Browsing by Author "Kaggwa, Mark Mohan"
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Item An Adolescent’s Use of Veterinary Medicines: A Case Report Exploring Addiction(Journal of psychoactive drugs, 2021) Kaggwa, Mark Mohan; Nuwamanya, Sympson; Ashaba, Scholastic; Rukundo, Godfrey Zari; Harms, SheilaThis case report describes a 17-year-old high school student serious suicide attempt using an injectable composite of veterinary medications (vitamins, vaccines, antibiotics, and antihelminthics) typically used to treat chickens. The use of this particular substance and the route of administration was novel as a method for suicide lethality and there have been no previous cases of this kind. However, this youth also developed chronic self-harming behaviors where she would repeatedly self-inject the veterinarian medication composite which included substances that were largely inert but did have a potential neuropsychiatric side effect profile that complicated her psychiatric presentation. In this context of chronically injecting a substance with unclear psychoactive properties, an interesting set of symptoms and behaviors emerged that required diagnostic clarification and interpretation. Diagnostic considerations for this youth included major depressive disorder with psychotic features, a possible emerging borderline personality disorder, post-traumatic stress disorder (PTSD), as well a possibility of an unknown substance use disorder using the veterinary medication composite. The purpose of this case study is to highlight the clinical course and explore sociocultural factors, including family and interpersonal relationships as contextually important variables.Item Anemia in Diabetes Mellitus in Africa: A Systematic Review and Meta-analysis(Clinical Research & Reviews, 2021) Olum, Ronald; Bongomin, Felix; Kaggwa, Mark Mohan; Andia-Biraro, Irene; Baluku, Joseph BaruchAnemia accelerates chronic complications of diabetes mellitus (DM). We aimed to conduct a systematic review and meta-analysis to estimate the prevalence of anemia among people with DM in Africa.A search of studies was conducted in the main databases (Medline, EMBASE, Scopus, CINAHL, AJOL and Google Scholar) and the reference lists of selected studies. Observational studies that met the eligibility criteria were included in this meta-analysis. There was no limitation in terms of language.We obtained data from 27 eligible studies, including 5913 patients. The pooled prevalence of anemia was 35% (95% CI: 28%–42%, I2 = 97.7%, p < 0.01). In sub-group analysis, the pooled prevalence was higher in people with diabetic foot lesions (56%, 95% CI: 49%–63%, I2 = 51.04%, p = 0.100) than in the general population of people with diabetes (30%, 95% CI: 23%–37%, I2 = 97.6%, p < 0.01). Pooled prevalence rates were also higher in; males than females (34% vs 31%), type II DM than type I DM (35% vs 26%), and in patients with poor glycemic control compared to those with good glycemic control (33% vs. 22%).The prevalence of anemia in DM was high warranting enhanced clinical and public health interventions.Item Burnout and Associated Factors Among Medical Students in a Public University in Uganda: A Cross-Sectional Study(Advances in Medical Education and Practice, 2021) Kajjimu, Jonathan; Kaggwa, Mark Mohan; Bongomin, FelixBurnout is a well-recognized phenomenon that may manifest with feelings of stress, fatigue, or exhaustion. It is a common and emerging problem among healthcare workers. Medical students may be at increased risk of burnout given the rigorous nature of their training. However, there is a paucity of data on the burden of burnout among medical students in Africa.This study aimed to determine the prevalence of burnout, as assessed using the Maslach Burnout Inventory – Student Survey (MBI-SS) as well as factors associated with the development of burnout among students pursuing Bachelor of Medicine and Bachelor of Surgery (MBChB) degrees at Mbarara University of Science and Technology (MUST), Uganda.A single-centre, cross-sectional, online survey was conducted among MBChB students of MUST. Burnout was assessed using the Maslach Burnout Inventory – Student Survey (MBI-SS) tool. Bivariate analysis and backward stepwise logistic regression analysis were performed to assess possible associations between variables related to participants’ demography, socioeconomic, personal, learning environment, outside school environment aspects and burnout prevalence scores.A total of 145 medical students, 102 (70.3%) male, with a median (range) age of 23 (18–40) years were studied. A total of 135 students (93.1%) presented with high levels of emotional exhaustion, 90 (62.1%) students had low levels of professional efficacy scores and 141 (97.2%) of the medical students had high levels of cynicism. Overall, 79 (54.5%) students had burnout, as defined by the MBI-SS tool. Choosing MBChB willingly appears to be an independent predictor of burnout (Adjusted odds ratio: 7.2; 95% CI: 1.4–36.9; p=0.018). More than one-half of medical students questioned at MUST do experience a degree of burnout. Preventative and interventional measures should be considered in the development of the medical curriculum.Item Cannabis-Induced Mania Following COVID-19 Self-Medication: A Wake-Up Call to Improve Community Awareness(International medical case reports journal, 2021) Kaggwa, Mark Mohan; Bongomin, Felix; Najjuka, Sarah Maria; Rukundo, Godfrey Zari; Ashaba, ScholasticSelf-medication is becoming common