Kim Madundo

The growing burden of mental disorders in sub-Saharan Africa is compounded by limited access to care, under-resourced systems and fragmented research and mentorship efforts. Existing research is often nationally isolated, dependent on unstable external funding and relies on models transposed from high-income countries without sufficient local adaptation. This article proposes a model for establishing regional “South–South” research networks, drawing on lessons from the East African Mental Health Collaborative (EAMHC), a partnership among institutions in Kenya, Rwanda, Tanzania and Uganda, and facilitated by Duke University. Formed in 2024, the EAMHC brings together early- to mid-career researchers and senior mentors to promote cross-country collaboration, mentorship and co-production of research. Using a hybrid structure of annual in-person meetings and monthly virtual engagements, the collaborative network emphasizes joint research output, capacity strengthening and sustainability through shared leadership and cross-learning. Early successes include the submission of three manuscripts and the procurement of two grants. The structure stresses equitable leadership, with East African investigators rotating as site leads to promote institutional ownership and protected research time. This proposed model demonstrates that regional networks can effectively pool limited expertise to develop contextually relevant, evidence-based solutions. By prioritizing bidirectional and peer-led mentorship and harmonized research frameworks, the EAMHC provides a scalable blueprint for strengthening mental health systems and fostering researcher independence in resource-limited settings.

Background: Traumatic brain injury (TBI) is a major cause of morbidity and mortality in low-and middle-income countries (LMICs), where the burden of injury is disproportionately high, and healthcare resources are often limited. Clinical Practice Guidelines (CPGs) improve the consistency and quality of TBI care by shifting medical decision-making from individual judgement to evidence-based recommendations. The strong link between improved TBI outcomes and CPG adoption has largely been established in high-income country (HIC) hospital settings; evidence on implementing TBI CPGs in LMIC hospital settings is limited. Objective: This study explored healthcare providers’ experiences to identify barriers and facilitators to implementing a TBI CPG in the Emergency Department (EMD) at Kilimanjaro Christian Medical Center in Northern Tanzania, guided by the Consolidated Framework for Implementation Research 2.0 (CFIR). Methods: We conducted semi-structured in-depth interviews (IDIs) with doctors and nurses who regularly managed TBI patients at the EMD. We purposively sampled participants between June and August 2023. The research team analysed data using thematic content analysis guided by CFIR domains, developing codes and memos iteratively. Results: 7 nurses and 8 doctors with an average of 5 years of experience caring for patients in the EMD completed in-person, in-depth interviews. Most providers reported frequent exposure to TBI cases and regular use of the CPG in routine clinical practice. However, not all participants reported consistent CPG use, highlighting variation in implementation among providers. Key facilitators included strong interprofessional teamwork, readily accessible guideline materials in clinical areas, availability of diagnostic imaging, and perceived improvements in patient outcomes. Barriers to consistent adherence included ICU bed shortages, limited operating theatre capacity, equipment and medication stock-outs, high patient volumes, staffing pressures, and a lack of structured refresher training or formal audit and feedback mechanisms. Variability in procedural confidence, particularly among less experienced providers, also affected implementation consistency. Conclusion: Our findings show that a TBI CPG is well accepted and largely integrated into routine care among experienced providers. However, sustainability depends on strengthening training, mentorship, audit, and feedback systems for CPG use and on addressing system-level resource constraints. Institutional investment in capacity building is essential to ensure consistent and sustained CPG uptake in our setting.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease increasingly associated with psychiatric co­morbidities, particularly anxiety and depression. Yet, evidence from sub-Saharan Africa remains scarce. Objectives: To determine the prevalence and associated factors of anxiety and depression among adult patients with AD in Northern Tanzania. Methods: A hospital-based cross-sectional study was conducted at the Regional Dermatology Training Centre (RDTC) between January 2022 and July 2023. AD was diagnosed using the Hanifin and Rajka criteria, and severity assessed with Scoring Atopic Dermatitis (SCORAD). Anxiety and depression were evaluated using the General Anxiety Disorder-7 and Patient Health Questionnaire-9 tools, respectively. Descriptive statistics and logistic regression were used to identify associations. P-values < 0.05 were considered statistically significant. Results: Overall, 241 adult patients with AD attending RDTC were enrolled, of whom 57.3% (n = 138/241) were women. The median age was 38 years (interquartile range 28–56). The prevalences of anxiety and depression were 41.5% and 30.3%, respectively. Anxiety was found to be associated with AD severity and cigarette smoking, while depression was significantly associated with female sex, age 40–59 years, occupation and AD severity. Conclusions: A considerable proportion of patients with AD in Tanzania experience psychological distress. Routine mental health screening and integrated multidisciplinary care are crucial in AD management, especially in low-resource settings.

