Browsing by Author "Ssesanga, Titus"

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    Effects and costs of a multi-component menstrualhealth intervention (MENISCUS) on mental health problems, educational performance, and menstrual health in Ugandan secondary schools: an open-label, school-based, cluster-randomised controlled trial
    (The Lancet Global Health, 2025) Kate, Andrews Nelson; Stephen, Lagony; Kansiime, Catherine; Torondel, Belen; Clare, Tanton; Ndekezi, Denis; Mugenyi, Levicatus; Batuusa, Ratifah; Baleke, Christopher; Katherine, A. Thomas; Ssesanga, Titus; Bakanoma, Robert; Namirembe, Prossy; Tumuhimbise, Aggrey; Nanyonga, Beatrice; Nambi, Rodah; Obicho, Edward; Ssenyondwa, Denis; Bucci, Daria; Sophie, Belfield; Ocen, Agnes Akech; Nakalema, Shamirah; Alezuyo, Connie; Matovu, Fred; Neema, Stella; Kyegombe, Nambusi; Giulia, Greco; John, Jerrim; Chris, Bonell; Janet, A. Seeley; Helen A. Weiss
    Background Menstrual health is a human rights issue, affecting mental health, wellbeing, and education. We assessed the effectiveness and costs of a school-based multi-component menstrual health intervention (“MENISCUS”) to improve mental health problems and educational performance. Methods We conducted a cluster-randomised trial in 60 Ugandan secondary schools, randomised 1:1 to the intervention or control condition (printed government menstrual health materials). The intervention included creating action groups, strengthening teacher-delivered puberty education, distributing menstrual kits, supporting student-led drama skits, providing pain-management strategies, and improving school water and sanitation facilities. Primary outcomes were mental health problems using the Strength and Difficulties Questionnaire (SDQ) Total Difficulties Score and independently-assessed educational performance. Secondary outcomes included menstrual knowledge, attitudes, practices, and self-efficacy, school attendance, confidence, symptomatic urinary tract infections, and quality of life in females, plus knowledge and attitudes in males. We estimated intention-to-treat intervention effects using mixed-effects models accounting for school clustering and adjusted for randomisation strata and baseline school-level means of outcomes. Registration: ISRCTN45461276. Findings Between 21 March and 5 July 2022, 3841 female students participated in baseline assessments (89.7% of those eligible) and between 5 June and 22 August 2023, 3356 participated in endline assessments. At endline, there was no evidence of a difference in mental health problems (mean SDQ score: 10.8 vs 10.7 in intervention vs control arms; adjusted mean difference [aMD] 0.05, 95% CI -0.40 to 0.50) or educational performance (mean z-score: 0.20 vs 0.12; aMD 0.05, 95% CI -0.11 to 0.20). There was strong evidence for effects on menstrual health-related outcomes. Interpretation Improving multiple dimensions of menstrual health in secondary schools in Uganda is feasible and important for health and human rights but is not sufficient to improve mental health or educational performance over one year.
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    Neurocognitive Function Among Hivinfected Children On Protease Inhibitor -Based Versus Non-Protease Inhibitor Based Antiretroviral Therapy In Uganda: A Pilot Study
    (BMC pediatric, 2021) Nalwanga, Damalie; Musiime, Victor; Bangirana, Paul; Nishiguchi, Erika Phelps; Kiggwe, Andrew; Ssesanga, Titus; Ssenkusu, John M.; Musoke, Philippa; Cusick, Sarah E.
    HIV infection is associated with significant neurocognitive deficits making maximization of cognitive function among children receiving antiretroviral therapy (ART) a public health imperative. Non-protease inhibitors (non-PIs) achieve higher drug levels in the cerebral spinal fluid (CSF) compared to PIs, potentially leading to better neurocognitive function by reducing CSF viral load and inflammation. ART that maximises children’s neurodevelopment and school achievement could result in improved quality of life and productivity as adults, but little research to date has examined whether non-PI ART is associated with better neurocognitive outcomes. We compared the neurocognitive function between children living with HIV receiving PI-based and non PI-based ART.We recruited a consecutive sample of clinically stable Ugandan children living with HIV aged 5–12 years who received PI-based or non PI-based ART for ≥ 1 year (viral load < 1000 copies). Neurocognitive function was assessed using the Kaufman Assessment Battery for Children, the Test of Variables of Attention, and Bruininks-Oseretsky Test of Motor Proficiency. Age-adjusted neurocognitive z-scores for the two groups were compared using linear regression models in STATA version 13. The Hommel’s method was used to adjust for multiple testing.We enrolled 76 children living with HIV; 34 on PI ART and 42 on non-PI ART. Mean (±SD) age was greater in the non-PI vs. PI group (9.5 ± 1.9 vs. 8.5 ± 2.0) years (p = 0.03). Children in the non-PI group had lower socioeconomic scores (5.7 ± 3.3 vs. 7.4 ± 2.8, p = 0.02). There was no difference in neurocognitive function between the groups (adjusted p > 0.05) for KABC and TOVA. Children in the PI group had better total BOT scores than their counterparts (46.07 ± 1.40) vs. 40.51 (1.24), p = 0.03).We detected no difference in neurocognitive function among children on PI and non PI-based ART therapy based on KABC and TOVA tests. Children on PI based ART had better motor function than their counterparts. We recommend a prospective study with a larger sample size.
