School of Medicine (Sch. of Med.)
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Browsing School of Medicine (Sch. of Med.) by Author "Abbo, Catherine"
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ItemEducation choices for children with Autism spectrum disorder in a clinical setting: Facilitators and barriers(Makerere University, 2022-11) Nabitaka, Irene ; Kitaka, Sabrina ; Abbo, Catherine ; Siu, GodfreyAutism Spectrum Disorder (ASD) is increasingly being diagnosed in low income countries. The global mean prevalence of 62/10 000 which translates into one child out of 160 with ASD. Unlike children with ASD in high income countries who are privileged to have several options for placement within the education system, those in low income countries tend to have limited access to appropriate structures and standardization of the education system. A Uganda Bureau of Statistics report of 2016 reported that only 2% of children in Uganda with ASD were in school, however the choices of school and barriers and facilitators were not described. This study therefore, aimed to study the facilitators and barriers to choice of education placement among children with ASD. Objective: To determine the type of school and facilitators and barriers that influence the choice of education placement for children diagnosed with ASD attending Bbosa Clinic in Mulago National Referral Hospital and Butabika National Referral Hospital. Methods: This was a descriptive mixed methods cross-sectional study. For quantitative data, consecutive sampling of primary caretakers of school going age children of 6 to 18 years was done, and interviewed using a pre tested semi structured questionnaire after an informed consent. Data was analyzed at Univariate and descriptive analysis with cross tabulations were run, For qualitative data, purposive sampling was done. Four focus group discussions with primary caretakers, and key informant interviews were conducted among key stake holders of education of children with ASD. Content thematic approach was used to explore the facilitators and barriers to choice of educational placement. Results Forty five primary care takers of children with a definitive diagnosis of autism were recruited in the study. The median age of the caretaker was 34 (IQR: 30-36) years with almost half being youth 20 (44.4%) between the age of 25 and 34 years. Female were more than the males, 30 (66.7%). The overall proportion of children diagnosed with ASD attending school was 87%, while only 13% were not in school. At time of diagnosis only 45% were attending school, while 55% were not in school at time of diagnosis. Among the 47 children, almost half were attending Private inclusive schools 19(40.4%), while 10(21.3%) were attending public inclusive schools. 10 (21.3%) of the children were attending specialized schools. Six (12.8%) of the children were not in school. School proximity, affordability of services and availability of a range of services, were the common resonated facilitators. While understanding of autism was identified as both a facilitator and barrier. The other barriers that were expressed include: inadequate training of teachers, stigma and limited financial resources. Conclusion In conclusion, we found that 87% of children diagnosed with autism were enrolled in school which is much higher than that reported by Uganda Demographic and Health Survey (UDHS) -2016. The high education status of majority of the caretakers may have contributed to the high percentage of school enrollment. Children with mild level of autism were mainly enrolled in inclusive schools. Close proximity, financial stability and availability of services were enlisted as major facilitators to choice of education placement. While limited knowledge and understanding of autism by both the teachers and caretakers were highlighted as barriers.
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ItemMental health literacy among secondary school students in North and Central Uganda: a qualitative study(WCPRR, 2014) Okello, Elialilia S. ; Abbo, Catherine ; Muhwezi, Wilson W. ; Akello, Grace ; Ovuga, EmilioObjectives There has been limited effort to explore young people’s perceptions about mental illness in Uganda. For mental health programs targeting young people to succeed, it is important to incorporate their understanding of mental illness, their perceptions about causes of mental illness and their attitudes about mentally ill people. The objective of this study was to explore the mental health of young people in secondary schools in Northern and Central Uganda. Subjects and Methods This was a qualitative study where 24 focus group discussions (FGDs) were held with young people in secondary schools. Respondents aged 14-24 years were purposively selected from 4 secondary schools in the two regions. During the FGDs, young people’s perceptions and understanding of three areas listed below were explored: meaning of mental health/mental illness; causes of mental illness and attitudes toward mental illness. Data management and analysis was done with the help of Atlas.ti, a-qualitative-analysis software. Thematic analysis approach was employed. Results FGD participants used concepts like a sound and normal mind, right thinking, normal behavior and normal thoughts to define mental health. Mental illness on the other hand was defined as loss of sense of reality, malfunctioning of the brain, impaired thinking and bizarre behavior. Young people attributed mental illness to; substance abuse (Marijuana, alcohol), witnessing traumatic events (seeing ones your relatives being killed, or being forced to participate in killing-frequently mentioned by young people in Northern Uganda); witch craft, effect of physical illness e.g. HIV/epilepsy, thinking too much, accidents and genetic explanations. They had mixed opinions about interacting with mentally ill individuals. Unpredictability and dangerousness were known to be a recurrent theme among people with negative views about mentally ill. Nonetheless, some FGD participants believed that the level of interaction with mentally ill persons depended on familiarity with mental illness and the severity of the symptoms. Similarly, there were mixed opinions regarding mental illness and work. Three main clusters of responses emerged. These were: i) “mentally ill people should not work”; ii) “mentally ill people should work but..”; iii) “mentally ill people should work like everyone else”. Conclusions Findings point to key gaps in the knowledge and attitudes of young people that need to be targeted by young-people-focused-interventions for mental health. In order for such interventions to succeed, young people must be able to recognize and respond appropriately to signs of distress, reduced functioning, and other early signs of poor mental health.
