀናት ሳይጨምር፣ የተለመደ ስራ ወይም
እንቅስቃሴዎትን ለመቀነስ የተገደዱባቸዉ ምን ያህል ቀናት ነበሩ?

ካርድ ቁጥር 1

የጤና ችግሮች

በሽታ ህመም ወይም ሌላ የጤና ችግር


ጉዳቶች
40
የአእምሮ ወይም የመንፈስ መታወክ
ከመጠጥ (አልኮል) ጋር ተገናኙ ችግሮች
ከዕጽ ጋር የተያያዙ ችግሮች

"አንድን ተግባር ለማከናወን መቸገር" ማለት፤

ስራውን ለማከናወን ተጨማሪ ጥረት ሲያስፈልግ


ስራውን ማከናወን አለመመቸት ወይም የህመም ስሜት ሲፈጥር
ስራውን ለማከናወን ብዙ ጊዜ ሲፈጅ
ስራዉን ለማከናወን ወድሞ ከሚሰሩበት ሌላመንገድ ለመጠቀም ሲገደዱ ማለት
ነው፡፡

41
ካርድ ቁጥር 2
5 -- በጣም ከፍተኛ

4 -- ከፍተኛ

3 -- መካከለኛ

2 -- አነስተኛ

1 -- ምንም

3.7. To be filled from FMOH integrated antenatal, labor, delivery, newborn and postnatal
care card

ጠያቂውከመዝገብላይየሚሞላው

አለ 1 HIGHRISK
1 እርግዝናውላይየተለየችግርአለ?
የለም 2

42

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