Faculty of Medicine

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Browsing Faculty of Medicine by Author "Acup, Walter"

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    An Analysis of Post-Traumatic Stress Disorder and Quality of Life Among Adults Living with HIV in Western Uganda
    (HIV/AIDS - Research and Palliative, 2024) Kabunga, Amir; Kigongo, Eustes; Udho, Samson; Auma, Anna Grace; Tumwesigye, Raymond; Musinguzi, Marvin; Acup, Walter; Akello, Anne Ruth; Okalo, Ponsiano; Nabaziwa, Jannat; Shikanga, Enos Mwirotsi; Halima, Namata
    Background: HIV/AIDS remains a significant global public health issue, profoundly impacting infected individuals. Living with HIV involves complex mental health dynamics, with post-traumatic stress disorder (PTSD) being a prevalent challenge. This study aims to examine the correlation between PTSD and quality of life among HIV-positive individuals in western Uganda. Material and Methods: Conducted between May and July 2023, this facility-based cross-sectional study surveyed 439 participants from four HIV clinics in southwestern Uganda. Data were collected through interviewer-administered questionnaires, analyzed using descriptive statistics, simple linear regression, and multiple linear regression (p<0.05). Results: Respondents had a mean age of 40.6 years, with 68.3% female, 54.9% married, and 55.1% lacking formal education. The reported PTSD prevalence among HIV-positive individuals was 33.7%, significantly correlating with reduced overall quality of life (β = −4.52; p<0.001). The social quality of life had the highest mean score of 14.24 (±3.45) while the environmental quality of life had the lowest mean score 11.89 (±2.68). Conclusion: Our study reveals a concerning prevalence of PTSD, affecting 1 in 3 individuals, emphasizing the pressing need for comprehensive mental health support within HIV care settings. We observed a significant negative impact of PTSD on overall quality of life, particularly in physical and social aspects. Integrating mental health screening into routine HIV care is crucial, using validated tools like the PSTD Checklist Civilian Version, alongside training for healthcare providers to recognize PTSD symptoms in the context of HIV diagnosis and treatment.
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    Burnout and coping mechanisms among healthcare professionals in central Uganda
    (Psychiatry, 2024) Kabunga, Amir; Kigongo, Eustes; Okalo, Ponsiano; Udho, Samson; Auma, Anna Grace; Tumwesigye, Raymond; Akello, Anne Ruth; Musinguzi, Marvin; Acup, Walter; Nabaziwa, Jannat; Shikanga, Enos Mwirotsi; Namata, Haliama
    Background: The escalating global prevalence of burnout among healthcare professionals poses a serious health concern. Recent studies focus on prevalence and predictors of burnout among healthcare providers, emphasizing the need for well-being interventions. This study investigates burnout and coping mechanisms among healthcare professionals in central Uganda, addressing the dearth of knowledge about coping strategies specific to the region. Methods: An analytical facility cross-sectional study was conducted in five healthcare facilities in central Uganda between June to July 2023. Participants included physicians, nurses, and technicians actively engaged in direct patient care. Data were collected using socio-demographic surveys, the Professional Quality of Life (ProQOL-5), and the Brief-COPE tools. Results: The study revealed a high prevalence of burnout, with 39.8% of participants experiencing significant levels. Active coping, positive reframing, and denial were negatively correlated with low burnout levels. Dysfunctional coping, specifically self-distraction and denial, showed positive correlations with average and high burnout levels. Emotion-focused coping mechanisms were not employed across burnout levels. Conclusions: The results emphasize the demanding nature of healthcare roles in the region and highlight the need for comprehensive, context-specific interventions to address burnout globally. While some healthcare professionals utilized adaptive strategies such as seeking social support, engaging in self-care activities, and utilizing problem-solving skills, others resorted to maladaptive coping mechanisms such as substance use and avoidance behaviors. This dichotomy highlights the need for targeted interventions to promote adaptive coping strategies and mitigate the negative impact of maladaptive behaviors on individual well-being and patient care
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    Burnout and quality of life among healthcare workers in central Uganda
    (PLoS ONE, 2024) Kabunga, Amir; Kigongo, Eustes; Okalo, Ponsiano; Udho, Samson; Auma, Anna Grace; Tumwesigye, Raymond; Akello, Anne Ruth; Musinguzi, Marvin; Acup, Walter; Nabaziwa, Jannat; Shikanga, Enos Mwirotsi; Namata, Haliama
