Problematic use of the internet, smartphones, and social media among medical students and relationship with depression: An exploratory study.

BACKGROUND: Students in sub-Saharan African countries experienced online classes for the first time during the COVID-19 pandemic. For some individuals, greater online engagement can lead to online dependency, which can be associated with depression. The present study explored the association between problematic use of the internet, social media, and smartphones with depression symptoms among Ugandan medical students. METHODS: A pilot study was conducted among 269 medical students at a Ugandan public university. Using a survey, data were collected regarding socio-demographic factors, lifestyle, online use behaviors, smartphone addiction, social media addiction, and internet addiction. Hierarchical linear regression models were performed to explore the associations of different forms of online addiction with depression symptom severity. RESULTS: The findings indicated that 16.73% of the medical students had moderate to severe depression symptoms. The prevalence of being at risk of (i) smartphone addiction was 45.72%, (ii) social media addiction was 74.34%, and (iii) internet addiction use was 8.55%. Online use behaviors (e.g., average hours spent online, types of social media platforms used, the purpose for internet use) and online-related addictions (to smartphones, social media, and the internet) predicted approximately 8% and 10% of the severity of depression symptoms, respectively. However, over the past two weeks, life stressors had the highest predictability for depression (35.9%). The final model predicted a total of 51.9% variance for depression symptoms. In the final model, romantic relationship problems (ß = 2.30, S.E = 0.58; p<0.01) and academic performance problems (ß = 1.76, S.E = 0.60; p<0.01) over the past two weeks; and increased internet addiction severity (ß = 0.05, S.E = 0.02; p<0.01) was associated with significantly increased depression symptom severity, whereas Twitter use was associated with reduced depression symptom severity (ß = 1.88, S.E = 0.57; p<0.05). CONCLUSION: Despite life stressors being the largest predictor of depression symptom score severity, problematic online use also contributed significantly. Therefore, it is recommended that medical students' mental health care services consider digital wellbeing and its relationship with problematic online use as part of a more holistic depression prevention and resilience program.

Undergraduate Learning in the COVID-19 Pandemic: Lessons Learned and Ways Forward.

The SARS-CoV-2 coronavirus (COVID-19) pandemic is in constant evolution, much like the virus, and we must learn to adapt our undergraduate education and learning strategies to enable students to complete their studies. This narrative review focuses on what is currently known about the face-to-face and e-learning strategies of undergraduate medical students in resource-limited settings during the COVID-19 pandemic. The majority of studies, involving health professional students, took place in 2020. Few involved educators. Students have faced challenges with the transition to remote learning, for which a couple of interventions have been devised. Bridging the gap in access and utilisation of remote learning might have required more time, however, the COVID-19 pandemic has accelerated the learning curve and the transition from in-person to online learning.

Risky sexual behaviours among Ugandan university students: A pilot study exploring the role of adverse childhood experiences, substance use history, and family environment.

BACKGROUND: University students are known to have risky sexual behaviours (RSBs). The severity of the RSB is influenced by many factors, including the family environment, exposure to adverse childhood events (ACEs), and the use of addictive substances. However, there is limited information about the influence of ACEs and the family environment of these students in low-and medium-income countries (LMICs). Therefore, a pilot study was conducted among university students from a LMIC, Uganda. METHODS: The present study comprised a cross-sectional online survey among Ugandan students at a public university (N = 316; 75% male; 52.2% aged between 18-22 years). The survey included questions relating to socio-demographic information, family environmental information, the Sexual Risk Survey (SRS), and the Adverse Childhood Experiences-International Questionnaire (ACE-IQ). RESULTS: Over half (53.8%) reported having had sexual intercourse. Males reported over two times higher mean total SRS score compared to females (χ2 = 4.06, p = 0.044). Approximately one-sixth of the sample had drunk alcohol or used illicit psychoactive substances in the past six months (16.1%). Among four regression analysis models, sociodemographic variables predicted the highest variance (13%), followed by family environment variables (10%), and both psychoactive substance use history (past six months) and ACEs individually explained approximately 5% variance in total SRS score, with the final model predicting 33% of the variance in RSB. CONCLUSIONS: The present study demonstrated a gender disparity with males involved in more RSB than females, as has been reported in most previous RSB studies. Family environment, sociodemographic factors, substance use, and ACEs all appear to contribute to RSB among university students. These findings will benefit other researchers exploring factors associated with RSB among university students and will help develop interventions to reduce RSB to protect students from unwanted pregnancies, sexually transmitted diseases, and HIV/AIDS.

