Medical and Health Sciences

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The lived experience of families with a mentally ill family member
(Journal of Research in Nursing and Midwifery, 2013-09-04) Wankiiri, Moses; Drake, Karen B.; Meyer, Kimberley R.
The study of the lived experience of families with a mentally ill family member involved seven family members who had come to visit their mentally ill relatives in the mental Hospital. The major objective was to explore the lived experience of families with a persistent1 mentally ill family member. The study adopted a qualitative descriptive-phenomenological design, participants were purposively sampled and data was collected using a tape recorder. Colaizzi’s phenomenological approach for data management was then employed. The study revealed that family members held misconceptions about mental illness and described care as a contractual obligation. They lived in misery as the patients’ behavior was intolerable, sadistic, exasperated, and embarrassing. Although medication proved helpful, they had to plead with the patient to take it. Their homes were discriminated2 which made them desperate and disappointed. Patients had bizarre complaints, could vanish, which forced family members to be vigilant all the time and made them feel guilty if anything happened to the patient. Family revenue was devastated and admission of the patients was considered a liberty to the family members and a break from the monotonous, tiresome and costly collection of medication from the hospital. Family members were pessimistic, and always in dilemma. Living with a mentally ill family member was considered a prime issue in the affected families. The study recommended health education to the community, institute programs to screen patients, counseling, and community patients’ follow up. There was need to initiate home based income generation through micro financing.
The Lived Experience of Discontinuing Hormonal Contraception Among Women in Rural Uganda
(International Journal for Human Caring, 2011-04-20) Mwizerwa, Joseph; Rozzano, Locsin C.
The purpose of the study was to describe the experience of discontinuing hormonal contraceptive use among women in rural Uganda. Asignificant number of women in Uganda discontinue hormonal contraception even though such method has been effective. Consequently, these women have unprotected sex, although not wanting to conceive. Narrative descriptions of the experiences by eight women were analyzed using content analysis. The findings describe the experience as Frustration and Helplessness, Living in Fear of Uncertainty, Ingenuity of using other methods of contraception, thus fostering the Accomplishments of being a wife, mother, and woman. Implications for nursing practice, research, and education are described.
A highly tunable biocompatible and multifunctional biodegradable elastomer
(Advanced materials (Deerfield Beach, Fla.), 2012-12-12) Maria, José Nunes Pereira; Ouyang, Ben; Mark, C. Mochel; Mwizerwa, Olive; Karp, Jeffrey M.
Biodegradable elastomers have emerged as promising materials for their potential to mimic the viscoelastic properties of several tissues and exhibit compliance with dynamic environments without damaging the surrounding tissue.[1, 2] Several elastomers have been recently proposed;[3–8] however, the development of highly tunable biodegradable elastomers that can effectively and controllably present biological and physical signals and withstand repeated cycles of physiologic loads, has remained elusive. Such materials should be useful for a broad range of clinically-relevant applications, such as cardiac therapy. For example, following myocardial infarction, the local controlled delivery of bioactive cues[9] or the physical support of the left ventricle wall[10] have been shown to improve cardiac function. The synergistic therapeutic effect of biochemical and biophysical cues has not yet been explored using degradable materials given the absence of materials that can simultaneously deliver bioactive cues and maintain mechanical integrity in a dynamic environment such as the beating heart. Here, we describe a novel biocompatible and mechanically tunable elastomer, poly(glycerol sebacate urethane) (PGSU), suitable for efficient encapsulation and controlled delivery of bioactive macromolecules and with the potential to be applied to cardiac drug delivery.
