Browsing by Author "Abbo, Catherine"

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    Alcohol, Substance Use and Psychosocial Competence of Adolescents in Selected Secondary Schools in Uganda: A Cross Sectional Survey
    (International neuropsychiatric disease journal, 2016) Abbo, Catherine; Okello, Elialilia S.; Muhwezi, Wilson; Akello, Grace; Ovuga, Emilio; Makinodan, Manabu
    To determine the nature and extent of alcohol and substance use and 2) To describe the relationship between alcohol use and psychosocial competence among secondary school youths in Northern and Central Uganda. Study Design—This was a cross-sectional study. Place and Duration of study—Departments of Mental Health, Gulu University (Northern Uganda) and Department of Psychiatry, Makerere University College of Health Sciences (Central Uganda) between September 2011 and April 2012. Methodology—Four (4) and eight (8) secondary schools located in the rural and urban areas of Gulu and Kampala districts respectively were randomly selected to participate in the survey. A total of 3,200 students aged 12 to 24 years were recruited by proportionate multistage sampling. Data was collected using a socio-demographic questionnaire that included questions about nature and frequency of alcohol and substance use. A pre-tested self-administered survey questionnaire with scales to measure components of psychosocial competence (PSC) was administered. Data was entered in Epidata, and exported to SPSS version 16.0 for analysis. Psychosocial competence was classified as high or low depending on the responses in the sub-scales of decision making, self efficacy, empathy, emotional awareness, coping with stress and emotions, and accurate self-assessment and self-confidence. Results—A total of 2,902 questionnaires comprising of 2,502, (86.2%) from Kampala district and 400 (13.8%)) from Gulu district were analyzed. Male to female ratio was 1:1 with an age range of 12 to 24 years and a mean of 16.5. About 70.1% had ever used alcohol and substances. Only 39.1% used substances regularly. The commonest substance used was alcohol (23.3%), followed by kuber (10.8%), khat (10.5%), aviation fuel (10.1%), cannabis (9.2%) and cigarettes (5.9%). Respondents from the Gulu district were twice more likely to use all substances. Users and regular users from the North Northern Uganda had lower psychosocial competence. Factors significantly associated with non-use of alcohol were high levels of self-confidence, non-use of cannabis and kuber and age. In the alcohol user groups, a high level of coping was associated with discontinued and experimental use of drugs of abuse. Conclusion—More than two-thirds (70.1%) of young people in this study had ever used substances of abuse only once and slightly over a third had used it regularly. From the perspectives of service provision, mental health promotion and prevention of illicit substance use, school mental health programmes that target both non-users and users are recommended.
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    Assessment of the relationship between life events with psychosocial competence of students in selected secondary schools in Northern and Central Uganda
    (African Health Sciences, 2020) Muhwezi, Wilson Winstons; Abbo, Catherine; Okello, Elialilia S.; Akello, Grace; Ovuga, Emilio B. L.
    As they grow, young people transit through adolescence; a particularly challenging phase. Many go through without difficulties but some experience maladaptive responses in form of conduct and adjustment problems, pubertal challenges and life stress. Published research from the developed societies demonstrates consistent associations between young people’s exposure to life events, psychosocial competence (PSC) and mental health problems. However, comparable research from income-constrained societies remains scarce. The purpose of this study was to determine the prevalence of life events in secondary school students and describe the relationship between life events and PSC in the same population. Methods: This was a cross-sectional study. Participants were 2,902 randomly selected in Central and Northern Uganda. They responded to self-administered questionnaires on socio-demographics, life events and PSC. Results: Northern Ugandan students were more likely to be susceptible to stress-related illness associated with major life events (p = < 0.01). Among students with a high susceptibility to stress related illness, those with low scores on self-efficacy (p = < 0.001), accurate self-assessment (p = < 0.001) and self-confidence (p = < 0.001) were mostly from the North. Students from Northern Uganda had experienced more negative events. Students with higher scores on empathy, emotional awareness, accurate self- assessment and self-confidence tended to have low distress. Students that had a low susceptibility to stress related illness (AOR = 1.97; 95% CI: 1.57 - 2.48); high scores on self-efficacy (AOR 1.37; 95% CI: 1.09 - 1.74), self-confidence (AOR 1.32; 95% CI: 1.02- 1.72), and accurate self-assessment (AOR 2.19; 95% CI: 1.70 - 2.80) were mostly from northern Uganda. Conclusion: It is important to help students to cope with negative life events since an association exists between negative life events and PSC domains. PSC domains of empathy, emotional awareness, accurate self-assessment and self-confidence seem to be associated with lower distress levels, implying that these should be reinforced.
