Southwestern Uganda Research Articles

Maternal adverse childhood experiences, child mental health, and the mediating effect of maternal depression: A cross-sectional, population-based study in rural, southwestern Uganda.

This study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health. Data come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their children's mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis. Among 218 mother-child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership. Maternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families.

Type 1 diabetes patient experiences and management practices during the COVID-19 pandemic in rural Uganda.

The COVID-19 pandemic has impacted various aspects of the lives of persons with chronic diseases, including type 1 diabetes (T1D). However, the diabetes care experiences and practices adopted by persons living with T1D after the declaration of the COVID-19 pandemic in Uganda have not been well documented. We investigated diabetes management practices and experiences of persons with T1D during the COVID-19 pandemic lockdown in a rural district of southwestern Uganda. Using interactive sequential explanatory mixed methods, we conducted a cross-sectional study of persons with T1D aged 18-25 years, their caregivers and health workers. Quantitative data was exclusively collected from patients with T1D using Kobo Toolbox™ and analysed with SPSS™ version26; qualitative interviews were used to elicit responses from purposively selected patients with T1D, plus caregivers and health workers that were analysed using a thematic framework approach. The study enrolled 51 (24 males) patients with T1D; diabetes duration (mean ± SD) 6.6 ± 5 years. Access to insulin syringes significantly worsened in 19.6% of participants (p = 0.03). Insulin injection frequency (p = 0.01), blood glucose monitoring (p = 0.001) and meal frequency (p = 0.0001) significantly decreased. Qualitative interviews highlighted COVID-19 restriction measures had reduced household income, frequency of clinic visits, and access to food, diabetes support and social services. Experiences and practices were consistent with decisions to prioritise survival, even with known risks around metabolic control. The online version contains supplementary material available at 10.1007/s40200-023-01222-4.

Impact of Accounts Receivable Management on the Financial Performance of SACCOS in Sheema Municipality, Southwestern Uganda

The study aimed to examine the impact of accounts receivable management on the financial performance of Savings and Credit Cooperative Societies (SACCOs). Despite their significant contribution to a country's economic development, SACCOs still face financial challenges, with 26% of loans considered bad debts and 60% of them failing within a year. A correlational research design was adopted, with a sample size of 145 and a questionnaire used for data collection. A regression analysis using SPSS was used to analyze the data. The results showed that accounts receivable management significantly affects financial performance, suggesting that innovative programs can increase SACCOs' financial performance by.494 units. The study recommends the introduction of innovative programs to improve SACCOs' financial performance, benefiting government policy makers, researchers, and management teams. The findings will be beneficial to government policy makers, researchers, and Sheema Municipality management teams. Keywords: SACCOs, Accounts receivable management, financial performance

Outcomes and Their Predictors in Post- Intensive Care Patients Admitted With Traumatic Brain Injury at Mbarara Regional Referral Hospital, Southwestern Uganda: A Retrospective Study

Purpose: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. TBIs are increasing in Uganda, but little is known about outcomes and their predictors in post-ICU patients. This study assessed outcomes and their predictors in post-ICU patients admitted with TBI at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda.
 Methodology: Retrospective study was used to review hospital records of patients admitted to the Intensive Care Unit (ICU) for MRRH with TBI. Data were entered into Excel, cleaned and exported to Stata version for analysis and presented as mean (standard deviation), median (interquartile range) and number (percent), while using the chi-square test and multinomial logistic regression as predictors for Post-ICU outcomes were used
 Findings: In the study, males dominated at 73%, while 81% were of working age (15-64 years). Road traffic accidents (83%) were the most common injury mechanism, followed by physical injury at 11%. Length of stay in the Intensive Care Unit was 9 (IQR = 4–8) days, mean GCS at ICU admission and discharge was 7.7 (±2.65) and 10 (±3.27), respectively. Fifty-seven patients (63%) were discharged home; with 73% good recovery Glasgow coma Outcome Scale of hospital discharges. Post-ICU outcomes were associated with GCS at ICU discharge ( . Having moderate Glasgow Coma Scale on ICU discharge was 3.59 times higher of being discharged home than dying compared to severe GCS on ICU discharge (OR=3.59; 95%CI, 1.11 to 11.63). This study established GCS as a statistical predictor of patient outcomes at ICU discharge.
 Unique Contribution to Theory, Practice and Policy: Based on the findings of this study, prevention of TBI is critical in order to reduce incidence of TBI related mortality. Policy makers to put rules that continuously teach and enforce road safety and traffic rules to all road users.