Midwives’ practice and perception of labour and delivery care at the Mulago National Referral Hospital, Uganda
(African Journal of Midwifery and Women's Health, 2020-04-16) Namwaya, Ziidah; Namagembe, Imelda; Kaye, Dan; Nalwadda, Gorrette; Edwards, Grace; Nabirye, Rose Chalo
The majority of maternal deaths occur during labour, delivery, or within the first 4 hours after birth. This can be reduced by the care that midwives provide. At Mulago Hospital, little is documented on midwives' current practice and their perception of care offered during labor and delivery. The number of maternal and neonatal deaths as a result of preventable causes such as postpartum haemorrhage, obstructed labour, ruptured uterus and sepsis remains high. The aim of this study was to document the current practice of midwives, explore midwives' perception towards practice and identify factors that influence practice during birth in Uganda, to identify possible areas for improvement. A cross-sectional study was conducted of midwives working in the three labour wards at the Mulago National referral hospital: the general ward, the private ward and the midwifery-led ward. Midwives' perceptions were explored using a semi-structured questionnaire, which asked midwives about their current practice and their perception of the care offered. Care was found to be lacking in several areas. Only one-fifth (20.0%) of midwives reported always checking temperature every 4 hours. Only 20.5% reported that women are always supported in being mobile during labour. Less than half of the midwives (44.4%) knew the recommended drugs for managing the third stage of labour. Infection prevention practices were poor. Only 54% of midwives knew how to prepare magnesium sulphate for management of severe pre-eclampsia and eclampsia. Overall, the general labour ward was found to have the most gaps in midwives' knowledge. Lack of continuing education, supplies, teamwork and clinical guidelines were reported to affect practice. Staff shortages and midwives' decisions being underlooked by obstetricians were also reported to affect practice. Overall, the study found that midwifery practice is suboptimal in key areas such as infection prevention, use of a partograph, and management of pre-eclampsia and eclampsia. Continuous professional development, provision of resources, and strengthening teamwork are recommended to improve maternal health outcomes at Mulago Hospital.
Partograph initiation and completion: a criteria-based audit study in Uganda
(African Journal of Midwifery and Women's Health, 2017-06-18) Namwaya, Ziidah; Ayebare, Elizabeth; Muwanguzi, Sarah; Namutebi, Mariam; Birungi,Susan; Namutebi, Elizabeth; Mwebaza, Enid; Smyth, Rebecca
Although it is a cost effective tool in labour management, the partograph is not always used appropriately. The aim of this audit was to assess the initiation and completion of the partograph for women in labour at Mulago Hospital. A criteria-based audit was conducted, using patients’ files and delivery records from February to May 2016. A checklist was used to gather data and descriptive statistics computed. Of 7170 files, 256 (3.57%) had the partograph initiated. The recording of maternal wellbeing was low. For example, pulse was recorded in 20% of cases and blood pressure in 35%. Recording of vaginal examination results was 90% on admission but reduced to 57% in the first stage of labour. Similarly, recording of fetal heart rate in the first stage of labour was 62%. Partograph initiation was unacceptably low. Maternal well-being documentation was generally low compared to the set standard. There is need to strengthen the use of a partograph to improve care during labour
Effect of Butternut Squash (Cucurbita moschata) Seed Powder on the Chemical and Rheological Properties of Stirred Cultured Camel Milk and Yoghurt
(Food and Nutrition Sciences, 2024-07-19) Kangogo, Collins K.; Muliro, Patrick S.; Anyango, Joseph O.
Research shows that producing fermented camel milk is hard because of the milk’s inability to form a firm coagulum, attributed to low levels of κ-casein and ꞵ-lactoglobulin and the large casein micelle size, leading to a weak network of casein formation. In an effort to address this issue, researchers turned to corn starch as a thickening agent, discovering that a concentration of 2.0% effectively improved the viscosity and significantly reduced syneresis in stirred camel milk yoghurt and cultured camel milk. This study explores alternatives to corn starch, focusing on butternut squash seeds as a promising substitute due to their hydrocolloid composition. By incorporating butternut squash (Cucurbita moschata) seed powder (BSSP) as a thickening agent, this study aimed at enhancing the chemical and rheological properties of stirred camel milk yoghurt and cultured camel milk. Fermented camel milk was prepared using 4 litres of camel milk, 2% starter cultures (thermophilic culture for yoghurt and mesophilic aromatic culture for stirred cultured camel milk) and BSSP 0.0% (negative control), 0.4%, 0.8%, 1.2%, 1.6%, 2.0% mixed with 0.4% gelatin. 2.0% corn starch mixed with 0.4% gelatin was used as a standard for comparison. Results showed that increasing the BSSP level significantly (p < 0.05) decreased the moisture content while increasing the total solid content of stirred fermented camel milk products. There was an increase in ash content with an increase in BSSP levels. There was a significant (p < 0.05) reduction in the pH, with an increase in BSSP levels in stirred fermented camel milk samples. Increasing the concentration of BSSP from 0.4% to 2.0% resulted in a significant (p < 0.05) increase in viscosity and a reduction in syneresis of stirred camel milk yoghurt and stirred cultured camel milk samples. This study demonstrated that BSSP effectively enhances the viscosity, reduces syneresis and increases acidity in stirred fermented camel milk products during storage.