during the coronavirus disease −2019 (COVID-19) pandemic due to the increasing popularity of home-based management of asymptomatic and mild cases. In this case report, we describe a patient who developed manic symptoms as a result of self-medication with a regimen containing cannabis to manage COVID-19 symptoms.A 52-year-old man with no prior history of a mental disorder, presented with a one-week history of talking more than usual, poor sleep, destructiveness, irritability, and altered mental status, following use of homemade remedies containing oranges, garlic, ginger, onions, honey, lemon, and cannabis to treat COVID-19 related symptoms over a 2-week period. This was his index presentation with such symptoms in his life. He had never used any substance of addiction before, did not have any known chronic medical condition, and had no family member with a history of any known mental illness. He was a suspect because his father had tested positive for COVID-19 and was undergoing treatment. He tested negative for COVID-19 after 3-weeks of initial COVID-19 like symptoms, urine sample was positive for tetrahydrocannabinol (THC), and he had normal investigations. He was managed with a mood stabilizer (oral carbamazepine at a dose of 200mg three times daily), antipsychotic (chlorpromazine 200mg twice daily), a sedative (diazepam 10mg at before bedtime), and occupational therapy. All manic symptoms resolved in a period of two weeks. Cannabis induced mental illness following self-medication for COVID-19 like symptoms is on the rise in the population. Due to increasing COVID-19 cases globally, hospital congestion, the popularity of home-based care guidelines for asymptomatic and mild COVID-19 to reduce hospital burden in many countries, and easy access to cannabis. With no approved cure for COVID-19, patients are turning to natural remedies to relieve symptoms of COVID-19. Emphasis on prevention of this insalubrious self-medication among the COVID-19 patients is needed to stop complication related to cannabis use.Item Cervical Cancer Screening among HIV‑Positive Women in Urban Uganda: A Cross Sectional Study(BMC Women's Health, 2022) Najjuka, Sarah Maria; Olwit, Connie; Kaggwa, Mark Mohan; Nabirye, Rose Chalo; Ngabirano, Tom DenisWomen living with Human Immunodeficiency Virus (HIV) are at a high risk for early development of cervical cancer. Adherence to cervical cancer prevention strategies in this population is vital for the early detection and treatment of cervical cancer. This study aimed to determine the prevalence and factors associated with cervical cancer screening among HIV-positive women attending an urban HIV care center in Uganda.This cross-sectional study included 205 HIV-positive women receiving care at an urban HIV care center. An interviewer-administered questionnaire was used to capture sociodemographic information, history of screening for cervical cancer, and reproductive health characteristics. Logistic regression analysis was used to determine the factors associated with cervical cancer screening.Of the 205 HIV-positive women with a mean age of 37.5 ± 8.87 that participated in the study, majority (n = 201, 98%) were aware of cervical cancer screening. Ninety participants (44%) had ever been screened for cervical cancer and only 33 (16.1%) had been screened in the past year. Obtaining information about cancer of the cervix and cervical cancer screening from health care professionals was significantly associated with higher levels of cervical cancer screening (adjusted odds ratio = 5.61, 95% confidence interval: 2.50–12.61, p value < 0.001).This study highlights the low prevalence of cervical cancer screening among HIV-positive women and underscores the role of health professionals as an effective source of information on cervical cancer and cervical cancer screening. Patient education programs in HIV prevention and care facilities should emphasize cervical cancer screening messages to enhance the uptake of screening services.Item Depression in Ugandan Rural Women Involved in a Money Saving Group: The Role of Spouse’s Unemployment, Extramarital Relationship, and Substance Use(International Journal of Women's Health,, 2021) Kaggwa, Mark Mohan; Namatanzi, Brendah; Kule, Moses; Nkola, Rahel; Najjuka, Sarah Maria; Mamun, Firoj al; Hosen, Ismail; Mamun, Mohammed A.Rural women are highly prevalent to depression, where spouse-related factors, including extramarital affairs and poverty, intensify its likelihood of occurrence. However, women engaged with a Money-Saving Group (MSG) are financially self-dependent, which can reduce the risk of depression suffering. Despite this, there is less study among this cohort, which led us to investigate the prevalence and associated factors of depression among the Ugandan women involved in MSG.This was a cross-sectional study in Uganda among rural married or cohabiting women aged 18 to 45 years engaged in MSG. The survey was carried out within a total of 153 participants (33.3 ± 6.7 years) in April 2021. Information related to socio-demographic of the participants, their spouse characteristics, and depression were collected.About 65.4% of the participants had depressive symptoms (based on the cutoff 10/27 at the PHQ-9). But, 8.15 times (CI: 2.83–23.44, p<0.001) and 16.69 times (CI: 4.85–57.39, p<0.001), higher risk of depression were observed, if the participants’ spouses were using an addictive substance and had been involved in an extramarital relationship, respectively. Similarly, there