Browsing by Author "Musisi, Seggane"
Now showing 1 - 20 of 23
Results Per Page
Sort Options
Item 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, HansThe 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.Item Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda(Journal of Acquired Immune Deficiency Syndromes, 2018) Spittal, Patricia M.; Malamba, Samuel S.; Ogwang, Martin D.; Musisi, Seggane; Ekwaru, J. Paul; Sewankambo, Nelson K.; Pearce, Margo E.; Jongbloed, Kate; Patel, Sheetal H.; Katamba, Achilles; Blair, Alden H.; Muyinda, Herbert; Schechter, Martin T.As previously encamped resettle, potential for rapid HIV transmission in post-conflict Northern Uganda is concerning. Women in particular may be experiencing heightened vulnerability resulting from war-related sexual violence. Setting: Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in 3 districts in Northern Uganda. Methods: Eight randomly selected communities were mapped, and a census was conducted. Participants aged 13–49 years completed questionnaires in Luo on war-related experiences, mental health, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV and syphilis. Baseline data from all sexually active participants was used to determine gender differences in HIV prevalence. Multivariate modeling determined correlates of HIV by gender. Results: Among 2008 participants, HIV prevalence was higher among women [17.2; 95% confidence interval (CI): 14.7 to 19.7] compared to men (10.6; 95% CI: 8.0 to 13.2, ,0.001). Among women, correlates of HIV included: war-related sexual assault [adjusted odds ratio (AOR): 1.95; 95% CI: 1.16 to 3.26]; probable depression (AOR: 2.22; 95% CI: 1.46 to 3.37); probable post-traumatic stress disorder (AOR: 2.03; 95% CI: 1.45 to 2.84); experiencing $12 traumatic events (AOR: 2.04; 95% CI: 1.31 to 3.18); suicide ideation (AOR: 1.67; 95% CI: 1.22 to 2.28); living in a female-headed household (AOR: 2.76; 95% CI: 1.70 to 4.49); first sexual partner $10 years older (AOR: 1.69; 95% CI: 1.07 to 2.67); sex for exchange (AOR: 5.51; 95% CI: 1.76 to 17.31); having 2 (AOR: 2.54; 95% CI: 1.23 to 5.23) or 3+ (AOR: 4.65; 95% CI: 2.65 to 8.18) sexual partners; inconsistent condom use (AOR: 0.40; 95% CI: 0.29 to 0.57); genital ulcers (AOR: 3.08; 95% CI: 2.16 to 4.38); active syphilis (AOR: 4.33; 95% CI: 1.22 to 15.40); and ill health without medical care (AOR: 2.02; 95% CI: 1.22 to 3.34). Among men, correlates of HIV included no condom at sexual debut (AOR: 1.92; 95% CI: 1.30 to 2.83) and genital ulcers (AOR: 4.40; 95% CI: 1.35 to 14.40). Conclusion: Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Traumainformed HIV prevention and culturally safe mental health initiatives are urgently required.Item Challenges for the Implementation of World Health Organization Guidelines for Acute Stress, PTSD, and Bereavement: a Qualitative Study in Uganda(Implementation Science, 2015) Kane, Jeremy C.; Adaku, Alex; Nakku, Juliet; Odokonyero, Raymond; Okello, James; Musisi, Seggane; Augustinavicius, Jura; Tol, Wietse A.In 2013, the World Health Organization (WHO) published new guidelines for the management of conditions specifically related to stress, including symptoms of acute stress, bereavement, and post-traumatic stress disorder (PTSD). It is important to evaluate potential challenges for the implementation of these guidelines in low-resource settings, however, there is a dearth of research in this area. The current qualitative study aimed to assess perspectives on the feasibility and acceptability of the new guidelines in four clinics that provide mental health services in post-conflict northern Uganda. In-depth interviews were conducted with 19 mental health-care providers and program developers in northern Uganda to address three major research objectives: (1) describe the current standard practices and guidelines used for treating conditions related to stress in Uganda; (2) identify barriers and challenges associated with implementing the new WHO guidelines; and (3) identify and describe potential strategies for overcoming these barriers and challenges. An emergent thematic analysis was used to develop a coding scheme for the transcribed interviews. Practices for managing conditions related to stress included group psychological interventions, psychoeducation, and medication for clients with severe signs and symptoms. Several themes were identified from the interviews on barriers to guideline implementation. These included (1) a lack of trained and qualified mental health professionals to deliver WHO-recommended psychological interventions; (2) a perception that psychological interventions developed in high-income countries would not be culturally adaptable in Uganda; and (3) reluctance about blanket statements regarding medication for the management of acute stress symptoms and PTSD. Identified strategies for overcoming these barriers included (1) training and capacity building for current mental health staff; (2) a stepped care approach to mental health services; and (3) cultural modification of psychological interventions to improve treatment acceptability