Utilization of a novel mobile application, "HBB Prompt", to reduce Helping Babies Breathe skills decay.

Helping Babies Breathe (HBB) is a newborn resuscitation training program designed to reduce neonatal mortality in low- and middle-income countries. However, skills decay after initial training is a significant barrier to sustained impact. To test whether a mobile app, HBB Prompt, developed with user-centred design, helps improve skills and knowledge retention after HBB training. HBB Prompt was created during Phase 1 of this study with input from HBB facilitators and providers from Southwestern Uganda recruited from a national HBB provider registry. During Phase 2, healthcare workers (HCWs) in two community hospitals received HBB training. One hospital was randomly assigned as the intervention hospital, where trained HCWs had access to HBB Prompt, and the other served as control without HBB Prompt (NCT03577054). Participants were evaluated using the HBB 2.0 knowledge check and Objective Structured Clinical Exam, version B (OSCE B) immediately before and after training, and 6 months post-training. The primary outcome was difference in OSCE B scores immediately after training and 6 months post-training. Twenty-nine HCWs were trained in HBB (17 in intervention, 12 in control). At 6 months, 10 HCW were evaluated in intervention and 7 in control. In intervention and control respectively, the median OSCE B scores were: 7 vs. 9 immediately before training, 17 vs. 21 immediately after training, and 12 vs. 13 at 6 months after training. Six months after training, the median difference in OSCE B scores was -3 (IQR -5 to -1) in intervention and -8 (IQR -11 to -6) in control (p = 0.02). HBB Prompt, a mobile app created by user-centred design, improved retention of HBB skills at 6 months. However, skills decay remained high 6 months after training. Continued adaptation of HBB Prompt may further improve maintenance of HBB skills.

Depression, suicidality, substance-use and associated factors among people living with HIV the COVID-19 pandemic in Uganda.

Mental disorders are common in people living with HIV (PLHIV) but they are often unrecognized and untreated. Furthermore, the COVID-19 pandemic has disrupted the already limited mental health services in low resource countries such as Uganda, and yet the extent to which the COVID-19 mitigation measures have affected the mental health of PLHIV is not fully known. We aimed to determine the burden of depression, suicidality, substance use and associated factors among adult PLHIV who were seeking care at two HIV clinics in northern and southwestern Uganda. We conducted a phenomenological qualitative and quantitative cross-sectional study among 431 PLHIV to determine the burden of depression, suicidality and substance-use disorders at two HIV clinics, at Lira Regional Referral Hospital and Mbarara Regional Referral Hospital in northern and southwestern Uganda respectively, during the COVID-19 lockdown. We used the Patient Health Questionnaire (PHQ-9) to assess for depression and suicidality, and the Michigan Assessment-Screening Test for Alcohol and drugs (MAST-AD) to assess for substance use disorder. We conducted descriptive statistics analysis to determine the burden of the disorders, and logistic regression to determine the associated factors. For the qualitative method we conducted in-depth interviews with 30 PLHIV and did thematic analysis. Of the 431 PLHIV surveyed, mean age was 40.31 ± 12.20 years; 53.1% (n = 229) had depression; 22.0% (n = 95) had suicidality; and 15.1% (n = 65) had substance-use disorder. Female gender (PR = 1.073, 95%CI 1.004-1.148, P = 0.038), lack of formal education (PR = 1.197, 95% CI 1.057-1.357, P = 0.005), substance-use disorder (PR = 0.924, 95%CI 0.859-0.994, P = 0.034) and suicidality (PR = 0.757, 95%CI 0.722-0.794, p = 0.000) were associated with depression after adjusting for confounders. Further analysis showed that being female (PR = 0.843, 95% CI 0.787-0.903, P = 0.000*) and having depression (PR = 0.927, 95% CI 0.876-0.981, P = 0.009) and owning a large business (PR = 0.886, 95% CI 0.834-0.941, p = 0.000*) were significantly associated with having a substance-use disorder. Only depression was independently associated with suicidality after adjusting for confounding factors (PR 0.108, 95%CI 0.054-0.218, p = 0.000*). For the qualitative results, there were three apriori themes: a) Burden of depression, b) substance-use, and c) suicidality among the PLHIV during the COVID-19 containment measures. There was high prevalence of depression, suicidality and substance-use disorder in adult PLHIV in Uganda during the COVID-19 pandemic and the associated lockdown measures. The three mental health problems seem to have bidirectional relationships and gender has a lot of contribution to the relationships. Interventions aimed at any of the disorders should consider these bidirectional relationships.

