NRU :: Browsing by Author "Akello, Grace"

Browsing by Author "Akello, Grace"

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Action to protect the independence and integrity of global health research
(BMJ Global Health, 2019) Storeng, Katerini T.; Abimbola, Seye; Balabanova, Dina; McCoy, David; Ridde, Valery; Filippi, Veronique; Roalkvam, Sidsel; Akello, Grace; Parker, Melissa; Palmer, Jennifer
In a recent Viewpoint in the Lancet, some of us shared our experience of censorship in donor-funded evaluation research and warned about a potential trend in which donors and their implementing partners use ethical and methodological arguments to undermine research.1 Reactions to the Viewpoint—and lively debate at the 2018 Global Symposium on Health Systems Research—suggest that similar experiences are common in implementation and policy research commissioned by international donors to study and evaluate large-scale, donor-funded health interventions and programmes, which are primarily implemented in low resource settings. ‘We all have the same stories’, was one of the first comments on the Viewpoint, followed by many private messages divulging instances of personal and institutional pressure, intimidation and censorship following attempts to disseminate unwanted findings. Such pressure comes from major donors and from international non-governmental organisations (NGOs) obliged to have an external assessment but who then maintain a high degree of confidentiality and control.
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.
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.
Experiences of forced mothers in northern Uganda: the legacy of war
(Intervention, 2013) Akello, Grace
From 1986^2007, the Lord’s Resistance Army in£icted severe su¡ering on civilians in northern Uganda through indiscriminate killing and child abductions. While both abducted boys and girls were trained to use arms, girls were commonly distributed among commanders as forced ‘wives’. These traumatised girls and young women (both pregnant and ‘forced mothers’) were retained in rehabilitation centres longer than any other excombatants. While they may have been accorded special privileges in the centres, after reintegration, their home communities stigmatised and discriminated against both mothers and children.This paper discusses the experiences of forced mothers and their children, while at rehabilitation centres, and through the reintegration process. Additionally, it examines how communities should be stimulated to view forced mothers and their children as survivors of multiple human rights violations.
The first decade of Intervention: facts, figures & trends
(Intervention, 2013) Berg, Simon van den; Akello, Grace; Sonpar, Shobna
This paper aims to explore trends in developments in content and authors’ locations and perspectives in ‘Intervention, the International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict’, from 2003 to 2012. Over this 10 year period, Intervention has published 139 peer reviewed articles, 73 ¢eld reports, 36 book reviews and 33 debate papers.The articles cover academic expertise, practical experience and debates on mental health and psychosocial interventions in the aftermath of both natural, and man made, disasters. The authors of most papers (61%) originated from developed countries, versus 28% from low and middle income countries.Thematic analysis of the content of peer reviewed articles reveals shifting consensus and emerging new debates on mental health and psychosocial interventions. In the first years of Intervention, individual therapeutic approaches were more prominent than in later years, which saw more attention given to community based approaches. Another emerging theme is the trend to involve ‘beneficiaries’ in planning and evaluation of programmes, through participatory approaches. A significant number of peer reviewed papers (28%) describe policy development issues, such as guidelines (IASC) and processes of integration of mental health into general health care systems in post conflict settings. Recommendations are that the editorial priorities for the next years should continue strategies for increasing submissions from authors originating from areas rejected by conflict, and increasing inclusion of perspectives of those who have experienced extreme events.
Geophagy in Northern Uganda: Perspectives from Consumers and Clinicians
(The American Journal of Tropical Medicine and Hygiene, 2016) Huebl, Lena; Leick, Stephan; Guettl, Lukas; Akello, Grace; Kutalek, Ruth
The etiology and health consequences of geophagy are still poorly understood. The consumed soil, individual motives, consumption habits, and the clinical perspective of geophagy in northern Uganda were examined. A total of 50 semistructured interviews (17 pregnant, eight nonpregnant women, 10 men, and 15 health-care professionals) were conducted. Our results suggest that geophagy is not limited to pregnancy and can also be found among nonpregnant women and men. During gestation, excessive amounts of various soil types are consumed and can replace food at times. Nonpregnant women and men consume less soil and stick to one type. When pregnant, craving and alleviating gastrointestinal upset are the main motives. In men, the main reasons for geophagy were craving, hypersalivation, and natural stimulants. If soil is craved, it can show similarities to a dependency syndrome. When picked up in childhood, geophagy is more likely to be continued throughout life. The consumption habits differ and thereby vary in their possible implications on health. Our findings suggest that men should be included in further studies. Especially nurses from the antenatal care are exposed to geophagists; however, no national guidelines exist for geophagy. Further research is necessary to create guidelines to be included in medical training and practice.
