ASSESSMENT OF THE KNOWLEDGE AND PRACTICES OF EXCLUSIVE BREASTFEEDING AMONGST THE BREASTFEEDING MOTHERS IN ADJUMANI DISTRICT, WEST NILE.

BACKGROUND: Despite national policy guidelines advocating exclusive breastfeeding for the first six months of life to promote and accelerate child survival, the proportion of women exclusively breastfeeding for the first six months has remained small. OBJECTIVE: To describe the knowledge and practices of mothers regarding exclusive breastfeeding in a semi-urban Ugandan population. DESIGN: A descriptive cross-sectional study. SETTING: Semi-urban Ugandan population in four parishes in Adjumani District, the West Nile region of Uganda. SUBJECTS: The breastfeeding mothers with infants aged 3-12 months. RESULTS: Of the 385 breastfeeding mothers surveyed, 62.6% (241/385) and 53.5% (206/385) knew the exact meaning and the recommended duration of exclusive breastfeeding respectively. Nearly 68.6% (264/385) initiated breastfeeding within one hour after delivery and only 42.1% (162/385) exclusively breastfed their babies in the first six months of life. For the mothers who initiated non-breast milk feeds before the first six months of birth, most stated the following reasons: 'advice from the home', 'did not know the appropriate time', baby got thirsty and baby was crying at the sight of food'. CONCLUSION: This study revealed low levels of knowledge and practice of the recommended duration of exclusive breastfeeding among the breastfeeding mothers. Continuous breastfeeding awareness campaigns are needed to improve knowledge and practice of exclusive breastfeeding among breastfeeding mothers.

Taenia solium metacestode preparation in rural areas of sub-Saharan Africa: a source for diagnosis and research on cysticercosis.

BACKGROUND: Taenia solium metacestodes/cysts obtained from pig carcasses constitute a primary source for diagnostic tools used for the detection of human cysticercosis. Data on T. solium cyst preparation in Africa is still scarce but required to establish independent reference laboratories. OBJECTIVES: The aim of the present study is a) to present the likely yield of T. solium cyst material by the use of two different preparation methods in the field and b) to investigate its suitability for immunodiagnosis of human cysticercosis. METHODS: In Zambia, Uganda and Tanzania 670 pigs were screened for T. solium infection. Cysts were prepared by 'shaking method' and 'washing method'. Generated crude antigens were applied in a standard western blot assay. RESULTS: 46 out of 670 pigs (6.9%) were found positive for T. solium (Zambia: 12/367, 3.3%; Uganda: 11/217, 5.1%; Tanzania 23/86, 26.7%). Mean values of 77.7 ml whole cysts, 61.8 ml scolices/membranes and 10.9 ml cyst fluid were obtained per pig. Suitability of collected material for the use as crude antigen and molecular diagnostic techniques was demonstrated. CONCLUSION: This study clearly shows that T. solium cyst preparation in African settings by simple field methods constitutes an effective way to obtain high quality material as source for diagnostic tools and research purposes.

The role of FKBP5 genotype in moderating long-term effectiveness of exposure-based psychotherapy for posttraumatic stress disorder.

Exposure-based therapies are considered the state-of-the-art treatment for Posttraumatic Stress Disorder (PTSD). Yet, a substantial number of PTSD patients do not recover after therapy. In the light of the well-known gene × environment interactions on the risk for PTSD, research on individual genetic factors that influence treatment success is warranted. The gene encoding FK506-binding protein 51 (FKBP5), a co-chaperone of the glucocorticoid receptor (GR), has been associated with stress reactivity and PTSD risk. As FKBP5 single-nucleotide polymorphism rs1360780 has a putative functional role in the regulation of FKBP5 expression and GR sensitivity, we hypothesized that this polymorphism influences PTSD treatment success. We investigated the effects of FKBP5 rs1360780 genotype on Narrative Exposure Therapy (NET) outcome, an exposure-based short-term therapy, in a sample of 43 survivors of the rebel war in Northern Uganda. PTSD symptom severity was assessed before and 4 and 10 months after treatment completion. At the 4-month follow-up, there were no genotype-dependent differences in therapy outcome. However, the FKBP5 genotype significantly moderated the long-term effectiveness of exposure-based psychotherapy. At the 10-month follow-up, carriers of the rs1360780 risk (T) allele were at increased risk of symptom relapse, whereas non-carriers showed continuous symptom reduction. This effect was reflected in a weaker treatment effect size (Cohen's D=1.23) in risk allele carriers compared with non-carriers (Cohen's D=3.72). Genetic factors involved in stress response regulation seem to not only influence PTSD risk but also responsiveness to psychotherapy and could hence represent valuable targets for accompanying medication.

