Joyce Sserunjogi Nalugya

Background: A large number of adolescents with hearing impairment experience socio-emotional and structural challenges that may put them at risk for depression. However, depression is often undiagnosed among them due to lack of appropriate, culturally relevant tools for its assessment. This study set out to determine the prevalence of depression and its associated factors in this vulnerable population. Methods: A cross-sectional study was conducted among adolescents aged 10 to 17 years with hearing impairment, attending three primary schools of the deaf across Kampala City in Uganda. Depression was assessed using the Mini International Neuropsychiatric Interview for children and adolescents (MINI-KID), which underwent linguistic adaptation and translation into Ugandan Sign Language through a collaborative process involving sign language teachers and students, and administered in video format to ensure clarity and inclusion. Data were analyzed with Stata version 17. Modified Poisson regression with robust standard errors was used to examine associations. Results: A total of 116 adolescents participated (mean age = 14.5 ± 1.9 years; 51.7% female). The lifetime prevalence of depression was 60.3%, with point prevalence at 34.5%. Depression was more frequent among females, though these differences were not statistically significant. Living in father-only households (IRR = 2.11, 95% CI: 1.60–2.77 p < 0.001), and witnessing excessive disciplinary practices (IRR = 0.65, 95% CI: 0.49–0.87, p = 0.003), were significantly associated with depression. Conclusion: Using a linguistically adapted version of the MINI-KID, we found that depression is highly prevalent among adolescents with hearing impairment in Kampala. Strengthening family support, improving access to sign language-trained professionals, and implementing inclusive school-based interventions are key to identifying and managing depression in this population.

Child alcohol use is a public health concern in Uganda. This study assessed academic achievement skills and their association with alcohol use among primary school children in Mbale district, Uganda. This cross-sectional study assessed academic achievement skills (word reading, sentence comprehension, spelling, and math computation) in 6–13-year-old primary school children using the Wide Range Achievement Test, Fifth Edition (WRAT-5). Participants from grades 1–7, were randomly selected from 38 primary schools. Raw WRAT-5 scores were standardized to age- and sex-adjusted z-scores to enable meaningful comparisons across subgroups. Alcohol use was assessed using the validated Uganda–Lumasaaba version of the CRAFFT screening tool, while socio-demographic information was obtained through a structured questionnaire previously employed in studies using the same dataset. Data analysis was conducted in STATA 18. Multiple linear regression models were applied to examine the association between alcohol use and academic outcomes, adjusting for demographic, familial, and school-related factors. Of the 460 primary school children assessed, 25.2% reported alcohol use in the past 12 months; 56.6% were girls, and 70.9% were aged 10–13 years. Children who reported alcohol use performed significantly worse than non-users in multiple academic domains, with lower scores in word reading (–0.98, 95% CI: − 1.69 to − 0.28), spelling (–1.23, 95% CI: − 2.44 to − 0.14), and sentence comprehension (–0.14, 95% CI: − 0.59 to − 0.02). No significant differences were observed between the two groups in math computation scores. Among alcohol users, male gender, rural residence, and informal caregiver employment were associated with lower academic achievement. Among non-users, harmful parental drinking was a risk factor, while higher parental education appeared to be protective. Alcohol use among primary school children was associated with poorer academic achievement in word reading, spelling, and sentence comprehension, within the broader context of family and socioeconomic adversity. Targeted school- and community-based interventions are recommended to prevent early alcohol use and promote academic achievement, focusing on rural settings and vulnerable households. Longitudinal studies are needed to clarify the causal link between alcohol use and academic performance.

After successfully developing and evaluating group support psychotherapy (GSP) as a first-line treatment for mild-to-moderate depression in adults, we aimed to adapt and assess this approach for children and adolescents (CA) (ages 10–18) living with HIV. In June 2021, 30 young people and 30 caregivers participated in separate GSP sessions. Data on psychosocial issues and GSP effectiveness were collected through focus groups and interviews. Insights were guided by the ecological validity and culturally sensitive framework. An open-label randomized controlled trial in Kitgum, with 120 participants, registered with PACTR, number 202006601935462, compared GSP plus intensive adherence counseling (IAC) to IAC alone, assessing feasibility, acceptability, depression, anxiety, and HIV treatment outcomes. We found that CA with HIV struggled with self-esteem issues, suicidal thoughts, medication adherence, and food insecurity, alongside stigma, discrimination, and limited mental health programs. The adult GSP model was adapted for CA by creating gender- and age-specific groups, simplifying language, and incorporating play and expressive art activities. Caregivers were concurrently engaged with the adult GSP model. GSP participants showed a significantly greater reduction in depression symptoms compared to IAC participants.