Suicidal behaviours among ugandan university students: A cross-sectional study

Background: Suicide remains the leading cause of death among university students often resulting from multiple physical and psychological challenges. Moreover, suicidal behaviours among students appear to have increased due to the COVID-19 pandemic according to some studies. Objective: To explore the prevalence and associated factors for suicidal ideation, suicide plans, and suicide attempts among university students in Uganda. Methods: Cross-sectional study data were collected from May to September 2021 from 540 undergraduate university students in south-western Uganda (363 males, mean age 23.3 years). Questions from the General Health Questionnaire (GHQ-28) were used to assess suicidal ideation, while other bespoke questions were used to assess suicide plans and attempts. The survey also investigated the suicide attempt/plan method, location of the suicidal activity, and reason for not enacting the suicide plan. Three independent regression analyses were used to determine the factors associated with different forms of suicidal behaviours. Results: The prevalence of past-year suicidal behaviours was 31.85% for suicidal ideation, 8.15% for suicide plans, and 6.11% for suicide attempts. Having a chronic physical medical condition increased the likelihood of having all forms of suicidal behaviours. Suicidal ideation was associated with having difficulty paying university tuition fees. However, being in the fifth year of university education, and feeling satisfied with current academic grades reduced the likelihood of suicidal ideation. Individuals feeling satisfied with academic performance appeared to be a protective factor against having suicide plans. Suicide attempts were associated with having a history of sexual abuse and having difficulty paying university tuition fees. The most common method used for attempted suicide was a drug overdose, and the most common location for attempted suicide was their homes. Conclusion: University students have prevalent suicide behaviours especially among students with a chronic physical medical condition, a history of sexual abuse, and problems paying university tuition fees. Based on the present study, for students at risk, universities should provide appropriate interventions such as life skills education and suicide prevention techniques. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Prevalence and Factors Associated With Depression and Suicidal Ideation During the COVID-19 Pandemic Among University Students in Uganda: A Cross-Sectional Study.

Background: The COVID-19 pandemic has negatively impacted psychosocial well-being and mental health of students across the world. Although students are vulnerable to depression and suicidal ideation, few studies have been conducted in Uganda. This study aimed to determine the prevalence of depression and suicidal ideation, and associated factors among undergraduate university students in Uganda. Methods: A cross-sectional study was conducted among undergraduates [N = 540; 363 males; mean age = 23.3 (± 2.64) years] recruited from four universities using an online questionnaire that explored sociodemographic factors, depression, and other associated factors. The Patient Health Questionnaire (PHQ-9) was used to assess depression, and Item 9 was used to assess suicidal ideation in the past 2 weeks. Multivariable logistic regression analyses were performed to determine the factors associated with depression and suicidal ideation. Results: The prevalence of moderate to severe depression was 20% (n = 108) (cut-off: 10/27 based on the PHQ-9), and the prevalence of past-2-week suicidal ideation was 13.89% (n = 75) (cut-off: 1/3 based on the PHQ-9 Item 9). About half of the individuals who screened positive for depression had suicidal ideation. Factors associated with depression were: having relationship issues [adjusted odds ratio (aOR) = 1.79, 95% confidence interval (CI) = 1.13-2.81, p = 0.012], and having a history of sexual abuse (aOR = 2.06, 95% CI = 1.10-3.84, p = 0.023). Factors associated with reducing the risk of depression were: satisfaction with current academic performance (aOR = 0.50, 95% CI = 0.32-0.79, p = 0.003), and being in the fifth year of academic study (aOR = 0.16, 95% CI = 0.03-0.73, p = 0.018). Factors associated with suicidal ideation were: smoking cigarettes and/or marijuana (aOR = 4.83, 95% CI = 1.10-21.12, p = 0.037), and having financial tuition constraints (aOR = 1.85, 95% CI = 1.08-3.16, p = 0.024), However, satisfaction with current academic performance reduced the likelihood of suicidal ideation (aOR = 0.40, 95% CI = 0.23-0.70, p = 0.001). Conclusion: Approximately one-fifth of undergraduate university students were moderately to severely depressed, especially those who had relationship issues and those with a history of sexual abuse. Suicidal ideation was common among smokers and those having financial tuition constraints. Therefore, it is recommended that the university authorities implement measures to provide psychological support for the students with problems concerning financial tuition constraints, relationships, and sexual abuse. Also, all students with depression should be screened for suicidality.