by clients. Guidelines were viewed positively by mental health professionals in Uganda, but barriers to implementation were expressed. Recommendations for implementation include (1) strengthening knowledge on effectiveness of existing cultural practices for improving mental health; (2) improving supervision capacity of current mental health staff to address shortage in human resources; and (3) increasing awareness of help-seeking clients on the potential effectiveness of psychological vs. pharmacological interventions.Item 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, SegganeInfection 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.Item Comparative Studies of Orphans and Non-Orphans in Uganda(Center for International Health and Development, 2004) Munaaba, Flavia; Owor, Joseph; Baguma, Peter; Musisi, Seggane; Mugisha, Frank; Muhangi, DenisThere are now in Uganda more than two million orphans, i.e. children under 18 years old who have lost one or both of their parents. Roughly one in every five children is an orphan and one in every four households in the country is caring for at least one orphan. As a follow-up to a Situation Analysis of Orphans in Uganda in 2002, this monograph presents six studies carried out by Ugandan researchers in 2003 and 2004 on different aspects of the orphan crisis about which the Situation Analysis found inadequate data. Five studies focused on the following: the comparative psycho-social situation of orphans relative to other children (two studies), the legal issues (such as property grabbing and abuse) which they face, suspected differential care-giving practices, and whether orphans face greater risk for sexually transmitted diseases (including HIV/AIDS). The sixth study conducted a comparative evaluation of an orphan support and intervention effort to determine its impact and to test a particular evaluation approach. The results of these studies have already contributed to the preparatory discussions and formulation of the Uganda National Policy on Orphans as well as to the Uganda National Strategic Program Plan of Interventions for Orphans which were produced in 2004.Item A comparison of the behavioral and emotional disorders of primary school-going orphans and non-orphans in Uganda(African health sciences, 2007) Musisi, Seggane; Kinyanda, Eugene; Nakasujja, Noeline; Nakigudde, JanetThis study investigated the emotional and behavioral problems of orphans in Rakai District, Uganda, and to suggest interventions. Studies, elsewhere, have shown orphans to have high levels of psychological problems. However, in Uganda such studies are limited and no specific interventions have been suggested. Methods: The study employed a cross-sectional unmatched case control design to compare emotional and behavioral problems of 210 randomly selected primary school-going orphans and 210 non-orphans using quantitative and qualitative methods employing standardized questionnaires, Focus Group discussions and selected Key Informant interviews. All children were administered Rutter’s Children’s Teacher Administered Behavior Questionnaire to measure psychological distress and a modified version of Cooper’s Self-Report Measure for Social Adjustment. Standardized psychiatric assessments were done on children scoring > 9 on the Rutter’s Scale, using the WHO-ICD-10 diagnostic checklists. Results: Both orphans and non-orphans had high levels of psychological distress as measured using Rutter’s questionnaire but with no significant statistical difference between the two groups (Rutter score > 9; 45.1% & 36.5% respectively; p= 0.10) and no major psychiatric disorders such as psychotic, major affective or organic mental syndromes. Psychological distress was associated with poor academic performance (p=0.00) in both groups. More orphans, than non-orphans had more common emotional and behavioral problems e.g. more orphans reported finding “life unfair and difficult” (p=0.03); 8.3% orphans compared to 5.1 % of the non-orphans reported having had past suicidal wishes (p=0.30) and more reported past “forced sex / abuse” (p=0.05). Lastly, the orphans’ social functioning in the family rated significantly worse compared to the non-orphans (p= 0.05). Qualitatively, orphans, compared to nonorphans were described as “ needy, sensitive, isolative with low confidence and self-esteem and who often lacked love, protection, identity, security, play, food and shelter.” Most lived in big poor families with few resources, faced stigma and were frequently relocated. Community resources were inadequate. Conclusion: In conclusion, more orphans compared to non-orphans exhibited common emotional and behavioral problems but no major psychiatric disorders. Orphans were more likely to be emotionally needy, insecure, poor, exploited, abused, or neglected. Most lived in poverty with elderly widowed female caretakers. They showed high resilience in coping. To comprehensively address these problems, we recommend setting up a National Policy and Support Services for Orphans and Other Vulnerable Children and their families, a National Child Protection Agency