Developing a work/study programme for midwifery education in East Africa
(Midwifery, 2018-04-24) Edwards, Grace; Kyakuwaire, Hellen; Sharon, Brownie
there is extensive evidence to show that skilled midwifery care is crucial in reducing maternal deaths; however, in East Africa, the midwifery profession has been subsumed within the nursing role. This paper highlights issues in the preparation of skilled midwives in three East African countries, specifically, Uganda, Kenya and Tanzania and provides a case study description of a flexible work/study programme designed to develop skilled midwives to meet internationally regarded ICM competency standards in midwifery education and practice. a flexible, competency-based Bachelor's of Science in Midwifery programme (BScM) has been developed based on fifteen years' experience of running a Bachelor of Science in nursing programme. The new BSCM programme allows licensed diploma midwives the opportunity to study for two days a week towards a bachelor's degree in midwifery, whilst continuing to work and support their families. The model also provides education at degree level thus providing a sound platform for ongoing development of a cadre of midwifery leaders. the BScM education model for working midwives builds on the success of the BScN work/study model in developing strong leadership, clinical and critical thinking competencies. The newly developed midwifery programme provides a pathway by which to increase the availability of skilled East African midwives educated to the Global Standards for Midwifery Education
Challenges of Mass Media Interventions Regarding Mental Health: A Community Exemplar in Kampala Uganda
(Journal of Community Medicine & Health Education,, 2016-03-16) Wankiiri, Moses; Petrucka, P.
The Community Psychiatric Support Organization is a registered voluntary not for profit NGO in Uganda working to promote mental health by empowering the community to care for the mentally ill. Mental illness occurring in Uganda is often ‘explored’ or ‘explained’ from non-medical perspectives, including social, cultural, and/or religious belief systems. Over the last two years, the organization has conducted sixty six (66) live radio mental health education talks and twenty six (26) live television talk shows in an effort to reduce stigma towards mental illness. Such campaigns within developing contexts have not be examined extensively, although, in other sectors such as health promotion and disease prevention, it has been found to be highly successful. The retrospective document review of personal journaled materials related to the mental health messaging (radio and television) and responses between 2013 and 2015. These journals captured responses by callers, which were then analyzed using a content analysis methodology. Through this effort, it was recognized that there is an appetite of the public for necessary and appropriate information about mental health in their community. It has also shown the need to more efforts to share information and knowledge about mental health in a manner which reaches the public to reduce misperceptions and misinformation in a manner which is culturally appropriate and social acceptable. This is a major challenge in a context of development which faces various levels of literacy, embedded social/cultural beliefs, religious strengths, and a lack of resources to address mental illness.
Interventions for male involvement in pregnancy and labour: A systematic review
(African Journal of Midwifery and Women's Health, 2015-02-19) Ayebare, Elizabeth; Mwebaza, Enid; Mwizerwa, Joseph; Namutebi, Elizabeth; Kinengyere , Alison Annet; Smyth, Rebecca
Male involvement in pregnancy and labour care has been shown to improve maternal and newborn outcomes. Nevertheless, it continues to be low, especially in low income countries. Several interventions have been suggested for supporting male involvement in reproductive health and maternity care, but no assessment has been made in terms of their effectiveness. The objective of this review was to summarise and evaluate the current evidence related to male partner involvement in maternal health. Three databases were searched electronically. This review included two randomised controlled trials and two observational studies. Two interventions emerged from the review: facility-based couple health education and workplace-based health education. These interventions showed positive outcomes regarding the presence of partners during antenatal visits, postpartum visits, childbirth, and the initiation of breastfeeding within one hour of birth among others. More rigorous research is needed into strategies for, and the effect of, including men in maternal and newborn health.