Knowledge, Perceptions and Acceptability to Strengthening Adolescents' Sexual and Reproductive Health Education amongst Secondary Schools in Gulu District.

Adolescents in Northern Uganda are at risk of teenage pregnancies, unsafe abortions and sexually transmitted infections (STIs). There is silence on sex both at home and school. This cross sectional descriptive analytical study interviews a random sample of 827 students and 13 teachers on knowledge, perception and acceptability to a comprehensive adolescent sexual and reproductive health education in "O" and "A" level secondary schools in Gulu District. Quantitative data was analysed using SPSS 16.0. Directed content analysis of themes of transcribed qualitative data was conducted manually for common codes, sub-categories and categories. Of the 827 students; 54.3% (449) reported being in a sexual relationship especially those aged 15-17 years. Majority 96.1% (807) supported the teaching of a comprehensive ASRHE, citing no negative impact 71.5% (601). Majority 81.6% (686) agreed that such education could help prevention of STIs, abortions and teenage pregnancies, and that it should be taught by health workers 69.0% (580). Majority 76.6% (203) reported that ASRHE was not currently being taught in their schools. Students had low knowledge levels and misconceptions about ASRHE. ASRHE was highly acceptable though not being emphasized; its success in school settings requires multidisciplinary culturally sensitive approaches amongst which health workers should be frontiers.

Risk factors towards self-destructive behaviour among fresh students at Makerere University

It has been suggested that some individuals are suicide prone; and that such individuals can be detected long before they commit suicide. This paper reports the risk factors associated with potential self-destructive behaviour among a group of freshwomen at Makerere University. A suicide proneness questionnaire; the Umzimkulu suicide Proneness Inventory (USPI); was completed by 619 students admitted to the University in the academic year 1992/93. The results indicate that students' propensity to self-destructive behaviour was significantly related to the history of suicide behaviour among the students; or their relatives; and the presence of a probable depressive disorder as indicated by scores above at least 60 on each of SR; AL; AS; and PDW; scales on the questionnaire. The paper describes in detail the development of the USPI; and the theory underlying the study. Implications for improving counselling services for students at Makerere University are highlighted

Mental illness in one district of Uganda.

AIMS: To estimate the prevalence of psychiatric disorder in one district of Uganda. METHODS: Data were collected from a survey of a random sample of households in Kabarole, West Uganda. Interviews were carried out with household members. Further information was obtained from interviews of key community informants and from Focus Group discussions conducted in each Parish. RESULTS: Some 384 households were surveyed. Of these, 99 households identified members with a mental illness in the previous year and a total of 130 individuals were identified, 12 of whom were children. Few individuals had been seen by formal mental health services and traditional methods of treatment were commonly used. CONCLUSIONS: The estimated prevalence of 30.7% in adults is higher than that of 25.3% found in the only other community based survey of mental illness previously conducted in Uganda. A well conducted study using modern case defining methods needs to be carried out in Uganda.

Obsessive compulsive disorder: report of six cases.