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    Childhood Adversity and Co-Dependency Roles in a Case of a Midwife with Pethidine use Disorder Attending Mulago National Referral Hospital, Kampala, Uganda
    (Cogent Public Health, 2022) Odokonyero, Raymond; Aujo, Tabitha; Agaba, Denis; Abbo, Catherine
    Pethidine is a short and fast-acting synthetic opioid that has a high potential for abuse and addiction compared to other opioids. It is popularly used in the management of pain such as pancreatitis, and cholecystitis peri- and post-operations. Among patients, addiction to pethidine is usually induced unintentionally by a health worker in the course of treating the patient’s pain. Addiction to pethidine is a common but silent problem for healthcare workers such as doctors, nurses, and midwives, and it is often underreported. Childhood adversity and co-dependency roles by family members have been linked to the development and maintenance of addiction to psychoactive substances including pethidine. This case study on a midwife with pethidine addiction in Uganda is a call to draw attention to childhood adversity and co-dependency roles in pethidine addiction.
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    Doxycycline for the treatment of nodding syndrome: a randomised, placebo-controlled, phase 2 trial
    (Elsevier Ltd, 2024-07) Idro, Richard; Ogwang, Rodney; Anguzu, Ronald; Akun, Pamela; Ningwa, Albert; Abbo, Catherine; Giannoccaro, Maria P; Kubofcik, Joseph; Mwaka, Amos D; Nakamya, Phellister; Opar, Bernard; Taylor, Mark; Nutman, Thomas B; Elliott, Alison; Vincent, Angela; Newton, Charles R; Marsh, Kevin
    Nodding syndrome is a poorly understood neurological disorder that predominantly occurs in Africa. We hypothesised that nodding syndrome is a neuroinflammatory disorder, induced by antibodies to Onchocerca volvulus or its Wolbachia symbiont, cross-reacting with host neuronal proteins (HNPs), and that doxycycline can be used as treatment.BACKGROUNDNodding syndrome is a poorly understood neurological disorder that predominantly occurs in Africa. We hypothesised that nodding syndrome is a neuroinflammatory disorder, induced by antibodies to Onchocerca volvulus or its Wolbachia symbiont, cross-reacting with host neuronal proteins (HNPs), and that doxycycline can be used as treatment.In this randomised, double-blind, placebo-controlled, phase 2 trial, we recruited participants from districts affected by nodding syndrome in northern Uganda. We included children and adolescents aged 8-18 years with nodding syndrome, as defined by WHO consensus criteria. Participants were randomly assigned (1:1) to receive either 100 mg doxycycline daily or placebo for 6 weeks via a computer-generated schedule stratified by skin microscopy results, and all parties were masked to group assignment. Diagnoses of O volvulus and antibodies to HNPs were made using luciferase immunoprecipitation system assays and immunohistochemistry. The primary outcome was change in the proportion with antibodies to HNPs, assessed at 24 months. All participants were included in safety analyses, and surviving participants (those with samples at 24 months) were included in primary analyses. Secondary outcomes were: change in concentrations of antibodies to HNPs at 24 months compared with baseline; proportion of participants testing positive for antibodies to O volvulus-specific proteins and concentrations of Ov16 or OVOC3261 antibodies at 24 months compared with baseline; change in seizure burden, proportion achieving seizure freedom, and the proportions with interictal epileptiform discharges on the diagnostic EEG; overall quality of life; disease severity at 24 months; and incidence of all-cause adverse events, serious adverse events, and seizure-related mortality by 24 months. This trial is registered with ClinicalTrials.gov, NCT02850913.METHODSIn this randomised, double-blind, placebo-controlled, phase 2 trial, we recruited participants from districts affected by nodding syndrome in northern Uganda. We included children and adolescents aged 8-18 years with nodding syndrome, as defined by WHO consensus criteria. Participants were randomly assigned (1:1) to receive either 100 mg doxycycline daily or placebo for 6 weeks via a computer-generated schedule stratified by skin microscopy results, and all parties were masked to group assignment. Diagnoses