was an increased likelihood of depression when the participant or spouse was unemployed. This study observed a higher prevalence of depression, which suggests paying attention to this cohort. Thus, there should be routine screening for depression among married women involved in MSG at lower-level health facilities in rural settings, especially those with spouses engaged in substance use, having an extramarital relationship, and being unemployed.Item Depression, Anxiety, and Stress among Ugandan University Students during the COVID-19 Lockdown: an Online Survey(African Health Sciences, 2021) Najjuka, Sarah Maria; Checkwech, Gaudencia; Olum, Ronald; Ashaba, Scholastic; Kaggwa, Mark MohanCOVID19 pandemic forced most countries to lockdown, leading to the prolonged closure of many learning institutions. This dramatic shift led to increase of mental illness symptoms among university students.To determine the prevalence and factors associated with symptoms of depression, anxiety, and stress among Uganda’s university students during the COVID-19 lockdown.We conducted a one-month online survey using the Depression Anxiety and Stress Scale (DASS-21).Participants n=321 were enrolled with mean age, 24.8(SD=5.1) years and 198(61.7%) were males. The prevalence of mental health symptoms among participants was 80.7%, 98.4%, and 77.9% for depression, high levels of anxiety, and stress, respectively. Statistically significant association between mental health symptoms on multi-logistic regression was found with Males (depression=2.97[1.61–5.48] and stress=1.90[1.07–3.35]), engagement in leisure activity (depression= 1.87[1.01–3.49] and stress=1.98[1.10–3.56]), and being finalist (stress=0.55[0.31– 0.97]). Use of addictive substances seem to potentially alleviate symptoms of depression, anxiety and stress in the short term. The findings of this study suggest a high prevalence of symptoms of depression, anxiety and stress among university students during the COVID-19 lockdown. Students’ mental health should be monitored by all stakeholders, especially as the pandemic progresses.Item Distribution of β-Thalassemia and Other Hemoglobinopathies in Bangladeshi University Students and Ready-Made Garment Workers(Risk Management and Healthcare Policy, 2021) Islam, Mohammad Manirul; Hossain, Fahima; Sakib, Najmuj; Zeba, Zebunnesa; Mamun, Mohammed A.; Kaggwa, Mark Mohan; Yoshimura, Ken; Afrin, Sadia; Selim, Sheikh; HossainThe inheritable thalassemia and other structural hemoglobinopathies are prevalent globally. In Bangladesh, there is a scarcity of studies concerning thalassemia and other structural hemoglobinopathies. Hence, the present study investigated the prevalence and distribution of β-thalassemia and other hemoglobinopathies among the university students and ready-made garment (RMG) workers.A cross-sectional study was conducted, whereas a total of 989 subjects were selected randomly from 10 garments industries (n=495) and five universities (n=494) for diagnosis and counseling from April 2018 to August 2018. Basic information related to the study and venous blood was collected and subjected to capillary Hb-electrophoresis for each participant. The present study identified thalassemia carriers and other hemoglobinopathies among 13.6% of the participants (14.1% university students and 13.2% RMG workers). The most common form of hemoglobin formation disorder was the Hb-E trait (10.5%), considering both participants’ groups. Other forms of hemoglobin formation disorders observed were a β-thalassemia trait, Hb-D trait, Hb-E disease, and β-thalassemia major. The hemoglobinopathies were significantly associated with the individuals who had a family history of thalassemia and were not vaccinated against hepatitis B in the total sample. Although not statistically suggestive, the most considerable portion (87.3%) of the carriers was unmarried in the present findings.The present study findings are anticipated to help the public health authorities by providing novel data (of a neglected cohort, ie, RGM workers), facilitating the upcoming comprehensive national thalassemia prevention programs.Item Excessive eating and weight gain:A rare post-acute COVID-19 syndrome(Clinical Research & Reviews, 2021) Kaggwa, Mark Mohan; Favina, Alain; Najjuka, Sarah Maria; Zebunnesa, Zeb; Mamun, Mohammed A.; Bongomin, FelixThe coronavirus disease - 2019 (COVID-19) is a multisystem illness associated with several metabolic derangements. Studies report that post-acute COVID-19 syndromes (PACs) continue to evolve, however, polyphagia is not uncommon. Herein, we report a rare occurrence of polyphagia in a patient following acute COVID-19 illness. A-41-year-old Ugandan female with a negative past medical history presented with complains of excessive appetite, eating large amounts of food, inability to feel satisfied, failure to control desire to eat, and weight gain 6 months following recovery from a mild episode of acute COVID-19 pneumonia. Her body mass index rose to 30 Kg/m2 from 22 Kg/m2 prior to suffering from COVID-19. There was no history of polyuria, polydipsia, pruritus, or prior eating disorder or related history. Investigation found that brain computed tomography scan was normal, fasting blood sugar to be 5.6 mmol/L (normal range, 3.9–7.0 mmol/L), adrenocorticotropin hormone level to be 8.763 pg/mL (normal range, 6–40 pg/mL), erythrocyte sedimentation rate to be 12 mm/hour (0–30 mm/hour), but there was an elevation in glycosylated hemoglobin level (HbA1c, 7.7%). She