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    Understanding menstrual factors associated with poor mental health among female secondary school students in Uganda: a cross-sectional analysis
    (BioMed Central Ltd, 2024-10) Ssesanga, Titus; Thomas, Katherine A; Nelson, Kate Andrews; Oenen, Evaline; Kansiime, Catherine; Lagony, Stephen; Enomut, Jonathan R; Mayanja, Yunia; Weiss, Helen A
    There is growing global concern about poor mental health among adolescents in sub-Saharan Africa. In particular, adolescent girls face multiple challenges in managing menstruation which can impact both their health and wellbeing. In this study we address an evidence gap on the association of a broad range of menstrual-related factors with mental health problems amongst secondary school female adolescents in Uganda. We used baseline data from a cluster-randomised menstrual health intervention trial conducted in 60 secondary schools in two districts in Uganda. Baseline data were collected between March and July 2022, including socio-demographic characteristics, menstrual knowledge and attitudes, menstrual practices and self-efficacy, and mental health problems measured using the Strengths and Difficulties Questionnaire Total Difficulties score (SDQ-25). We used random-effects linear regression to estimate the adjusted mean difference (aMD) for the association between mental health problems (SDQ Total Difficulties Score) and menstrual-related factors, including the Menstrual Practice Needs Scale (MPNS) and the Self-Efficacy in Addressing Menstrual Needs scale (SAMNS)), accounting for school-level clustering and adjusting for prior confounders. Among the 3841 female participants, there was strong and consistent evidence of associations between mental health problems and menstrual-related factors. Mental health problems were associated with poor knowledge about menstruation (aMD = 1.17, 95%CI 0.50, 1.84 <0.001), using disposable and reusable menstrual products compared to using just disposable products (aMD = 1.42, 95%CI 0.92, 1.92, p <0.001), and experiencing menstrual pain even when using an effective management method at last menstrual period (LMP) compared to those experiencing no pain (aMD = 1.60, 95%CI 1.19, 2.01, p <0.001). Mental health problems were also associated with greater unmet menstrual needs according to the MPNS (aMD = 4.40 95%CI 3.96, 4.84, p <0.001), and with lower menstrual self-efficacy measured by the SAMNS (aMD = 0.94 95% CI 0.51, 1.37, p <0.001). This study shows strong evidence that mental health problems reported by adolescent girls in Uganda are associated with poor menstrual health. The association between menstrual health and mental health provides evidence as to why menstrual health should be a public health priority. Trial registration: ISRCTN 45461276. Registered on 16 September 2021.
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    Understanding menstrual factors associated with poor mental health among female secondary school students in Uganda: a crosssectional analysi
    (Child and adolescent psychiatry and mental health, 2024-10-14) Ssesanga, Titus; Thomas, Katherine A.; Oenen, Evaline; Kansiime, Catherine; Mayanja, Yunia; Weiss, Helen A.
    There is growing global concern about poor mental health among adolescents in sub-Saharan Africa. In particular, adolescent girls face multiple challenges in managing menstruation which can impact both their health and wellbeing. In this study we address an evidence gap on the association of a broad range of menstrual-related factors with mental health problems amongst secondary school female adolescents in Uganda. We used baseline data from a cluster-randomised menstrual health intervention trial conducted in 60 secondary schools in two districts in Uganda. Baseline data were collected between March and July 2022, including socio-demographic characteristics, menstrual knowledge and attitudes, menstrual practices and self-efficacy, and mental health problems measured using the Strengths and Difficulties Questionnaire Total Difficulties score (SDQ-25). We used random-effects linear regression to estimate the adjusted mean difference (aMD) for the association between mental health problems (SDQ Total Difficulties Score) and menstrual-related factors, including the Menstrual Practice Needs Scale (MPNS) and the Self-Efficacy in Addressing Menstrual Needs scale (SAMNS)), accounting for school-level clustering and adjusting for prior confounders. Among the 3841 female participants, there was strong and consistent evidence of associations between mental health problems and menstrual-related factors. Mental health problems were associated with poor knowledge about menstruation (aMD = 1.17, 95%CI 0.50, 1.84 <0.001), using disposable and reusable menstrual products compared to using just disposable products (aMD = 1.42, 95%CI 0.92, 1.92, p <0.001), and experiencing menstrual pain even when using an effective management method at last menstrual period (LMP) compared to those experiencing no pain (aMD = 1.60, 95%CI 1.19, 2.01, p <0.001). Mental health problems were also associated with greater unmet menstrual needs according to the MPNS (aMD = 4.40 95%CI 3.96, 4.84, p <0.001), and with lower menstrual self-efficacy measured by the SAMNS (aMD = 0.94 95% CI 0.51, 1.37, p <0.001). This study shows strong evidence that mental health problems reported by adolescent girls in Uganda are associated with poor menstrual health. The association between menstrual health and mental health provides evidence as to why menstrual health should be a public health priority.