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Background Armed conflict in Africa has led to displacement of over 24.2 million people, more than 1.4 million of whom are living in Uganda. Studies show that refugees living in Ugandan refugee settlements are at increased risk for post-traumatic stress disorder. However data on the prevalence of other mental health problems among refugees including depression, anxiety and substance use disorder among refugees in Uganda is lacking. Our aim was to determine the prevalence of post-traumatic stress disorder, its main psychiatric comorbidities and perceived psychosocial needs among refugees in Nakivale refugee camp. Methods We conducted a cross-sectional survey of refugee camp residents ( n  = 387) from nine different countries of origin. Psychiatric disorders were assessed using the MINI International Neuropsychiatric Interview (MINI) and perceived needs by the Humanitarian Emerging Settings Perceived Needs Scale (HESPER). Results The prevalence of psychiatric disorders was high among refugees as was the level of perceived needs. The most prevalent psychiatric disorders were generalized anxiety disorders (73%), post-traumatic stress disorder (PTSD) (67%), major depressive disorder (58%) and substance use disorders (30%). There was a higher level of comorbidity between PTSD and substance use disorder (OR = 5.13), major depressive disorder (OR = 4.04) and generalized anxiety disorder (OR = 3.27). In multivariate analysis, PTSD was positively associated with the perception of stress as a serious problem (OR = 6.52; P -value = 0.003), safety and protection for women in the community (OR = 2.35; P-value = 0.011), care for family (OR = 2.00; P-value = 0.035) and Place to live in (OR = 1.83; P-value = 0.04). After applying the Bonferroni correction, the perception of stress remained significantly associated with PTSD. Conclusion Our findings suggest a strong association between PTSD, its main comorbidities and basic needs in Nakivale refugee camps. Mental health support should include psychological interventions as well as social assistance to improve the health of refugees.

The prevalence of post-traumatic stress disorder (PTSD) and its risk factors among adult refugees in the context of war-related forced migration is well established. However, reliable data are lacking on war-related trauma among refugee children and adolescents residing in refugee settlements. This study estimated the magnitude of PTSD and its associated factors among children and adolescents in Nakivale refugee settlement, south-western Uganda. We conducted a cross-sectional quantitative study among 325 adolescent (10-19-year-old) refugees, who were selected using a simple random sampling approach. The presence of PTSD was assessed by the Mini-International Neuropsychiatric Interview for Children and Adolescents. The main predictor variables were assessed by structured checklists for war trauma and post-migration using Kobol collect software. Data were exported to Stata 23 for analysis. The prevalence of PTSD was computed using descriptive statistics. Bivariate and multivariate logistic regression analyses were used to determine factors associated with PTSD. The prevalence of PTSD in our study was 83% (269/325, 95% CI 0.782-0.867). Factors associated with PTSD included post-migration difficulties (OR = 4.11, 95% CI 2.52-8.43,  < .001) and exposure to war-related trauma (OR = 2.23, 95% CI 1.16-4.261,  = .016). The high prevalence of PTSD in our sample of refugee children and adolescents is associated with both war trauma and post-migration difficulties. This information is important for the psychological assessment and treatment of the children and adolescents living in the refugee settlement. Identification of potentially modifiable factors in post-migration conditions and acknowledgement of the effects of conflicts on health are of high priority from both societal and global perspectives.