of O volvulus and antibodies to HNPs were made using luciferase immunoprecipitation system assays and immunohistochemistry. The primary outcome was change in the proportion with antibodies to HNPs, assessed at 24 months. All participants were included in safety analyses, and surviving participants (those with samples at 24 months) were included in primary analyses. Secondary outcomes were: change in concentrations of antibodies to HNPs at 24 months compared with baseline; proportion of participants testing positive for antibodies to O volvulus-specific proteins and concentrations of Ov16 or OVOC3261 antibodies at 24 months compared with baseline; change in seizure burden, proportion achieving seizure freedom, and the proportions with interictal epileptiform discharges on the diagnostic EEG; overall quality of life; disease severity at 24 months; and incidence of all-cause adverse events, serious adverse events, and seizure-related mortality by 24 months. This trial is registered with ClinicalTrials.gov, NCT02850913.Between Sept 1, 2016, and Aug 31, 2018, 329 children and adolescents were screened, of whom 240 were included in the study. 140 (58%) participants were boys and 100 (42%) were girls. 120 (50%) participants were allocated to receive doxycycline and 120 (50%) to receive placebo. At recruitment, the median duration of symptoms was 9 years (IQR 6-10); 232 (97%) participants had O volvulus-specific antibodies and 157 (65%) had autoantibodies to HNPs. The most common plasma autoantibodies were to human protein deglycase DJ-1 (85 [35%] participants) and leiomodin-1 (77 [32%] participants) and, in cerebrospinal fluid (CSF), to human DJ-1 (27 [11%] participants) and leiomodin-1 (14 [6%] participants). On immunohistochemistry, 46 (19%) participants had CSF autoantibodies to HNPs, including leiomodin-1 (26 [11%]), γ-aminobutyric acid B receptors (two [<1%]), CASPR2 (one [<1%]), or unknown targets (28 [12%]). At 24 months, 161 (72%) of 225 participants had antibodies to HNPs compared with 157 (65%) of 240 at baseline. 6 weeks of doxycycline did not affect the concentration of autoantibodies to HNPs, seizure control, disease severity, or quality of life at the 24-month follow-up but substantially decreased Ov16 antibody concentrations; the median plasma signal-to-noise Ov16 ratio was 16·4 (95% CI 6·4-38·4), compared with 27·9 (8·2-65·8; p=0·033) for placebo. 14 (6%) participants died and, other than one traffic death, all deaths were seizure-related. Acute seizure-related hospitalisations (rate ratio [RR] 0·43 [95% CI 0·20-0·94], p=0·028) and deaths (RR 0·46 [0·24-0·89], p=0·028) were significantly lower in the doxycycline group. At 24 months, 96 (84%) of 114 participants who received doxycycline tested positive for antibodies to Ov16, compared with 97 (87%) of 111 on placebo (p=0·50), and 74 (65%) participants on doxycycline tested positive for antibodies to OVOC3261, compared with 57 (51%) on placebo (p=0·039). Doxycycline was safe; there was no difference in the incidence of grade 3-5 adverse events across the two groups.FINDINGSBetween Sept 1, 2016, and Aug 31, 2018, 329 children and adolescents were screened, of whom 240 were included in the study. 140 (58%) participants were boys and 100 (42%) were girls. 120 (50%) participants were allocated to receive doxycycline and 120 (50%) to receive placebo. At recruitment, the median duration of symptoms was 9 years (IQR 6-10); 232 (97%) participants had O volvulus-specific antibodies and 157 (65%) had autoantibodies to HNPs. The most common plasma autoantibodies were to human protein deglycase DJ-1 (85 [35%] participants) and leiomodin-1 (77 [32%] participants) and, in cerebrospinal fluid (CSF), to human DJ-1 (27 [11%] participants) and leiomodin-1 (14 [6%] participants). On immunohistochemistry, 46 (19%) participants had CSF autoantibodies to HNPs, including leiomodin-1 (26 [11%]), γ-aminobutyric acid B receptors (two [<1%]), CASPR2 (one [<1%]), or unknown targets (28 [12%]). At 24 months, 161 (72%) of 225 participants had antibodies to HNPs compared with 157 (65%) of 240 at baseline. 6 weeks of doxycycline did not affect the concentration of autoantibodies to HNPs, seizure control, disease severity, or quality of life at the 24-month follow-up but substantially decreased Ov16 antibody concentrations; the median plasma signal-to-noise Ov16 ratio was 16·4 (95% CI 6·4-38·4), compared with 27·9 (8·2-65·8; p=0·033) for placebo. 