    Background The widespread problem of burnout among healthcare workers is not only common but also a significant concern that impacts the entire healthcare system in Uganda. It is essential to understand the connection between burnout and quality of life among healthcare workers in the specific context of central Uganda, where healthcare professionals face high patient volumes, limited resources, exposure to infectious diseases, and socioeconomic challenges. This study examined the relationship between burnout and quality of life among healthcare workers in central Uganda. Methods This research utilized a cross-sectional study conducted across various healthcare settings in central Uganda. The data were analyzed at descriptive, bivariate, and multivariate levels. The relationship between dependent and independent variables was evaluated using an independent t-test for binary variables and a one-way analysis of variance (ANOVA) for categorical variables. Significance was determined with a reported p-value, with relationships deemed significant at p < 0.2. For multivariable analysis, multiple linear regression was employed using a forward selection method, with significance set at 5% (p < 0.05). Results Our findings indicate that nearly 40% of healthcare workers reported experiencing high levels of burnout. The average score for overall quality of life was 10.71 (±4.89), with variations observed across different domains. The study reveals a significant connection between socio-demographic factors, burnout, and overall quality of life, emphasizing the impact of job category, supervisory support, sleep quality, and burnout on the well-being of healthcare workers. Predictive analysis illustrates how these factors influence both overall quality of life scores and scores in specific domains. Particularly noteworthy is that nurses and technicians tend to have a lower quality of life compared to physicians. Conclusion The results underscore the relationship between socio-demographic factors, burnout, and particular aspects of quality of life. Notably, job category, supervisory support, sleep quality, and burnout stand out as significant factors shaping the well-being of healthcare workers. Nurses and technicians encounter distinct challenges, suggesting the need for interventions tailored to their needs. Addressing issues such as inadequate supervisory support, burnout, and sleep-related problems is recognized as a potential approach to improving the overall quality of life among healthcare workers.
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    Chronic stress and its correlates among nurses: A case of Central Uganda
    (Avicenna J Neuro Psycho Physiology, 2023) Kabunga, Amir; Kigongo, Eustes; Udho, Samson; Musinguzi, Marvin; Tumwesigye, Raymond; Acup, Walter
    Background: Despite an overwhelming disease burden, nursing shortages are evident in Sub-Saharan Africa, with the potential for significant healthcare crises. Nurses face increased work demands and chronic stress due to a skilled personnel shortage, which may lead to stress. The present study aimed to examine chronic stress and its correlates among nurses in central Uganda. Methods: The 12-item Short Form Survey (SF-12) for the assessment of chronic stress among nurses, a validated and standardized tool, was used in this cross-sectional study in 2022. For explanatory analysis, the items were combined with dichotomous variables reflecting predictors of chronic stress. These items were used to create dichotomous variables denoting frequent and demanding challenges for exploratory analysis. The relationship between the variables and high levels of chronic stress was investigated using a multivariate logistic regression model. Results: Based on the findings, the majority, 485 (76.0%), had chronic stress. The results indicate that the correlates of chronic stress among participants were widowhood (AOR: 0.040; 95% CI: 0.013-0.127; P= <0.001), being worried about looming deadlines (aOR: 0.003; 95% CI: 0.001-0.023; P = <0.001), long working hours (AOR: 0.283; 95% CI: 0.159-0.504; p=<0.001), insufficient job control (AOR: 0.304; 95% CI: 0.127-0.727; P = 0.007), and inadequate rewards (AOR: 2.554; 95% CI: 1.170-5.574; P = 0.019). Conclusion: According to our findings, three in four nurses in central Uganda suffer from chronic stress. This can exert a negative impact on their overall well-being and caring behaviors. Chronic stress was associated with widowhood, a looming deadline, long working hours, insufficient job control, and inadequate rewards. It is critical to adapt interventions, such as hiring additional nurses, to reduce workload and ensure adequate rest periods.