Smallholder Farmers’ Coping Strategies to Perceived Climate Change and Variability in Isingiro District, South Western Uganda

Climate change and variability pose a major challenge facing the agricultural sector around the world and trends are feared to intensify by 2050. This is likely to complicate agricultural decisions affecting local communities who depend on the sector for their livelihood. Seasonal changes in weather patterns are projected to reduce food production due to the reduction in average yields of common food crops. With the majority of smallholder farmers in Uganda depending on agriculture for survival, building their adaptive capacity to climate change is vital to ensure household food and income security. This study aimed at establishing the smallholder farmers’ perceptions of climate change and their initiatives to cope with and manage the associated risks. A sample of 126 farming households were randomly selected from three Sub counties in Isingiro District and studied using field observations and questionnaires. Key informant interviews were also conducted with three extension workers. The collected data was analysed using Stata 14 and Excel. The findings revealed that there was increasing awareness of the climate change and variability challenge among smallholder farmers with the increasing need to take on adaptation strategies. The results showed that the major perceived changes were, increased intensity and frequency of droughts (98%), increase in daytime temperatures (92.7%), decrease in rainfall intensity (92.1%) and changes in rainfall distribution patterns (90%). It also showed that different initiatives had been taken by farmers to cope with the changes like changing planting dates (92.1%), growing crop variety mixtures (73.8%) and practising soil and water conservation (62.7%). Based on the findings of this study, smallholder farmers greatly perceived climate change and variability with negative impacts imposed on their farming operations. Although farmers have tried to adapt, there is still a need to support their coping strategies through appropriate policies. This will facilitate increased adoption of adaptation measures, thereby reducing the negative consequences of climate change in future

The Effect of Economic Factors on Coffee Consumption in Rukungiri District, South-Western Uganda

Rukungiri District production and marketing department has pursued campaigns to educate the public about the health benefits of coffee, including its high antioxidant content, potential to prevent certain malignancies, and potential to lower type 2 diabetes risk. Despite these efforts, the District still has a low level of coffee consumption. This study tried to determine whether economic variables could be responsible for the low consumption. Through the use of both quantitative and qualitative methods and a cross-sectional survey research design, this study was able to quickly assess the relationship between the study variables. Simple random and purposeful sampling methods were used to choose a sample of 123 respondents. The thematic analysis method was utilized to assess the qualitative data, while SPSS Version 23.0 was used to analyze the quantitative data. Based on the study's aims, quantitative data were presented in tables as descriptive statistics, correlations, and regressions. The study discovered a substantial positive association between economic parameters and coffee intake (r = 0. 876, P.01). Coffee consumption is influenced by the economic status in terms of higher incomes, wages, and general standards of living because these factors have a tendency to affect people's consumption habits. The study also came to the conclusion that raising the economic standing of residents of the Rukungiri District is what will drive up coffee consumption.

The Effect of Economic Factors on Coffee Consumption in Rukungiri District, South-Western Uganda

The Effect of Economic Factors on Coffee Consumption in Rukungiri District, South-Western Uganda

Demographics, referral patterns, and outcome of patients with neural tube defects in southwestern Uganda.