Although psychiatric comorbidities are common among trauma-exposed individuals with PTSD, their patterns and covariates among refugee adolescents in low-resource settings remain understudied. This study aimed to identify distinct patterns of psychiatric comorbidities and their associated factors among adolescent refugees with PTSD in Nakivale refugee settlement, Uganda. In this cross-sectional study, 325 refugee youth were assessed on various PTSD psychiatric comorbidities and covariates of (age, gender, war trauma, post-migration stressors) using MINI International Neuropsychiatric Interview 7.02 and standardized measures of war trauma and post-migration stressors. Latent class analysis (LCA) was used to identify patterns and covariates of comorbidity. Of 269 adolescents with PTSD, 97% had at least one comorbid disorder: panic disorder (88.9%), generalized anxiety disorder (84%), agoraphobia (75.1%), depressive disorder (62.8%), obsessive compulsive disorder (60.6%), attention deficit disorder (43.9%), oppositional defiant disorder (40.9%), conduct disorder (33.8%), and alcohol use disorder (10.8%). LCA revealed three classes: low-moderate comorbidity (n = 66, 24.5%), high internalizing comorbidity (n = 101, 37.5%) with high probabilities of depression and anxiety disorders, and high overall comorbidity (n = 102, 37.9%) with relatively high probabilities of all disorders. The high overall comorbidity class had more girls than the other two classes. Both high comorbidity classes had higher war trauma and post-migration stressors than the low-moderate comorbidity class. Adolescent refugees with PTSD exhibit high psychiatric comorbidity that clusters in distinct patterns. These findings highlight the need for interventions that address the identified comorbidity patterns, consider gender disparities, and account for cumulative trauma and post-migration stressors to effectively support traumatized youth. •Almost all adolescent refugees with PTSD had at least one comorbid disorder.•Three classes: Low-moderate, high internalizing and high overall PTSD comorbidity.•High overall comorbidity had most girls and highest war trauma exposure.•Higher trauma & post-migration stressors in high internalizing vs. low-moderate class.•Both high comorbidity classes did not differ in post-migration stressors.

Worldwide, children who grow up under adverse conditions risk the development of mental health problems. However, reliable data on the estimated magnitude of mental disorders of PTSD, depression and their associated factors among maltreated children and adolescents in low- and middle-income-countries (LMICs) is still lacking. This study estimated the magnitude of PTSD, depression and the associated factors among the children and adolescents with ahistory of maltreatment in Southwestern Uganda. Children with a history of maltreatment are likely to meet depression and PTSD diagnosis that is associated with factors such as witnessing intimate partner violence, living in multiple homes, having been cared for by none relatives and being female. In this cross-sectional study, we assessed 232 children and adolescents on the prevalence of PTSD using Child PTSD Symptoms Scale for DSM-5 - Self-Report (CPSS-VSR) and Depression using the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Predictor variables were taken from the Maltreatment and Abuse Chronology of Exposure- Paediatric Version (Pedi MACE). Logistic regressions analyses were selected for statistical modelling while odds-ratios were calculated to assess the strength of associations between the predictor and outcome variables. In total, 140 (60%) participants fulfiled diagnostic criteria for PTSD and 91 (39%) for depression respectively. Predictor variables of PTSD were witnessing intimate partner violence (OR = 1.48, 95% CI: 1.19-1.83, p = <0.001), having lived in more than two homes (OR = 2.69, 95%CI: 1.34-5.41, p = .005), and being cared for by non-relatives (OR = 2.25; 95%CI: 2.26-223.9, p = .008). Variables predicting depression were witnessing intimate partner violence (OR = 1.30; 95%CI: 108-1.57, p = .006); being cared for by non-relatives (OR = 5.62, 95%CI: 1.36-23.1, p = .001) and being female (OR = .054, 95% CI: 0.30-1.00, p = .005). Children living under adverse conditions are at a higher risk of developing PTSD and depression. We recommend interventions that aim at reducing adverse psychosocial stressors so as to improve or restore the children's mental health.Abbreviations: PTSD: Post traumatic stress disorder; LMICs: Low- and middle-income countries; IPV: Intimate partner violence; OVC: Orphans and vulnerable children

Background Uptake of clinical guideline recommendations into routine practice requires changes in attitudes and behaviors of the health care providers. The World Health Organization (WHO) has heavily invested in public health and health promotion globally by developing policy recommendations to guide clinical practice; however, clinical guidelines are often not applied. The success of the implementation of any guidelines depends on consideration of existing barriers and adequately addressing them. Therefore, exploring the context specific barriers and facilitators affecting the primary care providers (PCPs) in Mbarara district, Uganda may provide a practical way of addressing the identified barriers thus influence the PCPs action towards integration of mental healthcare services into PHC. Methods We adopted a theoretical model of behavior change; Capability, Opportunity and Motivation developed to understand behavior (COM-B). This was a cross-sectional study which involved using a semi-structured qualitative interview guide to conduct in-depth interviews with PCP’s (clinical officers, nurses and midwives). Results Capability - inadequacy in knowledge about mental disorders; more comfortable managing patients with a mental problem diagnosis than making a new one; knowledge about mental health was gained during pre-service training; no senior cadre to consultations in mental health; and burdensome to consult the Uganda Clinical Guidelines (UCG). Opportunity - limited supply of hard copies of the UCG; guidelines not practical for local setting; did not regularly deal with clients having mental illness to foster routine usage of the UCG; no sensitization about the UCG to the intended users; and no cues at the health centers to remind the PCPs to use UCG. Motivation - did not feel self-reliant; not seen the UCG at their health facilities; lack of trained mental health specialists; conflicting priorities; and no regulatory measures to encourage screening for mental health. Conclusions Efforts to achieve successful integration of mental health services into PHC need to fit in the context of the implementers; thus the need to adapt the UCG into local context, have cues to enforce implementation, and optimize the available expertize (mental healthcare providers) in the process.

