Prevalence and Severity of Premenstrual Syndrome among Female University Students in Central Uganda: A Cross-sectional Study

Background Premenstrual Syndrome (PMS) is characterized by recurrent psychological, behavioural, and/or physical symptoms occurring before menses and usually resolve by the end of or during menstruation. These symptoms usually affect the women’s quality of life and efficiency. Although over 95% of women worldwide suffer from PMS, in Uganda, little is documented about the prevalence and existence of PMS among students. This study, therefore, sought to determine the prevalence and severity of PMS among female university students in Central Uganda. Methodology A cross-sectional study was carried out using a questionnaire between November 2021 and May 2022. The sample of 238 participants was taken from female students in 4 universities who met the inclusion criteria. Sampling was done by proportionate sampling. Primary data was obtained about Premenstrual Syndrome prevalence and severity using modifications of the following tools: The American College of Obstetricians and Gynecologists' diagnostic criteria for PMS; the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-IV) diagnostic criteria for PMDD; and the premenstrual symptoms screening tool (PSST). The data was analysed to obtain descriptive statistics such as frequencies and percentages. A student was considered to be suffering from PMS if they satisfied the DSM-IV criteria for the diagnosis of PMS.  Results The prevalence of PMS among female University students in central Uganda was found to be 28.3% (60). However, at least 76.9% (163) of the respondents suffered at least one or more symptoms of PMS.  Conclusion Over a quarter of female university students suffer from Premenstrual syndrome. Recommendation There is a need to create awareness as well as mobilize social support so that there is help available to the students who suffer PMS

Effects and coping mechanisms associated with Premenstrual Syndrome among female University Students in Central Uganda: A Cross-sectional Study

Background The cyclic nature of Premenstrual Syndrome (PMS) affects those with severe symptoms in ways that make them incapacitated or inefficient every month impairing their quality of life. This problem in Uganda is compounded by the cultural stigma associated with menstruation making it difficult for ladies and communities to address the associated problems. Therefore, this study sought to identify how Premenstrual Syndrome affects the quality of life of female University students in Central Uganda in terms of effects and coping mechanisms.  Methodology A cross-sectional study was carried out using a questionnaire between November 2021 and May 2022. 238 participants from 4 universities who met the inclusion criteria were given self-administered questionnaires on PMS symptoms, effects and coping mechanisms. The data was analysed to obtain frequencies and percentages. Statistically significant associations between PMS and Effects of PMS as well as the Coping mechanism were determined using Chi-square correlations. Results At least 70 (33%) of the 212 respondents reported that the PMS symptoms affected either their school and/or their relationships or their daily activities plus home chores. Statistically significant effects of PMS on school efficiency were: sleeping in class χ2(1, n=212) = 4.957, p=0.026; and being late on assignments χ2(1, n=212) = 6.279, p=0.012. Coping mechanisms that were found to be statistically significantly associated with PMS at α-level of 5% were: hiding or locking self in a room χ2(1, n=212) = 4.846, p=0.028; taking alcohol χ2(1, n=212) = 5.115, p=0.024; seeing a health worker χ2(4, n=212) = 14.201, p=0.007; and taking pain killers χ2(1, n=212) = 5.202, p=0.03. Conclusion PMS was significantly affecting school efficiency of students. Recommendation There are still huge knowledge gaps about PMS that need addressing. Some students reported that they used herbal preparations for PMS symptoms which need to be investigated for potential pharmaceutical development

Social-demographic factors associated with Premenstrual Syndrome among female University students in Central Uganda: A Cross-sectional Study.

Background Premenstrual Syndrome (PMS) is a common disorder among females of reproductive age, which also happens to be the most productive period within the life of a woman. Unfortunately, the aetiology of PMS is still not known; although, the following theories have been proposed to explain PMS symptoms: A genetic predisposition; changes in neurotransmitter levels; or changes in different hormone levels during the menstrual cycle.  In Uganda the factors associated with PMS are hardly documented, making awareness, prevention, and management complicated. The aim of this study, was to determine the social demographic factors associated with PMS among female university students in Central Uganda. Methodology A cross-sectional study was carried out using a self-administered questionnaire between November 2021 and May 2022. 238 female students in 4 universities who consented and met the inclusion criteria participated in the study. Data which was obtained about social demographic characteristics and PMS symptoms was coded and analysed to obtain descriptive statistics and Chi-square correlations.  Results The mean age of the respondents was 22.67±5.595, with most of the respondents (188, 88.7%) being between 19 to 24 years of age, the minimum age was 19 years and the maximum was 55 years. Among this study population, menarche age group χ2(2, n=212) = 7.756, p=0.021, and several menstrual bleeding days χ2(1, n=212) = 5.188, p=0.023 were associated with PMS among the female university students. Conclusion The cause of the PMS among this study population is likely biological as respondents who reported that they started their menses started at age ≤12 years; as well as those whose bleeding days were more than or equal to 5 days were more likely to suffer PMS. Recommendation Studies need to be carried out to investigate the biological causes of PMS to guide management and prevention