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    HIV-Related Stigma Among Pregnant Adolescents: A Qualitative Study of Patient Perspectives in Southwestern Uganda
    (Taylor and Francis, 2024) Kabunga, Amir; Nabasirye, Caroline Kambugu; Kigingo, Eustes; Namata, Halimah; Shikanga, Enos Mwirotsi; Udho, Samson; Auma, Anna Grace; Nabaziwa, Jannat; Tumwesigye, Raymond; Musinguzi, Marvin; Okalo, Ponsiano; Acup, Walter
    Background: The HIV epidemic disproportionately affects adolescents in Sub-Saharan Africa, with adolescent girls facing heightened vulnerability. Despite advancements in antiretroviral therapy, HIV-related stigma remains prevalent, particularly among pregnant adolescents. This qualitative study explores the perspectives of adolescents living with HIV in southwestern Uganda, seeking to understand the nature of HIV-related stigma in this context. Methods: One-on-one narrative interviews were conducted with 28 pregnant adolescents living with HIV aged 14–19 receiving care at Mbarara Regional Referral Hospital. The qualitative approach allowed for in-depth exploration of participants’ experiences. Thematic analysis was employed to identify recurring patterns in the narratives. Results: Five overarching themes emerged from the analysis: Experiences of double stigma, social and cultural influences shaping stigma, healthcare system challenges, psychosocial impacts of stigma, and resilience and coping mechanisms. Double stigma, arising from societal prejudices related to both HIV status and teenage pregnancy, created a complex environment for participants. Despite these challenges, participants exhibited resilience through external support and internal strength. Conclusion: This study reveals the pervasive double stigma experienced by pregnant adolescents living with HIV in southwestern Uganda, driven by societal biases against both HIV status and teenage pregnancy. Urgent targeted interventions are needed to address the intersectionality of stigma, cultural influences, healthcare issues, and psychosocial well-being for the betterment of this vulnerable population.
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    A systematic review and meta-analysis of compassion fatigue among healthcare professionals before and during COVID-19 in Sub-Saharan Africa
    (PLOS Glob Public Health, 2024) Kabunga, Amir; Kigongo, Eustes; Tumwesigye, Raymond; Udho, Samson; Musinguzi, Marvin; Acup, Walter; Auma, Anna Grace; Akello, Anne Ruth; Okalo, Ponsiano; Nabaziwa, Jannat; Shikanga, Enos Mwirotsi
    Compassion fatigue is a significant concern globally, particularly in Sub-Saharan Africa, where the COVID-19 pandemic exacerbated existing challenges, placing unprecedented strain on healthcare professionals. This study systematically estimated the prevalence of compassion fatigue among healthcare professionals before and during COVID-19 in SubSaharan Africa. A systematic review was conducted using keywords in PubMed, ScienceDirect, Google Scholar, and grey literature, covering all literature published between 2012 and December 30, 2023. The search team independently conducted study selection, quality assessments, data extractions, and analysis of all included studies. The systematic review, reported following PRISMA guidelines, included 11 studies. The results show that the pooled overall prevalence of compassion fatigue in Sub-Saharan Africa was 70% (95% CI: 57–82, I 2 = 88.37%). The highest prevalence was found in Eastern Africa at 74% (95% CI: 55–93, I 2 = 94.40%), compared to 64% in Southern Africa (95% CI: 49–79, I 2 = 59.01%). Nurses reported the highest rates of compassion fatigue at 80% (95% CI: 57–100, I 2 = 34.77%), followed by general healthcare professionals at 59% (95% CI: 22–97, I 2 = 94.11%) and nursing students at 50% (95% CI: 35–64, I 2 = 0.00%). Before COVID-19, the overall prevalence of compassion fatigue was 66% (95% CI: 41–91, I 2 = 27%). During COVID-19, this increased to 74% (95% CI: 63–85, I 2 = 88.73%). Our results indicate that nearly 3 in 4 healthcare professionals in Sub-Saharan Africa experience compassion fatigue, and this prevalence increased due to the pandemic. The high prevalence underscores the importance of addressing and mitigating compassion fatigue to support the mental health and emotional well-being of healthcare professionals dedicated to helping others in challenging circumstances.