Alcohol use among children in low-resource settings has received limited attention. This study investigated the prevalence of and biopsychosocial factors associated with alcohol use among children aged 6 to 13 years enrolled in primary education in Uganda. This cross-sectional study conducted in primary schools within Mbale district, employed stratified random sampling to select 470 child-parent dyads. Screening for child alcohol consumption utilized the validated Ugandan (Lumasaaba) version of the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool. Alcohol Use Disorder (AUD) was diagnosed using the AUD module of the Mini International Neuropsychiatric Interview for children and adolescents (MINI KID). Logistic regression analysis explored associations between alcohol consumption (CRAFFT cut-off score: 1 or more) and biopsychosocial factors (age, sex, nutrition, family dynamics, socioeconomic indicators, and school environment). Data analysis utilized STATA-17 statistical software. The median age of the participants was 11 years, with an interquartile range (IQR) of 9 to 12 years and a male to female ratio of 1:1.3. The screened prevalence of alcohol consumption among the children in the past 12 months was 25.2% (95% CI: 21.4–29.4) and 7.2% (95% CI: 5.1–10.0) were diagnosed with AUD. The study found a comparable prevalence of alcohol use between boys (25.0%, 95% CI: 19.4–31.5) and girls (25.4%, 95% CI: 20.0-31.1). Age-specific variations indicated that early adolescents (10 to 13 years), were more likely to consume alcohol 28.1% (95% CI: 23.5–33.3) compared to pre-adolescent children (6 to 9 years) 17.6% (95% CI: 11.9–25.1) in the past 12 months. Factors associated with alcohol use included single-parent households, lower caregiver education, low socioeconomic status, maternal drinking, food insecurity, under-weight, physical discipline by parents, peer influence, rural school attendance, and the school environment. The prevalence of alcohol consumption among children in Mbale district, eastern Uganda was high with one-in-four primary-school-children aged 6 to 13 years consuming alcohol in the past year, and no significant gender differences. It highlights various interconnected factors associated with alcohol use among school-aged children. We recommend awareness campaigns at all levels, stricter implementation of alcohol policies, school prevention programs, and family-focused and socio-economic interventions. Nationwide school surveys should target pre-adolescent alcohol use.

Background: Children at risk of substance use disorders (SUD) should be detected using brief structured tools for early intervention. This study sought to translate and adapt the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool to determine its diagnostic accuracy, and the optimum cut-point to identify substance use disorders (SUD) risk in Ugandan children aged 6 to 13 years. Methods: This was a sequential mixed-methods study conducted in two phases. In the first qualitative phase, in Kampala and Mbale, the clinician-administered CRAFFT tool version 2.1 was translated into the local Lumasaaba dialect and culturally adapted through focus group discussions (FGDs) and in-depth interviews, in collaboration with the tool’s authors. Expert reviews and translations by bilingual experts provided insights on linguistic comprehensibility and cultural appropriateness, while pilot testing with the target population evaluated the tool’s preliminary effectiveness. In the second phase, the CRAFFT tool, adapted to Lumasaaba, was quantitatively validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) for diagnosing SUD in Mbale district, through a survey. Participants, chosen randomly from schools stratified according to ownership, location, and school size, were assessed for the tool’s reliability and validity, including comparisons to the MINI KID as the Gold Standard for diagnosing SUD. Data were analyzed using STATA-15. Receiver-operating-characteristic analysis was performed to determine the sensitivity, specificity, and criterion validity of the CRAFFT with the MINI-KID. Results: Of the 470 children enrolled, 2.1% (n = 10) had missing data on key variables, leaving 460 for analysis. The median age and interquartile range (IQR) was 11 (9–12) years and 56.6% were girls. A total of 116 (25.2%) children had consumed alcohol in the last twelve-month period and 7 (1.5%) had used other substances. The mean CRAFFT score for all the children (n = 460) was 0.32 (SD 0.95). The prevalence of any alcohol use disorder (2 or more positive answers on the MINI KID) in the last 12 months was 7.2% (n = 32). The Lumasaaba version of the CRAFFT tool demonstrated good internal consistency (Cronbach’s α = 0.86) and inter-item correlation (Spearman correlation coefficient of 0.84 (p < 0.001). At a cut-off score of 1.00, the CRAFFT had optimal sensitivity (91%) and specificity (92%) (Area Under the Curve (AUC) 0.91; 95% CI 0.86–0.97) to screen for SUD. A total of 62 (13.5%) had CRAFFT scores of > 1. Conclusion: The Lumasaaba version of the CRAFFT tool has sufficient sensitivity and specificity to identify school-age children at risk of SUD.

