Browsing by Author "Omech, Bernard"
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Item Access to family planning services and associated factors among young people in Lira city northern Uganda(BMC Public Health, 2024) Kigongo, Eustes; Tumwesigye, Raymond; Anyolitho, Maxson Kenneth; Musinguzi, Marvin; Kwizera, Gad; Achan, Everlyne; Nabasirye, Caroline Kambugu; Udho, Samson; Kabunga, Amir; Omech, BernardBackground Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda. Methods and materials A mixed-methods study was conducted in March to April 2022. Quantitative data were collected using a structured questionnaire from 553 participants aged 15–24 years. Qualitative data were obtained through in-depth interviews and focus group discussions. Data analysis included univariate, bivariate, and multivariate analyses for quantitative data, while interpretative phenomenological analysis was used for qualitative data. Results Overall, 31.7% of the respondents had a good perceived access to family planning services, with 64.6% reporting perceived availability of FP methods. Challenges included lack of privacy (57.7%), fear of mistreatment (77.2%), and decision-making difficulties (66.2%). Among females, good perceived access to FP services was less likely among urban residents (AOR: 0.22, 95% CI: 0.09–0.53), Christian respondents (AOR: 0.51, 95% CI: 0.01–0.36), Muslim respondents (AOR: 0.07, 95% CI: 0.01–0.55) and respondents with poor attitude to FP services (AOR: 0.39, 95% CI: 0.24–0.64), but more likely among respondents with a sexual a partner (AOR: 4.48, 95% CI: 2.60–7.75). Among males, good perceived access to FP services was less likely among respondents living with parents (AOR: 0.19, 95% CI: 0.05–0.67) but more likely among respondents with good knowledge of FP services (AOR: 2.28, 95% CI: 1.02–5.32). Qualitative findings showed that three themes emerged; knowledge of family planning methods, beliefs about youth contraception and, friendliness of family planning services. Conclusion The study revealed a substantial gap in perceived access to family planning services among young people in Lira City. Barriers include privacy concerns, fear of mistreatment, and decision-making difficulties. Tailored interventions addressing urban access, religious beliefs for females, and knowledge enhancement for males are essential. Positive aspects like diverse FP methods and physical accessibility provide a foundation for targeted interventions. Youth-friendly services, comprehensive sexual education, and further research are emphasized for a nuanced understanding and effective interventions in Northern Uganda. Keywords Access, Contraception, Family planning, Youths, Young peopleItem Adherence to Benzathine Prophylaxis Among Rheumatic Fever and Rheumatic Heart Disease Patients Attending Outpatient Clinic at Lira Regional Referral Hospital(Lira University, 2022) Atala, Jenifer; Omech, Bernard; Obura, BonnifaceBackground:Secondary prevention of Rheumatic fever and Rheumatic Heart Disease with 3-4 weekly Benzathine prophylaxis is the most effective strategy in preventing disease progression and complications. Efficacy of this regimen is dependent on its rational use. However, adherence to Benzathine prophylaxis worldwide is suboptimal. Magnitude and impact of poor adherence is higher in developing countries. Methods: A retrospective cohort study design using mixed methods was done. To acquire information on adherence to monthly BPG injections, the quantitative component involved a retrospective chart review of secondary data extracted from the Lira RHD Registry. The primary information was qualitative, obtained from key informant and in-depth interviews with RHD patients, care givers, and healthcare professionals respectively. Utilizing a logistic regression model, data was evaluated. Predictors that were at alpha=0.2 were considered significant at bivariate analysis and submitted to multivariate analysis. A significant threshold was set at 0.05 and 95% confidence interval. Thematic analysis using both inductive and deductive coding was used to analyze qualitative data. Results: Overall, 57.8% (89/154) of patients adhered to their benzathine prophylactic regimen. Majority of participants had at least primary education (84/153). Those with tertiary education were 2.6 times more likely to adhere to Benzathine penicillin prophylaxis. (AOR 2.69, 95% CI: 1.00-7.3, P value 0.049). Demand side factors associated with adherence included logistics involved, suboptimal communication, patient related factors and condition related factors whereas supply side factors included