Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels

Background: Self-management strategies such as physical activity (PA) can address disability and optimize mental, physical, social and economic outcomes for persons living with HIV (PLWH). Understanding factors that influence PA behavior in PLWH is a first step in order to devise effective interventions.Objective: The present review provides a systematic review of the correlates of PA in PLWH in sub-Saharan Africa.Methods: Electronic databases were searched till April 2016. Keywords included ‘physical activity’ or ‘exercise’ or ‘sports’ and ‘AIDS’ or ‘HIV’.Results: Ten correlates were identified in 6 studies including 1,015 (329♂) PLWH (mean age range=30.5-40.8years). Lower levels of PA were associated with older age (2/2 studies), a lower number of CD4 cells/μl (1/1), a more severe HIV-stage (1/1), a higher HIV load (1/1), the presence of opportunistic infections (1/1) and a higher BMI (1/1). Fisher’s exact tests showed there were more significant correlates in objective tools versus subjective self-report (P=0.03).Conclusion: The current review shows that participation in PA by PLWH in sub-Saharan Africa is associated with a range of complex factors which should be considered in the daily care of PLWH. This however might require repackaging of the current interventions for PLWH to allow a focus on PA.Keywords: Physical activity, exercise, physiotherapy, AIDS, HIV

Short-Term Debt and Financial Performance of Small and Medium Scale Enterprises in Buganda Region, Uganda

Short-term debt is regarded as an important source of financing for Small and Medium-sized enterprises (SMEs). This is because it can be easily accessed and useful during times of emergent working capital shortage. However, short-term debt is the least researched among the components of capital structure, which explains why its contribution to the financial performance of small and medium-sized businesses still lacks empirical validation especially in the Ugandan context. This paper sought to determine the effect of short-term debt on financial performance of Small and Medium Enterprises in Uganda. The study adopted a descriptive cross-sectional research design to collect and analyse the data. Stratified random sampling technique was used to select SMEs while purposive sampling technique was used to select one key respondent from each of the sampled 453 SMEs in Uganda. Primary data was collected using survey questionnaire. Data was analysed using descriptive statistics and simple linear regression analysis. The findings indicted that short-term debt had a negative and significant effect on financial performance of SMEs as measured by return on assets. The study provides empirical evidence to support the propositions in the extant literature that short-term debt significantly hampers financial performance of SMEs. The study recommends that SMEs should adopt low cost operation procedures to improve profitability. This would lead to accumulated profits that can be used for investment purposes as a means of driving growth among the SMEs without resorting to borrowing. This paper suggests that further research should be conducted to establish the justification for the negative and significant effect of short-term debt on financial performance using qualitative approaches

The experiences of caregivers of children living with HIV and AIDS in Uganda: a qualitative study.

BACKGROUND: Home-based care for HIV patients is popular in contexts severely affected by the epidemic and exacts a heavy toll on caregivers. This study aimed at understanding the experiences of caregivers and their survival strategies. METHODS: A total of 18 caregivers (3 males and 15 females) were interviewed using a semi-structured interview guide, and thematic analysis was used to analyse the data. RESULTS: Analysis suggests that the caregivers are burdened with insecure provisions for food and difficulties in accessing health care. They however survived these strains through managing their relationships, sharing burden with care-recipients, social networks and instrumental spirituality. These findings are discussed under two major themes: 1). Labour of caregiving and 2). Survivalism. CONCLUSIONS: Home-based care presents huge opportunities for community response to the HIV/AIDS epidemic in African settings. It is however burdensome and thus should not be left for families alone to shoulder. There is therefore an urgent need for protecting home-based care for HIV children in Uganda. Implications for improving and strengthening social interventions in home-based care of HIV/AIDS in the Ugandan context are addressed

Growing up HIV-positive in Uganda: "psychological immunodeficiency"? A qualitative study.

