Browsing by Author "Rukundo, Godfrey Z."

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    Healthcare Provider Perspectives Regarding Epilepsy Care in Uganda
    (Epilepsy & Behavior, 2021) Koltai, Deborah C.; Smith, Caleigh E.; Cai, Grace Y.; Ratliff, Olivia; Mwesige, Angelina Kakooza; Najjuma, Josephine N.; Muhindo, Rose; Rukundo, Godfrey Z.; Teuwen, Dirk E.; Kayanja, Adrian; Kalubi, Peter; Haglund, Michael M.; Fuller, Anthony T.
    Epilepsy is the most common chronic neurological disorder in the world and imposes a large economic burden on global healthcare systems, especially in low-income settings and rural areas as is found in sub-Saharan Africa (SSA). Despite the high epilepsy prevalence, there are no systematic descriptions of healthcare provider (HCP) perceptions and needs in managing people with epilepsy (PWE) in Uganda. Identifying these perceptions and needs is crucial for understanding community priorities, thereby enhancing the development of culturally sensitive communications, interventions, and research approaches.In this qualitative study, we used semistructured interview guides to conduct focus group discussions that explored the perspectives of 32 providers of epilepsy care from health facilities around Mbarara, Uganda. Our sample included nonspecialized general physicians (n = 3), medical residents (n = 8), medical clinical officers (n = 3), psychiatric clinical nurses (n = 6), medical nurses and nursing assistants (n = 9), and other providers (n = 3), who were loosely grouped into discussion groups based on level or type of training. Self-assessed proficiency ratings were also administered to gain a better understanding of participants' confidence in their training, preparedness, and capabilities regarding epilepsy care. Thematic analysis of the focus group transcripts was conducted to ascertain commonly occurring themes about perceptions and challenges in epilepsy care.Our analyses identified nine major themes that dominated the perspectives of the study participants: care management, medications, diagnostics, HCP training, human resources, location, patient education, social support, and community knowledge and beliefs. Proficiency ratings prioritized areas of confidence as knowledge related to referrals, psychosocial impacts, and seizure neurophysiology. Areas of need were revealed as knowledge of diagnostic tools and antiepileptic drug (AED) regimens.Our findings delineate the perspectives of providers caring for PWE, with consistent recognition of challenges centering around resource augmentation, infrastructure strengthening, and education. Participants emphasized the urgent need to augment these resources to address limitations in medication types and access, trained human resources, and diagnostic tools. They overwhelmingly recognized the need for infrastructure strengthening to address human, diagnostic, medicinal, and capital resource limitations that place undue burden on patients with epilepsy and physicians. Providers indicated a clear desire to learn more about different diagnostic tools and medical management practices, potentially through continuing education, specialized training, or more intentional in-school diagnostic preparation. They also advocated for the powerful influence of patient and family education and clearly articulated the need for community sensitization and support. This article is part of the Special Issue “The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda”
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    Participation in gardening activity and its association with improved mental health among family caregivers of people with dementia in rural Uganda
    (Preventive medicine reports, 2021) Ainamani, Herbert E.; Bamwerinde, Wilson M.; Rukundo, Godfrey Z.; Tumwesigire, Sam; Kalibwani, Rebecca M.; Bikaitwaho, Evard M.; Tsai, Alexander C.
