Browsing by Author "Odokonyero, Raymond"
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Item An Association of Quality of Life and Ageing Perceptions Among Community Dwelling Older Adults in Uganda(2021) Louise -Onoria, Joy; Odokonyero, Raymond; Akena, Dickens; Mwesiga, Emmanuel; Ssuna, Bashir; Sewankambo, Nelson K.; Nakasujja, NoelineUganda’s population, though, largely characterized by young people, has seen the number of people aged 60 and over grow from 686,000 twenty years ago, to 1,433,596 in 2014. Effective caring for the well-being of this population requires strategic and deliberate planning that involves quality of life (QoL) assessments. QoL assessments among the elderly are important in evaluating the efficacy of strategies, such as health interventions, welfare programs, health care, and well-being of the elderly. However, elderly in Uganda face several challenges, ranging from loneliness, poor housing, lack of social and financial support, and poor health. These may negatively affect older persons’ quality of life and consequently their perceptions and attitudes towards aging.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 Childhood Adversity and Co-Dependency Roles in a Case of a Midwife with Pethidine use Disorder Attending Mulago National Referral Hospital, Kampala, Uganda(Cogent Public Health, 2022) Odokonyero, Raymond; Aujo, Tabitha; Agaba, Denis; Abbo, CatherinePethidine is a short and fast-acting synthetic opioid that has a high potential for abuse and addiction compared to other opioids. It is popularly used in the management of pain such as pancreatitis, and cholecystitis peri- and post-operations. Among patients, addiction to pethidine is usually induced unintentionally by a health worker in the course of treating the patient’s pain. Addiction to pethidine is a common but silent problem for healthcare workers such as doctors, nurses, and midwives, and it is often underreported. Childhood adversity and co-dependency roles by family members have been linked to the development and maintenance of addiction to psychoactive substances including pethidine. This case study on a midwife with pethidine addiction in Uganda is a call to draw attention to childhood adversity and co-dependency roles in pethidine addiction.Item Combining a guided self-help and brief alcohol intervention to improve mental health and reduce substance use among refugee men in Uganda: a cluster-randomized feasibility trial(Cambridge University Press, 2024-11) Greene, M. Claire; Andersen, Lena S; Leku, Marx R; Au, Teresa; Akellot, Josephine; Upadhaya, Nawaraj; Odokonyero, Raymond; White, Ross; Ventevogel, Peter; Garcia-Moreno, Claudia; Tol, Wietse AAbstract Evidence on the effectiveness and implementation of mental health and psychosocial support (MHPSS) interventions for men in humanitarian settings is limited. Moreover, engagement and retention of men in such interventions has been challenging. Adaptations may therefore be required to improve the appropriateness and acceptability of these interventions for men. This study conducted formative research and examined the feasibility of combining an MHPSS intervention, Self-Help Plus, with a brief intervention to reduce harmful alcohol use among refugee men in Uganda. We conducted a cluster randomized feasibility trial comparing the combined alcohol intervention and Self-Help Plus, Self-Help Plus alone and enhanced usual care. Participants were 168 South Sudanese refugee men in Rhino Settlement who reported moderate or high levels of psychological distress. Session attendance was adequate: all sessions had at least 69% of participants present. Participant outcome measures, including symptoms of psychological distress, functional impairment, self-defined problems, depressive symptoms, post-traumatic stress symptoms, overall substance use risk, substance specific risk (alcohol, cannabis, stimulants and sedatives) and well-being, were sensitive to change. A combined approach to addressing mental health and alcohol use appears feasible among men in refugee settings, but further research is needed to examine the effectiveness of combined interventions among men.