BACKGROUND: This study is part of a longitudinal study among children and adolescents with HIV in both urban and rural Uganda: 'Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (CHAKA)'. METHOD: The study is constructed of both quantitative and qualitative components. In this article we report a qualitative study on the experiences of 21 adolescents (twelve to seventeen years) living with HIV in Uganda. The purpose of the study was to investigate both the protective and the risk factors in HIV-infected adolescents' care environment in order to understand what might contribute to negative outcomes and what might provide a protective buffer against harmful life events. Semi-structured interviews with vignettes about mental disorders were employed and a phenomenological analysis was done. RESULTS: The findings uncovered that the adolescents' families were mostly characterized by instability and diffuse relationships that provided an insecure basis for secure attachment and emotional support. Even in stable and secure family environments, there was no guarantee for getting sufficient emotional support in order to develop a positive self-concept due to the fate being the only infected child in the family. Both secure attachment and positive self-concept are known psychological protective mechanisms that provide the individual with resilience. The adolescents in this study seemed hampered in the development of protective mechanisms and consequently seemed psychologically vulnerable and badly equipped for coping with challenges, which paves the way for the possible development of mental disorders. CONCLUSION: To change the focus towards strengthening the children and adolescents' development of psychological protective mechanisms implicates a change in focus from illness to health and has consequences for both treatment and prevention. Psychological health promotion must be systemic and aim at strengthening the family environment, but also to establish peer group support

Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels

Background: Self-management strategies such as physical activity (PA) can address disability and optimize mental, physical, social and economic outcomes for persons living with HIV (PLWH). Understanding factors that influence PA behavior in PLWH is a first step in order to devise effective interventions. Objective: The present review provides a systematic review of the correlates of PA in PLWH in sub-Saharan Africa. Methods: Electronic databases were searched till April 2016. Keywords included \u2018physical activity\u2019 or \u2018exercise\u2019 or \u2018sports\u2019 and \u2018AIDS\u2019 or \u2018HIV\u2019. Results: Ten correlates were identified in 6 studies including 1,015 (329&42) PLWH (mean age range=30.5-40.8years). Lower levels of PA were associated with older age (2/2 studies), a lower number of CD4 cells/\u3bcl (1/1), a more severe HIV-stage (1/1), a higher HIV load (1/1), the presence of opportunistic infections (1/1) and a higher BMI (1/1). Fisher\u2019s exact tests showed there were more significant correlates in objective tools versus subjective self-report (P=0.03). Conclusion: The current review shows that participation in PA by PLWH in sub-Saharan Africa is associated with a range of complex factors which should be considered in the daily care of PLWH. This however might require repackaging of the current interventions for PLWH to allow a focus on PA

The experience of mental health service users in health system strengthening: lessons from Uganda.

BACKGROUND: Mental, neurological and substance use disorders are a public health burden in Uganda. Mental health service user involvement could be an important strategy for advocacy and improving service delivery, particularly as Uganda redoubles its efforts to integrate mental health into primary health care (PHC). However, little is known on the most effective way to involve service users in mental health system strengthening. METHODS: This was a qualitative key informant interview study. At national level, 4 interviews were conducted with national level health workers and 3 service user organization representatives. At the district level, 2 interviews were conducted with district level health workers and 5 service user organization representatives. Data were analyzed using content thematic analysis. FINDINGS: Overall, there was low mental service user participation in health system strengthening at both national and district levels. Health system strengthening activities included policy development, implementation of programs and research. Informants mentioned several barriers to service user involvement in mental health system strengthening. These were grouped into three categories: institutional, community and individual level factors. Institutional level barriers included: limited funding to form, train and develop mental health service user groups, institutional stigma and patronage by founder members of user organizations. Community level barriers included: abject poverty and community stigma. Individual level barriers included: low levels of awareness and presence of self-stigma. Informants also recommended some strategies to enhance service user involvement. CONCLUSION: The Uganda Ministry of Health should develop a strategy to improve service user participation in mental health system strengthening. This requires an appreciation of the importance of service users in improving service delivery. To address the barriers to service user involvement identified in this study requires concerted efforts by the Uganda Ministry of Health and the district health services, specifically with regard to attitudes of health workers, dealing with stigma at all levels, raising awareness about the rights of service users to participate in health systems strengthening activities, building capacity and financial empowerment of service user organizations

Prevalence of suicidal ideation and attempt: associations with psychiatric disorders and HIV/AIDS in post-conflict Northern Uganda.