Obsessive-compulsive disorder (OCD) refers to interloping and interative thoughts, ideas, images, fantasies, impulses and actions accompanied by feelings of distress and declarations of resistance. It is assumed that OCD is rare among black Africans. This paper reports six cases from Uganda. The report indicates that OCD exists among black Africans and that those affected experience considerable amounts of emotional, social and occupational distress. It is suggested that OCD should be taught adequately to medical students to enable future general-duty medical officers to recognise and manage it appropriately. The names that appear in the text are pseudonyms.

Obsessive compulsive disorder: report of six cases

Obsessive compulsive disorder (OCD) refers to interlping and interative thoughts; ideas; images; fantasies; impulses and actions accompanied by feelings of distress and declarations of resistance. It is assumed that OCD is rare among black Africans. This paper reports six cases from Uganda. The report indicates that OCD exists among black Africans and that those affected experience considerable amounts of emotional; social and occupational distress. It is suggested that OCD should be taught adequately to medical students to enable future general -duty medical officers to recognise and manage it appropriately. The names that appear in the text are pseudonyms

Gender and the stigma of onchocercal skin disease in Africa.

This paper reports results from a multicenter study of gender differences in the stigma associated with onchocercal skin disease (OSD) in five African sites: Cameroon, Ghana, Nigeria (Awka and Ibadan) and Uganda. The studies used a common protocol to compare affected and unaffected respondents, that is, men and women with onchodermatitis in highly endemic areas and respondents from communities with low endemicity or no onchocerciasis. The methods were both quantitative and qualitative, allowing for the comparison of stigma scores and people's verbal descriptions of their experiences and attitudes. Questions to the unaffected were asked after providing them with photographs and short descriptions (vignettes) depicting typical cases. We found that stigma was expressed more openly by the unaffected, who perceived OSD as something foreign or removed from themselves, whereas the affected tended to deny that they experienced stigma as a result of the condition. Gender differences in stigma scores were not significantly different for men and women, but qualitative data revealed that stigma was experienced differently by men and women, and that men and women were affected by it in distinctive ways. Men were more concerned about the impact of the disease on sexual performance and economic prospects, whereas women expressed more concern about physical appearance and life chances, especially marriage. Similar trends were found in the different sites in the responses of affected and unaffected respondents, and differences between them, despite geographical and cultural variations.

The effects of ivermectin on onchocercal skin disease and severe itching: results of a multicentre trial.

OBJECTIVE: To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin p6isease (OSD) and severe itching. METHOD: A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits. RESULTS: While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40-50% among those receiving ivermectin compared to the trend in the placebo group. CONCLUSION: This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study.

Prediction of self-destructive behaviour among Makerere University students.

Student suicides at Makerere University have occurred sporadically and no systematic programme of suicide prevention has been developed. In addition, no clear guidelines have been worked out to guide the operations of the university counselling centre. A study on the possible predictability of suicide behaviour among students was conducted from October 1992 to June 1995. Study objectives included the identification of possible characteristics of suicidal students; the determination of the proportion of students who will seek counselling services at the university hospital in the course of their studies; and the identification of characteristics of counsellees. Study participants were the entire group of the 1992/93 academic year intake. Six hundred and nineteen students consented to complete a self-administered questionnaire, especially designed to identify suicidal and or depressed persons. The students were then followed up for three years during which data on student attendance at the counselling centre were collected. The results were analysed using the EPI INFO computer software. The results indicated that some students (at least 5.5%) who enrolled at Makerere university annually will probably require counselling services in the course of their studies; and it is possible to recognise students who might require counselling services early at the time of their enrollment at the university. The following recommendations are made to improve counselling services for students: all students should be inducted at the time of their entry into the university; counselling services should be made attractive to students; students should be involved in providing counselling services, particularly at emergency level; a prompt and attractive referral system for students requiring psychiatric care should be established; a telephone hot-line to be managed by the students should be established and; further research is needed to improve counselling services for students at Makerere university.

