Emotional And Behavioural Disorders In HIV Seropositive Adolescents In Urban Uganda

Objective: To investigate the emotional and behavioral problems of HIV sero-positive adolescents.Design: A cross-sectional descriptive study.Setting: A specialised HIV/ AIDS Health Care Centre, the Mildmay Centre, in Kampala, Uganda.Subjects: Eighty two HIV sero-positive adolescents were consecutively enrolled for the study.Results: Over half (55.6%) of the subjects were females. They were mostly (88.9%) under the age of 15 years, orphans (97.6%) and stayed with non-parental relatives (68.3%). Almost two thirds (60.9%) of them were in the HIV/ AIDS clinical disease stage III or IV and were not on ARVs drugs. Forty two (51.2%) of the subjects had significant psychological distress (SRQ-25 scores > 6) and 14 (17.1 %) had attempted suicide within the last 12 months. Their specific psychiatric disorders, made usingICD-10 criteria, were: Anxiety 45.6%, depression 40.8%, somatisation 18.0%, seizures 8.4%, mania 1.2% and HIV-associated progressive encephalopathy 4.8%.Conclusion: HIV/AIDS infection in adolescence was associated with considerable psychological problems and the presence of major psychiatric disorders. With the current increasing availability of effective antiretroviral therapy, many of these children are surviving into adolescence, thus calling for the development of adolescent friendly HIV medical and psychological support and treatment services in developing countries such as Uganda

A comparison of the clinical features of depression in HIV-positive and HIV-negative patients in Uganda

Objective: Depressive illness is the most common psychiatric disorder in HIV/AIDS with prevalence 2 to 3 times higher than the general population. It’s still questionable whether HIV related depression is clinically different from depression in HIV-negative populations, a fact that could have treatment implications.This study compared the clinical features of major depression between HIV-Positive and HIV-negative patients with a view to intervention strategies. Method: A comparative, descriptive, cross-sectionalstudy was carried out on 64 HIV-Positive depressed patients and 66 HIV-negative depressed patients in Butabika and Mulago hospitals. They were compared along the parameters of clinical features of depression, physical examination and laboratory findings. Pair wise comparisons, logistic regression and Multivariate analysis were done for the two groups on a number of variables. Results: Compared to HIV-Negative patients, HIV-Positive patients were more likely to be widowed ; older (≥ 30years), less likely to have a family member with a mental illness; a later onset of depressive illness (≥30years); more likely to have a medical illness and taking medication before onset of depressive, symptomatically compared to HIV-Negative patients, HIV-Positive patients were more critical of themselves ; had significantly more problems making decisions ; had poorer sleep; felt more easily tired; more appetite changes; more cognitive impairment. Low CD4 counts were not significantly associated with depression, but HIV related depression was more likely to occur in stages II and III illness. Conclusion: These findings show that the clinical and associated features of depression differ between HIV-Positive and HIV-Negative patients, thus requiring different management approaches and further studies related to HIV-related depression.Key words: Clinical features; Depression; HIV/AIDS; Ugand

The core competencies for mental, neurological, and substance use disorder care in sub-Saharan Africa.

The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated with providing MNS disorder care. In 2012, the Neuroscience Forum of the Institute of Medicine convened a meeting of key stakeholders in Kampala, Uganda, to discuss a set of candidate core competencies for the delivery of mental health and neurological care, focusing specifically on depression, psychosis, epilepsy, and alcohol use disorders. This article discusses the candidate core competencies for non-specialist health workers and the complexities of implementing core competencies in low- and middle-income country settings. Sub-Saharan Africa, however, has the potential to implement novel training initiatives through university networks and through structured processes that engage ministries of health. Finally, we outline challenges associated with implementing competencies in order to sustain a workforce capable of delivering quality services for people with MNS disorders

Prevalence and types of cognitive impairment among patients with stroke attending a referral hospital in Uganda