was commenced on psychotherapy and behavioral changes with good outcomes. Polyphagia may be one of the rare PACs, requiring further research.Item Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System(Risk Management and Healthcare Policy, 2021) Kaggwa, Mark Mohan; Nkola, Rahel; Najjuka, Sarah Maria; Bongomin, Felix; Ashaba, Scholastic; Mamun, Mohammed A.The burden of substance use disorders is increasing in most countries in sub-Saharan Africa. Individuals with substance use disorders (eg, alcohol use disorder) are at high risk of manifesting extrapyramidal side effects or extrapyramidal symptoms (EPS) during treatment of alcohol-induced mental illness symptoms especially psychosis. EPS management poses a challenge since some of the drugs used for treating EPS have addictive properties. The knowledge about EPS diagnosis and treatment is not well distributed across the health system, with health workers at lower health facilities having least awareness. The present case gives details of a patient who developed EPS during the management of alcohol withdrawal symptoms.Following cessation of alcohol use, a 54-year-old man with alcohol use disorder presented with a one-week history of visual, auditory and tactile hallucinations, illusions, insomnia, extreme fear and irritability. He was managed with several daily doses of intramuscular chlorpromazine 100 mg, whenever he woke up aggressive from sedation from a peripheral health facility. Four days after his admission, he became mute, stiff, immobile, triple-flexed, tremulous and was drooling saliva. He was referred to a secondary facility for further management while on antipsychotic medication. Finally, he was referred to a tertiary facility, managed with tablets of benzhexol 5 mg twice daily and intravenous diazepam 20 mg per day. Daily follow-up was done using the extrapyramidal symptom rating scale (ESRS) for EPS. EPS symptoms resolved ten days after initiation of treatment.EPS among individuals with addictive disorders poses a challenge in its management, especially in countries where the mental health care system is not well developed at lower-level health facilities. The mental health system has to prepare sustainable interventions to properly manage EPS among the growing population of individuals with addictive disorders through strengthening the mental health policy by training and equipping all health providers with knowledge and skills in managing EPS, increasing finances allocated for mental health and controlling the production and use of addictive substances.Item Gambling-Related Suicide in East African Community Countries: Evidence from Press Media Reports(BMC public health, 2022) Kaggwa, Mark Mohan; Mamun, Mohammed A.; Najjuka, Sarah Maria; Muwanguzi, Moses; Kule, Moses; Nkola, Rahel; Favina, Alain; Kihumuro, Raymond Bernard; Munaru, Gideon; Arinaitwe, Innocent; Rukundo, Godfrey Zari; Griffiths, Mark D.Gambling activities and associated mental health problems have become a topic of increased concern globally. Many individuals with a severe gambling disorder have gambling-related suicidality. However, no study has explored gambling-related suicide in East African Community (EAC) countries. The present study investigated the press media reporting of gambling-related suicide cases from EAC countries.As there is no established suicide database in that region, media reports were utilized to collect gambling-related suicide data. Gambling-related suicide case reports were searched for in EAC countries’ press media websites using Google. After removing duplicates, a total of 18 suicides were found.The victims were all males aged 16 to 40 years. The most prevalent reason for the death was university students who had used their university tuition fees for gambling and losing the money (n = 4/17). All the suicide deaths were in Kenya (10/18), Uganda (7/18), and Tanzania (1/18). Betting on soccer was the most common type of gambling reported (n = 11/15), and hanging was the most used mode of suicide (n = 10/16).Based on the press media reports, 18 males were identified as having carried out gambling-related suicides. The countries with the most widespread opportunities to gamble had more gambling-related suicides, although the number of suicides was very small.Item Health‑Related Quality of Life among Patients with Bipolar Disorder in Rural Southwestern Uganda: A Hospital Based Cross Sectional Study(Health and Quality of Life Outcomes, 2021) Anyayo, Lucas; Ashaba, Scholastic; Kaggwa, Mark Mohan; Maling, Samuel; Nakimuli‑Mpungu, EtheldredaBipolar disorder is a psychiatric disorder that alters mood and affects over 55 million people globally with an estimated lifetime prevalence of approximately 0.8–1.1%. In Africa, the lifetime prevalence of the bipolar spectrum disorders is slightly lower at 0.1–0.6%. Bipolar disorder is ranked the sixth leading cause of disability with high rates of morbidity and mortality and negatively impacts quality of life of those affected.The aim of the study was to determine the health-related quality of life of patients with bipolar disorder attending a mental health clinic in south western Uganda. We enrolled a consecutive sample of 169 participants and evaluated their health-related quality of life using the medical outcomes health survey short form-36 (SF-36) scale. We used bivariate and multivariable logistic regression to determine associations between quality of life, sociodemographic and clinical factors setting the physical and