Maternal mental health screening and management by health workers in southwestern Uganda: a qualitative analysis of knowledge, practices, and challenges.

BACKGROUND: Maternal mental health (MMH) problems, such as perinatal depression, maternal anxiety, suicide ideation and puerperal psychosis among others, have a significant impact on maternal morbidity and mortality, as well as the health and development of children. One in every four pregnant women and one in every five postpartum women in low-income countries, suffer from maternal mental health (MMH) problems. Despite this, MMH screening, diagnosis, and reporting remain scanty in Uganda. Consequently, this study aimed to investigate the knowledge, practices, and impediments that maternity care workers face when screening and managing women with maternal mental health disorders in health facilities in south-western Uganda. METHODS: In-depth interviews were conducted with 22 health-care professionals who work in maternity care departments in primary and tertiary healthcare facilities in southwestern Uganda to investigate their medical knowledge, clinical practices, and challenges related to the screening and management of maternal mental health problems. Using qualitative content analysis, distinct categories and subcategories were found. RESULTS: Medical staff especially midwives lacked specialized training in screening and managing women with maternal mental health problems They screened and managed MMH problems solely based on history and physical examination, and they referred nearly every mother displaying signs of mental illness because they felt ill-prepared to handle them. On the other hand, medical staff with some level of specialized training in mental health particularly staff working in mental health units, were more likely to use a mental health screening tool in addition to history and physical examination; and to treat any women exhibiting signs and symptoms of maternal mental problems without referring them. Lack of in-service training on maternal mental health, poorly coordinated referral systems, reluctance of mentally ill to visit medical facilities, scarcity of mental health specialists, and shortage of relevant medications were identified as the major challenges. Age, experience level, or gender had no effect on screening or management practices. CONCLUSIONS: The results suggest that specialized training in mental health, and particularly maternal mental health, is essential for the effective screening and management of maternal mental health conditions in South Western Uganda.

Experiences and Perceptions on Community Client-Led ART Delivery (CCLADS) Model of Antiretroviral (ART) Delivery: Patients' and Providers' Perspectives in South Western Uganda.

Purpose: Community Client-Led ART Delivery groups (CCLADS) were introduced as part of the differentiated service delivery models in 2017 to better serve growing number of HIV patients and reduce unnecessary burden on the HIV care delivery system. However, there is limited evidence on the exact patients' and care providers' experiences and perceptions regarding the CCLADS model of ART delivery. We therefore aimed to explore the experiences and perceptions on CCLADS model from the patient and provider perspectives. Participants and Methods: A descriptive qualitative study was conducted at two ART clinics in Southwestern Uganda. We conducted in-depth interviews (IDI) to get a deeper understanding of the patient and providers' perspective regarding the model. Responses from participants were recorded using audio recorders and were translated and transcribed. We used thematic approach to analyze the data. Results: A total of 20 in depth interviews were conducted, with providers, CCLAD leaders and Adults Living with HIV (ALHIV) to assess the experiences and perceptions to participation among People Living with HIV (PLHIV) enrolled in CCLADS and the care providers. Key themes included benefits, limitations, experiences and perceptions of CCLADS. Benefits to ALHIV included: Longer refills, reduced transport costs, receive drugs in time, peer advice; to providers: time saving, less tiresome and reduced congestion at facility. Barriers included: stigma, limited outreaches, failure to comply. Patients perceived the model positively (cost effective, improved quality care, no missed appointment where as others were negative (blood samples not taken like before). Experiences also included enough time, learnt some activities and good adherence. Conclusion: Participation in the CCLADS groups provides several benefits to the patient including reduced transport, longer refills and good adherence. Stigma remains a challenge to CCLADS participation, which requires innovative and collaborative strategies from Ministry of Health (MOH) and implementation partners to address in order to sustain CCLADS participation.

Experiences of HIV Positive Serostatus Disclosure to Sexual Partner Among Individuals in Discordant Couples in Mbarara City, Southwestern Uganda.

Purpose: Disclosure of HIV status is key in HIV management. Despite many studies on serostatus disclosure, there is a gap in experiences regarding HIV status disclosure among discordant couples. The current study addressed this research gap, and explored the lived experiences of serostatus disclosure among discordant couples in Mbarara City, South Western Uganda. Participants and Methods: We conducted 12 in-depth interviews with the help of a translated interview guide, and they were audio recorded. Participants were purposively enrolled in the study, which employed a phenomenological qualitative design. The study was conducted at three public health facilities in Mbarara City. The data was analyzed using thematic content analysis. Approval for this research was obtained from the Mbarara University Research Ethics Committee (MUST-REC) and administrative clearance from the city clerk of Mbarara City. Results: The mean age of the participants was 38 years old, ranging from 20 to 67 years. An equal number of males (six) and females participated in this study. Most of them had at least secondary level education, and only three had primary education. Half of the participants disclosed their serostatus to partners immediately after testing HIV positive. Key emerging themes as experienced benefits of HIV serostatus disclosure included: 1) social support and care; 2) decisions regarding health, fertility, and child bearing; 3) sharing information on HIV prevention and protection measures; 4) positive living; and 5) ease of HIV serostatus disclosure. The challenges associated with serostatus disclosure were summarized as one theme: misunderstandings in the families of the discordant couples. Conclusion: Socially, psychologically and financially HIV positive individuals have benefited from their negative partners. Healthwise, they have been supported, and cared for after disclosing their positive status, but some have faced challenges, such as family misunderstandings. Couple HIV counseling and testing by a trained health worker is beneficial in HIV care and could mitigate the challenges related HIV serostatus disclosure.

Dementia assessment and diagnostic practices of healthcare workers in rural southwestern Uganda: a cross-sectional qualitative study.

BACKGROUND: An estimated 50 million people worldwide have Alzheimer's disease and related dementias (ADRD), and this number is projected to increase with the growth of the aging population, with the largest growth occurring in low and middle-income countries. Diagnostic coverage for dementia is estimated to be only 5-10% in low- and middle-income countries. Timely diagnosis of ADRD could prompt early access to information, medical treatments, and support for caregivers. The aim of this study was to assess how healthcare workers in rural southwestern Uganda assess for and diagnose ADRD. METHODS: We used in-depth interviews to investigate the medical knowledge and clinical practices surrounding ADRD diagnoses among 42 healthcare workers employed at mid-tier health facilities in southwestern Uganda. Qualitative content analysis was used to identify distinct categories and themes. RESULTS: Our findings show that healthcare workers without specific mental health training assessed and diagnosed dementia based on history and physical examination alone. On the other hand, healthcare workers with some specialized training in mental health were more likely to use neuropsychological tests, blood tests, urine tests, and brain imaging in the diagnosis of dementia. Collateral history from caregivers was noted to be very important in proper assessment and diagnosis of dementia among all categories of healthcare workers. The majority of healthcare workers regarded memory loss as part of the normal aging process and reported that it does not need any specific treatment. Other healthcare workers could recognize signs and symptoms of dementia, but focused on managing other medical problems at the expense of assessing cognitive decline and mental health. Diagnostic practices did not differ based on age, years of experience, or gender of the healthcare workers. CONCLUSION: These results indicate that specialized training in mental health among healthcare workers is crucial for the assessment and diagnosis of ADRD in rural southwestern Uganda.