Browsing by Author "Ehnvall, Anna"

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    Adaptation of the multidimensional scale of perceived social support in a Ugandan setting
    (African health sciences, 2009) Nakigudde, Janet; Musisi, Seggane; Ehnvall, Anna; Airaksinen, Eija; Agren, Hans
    The Multidimensional Scale of Perceived Social Support (MSPSS) was developed in the USA. The adequacy of its use in Uganda to guarantee its reliability and validity has not been ascertained. Aim: Thus the aim of the present study was to adapt the MSPSS scale by testing the validity and reliability of the scale in a Ugandan setting. Methods: A cross-sectional design was employed and 240 respondents were consecutively recruited from postnatal clinics in Mulago hospital. Analysis of reliability and validity of the adapted MSPSS was done. Cronbach alpha and principal component analyses were respectively generated. Results: Three subscales of the MSPSS that had been identified in other populations were evident in the Ugandan population. Using the Cronbach’s alpha, the MSPSS demonstrated good internal consistency at .83. A dendrogram indicated that all sub items of the MSPSS were inter-linked. Exploratory Factor analysis derived three components. Principal Component analysis using rotated varimax generated high loadings on all subscales. Conclusion: The adapted MSPSS can reliably be used in Uganda.
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    Cognition, Behaviour And Academic Skills After Cognitive Rehabilitation In Ugandan Children Surviving Severe Malaria: A Randomised Trial
    (BMC neurology, 2011) Bangirana, Paul; Allebeck, Peter; Boivin, Michael J.; John, Chandy C.; Page, Connie; Ehnvall, Anna; Musisi, Seggane
    Infection with severe malaria in African children is associated with not only a high mortality but also a high risk of cognitive deficits. There is evidence that interventions done a few years after the illness are effective but nothing is known about those done immediately after the illness. We designed a study in which children who had suffered from severe malaria three months earlier were enrolled into a cognitive intervention program and assessed for the immediate benefit in cognitive, academic and behavioral outcomes.This parallel group randomised study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-one Ugandan children aged 5 to 12 years with severe malaria were assessed for cognition (using the Kaufman Assessment Battery for Children, second edition and the Test of Variables of Attention), academic skills (Wide Range Achievement Test, third edition) and psychopathologic behaviour (Child Behaviour Checklist) three months after an episode of severe malaria. Twenty-eight were randomised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group. Post-intervention assessments were done a month after conclusion of the intervention. Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment, adjusting for age, sex, weight for age z score, quality of the home environment, time between admission and post-intervention testing and pre-intervention score. The primary outcome was improvement in attention scores for the intervention group. This trial is registered with Current Controlled Trials, number ISRCTN53183087.Significant intervention effects were observed in the intervention group for learning mean score (SE), [93.89 (4.00) vs 106.38 (4.32), P = 0.04] but for working memory the intervention group performed poorly [27.42 (0.66) vs 25.34 (0.73), P = 0.04]. No effect was observed in the other cognitive outcomes or in any of the academic or behavioural measures.In this pilot study, our computerised cognitive training program three months after severe malaria had an immediate effect on cognitive outcomes but did not affect academic skills or behaviour. Larger trials with follow-up after a few years are needed to investigate whether the observed benefits are sustained.
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    An exploratory study on the feasibility and appropriateness of family psychoeducation for postpartum women with psychosis in Uganda
    (BMC Psychiatry, 2013) Nakigudde, Janet; Ehnvall, Anna; Mirembe, Florence; Musisi, Seggane; Airaksinen, Eija
    We explored how family psychoeducation could be made culturally sensitive for postpartum mothers with psychotic illness in a Ugandan setting. Methods: A qualitative multi-method approach using an already existing family psychoeducation Tool Kit was adapted to incorporate lay perceptions related to psychotic illness in the postpartum period in this Ugandan setting. The participants consisted of postpartum women with psychotic illness, caregivers/family members, psychiatric nurses and psychologists. A modified version of a family psychoeducation programme for postpartum women with psychosis was formulated and pilot-tested. Results: Modifications in the standard family psychoeducation programme were both in the process and content of family psychoeducation. Under process, effective communication, cultural background, appropriate dress, involving only one family member, low literacy, and flexibility in timekeeping were raised. The theme of content yielded the incorporation of lay perceptions of mental illness, family planning, income generating, and an emphasis of premorbid and morbid personalities of the patients. Conclusion: The basic principles and assumptions underlying psychoeducation remained the same. Changes made in the process and content of family psychoeducation reflected the social, cultural and gender reality of the population.
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    Malaria With Neurological Involvement In Ugandan Children: Effect On Cognitive Ability, Academic Achievement And Behaviour
    (Malaria journal, 2011) Bangirana, Paul; Musisi, Seggane; Boivin, Michael J.; Ehnvall, Anna; John, Chandy C.; Bergemann, Tracy L.; Allebeck, Peter
    Malaria is a leading cause of ill health and neuro-disability in children in sub-Saharan Africa. Impaired cognition is a common outcome of malaria with neurological involvement. There is also a possibility that academic achievement may be affected by malaria with neurological involvement given the association between cognitive ability and academic achievement. This study investigated the effect of malaria with neurological involvement on cognitive ability, behaviour and academic achievement.This prospective case-control study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-two children with a history of malaria with neurological involvement were followed up and given assessments for cognitive ability (working memory, reasoning, learning, visual spatial skills and attention), behaviour (internalizing and externalizing problems) and academic achievement (arithmetic, spelling and reading) three months after the illness. Sixty-one community controls recruited from the homes or neighbouring families of the cases were also given the same assessments. Tests scores of the two groups were compared using analysis of covariance with age, sex, level of education, nutritional status and quality of the home environment as covariates. This study was approved by the relevant ethical bodies and informed consent sought from the caregivers.Children in the malaria group had more behavioural problems than the community controls for internalizing problems (estimated mean difference = -3.71, 95% confidence interval (CI), = -6.34 to -1.08, p = 0.007). There was marginal evidence of lower attention scores (0.40, CI = -0.05 to 0.86, p = 0.09). However, excluding one child from the analyses who was unable to perform the tests affected the attention scores to borderline significance (0.32, CI, = 0.01 to 0.62, p = 0.05). No significant differences were observed in other cognitive abilities or in academic achievement scores.Malaria with neurological involvement affects behaviour, with a minimal effect on attention but no detectable effect on academic achievement at three months post discharge. This study provides evidence that development of cognitive deficits after malaria with neurological involvement could be gradual with less effect observed in the short term compared to the long term.