Knowledge of integrated management of childhood illnesses community and family practices (C-IMCI) and association with child undernutrition in Northern Uganda: a cross-sectional study

BACKGROUND: Childhood undernutrition is a major challenge in Uganda with a prevalence of wasting and stunting at 5% and 33%, respectively. Community and family practices of the Integrated Management of Childhood Illnesses (C-IMCI) was introduced in sub-Saharan Africa early after the year 2000. C-IMCI was postulated to address major childhood morbidity and mortality challenges with nutrition as one of the outcomes. The association between knowledge patterns of C-IMCI and undernutrition has not been fully established especially in sub-Saharan Africa. This study was done to address the prevalence of stunting and wasting and the association with the knowledge and practices of C-IMCI among caretakers in Gulu district, Northern Uganda. METHODS: This was a community-based cross-sectional study among 442 caretaker-child pairs. A standardized questionnaire was employed to assess the knowledge and practices of the C-IMCI among caretakers including four practices: breastfeeding, immunization, micronutrient supplementation and complementary feeding. Weight and height of children (6–60 months) were recorded. Wasting and stunting were defined as weight-for-height and height-for-age z-score, respectively, with a cut-off < -2 according to the World Health Organization growth standards. Logistic regression analysis reporting Odds Ratios (OR) with 95% confidence intervals (CI) was used to explore associations using SAS statistical software. RESULTS: The percentage of caretakers who had adequate knowledge on C-IMCI (basic knowledge within each pillar) was 13%. The prevalence of wasting and stunting were 8% and 21%, respectively. Caretakers’ lack of knowledge of C-IMCI was associated with both wasting (OR 24.5, 95% CI 4.2-143.3) and stunting (OR 4.0, 95% CI 1.3-12.4). Rural residence was also associated with both wasting (OR = 3.1, 95% CI 1.5-6.5) and stunting (OR = 1.7, 95% CI 1.0-2.7). Children younger than 25 months were more likely to be wasted (OR = 3.3, 95% CI 1.7-10.0). CONCLUSION: We found a low level of overall knowledge of the C-IMCI of 13.3% (n = 59). There is also a high prevalence of childhood undernutrition in Northern Uganda. Caretakers’ limited knowledge of the C-IMCI and rural residence was associated with both wasting and stunting. Interventions to increase the knowledge of the C-IMCI practices among caretakers need reinforcement

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Treatment compliance among adult cervical cancer patients receiving care at Uganda cancer institute, Uganda: a retrospective data review

Abstract Background Cervical cancer is one of the most common cancers and a major cause of morbidity among women globally. Chemoradiation therapy is the preferred standard treatment for women with stage IB to IVA. However, the benefits of this treatment can only be achieved if patients adhere to the treatment guidelines. In this study, the proportion of compliance or adherence to chemo-radiation treatment among cervical cancer patients at Uganda Cancer Institute (UCI) was determined. Methods This was a cross-sectional study that reviewed data retrospectively for 196 cervical cancer patients who were prescribed to chemo-radiation therapy at UCI between November 2020 to May 2021, having been diagnosed with disease stage IB to IVA. Patient data and information on treatment uptake was obtained by review of the patient’s medical records. Treatment compliance was determined by calculating the number of participants who completed the prescribed treatment (definitive pelvic concurrent chemoradiation to 50 Gy external beam radiotherapy with weekly concurrent cisplatin followed by intracavitary brachytherapy 24 Gy in 3 fractions at 8 Gy once a week over 3 weeks). Associations between patient factors and treatment adherence were determined using logistic regression analysis. In all statistical tests, a P- value of < 0.05 was considered as significant. Results The proportion of patients who were administered with external beam radiation (EBRT), chemotherapy and brachytherapy were 82.6%, 52.04% and 66.2% respectively. However, only 23 of 196 patients (11.7%) were found to have adhered to the treatment plan by completion of all definitive pelvic concurrent chemoradiation to 50 Gy external beam radiotherapy (5 weeks) with weekly concurrent cisplatin (5 cycles) followed by intracavitary brachytherapy 24 Gy in 3 fractions at 8 Gy once a week over 3 weeks (3 sessions). There were no significant associations between patient factors and treatment adherence after multivariable analysis. Conclusions Treatment compliance was found in only 12% of the cohort participants. No association of patient factors with treatment compliance was found. Additional studies on treatment adherence with larger sample sizes are needed to confirm the associations

HIV viral load suppression among people with mental disorders at two urban HIV clinics in Uganda: a parallel convergent mixed methods study using the social ecological model