    Evidence from high-income settings suggests that gardening is associated with reductions in depression,anxiety,and stress. The benefits of gardening are less well understood by mental health practitioners andresearchers from low- and middle-income countries. Our study estimated the association between participation in gardening and symptoms of depression, anxiety, and stress among caregivers of people living with dementia in rural, southwestern Uganda. In a cross-sectional study, we interviewed 242 family caregivers of people with dementia to elicit their gardening activities; symptoms of depression, anxiety, and stress (Depression Anxiety Stress Scales); and caregiving burden (Zarit Burden Interview).Linear multivariable regression models estimated the association between participation in gardening and symptoms of depression, anxiety, and stress. Out of 242participants, 131(54%) caregivers were involved in gardening. Severe to extremely severe symptoms of depression were less prevalent among those who were involved in gardening compared with those who were not (0 [0%] vs. 105 [95%], P < 0.001), as were severe to extremely severe symptoms of anxiety(36 [27%] vs.110 [99%], P < 0.001) and stress (2 [2%] vs. 94 [85%], P < 0.001).In regression models adjusting for covariates,we foundstatistically significantassociations betweenparticipation in gardening and symptoms of depression (b = -18.4; 95% CI,20.5 to −16.3), anxiety (b = -16.6; 95% CI, −18.6 to –14.6), and stress (b = -18.6; 95% CI, −20.6 to –16.6).Caregivers of people with dementia who participate in gardening have lower symptoms of depression, anxiety, and stress. Gardening interventions in this at-risk population may ameliorate symptoms of depression, anxiety, and stress.
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    Predictors of unknown HIV serostatus at the time of labor and delivery in Kampala, Uganda
    (International Journal of Gynecology & Obstetrics, 2014) Onongea, Sam; Karamagi, Charles; Nakabiito, Clemensia; Wandabwa, Julius; Mirembe, Florence; Rukundo, Godfrey Z.; Jennings, Larissa
    To determine factors associated with an unknown HIV serostatus among pregnant women admitted in labor to Mulago Hospital, Kampala, Uganda. Methods—In total, 665 pregnant women admitted to Mulago Hospital were interviewed about their sociodemographic characteristics, obstetric history, access to prenatal care, fears regarding HIV testing, and knowledge about modes of mother-to child-transmission (MTCT). Knowledge of the HIV serostatus was assessed by self-report and verified by prenatal card review. Results—The prevalence of unknown HIV serostatus at the time of labor was 27.1%. Factors associated with an unknown HIV serostatus included high parity (odds ratio [OR] 1.9; 95% confidence interval [CI], 1.16–3.14), preterm delivery (OR 2.60; 95% CI, 1.06–6.34), prenatal care at a private clinic (OR 12.87; 95% CI, 5.68–29.14), residence more than 5 km from the nearest prenatal clinic (OR 2.86; 95% CI, 1.18–17.9), high knowledge about MTCT (OR 0.25; 95% CI, 0.07–0.86), and fears related to disclosing the test result to the partner (OR 3.60; 95% CI, 1.84–7.06). Conclusion—The high prevalence of unknown HIV serostatus among women in labor highlights the need to improve accessibility to HIV testing services early during pregnancy to be able to take advantage of antiretroviral therapy.
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    Prevalence of depressive symptoms and associated factors among adolescents living with HIV/AIDS in South Western Uganda
    (AIDS care, 2019) Kemigisha, Elizabeth; Zanoni, Brian; Bruce, Katharine; Menjivar, Ricardo; Kadengye, Damazo; Atwine, Daniel; Rukundo, Godfrey Z.
    Adolescents living with HIV (ALHIV) are prone to depression, which can have detrimental effects including disease progression, poor treatment adherence and mortality. We aimed to determine the prevalence of depressive symptoms and their associated factors among ALHIV in Uganda. We conducted a cross-sectional survey among ALHIV (10–19 years) attending urban and rural clinics in Mbarara, Uganda between March and May 2017. Presence of depressive symptoms was assessed using the Centre for Epidemiological Studies’ Depression scale. We interviewed 336 adolescents with a median age of 13 years, 62% of whom were female. A third (37%) had disclosed their HIV/AIDS status and 13% were sexually active. Overall, 154 (∼46%, [95% CI: 40.5– 51.2]) had depressive symptoms. On bivariate analysis, the odds of having depressive symptoms were higher among adolescents who were ≥ 15 years, had disclosed HIV status, traveled >30 min for routine care and had risky sexual practices. On multiple variable analysis, only travel time to the clinic of >30 min was independently associated with depressive symptoms (AOR = 1.6 [95% CI: 1.02–2.7]). With the high prevalence of depressive symptoms among ALHIV in Uganda, screening and prompt treatment of depression should be incorporated within their routine care.