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ItemProfiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda.(Makerere University, 2010-01) Abbo, CatherineBackground: The WHO estimates that more than 80% of African populations attend traditional healers for health reasons. However, little is known about the profiles and outcome of this traditional approach to treatment of mental illnesses. Main Objective: The purpose of this study was to describe the profiles and outcome of traditional healing practices for severe mental illnesses in Jinja and Iganga districts in the Busoga region of Eastern Uganda. Methods: Four studies were conducted (I-IV). Study I used Focus Group Discussions with Case Vignettes with local community members and traditional healers to explore the lay concepts of psychosis. Studies II and III concerned a cross-sectional survey of patients above 18 years at the traditional healer’s shrines and study IV was made on a prospective cohort of patients diagnosed with psychosis in study III. Manual content analysis was used in study I; quantitative data in studies II, III and IV were analyzed at Univariate, Bivariate and Multivariate levels to determine the association between psychological distress and socio-demographic factors; for study IV, factors associated with outcome were analyzed. One-way ANOVA for independent samples was the analysis used in Study IV. Results: The participants differentiated schizophrenia (eddalu, ilalu) from mania (kazoole) and psychotic depression (described as illness from too much thinking), describing the symptomatology and natural course. Clan/family/cultural issues were mentioned as causing schizophrenia and psychotic depression, while physical causes and a failed relationship with God were mentioned for mania. Other causes were witchcraft, genetics and substance misuse. Choice of care depended on what was believed to be the cause of the psychotic symptoms (I).The prevalence of psychological distress was 65.1%. Significant associated factors were having a co-wife, more than four children; debts and lack of food. The distressed group was more likely to need explanations for ill health. Those who visited both the healer and a health unit were less likely to be distressed (II). Of the 387 respondents, 60.2% had diagnosable current mental illness and 16.3% had had one disorder in their lifetime. Of those with diagnosable current mental illnesses, 29.7% had psychosis; 5.4% a major depressive episode; 5.6% anxiety disorders; 3.6% mixed anxiety-depression; and 3.9% suicidality. Symptoms were severe in 37.7%, moderate in 35.1%, and mild in 13.2%. Patients with moderate to severe symptoms were more likely to use both biomedical services and traditional healers (III). All the symptom scales showed a percentage reduction of more than 20% at the three- and six-month follow-ups. The differences between the mean scores of the scales were all significant (P<0.0001). The Turkey HSD test was also consistently significant at P<0.01 except for psychotic depression. Over 80% of the participants used biomedical services for the same symptoms in the study period. Patients who combined treatment were less likely to be cases at the three-month follow-up (P=0.002; OR 0.26[0.15-0.58]), but more likely at the six-month follow-up (P=0.020; OR 2.05 [1.10-3.18]). Being in debt was associated with caseness at both three and six months. Conclusion: The community gave indigenous names to psychoses (Mania, Schizophrenia and Psychotic depression) and had multiple explanatory models for them. Thus multiple solutions for these problems are sought (I). Traditional healers shoulder a large burden of care of patients with mental health problems (II and III). An overwhelming majority of Ugandans with psychosis use both biomedical and traditional healing systems. The combined use of these two systems seems to confer some benefits (IV). Implications: For policy makers, for mental health professionals, for traditional healers, for researchers – indeed for all those who share the goal of improving the mental health of individuals – there can be no alternative to engaging with traditional healers. Key words: Mental illness, traditional healers, outcome, Western Medicine