for all Children, Child Guidance Counselors in those schools with many orphans and lastly social skills training for all children.Item An exploration of caregiver burden for children with nodding syndrome (lucluc) in Northern Uganda(BMC psychiatry, 2016) Nakigudde, Janet; Mutamba, Byamah Brian; Bazeyo, William; Musisi, Seggane; Okello, JamesCaregivers of patients with chronic illnesses are often uncompensated for work that is physically demanding, time consuming and emotionally and economically draining. This is particularly true for caregivers of children with nodding syndrome, an emergent neurological disorder of unknown etiology in resource poor settings in Africa. We aimed to explore perceptions of caregivers regarding challenges that a typical caregiver faces when caring for a child with nodding syndrome. Methods: We used a qualitative exploratory study design with focus group discussions and in-depth interviews to collect data. We analyzed data using the qualitative analysis software package of NVivo and thematic query building. Results: Emergent themes centered on burden of care with emotional agony as the most prominent. Subthemes reflecting the burden of care giving included child and caregiver safety concerns, burnout, social isolation and rejection, and homicidal ideation. Caregivers also complained of physical and financial constraints associated with the care of children with nodding syndrome. Conclusions: The findings point to a high burden of care for caregivers of children with nodding syndrome and suggests the need to incorporate community-based psychosocial and mental health care services for the caregivers of affected children into the national health system response.Item 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, EijaWe 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.Item Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda(BioMed Central Ltd, 2023-11) van Loggerenberg, Francois; Akena, Dickens; Alinaitwe, Racheal; Birabwa-Oketcho, Harriet; Méndez, Camilo Andrés Cabarique; Gómez-Restrepo, Carlos; KulenoviÄ, Alma Dzubur; Musisi, Seggane; Nakasujja, Noeline; Sewankambo, Nelson K; Priebe, StefanAbstract INTRODUCTIONThe management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources.METHODSAn exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions.RESULTSA total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation.CONCLUSIONThe findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries.TRIAL REGISTRATIONAll studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).Item Giving ‘‘Sadness’’ a Name: The Need for Integrating Depression Treatment into HIV Care in Uganda(Journal of the International Association of Providers of AIDS Care (JIAPAC), 2015) Odokonyero, Raymond; Wagner, Glenn; Nakasujja, Noeline; Musisi, Seggane; Akena, DickensDepression is common among people living with HIV/AIDS (PLWHA) in sub-Saharan Africa (SSA), and can have significant consequences for HIV disease progression, treatment response and prevention. Yet mental health services are limited in most HIV care programs in this region, in part due to severe shortages of mental health professionals. To address the need for establishing an effective, sustainable model for integrating depression treatment into HIV care in SSA, we have embarked upon a 3-year research project, INDEPTH Uganda (INtegrating DEPression Treatment and in HIV care in Uganda), to evaluate a task-sharing, protocolized approach to providing antidepressant care in ten HIV clinics in Uganda. In this paper we share our experiences with two treated cases identified during the initial days of implementation, which we believe highlight the potential value and policy implications for task shifting depression care models in under-resourced settings.Item Group Support Psychotherapy for Depression Treatment in People with HIV/AIDS in Northern Uganda: A Single-Centre Randomised Controlled Trial(The lancet HIV, 2015) Nakimuli-Mpungu, Etheldreda; Wamala, Kizito; Okello, James; Alderman, Stephen; Odokonyero, Raymond; Mojtabai, Ramin; Nachega, Jean B.; Musisi, SegganeGroup support psychotherapy (GSP) is a culturally sensitive intervention that aims to treat depression by enhancing social support, teaching coping skills, and income-generating skills. We compared GSP with group HIV education (GHE) for treatment of depression in people with HIV in Uganda. In this open-label randomised controlled trial, we included men and women with HIV, aged 19 years or older, who met the Mini International Neuropsychiatric Interview criteria for major depression from an urban HIV care centre in Kitgum district, northern Uganda. Participants were randomly assigned to receive eight weekly sessions of either GSP or GHE. Randomisation was achieved by urn (men and women separately picked a paper containing the intervention allocation from a basket; ratio 1:1), and the intervention sessions were given to gender-specific groups. Participants were followed up immediately after the intervention and 6 months after the end of treatment. The primary outcomes were change in depressive symptom