14 (6%) participants died and, other than one traffic death, all deaths were seizure-related. Acute seizure-related hospitalisations (rate ratio [RR] 0·43 [95% CI 0·20-0·94], p=0·028) and deaths (RR 0·46 [0·24-0·89], p=0·028) were significantly lower in the doxycycline group. At 24 months, 96 (84%) of 114 participants who received doxycycline tested positive for antibodies to Ov16, compared with 97 (87%) of 111 on placebo (p=0·50), and 74 (65%) participants on doxycycline tested positive for antibodies to OVOC3261, compared with 57 (51%) on placebo (p=0·039). Doxycycline was safe; there was no difference in the incidence of grade 3-5 adverse events across the two groups.Nodding syndrome is strongly associated with O volvulus and the pathogenesis is probably mediated through an O volvulus induced autoantibody response to multiple proteins. Although it did not reverse disease symptoms, doxycycline or another prophylactic antibiotic could be considered as adjunct therapy to antiseizure medication, as it might reduce fatal complications from acute seizures and status epilepticus induced by febrile infections.INTERPRETATIONNodding syndrome is strongly associated with O volvulus and the pathogenesis is probably mediated through an O volvulus induced autoantibody response to multiple proteins. Although it did not reverse disease symptoms, doxycycline or another prophylactic antibiotic could be considered as adjunct therapy to antiseizure medication, as it might reduce fatal complications from acute seizures and status epilepticus induced by febrile infections.Medical Research Council (UK).FUNDINGMedical Research Council (UK).For the Luo translation of the abstract see Supplementary Materials section.TRANSLATIONFor the Luo translation of the abstract see Supplementary Materials section. MEDLINE - Academic
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    Epilepsy in Onchocerca volvulus Sero-Positive Patients From Northern Uganda—Clinical, EEG and Brain Imaging Features
    (Frontiers in Neurology, 2021) Ogwang, Rodney; Ningwa, Albert; Akun, Pamela; Bangirana, Paul; Anguzu, Ronald; Mazumder, Rajarshi; Abbo, Catherine; Mwaka, Amos Deogratius; Idro, Richard
    Globally, epilepsy is the most common chronic neurological disorder. The incidence in sub-Saharan Africa is 2-3 times higher than that in high income countries. Infection by Onchocerca volvulus may be an underlying risk factor for the high burden and based upon epidemiological associations, has been proposed to cause a group of disorders—Onchocerca associated epilepsies (OAE) like nodding syndrome (NS). To improve our understanding of the disease spectrum, we described the clinical, electroencephalographic (EEG) and magnetic resonance imaging (MRI) features of children with epilepsy and sero-positive for Onchocerca volvulus (possible OAEs other than nodding syndrome). Twenty-nine children and adolescents with non-nodding syndrome OAE in northern Uganda were enrolled. A diagnosis of OAE was made in patients with epilepsy and seizure onset after age 3 years, no reported exposure to perinatal severe febrile illness or traumatic brain injury, no syndromic epilepsy diagnosis and a positive Ov-16 ELISA test. Detailed clinical evaluation including psychiatric, diagnostic EEG, a diagnostic brain MRI (in 10 patients) and laboratory testing were performed. Twenty participants (69%) were male. The mean age was 15.9 (standard deviation [SD] 1.9) years while the mean age at seizure onset was 9.8 (SD 2.9) years. All reported normal early childhood development. The most common clinical presentation was a tonic-clonic seizure. The median number of seizures was 2 (IQR 1–4) in the previous month. No specific musculoskeletal changes, or cranial nerve palsies were reported, neither were any vision, hearing and speech difficulties observed. The interictal EEG was abnormal in the majority with slow wave background activity in 52% (15/29) while 41% (12/29) had focal epileptiform activity. The brain MRI showed mild to moderate cerebellar atrophy and varying degrees of atrophy of the frontal, parietal and occipital lobes. The clinical spectrum of epilepsies associated with Onchocerca may be broader than previously described. In addition, focal onset tonic-clonic seizures, cortical and cerebellar atrophy may be important brain imaging and clinical features.