Background Cognitive impairment is associated with short and long term adverse outcomes in stroke patients that may impair functional recovery during their rehabilitative process.Aims This study determined the prevalence, grades and demographic factors associated with cognitive impairment among patients with stroke attending Mulago National Referral Hospital in Uganda, a teaching hospital for Makerere University College of Health Sciences.Methods This was a cross-sectional descriptive study conducted from Mulago National Referral Hospital between June 2006 and March 2007. Eighty five patients with stroke confirmed by brain computed tomography scan, consenting either by themselves or by their guardians, were consecutively recruited from the Medical wards, Neurology clinic and the Physiotherapy department. A standardized questionnaire was interviewer administered, to obtain demographic and clinical data, and the Mini-Mental State Examination instrument was used to screen and grade cognitive impairment.Results Of the 85 patients evaluated, 70 (82.4%) had infarct and 15 (17.6%) hemorrhagic stroke. Fifty-four (63%, 95% confidence interval (CI): 53 - 73) had cognitive impairment; of which 23 (27%) and 14 (16%) had mild and moderate cognitive impairment respectively accounting for 43% of the cognitively impaired but with no dementia, and 17 (20%) had severe cognitive impairment (dementia). The only socio-demographic factor associated with cognitive impairment was age . 40 years (odds ratio (OR) 4, 95% CI 1.2 - 13.4, P = 0.024). Conclusions The prevalence of cognitive impairment among patients with stroke is high. Increasing age is significantly associated with cognitive impairment. There is need for neurocognitive assessment programs among stroke patients and the introduction of rehabilitation services should target to maximize their functional recovery

The role of psycho-education in improving outcome at a general hospital psychiatry clinic in Uganda

Objective: While psychoeducation has been shown to positively affect outcomes in psychiatric disorders, its utility has been little studied in developing countries. The current study sought to examine the role of psychoeducation at a general psychiatric outpatient clinic in Kampala, Uganda in improving clinic attendance, treatment adherence, and clinical outcomes. Method: A prospective casecontrol study using a quasi-experimental design was conducted in 117 patients suffering various psychiatric disorders. Participants were recruited for two months and then followed for a further three months after recruitment ended. Participants in the intervention group received formalized psychoeducation sessions at each clinic visit in addition to the usual psychiatric evaluation and care. Participants in the control group received the usual clinical care. Measured outcomes were knowledge of mental illness, compliance with medications and follow-up, and Clinical Global Impression (CGI). Results: The groups did not differ with respect to sociodemographiccharacteristics or attendance at scheduled follow-up visits. Both groups significantly improved on the CGI, but with no significant difference between the groups. However, the intervention group was more likely to adhere to medication, and their knowledge of mental illness was significantly higher at follow-up. Conclusion: These data suggest that psychoeducation is a beneficial mental health intervention in a developing country that may increase compliance with medication and result in greater knowledge of mental illness. However, other factors such as distance from a centralized clinic or cost of treatment may impact outcomes, including attendance at scheduled follow-up visits.Keywords: Low and middle income countries; Outpatient treatment; Psychosocial interventions; Transcultural Psychiatry; Africa;  Psychoeducatio

Effect of HIV infection on time to recovery from an acute manic episode

E Nakimuli-Mpungu1,2,3, B Mutamba2,3, S Nshemerirwe2,3, MS Kiwuwa4, S Musisi21Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; 2Department of Psychiatry, Makerere College of Health Sciences, School of Medicine, Kampala; 3Butabika National Referral Mental Hospital, Ministry of Health, Kampala; 4Clinical Epidemiology Unit, Makerere College of Health Sciences, School of Medicine, Kampala, UgandaIntroduction: Understanding factors affecting the time to recovery from acute mania is critical in the management of manic syndromes. The aim of this study was to determine the effect of HIV infection on time to recovery from acute mania.Methods: We performed a retrospective study in which medical charts of individuals who were treated for acute mania were reviewed. Survival analysis with Cox regression models were used to compare time to recovery from an acute manic episode between human immunodeficiency virus (HIV)-positive individuals and HIV-negative individuals.Results: Median survival time was one week for HIV-positive individuals and more than four weeks for HIV-negative individuals (Χ2 = 18.4, P value = 0.000). HIV infection was the only marginally significant independent predictor of survival probability on the acute admission ward (hazards ratio 2.87, P = 0.06).Conclusion: Acute mania in HIV-infected persons responds faster to psychotropic drugs compared with that in HIV-negative persons.Keywords: HIV-related mania, bipolar disorder, HIV infection, Uganda, immunodeficiency viru