mental component categories of quality life scale as the main outcome variables.The mean age of the participants was 37.23 (12.83) and slightly over half (54.4%) were females. More than half (66.86%) of the participants had poor physical component summary (mean = 45.06, SD = 8.44) while 81% of the participants had poor mental component summary (mean = 41.95, SD = 8.45). Poor physical quality of life had a statistically significant association with history of suicidal thoughts (OR = 2.75, 95% CI = 1.14–6.63, P = 0.02), while poor mental quality of life had a statistically significant association with history of suicidal thoughts (OR = 3.94, CI = 1.22–12.71, P = 0.02) and history of psychotic symptoms (OR = 2.46, CI = 1.07–5.64, P = 0.03).The mental and physical quality of life of our participants was poor and history of suicidal thoughts and psychotic symptoms were associated with poor quality of life. There is need to address psychotic symptoms and suicidal thoughts in the management of patients with bipolar disorder to improve health related outcomes and quality of life.Item How Has the COVID-19 Pandemic Impacted Internet Use Behaviors and Facilitated Problematic Internet Use? A Bangladeshi Study(Psychology Research and Behavior Management, 2021) Jahan, Israt; Hosen, Ismail; Mamun, Firoj al; Kaggwa, Mark Mohan; Griffiths, Mark D.; Mamun, Mohammed A.The COVID-19 pandemic-related “stay-at-home” and confinement orders has led individuals to be more engaged with technology use (eg, internet use). For a minority of individuals, excessive use can become problematic and addictive. However, the investigation of problematic internet use in the COVID-19 context is only just emerging. Therefore, the present study investigated the changes in internet use behaviors and addiction rates in comparison with prior Bangladeshi studies. An online cross-sectional study was carried out among a total of 601 Bangladeshi students between October 7 and November 2, 2020. The survey included questions relating to socio-demographic, behavioral health, online use behaviors, and psychopathological variables.A quarter of the participants (26%) reported having low levels of internet addiction, whereas 58.6% were classed as having moderate internet addiction and 13% severe internet addiction. A total of 4% of the sample were classed as being at risk of severe internet dependency (ie, scoring over ≥80 on IAT). Risk factors for internet addiction included smartphone addiction, Facebook addiction, depression, and anxiety. However, the final hierarchical regression model comprising all variables explained a total of 70.6% variance of problematic internet use.Based on the present findings, it is concluded that individuals are at elevated risk of problematic internet use like other psychological impacts that have been reported during the COVID-19 pandemic. Therefore, risk-reducing measures and healthy control use strategies should be implemented for vulnerable individuals.Item Mental Disorders of Bangladeshi Students During the COVID-19 Pandemic: A Systematic Review(Psychology Research and Behavior Management, 2021) Mamun, Firoj al; Hosen, Ismail; Misti, Jannatul Mawa; Kaggwa, Mark Mohan; Mamun, Mohammed A.The unprecedented COVID-19 pandemic has become a global burden disrupting peoples’ quality of life. Students being an important cohort of a country, their mental health during this pandemic has been recognized as a concerning issue. Therefore, the prevalence and associated risk factors of Bangladeshi students’ mental health sufferings (ie, depression, anxiety, and stress) are systematically reviewed herein for the first time.Adhering to the PRISMA guideline, a systematic search was performed from 1 to 5 April, 2021 in several databases including PubMed; and finally, a total of 7 articles were included to this review.The prevalence rates of mild to severe symptoms of depression, anxiety, and stress ranged from 46.92% to 82.4%, 26.6% to 96.82%, and 28.5% to 70.1%, respectively. The risk factors concerning mental health problems included the factors related to (i) socio-demographic (younger age, gender, lower educational grade, urban residence, family size, currently living with family/parents, and having children in the family), (ii) behavior and health (smoking status, lack of physical exercise, more internet browsing time, and dissatisfaction with sleep), (iii) COVID-19 pandemic- (COVID-19 related symptoms, COVID-19 related perceptions, and fear of COVID-19 infection), (iv) miscellaneous (losing part-time teaching job, lack of study concentration, agitation, fear of getting assaulted or humiliated on the way to the hospital or home, financial problems, academic dissatisfaction, inadequate food supply, higher exposure to COVID-19 social and mass media, engaging with more recreational activities, and performing more household chores).The overall assumption of mental disorders’ prevalence rates can be regarded as problematic to this cohort. Thus, the authorities should consider setting up possible strategies to diminish the pandemic effect on students’ mental health.Item Patients’ Perspectives on the Experience of Absconding from a psychiatric hospital: a qualitative study(BMC psychiatry, 2021) Kaggwa, Mark Mohan; Acai, Anita; Rukundo, Godfrey Zari; Harms, Sheila; Ashaba, ScholasticAbsconding (i.e., escaping) is common among patients with mental illness admitted to psychiatric hospitals. Patients use various strategies to make absconding successful due to the