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    Household poverty, schooling, stigma and quality of life in adolescents with epilepsy in rural Uganda
    (Epilepsy & Behavior, 2021) Anguzu, Ronald; Akun, Pamela; Katairo, Thomas; Abbo, Catherine; Ningwa, Albert; Ogwang, Rodney; Mwaka, Amos Deogratius; Idro, Richard
    Epilepsy remains a leading chronic neurological disorder in Low- and Middle-Income Countries. In Uganda, the highest burden is among young rural people. We aimed to; (i) describe socio-economic status (including schooling), and household poverty in adolescents living with epilepsy (ALE) compared to unaffected counterparts in the same communities and (ii) determine the factors associated with the overall quality of life (QoL). This was a cross-sectional survey nested within a larger study of ALE compared to age-matched healthy community children in Uganda. Between Sept 2016 to Sept 2017, 154 ALE and 154 healthy community controls were consecutively recruited. Adolescents recruited were frequency and age-matched based on age categories 10–14 and 15–19 years. Clinical history and standardized assessments were conducted. One control participant had incomplete assessment and was excluded. The primary outcome was overall QoL and key variables assessed were schooling status and household poverty. Descriptive and multivariable linear regression analysis were conducted for independent associations with overall QoL. Mean (SD) age at seizure onset was 8.8 (3.9) years and median (IQR) monthly seizure burden was 2 (1–4). Epilepsy was associated with living in homes with high household poverty; 95/154 (61.7%) ALE lived in the poorest homes compared to 68/153 (44.5%) of the healthy adolescents, p = 0.001. Nearly two-thirds of ALE had dropped out of school and only 48/154 (31.2%) were currently attending school compared to 136/153 (88.9%) of healthy controls, p < 0.001. QoL was lowest among ALE who never attended school (p < 0.001), with primary education (p = 0.006) compared to those with at least secondary education. Stigma scores [mean(SD)] were highest among ALE in the poorest [69.1(34.6)], and wealthy [70.2(32.2)] quintiles compared to their counterparts in poorer [61.8(31.7)], medium [68.0(32.7)] and wealthiest [61.5(33.3)] quintiles, though not statistically significant (p = 0.75). After adjusting for covariates, ALE currently attending school had higher overall QoL compared to their counterparts who never attended school (β = 4.20, 95%CI: 0.90,7.49, p = 0.013). QoL scores were higher among ALE with ≥secondary education than those with no or primary education (β = 10.69, 95%CI: 1.65, 19.72). rural area are from the poorest households, are more likely to drop out of school and have the lowest QoL. Those with poorer seizure control are most affected. ALE should be included among vulnerable population groups and in addition to schooling, strategies for seizure control and addressing the epilepsy treatment gap in affected homes should be specifically targeted in state poverty eradication programs.
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    Is nodding syndrome an Onchocerca volvulus induced neuro-inflammatory disorder? Uganda's story of research in understanding the disease
    (International Journal of Infectious Diseases, 2016) Idro, Richard; Opar, Bernard; Wamala, Joseph; Abbo, Catherine; Onzivua, Sylvester; Mwaka, Deogratius Amos; Kakooza-Mwesige, Angelina; Mbonye, Anthony; Aceng, Jane R.
    Nodding syndrome is a devastating neurological disorder, mostly affecting children in eastern Africa. An estimated 10 000 children are affected. Uganda, one of the most affected countries, set out to systematically investigate the disease and develop interventions for it. On December 21, 2015, the Ministry of Health held a meeting with community leaders from the affected areas to disseminate the results of the investigations made to date. This article summarizes the presentation and shares the story of studies into this peculiar disease. It also shares the results of preliminary studies on its pathogenesis and puts into perspective an upcoming treatment intervention. Clinical and electrophysiological studies have demonstrated nodding syndrome to be a complex epilepsy disorder. A definitive aetiological agent has not been established, but in agreement with other affected countries, a consistent epidemiological association has been demonstrated with infection by Onchocerca volvulus. Preliminary studies of its pathogenesis suggest that nodding syndrome may be a neuroinflammatory disorder, possibly induced by antibodies to O. volvulus cross-reacting with neuron proteins. Histological examination of post-mortem brains has shown some yet to be characterized polarizable material in the majority of specimens. Studies to confirm these observations and a clinical trial are planned for 2016.
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    Is Nodding Syndrome an Onchocerca Volvulus-Induced Neuroinflammatory Disorder? Uganda’s Story of Research in Understanding the Disease
    (International Journal of Infectious Diseases, 2016) Idro, Richard; Opar, Bernard; Wamala, Joseph; Abbo, Catherine; Onzivua, Sylvester; Mwaka, Deogratius Amos; Kakooza-Mwesige, Angelina; Mbonye, Anthony; Aceng, Jane R.
    The Sustainable Development Goals (SDGs) mandate systematic monitoring of the health and wellbeing of all children to achieve optimal early childhood development. However, global epidemiological data on children with developmental disabilities are scarce. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 provides a comprehensive assessment of prevalence and years lived with disability (YLDs) for development disabilities among children younger than 5 years in 195 countries and territories from 1990 to 2016.
