Browsing by Author "Oboke, Henry"
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Item Anger and Bitter Hearts: The Spread of Suicide in Northern Ugandan Families(Journal of Anthropology, 2019) Oboke, Henry; Whyte, Susan ReynoldsIn many societies, the phenomenon of suicide provides a particularly powerful example of how something sinister might ‘run in the family’. In the Acholi sub-region of northern Uganda, concerns about its capacity to spread increased during and after the Lord’s Resistance Army war. Based on interviews with bereaved families in 2016 and historical material on suicide, we offer an analysis of suicide as an approach to the contagious connections of kin. Successful and attempted suicides were often preceded by affective contamination of family relations through feelings of neglect, humiliation, abuse, indignation and resentment that made hearts bitter. Anger finally moved people to take their lives, often leaving behind questions of liability. Suicide requires that we consider these questions together with notions of personhood and mutuality of being. The concept of affective contamination contributes to the understanding of both suicide and contagious kinship connections.Item Equitable Access to Health Professional Training in Uganda: A Cross Sectional Study(Annals of global health, 2018) Galukande, M.; Maling, S.; Kabakyenga, J.; Nshaho, J.; Oboke, Henry; Oonge, B.; Muyenje, H.; Katumba-Sentongo, G.; Mayanja-Kizza, H.; Sewankambo, N.K.Objective: We set out to assess inequalities to access health professional education, and the impact of an education improvement program supported by MEPI (Medical Education Partnership Initiative). Inequalities in the higher education system in sub-Saharan Africa remain despite some transformative policies and affirmative action. Methods: We reviewed enrollment data from four universities for the period 2001–2014 for various health professional training programs, and conducted group discussions through an iterative process with selected stakeholders, and including a group of education experts. Two time periods, 2001–2010 and 2011–2014, were considered. In 2010–11, the MEPI education program began. Gender ratios, regional representation, secondary schools, and the number of admissions by university and year were analysed. We used SPSS version 17 software to analyse these data with level of significance p < 0.05. We collated qualitative data along predetermined and emerging themes. Results: The overall male-to-female ratio among the student population was 2.3:1. In total, there were 7,023 admissions, 4,403 between 2001–2010 (440 per annum) and 2,620 between 2011–2014 (655 per annum) with p = 0.018. There were no significant increases in admissions in the central and western regions over the two time periods, 1,708 to 849 and 1,113 to 867 respectively, both p = 0.713 and p = 0.253. We propose improving the university admission criteria and increasing enrollment to health professions training schools. Conclusion: There were significant inequalities for higher education training in Uganda by gender, regional representation and school attended. Modifying the admission criteria and increasing enrollment may reduce these inequalities.Item ICD-11 Trauma Questionnaires for PTSD and Complex PTSD: Validation among Civilians and Former Abducted Children in Northern Uganda(Journal of Psychiatry, 2015) Dokkedahl, Sarah; Oboke, Henry; Ovuga, Emilio; Elklit, AskAbstract Objectives: ICD-11 is expected to introduce a new diagnosis of C-PTSD, along with a revision of the current PTSD diagnosis. Are the suggested diagnostic tools for PTSD and C-PTSD valid in a developing country? Method: The tools have been tested on former abducted and regular civilians in northern Uganda (n=314), who have been influenced by the civil war that lasted for more than two decades. Results: The prevalence of either PTSD or C-PTSD was 36.6% and PTSD and C-PTSD was further found to correlate with symptoms of depression, anxiety and somatic complaints. Conclusion: Based on its findings the study concludes that the ICD-11 tools for PTSD and C-PTSD both appear to be valid as suggested by both discriminant and convergent validation of the tools. However, future research can benefit from studying cultural aspects of these diagnoses.Item Impact of Mental Health Training on Mental Well-being of Lay Counselors in Northern Uganda(Jacobs Journal of Community Medicine, 2018) Oboke, Henry; Abio, A; Kaducu, Ocaka F; Sodemann, M; Elklit, A; Ovuga, EData on the impact of mental health first aid training on the mental well-being of lay counselors is limited despite a wealth of research on the training of lay counselors. We tested the hypothesis that mental health first aid training improves the mental well-being of trainees. We trained 60 community representatives selected based on desired qualities in Gulu district using an experiential training method. We assessed pre- and immediate post training mental well-being of trainees with the 32-item Response Inventory for Stressful Events (RISLE) in terms of the prevalence of suicidal ideation using. Just under 78 percent (77.8%) of the trainees were male while 22.2% were female. The age of participants ranged from 22 to 62 years (media = 32). Each of the trainees had received a level education but 57.9% of the trainees were peasant farmers. Pre-test prevalence of suicide ideation was 9.3% while post-test prevalence was 11.1%. However, immediate post-training assessment with the RISLE indicated improved mental well-being. Qualitative assessment after three months indicated that trainees were less suicidal and they had improved psychosocial functioning. Experiential