Prediction of self-destructive behavior among Makerere University students

Student suicides at Makerere University have occured sporadically and no systematic programme of suicide prevention has been developed. In addition; no clear guidelines have been worked out to guide the operations of the University counselling centre. A study on the predictability of suicide behaviour among students was conducted from October 1992 to June 1995. Study objectives included the identification of possible characteristics of suicidal students; the determination of the proportion of students who will seek counselling services at the University hospital in the course of their studies; and the identification of characteristics of counsellees. Study participants were the entire group of the 1992/93 academic year intake. Six hundred and nineteen students consented to complete a self-adminsitered questionnaire; especially designed to identify suicidal and or depressed persons. The students were then followed up for three years during which data on student attendance at the counselling centre were collected. The results were analysed using the EPIINFO computer software. The results indicated that some students (at least 5.5) who enrolled at Makerere University annually will probably require counselling services early at the time of their enrollment at the University. The following recommendations are made to improve counselling services for students: all students should be inducted at the time of their entry the University; counselling services should be made attractive to students; students should be involved in providing counselling services; particularly at emergency level; a prompt and attractive referral system for students requiring psychiatric care should be established; a telephone hot-line to be managed by the students should be established and; further research is needed to improve counselling services for students at Makerere University

Risk factors towards self-destructive behaviour among fresh students at Makerere University.

It has been suggested that some individuals are suicide prone, and that such individuals can be detected long before they commit suicide. This paper reports the risk factors associated with potential self-destructive behaviour among a group of freshmen and freshwomen at Makerere University. A suicide proneness questionnaire, the Umzimkulu Suicide Proneness Inventory (USPI), was completed by 619 students admitted to the university in the academic year 1992/93. The results indicate that students' propensity to self-destructive behaviour was significantly related to the history of suicide behaviour among the students, or their relatives, and the presence of a probable depressive disorder as indicated by scores above at least 60 on each of SR, AL, AS, and PDW, scales on the questionnaire. The paper describes in detail the development of the USPI, and the theory underlying the study. Implications for improving counselling services for students at Makerere University are highlighted.

Social anthropological aspects of onchocercal skin disease in Nebbi District, Uganda.

In providing health care, the busy medical practitioner often lacks the "I-You" quality of the personal experience of illness. This paper reports the perceptions, beliefs and practices of persons living in a hyperendemic focus of onchocerciasis in Nebbi District, north-western Uganda. The study involved the use of focus group discussion and semi-structured interviews designed to explore the experiences, meanings, and illness-related coping strategies employed by the community. The results indicated that oncherciasis is considered to be a mysterious elusive disease which cannot be treated by local herbs. The disease is often mistaken for measles (odyer), and leprosy (dhobu). Persons who suffer from onchocerciasis believed that the cause of the disease is the small black fly (Kamacur), dirty water or rivers. However, non-affected individuals believed that the condition is caused by poor personal and environmental hygiene, and personal contact with persons affected by onchocerciasis. Affected people recommended public health education to control the disease while non-affected people, recommended the avoidance of personal contact with affected people, ensuring personal hygiene, and the improvement of environmental sanitation and the nutritional status of community. The belief systems of the community are probably responsible for the discriminatory practices of the people against those affected by the condition. The results indicate that onchocerciasis is a serious public health problem which needs to be controlled.

Social and psychological aspects of onchocercal skin disease in Nebbi district, Uganda.

Onchocerciasis affects 7% of Uganda's population and 1.5 million more people are at risk of infection with Onchocerca volvulus, the nematode that causes the disease. This paper reports the results of part of a multi-centre study whose objective was to determine the prevalence of onchocercal skin disease and its associated psychosocial importance in Uganda. The study employed a standardised clinical dermatological survey method along with the use of structured questionnaires, focus group discussions and key informant interviews. Out of a total of 993 persons examined to determine the prevalence of onchocercal skin lesions 253 persons were interviewed to determine the psychosocial importance of the disease. The results indicate that onchocercal skin disease is associated with a variety of psychosocial, physical and economic effects. The disease also leads to stigmatisation of affected persons and their families. It is suggested that dermatological effects of onchocerciasis should be recognised as an important cause of morbidity in Uganda.