Social media has an estimated global user base of 3.5 billion. Adolescents, constituting over 90% of this group, and thereby university students. are extensively involved in social media use, emphasizing its significance in their daily lives. Excessive use of social media poses risks such as depression, affecting academic performance. The objective of this study was to determine the association between social media use and depression among university students in Urban Northern Tanzania. This was a cross-sectional study that involved university students from three universities. Data was collected through an online close-ended questionnaire. Statistical analysis included the use of frequencies, percentages, chi-square and bivariate logistic regression at 95% confidence intervals (CIs) and significance at p value <0.05. A total of 384 participants were enrolled in the study. 36.7% reported that they used social media for 1 to 3 hours daily. 58.1% of all participants reported high frequency of social media use for social purposes. 29.2% of university students who participated in the study were screened to have depression. The prevalence of depression increased with longer daily duration of social media use. Those using social media for more than 5 hours daily, had 3.049 times higher odds of being depressed. Moderate frequency of social media use for social purposes was linked to reduced depression. Daily duration of social media was significantly associated with depression levels among university students. Significant associations were also found between moderate use of social media for socializing, with lower risk of depression. We recommend that universities develop targeted mental health interventions and promote balanced, purposeful social media use among students.

Cancer stigma, both underaddressed and understudied, remains a pervasive challenge in sub-Saharan Africa. Currently, the region is experiencing rising cancer incidence alongside some of the lowest cancer survival rates worldwide. With complex and multifaceted sociocultural factors contributing to this stigma and subsequent lack of screening, low treatment adherence and poorer health outcomes, it is critical to implement effective interventions in the region, at both the clinical and policy levels. To achieve a path forward, it is necessary to create targeted efforts that incorporate existing infrastructure and key cultural contexts.

Background: Alcohol use is a leading modifiable risk factor for injury in sub-Saharan Africa. In Tanzania, young people (≤24 years) experience greater alcohol-related harm despite drinking less frequently than adults. Punguza Pombe kwa Afya Yako (PPKAY) is a culturally adapted, brief intervention for injury patients in Tanzania. This study examined whether age moderates its effectiveness. Methods: We conducted an exploratory secondary analysis of baseline and 3-month data from the PPKAY randomized trial among injury patients aged ≥18 years at Kilimanjaro Christian Medical Centre, Tanzania. Eligible participants reporting alcohol use before injury, AUDIT ≥8, or positive breathalyzer were randomized to usual care or PPKAY with SMS boosters. The primary outcome was binge drinking days. Count outcomes were analyzed using negative binomial regression with robust SEs and continuous outcomes using mixed-effects models. Effect modification was assessed using a three-way interaction (Time × intervention × Age). Results: Among 543 participants (mean age 36.8 years; 16.2% aged 18–24), age moderated the intervention effect for drinking days (IRR = 0.27, 95% CI 0.07–0.98; p = 0.046) and drinks consumed (IRR = 0.17, 95% CI 0.04–0.77; p = 0.021). The intervention reduced 4 drinking days (95% CI −7.1 to −0.8) and 27.5 drinks (95% CI −42.8 to −12.2) among young people, while adults showed reductions in both arms, without intervention-specific effect. Conclusion: The effects of ED-based brief alcohol interventions are not uniform, varying across both age groups and alcohol-related outcomes. We found a greater responsiveness in drinking frequency and quantity reported among young people.