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    Is the glass half full or half empty? A qualitative exploration on treatment practices and perceived barriers to biomedical care for patients with nodding syndrome in post-conflict northern Uganda
    (BMC Research Notes, 2015) Mwaka, Amos Deogratius; Okello, Elialilia S.; Abbo, Catherine; Odwong, Francis Okot; Olango, Willy; Etolu, John Wilson; Oriyabuzu, Rachel; Lagoro, David Kitara; Mutamba, Byamah Brian; Idro, Richard; Opar, Bernard Toliva; Aceng, Jane Ruth; Lukwago, Assuman; Neema, Stella
    Nodding syndrome has increasingly become an issue of public health concern internationally. The etiology of the disorder is still unknown and there are yet no curative treatments. We explored perceptions about treatment practices and barriers to health seeking for nodding syndrome in Pader and Kitgum districts in northern Uganda in order to provide data necessary for informing policy on treatment adherence and rehabilitations.We used focus group discussions and individual interviews to gain deep insights into help-seeking and treatment practices for nodding syndrome. Purposive sampling was used to identify information-rich participants that included village health teams, community members not directly affected with nodding syndrome, district leaders, healthcare professionals, and caregivers of children affected with nodding syndrome. We used qualitative content analysis to analyze data and presented findings under distinct categories and themes.Caregivers and communities sought care from multiple sources including biomedical facilities, traditional healers, traditional rituals from shrines, and spiritual healing. Nodding syndrome affected children reportedly have showed no enduring improvement with traditional medicines, traditional rituals, and prayers. A substantial minority of participants reported minimal improvements in symptoms of convulsions with use of western medicines. Challenges involved in health seeking included; (1) health system factors e.g. long distances to facilities, frequent unavailability of medicines, few healthcare providers, and long waiting times; (2) contextual and societal challenges e.g. lack of money for transport and medical bills, overburdening nature of the illness that does not allow time for other activities, and practical difficulties involved in transporting the physically deformed and mentally retarded children to the health facilities.Help-seeking for nodding syndrome is pluralistic and include use of traditional and biomedical practices. Western medicines admittedly showed at least short term control on nodding syndrome symptoms, especially convulsions and led in a few cases to regain of functional abilities. However, multiple barriers hinder health seeking and interfere with adherence to biomedical treatments. Regarding cure, there are hitherto no treatments participants perceive cure nodding syndrome.
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    Mental health literacy among secondary school students in North and Central Uganda: a qualitative study
    (Journal of World Association of Cultural Psychiatry, 2014) Okello, Elialilia S.; Abbo, Catherine; Muhwezi, Wilson W.; Akello, Grace; Ovuga, Emilio
    There has been limited effort to explore young people’s perceptions about mental illness in Uganda. For mental health programs targeting young people to succeed, it is important to incorporate their understanding of mental illness, their perceptions about causes of mental illness and their attitudes about mentally ill people. The objective of this study was to explore the mental health of young people in secondary schools in Northern and Central Uganda. Subjects and Methods—This was a qualitative study where 24 focus group discussions (FGDs) were held with young people in secondary schools. Respondents aged 14-24 years were purposively selected from 4 secondary schools in the two regions. During the FGDs, young people’s perceptions and understanding of three areas listed below were explored: meaning of mental health/mental illness; causes of mental illness and attitudes toward mental illness. Data management and analysis was done with the help of Atlas.ti, a-qualitative-analysis software. Thematic analysis approach was employed. Results—FGD participants used concepts like a sound and normal mind, right thinking, normal behavior and normal thoughts to define mental health. Mental illness on the other hand was defined as loss of sense of reality, malfunctioning of the brain, impaired thinking and bizarre behavior. Young people attributed mental illness to; substance abuse (Marijuana, alcohol), witnessing traumatic events (seeing ones your relatives being killed, or being forced to participate in killing-frequently mentioned by young people in Northern Uganda); witch craft, effect of physical illness e.g. HIV/epilepsy, thinking too much, accidents and genetic explanations. They had mixed opinions about interacting with mentally ill individuals. Unpredictability and dangerousness were known to be a recurrent theme among people with negative views about mentally ill. Nonetheless, some FGD participants believed that the level of interaction with mentally ill persons depended on familiarity with mental illness and the severity of the symptoms. Similarly, there were mixed opinions regarding mental illness and work. Three main clusters of responses emerged. These were: i) “mentally ill people should not work”; ii) “mentally ill people should work but..”; iii) “mentally ill people should work like everyone else”. Conclusions—Findings point to key gaps in the knowledge and attitudes of young people that need to be targeted by young-people-focused-interventions for mental health. In order for such interventions to succeed, young people must be able to recognize and respond appropriately to signs of distress, reduced functioning, and other early signs of poor mental health.