medicine stockout, human resource related challenges, costs involved and poor provider client relationship. Conclusion: Adherence was sub-optimal. To address some of the issues impacting adherence to BPG prophylaxis among these patients, it is necessary to address the demand side and supply side factors associated with adherence to BPG, such as training of healthcare professionals and strengthening the sensitization and health education of patients and their caregivers on the need for the monthly BPG injections in relation to their condition.Item Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana(South African Medical Journal, 2018) Mwita, Julius Chacha; Magafu, Mgaywa Gilbert Mjungu Damas; Omech, Bernard; Dewhurst, Matthew J; Mashalla, YohanaBackground. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients. Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF. Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality. Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality. Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub- Saharan Africa, and call for more studies to be done in this region.Item Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review(International journal of dermatology, 2019) Madu, Pamela N.; Williams, Victoria L.; Noe, Megan H.; Omech, Bernard; Kovarik, Carrie L.; Wanat, Karolyn A.Background There is a paucity of data describing autoimmune skin diseases in sub- Saharan Africa and in HIV positive cohorts. We describe the incidence of autoimmune skin diseases in public dermatology clinics in Botswana. Methods New patient records from public dermatology clinics were reviewed retrospectively for the period of September 2008 to December 2015. New diagnoses of cutaneous lupus erythematosus, systemic lupus erythematosus (SLE) with cutaneous involvement, dermatomyositis, systemic sclerosis, lichen sclerosus, bullous pemphigoid, pemphigus foliaceus, pemphigus vulgaris, and pemphigus vegetans were identified. Demographic data were recorded, and incidence was determined. Results A total of 262 patients were diagnosed with autoimmune skin disease (4% of all new patients) with an incidence rate of 28.8 (per 1,000,000). Cutaneous lupus was the most common diagnosis with discoid lupus occurring most frequently (12.6). The incidence of systemic sclerosis (2.2), morphea (1.6), lichen sclerosus (1.5), SLE with cutaneous involvement (1.3) and dermatomyositis (1.2) was relatively lower. Bullous pemphigoid was the most common bullous disease (3.8). Pemphigus foliaceus (0.9), pemphigus vulgaris (0.6), and pemphigus vegetans (0.2) were observed at a lower rate. At least 19.8% of these patients were also HIV positive. Conclusions The incidence of autoimmune skin diseases in Botswana is lower compared to other published studies in other geographic areas, which may be reflective of a younger population, barriers to access, genetic differences, and a lack of comparative studies in sub-Saharan Africa. The hygiene hypothesis and helminth infections may also contribute to these differences. Further studies are needed to understand these disorders in this regionItem Barriers to treatment and care for depression among the youth in Uganda: The role of mental health literacy(Frontiers in Public Health, 2023) Amone-P’Olak, Kennedy; Kakinda, Adrian Ivan; Kibedi, Henry; Omech, BernardBackground: Depression represents a significant mental health problem (MHP) in low- and middle-income countries (LMICs), especially among early adults. Nevertheless, most early adults with depression do not seek treatment. Failure to recognize depression and knowledge about mental health literacy (MHL) may contribute to poor help-seeking behavior. This study assessed MHL, access and barriers to mental health care for depression among early adults in Uganda. Methods: Data were collected from students in two of the largest universities in Uganda. Participants completed questionnaires on depression, MHL, sources of barriers and opportunities for MH service. Regression analyses and parametric tests were used to assess depression, access, barriers and opportunities to promote MH. Results: About 12 per cent (n = 56) of the respondents were at the level of moderately severe to severe depression. Mental health literacy (MHL) scores were generally low ranging from “Ability to recognize mental disorders” (mean = 19.32, SD 3.22, range 18–32), and “Knowledge of risk factors” (mean = 4.39, SD 1.17, range 2–8), and “Knowledge of available information” (mean = 9.59, SD 2.53, range 5–20). Respondents reported barriers such as “stigma/discrimination” (65.53%), “lack of knowledge