training appears to have improved the mental wellness of trainees.Item Promoting Psychiatry in the medical school: "The case of Uganda"(Psychiatry Bulletin, 2002) Ovuga, E; Buga, J; Oboke, Henry; Boardman, JUganda has a rich history of medical education Odonga, 1989) that was severely harmed by the rise of Idi Amin and the years of internal strife. It is only over recent years that the country has begun to rebuild itself Boardman & Ovuga, 1997). A central problem for psychiatry in Uganda …Item The Psychological Impact of War and Abduction on Children in Northern Uganda: A Review(International Journal of Mental Health and Psychiatry, 2015) Dokkedahl, Sarah Bøgelund; Oboke, Henry; Ovuga, Emilio; Elklit, AskIn more than two decades northern Uganda was affected by the war between the government and the LRA. Children were abducted and affected during the war, but what is the psychological and social impact of war on the children? Methods: In this study we reviewed 40 epidemiological trauma studies conducted in Uganda from 2004-2014 using databases. Results: The psychological impact was found in many different domains ranging from mental health problems like PTSD, depression, anxiety, and psychosis to suicidal ideation, alcohol abuse, partner violence, child abuse, and feelings of guilt and revenge, furthermore, many experienced problems when returning to their home communities. Uganda only has few mental health workers, few clinical facilities and lack medication to treat mental health problems. Conclusion: We therefore conclude that the prevalence of mental health problems continue to be high to this day, despite the war ending in 2007.Item Undergraduate students’ contributions to health service delivery through communitybased education: A qualitative study by the MESAU Consortium in Uganda(BMC Medical Education, 2016) Atuyambe, Lynn M.; Baingana, Rhona K.; Kibira, Simon P. S.; Katahoire, Anne; Okello, Elialilia; Mafigiri, David K.; Ayebare, Florence; Oboke, Henry; Acio, Christine; Muggaga, Kintu; Mbalinda, Scovia; Nabaggala, Ruth; Ruzaaza, Gad; Arubaku, Wilfred; Mary, Samantha; Akera, Peter; Tumwine, James K.; Peters, David H.; Sewankambo, Nelson K.Background: It has been realised that there is need to have medical training closer to communities where the majority of the population lives in order to orient the trainees’ attitudes towards future practice in such communities. Although community based education (CBE) has increasingly been integrated into health professions curricula since the 1990s, the contribution students make to service delivery during CBE remains largely undocumented. In this study, we examined undergraduate health professions students’ contribution to primary health care during their CBE placements. Methods: This was a qualitative study involving the Medical Education for Equitable Services to All Ugandans consortium (MESAU). Overall, we conducted 36 Focus Group Discussions (FGDs): one each with youth, men and women at each of 12 CBE sites. Additionally, we interviewed 64 community key-informants. All data were audio-recorded, transcribed and analysed using qualitative data analysis software Atlas.ti Ver7. Results: Two themes emerged: students’ contribution at health facility level and students’ contribution at community level. Under theme one, we established that students were not only learning; they also contributed to delivery of health services at the facilities. Their contribution was highly appreciated especially by community members. Students were described as caring and compassionate, available on time and anytime, and as participating in patient care. They were willing to share their knowledge and skills, and stimulated discussion on work ethics. Under the second theme, students were reported to have participated in water, sanitation, and hygiene education in the community. Students contributed to maintenance of safe water sources, educated communities on drinking safe water and on good sanitation practices (hand washing and proper waste disposal). Hygiene promotion was done at household level (food hygiene, hand washing, cleanliness) and to the public. Public health education was extended to institutions. School pupils were sensitised on various health-related issues including sexuality and sexual health. Conclusion: Health professions students at the MESAU institutions contribute meaningfully to primary health care delivery. We recommend CBE to all health training programs in sub-Saharan Africa.Item Utilization of antiretroviral therapy services and associated factors among adolescents living with HIV in northern Uganda: A cross-sectional study(PLoS ONE, 2023) Odongo, Innocent; Arim, Barbara; Ayer, Patrick; Murungi, Tom; Akullo, Susan; Aceng, Docus; Oboke, Henry; Kumakech, Edward; Obua, Celestino; Auma, Anna Grace; Richard, NyekoBackground Suboptimal utilization of antiretroviral therapy (ART) services remains a problem among adolescents in low- and middle-income countries, which has a negative impact on their response to treatment and increases the risk of developing resistance. Optimal use is essential to enhancing treatment efficacy. We investigated the optimal use of ART service and predictors among adolescents living with HIV (ALHIV) in northern Uganda. Methods We used a cross-sectional study design to collect quantitative data from 293 ALHIV at three health facilities in Lira municipality, northern Uganda. We used an interviewer-administered questionnaire and data abstraction form. Data were analysed using SPSS version 23 soft ware. Descriptive analysis and logistic regressions were performed to determine the relation ship between the predictor and