Background Harmful alcohol use is widespread in Tanzania, yet specialized resources to address this remain limited. This case series explores outcomes of three individuals who received a culturally-adapted brief intervention to reduce harmful alcohol use in an emergency department in Kilimanjaro, Tanzania. Methods The PPKAY intervention is a 15-minute nurse-delivered motivational interview for adults with acute (<□24□h) injuries, with an Alcohol Use Disorder Identification Test (AUDIT) of 8 or above or self-reported drinking alcohol within 6 hours of injury. The primary outcome was participants’ experience of the intervention. Secondary outcomes included number of binge drinking days in the prior month; depression, measured using the Patient Health Questionnaire-9 (PHQ-9); and alcohol-related consequences, measured by the Drinker Inventory of Consequences (DrInC). All outcomes were reported from baseline and at 3-month timepoints. Experience with the intervention was assessed with open-ended questions at a three-month post-intervention survey. Results Participants reported fewer binge drinking days, improved self-efficacy in managing triggers, reduced alcohol-related consequences, remission of depression, and strengthened interpersonal relationships. These were corroborated by significantly lower AUDIT, PHQ-9, and DrInC scores. One participant was not able to meet his drinking reduction target, accompanied by an avoidance of discussing interpersonal consequences of alcohol. Conclusions Our findings underscore the importance of integrated and targeted early screening and intervention in resource-limited emergency care settings. The narratives emphasize how a brief negotiational intervention can equip individuals with practical strategies to minimize harmful alcohol consumption. Further research is recommended to validate these outcomes in larger cohorts and diverse settings.

Tanzania faces significant HIV-related challenges with 1.4 million people currently living with HIV, 33,000 new infections, and 22,000 AIDS-related deaths annually. Suicide is a leading cause of death among People with HIV (PWH), with one-quarter of all deaths by suicide in Tanzania occurring among PWH. Despite this challenge, mental health resources are scarce, with only 55 psychologists and psychiatrists in the country, and clinic staff in HIV care lack adequate mental health training. This qualitative study explores the experiences of PWH who have recently had suicidal thoughts. The aim is to create targeted mental health interventions in Kilimanjaro. Participants were screened for suicidal ideation during routine care at two HIV clinics, with semi-structured qualitative interviews conducted thereafter. Data were analyzed using thematic analysis aided by NVivo 12 software. PWH experiencing suicidal ideation encounter multiple stressors related to their HIV diagnosis, societal stigma, financial stress, and broader social challenges. Suicide is sometimes viewed as an escape from these difficulties. Coping mechanisms include seeking assistance from family and religious leaders, but social support is hindered by fear of stigma. While participants expressed openness to counseling, treatment options were extremely limited. Suicide risk among PWH is influenced by stressors related to HIV, such as socioeconomic challenges, HIV stigma, low social support, and accompanying psychological distress. There is a clear need for improved mental health care options customized to the needs of PWH in Tanzania and other low-resource settings.

Introduction: Depression and suicidal thoughts and behaviour are remarkably common among people living with HIV worldwide, leading to a higher burden of disease, poor HIV care engagement, and death. Suicidal behaviour is criminalized in 20 countries worldwide, including Tanzania, where context-appropriate interventions are lacking.Methods: We describe the experiences of patients who were screened for depression and suicidal ideation by HIV clinic nurses, and how the socio-cultural context influences these experiences. This screening was the initial procedure in a randomized controlled clinical trial and parent study aimed at reducing suicide and depression and improving HIV care engagement in Kilimanjaro, Tanzania. We conducted in-depth interviews (IDIs) with 20 people living with HIV. Interviews were held 3 months post-enrollment of participants. Data was collected from July to November 2023. We referred to a brief screener developed for the trial, combining the PHQ-2 for depression and one question on suicidal ideation. IDIs focused on the experiences and appropriateness of being screened for depression and suicidal ideation, factors influencing these challenges, and opinions on the illegality of suicidal behaviour in Tanzania. Data was analyzed using Nvivo 14. Thematic analysis approach was utilized to identify, review and, label codes. Differences were resolved by the first three and final authors.Results: Our findings revealed high appreciation for the screening and occasional initial discomfort. Stigma, misinformation, and poverty contributed to mental health challenges. Patients favoured abolishment of laws against suicide due to their hindering support-seeking and impracticality for individuals in mental health crises.Discussion: In a mental health resource-limited setting, these findings highlight the need for targeted and integrated non-specialist screenings and interventions and outsourcing HIV and mental health support beyond healthcare facilities. Further research is needed to assess the sustainability of screening.