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    Systematic review and meta-analysis of postpartum depression and its associated factors among women before and after the COVID-19 pandemic in Uganda
    (BMJ Open, 2024) Kabunga, Amir; Tumwesigye, Raymond; Kigongo, Eustes; Musinguzi, Marvin; Acup, Walter; Auma, Anna Grace
    Objective This meta-analysis aimed to estimate the national prevalence of postpartum depression (PPD) in Uganda and identify predictors in both pre-COVID-19 and post-COVID-19 eras. Design Used a systematic review and meta-analysis methodology. Data sources Reviewed papers were sourced from Medline/PubMed, PsycINFO, CINAHL/EBSCOhost, Google Scholar, ScienceDirect and African Journals Online. Eligibility criteria for selected studies The review encompassed observational studies published on PPD in Uganda from 1 January 2000 to 30 November 2023. Results 11 studies (involving 7564 participants) published from 1 January 2000 to 30 November 2023 were reviewed. The pooled prevalence of PPD in Uganda was 29% (95% CI 21% to 37%, I2 =98.32%). Subgroup analysis indicated a similar prevalence before (29%, 95% CI 20% to 39%) and during (28%, 95% CI 22% to 32%) the COVID-19 period. Special groups exhibited a higher prevalence (32%, 95% CI 16% to 47%) than general postpartum women (28%, 95% CI 19% to 37%). Factors associated with PPD included poor social support (OR 1.19, 95% CI 1.17 to 1.22, I2 =96.8%), maternal illness (OR 1.22, 95% CI 1.19 to 1.26, I2 =96.9%), poor socioeconomic status (OR 1.43, 95% CI 1.40 to 1.46, I2 =99.5%) and undergoing caesarean section (OR 1.15, 95% CI 1.12 to 1.17, I2 =80.6%). Surprisingly, there was a marginal decrease in PPD during the COVID-19 period. Subgroup analysis highlighted a higher prevalence among mothers with HIV. Conclusion This study underscores the significant prevalence of PPD in Uganda, with sociodemographic factors increasing risk. Despite a slight decrease during the COVID-19 period, the importance of prioritising maternal mental health is emphasised, considering sociodemographic factors and pandemic challenges, to improve maternal and child health outcomes and overall well-being.
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    A Systematic Review and Meta-analysis of the Prevalence of Depression among Breast Cancer Patients in Sub-Saharan Africa
    (Avicenna Journal of Neuropsychophysiology, 2023) Kabunga, Amir; Kigongo, Eustes; Musinguzi, Marvin; Tumwesigye, Raymond; Acup, Walter
    Background: Breast cancer is linked to neuropsychiatric conditions, particularly depression, which lowers life expectancy. Studies from Sub-Saharan Africa, however, have revealed conflicting prevalence rates of depression. Objective: To assess the combined prevalence of breast cancer-related depression among patients in Sub-Saharan Africa. Methods: The following search terms—depression, depressive disorders, breast cancer, mammary cancer, mammary adenocarcinoma and breast carcinoma, and Sub-Saharan African—were used to conduct a systematic search for English articles on depression published in PubMed, Scopus, Web of Science, African Journal Online, and Google Scholar. A meta-command was used to combine the results of different studies on depression linked to breast cancer through a random effects model at a 95% confidence interval in Stata software (version 17). Results: After the elimination of duplicates, 9,272 articles were still found after the electronic search yielded 12051 results. A number of 19 articles were still available after abstract and title screening, and they underwent full-text screening. A number of 10 articles were removed for a variety of reasons, including the lack of the full text (n=2), incorrect publication type (n=2), and not reporting the full outcome of interest (n=6). In Sub-Saharan Africa, the combined prevalence of breast cancer patients was 60%. (95CI, 0.51-0.69). The prevalence rates of depression among breast cancer patients in East Africa, South Africa, and West Africa were reported as 64% (95CI, 0.51-0.75), 60% (95CI, 0.53-0.67), and 55%. (95CI, 0.36-0.73), respectively. Conclusion: In Sub-Saharan Africa, about 6 in 10 cancer patients experience depression. Since depression negatively affects the quality of life, it is important to properly diagnose depression in order to treat it effectively with the fewest possible side effects. Keywords: Breast cancer, Depression, Depressive disorders, Neuropsychiatric disorder