Prevalence, correlates and help-seeking behaviour for depressive symptoms in rural Uganda: a population-based survey.

BACKGROUND: Depression is a common disorder characterized by delayed help-seeking, often remaining undetected and untreated. OBJECTIVES: We sought to estimate the proportion of adults in Kamuli District with depressive symptoms and to assess their help-seeking behaviour. METHODS: This was a population-based cross-sectional study conducted in a rural district in Uganda. Sampling of study participants was done using the probability proportional to size method. Screening for depression was done using Patient Health Questionnaire (PHQ-9). The participants who screened positive also reported on whether and where they had sought treatment. Data collected using PHQ-9 was used both as a symptom-based description of depression and algorithm diagnosis of major depression. All data analysis was done using STATA version 13. RESULTS: With a cut-off score of ⩾10, 6.4% screened positive for current depressive symptoms and 23.6% reported experiencing depressive symptoms in the past 12 months. The majority of individuals who screened positive for current depression (75.6%) were females. In a crude analysis, people with lower education, middle age and low socio-economic status were more likely to have depressive symptoms. Help-seeking was low, with only 18.9% of the individuals who screened positive for current depression having sought treatment from a health worker. CONCLUSION: Depressive symptoms are common in the study district with low levels of help-seeking practices. People with lower levels of education, low socio-economic status and those in middle age are more likely to be affected by these symptoms. Most persons with current depression had past history of depressive symptoms.

Evaluation of the impacts of a district-level mental health care plan on contact coverage, detection and individual outcomes in rural Uganda: a mixed methods approach.

BACKGROUND: The burden of mental disorders in low- and middle-income countries is large. Yet there is a major treatment gap for these disorders which can be reduced by integrating the care of mental disorders in primary care. AIM: We aimed to evaluate the impact of a district mental health care plan (MHCP) on contact coverage for and detection of mental disorders, as well as impact on mental health symptom severity and individual functioning in rural Uganda. RESULTS: For adults who attended primary care facilities, there was an immediate positive effect of the MHCP on clinical detection at 3 months although this was not sustained at 12 months. Those who were treated in primary care experienced significant reductions in symptom severity and functional impairment over 12 months. There was negligible change in population-level contact coverage for depression and alcohol use disorder. CONCLUSION: The study found that it is possible to integrate mental health care into primary care in rural Uganda. Treatment by trained primary care workers improves clinical and functioning outcomes for depression, psychosis and epilepsy. Challenges remain in accessing the men for care, sustaining the improvement in detection over time, and creating demand for services among those with presumed need.

Validity and diagnostic accuracy of the Luganda version of the 9-item and 2-item Patient Health Questionnaire for detecting major depressive disorder in rural Uganda.

BACKGROUND: The prevalence of depression in rural Ugandan communities is high and yet detection and treatment of depression in the primary care setting is suboptimal. Short valid depression screening measures may improve detection of depression. We describe the validation of the Luganda translated nine- and two-item Patient Health Questionnaires (PHQ-9 and PHQ-2) as screening tools for depression in two rural primary care facilities in Eastern Uganda. METHODS: A total of 1407 adult respondents were screened consecutively using the nine-item Luganda PHQ. Of these 212 were randomly selected to respond to the Mini International Neuropsychiatric Interview diagnostic questionnaire. Descriptive statistics for respondents' demographic characteristics and PHQ scores were generated. The sensitivity, specificity and positive predictive values (PPVs), and area under the ROC curve were determined for both the PHQ-9 and PHQ-2. RESULTS: The optimum trade-off between sensitivity and PPV was at a cut-off of ≧5. The weighted area under the receiver Operating Characteristic curve was 0.74 (95% CI 0.60-0.89) and 0.68 (95% CI 0.54-0.82) for PHQ-9 and PHQ-2, respectively. CONCLUSION: The Luganda translation of the PHQ-9 was found to be modestly useful in detecting depression. The PHQ-9 performed only slightly better than the PHQ-2 in this rural Ugandan Primary care setting. Future research could improve on diagnostic accuracy by considering the idioms of distress among Luganda speakers, and revising the PHQ-9 accordingly. The usefulness of the PHQ-2 in this rural population should be viewed with caution.

Effect of brief training on reliability and applicability of Global Assessment of functioning scale by Psychiatric clinical officers in Uganda.