Librarians’ involvement in evidence-based medical practice and health policy-making: the collaboration between Albert Cook Library and the Africa Centre for Systematic Reviews and Knowledge Translation
(IFLA Library, 2015-06-28) Kinengyere, Alison Annet; Ssenono, Richard; Obuku, Ekwaro
In 2013, Makerere University College of Health Sciences (MakCHS) received funding support from the International Development Research Centre, Canada, to establish an Africa Centre for Systematic Reviews and Knowledge Translation. The aim of the Centre is to build capacity for knowledge translation for health policy in Uganda and East Africa. The Centre is steadily transforming Uganda and the East African region into an environment that is driven by evidence informed health policy and action, and one that is self-reliant in capacity for evidence synthesis and knowledge translation. The Centre team comprises clinical epidemiologists, public health physicians, health policy analysts, health systems researchers and library and information scientists. The paper examines the instructional and research roles of health sciences librarians at the Centre, in informing evidence-based medical practice and health policy-making. The paper was informed by data from the Centre activities: courses conducted in knowledge translation (such as a course on systematic reviews and meta-analyses of health systems research), systematic reviews and evidence-informed policy briefs (completed and in-publication), and reports, focusing on the librarians’ activities. The findings show that the health librarian's role as an expert searcher and evidence locator in a systematic review process is steadily embracing further roles of formulator of research questions using PICO, developer of exclusion/inclusion criteria, quality literature filterer, critical appraiser, systematic reviews author as well as educator. Library and information scientists are playing vital instruction and research roles in learning, teaching, research, as well as informing evidence based medicine and health policy.
Endothelial cells promote migration and proliferation of enteric neural crest cells via β1 integrin signaling
(Developmental biology, 2009-06-15) Nagy, Nandor; Mwizerwa, Olive; Yaniv , Karina; Goldstein, Allan M.
Enteric neural crest-derived cells (ENCCs) migrate along the intestine to form a highly organized network of ganglia that comprises the enteric nervous system (ENS). The signals driving the migration and patterning of these cells are largely unknown. Examining the spatiotemporal development of the intestinal neurovasculature in avian embryos, we find endothelial cells (ECs) present in the gut prior to the arrival of migrating ENCCs. These ECs are patterned in concentric rings that are predictive of the positioning of later arriving crest-derived cells, leading us to hypothesize that blood vessels may serve as a substrate to guide ENCC migration. Immunohistochemistry at multiple stages during ENS development reveals that ENCCs are positioned adjacent to vessels as they colonize the gut. A similar close anatomic relationship between vessels and enteric neurons was observed in zebrafish larvae. When EC development is inhibited in cultured avian intestine, ENCC migration is arrested and distal aganglionosis results, suggesting that ENCCs require the presence of vessels to colonize the gut. Neural tube and avian midgut were explanted onto a variety of substrates, including components of the extracellular matrix and various cell types, such as fibroblasts, smooth muscle cells, and endothelial cells. We find that crest-derived cells from both the neural tube and the midgut migrate avidly onto cultured endothelial cells. This EC-induced migration is inhibited by the presence of CSAT antibody, which blocks binding to β1 integrins expressed on the surface of crest-derived cells. These results demonstrate that ECs provide a substrate for the migration of ENCCs via an interaction between β1 integrins on the ENCC surface and extracellular matrix proteins expressed by the intestinal vasculature. These interactions may play an important role in guiding migration and patterning in the developing ENS.
Introducing a new cadre into Uganda’s health care system: Lessons learnt from the implementation process
(Procedia-Social and Behavioral Sciences, 2013-10-21) Amandu, Gerald M.; Uys, Leana R.; Mwizerwa, Joseph; Erejo, Alex; Cheruto, Irene A.; Chota, Margaret
Uganda introduced Registered Comprehensive Nursing (RCN) and Enrolled Comprehensive Nursing (ECN) training programs in 1994 and 2003 respectively, to create certificate and diploma level cadre of nurses with competencies in general nursing, midwifery, public health, psychiatry, paediatrics and management. This paper is based on an evaluation study undertaken to assess how the programs were implemented including stakeholders’ perceptions about the graduates. Despite being relevant, the implementation process of both programs failed to meet acceptable standards. We conclude that introducing a new cadre of nurses without proper preparation hinders realization of their full potential including their contribution to the healthcare system.