In Uganda, the burden of neural tube defects (NTDs) poses a serious neurosurgical and public health challenge; however, published data on this patient population are lacking. The authors sought to characterize the population of patients with NTDs, maternal characteristics, and referral patterns of these patients, and to quantify the burden of NTDs in southwestern Uganda. A retrospective neurosurgical database at a referral hospital was reviewed to identify all patients with NTDs treated between August 2016 and May 2022. Descriptive statistics were used to characterize the patient population and maternal risk factors. A Wilcoxon rank-sum test and chi-square test were used to determine the association between demographic variables and patient mortality. A total of 235 patients were identified (121 male, 52%). The median age at presentation was 2 days (IQR 1-8 days). A total of 87% of patients with NTDs presented with spina bifida (n = 204) and 31 presented with encephalocele (13%). The most common location of dysraphism was lumbosacral (n = 180, 88%). Of all patients, 80% were delivered vaginally (n = 188). Overall, 67% of patients were discharged (n = 156) and 10% died (n = 23). The median length of stay was 12 days (IQR 7-19 days). The median maternal age was 26 years (IQR 22-30 years). The majority of mothers received only primary education (n = 100, 43%). The majority of mothers reported prenatal folate use (n = 158, 67%) and regular antenatal care (n = 220, 94%), although only 23% underwent an antenatal ultrasound (n = 55). Mortality was associated with younger age at presentation (p = 0.01), need for blood transfusion (p = 0.016) and oxygen supplementation (p < 0.001), and maternal education level (p = 0.001). To the authors' knowledge, this is the first study to describe the population of patients with NTDs and their mothers in southwestern Uganda. A prospective case-control study is necessary to identify unique demographic and genetic risk factors associated with NTDs in this region.

Safety and tolerability of adjunctive linezolid with high or standard dose rifampin for the treatment of adults with HIV-associated tuberculous meningitis in Uganda: preliminary findings from the ALTER trial (S25.003)

<h3>Objective:</h3> To analyze preliminary safety data from the <b>A</b>djunctive <b>L</b>inezolid for the <b>T</b>reatment of Tub<b>ER</b>culous Meningitis (ALTER) trial, a phase II trial of high or standard-dose rifampin with or without linezolid 1200 mg for the first 4 weeks of treatment on a backbone of isoniazid, pyrazinamide, and ethambutol. <h3>Background:</h3> Better treatments are needed for tuberculous meningitis (TBM), which leads to mortality in excess of 50%. Linezolid penetrates into cerebrospinal fluid and is effective against TB. Little is known about its use in often critically ill TBM patients. <h3>Design/Methods:</h3> Persons with HIV (PWH) with definite or suspected TBM were recruited from a rural hospital in southwestern Uganda. Participants were seen on day 2, weeks 1, 2, 4, 8, 12, 18, and 24 for symptom assessment, medication adherence, physical examination, visual testing, neuropathy screening, and/or safety labs. <h3>Results:</h3> Of 23 participants enrolled (52% women, mean age 37 years, 78% with moderate to severe TBM grade), 12 were allocated to linezolid. Median CD4 count was 150 cells/mm³, (IQR 81–331) and 7 were on anti-retroviral therapy (ART). Twelve serious adverse events (SAEs) occurred, 6 among those on linezolid. The six included, sepsis (n=2), aspiration pneumonia (n=1), ART-related Stevens-Johnson syndrome (n=1), dehydration (n=1), and hyponatremia (n=1). Seven participants died, 2 on linezolid. No SAE was determined to be related to linezolid. No participants required linezolid discontinuation or dose reduction. Three participants developed ≥grade 3 hyponatremia. No ≥grade 3 anemia, thrombocytopenia, or neutropenia occurred. Mild grade 1 or 2 neuropathy symptoms were reported, more commonly among linezolid recipients (55% versus 0%, p=0.025), but resolved after treatment ended. <h3>Conclusions:</h3> In this preliminary analysis, linezolid was generally safe and well tolerated in TBM patients. Data from the completed trial will increase the power to determine if linezolid is safe to use with high and standard dose rifampin in PWH and TBM. <b>Disclosure:</b> Dr. Kibengo has nothing to disclose. Dr. Kabarambi has nothing to disclose. Mr. Kafeero has nothing to disclose. Dr. Patrick has nothing to disclose. Dr. NAKIMBUGWE has nothing to disclose. Mr. Ssemaganda has nothing to disclose. Mr. Tayebwa has nothing to disclose. The institution of Dr. Nahid has received research support from NIH . The institution of Fiona Cresswell has received research support from Janssen. Dr. Chow has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal consulting. The institution of Dr. Chow has received research support from NIH.