BACKGROUND: The Global Assessment of Functioning (GAF) is the standard method and an essential tool for representing a clinician's judgment of a patient's overall level of psychological, social and occupational functioning. As such, it is probably the single most widely used method for assessing impairment among the patients with psychiatric illnesses. OBJECTIVE: To assess the effects of one-hour training on application of the GAF by Psychiatric Clinical Officers' in a Ugandan setting. METHOD: Five Psychiatrists and five Psychiatric Clinical Officers (PCOs) or Assistant Medical Officers who hold a 2 year diploma in Clinical Psychiatry were randomly selected to independently rate a video-recorded psychiatric interview according to the DSM IV-TR. The PCOs were then offered a one-hour training on how to rate the GAF scale and asked to rate the video case interview again. All ratings were assigned on the basis of past one year, at admission and current functioning. Interclass correlations (ICC) were computed using two-way mixed models. RESULTS: The ICC between the psychiatrists and the PCOs before training in the past one year, at admission and current functioning were +0.48, +0.51 and +0.59 respectively. After training, the ICC coefficients were +0.60, +0.82 and +0.83. CONCLUSION: Brief training given to PCOs improved the applications of their ratings of GAF scale to acceptable levels. There is need for formal training to this cadre of psychiatric practitioners in the use of the GAF.

Transitioning mental health & psychosocial support: from short-term emergency to sustainable post-disaster development. Humanitarian Action Summit 2011.

INTRODUCTION: The Working Group (WG) on Mental Health and Psychosocial Support participated in its second Humanitarian Action Summit in 2011. This year, the WG chose to focus on a new goal: reviewing practice related to transitioning mental health and psychosocial support programs from the emergency phase to long-term development. The Working Group's findings draw on a review of relevant literature as well as case examples. OBJECTIVES: The objective of the Working Group was to identify factors that promote or hinder the long term sustainability of emergency mental health and psychosocial interventions in crisis and conflict, and to provide recommendations for transitioning such programs from relief to development. METHODS: The Working Group (WG) conducted a review of relevant literature and collected case examples based on experiences and observations of working group members in implementing mental and psychosocial programming in the field. The WG focused on reviewing literature on mental health and psychosocial programs and interventions that were established in conflict, disaster, protracted crisis settings, or transition from acute phase to development phase. The WG utilized case examples from programs in Lebanon, the Gaza Strip, Sierra Leone, Aceh (Indonesia), Sri Lanka, and New Orleans (United States). RESULTS: The WG identified five key thematic areas that should be addressed in order to successfully transition lasting and effective mental health and psychosocial programs from emergency settings to the development phase. The five areas identified were as follows: Government and Policy, Human Resources and Training, Programming and Services, Research and Monitoring, and Finance. CONCLUSIONS: The group identified several recommendations for each thematic area, which were generated from key lessons learned by working group members through implementing mental health and psychosocial support programs in a variety of settings, some successfully sustained and some that were not.

Community Management of Acute Respiratory Tract Infections in Children in Rural Sabaddu--B-Sub -County Gombe; Mpigi District

Acute Respiratory Infections (ARI) are a major health problem for children. It has been estimated that about 20of infants born in developing countries fail to survive to their fifth birthday; and that one-fourth to one-third of child mortality is attributed to acute respiratory infections. Acute respiratory infections is one of the leading reasons for the use of health services. The constitute 30to 50of paediatric out-patient attendances and 10to 30(WHO/UNICEF; 1986) of children admissions to hospitals. Nevertheless; ARI has not been well studied locally today; especially regarding the influence of socio-cultural factors. According to the national capacity building for child survival and Development Survey; ARI has a low cumulative amount of research (Wamai; Katahoire; Barton; 1992). Objectives:The major objectives of the study were to examine the family knowledge of Acute Respiratory infections paying special attention to terminologies used and to describe signs; symptoms; causes and home therapy of acute respiratory infections. Attention was also paid to the nature of practitioners consulted; expenses incurred on children with acute respiratory infections; approaches to prevention and attitudes towards modern medical methods. Methodology: Qualitative data was collected using focus group discussions and indepth key-informant interviews. Participants in the different groups included mothers of children below five years old; elderly women; Community Health Workers (CHWs); Traditional Birth Attendants (TBAs); Traditional Healers (THs) and Village Health Committee (VHC) (members). Key informants were also chosen from the same groups after the sessions. In all sessions; a topic guide was used to guide the sessions. Conclusion: The prevalence of ARI among children in the study community was hgih. It was estimated that in every ten home there is a child with an ARI episode. Commonest forms of ARI were coughs; sore throat and common colds. The community is aware of gravity of the problem of ARI with an extensive indigenous knowledge as regards ARIs in children. However; this needs to be studied in detail. Information as regards the vernacular terminologies in other parts of the country should be documented in order to have a broader spectrum of ARIs knowledge