Background: There is little research on alcohol and other drugs (AOD) use by school-age children in low-resource settings like Uganda. Including the voices of children in research can inform prevention and early intervention efforts for those at risk of AOD use. The aim of this study was to understand the perspectives of children aged 6 to 13 years regarding AOD in Uganda. Methods: This qualitative study was conducted in Mbale district, Uganda from February to March 2020. Eight focus group discussions (FGDs) were conducted with 56 primary school-age children, stratified by age (6–9 and 10–13 years), sex (male and female), and school status (in school and out of school). All FGDs were conducted in either Lumasaaba or Luganda. The FGDs were audio-recorded, transcribed verbatim, and translated into English. Data were coded, and overarching themes were identified using thematic framework analysis. Results: Two themes identified were (1) Children’s perceptions and experiences with AODs. The participants understood alcohol by its consistency, colour, odour, and by brand/logo. They described the types and quantities of AOD consumed by school-age children, brewing processes for homemade alcoholic drinks, and short and long-term consequences of the use of alcohol. (2) Contributing factors to childhood drinking included: Stress relief for children who experienced multiple adversities (orphaned, poverty-stricken, and hailing from broken homes), fitting in with friends, influence from families, and media exposure that made alcohol look cool. Children would start drinking at an early age) or were given alcohol by their parents, sometimes before they could start talking. In the community, alcohol and other drugs were cheap and available and children could drink from anywhere, including in the classroom. Conclusions: Children eligible for primary education in Uganda can easily access and use AOD. Several factors were identified as contributing to alcohol and other drug use among children, including availability and accessibility, advertising, lack of parental awareness and supervision, peer influence, adverse childhood experiences, socioeconomic factors, and cultural norms. There is a need for multi-sectoral action for awareness of childhood AOD use and deliberate consideration of children in the planning, design, and implementation of research, policies, and programs for prevention and early intervention.

Early identification and management of child and adolescent mental health (CAMH) disorders helps to avert mental illness in adulthood but a CAMH treatment gap exists in Uganda. CAMH integration into primary health care (PHC) through in-service training of non-specialist health workers (NSHW) using the World Health Organisation (WHO) Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) is a strategy to address this gap. However, results of such training are not supported by information on training development or delivery; and are undifferentiated by NSHW cadre. We aim to describe an in-service CAMH training for NSHW in Uganda and assess cadre-differentiated learning outcomes. Thirty-six clinical officers, nurses and midwives from 18 randomly selected PHC clinics in eastern Uganda were trained for 5 days on CAMH screening and referral using a curriculum based on the mhGAP-IG version 1.0 and PowerPoint slides from the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP). The residential training was evaluated through pre- and post- training tests of CAMH knowledge and attitudes using the participants’ post-test scores; and the difference between pre-test and post-test scores. Two-tailed t-tests assessed differences in mean pre-test and post-test scores between the cadres; hierarchical linear regression tested the association between cadre and post test scores; and logistic regression evaluated the relationship between cadre and knowledge gain at three pre-determined cut off points. Thirty-three participants completed both pre-and post-tests. Improved mean scores from pre- to post-test were observed for both clinical officers (20% change) and nurse/midwives (18% change). Clinical officers had significantly higher mean test scores than nurses and midwives (p < 0.05) but cadre was not significantly associated with improvement in CAMH knowledge at the 10% (AOR 0.08; 95 CI [0.01, 1.19]; p = 0.066), 15% (AOR 0.16; 95% CI [0.01, 2.21]; p = 0.170), or 25% (AOR 0.13; 95% CI [0.01, 1.74]; p = 0.122) levels. We aimed to examine CAMH learning outcomes by NSHW cadre. NSHW cadre does not influence knowledge gain from in-service CAMH training. Thus, an option for integrating CAMH into PHC in Uganda using the mhGAP-IG and IACAPAP PowerPoint slides is to proceed without cadre differentiation.