Patterns of and Factors Associated With Mental Health Service Utilization Among School-Going Adolescent Girls in Southwestern Uganda: A Latent Class Analysis

PurposeThe study aimed to improve understanding of patterns of multiple family group intervention engagement and associated factors among adolescent girls in a low-resource country, Uganda. MethodsThe data used in this analysis were part of a larger cluster randomized controlled trial consisting of 1260 adolescent girls across 47 public secondary schools. The sample in the current study consisted of 317 adolescent girls (ages 14–17 at enrollment) recruited from senior one and senior two classes across 12 secondary schools in the southwestern region of Uganda. Participants in this study participated in the multiple family group intervention—a 16-week manualized intervention. Attendance data from 16 sessions were used to identify the heterogeneity of intervention engagement using latent class analysis modeling. Logistic regression analysis was conducted to assess the association between predisposing, enabling, need factors, and mental health utilization patterns. ResultsOn average, participants attended 10 sessions (standard deviation = 5.90), 34.38% (N = 109) completed all 16 sessions, and 13.56% (N = 43) did not attend any of the sessions. Two attendance groups were identified: low and high attendants using latent class analysis. In addition, two family-level factors, the number of adults and the number of children in the family, were associated with an increase in the utilization of mental health services. DiscussionFindings suggest that enhancing family support systems may be useful in promoting mental health utilization among adolescent girls with the potential to improve self-esteem, reduce feelings of inadequacy, and ultimately achieve better mental health outcomes.

"If you have light, your heart will be at peace": A qualitative study of household lighting and social integration in southwestern Uganda.

Expanding electrification and access to other clean and affordable energy, such as solar energy, is a critical component of the Sustainable Development Goals, particularly in sub-Saharan Africa where 70% of people are energy insecure. Intervention trials related to access or less polluting household energy alternatives have typically focused on air quality and biological outcomes rather than on how an intervention affects the end user's lived experiences, a key determinant of uptake and adoption outside of a research setting. We explored perceptions of and experiences with a household solar lighting intervention in rural Uganda. In 2019, we completed a one-year parallel group, randomized wait-list controlled trial of indoor solar lighting systems (ClinicalTrials.gov NCT03351504) in rural Uganda where participants are largely relying on kerosene and other fuel-based lighting received household indoor solar lighting systems. In this qualitative sub-study, we conducted one-on-one, in-depth qualitative interviews with all 80 female participants enrolled in the trial. Interviews explored how solar lighting and illumination impacted participants' lives. We applied a theoretical model linking social integration and health to analyse dynamic interactions across aspects of study participants' lived experiences. Sensors were used to measure daily lighting use before and after receipt of the intervention solar lighting system. Introduction of the solar lighting system increased daily household lighting use by 6.02 (95% confidence intervals (CI) = 4.05-8.00) hours a day. The solar lighting intervention had far-reaching social implications with improved social integration and, consequently, social health. Participants felt that lighting improved their social status, mitigated the stigma of poverty, and increased the duration and frequency of social interactions. Household relationships improved with access to lighting because of reduced conflicts over light rationing. Participants also described a communal benefit of lighting due to improved feelings of safety. At the individual-level, many reported improved self-esteem, sense of well-being, and reduced stress. Improved access to lighting and illumination had far reaching implications for participants, including improved social integration. More empirical research, particularly in the light and household energy field, is needed that emphasizes the impacts of interventions on social health. ClinicalTrials.gov No. NCT03351504.

The Relationship Between Family Cohesion and Depression Among School-Going Children With Elevated Symptoms of Behavioral Challenges in Southern Uganda

PurposeDepression is among the leading causes of disability and contributes significantly to the overall disease burden affecting children. Family cohesion has been identified as a protective factor against depression. Examining this relationship is necessary in sub-Saharan Africa, specifically in Uganda—a country characterized by a high prevalence of HIV/AIDS, and high rates of chronic poverty, all of which stress family functioning and elevate child behavioral challenges. This study examined the relationship between family cohesion and depression among school-going children with elevated symptoms of behavioral challenges in southern Uganda. MethodsAt baseline, 2089 children were enrolled in the National Institutes of Health-funded Strengthening Mental Health and Research Training Africa study in Southwestern Uganda. This article analyzed data from 626 children aged 8–13 years with elevated behavioral challenges. We conducted multilevel mixed-effects Poisson regression to determine the association between family cohesion and depression. We controlled for sociodemographic and household characteristics. ResultsThe mean age was 10.3 years. The overall mean depression score was 3.2 (standard deviation = 2.7, range = 0–15). Family cohesion (β = −0.03, 95% confidence interval [CI]: −0.04, −0.02, p < .001) and owning essential items by the child (β = −0.13, 95% CI: −0.23, −0.04, p = .005) were protective against depression among children. Additionally, we observed being a single orphan (β = −0.44, 95% CI: −0.03, −0.86, p = .036) and having both parents (β = −0.43, 95% CI: −0.06, −0.81, p = .023) were associated with depression among children. DiscussionFindings from this study reveal that family cohesion was protective against depression. Therefore, it is vital to strengthen family support systems by developing programs aimed at strengthening family relationships as a catalyst for addressing depression among children.

