Post traumatic stress disorder among former child soldiers attending a rehabilitative service and primary school education in northern Uganda.

Background: This study was prompted by the psychiatric hospitalization of 12 former child soldiers of the Lord's Resistance Army (LRA) at a rehabilitation school in northern Uganda with a case of mass psychotic behavior. Objectives: To report the prevalence of post-traumatic stress disorder, depressed mood, and associated risk factors. Methods: Data on post-traumatic stress disorder, depressed mood, physical disabilities, socio-demographic variables, and the children's war experiences were collected in face-to-face interviews using the Harvard Trauma Questionnaire (HTQ), a modified Hopkins Symptoms Check-List (HSCL), and a 15-item War Trauma Experience Check-list (WTECL-15). Data was analyzed with SPSS version 11.0. Results: There were 58 girls and 44 boys. Eighty nine children (87.3%) reported having experienced ten or more war-related traumatic psychological events; 55.9% of the children suffered from symptoms of post-traumatic stress disorder, 88.2%, symptoms of depressed mood and 21.6% had various forms of physical disability. Nearly half of the children (42.2%) reported a positive family history of severe mental illness; 10.8%, a family history of suicide; 22.5%, a family history of suicide attempt; and 45.1%, a family history of alcohol abuse. Children who experienced 10 or more traumatic war events were more likely than the rest to experience depressed mood. Return through a reception center or through a cleansing ritual did not protect against depression. Discussion: Post-traumatic stress disorder among former LRA child soldiers at a rehabilitation centre in northern Uganda is presented. The report highlights the huge unmet need for psychological services among former child soldiers of the LRA. African Health Sciences Vol. 8 (3) 2008: pp. 136-14

The use of electroconvulsive therapy in the treatment of psychiatric illness at Umzimkulu Hospital in Transkei A retrospective study

Out of 1816 patients admitted to Umzimkulu Hospital between 1976 and 1982, 378 (20,8%) received electroconvulsive therapy (ECT) in combination with drugs. The use of ECT at this hospital is described and comparisons are made between ECT and non-ECT patients using length of stay in hospital as the criterion variable. The percentage of patients receiving ECT dropped from 32% in 1976 to 6% in 1982, when it was discontinued. ECT patients tended to be slightly younger and stayed in hospital a few days more. There was a tendency for all groups of patients, male v. female, first admissions v. previously admitted, to stay in hospital slightly longer if they received ECT. It is suggested that the use of ECT in addition to neuroleptics was probably a reflectio!l of the severity of symptomatology

Cohort profile: mental health following extreme trauma in a northern Ugandan cohort of War-Affected Youth Study (The WAYS Study).

War experiences are associated with the risk of long-term mental health problems. The War-affected Youths (WAYS) Study comprises a cohort of 539 youths (61% female) aged between 18 to 25 (at baseline) randomly sampled from the population of war-affected youths in northern Uganda. The study aims to chart the trajectory of long-term mental health consequences of war and the roles of individual, family, and community contextual risk and protective factors in influencing the course of mental health using Social Ecology Model, thus, addressing both the individual and its social ecology. Knowledge of postwar contexts may inform policy and guide interventions on postwar psychosocial adjustment and reintegration in conflict-prone Great Lakes region of Africa (Rwanda, Burundi, DR Congo, Uganda, Central African Republic, and South Sudan). Two waves of data collection have been conducted and more data collection is planned. At baseline, information on demographic characteristics, pre-war experiences, psychosocial outcomes, coping, stigma/discrimination, family and community acceptance and relationship, family functioning, and post-war experiences were obtained. At follow-up, information on general health, gender-based violence, PTSD, social skills, trauma memory quality, rumination, self-esteem, and psychosocial outcomes were collected. Approval to access the data can be obtained on application to the Principal Investigator upon submission of a research proposal with ethical approval from the applicant's institution. This research is funded by Wellcome Trust and Gulu University.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

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

Correlates of Suicide Ideation and Attempt among Youth Living in the Slums of Kampala

While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14–24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23–4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16–3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09–3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20–4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12–6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53–4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11–3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30–7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25–3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed

Sexual violence and general functioning among formerly abducted girls in Northern Uganda: the mediating roles of stigma and community relations--the WAYS study.

BACKGROUND: Although sexual violence in war is associated with long-term mental health problems, little is known about its association with general functioning and the factors that explain this association. This study aims to illuminate the path from sexual violence to poor functioning. The prevalence of sexual violence among formerly abducted girls in Northern Uganda was assessed as well as the extent to which stigma and community relations explain the association between sexual violence and general functioning. METHOD: In a cross-sectional analysis using data from the WAYS study (N = 210, baseline age 22.06, SD = 2.06, minimum-maximum 18-25), the extent of mediation of the association between sexual violence and general functioning was assessed in multiple regression models. RESULTS: Sexual violence was found to be associated with increased stigma, poor community relations, and poor general functioning. The association between sexual violence and general functioning was mediated by stigma and community relations. The bootstrap results indicated significant mediation by stigma of 47 % (95 % confidence interval [CI] 35 to 78 % and by community relations of 67 % (95 % CI: 52 to 78 %) in the association between sexual violence and general functioning. CONCLUSION: Thus, poor functioning among formerly abducted girls is largely mediated by stigma and poor community relations. However, due to the relatively small effect sizes of the associations, targeted interventions to prevent impaired functioning may have only modest benefits to the formerly abducted girls. Interventions to alleviate the toxic effects of sexual violence in formerly abducted girls would benefit from a holistic approach that targets stigma and poor relationships within communities

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.Keywords: Taenia solium, cysticercosis, neurocysticercosis, antigen, immunoblo

Lay Counselors’ Mental Wellness in Suicide Prevention after Prolonged Mass Trauma: A Pre- and Post-Training Appraisal

Information on the mental wellness of lay counselors in Uganda is unavailable. Sixty representatives of three sub counties in Gulu District in Northern Uganda were equipped with counseling skills through 40 hours of training over 5 days. The trainees completed the 32-item Response Inventory for Stressful Life Events (RISLE) immediately before the commencement of the training and soon after the completion of the training. Pretest prevalence of suicide ideation was 9.3%, and posttest prevalence was 11.1%. Immediate post-training assessment showed better overall mental wellbeing as judged by overall RISLE scores, which were statistically significantly lower post-training than pre-training for gender (P = 0.05) and marital status (P = 0.001) on most RISLE scores. Qualitative assessment after 3 months of training showed that trainees were less suicidal, and they had improved psychosocial functioning. The current results point to the need to pay attention to the mental wellness of volunteer counselors and support them in their role in preventing suicide in areas of mass trauma. We recommend robust randomized community trials to determine the role of the mental wellbeing of volunteer lay counselors in the provision of psychological first aid to communities exposed to prolonged mass trauma