Background Communication on sexual and reproductive health (SRH) between caregivers and their young adolescent children plays a significant role in shaping attitudes and behaviours that are critical to laying the foundations for positive and safe SRH behaviours in later adolescence. Nevertheless, this communication is often limited, particularly in countries where adolescent sexuality is taboo. This study assessed the topics discussed (‘level’) and the comfort of caregivers with communicating with young adolescents on SRH, and their correlates.  Methods A cross-sectional survey was conducted among 218 caregivers of young adolescents (10–14 years) in Mbarara district of south-western Uganda in January and February 2020. Participants were selected through consecutive sampling. A structured, pre-tested questionnaire administered by interviewers was used for data collection. The surveys were computer-assisted using Kobo Collect software. Data was exported to STATA 14 for analysis. Level of SRH communication was measured based on 10 SRH communication topics, while comfort was based on 9 SRH discussion topics. Bivariate and multivariate linear regression analyses were conducted to determine correlates of level of, and comfort with, SRH communication P -value < 0.05 was considered for statistical significance. Results The mean number of topics that caregivers discussed was 3.9 (SD = 2.7) out of the 10 SRH topics explored. None of the respondents discussed all the topics; 2% reported ever discussing nine topics with their young adolescent, while 3.5% reported never discussing any of the topics. General health and bodily hygiene (89.9%) and HIV/AIDS and other sexually transmitted infections (STIs) (77.5%) were the most commonly discussed, while night emissions in boys (4.3%) and condoms (8.3%) were least discussed. The majority of caregivers (62%) reported a high level of comfort with discussing SRH. The mean comfort score was 21.9 (SD = 3.8). In general, the level of SRH communication increased with an increase in comfort with SRH communication β = 0.22 (0.04); 95% CI = (0.15, 0.30). The level of comfort with SRH communication decreased with an increase in the number of YAs in a household β = -0.92 (0.38); 95%CI = (-1.66,-0.18). Conclusion Overall, the level of SRH communication is low and varies according to the number of SRH topics. Caregivers’ comfort with SRH communication with YAs was a significant correlate of SRH communication. This justifies the need for interventions that aim to improve caregivers’ comfort with communicating with young adolescents about SRH. Plain English summary Communication between parents and children about sexual and reproductive health (SRH) during the early adolescence stage (10–14 years) plays a significant role in creating positive reproductive health outcomes in later adolescence and adulthood. We conducted surveys in rural areas of Mbarara district among 218 pairs of caregivers and their children aged 10–14 years between January and February 2020. The purpose of the study was to understand whether there is communication between the two, and how comfortable they felt having discussions about SRH. We also asked caregivers and their children about their knowledge of SRH, and how they generally felt about SRH for young people. This study, however, reports only results from caregivers. We found that, on average, caregivers discussed 4 of the 10 SRH topics explored in this survey with their child, and that the majority of the caregivers reported being very comfortable discussing SRH—especially general health and bodily hygiene—with their children. On the whole, we found that caregivers’ SRH communication was largely influenced by their comfort with discussing SRH with their adolescent child. The level of comfort was influenced by the number of young adolescents living in a household. However, there is no clear justification for this finding from existing literature. In conclusion, there is a need for interventions that facilitate improvement of communication on SRH between parents/caregivers and young adolescents. These should focus on improving comfort levels by promoting communication skills for caregivers and emphasizing value clarification.

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.