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    Naturalistic outcome of treatment of psychosis by traditional healers in Jinja and Iganga districts, Eastern Uganda – a 3- and 6 months follow up
    (International Journal of Mental Health Systems, 2012) Abbo, Catherine; Okello, Elialilia S.; Musisi, Seggane; Waako, Paul; Ekblad, Solvig
    To determine the naturalistic outcome of treatment of psychosis by traditional healers in Jinja and Iganga districts of Eastern Uganda. Method: A cohort of patients with psychosis receiving treatment from traditional healers’ shrines were recruited between January and March 2008 and followed up at three and six months. The Mini International Neuropsychiatry Interview (MINI Plus) was used for making specific diagnosis at the point of contact. For specific symptoms, Positive and Negative Symptom Scale (PANSS), Young Mania Rating Scale (YMRS) and Montgomery Asberg Depression Rating Scale (MADRS) were used to measure severity of schizophrenia, mania and psychotic depression, respectively. The Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) were used for objective assessments. The Compass Mental Health Index measured well being. Mean scores of the scales were computed using one way ANOVA for independent samples. Associations between outcome and categorical variables were examined at bivariate and multivariate levels.
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    Patients with Nodding Syndrome in Uganda Improve with Symptomatic Treatment: A Cross-Sectional Study
    (BMJ open, 2014) Idro, Richard; Namusoke, Hanifa; Abbo, Catherine; Mutamba, Byamah B.; Mwesige, Angelina Kakooza; Opoka, Robert O.; Musubire, Abdu K.; Mwaka, Amos D.; Opar, Bernard T.
    Nodding syndrome (NS) is a poorly understood neurological disorder affecting thousands of children in Africa. In March 2012, we introduced a treatment intervention that aimed to provide symptomatic relief. This intervention included sodium valproate for seizures, management of behaviour and emotional difficulties, nutritional therapy and physical rehabilitation. We assessed the clinical and functional outcomes of this intervention after 12 months of implementation.This was a cross-sectional study of a cohort of patients with NS receiving the specified intervention. We abstracted preintervention features from records and compared these with the current clinical status. We performed similar assessments on a cohort of patients with other convulsive epilepsies (OCE) and compared the outcomes of the two groups.Participants were patients with WHO-defined NS and patients with OCE attending the same centres.The primary outcome was the proportion of patients with seizure freedom (≥1 month without seizures). Secondary outcome measures included a reduction in seizure frequency, resolution of behaviour and emotional difficulties, and independence in basic self-care.Patients with NS had had a longer duration of symptoms (median 5 (IQR 3, 6) years) compared with those with OCE (4 (IQR 2, 6) years), p<0.001. The intervention resulted in marked improvements in both groups; compared to the preintervention state, 121/484 (25%) patients with NS achieved seizure freedom and there was a >70% reduction in seizure frequency; behaviour and emotional difficulties resolved in 194/327 (59%) patients; 193/484 (40%) patients had enrolled in school including 17.7% who had earlier withdrawn due to severe seizures, and over 80% had achieved independence in basic self-care. These improvements were, however, less than that in patients with OCE of whom 243/476 (51.1%) patients were seizure free and in whom the seizure frequency had reduced by 86%.Ugandan children with NS show substantial clinical and functional improvements with symptomatic treatments suggesting that NS is probably a reversible encephalopathy.
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    The prevalence and severity of mental illnesses handled by traditional healers in two districts in Uganda
    (African Health Sciences, 2009) Abbo, Catherine; Ekblad, Solvig; Waako, Paul; Okello, Elialilia; Musisi, Seggane
    Little is known about the prevalence and severity of DSM-IV mental disorders treated by traditional healers in Uganda. Objective: To describe the prevalence and severity of DSM-IV disorders handled by traditional healers in Jinja and Iganga districts, Eastern Uganda. Method: Between January and March 2008, Face-to-Face Interviews were conducted with 400 patients attending traditional healers’ shrines for mental health problems, using Self Rating Questionnaire 25 (SRQ-25) for screening, the Mini International Neuropsychiatric Interview (MINI-Plus) for specific DSM-IV diagnosis and the Global Assessment of Functioning (GAF) for severity of illness. Descriptive data analysis and frequency estimates were performed using SPSS version 15.0 for Windows. Pearson’s chi– square tests and odds ratios were used to explore the relationship between severity and combined use of biomedical services and traditional healing. Results: Of 387 respondents, 60.2% had diagnosable current mental illness and 16.3% had had one disorder in their lifetime. Of the diagnosable current mental illnesses, 29.7% were Psychosis; 5.4% Major depressive episode; 5.6% Anxiety disorders; 3.6% mixed Anxiety-Depression; and 3.9% Suicidality. In terms of severity, 37.7% of the current mental illnesses were severe, 35.1% moderate and 13.2% mild. Patients with moderate to severe symptoms were more likely to use both biomedical services and traditional healers. Conclusion: These findings suggest that a considerable number of patients with DSM-IV diagnosable mental disorders attend traditional healing shrines; the majority had moderate to severe symptoms. Mental health professionals therefore need to come up with ways to co-operate with traditional healers, e.g. as officially designated Traditional Mental Attendants (TMA), for the benefit of their patients.