outcome variables. Statistical significance was determined at P-value<0.05 and the adjusted odds ratio with a 95% confidence interval was used. Results The level of utilization of ART services was suboptimal among 27.6% (81/293) of the partici pants, and only 63.1% (185/293) were virally suppressed. Of the participants who were opti mally utilizing ART services, the majority 86.8% (184/212) were virally suppressed. Age 10– 14 years (aOR = 3.34), the presence of both parents (aOR = 1.85), parental and peer reminders (aOR = 2.91) and (aOR = 0.49) respectively, and being on ART for five years or less were the characteristics related with optimal utilization of ART services. Conclusions and recommendations Not all ALHIV used ART services to their full potential. However, factors such as partici pants’ age, the presence of both parents, reminders from parents and peers, and being on ART for some time were all related to the optimal use of ART services. There is a need for developing strategies to increase family and peer support with a focus on older adolescents if the 95-95-95 goal is to be achieved in this age group.Item Utilization of antiretroviral therapy services and associated factors among adolescents living with HIV in northern Uganda: A crosssectional study(PLoS ONE, 2023) Odongo, Innocent; Arim, Barbara; Ayer, Patrick; Murungi, Tom; Akullo, Susan; Aceng, Docus; Oboke, Henry; Kumakech, Edward; Obua, Celestino; Auma, Anna Grace; Nyeko, RichardBackground Suboptimal utilization of antiretroviral therapy (ART) services remains a problem among adolescents in low- and middle-income countries, which has a negative impact on their response to treatment and increases the risk of developing resistance. Optimal use is essential to enhancing treatment efficacy. We investigated the optimal use of ART service and predictors among adolescents living with HIV (ALHIV) in northern Uganda. Methods We used a cross-sectional study design to collect quantitative data from 293 ALHIV at three health facilities in Lira municipality, northern Uganda. We used an interviewer-administered questionnaire and data abstraction form. Data were analysed using SPSS version 23 software. Descriptive analysis and logistic regressions were performed to determine the relationship between the predictor and outcome variables. Statistical significance was determined at P-value<0.05 and the adjusted odds ratio with a 95% confidence interval was used. Results The level of utilization of ART services was suboptimal among 27.6% (81/293) of the participants, and only 63.1% (185/293) were virally suppressed. Of the participants who were optimally utilizing ART services, the majority 86.8% (184/212) were virally suppressed. Age 10– 14 years (aOR = 3.34), the presence of both parents (aOR = 1.85), parental and peer reminders (aOR = 2.91) and (aOR = 0.49) respectively, and being on ART for five years or less were the characteristics related with optimal utilization of ART services. Conclusions and recommendations Not all ALHIV used ART services to their full potential. However, factors such as participants’ age, the presence of both parents, reminders from parents and peers, and being on ART for some time were all related to the optimal use of ART services. There is a need for developing strategies to increase family and peer support with a focus on older adolescents if the 95-95-95 goal is to be achieved in this age group.Item War related sexual violence and it's medical and psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional study(BMC International Health and Human Rights, 2009) Eugene, Kinyanda; Musisi, Seggane; Biryabarema, Christine; Ezati, Isaac; Oboke, Henry; Ojiambo-Ochieng, Ruth; Were-Oguttu, Juliet; Levin, Jonathan; Grosskurth, Heiner; Walugembe, JamesBackground: Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting. This paper examines the specific long term health consequences of war related sexual violence among rural women living in two internally displaced person's camps in Kitgum district in war affected Northern Uganda who accessed the services of an Isis-Women's International Cross Cultural Exchange (Isis-WICCE) medical intervention. Methods: The study employed a purposive cross-sectional study design where 813 respondents were subjected to a structured interview as part of a screening procedure for an emergency medical intervention to identify respondents who required psychological, gynaecological and surgical treatment. Results: Over a quarter (28.6%) of the women (n= 573) reported having suffered at least one form of war related sexual violence. About three quarters of the respondents had 'at least one gynaecological complaint' (72.4%) and 'at least one surgical complaint' (75.6%), while 69.4% had significant psychological distress scores (scores greater than or equal to 6 on the WHO SRQ-20). The factors that were significantly associated with war related sexual violence were the age group of less than or equal to 44 years, being Catholic, having suffered other war related physical trauma, and having 'at least one gynaecological complaint'. The specific gynaecological complaints significantly associated with war related sexual violence were infertility, chronic lower abdominal pain, abnormal vaginal bleeding, and sexual dysfunction. In a multivariable analysis the age group of less than or equal to 44 years, being Catholic and having 'at least one gynaecological complaint' remained significantly associated with war related sexual violence. Conclusion: The results from this study demonstrate that war related sexual violence is independently associated with the later development of specific gynaecological complaints.