BACKGROUND: Research on the prevalence of suicidal ideation, attempt, and cormorbid psychiatric disorders in post-conflict areas is still limited. AIM: We explored the prevalence of suicidal ideation, attempt, associated psychiatric disorders and HIV/AIDS in post-conflict Northern Uganda, an area that experienced civil strife for over two decades. METHODS: A total of 2400 respondents (aged 18 and above) and randomly selected in three districts (Gulu, Amuru and Nwoya), were interviewed. Multivariable logistic regression was used to assess for associations between suicidality (suicidal ideation and attempt) and psychiatric cormorbidities. RESULTS: The prevalence of suicidal ideation and attempt were 12.1 % and 6.2 % respectively. Suicidality was significantly (P<0.001) higher among respondents with major depressive disorder (adjusted Odds Ratio (OR) = 9.5; 95%CI= 7.4, 12.1) and post-traumatic stress disorder (adjusted OR =2.4; 95%CI= 1.6, 3.6). Men had lower odds of ideating or attempting suicide compared to women (adjusted OR = 0.55; 95%CI: 0.38, 0.82). CONCLUSION: The prevalence rate of suicide ideation and attempt indicate a major public health problem in post-conflict Northern Uganda. Effective public mental health programs that that target both suicidality and psychiatric co-morbodities will be vital. Special attention should be given to women in post conflict Northern Uganda

Participatory Evaluation of Common Bean for Drought and Disease Resilience Traits in Uganda

The use of genetic resources to respond to occurring and unpredictable climatic changes is one of the coping mechanisms for small scale farmers in Africa. This paper summarizes findings of a participatory action research (PAR) project evaluating different common bean (Phaseolus vulgaris) varieties with nine farmer groups across nine villages in two CCAFS sites of Rakai and Hoima districts in Uganda. Six and fifteen bean varieties including local landraces, farmer variety (commonly grown by farmers), Uganda officially released varieties and new germplasm bearing different characteristics were evaluated with over 300 farmers in replicated trials in the first season of 2012, and two seasons of 2013, respectively. The study provides evidence that breeders and farmers look out for similar traits, with yield being the major driver, and in most cases end up with the same results with a few discrepancies. Some key lessons emerged from the findings. First, making blanket variety and management recommendations to cover large physical areas is erroneous. Site and context specific recommendations, especially in the view of the variability in climatic conditions and soils are probably the best option. Second, the results highlight the need for plasticity in bean varieties (i.e. ability to change structure and function when exposed to changes in the environments hence suitability to a wide range of environments) in addition to having farmer preferred traits. Lastly, the project also highlighted the ability, capacity and willingness of farmers to adopt and adapt new technologies in the face of varying climate scenarios

A quantitative assessment of the views of mental health professionals on exercise for people with mental illness: perspectives from a low-resource setting

Background: Exercise is nowadays considered as an evidence-based treatment modality in people with mental illness. Nurses and occupational therapists working in low-resourced mental health settings are well-placed to provide exercise advice for people with mental illness. Objectives: We examined the current exercise prescription practices employed by Ugandan health care professionals when working with people with mental illness, and identified perceived barriers to exercise prescription and exercise participation for people with mental illness. Methods: In this study, 31 Ugandan health care professionals 20 men; 31.2 ± 7.1 years completed the Exercise in Mental Illness Questionnaire– Health Professionals Version EMIQ-HP. Results: The vast majority of the respondents 29/31, 94% reported they prescribed exercise at least "occasionally" to people with mental illness. Exercise-prescription parameters used were consistent with those recommended for people with mental illness. Regarding barriers to exercise participation, coping with side effects of psychotropic medication at the individual level and reducing stigma at community level should be prioritized. Conclusion: A health care reform to enable collaboration with exercise professionals, such as exercise physiologists or physiotherapists, might increase exercise uptake for people with mental illness, thereby improving health outcomes for this vulnerable population