experiences faced during admission. We conducted a study to identify patients’ perspectives on the experience of absconding from the psychiatry facility.We conducted 10 in-depth interviews with patients with a history of absconding from the hospital who were accessing care at the Mbarara Regional Referral Hospital in Mbarara city Uganda. Interviews were audio-recorded, translated when required, transcribed into English, and analyzed thematically to identify relevant themes.Participants ranged in age from 18 to 55 and the majority (n = 9) were male. Most had absconded at least twice from a psychiatric facility. We identified different experiences that influenced patients’ engagement in absconding from the psychiatry hospital ward. These included: (1) stigma, (2) experiences with caregivers: mixed emotions, (3) poor resources and services, and (4) the influence of mental illness symptoms. The loneliness of stigma, negative emotions associated with the loss of important roles given the nature and framework of caregiving on the psychiatric ward, as well as the stress of limited resources were a salient part of the patient experience as it relates to absconding.Our findings indicate that absconding is a symptom of a larger problem with a mental health system that perpetuates stigma in its design, isolates patients and makes them feel lonely, and forces patients to rely on caregivers who infantilize them and take away all their freedom in a facility with no basic services. For many patients, this makes absconding the only option. Within such a system, all stakeholders (policymakers, health-care providers, caregivers, and patients) should be involved in rethinking how psychiatric facilities should be operated to make the journey of patient recovery more positive.Item Prevalence and Factors Associated With Depression and Suicidal Ideation During the COVID-19 Pandemic Among University Students in Uganda: A Cross-Sectional Study(Frontiers in Psychiatry, 2022) Kaggwa, Mark Mohan; Arinaitwe, Innocent; Nduhuura, Elicana; Muwanguzi, Moses; Kajjimu, Jonathan; Kule, Moses; Ajuna, Noble; Machacha, Ivan; Nkola, Rahel; Najjuka, Sarah Maria; Wamala, Nicholas Kisaakye; Bongomin, Felix; Griffiths, Mark D.; Rukundo, Godfrey Zari; Mamun, Mohammed A.The COVID-19 pandemic has negatively impacted psychosocial well-being and mental health of students across the world. Although students are vulnerable to depression and suicidal ideation, few studies have been conducted in Uganda. This study aimed to determine the prevalence of depression and suicidal ideation, and associated factors among undergraduate university students in Uganda.A cross-sectional study was conducted among undergraduates [N = 540; 363 males; mean age = 23.3 (± 2.64) years] recruited from four universities using an online questionnaire that explored sociodemographic factors, depression, and other associated factors. The Patient Health Questionnaire (PHQ-9) was used to assess depression, and Item 9 was used to assess suicidal ideation in the past 2 weeks. Multivariable logistic regression analyses were performed to determine the factors associated with depression and suicidal ideation.The prevalence of moderate to severe depression was 20% (n = 108) (cut-off: 10/27 based on the PHQ-9), and the prevalence of past-2-week suicidal ideation was 13.89% (n = 75) (cut-off: 1/3 based on the PHQ-9 Item 9). About half of the individuals who screened positive for depression had suicidal ideation. Factors associated with depression were: having relationship issues [adjusted odds ratio (aOR) = 1.79, 95% confidence interval (CI) = 1.13–2.81, p = 0.012], and having a history of sexual abuse (aOR = 2.06, 95% CI = 1.10–3.84, p = 0.023). Factors associated with reducing the risk of depression were: satisfaction with current academic performance (aOR = 0.50, 95% CI = 0.32–0.79, p = 0.003), and being in the fifth year of academic study (aOR = 0.16, 95% CI = 0.03–0.73, p = 0.018). Factors associated with suicidal ideation were: smoking cigarettes and/or marijuana (aOR = 4.83, 95% CI = 1.10–21.12, p = 0.037), and having financial tuition constraints (aOR = 1.85, 95% CI = 1.08–3.16, p = 0.024), However, satisfaction with current academic performance reduced the likelihood of suicidal ideation (aOR = 0.40, 95% CI = 0.23–0.70, p = 0.001). Conclusion Approximately one-fifth of undergraduate university students were moderately to severely depressed, especially those who had relationship issues and those with a history of sexual abuse. Suicidal ideation was common among smokers and those having financial tuition constraints. Therefore, it is recommended that the university authorities implement measures to provide psychological support for the students with problems concerning financial tuition constraints, relationships, and sexual abuse. Also, all students with depression should be screened for suicidality.Item Prevalence of Burnout among University Students in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis(PloS one, 2021) Kaggwa, Mark Mohan; Kajjimu, Jonathan; Sserunkuma, Jonathan; Najjuka, Sarah Maria; Atim, Letizia Maria; Olum, Ronald; Tagg, Andrew; Bongomin, FelixBurnout is common among university students and may adversely affect academic performance. Little is known about the true burden of this preventable malady among university students in low-and-middle-income countries (LMICs).This study aimed to systematically estimate the prevalence of burnout among university students in LMICs.We searched