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    Social Networks and Barriers to ART Adherence Among Young Adults (18–24 years) Living with HIV at Selected Primary Health Facilities of South- Western Uganda: A Qualitative Study
    (Research and Palliative Care, 2021-10-17) Ajuna, Noble; Tumusiime, Brian; Amanya, Joseph; Awori, Sharon; Rukundo, Godfrey Z.; Asiimwe, John Baptist
    Young adults living with HIV (YALWH) struggle to maintain high levels of adherence to antiretroviral therapy (ART) because of numerous barriers. This study describes the social networks of YALWH (18–24 years), their barriers to ART adherence, and the perceived role of social networks in overcoming those barriers. This study used a qualitative descriptive research design. Twenty-three (23) YALWH who were on ART for a period of greater than one (1) month and had consented to participate in the study were purposively selected from two primary health care facilities in southwestern Uganda. We held four (4) focus group discussions with the YALWH over 5 weeks between the 24th of July and 7th September 2020. Data were audio recorded, transcribed, and entered in Microsoft word 2010. Using the content analysis techniques, data were inductively coded and categories or themes developed. Most YALWH belonged to bonding (family, friends, and neighbors), followed by bridging (informal groups), and linking (health professionals) social networks, respectively. Most YALWH, irrespective of gender, had close connections with their mothers or elder sisters. The commonest form of bridging networks was informal community groups that provided financial services, whereas the linking ones comprised health professionals’ directly involved in HIV patient care such as nurses, counselors, and their affiliates (expert clients or clinic based peer supporters), who occasionally acted as bonding networks. Structural barriers to ART adherence (eg, stigma) were the most cited, followed by medication- (eg, pill burden), and patient-related barriers (eg, non-disclosure of HIV status). Bonding networks were perceived to help overcome patient, medication, and structural barriers to ART adherence. Bridging networks overcame structural and medication-related barriers to ART adherence. Linking networks were perceived to help overcome some health systems and medication-related barriers to ART adherence. Bonding social networks seem to play a prominent role in overcoming numerous barriers to ART adherence compared with bridging and linking social networks.
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    A systematic review of the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in sub-Saharan Africa between 1986 and 2018: protocol for a systematic review of observational studies
    (Systematic reviews, 2018) Rukundo, Godfrey Z.; Kemigisha, Elizabeth; Ocan, Moses; Adriko, Wilson; Akena, Dickens H.
    Suicide is one of the leading causes of death among children and adolescents. Most studies about the burden and risk factors for suicide have been conducted in high-income countries. However, there is a dearth in the literature about the burden and risk factors for suicide among children and adolescents in low- and middle-income countries including within Sub-Saharan Africa (SSA). There is need to summarise the available literature about the burden and risk factors for suicide among children and adolescents in SSA. In this review, we will (a) determine the overall prevalence of suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA; (b) describe the methods (such as hanging, firearms, overdose, poisoning, drowning and burning) used for suicidal attempt, and completed suicide among children and adolescents in SSA; and (c) document the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA. Methods: The review will be conducted and reported in accordance to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. We will include journal articles that have documented the prevalence and risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents aged 5–19 years in SSA. We will also include accessible grey literature about the topic. Qualitative studies will be excluded from the study since they are limited in estimating prevalence. We will search different search engines including PUBMED, EMBASE, Psych-INFO, Cochrane Library, Africa wide-information and global health using suicide, adolescents and children, SSA as the keywords. We will use a meta-analysis, should we find that there is no heterogeneity between included studies. Discussion: This protocol describes a systematic review of observational studies reporting completed suicide, suicidal ideation and suicidal attempt among children and adolescents in sub-Saharan Africa. We anticipate that once this review is complete and published, our findings will be of interest to adolescents with suicidal behaviour, their families and caregivers, clinicians and other healthcare professionals, scientists and policy makers.