Dermatological problems of onchocerciasis in Nebbi District, Uganda.

A cross-sectional survey of 770 subjects in onchocerciasis hyperendemic villages and 223 subjects from a control community in Nebbi District in the West Nile region of Uganda revealed a high prevalence of onchocercal skin disease of 48% in endemic villages. The most common skin problem was troublesome itching (40%); and the prevalent skin lesions were chronic papular onchodermatitis (16%), depigmentation (4%), lichenified onchodermatitis (2%) and acute papular onchodermatitis (1%). Other typical varieties of onchocercal skin diseases such as, hanging groin, lymphoedema and marked lymphadenopathy were infrequent, and considered rare. Pityriasis vergicolor was the most common non-onchocercal skin lesion in both control and endemic communities, accounting for 37% of all non-onchocercal skin lesions. These skin lesions were associated with a variety of psycho-social and economic impact; and there was a positive correlation between the prevalence of troublesome itching and the prevalence of modules (correlation coefficient r = 0.62, p = 0.00). Given the prospects of onchocerciasis control based on mass ivermectin distribution in communities where blindness is common, we recommend that treatment be extended to communities where blindness is less common, but skin disease known to be predominant.

Social anthropological aspects of onchocercal skin disease in Nebbi District; Uganda

"In providing health care; the busy medical practitioner often lacks the ""I-You"" quality of the personal experience of illness. This paper reports the perceptions; beliefs and practices of persons living in a hyperendemic focus of onchocerciasis in nebbi District; north-western Uganda. The study involved the use of focus group discussion and semi-structured interviewes designed to explore the experiences; meanings; and illness-related coping strategies employed by the community. The results indicated that oncherciasis believed that the cause of the disease is the small black fly (Kamacur); dirty water or rivers. However; non-affected individuals believed that the condition is caused by poor personal and environmental hydiene; and personal contact with persons affected by onchocerciasis. Affected people recommended public health education to control the diases while non-affected people; recommended the avoidance of personal contact with affected people; ensuring personal hygiene; and the improvement of environmental sanitation and the nutritional status of community. The belief systems of the community are probably responsible for the discriminatory practices of the people against those affected by the condition. The results indicate that onchocerciasis is a serious public health problem which needs to be controlled."

Dermatological problems of onchocerciasis in Nebbi District; Uganda

A cross-sectional survey of 770 subjects in onchocerciasis hyperendemic villages and 223 subjects from a control community in Nebbi District in the West Nile Region of Uganda revealed a high prevalence of onchocercial skin disease of 48in endemic villages. The most chronic skin problem was troublesome itching (40); and the prevalent skin lesions were chronic popular onchodermatitis (16); depigmentation (4); lichenifield onchodermatitis (2) and acute popular onchodermatitis (1). Other typical varieties of onchocercal skin diseases such as; hanging groin; lymphoedema and marked lymphadenopathy were infrequent; and considered rare. Pityriasis vergicolor was the most common non-onchocercal skin lesion in both control and endemic communities; accounting for 37of all non-onchocercal skin lesions. These skin lesions were associated with a variety of psycho-social and economic impact; and there was a positive correlation between the prevalence of troublesome itching and the prevalence of modules (correlation coefficient r=0.62; p=0.00). Given the prospects of onchorcerciasis control based on mass ivermectin distribution in communities where blindness is less common; but skin disease known to be predominant

Epilepsy: case report and analysis of clinical management problems.

Epilepsy is a major cause of morbidity and accounted for up to 40% of psychiatric outpatient attendances in the experience of the author in Transkei, South Africa. In many cases clinical diagnosis and management were easy. In this paper, the author analyses the clinical management problems presented by seven patients between January 1986 and May 1989. A detailed case report is presented to illustrate difficulties in management. It is suggested that ethosuximide might be effective in the control of probable partial seizure disorders. Underlying electrophysiological considerations are discussed. It is noted, however, that it may not be easy to differentiate between partial or generalised seizure disorders on clinical grounds.