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder among the children. The burden of ADHD or its associated factors in Uganda are not known. The objective of this study was to determine the prevalence and the associated factors of ADHD among children attending the neurology and psychiatry clinics at Mulago National Referral Hospital. Using the disruptive behavior scale (45 items), we investigated the presence of ADHD symptoms among children attending Mulago Hospital. Questionnaires were administered to the primary care-takers of the study participants to gather information on the factors associated with ADHD. All children were subject to a clinical examination. Children presumed to have ADHD, using the aforementioned rating scale were further assessed by a child psychiatrist to confirm the diagnosis and associated co-morbid conditions. The estimated prevalence of DSM-IV ADHD symptoms was 11%. Children aged less than 10 years were four times likely to have ADHD (OR 4.1, 95% CI 1.7–9.6, p < 0.001). The demographic factors independently associated with ADHD were age less than 10 years, male gender, history of maternal abnormal vaginal discharge during pregnancy, and no formal education or the highest level of education being primary school. The prevalence of ADHD among children attending the pediatric neurology and psychiatry clinics is high in our settings and is associated with delayed milestones. Early identification and addressing the co-morbid conditions associated with ADHD such as epilepsy, autism spectrum of disorder, conduct disorder, opposition defiant disorder and intellectual disability in our setting is needed.

Depression in adolescents constitutes a global public health concern. However, data on its prevalence and associated factors are limited in low income countries like Uganda. Using a cross-sectional descriptive study design, 519 adolescent students in 4 secondary schools in Mukono district, Uganda, were randomly selected after meeting study criteria. The 4 school types were: boarding mixed (boys and girls) school; day mixed school; girls’ only boarding school; and, boys’ only boarding school. The 519 participants filled out standardized questionnaires regarding their socio-demographic characteristics and health history. They were then screened for depression using the Children Depression Inventory (CDI) and those with a cut-off of 19 were administered the Mini International Neuro-Psychiatric Interview for Children and Adolescents 2.0 (MINI-KID), to ascertain the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV) diagnostic types of depression and any co morbidity. Logistic regression analyses were used to assess factors associated with significant depression symptoms (a score of 19 or more on the CDI). There were 301 (58 %) boys and 218 (42 %) girls with age range 14–16 years and a mean age of 16 years (SD 2.18). Of 519 participants screened with the CDI, 109 (21 %) had significant depression symptoms. Of the 109 participants with significant depression symptoms, only 74 were evaluated with the MINI-KID and of these, 8 (11 %) met criteria for major depression and 6 (8 %) met criteria for dysthymia. Therefore, among participants that were assessed with both the CDI and the MINI-KID (n = 484), the prevalence of depressive disorders was 2.9 %. In this sample, 15 (3.1 %) reported current suicidal ideation. In the logistic regression analyses, significant depression symptoms were associated with single-sex schools, loss of parents and alcohol consumption. This is a cross-sectional study therefore, causal relationships are difficult to establish. Limited resources and the lack of collateral information precluded the assessment of a number of potential factors that could be associated with adolescent depression. The MINI-KID was administered to only 74 out of 109 students who scored ≥19 on the CDI since 35 students could not be traced again due to limited resources at the time. Significant depression symptoms are prevalent among school-going adolescents and may progress to full-blown depressive disorders. Culturally sensitive psychological interventions to prevent and treat depression among school-going adolescents are urgently needed.

Cerebral malaria (CM) and severe malarial anaemia (SMA) are associated with neuro-developmental impairment in African children, but long-term mental health disorders in these children are not well defined. A cohort of children previously exposed to CM (n = 173) or SMA (n = 99) had neurologic assessments performed and screening for behaviour difficulties using the Strengths and Difficulties Questionnaire (SDQ) a median of 21 months after the disease episode. These findings were compared to concurrently recruited community children (CC, n = 108). Participants with SDQ total difficulties score ≥17 had a mental health interview with the child and adolescent version of the Mini-International Neuropsychiatric Interview (MINI-KID) and a sample had brain magnetic resonance imaging (MRI). Fifty-five children had SDQ score ≥17. On the MINI-KID, these children were classified as having no difficulties (n = 18), behaviour difficulties only (n = 13) or a mental health disorder (n = 24). Behaviour difficulties were seen in similar frequencies in CM (3.5 %), SMA (4.0 %) and CC (2.8 %). In contrast, mental health disorders were most frequent in CM (10.4 %), followed by SMA (4.0 %) and CC (1.8 %). Externalizing disorders (conduct, oppositional defiance and attention deficit hyperactivity) were the most common mental health disorders. The median total coma duration was 72 (IQR 36.0–115.0) h in patients with mental health disorders compared to 48 (IQR 28.5–78.7) h in those without, p = 0.039. Independent risk factors for mental health disorder included neurologic deficit at discharge (OR 4.09 (95 % CI 1.60, 10.5) and seizure recurrences during hospitalization, (OR 2.80, 95 % CI 1.13, 6.97). Brain MRI findings consistent with small vessel ischaemic neural injury was seen in over half of these children. Cerebral malaria may predispose children to mental health disorders, possibly as a consequence of ischaemic neural injury. There is urgent need for programmes of follow-up, diagnosis and interventions for these children.