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.
Physical Activity in People With Posttraumatic Stress Disorder: A Systematic Review of Correlates
(Journal of Physical Activity and Health, 2016) Vancampfort, Davy; Richards, Justin; Stubbs, Brendon; Akello, Grace; Ademola Gbiri, Caleb; Ward, Philip B.; Rosenbaum, Simon
People with posttraumatic stress disorder (PTSD) are more likely than the general population to be physically inactive. The present review systematically evaluated correlates of physical activity across the socioecological model for people with PTSD. Methods: Two independent reviewers searched Embase, PubMed, PsycARTICLES, and CINAHL from inception until June 2015, combining the medical subject heading “posttraumatic stress disorder” or “PTSD,” with “physical activity” or “exercise.” Data were extracted by the same independent researchers and summarized according to the socioecological model. Results: Eight papers involving 1368 (994 men) participants (age range = 18–70 years) were eligible and enabled evaluation of 21 correlates. The only correlate (n ≥ 4) consistently associated with lower physical activity participation in people with PTSD was symptoms of hyperarousal. No consistent facilitators were identified. Conclusions: Hyperarousal symptoms are associated with lower physical activity participation among people with PTSD and should be considered in the design and delivery of individualized exercise programs targeting this population. The role of social, environmental, and policy factors on physical activity participation among people with PTSD is unknown and should be addressed by future research.
Primary school children’s perspectives on common diseases and medicines used: implications for school healthcare programmes and priority setting in Uganda
(African health sciences, 2007) Akello, Grace; Reis, Ria; Ovuga, Emilio; Rwabukwali, Charles B.; Kabonesa, Consolata; Richters, Annemiek
Existing school health programmes in Uganda target children above five years for de-worming, oral hygiene and frequent vaccination of girls of reproductive age. Objective: To assess primary school children’s perspectives on common diseases they experience and medicines used in order to suggest reforms for school healthcare programmes and priority setting. Methods: Rapid appraisal approaches, triangulated with a survey, using a semi-structured questionnaire with 80 children aged 8-15 years, were used in data collection. This was done during a three months fieldwork in one primary boarding school in Kampala. An investigation was made into perspectives of children on their recent illness experiences and medicines they used to recover. Other techniques in data collection included participant observation and eliciting children’s narratives of diseases they experienced in a two weeks recall. Key informants, who included school teachers, a nurse, 2 paediatricians, 4 matrons and private health service providers in the vicinity of the school, were approached to validate children’s narratives. Results: Children named and ranked malaria as the most severe and frequently experienced disease. Other diseases mentioned included diarrhoea, skin fungal infections, flu, and typhoid. The symptoms children recognised in case of illness were high body temperature, vomiting, headache, weakness, appetite loss and diarrhoea. Children were either given medicines by the school nurse or they selfmedicated using pharmaceuticals including chloroquine, panadol, flagyl, fansidar, quinine injections, capsules (amoxicillin and ampicillin) obtained from the clinics, drug shops, pharmacies, and other unspecified indigenous medicines from their home and markets. Conclusion: The healthcare needs and priorities of children in primary school are infectious diseases which they could readily identify.
Reintegration of Amnestied LRA Ex-Combatants and Survivors’ Resistance Acts in Acholiland, Northern Uganda
(International Journal of Transitional Justice, 2019) Akello, Grace
This article examines the social dynamics among survivors and amnestied Lord’s Resistance Army (LRA) ex-combatants living together in Acholiland, asking how and if Acholi survivors have forgiven Acholi LRA returnees, forgotten past violence and moved on, as stated in northern Uganda’s amnesty framework. The amnestied LRA ex-combatants interviewed stated that they wanted and needed to reintegrate among Acholi survivors. Yet, after two decades of amnesty, the magnitude of the brutality of the war remains etched in survivors’ minds. My ethnographic findings suggest feigned compliance as well as resistance to amnesty by-laws. Many practise what I call survivors’ acts of resistance, which includes name calling, attributing misfortune to the presence of ex-combatants, stigmatization and stealing. In short, survivors make returnees’ lives unbearable. My analysis is framed in reference to and critique of conventional transitional justice mechanisms and I underscore the importance of memory in the cessation of war violence and the restoration of peace.
Reintegration of former child soldiers in northern Uganda: Coming to terms with children's agency and accountability
(Intervention, 2006) Akello, Grace; Richters, Annemiek; Reis, Ria
Reintegration processes of formerly abducted children have yielded limited success in northern Uganda. The article seeks answers to the question why reintegration processes in the area have failed. The approach of one Christian non-governmental organization towards reintegration is compared with the ideas and strategies of formerly abducted child soldiers and people in their communities on how best to deal with their violent past.

Browsing by Author "Akello, Grace"

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