Use of peers, community lay persons and Village Health Team (VHT) members improves six-week postnatal clinic (PNC) follow-up and Early Infant HIV Diagnosis (EID) in urban and rural health units in Uganda: A one-year implementation study
(BMC health services research, 2015-11-18) Namukwaya, Zikulah; Barlow-Mosha, Linda; Mudiope, Peter; Matovu, Joyce Namale; Etima, Juliane; Musoke, Philippa Martha
Effective Prevention of Mother to child Transmission of HIV (PMTCT) relies heavily on follow-up of HIV-infected women and infants from antenatal, through postnatal, to the end of the breastfeeding period. In Uganda, postnatal (PNC) follow-up remains below 50 % creating a missed opportunity for linkage to comprehensive HIV care and early infant diagnosis (EID). We evaluated the use of HIV infected peer mothers (peers), community lay persons and Village health team (VHT) members to improve PNC follow up and EID in urban and rural health units.
Once-daily dolutegravir-based antiretroviral therapy in infants and children living with HIV from age 4 weeks: results from the below 14 kg cohort in the randomised ODYSSEY trial
(The Lancet HIV, 2022-09-17) Amuge, Pauline; Lugemwa, Abbas; Mujuru, Hilda A.; Kityo, Cissy M.; Atwine, Lorna; Ford, Deborah
Young children living with HIV have few treatment options. We aimed to assess the efficacy and safety of dolutegravir-based antiretroviral therapy (ART) in children weighing between 3 kg and less than 14 kg.
Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial
(The Lancet HIV, 2022-07-19) Turkova, Anna; Bwakura-Dangarembizi, Mutsa F.; Kekitiinwa, Adeodata R.; Lugemwa, Abbas; Ahimbisibwe, Grace Miriam; Burger, David M.
Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB.
Patients experiences of self-management and strategies for dealing with chronic conditions in rural Malawi
(PloS one, 2018-07-02) Angwenyi, Vibian; Kajumi, Murphy; Man, Jeroen De; Bunders-Aelen, Joske
The high burden of chronic communicable diseases such as HIV/AIDS, and an escalating rise of non-communicable diseases (NCDs) in Malawi and other sub-Saharan African countries, calls for a shift in how health care services are designed and delivered. Patient-centred care and patient self-management are critical elements in chronic care, and are advocated as universal strategies. In sub-Saharan Africa, there is need for more evidence around the practice of patient self-management, and how to best support patients with chronic conditions in the African context. Our study explored self-management practices of patients with different chronic conditions, and their strategies to overcome care challenges in a resource-constrained setting in Malawi. This is primarily a qualitative study, involving patients with different chronic conditions from one rural district in Malawi. Data are drawn from semi-structured questions of a survey with 129 patients (from the third of four-part data collection series), 14 in-depth interviews, and four focus-group discussions with patients (n = 31 respondents). A framework approach was used for qualitative analysis, and descriptive statistical analysis was performed on survey data. Patients demonstrated ability to self-manage their conditions, though this varied between conditions, and was influenced by individual and external factors. Factors included: 1) ability to acquire appropriate disease knowledge; 2) poverty level; 3) the presence of support from family caregivers and community-based support initiatives; 4) the nature of one’s social relations; and 5) the ability to deal with stressors and stigma. NCD and HIV comorbid patients were more disadvantaged in their access to care, as they experienced frequent drug stock-outs and incurred additional costs when referred. These barriers contributed to delayed care, poorer treatment adherence, and likelihood of poorer treatment outcomes. Patients proved resourceful and made adjustments in the face of (multiple) care challenges. Our findings complement other research on self-management experiences in chronically ill patients with its analysis on factors and barriers that influence patient self-management capacity in a resource-constrained setting. We recommend expanding current peer-patient and support group initiatives to patients with NCDs, and further investments in the decentralisation of integrated health services to primary care level in Malawi.