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    Psychological distress and associated factors among the attendees of traditional healing practices in Jinja and Iganga districts, Eastern Uganda: a cross-sectional study
    (International Journal of Mental Health Systems, 2008) Abbo, Catherine; Ekblad, Solvig; Waako, Paul; Okello, Elialilia; Muhwezi, Wilson; Musisi, Seggane
    Mental health problems are a major public health concern worldwide. Evidence shows that African communities, including Uganda, use both modern and traditional healing systems. There is limited literature about the magnitude of psychological distress and associated factors among attendees of traditional healing practices. This study aimed to determine the prevalence and associated factors of psychological distress among attendees of traditional healing practices in two districts in Uganda.
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    Risk Factors for Nodding Syndrome and Other Forms of Epilepsy in Northern Uganda: A Case-Control Study
    (Pathogens, 2021) Gumisiriza, Nolbert; Kugler, Marina; Mubiru, Frank; Anguzu, Ronald; Ningwa, Albert; Ogwang, Rodney; Akun, Pamela; Mwaka, Amos Deogratius; Abbo, Catherine; Sekibira, Rogers; Idro, Richard
    Epidemiological studies suggest a link between onchocerciasis and various forms of epilepsy, including nodding syndrome (NS). The aetiopathology of onchocerciasis associated epilepsy remains unknown. This case-control study investigated potential risk factors that may lead to NS and other forms of non-nodding epilepsy (OFE) in northern Uganda. We consecutively recruited 154 persons with NS (aged between 8 and 20 years), and age-frequency matched them with 154 with OFE and 154 healthy community controls. Participants’ socio-demography, medical, family, and migration histories were recorded. We tested participants for O. volvulus serum antibodies. The 154 controls were used for both OFE and NS separately to determine associations. We recruited 462 people with a median age of 15 years (IQR 14, 17); 260 (56.4%) were males. Independent risk factors associated with the development of NS were the presence of O. volvulus antibodies [aOR 8.79, 95% CI (4.15–18.65), p-value < 0.001] and preterm birth [aOR 2.54, 95% CI (1.02–6.33), p-value = 0.046]. Risk factors for developing OFE were the presence of O. volvulus antibodies [aOR 8.83, 95% CI (4.48–17.86), p-value < 0.001] and being born in the period before migration to IDP camps [aOR 4.28, 95% CI (1.20–15.15), p-value = 0.024]. In conclusion, O. volvulus seropositivity was a risk factor to develop NS and OFE; premature birth was a potential co-factor. Living in IDP camps was not a risk factor for developing NS or OFE.
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    Setting up a clinical trial for a novel disease: a case study of the Doxycycline for the Treatment of Nodding Syndrome Trial – challenges, enablers and lessons learned
    (Global Health Action, 2018) Anguzu, Ronald; Akun, Pamela R; Ogwang, Rodney; Sekibira, Rogers; Ningwa, Albert; Nakamya, Phellister; Abbo, Catherine; Mwaka, Amos D; Opar, Bernard; Idro, Richard
    A large amount of preparation goes into setting up trials. Different challenges and lessons are experienced. Our trial, testing a treatment for nodding syndrome, an acquired neurological disorder of unknown cause affecting thousands of children in Eastern Africa, provides a unique case study. As part of a study to determine the aetiology, understand pathogenesis and develop specific treatment, we set up a clinical trial in a remote district hospital in Uganda. This paper describes our experiences and documents supportive structures (enablers), challenges faced and lessons learned during set-up of the trial. Protocol development started in September 2015 with phased recruitment of a critical study team. The team spent 12 months preparing trial documents, procurement and training on procedures. Potential recruitment sites were pre-visited, and district and local leaders met as key stakeholders. Key enablers were supportive local leadership and investment by the district and Ministry of Health. The main challenges were community fears about nodding syndrome, adverse experiences of the community during previous research and political involvement. Other challenges included the number and delays in protocol approvals and lengthy procurement processes. This hard-to-reach area has frequent power and Internet fluctuations, which may affect cold chains for study samples, communication and data management. These concerns decreased with a pilot community engagement programme. Experiences and lessons learnt can reduce the duration of processes involved in trial-site set-up. A programme of community engagement and local leader involvement may be key to the success of a trial and in reducing community opposition towards participation in research.