Prevalence of burnout among university students in low- and middle-income countries: A systematic review and meta-analysis.

BACKGROUND: Burnout is common among university students and may adversely affect academic performance. Little is known about the true burden of this preventable malady among university students in low-and-middle-income countries (LMICs). OBJECTIVES: This study aimed to systematically estimate the prevalence of burnout among university students in LMICs. METHODS: We searched PubMed, Google Scholar, CINAHL, Web of Science, African Journals Online, and Embase from the inception of each database until February 2021. Original studies were included. No study design or language restrictions were applied. A random-effects meta-analysis was performed using STATA version 16.0. Heterogeneity and publication bias were assessed using Q-statistics and funnel plots, respectively. RESULTS: Fifty-five unique articles, including a total of 27,940 (Female: 16,215, 58.0%) university students from 24 LMICs were included. The Maslach Burnout Inventory (MBI) was used in 43 studies (78.2%). The pooled prevalence of burnout was 12.1% (95% Confidence Interval (CI) 11.9-12.3; I2 = 99.7%, Q = 21,464.1, p = < 0.001). The pooled prevalence of emotional exhaustion (feelings of energy depletion), cynicism (negativism), and reduced professional efficacy were, 27.8% (95% CI 27.4-28.3; I2 = 98.17%. p = <0.001), 32.6 (95% CI: 32.0-33.1; I2: 99.5%; p = < 0.001), and 29.9% (95% CI: 28.8-30.9; I2: 98.1%; p = < 0.001), respectively. CONCLUSION: Nearly one-third of university students in LMICs experience burnout. More studies are needed to understand the causes of burnout in this key population. There is a need to validate freely available tools for use in these countries.

Fear of COVID-19 and the Media Influence on Herbal Medication Use in Uganda: A Cross-Sectional Study.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has created fear in people around the world. This has led to the widespread use of various herbal remedies in its prevention and treatment regardless of the paucity of scientific evidence about their safety and efficacy. This study assessed the fear of COVID-19 and the influence of media on the use of herbal medicine to prevent or treat COVID-19 in Uganda. METHODS: In the first 2 weeks of July 2021, a descriptive online cross-sectional study was carried out anonymously in the general population in Uganda. A validated questionnaire was used to collect data on herbal medicine use and the influence of media. Fear of COVID-19 was rated using the Fear of COVID-19 Scale (FCV-19S). RESULTS: We recruited 488 participants, 273 (55.9%) were female, with a median age of 25 (range: 18-73) years. Sixty-seven (57.8%) participants had a confirmed COVID-19 diagnosis. The mean FCV-19S score was 21.7 SD 5.9 with 53.3% reporting high levels of COVID-19 fear. About 57.4% of participants reported using herbal remedies either to prevent or treat COVID-19-like symptoms. Media was the main source of information, with more than 80% of the participants reporting seeing or accessing information about herbal medication use. Women (adjusted odds ratio (aOR): 1.74, 95% CI: 1.2-2.5, p=0.003) and people with a previously confirmed COVID-19 diagnosis (aOR: 3.1, 95% CI: 1.35-7.14, p=0.008) had a statistically significantly higher FCV-19S score. Being unemployed (aOR: 1.0, 95% CI: 1.1-2.3, p=0.008) and a female (aOR: 1.0, 95% CI: 1.1-2.3, p=0.012) were statistically significantly associated with herbal medicine use. Participants who used herbal remedies had a higher median FCV-19S score compared to non-users (23 versus 21, p<0.001). CONCLUSION: The use of herbal medicines to treat or prevent COVID-19 is a widespread practice among the general population in Uganda amidst the high levels of fear of COVID-19.

Suicide among Ugandan university students: evidence from media reports for 2010-2020.