Vitamin C as well as β-carotene attenuates experimental liver fibrosis after intoxication with carbon tetrachloride in rats

The therapeutic effects of vitamin C and β-carotene on chronic liver diseases have not yet been fully demonstrated and their application as dietary intakes or supplements lacks strong experimental backing. We aimed at investigating the therapeutic efficacy of these vitamins on hepatic fibrogenesis caused by carbon tetrachloride (CCl4)-intoxication in rats. Four groups of albino rats were used: group 1 (control) received only saline, whereas groups 2-4 were injected intraperitoneally with 0.5 mL/kg body weight CCl4 every 3 days plus pentobarbital (0.3 mg/L) in drinking water for 10 weeks; after which CCl4 and pentobarbital were stopped and the animals in group 2 were allowed to rest, while those in groups 3 and 4 were treated with intramuscular injections (100 mg/kg/day) of vitamins C and β-carotene, respectively, for further 2 weeks. CCl4 plus pentobarbital resulted in well established fibrosis associated with notable steatosis and ballooning. Treatment with vitamin C or β-carotene modulated CCl4-induced liver pathology, as reflected by significantly lower histological scores (p<0.05). Vitamin C intervention was also associated with significantly lower levels of liver enzymes, unlike β-carotene. We conclude that compared to β-carotene, vitamin C significantly ameliorated both biochemical and histological changes in CCl4-induced liver disease and that both vitamins separately attenuated liver fibrosis.Keywords: Albino rats, liver enzymes, hepatic fibrosis, histological scores, CCl

Implementation and Scale-Up of Psycho-Trauma Centers in a Post-Conflict Area: A Case Study of a Private–Public Partnership in Northern Uganda

As one article in an ongoing series on Global Mental Health Practice, Etheldreda Nakimuli-Mpungu and colleagues describe a private-public partnership that implemented and scaled psycho-trauma centers in Northern Uganda

War related sexual violence and it's medical and psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional study

BACKGROUND: Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting.This paper examines the specific long term health consequences of war related sexual violence among rural women living in two internally displaced person's camps in Kitgum district in war affected Northern Uganda who accessed the services of an Isis-Women's International Cross Cultural Exchange (Isis-WICCE) medical intervention. METHODS: The study employed a purposive cross-sectional study design where 813 respondents were subjected to a structured interview as part of a screening procedure for an emergency medical intervention to identify respondents who required psychological, gynaecological and surgical treatment. RESULTS: Over a quarter (28.6%) of the women (n = 573) reported having suffered at least one form of war related sexual violence. About three quarters of the respondents had 'at least one gynaecological complaint' (72.4%) and 'at least one surgical complaint' (75.6%), while 69.4% had significant psychological distress scores (scores greater than or equal to 6 on the WHO SRQ-20). The factors that were significantly associated with war related sexual violence were the age group of less than or equal to 44 years, being Catholic, having suffered other war related physical trauma, and having 'at least one gynaecological complaint'. The specific gynaecological complaints significantly associated with war related sexual violence were infertility, chronic lower abdominal pain, abnormal vaginal bleeding, and sexual dysfunction. In a multivariable analysis the age group of less than or equal to 44 years, being Catholic and having 'at least one gynaecological complaint' remained significantly associated with war related sexual violence. CONCLUSION: The results from this study demonstrate that war related sexual violence is independently associated with the later development of specific gynaecological complaints

Grand Challenges: Improving HIV Treatment Outcomes by Integrating Interventions for Co-Morbid Mental Illness.

In the fourth article of a five-part series providing a global perspective on integrating mental health, Sylvia Kaaya and colleagues discuss the importance of integrating mental health interventions into HIV prevention and treatment platforms. Please see later in the article for the Editors' Summary