Prevalence of Alcohol Use Disorders among Patients in the Psychiatry Unit of Kampala International University Teaching Hospital in South Western Uganda

Globally, the World Health Organization (WHO) estimated that, there are 2 billion people worldwide who consume alcoholic beverages. The burden of alcohol use is a public health concern. In South, East and West Africa, prevalence of alcohol abuse ranges between 10%- 70%. Uganda has previously reported that, annual per capital alcohol consumption was 23.7 litters. The objective of this study was to determine the prevalence of alcohol use disorders among patients attending psychiatry unit of KIU-TH. The researcher used a retrospective study in patients admitted at KIU-TH psychiatry unit within a period of six months from January, 2017 to June, 2017. From the results of this study, mental health problems were on the increase and up to 34% of admissions were due to alcohol related mental disorders, 70.6% are new admissions. Alcohol induced psychosis is the most prevalent diagnosed alcohol related mental illness with 41.2%, followed by Alcohol abuse with 23.5%, then alcohol withdrawal with 17.6%. Stress was the number one factor associated with alcohol use mental disorder with 70.6%. However, when treated, alcohol related mental disorders has a good prognosis of 82.6%. It is recommended that KIUTH in collaboration with the University section should create awareness of alcoholism as a mental health disorder that can be managed and treated. Youths should abstain from alcohol completely or limit their intake of alcohol. Alcohol sale and use should be strictly limited to few licensed shops. Keywords: Alcohol, Youth, psychiatry, mental disorders

Evaluation of the factors that contribute to patient self-medication in outpatient department (OPD) at Kabwohe Health Centre IV

Self-medication is a common practice in both rural and urban settings, in older people with chronic illness and young people. Self-medication leads to irrational drug use, drug resistance, and severe disease development. This study seeks to determine the factors that contributes to self-medication among patients at out-patient department at Kabwohe Health Center (HC) IV. It was a cross sectional study using quantitative method of data collection. It was conducted at Kabwohe HC IV located in Sheema District in southwestern Uganda. The study involved patients attending Outpatient Department (OPD) at Kabwohe HC IV. Simple random sampling was used to recruit patients into the study. Microsoft excel was used to analyze data and it was presented in form of frequency distribution tables, pie charts and bar graphs. The study involved 89 participants attending OPD at Kabwohe HC IV, majority of the participants (86.5%) were less than 35 years and females were slightly more than males. The reasons for self-medication include; non-availability of doctors at the health facility as the main factor (95%), knowledge of diagnosis (84%), lack of time (75%) and financial problems (74%). Self-medication remains a challenge at Kabwohe HC IV. Patients should be educated on the advantages and disadvantages of self-medication. The DHO should strengthen policy implementation on the use of drugs to reduce the burden of irrational drug use that increases the cost of purchasing the wasted drugs, and increasing drug resistance. DHO, should also conduct routine clinical audit on patient care to identify missed opportunity in care and develop action plan to address challenges in service delivery. Keywords: Health Centre, Patients, Kabwohe, Outpatient Department and Self-Medication

Childhood trauma among adult patients with mental illness in south-western Uganda: A hospital-based study

IntroductionChildhood trauma plays a central role in the long-term outcomes and quality of life of adults with mental disorders. Its burden among patients receiving mental health care in rural health facilities has not been established formally. This study determined the prevalence of childhood trauma among individuals receiving treatment at two mental health facilities in southwestern Uganda. MethodsTwo hundred forty-nine adult psychiatric patients were screened for childhood trauma using the Adverse Childhood Experience International Questionnaire. Descriptive analyses were performed to determine the information on prevalence rates, cumulative traumas and types of trauma experienced by individuals receiving treatment at Ugandan mental health facilities. ResultsNine in ten mentally ill patients had experienced childhood adversities which were more significant greater among participants diagnosed with depression and substance use disorder compared to those with bipolar disorder and schizophrenia. 99.6% of participants with childhood trauma experienced multiple forms of adverse childhood adversities. The commonest adverse childhood experiences in our sample were witnessing violence against household members, physical neglect, bullying and emotional violence. ConclusionOur results highlight the extremely high rate of childhood trauma among patients with mental disorders and raise the global health policy issue revealing the need for a primary health level intervention to address its effects along the mainstream mental health care.