scores (measured with the Self-Reporting Questionnaire) and in function scores (measured with a locally developed method), analysed by intention to treat using cluster-adjusted t tests and permutation tests. This trial is registered with The Pan African Clinical Trials Registry, number PACTR201402000742370.Between Jan 6, and Jan 20, 2014, we assessed 150 individuals, of whom 109 were randomly assigned to receive eight weekly sessions of either GSP (n=57) or GHE (n=52). Change in mean depression scores immediately after intervention did not differ between groups (mean difference −0·19, 95% CI −1·77 to 1·39, p=0·78). Mean function scores did not differ between groups either (0·24, −0·41 to 0·88; p=0·41). At 6 months after end of treatment, participants in the GSP group had lower mean depression scores than did those in the GHE group (−2·50, −3·98 to 1·02, p value=0·005), and higher function scores (0·74, −0·17 to 1·65, p=0·09) than did participants in the GHE group. No adverse events were reported. The benefits of existing HIV educational interventions in HIV care services could be improved by the addition of GSP content. Potential benefits of the integration of GSP into existing HIV interventions, such as adherence counselling or group HIV educational programmes, should be addressed in future studies.Item Life events and depression in the context of the changing African family The case of Uganda(World Cultural Psychiatry Research Review, 2007) Muhwezi, Wilson Winstons; Ågren, Hans; Neema, Stella; Musisi, Seggane; Koma, Albert; Koma Maganda, AlbertTraditionally, the African extended family gave psychosocial support to all members, which cushioned any illness effects including depression. Recent changes in the African family, notably urbanization and market economies, have changed that structure. Changes, especially roles of the family and its relationship to life events and depression, have not received much research attention. Aim: To compare depressed and non-depressed patients in terms of their demographics, family structure, life events and depression. Methods: We compared quantitative data from 85 DSM-IV depressed patients that sought care at three Primary Health Care (PHC) centres with 170 unmatched non-depressed patients. To each group, we administered three questionnaires covering socio-demographics, family structure and an adapted Interview For Recent Life Events (IRLE). Results: Of the depressed patients, over 70% were females giving a M:F ratio of 2.3:1; 71.8% were aged < 39 years and 50.6% were married; the single were 14.1% and 73.9% belonged to male-headed households. Depressed patients significantly differed from the non-depressed in having less post-primary education (p=0.02), fewer singles (0.04), fewer had regular incomes (p=0.01), more were single parents (p=0.02) and separated (p=0.01). Family structure in the two groups never significantly differed. For life events, depressed patients had more deaths of close family members and poor harvests (p=0.003), deaths of children and funeral rites (p=0.014) and sexual health problems (p=0.002). Positive exciting events were more common among non-depressed patients from extended families (p=0.047) while saddening and bereavement events were more common among depressed patients from extended families. Sexual problems were more common among depressed patients and from nuclear families (p= 0.001 & 0.006 respectively). Being a regular income earner was protective against depression [OR=0.45 (95% CI: 0.23-0.85)]. Conclusion: Depressed patients were often single, separated and had children signifying family break ups. They had less income, lower education and had experienced more negative life events, highlighting the weakened family ties in times of modern adversities. This calls for training of more mental health workers and informal helpers for vigorous family therapy interventions in modern Africa, in the face of the weakening extended family.Item Life Events Associated With Major Depression in Ugandan Primary Healthcare (PHC) Patients: Issues of Cultural Specificity(International Journal of Social Psychiatry, 2008) Muhwezi, Wilson Winstons; Ågren, Hans; Neema, Stella; Koma Maganda, Albert; Musisi, SegganeThe study compared life events experienced by depressed patients seen at primary healthcare (PHC) centres with those among healthy community controls. Method: Data was collected from 74 depressed patients and 64 unmatched controls from village locales of patients. Interview instruments included the depression module of the Mini International Neuropsychiatric Interview (MINI) and Interview for Recent Life Events (IRLE). Associations between type of respondent and demographic variables were examined. Statistical comparisons were done for the two groups on other variables. Results: Most depressed patients were single by marital status, lacked formal employment and had less post-primary education. They had experienced more life events; job changes, discomforting working hours, unfavourable working conditions, and job losses; personal health problems; loss of valuables; difficulties