PubMed, Google Scholar, CINAHL, Web of Science, African Journals Online, and Embase from the inception of each database until February 2021. Original studies were included. No study design or language restrictions were applied. A random-effects meta-analysis was performed using STATA version 16.0. Heterogeneity and publication bias were assessed using Q-statistics and funnel plots, respectively.Fifty-five unique articles, including a total of 27,940 (Female: 16,215, 58.0%) university students from 24 LMICs were included. The Maslach Burnout Inventory (MBI) was used in 43 studies (78.2%). The pooled prevalence of burnout was 12.1% (95% Confidence Interval (CI) 11.9–12.3; I2 = 99.7%, Q = 21,464.1, p = < 0.001). The pooled prevalence of emotional exhaustion (feelings of energy depletion), cynicism (negativism), and reduced professional efficacy were, 27.8% (95% CI 27.4–28.3; I2 = 98.17%. p = <0.001), 32.6 (95% CI: 32.0–33.1; I2: 99.5%; p = < 0.001), and 29.9% (95% CI: 28.8–30.9; I2: 98.1%; p = < 0.001), respectively. Nearly one-third of university students in LMICs experience burnout. More studies are needed to understand the causes of burnout in this key population. There is a need to validate freely available tools for use in these countries.Item Prevalence of Severe Neurocognitive Impairment and Its Association with Socio-Demographics and Functionality Among Ugandan Older Persons: A Hospital-Based Study(Clinical Interventions in Aging, 2021) Atim, Letizia Maria; Kaggwa, Mark Mohan; Mamun, Mohammed A.; Ashaba, Scholastic; Maling, SamuelThe prevalence of neurocognitive disorders, especially dementia, is rising due to an increase in longevity. Early detection and diagnosis of neurocognitive impairments are important for early interventions and appropriate management of reversible causes, especially by the primary health workers. However, this study aimed to determine the prevalence and associated factors of severe neurocognitive impairment among elderly persons attending a tertiary hospital in Uganda.This cross-sectional survey was conducted in a Ugandan hospital setting, where older adults go for treatment for their chronic health problems. Following the inclusion criteria, interviews were conducted, where information about socio-demographics was collected, whereas neurocognitive impairment and functionality were assessed by Mini-Mental State Examination and Barthel Index, respectively. Chi-square test, Pearson correlation test, and logistic regression were performed to determine the factors associated with severe neurocognitive impairment.A total of 507 elderly persons aged 60 years and above were enrolled in this study (mean age 68.62 ±7.95 years), and the prevalence of severe neurocognitive impairment was 28.01%. Advanced age, female gender, lower education level, and functional dependency were significantly associated with severe neurocognitive impairment. Severe neurocognitive impairment is prevalent among Ugandan hospital attending elderlies with functional dependency. This suggests a need to routinely screen cognitive disorders among older persons who visit the healthcare facilities with other physical complaints to enable early detection and treatment of reversible causes of neurocognitive impairment, such as depression and delirium to enable better functionality.Item Psychometrics of the Patient Health Questionnaire (PHQ-9) in Uganda: A Systematic Review(Frontiers in psychiatry, 2022) Kaggwa, Mark Mohan; Najjuka, Sarah Maria; Ashaba, Scholastic; Mamun, Mohammed A.Depression is screened by many psychological tools, whereas the Patient Health Questionnaire-9 (PHQ-9) is one of the most commonly used self-administered tools. Uganda is a culturally diverse country with a wide variety of tribes, ethnic groups, languages, and disease conditions; it is urgent to know the psychometrics of the used PHQ-9 across different cohorts. However, there is no prior review to assess its reliability in this culturally diverse country, where this review fulfills the knowledge gap. Adhering to the PRISMA guideline, a systematic search was performed in several databases (i.e., PubMed, Africa-Wide Information, AJOL, and PsycINFO, among others), and a total of 51 articles were included in this review, confirming the study inclusion criteria (e.g., using the PHQ-9).The PHQ-9 has been used among individuals above 10 years and both genders, and the tool has been used most among the HIV patient group (n = 28). The tool is frequently administered by interviews and has been translated into several languages (mostly Luganda, n = 31). A cutoff of 10 was commonly used to identify clinical or major depression (n = 23), and its prevalence ranged from 8 to 67%. It has been validated for use in two populations, (i) HIV-positive participants and (ii) the general population attending a health facility. The sensitivity and specificity were 92 and 89%, respectively, at a cutoff score of 10, whereas 67 and 78%, respectively, at a cutoff score of 5. The Cronbach alpha ranged between 0.68 and 0.94.The PHQ-9 has been used in several studies in Uganda but validated in only two populations and is commonly used in one language. Thus, validation of the tool in various populations and languages is warranted to improve the tool's acceptance in Uganda.Item Response to the Letter to the Editor Regarding Our Feature “Burnout and Associated Factors Among Medical Students in a Public University in Uganda: A Cross-Sectional Study”(Advances in Medical Education and Practic, 