Scaling up availability, accessibility, quality and equity – highlights from the 4th Uganda conference on cancer and palliative care, held in Kampala, Uganda
(ecancermedicalscience, 2023-11-13) Downing, Julia; Mwebesa, Eddie; Asasira, Judith; Basemera, Bernadette; Adong, Dorothy Olet; Mwesiga, Mark
The 4th Uganda Conference on Cancer and Palliative Care was held from the 14th–15th September 2023. It was run jointly by the Uganda Cancer Institute and the Palliative Care Association of Uganda, in collaboration with the Ministry of Health. The conference was held at the Speke Resort, Munyonyo and 450 participants came together for a face-to-face conference following the virtual one held in 2021. It was an opportunity for all those working in the fields of cancer and palliative care to come together, to share lessons and learn from each other, as well as celebrate 30 years since specialist palliative care came to Uganda. The conference was officially opened by the Commissioner for Non-Communicable Diseases on behalf of the Minister of Health, who reiterated the Government’s commitment to reducing the burden of cancer and expanding the provision of palliative care within Uganda. Dr Tedros Adhanom Ghebresus, the Director General of the World Health Organization welcomed participants to the conference, and the Assistant Bishop of Kampala Diocese, the Right Reverend Hannington Mutebi shared his experience of living with cancer. The conference was organised into six tracks: Innovations and new technologies; Education, advocacy, policy and law; Health promotion, prevention and early detection; Family and community involvement and empowerment; Clinical care and symptom management; and, Psychological, social and spiritual care. The themes of paediatrics, vulnerable populations, service development and research were integrated throughout the tracks, and workshops were held that explored topics such as governance, access to essential medicines, national data reporting, research and education, and aging and ageism. Throughout the conference there was a sense of optimism, of resilience and a commitment to the ongoing development of cancer and palliative care services within the country.
Mental Health Interventions for Adolescents in Sub-Saharan Africa: A scoping review
(Frontiers in psychiatry, 2022-08-11) Mabrouk, Adam; Mbithi, Gideon; Chongwo, Esther; Namuguzi, Mary; Atukwatse, Joseph; Ssewanyana, Derrick; Abubakar, Amina
Globally, adolescents are vulnerable to mental health problems, particularly those from sub-Saharan Africa (SSA) due to impoverished living conditions and a higher prevalence of chronic conditions such as HIV/AIDS in the region. The COVID-19 pandemic has further exacerbated this risk. This calls for an urgent need for evidence-based adolescent mental health interventions to reduce the risk and burden of mental health problems in SSA. The review aims to identify and characterize existing adolescent mental health interventions in SSA, as well as to evaluate their implementation strategies and effectiveness. We systematically searched PubMed, African Index Medicus, PsycINFO, Web of Science, and CINAHL databases for relevant articles. Furthermore, we searched gray literature databases, including Think Tank search, open gray, NGO search engine, and IGO search engine for additional relevant articles. The scoping review was conducted to identify original research articles on mental health interventions among adolescents in sub-Saharan Africa published from database inception to 31 December 2021. We carried out a narrative synthesis to report our findings. Our literature search generated 4,750 studies, of which 1,141 were duplicates, 3,545 were excluded after screening, and 64 articles met the inclusion criteria. The 64 studies describe a total of 57 unique mental health interventions comprising 40,072 adolescents. The nature of these interventions was diverse, encompassing various implementation strategies such as economic-based, family strengthening, psychoeducation, interpersonal psychotherapy, Cognitive Behavioral Therapy, and resilience training, among others. Most of the interventions were selective interventions that targeted adolescents at high risk of developing mental health problems including adolescents living with HIV, war-affected adolescents, orphans, adolescents from poorer backgrounds, and survivors of sexual violence. Half of the interventions were delivered by lay persons. Sixty-two of the eligible studies examined the effectiveness of the mental health interventions, of which 55 of them reported a positive significant impact on various mental health outcomes. The review findings show that there exist several diverse interventions that promote mental health among adolescents in sub-Saharan Africa. These interventions can be implemented in diverse settings including schools, communities, health facilities, and camps, and can be delivered by lay persons.
Supporting Healthy Futures for East Africa: Celebrating 15 years of partnership in nursing education. School of Nursing and Midwifery in East Africa, Aga Khan University, Nairobi, Kenya
(SUPPORTING HEALTHY FUTURES FOR EAST AFRICA, 2016-02-13) Brownie, Sharon; Robb, Walter; Aliga, Cliff; Kambo, Isabel
This impact evaluation study was designed on the basis of quality and accountability. It focused on sourcing evidence regarding the impact and achievements of a 15-year investment in nursing education and workforce capacity building. The study was also designed to enhance alumni connection and establish sustainable models for monitoring and evaluation.
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.

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