Abstract Background Uganda adopted and implemented the Universal Test and Treat (UTT) guidelines in 2017, which require HIV-infected persons to be initiated on antiretroviral therapy (ART) at any CD4 + cell count, and to be routinely monitored for viral load to assess response to ART. However, there is paucity of data on viral load suppression (VLS) among people living with HIV (PLHIV) with mental disorders. We conducted a parallel convergent mixed methods study to determine HIV VLS among people with a mental disorder and explored the socio-cultural determinants of VLS at Butabika hospital and Mulago (ISS) HIV Clinics in Uganda. Methods We conducted a retrospective medical records review; seven key informant interviews (KII) among purposively selected healthcare providers and 12 in-depth interviews (IDI) among clinically stable PLHIV with a mental disorder. Data was collected on demographics, mental disorder, ART, viral load status, social support, stigma, and disclosure of HIV status. Quantitative data was analysed using descriptive statistics and modified Poisson regression, while Inductive thematic analysis was used for the qualitative data. Results Of the 240 PLHIV with a mental disorder who were enrolled, 161 (67.1%) were female with mean age 38.9 (± 11.2) years. Overall, 88.8% (95% Cl: 84.0 – 92.2%) achieved VLS. Age (aPR = 1.00, 95%Cl = 1.00–1.00), male gender (aPR = 0.90, 95%Cl = 0.82–0.98), divorced (aPR = 0.88, 95%Cl = 0.82–0.94), widowed (aPR = 0.84, 95%Cl = 0.83–0.86), baseline CD4 count < 200 (aPR = 0.89, 95%Cl = 0.85–0.94), psychotic mental disorders (aPR = 1.11; 95%CI = 1.08–1.13) and fair (85–94%) ART adherence level (aPR = 0.69, 95%Cl = 0.55–0.87) and TDF/3TC/DTG (aPR = 0.92; 95%CI = 0.91–0.94) were associated with HIV VLS. Social support from family members, knowledge of impact of negative thoughts on VLS, fear of breaking up with partners and compassionate healthcare providers positively influenced VLS. Stigma and discrimination from the community, self-perceived stigma hindering social relations, socio-economic challenges and psychiatric drug stock-outs negatively affected VLS. Conclusion and recommendations HIV VLS among PLHIV with mental disorders at institutions that provide integrated HIV and mental health care is still below the UNAIDS 95% target. Health promotion messaging focusing on benefits of VLS and countering stigma to create a safe environment; and active involvement of family members in care could improve HIV treatment outcomes for PLHIV with mental disorders

Acceptance of assisted partner notification among HIV-positive adults with severe mental illness at a national referral hospital in Uganda: a cross-sectional study

Abstract Background HIV mostly affects people with severe mental illnesses (SMIs) than the general population. In 2015, the World Health Organization (WHO) introduced assisted partner notification (APN) as a strategy to increase HIV testing. Although research has demonstrated the effectiveness of APN in the general population, its use among people living with HIV (PLHIV) who have SMI is not well understood. This study sought to determine the acceptance of the APN strategy among PLHIV who had a diagnosis of SMI. Methods This study used a cross-sectional study design that was retrospective to determine acceptance of APN among PLHIV with a documented diagnosis of SMI. We enrolled participants with a diagnosis of both HIV and SMI from August 2018 to January 2022, attending the HIV clinic at Butabika Hospital. We used pretested questionnaires to extract participants’ demographic and clinical data from their existing clinical charts, antiretroviral therapy (ART) registers and APN registers. We defined acceptance of APN as the number of PLHIV with SMI diagnoses who agreed to provide information about their sexual partners. We used modified Poisson regression analysis to assess the factors associated with the acceptance of APN. Results A total of 125 participants were enrolled, of whom 83 (66.4%) were female. The median age was 30 (interquartile range (IQR) (25–34)), and 41 (33%) of them accepted APN (95% CI: 25.05–41.61). Receipt of at least three counselling sessions before enrollment in APN (aPR = 1.8, 95% CI: 1.72–1.98) was the most significant factor associated with increased acceptance of APN. Poor adherence to ART (aPR = 0.62, 95% CI: 0.54–0.80), being escorted to hospital by a distant relative (aPR = 0.55, 95% CI: 0.39–0.80), being married/cohabiting (aPR = 0.65, 95% CI: 0.60–0.81), and being a Seventh Day Adventist (SDA) (aPR = 0.53, 95% CI: 0.45–0.71) or Pentecostal (aPR = 0.44, 95% CI: 0.22–0.98) by faith were associated with reduced acceptance of APN. Conclusion and recommendation The acceptance of APN is low among PLHIV with a diagnosis of SMI. More structured counselling would facilitate earlier identification of undiagnosed HIV-positive partners. We recommend a follow-up study to compare acceptance of APN among PLHIV with SMI and those without SMI