Young adults living with HIV (YALWH) struggle to maintain high levels of adherence to antiretroviral therapy (ART) because of numerous barriers. This study describes the social networks of YALWH (18-24 years), their barriers to ART adherence, and the perceived role of social networks in overcoming those barriers. This study used a qualitative descriptive research design. Twenty-three (23) YALWH who were on ART for a period of greater than one (1) month and had consented to participate in the study were purposively selected from two primary health care facilities in southwestern Uganda. We held four (4) focus group discussions with the YALWH over 5 weeks between the 24th of July and 7th September 2020. Data were audio recorded, transcribed, and entered in Microsoft word 2010. Using the content analysis techniques, data were inductively coded and categories or themes developed. Most YALWH belonged to bonding (family, friends, and neighbors), followed by bridging (informal groups), and linking (health professionals) social networks, respectively. Most YALWH, irrespective of gender, had close connections with their mothers or elder sisters. The commonest form of bridging networks was informal community groups that provided financial services, whereas the linking ones comprised health professionals' directly involved in HIV patient care such as nurses, counselors, and their affiliates (expert clients or clinic based peer supporters), who occasionally acted as bonding networks. Structural barriers to ART adherence (eg, stigma) were the most cited, followed by medication- (eg, pill burden), and patient-related barriers (eg, non-disclosure of HIV status). Bonding networks were perceived to help overcome patient, medication, and structural barriers to ART adherence. Bridging networks overcame structural and medication-related barriers to ART adherence. Linking networks were perceived to help overcome some health systems and medication-related barriers to ART adherence. Bonding social networks seem to play a prominent role in overcoming numerous barriers to ART adherence compared with bridging and linking social networks.

Background Suicide is one of the leading causes of death globally, with over 75% of all suicides occurring in low-and middle-income Countries. Although 25% of people have contact with their health care workers before suicide attempts, most never receive proper suicide assessment and management. We explored primary care health workers' knowledge, attitudes, and experiences in evaluating and managing suicidality in structured primary healthcare services in Uganda. Methods This was a cross-sectional qualitative study among health workers in southwestern Uganda from purposively selected health facilities. A semi-structured interview guide was used, and data were analyzed using thematic analysis. Results The in-depth interviews were conducted with 18 individuals (i.e., five medical doctors, two clinical officers, two midwives, and nine nurses) from 12 health facilities in the five selected districts. Four themes emerged from the discussions: a) Knowledge and attitudes of primary healthcare workers in the assessment and management of suicidality, b) Experiences in the assessment and management of suicidality, c) challenges faced by primary healthcare workers while assessing and managing suicidality, and d) Recommendations for improving assessment and management of suicidality in PHC. Most participants were knowledgeable about suicide and the associated risk factors but reported challenges in assessing and managing individuals with suicide risk. The participants freely shared individual experiences and attitudes in the assessment and management of suicide. They also proposed possible ways to improve the evaluation and management of suicidality in PHC, such as setting up a system of managing suicidality, regularizing community sensitization, and training health workers. Conclusion Suicidality is commonly encountered by primary health care workers in Uganda who struggle with its assessment and management. Improving the knowledge and attitudes of primary health care workers would be a big step towards ensuring equitable services.

The purpose of this study was to use the Columbia Suicide Severity Rating Scale (C-SSRS) to assess the prevalence and patterns of suicidality among young women living in poverty to guide effective, targeted interventions for vulnerable populations. Data were drawn from ‘The Onward Project On Wellbeing and Adversity’ (TOPOWA) study, a prospective cohort examining mental health in the context of social determinants of young women aged 18 to 24 years in Kampala’s urban slums. A cohort of 300 women, recruited from three study sites, participated in baseline assessments. Suicidality was assessed using the C-SSRS. Demographic and psychosocial factors and their associations with suicidality are presented. Of the 300 women participants, 66.0% had some secondary education and 62.0% had children, with most of them living with their children (81.7%). Suicidal thoughts were reported by 46.0%, and 17.3% had attempted suicide, with poisoning (23.1%) and hanging (21.2%) being the most common methods. The prevalence of suicidality in this population was very high, indicating significant unmet mental health needs. Since not all suicide attempts are associated with preceding thoughts or plans, it is crucial to consider a broader range of risk factors and warning signs. Social support systems and socioeconomic strengthening may be fruitful strategies for the prevention of suicidality in this population.