with intimate partners and family members’ marital problems. Independent life events were more among depressed patients and clustered around work, health, bereavement and marriage. Most events reported by depressed patients had high negative impact ratings compared to controls. Conclusion: Compared to healthy community controls, depressed patients reported more undesirable life events. The relationship between life events and depression implies that in PHC settings of poor countries, deploying mental health-oriented workers to manage life events may lessen escalation of distress.Item 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, PeterMalaria 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.Item 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, SolvigTo 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.Item One Year Prevalence Of Psychotic Disorders Among First Treatment Contact Patients At The National Psychiatric Referral And Teaching Hospital In Uganda(PloS one, 2020) Mwesiga, Emmanuel Kiiza; Nakasujja, Noeline; Nakku, Juliet; Nanyonga, Annet; Gumikiriza, Joy Louise; Bangirana, Paul; Akena, Dickens; Musisi, SegganeHospital based studies for psychotic disorders are scarce in low and middle income countries. This may impact on development of intervention programs.We aimed to determine the burden of psychotic disorders among first treatment contact patients at the national psychiatric referral hospital in Uganda.A retrospective patient chart-file review was carried out in March 2019 for all patients presenting to the hospital for the first time in the previous year. Patients were categorised into those with and without psychotic disorders. We collected sociodemographic data on age, gender, occupation, level of education, ethnicity, religion and home district. We determined the one year prevalence of psychotic disorders among first treatment contact patients. Using logistic regression models, we also determined the association between psychotic disorders and various exposure variables among first treatment contact patients.In 2018, 63% (95% CI: 60.2–65.1) of all first time contact patients had a psychosis related diagnosis. Among the patients with psychotic disorders, the median age was 29 years (IQR 24–36). Most of the patients were male (62.8%) and unemployed (63.1%). After adjusting for patients’ residence, psychotic disorders were found to be more prevalent among the female gender [OR 1.58 (CI1.46–1.72)] and those of Pentecostal faith [OR 1.25 (CI 1.10–1.42)].Among first treatment contact patients in Uganda, there is a large burden of psychotic disorders. The burden was more prevalent among females as well as people of Pentecostal faith who seemed to use their church for faith-based healing. Incidence studies are warranted to determine if this phenomenon is replicated at illness onset.Item Outcomes, Feasibility and Acceptability of a Group Support Psychotherapeutic Intervention for Depressed HIV Affected Ugandan Adults: A Pilot Study(Journal of affective disorders, 2014) Nakimuli-Mpungu, Etheldreda; Wamala, Kizito; Okello, James; Alderman, Stephen; Odokonyero, Raymond; Musisi, Seggane; Mojtabaie, Ramin; Mills, Edward J.Psychotherapy is the recommended first line treatment for mild to moderate depression. However, its availability in low resource settings is limited. We developed a manualized culturally sensitive group support psychotherapeutic intervention for depressed HIV affected Ugandan adults. In this study, we aimed to assess its feasibility, acceptability and impact on depression, functioning, social support and self-esteem. A total of 77 depressed individuals were assigned to the group intervention (n=48) and a wait-list control group (n=29), and assessed before, during and at the end of the intervention. The self-reporting questionnaire, a locally relevant function assessment instrument, the Rosenberg self-esteem scale, and the multiple dimensions perceived social support scale were administered to assess depression symptoms, functioning, self-esteem and social support at three assessment periods. Multivariate longitudinal regression models were used to determine change in outcomes over time between the two groups. Participants were asked to evaluate the intervention. Post –intervention assessments indicate that, in comparison to the wait-list control group, the intervention group had a faster reduction in depression symptom scores [OR=0.00,95% CI, 0.00–0.003] and faster increase in functioning scores [OR=4.82, 95% CI, 2.39 to 9.75], social support scores [OR=2.68, 95% CI, 1.50–4.78] and self-esteem [OR=1.90, 95% CI 1.48–2.44]. Sixty-three percent of participants strongly agreed that the intervention had reduced their depression and would recommend it to other depressed individuals. Inadequate study power due to small sample sizes may result in imprecise confidence intervals even when there are significant differences. The use of non-random samples could have resulted in selection bias. This intervention appears feasible, acceptable and promising in treating depression and restoring function, enhancing