2021) Kajjimu, Jonathan; Kaggwa, Mark Mohan; Bongomin, FelixWe wish to welcome the insightful comments by Lam, Parkes, and Wang regarding our study on the burden of burnout among medical students in a public university in Uganda.1 We especially appreciate this contribution and we believe that reaching a consensus will help in promoting future medical students’ well-being together with that of their patients. In performing this study, we wanted to start a conversation around the occurrence of burnout in Ugandan medical students aiming to build on this as our base-line dataset to inform future medical student-centered interventional studies. The readers raised several important comments. Firstly, the need to conduct more in-depth research on why choosing medicine may lead to burnout in Ugandan medical students and to explore if this single factor was the sole cause of burnout in our study population. We agree with the readers that this was somewhat an expected and a surprising finding. However, it is consistent with a report published about a decade ago by Pagnin and others.2 In their study, Pagnin et al investigated the predictive role of career choice motivation on burnout dimensions by attempting to find the association between burnout and the various factors underlying choosing of a career in medicine such as intellectual curiosity, professional autonomy, economic concern, illness or death experiences, altruism, the influence of someone, and interest in human relationships. This study found no correlation between these motivation factors and burnout, expect for medical students in whom career choice were motivated by experiences of illness/death of family members or personal illness that were found to have greater emotional exhaustion.2 We would thus also like to call for qualitative studies to explore such phenomena and longitudinal studies to make associations more clear in our setting and to thus help us underpin medical career selection factors associated with high risks of development of psychological distress in medical students to which specific context-based interventions would now need to be targeted if possible before even students joined medical school. Secondly, the readers made an enquiry into why our study results are inconsistent with reported burnout prevalence and there being no discernible pattern between burnout and personal stressors across twelve countries in a recent study. In our study, we assessed for many factors associated with burnout but due to perhaps the low response rate, a common problem in online studies conducted among Ugandan medical students. As also encountered in a recent first depression study among Ugandan medical students by Olum et al.3 This is attributed to a number of factors related to survey development, survey delivery (including the limited access to internet for instance in countries like Uganda), survey completion and survey return.4 Such factors might have limited us from coming up with more factors that were significantly associated with burnout in our setting. Perhaps future studies on the same topic will need to look at how to achieve higher response rates which would help in discovering of all significant causative factors of burnout among students.Globally, the influence of differences between countries on burnout prevalence in medical students has been less studied. Despite the fact that culture controls the perceptions, identities, roles, norms and practices which are associated with known burnout predictive factors.Much as though, Molodynsk et al6 found no discernible pattern between burnout and personal stressors such as housing, relationships, and academic studies, their study was conducted in no low-income country,7 yet Uganda is a low-income country and thus this limits comparing of our study findings to findings of this multi-center study. Also, Molodynsk et al did not have appropriate data analysis for identification of significant sources of stress. They analyzed sources of stress by use of frequencies and they were unable to determine significant associations between the identified sources of stress and burnout. In our study, and as in many other studies that have found significant associations between personal stressors and burnout, bivariate analyses and backward stepwise logistic regression analyses have been always carried out.Lastly, the readers called for an in-depth understanding of the socio-economic, cultural and political landscape of the study area which could help in identifying more causative factors of burnout and inform which targeted interventions may be effective in our setting. We agree with the readers on this and we also thank them for the suggestion of a qualitative study which would lead to the gathering of more data for a comprehensive understanding the burnout concept including the various factors that underly career selection in developing countries like Uganda.To ascertain more closely the causative factors for burnout, we would look to perform a series of local and nationwide structured interviews and focus group discussions that could provide more answers to our questions. We agree with the readers that it would be useful to determine if the high rates of burnout are found throughout other Ugandan medical schools and we hope to be able to do so in the future. In conclusion, as health professionals who have been trained from a low-income country, our lived experiences were closely aligned with those of our study respondents.