Suicide in Urban Kampala; Uganda: a Preliminary Exploration

Background: Suicide was investigated in the urban setting of Kampala; Uganda. Objectives: Firstly; to explore the use of two research methodologies; a retrospective review of patient records and the psychological autopsy methodology in suicide research in Uganda. Secondly to investigate the characteristics and correlates of urban suicide in Uganda. Results: A male to female ratio of suicide of 3.4:1 and a peak age of suicide in the 20-39 years age group were found. The main methods of suicide were hanging and ingestion of poison (organophosphates). Problems with social networks; negative life events; higher psychological distress and lower quality of life were associated with suicide at univariate analysis. It was only psychological distress that retained significance at multivariate analysis. Conclusion: The retrospective review of records at Mulago hospital was beset by incomplete records whereas a pilot psychological autopsy study was well accepted and might contribute valuable data in African settings

A comparison of the clinical features of depression in hiv-positive and hiv-negative patients in Uganda

Objective: Depressive illness is the most common psychiatric disorder in HIV/AIDS with prevalence 2 to 3 times higher than the general population. It's still questionable whether HIV related depression is clinically different from depression in HIV-negative populations; a fact that could have treatment implications.This study compared the clinical features of major depression between HIV-Positive and HIV-negative patients with a view to intervention strategies. Method: A comparative; descriptive; cross-sectional study was carried out on 64 HIV-Positive depressed patients and 66 HIV-negative depressed patients in Butabika and Mulago hospitals. They were compared along the parameters of clinical features of depression; physical examination and laboratory findings. Pair wise comparisons; logistic regression and Multivariate analysis were done for the two groups on a number of variables. Results: Compared to HIV-Negative patients; HIV-Positive patients were more likely to be widowed ; older (? 30years); less likely to have a family member with a mental illness; a later onset of depressive illness (?30years); more likely to have a medical illness and taking medication before onset of depressive; symptomatically compared to HIV-Negative patients; HIV-Positive patients were more critical of themselves ; had significantly more problems making decisions ; had poorer sleep; felt more easily tired; more appetite changes; more cognitive impairment. Low CD4 counts were not significantly associated with depression; but HIV related depression was more likely to occur in stages II and III illness. Conclusion: These findings show that the clinical and associated features of depression differ between HIV-Positive and HIV-Negative patients; thus requiring different management approaches and further studies related to HIV-related depression

Psychological Distress and Adherence to Highly Active Anti-Retroviral Therapy (HAART) in Uganda: a Pilot Study

Background: Mental health related risk factors for non-adherence to highly active anti-retroviral therapy (HAART) have not been investigated in Uganda and yet adherence is critical to the success of the current scale up in the provision of HAART to HIV positive individuals in rural areas of Uganda. Objective: To determine whether psychological distress is a risk factor for non-adherence to HAART among HIV positive individuals. Method: One hundred twenty-two HIV positive adult individuals receiving care from an Urban HIV clinic were enrolled in the study. Participants were screened for psychological distress with the Self Report Questionnaire (SRQ-20). Adherence was assessed using the self report method. Multivariate logistic regression analysis was used to determine whether psychological distress is a risk factor for non-adherence to HAART adjusting for various socio-demographic and clinical factors. Results: Psychological distress and living in isolation were significantly associated with non-adherence to HAART after adjusting for other demographic and clinical variables [OR=3.66; 95CI (1.39 - 9.78) and OR=9.80; 95CI (2.27 - 18.70)] respectively. Among HIV positive individuals who were receiving additional treatment for a mental disorder; psychological distress was not significantly associated with non-adherence to HAART [OR= 1.25; 95CI (0.30 - 5.20)] Conclusion: Regular screening and management of psychological distress may prevent further complications in HIV positive individuals in Uganda

The prevalence and severity of mental illnesses handled by traditional healers in two districts in Uganda

Background: Little 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 chisquare 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; 60.2had diagnosable current mental illness and 16.3had had one disorder in their lifetime. Of the diagnosable current mental illnesses; 29.7were Psychosis; 5.4Major depressive episode; 5.6Anxiety disorders; 3.6mixed Anxiety-Depression; and 3.9Suicidality. In terms of severity; 37.7of the current mental illnesses were severe; 35.1moderate and 13.2mild. 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

A comparison of the Behavioral and Emotional Disorders of Primary School-Going Orphans and Non-Orphans in Uganda

"Background: This 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 et 36.5respectively; 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 non-orphans 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."

HIV related risk behaviour and Psychological disorder among U.T.O.D.A. Taxi drivers in the new Taki Park; Kampala

Three hundred and thirty (330) tax drivers registered with The Uganda Taxi Owners and Drivers Association (U.T.O.D.A.) were interviewed using a semi-structured questionnaire. The questionnaire contains the following variables; socio-demographics; variables about the occupation; questions about knowledge; attitudes and practice with reference to HIV/AIDS and psychological assessment instruments; General Health Questionnaires (GHQ-12); ICD-10 checklists for depression; anxiety; somatoform disorder and alcohol abuse disorders. The results are presented; discussed and recomdendations made

HIV Risk Behaviour among Street Children Attending U.Y.D.E.L Clinic in Bakuli - Kampala

Introduction: A study was undertaken to investigate the nature; pattern and correlates of high HIV risk behaviour among street children attending the Uganda Youth Development Link (U.Y.D.E.L) Clinic in Bakuli; Kampala. Methodology: A total of 136 street children were consecutively interviewed with a semi-structured questionnaire. This instrument contained; socio-demographic variables; reasons for leaving home; nature of street childr career; previous attempts at resettlement; substance abuse behaviour; knowledge and attitudes about HIV/AIDS; high HIV risk behaviour and medical illness. Data analysis was undertaken using EPI-Info statistical package 6.0; this involved generating frequencies and frequency tables. Results: Most of the street children seen were male 129(94.8) with a male to female ratio of 18:1 and were largely 130(95.6) between the ages of 10-19 years of age. Mistreatment 66(48.5) and poverty leading to premature discontinuation of formal education 62(52.6) appears to be the main social factors underlying the decision to opt for the street. Substance abuse behaviour was reported 99(72.8) with the following substances abused; aviation fuel (tina) 90(66.2); cigarettes 31(22.8); marijuana 21(15.4); khat 14(10.3) and alcohol 11(8.1). Some of the children 20(20.2) abused more than one substance. Perceived causes of HIV/AIDS as reported by the children included organism 111(81.6) but 25(18.9) did not know the cause or reporting a wrong answer. For the perceived mode of transmission of HIV/AIDS; 105(77.2) correctly reported sex; 31(22.8) reported infected needles 29(21.3) blood transfusion and 10(7.4) mother to baby. The misperceived ideas about HIV transmission included; sharing food/drink 7(5.1) and hand shake 4(2.9) with 15(11) reporting ignorance about mode of transmission of HIV/AIDS. The majority of street children 100(73.5) were not sexually active. But those who were sexually active 36(26.5) displayed high HIV risk behaviour with; 27(58.3) reporting unprotected sex; 4(11.1) sex for money; 2(5.6) having suffered genital ulcers/discharge 2(5.6) multiple sexual partners. Only 6(16.6) reported regular use of a condom with 1(2.8) having taken an HIV test before. Conclusions and REcommendations: There is need for the design and development of HIV/AIDS awareness programmes that specifically target street children. These programmes need to address the deficits in knowledge and the small but high HIV risk group of sexually active children