social support and self-esteem. Larger and randomized evaluations are warranted.Item Prevalence and factors associated with depression symptoms among school‑going adolescents in Central Uganda(Child and adolescent psychiatry and mental health, 2016) Nalugya‑Sserunjogi, Joyce; Zari Rukundo, Godfrey; Ovuga, Emilio; Kiwuwa, Steven M.; Musisi, Seggane; Nakimuli‑Mpungu, EtheldredaDepression in adolescents constitutes a global public health concern. However, data on its prevalence and associated factors are limited in low income countries like Uganda. Methods: Using a cross-sectional descriptive study design, 519 adolescent students in 4 secondary schools in Mukono district, Uganda, were randomly selected after meeting study criteria. The 4 school types were: boarding mixed (boys and girls) school; day mixed school; girls’ only boarding school; and, boys’ only boarding school. The 519 participants filled out standardized questionnaires regarding their socio-demographic characteristics and health history. They were then screened for depression using the Children Depression Inventory (CDI) and those with a cut-off of 19 were administered the Mini International Neuro-Psychiatric Interview for Children and Adolescents 2.0 (MINIKID), to ascertain the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV) diagnostic types of depression and any co morbidity. Logistic regression analyses were used to assess factors associated with significant depression symptoms (a score of 19 or more on the CDI). Results: There were 301 (58 %) boys and 218 (42 %) girls with age range 14–16 years and a mean age of 16 years (SD 2.18). Of 519 participants screened with the CDI, 109 (21 %) had significant depression symptoms. Of the 109 participants with significant depression symptoms, only 74 were evaluated with the MINI-KID and of these, 8 (11 %) met criteria for major depression and 6 (8 %) met criteria for dysthymia. Therefore, among participants that were assessed with both the CDI and the MINI-KID (n = 484), the prevalence of depressive disorders was 2.9 %. In this sample, 15 (3.1 %) reported current suicidal ideation. In the logistic regression analyses, significant depression symptoms were associated with single-sex schools, loss of parents and alcohol consumption. Limitations: This is a cross-sectional study therefore, causal relationships are difficult to establish. Limited resources and the lack of collateral information precluded the assessment of a number of potential factors that could be associated with adolescent depression. The MINI-KID was administered to only 74 out of 109 students who scored ≥19 on the CDI since 35 students could not be traced again due to limited resources at the time. Conclusions: Significant depression symptoms are prevalent among school-going adolescents and may progress to full-blown depressive disorders. Culturally sensitive psychological interventions to prevent and treat depression among school-going adolescents are urgently needed.Item 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, SegganeLittle 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.Item Prevalence, types, distribution and associations of psychosocial problems among university students in Uganda(International Journal of Research Studies in Psychology, 2014) Nsereko, Norman David; Musisi, Seggane; Nakigudde, Janet; Holtzman, StevenThe prevalence of psychosocial problems and their associations among University students in Uganda has received very little research attention. Yet, this information is important to provide data to assist in mental health policy formulation for counseling intervention among the vulnerable university students populations in Uganda. The study objective was to investigate the prevalence, types, distribution and associations of psychosocial problems among university students in Uganda. It was part of a larger PhD study that validated an instrument for assessing university students’ psychosocial problems in Uganda. This study employed a descriptive cross sectional survey technique. Five universities participated in a survey conducted during the 2012/13 academic year. Out of 1101 approached students, 976 (88.6%) completed the survey which included a socio-demographic questionnaire, study program characteristics, medical health questionnaire and the University Students Evaluation of Psychosocial Problems (USEPP) instrument which was used to evaluate the psychosocial problems. The prevalence, types and distribution of psychosocial problems among the students was established using descriptive statistics and regression analysis established the relationship between psychosocial problems and the correlates of interest. The estimated prevalence of psychosocial problems among the university students was 36.5%. Students living in off- campus hostels, having chronic medical conditions, and those with a previous history of mental health problems and who perceived their health as poor/fair were at a higher risk of psychosocial problems. These findings highlight to the need to initiate policies to address the students’ psychosocial problems.