Association between obesity and cervical intraepithelial neoplasia: results from a case control study in south western Uganda

BackgroundThough obesity has been said to be associated with a number of malignancies including cervical cancer, its association with cervical intraepithelial neoplasia (CIN) is still a contentious issue. This study was designed to determining the prevalence and association between obesity and CIN.MethodsThis was an unmatched case control study, involving women with cervical intraepithelial neoplasia (cases) and those negative for intraepithelial lesions or malignancy (controls) at the cervical cancer clinic of Mbarara Regional Referral Hospital, in south-western Uganda, between April and November 2022. Cases and controls provided written informed consent and were recruited in a ratio of 1:1. Cases were identified by visual inspection with acetic acid (VIA) and subsequent confirmation with cytology and/or histology. Demographic information was collected using an enrolment form and height, weight and waist circumference were recorded. We calculated body mass index (BMI) and identified obese women as those with body mass index of ≥ 30 kg/m2 from both case and control groups. Central obesity was defined as waist: height ration of ≥ 0.5. Data was analysed using STATA version 17. Categorical variables were analysed using proportions, chi-square and logistic regression analysis to determine association between obesity and CIN. Our level of statistical significance was set at ≤ 0.05.ResultsThe prevalence of general and central obesity among cases was 25.5% (24/94) and 0% (0/94) respectively while the prevalence of general and central obesity among controls was 33.3% (37/111) and 0% (0/111) respectively. There was an increased prevalence of general obesity among women with low grade squamous intraepithelial lesions (LSIL). However, there was no statistically significant association between general obesity and CIN. Factors associated with general obesity included residing in Mbarara city (AOR 2.156, 95%CI 1.085–4.282, P-value 0.028), age group of 31–45 years (AOR 2.421, 95%CI 1.577–9.705, P-value 0.003) and ≥ 46 years (AOR 1.971, 95%CI 1.022–11.157, P-value 0.046).ConclusionWe observed an increased prevalence of general obesity among women with LSIL. However, there was no association between obesity and CIN. Factors associated with general obesity included residing in Mbarara city, and being in the age groups of 31–40 and ≥ 46 years. This highlights the need to rethink management of CIN to control other non-communicable diseases that could arise due to general obesity.

Intrapersonal predictors of internalized stigma among school going adolescents living with HIV in southwestern Uganda

ABSTRACT We assessed the association between internalized HIV stigma, resilience, health locus of control, coping self-efficacy and empowerment among adolescents living with HIV in Uganda. We conducted a cross-sectional study between August and October 2020 among 173 adolescents aged 13–18 years attending Mbarara Regional Referral Hospital’s HIV clinic. We used linear regression to determine the association between HIV stigma and intrapersonal factors adjusting for sociodemographic characteristics. The median age of the participants was 16 (IQR 3) years. There was a negative correlation between HIV stigma and resilience (β= −0.03, p < 0.001), internal health locus of control (β= −0.095, p < 0.001) and coping self-efficacy (β= −0.02, p < 0.001), while empowerment was positively correlated (β = 0.07, p < 0.001) with HIV stigma. After adjusting for the intrapersonal factors (resilience, health locus of control, coping self-efficacy and empowerment) and socio-demographic characteristics (education level and boarding school), only internal health locus of control (β=-0.044, p = 0.016) and coping self-efficacy (β=-0.015, p < 0.001) remained significantly correlated with HIV stigma. The findings suggest that interventions focusing on intrapersonal factors such as internal locus of control, empowerment and resilience may contribute towards reduction of HIV stigma among adolescents in boarding schools.

Poor Seizure Control Among Children Attending a Tertiary 8 Hospital in South Western Uganda - A Retrospective Study [Response to Letter

Poor Seizure Control Among Children Attending a Tertiary 8 Hospital in South Western Uganda - A Retrospective Study [Response to Letter