University students are in transition to adulthood and face multiple challenges that may lead to suicide. They are reported to have a higher risk of suicide by the World Health Organization. As there is no national suicide database in Uganda, we analysed student suicide using the press/media reports of suicides published between 2010 and 2020. A total of deaths by 23 suicide were identified: 19 were males, relationship problems were the main suicide reason (n = 6) and hanging was the most frequently used suicide method (n = 7). A strategic intervention to tackle suicide risk among university students is warranted.

Acceptance of the coronavirus disease-2019 vaccine among medical students in Uganda.

BACKGROUND: COVID-19 is still a major global threat for which vaccination remains the ultimate solution. Uganda reported 40,751 cases and 335 deaths as of 9 April 2021 and started its vaccination program among priority groups like health workers, teachers, those with chronic diseases among others in early March 2021. Unanimous uptake of the COVID-19 vaccine is required to subsequently avert its spread; therefore, we assessed COVID-19 vaccine acceptability, hesitancy, and associated factors among medical students in Uganda. METHODS: This study employed an online descriptive cross-sectional survey among medical students across 10 medical schools in Uganda. A structured questionnaire via Google Form was conveniently sent to eligible participants via WhatsApp. Each medical school had a coordinator who consistently shared the data tool in the WhatsApp groups. Chi-square or Fisher's exact test, and logistic regression were used to assess the association between vaccine acceptability with demographics, COVID-19 risk perception, and vaccine hesitancy. RESULTS: We surveyed 600 medical students, 377 (62.8%) were male. COVID-19 vaccine acceptability was 37.3% and vaccine hesitancy 30.7%. Factors associated with vaccine acceptability were being male (adjusted odds ratio (aOR) = 1.9, 95% CI 1.3-2.9, p=0.001) and being single (aOR= 2.1, 95% CI 1.1-3.9, p=0.022). Very high (aOR= 3.5, 95% CI 1.7-6.9, p<0.001) or moderate (aOR =2.2, 95% CI 1.2-4.1, p=0.008) perceived risk of getting COVID-19 in the future, receiving any vaccine in the past 5 years (aOR= 1.6, 95% CI 1.1-2.5, p=0.017), and COVID-19 vaccine hesitancy (aOR 0.6, 95% CI 0.4-0.9, p=0.036). CONCLUSIONS: This study revealed low levels of acceptance towards the COVID-19 vaccine among medical students, low self-perceived risks of COVID-19, and many had relied on social media that provided them with negative information. This poses an evident risk on the battle towards COVID-19 in the future especially when these future health professions are expected to be influencing decisions of the general public towards the same.

Perspective of Medical Students on the COVID-19 Pandemic: Survey of Nine Medical Schools in Uganda.

BACKGROUND: The coronavirus disease (COVID-19) pandemic is a global public health concern affecting over 5 million people and posing a great burden on health care systems worldwide. OBJECTIVE: The aim of this study is to determine the knowledge, attitude, and practices of medical students in Uganda on the COVID-19 pandemic. METHODS: We conducted an online, descriptive cross-sectional study in mid-April 2020, using WhatsApp Messenger. Medical students in 9 of the 10 medical schools in Uganda were approached through convenience sampling. Bloom's cut-off of 80% was used to determine good knowledge (≥12 out of 15), positive attitude (≥20 out of 25), and good practice (≥12 out of 15). RESULTS: The data of 741 first- to fifth-year medical students, consisting of 468 (63%) males with a mean age of 24 (SD 4) years, were analyzed. The majority (n=626, 84%) were pursuing Bachelor of Medicine and Bachelor of Surgery degrees. Overall, 671 (91%) had good knowledge, 550 (74%) had a positive attitude, and 426 (57%) had good practices. Knowledge was associated with the 4th year of study (adjusted odds ratio [aOR] 4.1, 95% CI 1.6-10.3; P<.001). Attitude was associated with the female sex (aOR 0.7, 95% CI 0.5-1; P=.04) and TV or radio shows (aOR 1.1, 95% CI 0.6-2.1; P=.01). Practices were associated with the ≥24 years age category (aOR 1.5, 95% CI 1.1-2.1; P=.02) and online courses (aOR 1.8, 95% CI 1.1-3.2; P=.03). In total, 592 (80%) medical students were willing to participate in frontline care if called upon. CONCLUSIONS: Medical students in Uganda have sufficient knowledge of COVID-19 and will be a large reservoir for health care response when the need arises.