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 Major Depression in Postconflict Northern Uganda: A Case Report(American Journal of Psychiatry, 2014) Nakimuli-Mpungu, Etheldreda; Odokonyero, Raymond; Laker, Jean; Alderman, Stephen“Ms. A” was a 49-year-old mother of five with a long-standing history of depressive symptoms and a 3-year history of HIV infection. She was receiving antiretroviral therapy at Mucwini Health Center III in Kitgum District at the time of her mental health evaluation by staff at the Peter C. Alderman Foundation (PCAF) clinic. She had a score of 18 on the 20-item Self-Reporting Questionnaire (SRQ-20), a depression and anxiety screening measure on which a score ≥6 indicates significant depression and anxiety symptoms; a mean total score of 2.1 on the culturally adapted Harvard Trauma Questionnaire, a posttraumatic stress symptom measure on which a score of 2.25 indicates significant posttraumatic stress symptoms; and a score of 7 on a locally developed functional assessment tool, indicating moderate impairment. She was clinically diagnosed with moderate to severe major depression with posttraumatic stress symptoms and was started on 50 mg/day of amitriptyline. Given the multiple persistent stressors in her life, she was deemed a good candidate for a weekly eight-session group support psychotherapeutic intervention that had been locally developed to treat depression in HIV-affected individuals. After completing the intervention, Ms. A’s depressive symptoms were reduced by 60%, her functioning scores had increased by 30%, her social support and self-esteem were enhanced, and she was able to engage in income-generating activities. The PCAF clinic staff decided to maintain her on antidepressant medication for 1 year.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 Post-Stroke Depression among Stroke Survivors Attending two Hospitals in Kampala Uganda(African Health Sciences, 2015) Gyagenda, Joseph Ogavu; Ddumba, Edward; Odokonyero, Raymond; Kaddumukasa, Mark; Sajatovic, Martha; Katabira, EllyThe burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. In a cross-sectional study, we assessed adult participants with confirmed first stroke with a standardized questionnaire. The Patient Health Questionnaire-9 was used to assess for depression among non-aphasic patients while the Aphasic Depression Rating Scale was administered to aphasic patients. Univariable and multivariable analyses performed to describe associations with PSD. Forty three females (58.9%) and 30 males (41.1%) who had a stroke participated. Fifty eight (79.5%) had ischemic strokes and 12 participants (16.4%) were aphasic. The prevalence of PSD among the study participants was 31.5%. PSD was higher among patients assessed within 6 months after the onset of stroke. PSD was strongly associated with the total Barthel index of activities of daily living (BIADL) score; p=0.001. There was no significant association between demographic characteristics and PSD. There is a high prevalence of unrecognized post-stroke depression. Post-stroke depression was strongly associated with the patient’s inability to undertake activities of daily life. There is urgent need for integration of screening for and management of post-stroke depression among stroke survivorsItem Prevalence and Factors Associated with Depression among Medical Students at Makerere University, Uganda(Advances in Medical Education and Practice, 2020) Olum, Ronald; Nakwagala, Frederick Nelson; Odokonyero, RaymondDepression affects about a third of medical students worldwide. There is paucity of data on depression among medical students in Uganda. The purpose of this study was to establish the prevalence and factors associated with depression among medical students at Makerere University College of Health Science (MakCHS), Uganda. Methods: A cross-sectional study was conducted among students pursuing a Bachelor of Medicine and Surgery at MakCHS in May and July 2019. Students were enrolled by consecutive sampling, both online using Google Forms and in person for those unable to access internet. The self-reported Patient Health Questionnaire 9 (PHQ9) was administered to assess depression, defined as a PHQ9 score ≥10. Microsoft Excel 2016 and Stata 16 were used for data analysis. Results: Overall, 331 valid responses (mean age 23.1±3.3 years) were submitted (response rate 93.8%). In a majority of participants, the prevalence of depression was 21.5% (n=71) of which 64.1% had moderate depression (n=50). On bivariate analysis, year of study, worrying about academic performance, and lectures were significantly associated with depression. On multivariate analysis, worrying about academic performance (aOR 2.52, 95% CI 1.50–4.22; P<0.001) and lectures (aOR 1.89, 95% CI 1.11–3.22; P=0.018) were significantly associated with depression. Conclusion: Depression affects a significant number of medical students at MakCHS. About one in five medical students have depression. Year of study and academic performance were significantly associated with depression. Efforts aimed at identification and evaluation of students at risk, administering appropriate interventions, and follow-up of affected students are vital. Analytical studies aimed at establishing the causative factors and the effects of depression on medical students are recommended.