of where to receive help” (65.15%), “lack of trust in health workers” (62.56%), and “distant health facilities” (19.70%) that impede access to treatment and care. MHL significantly predicted depression (based on a continuous scale) (β = 0.63, 95% confidence interval [CI]: [0.56, 0.70]) with the regression model yielding a significant fit [R 2 = 0.40, F (2, 460) = 189.84, p < 0.001]. Conclusions: MHL is low among university students amidst several barriers such as stigma, fear, and lack of trust. To attenuate the negative eItem A case of Shapiro’s Syndrome in an African young man(Case Reports in Internal Medicine, 2015) Chacha, Mwita Julius; Omech, Bernard; Keatlaretse, Siamisang; Humphrey, BoseShapiro’s syndrome is a rare congenital neurological disease characterized by episodes of excessive sweating and hypothermia, and by complete/partial agenesis of the corpus callosum. We report an 18 year-old male who was referred to Princess Marina Hopsital with a longstanding history of episodic shaking chills, excessive sweating, fatigue, and unsteady gait. During the episodes, he was bradycardic (pulse rate of less than 36 beats/minute), with blood pressure of less than 80/45 mmHg, and his axillary body temperatures were unrecordably low. Neurologic examination showed cerebellar signs. The MRI of the brain revealed agenesis of the corpus callosum with no other abnormalities. The patient responded to clonidine therapy. Shapiro’s syndrome is an important consideration when evaluating a patient with episodic hyperhidrosis and hypothermia. The syndrome is rare worldwide and to the best of our knowledge, this report constitutes the first documentation of a case from Africa.Item Coping with post-war mental health problems among survivors of violence in Northern Uganda: Findings from the WAYS study(J Health Psychol, 2018-05-01) Amone-P'Olak, Kennedy; Omech, BernardCognitive emotion regulation strategies and mental health problems were assessed in a sample of war-affected youth in Northern Uganda. Univariable and multivariable regression models were fitted to assess the influence of CERS on mental health problems. Maladaptive cognitive emotion regulation strategies (e.g., rumination) were significantly associated with more mental health problems while adaptive cognitive emotion regulation strategies (e.g., putting into perspective) were associated with reporting fewer symptoms of mental health problems. The youth with significant scores on mental health problems (scores ≥ 85th percentile) reported more frequent use of maladaptive than adaptive strategies. Interventions to reduce mental health problems should focus on enhancing the use of adaptive strategies.Item Cost effectiveness Analysis of adding Tuberculosis Household Contact Investigation on Passive Case Finding Strategy in Southwestern Uganda.(Lira University, 2022) Odongo, Dickens; Omech, Bernard; Acanga, AlfredBackground: The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of TB. A household contact investigation is an alternative approach. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HHCI) to passive case-findings (PCF)strategy in the Tuberculosis control program in south western Uganda. Methods: The study utilized decision-analytic modelling and bottom-up costing (ingredients) methods. The study obtained cost and ability and probability estimates on from national TB program data, activity costs, publicized literature, and expert opinions. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntuganu, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of actual TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients diagnosed over the screen. The incremental cost-effectiveness ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. Results: The TB screening yields were 0.52% (1496/289140) for HHCI and 5.8% (197/3414) for PCF. HHCI yield among children 0-14 Vs. 15+ years [6.2% Vs.5.4%] P=0.04. The yield among PLHIV Vs. HIV-negative [15.8% Vs. 5.3%] P=0.03 in HHCI. The PCF yield in men Vs. women [1.12% Vs. 0.28%] P<0.01. The NNS in PCF was 193 [95% CI: 186-294] and 17 [95% CI: 14-22] in HHCI. The unit costs of detecting a TB case were US$ 204.22 for PCF and US$ 315.07 for HHCI. Patient and caregiver cost are five times in PCF than HHCI [US$ 26.37 Vs.US$ 5.42]. Under the study baseline assumption, adding HHCI to PCF strategies was not cost effectives at US$ 3,596.94 per additional case detected. Conclusion: HHCI improves access to TB diagnosis in children 0.14 years and PLHIV; however, PCF improves access to TB diagnosis among men. The unit cost of detecting one TB case in HHCI was higher than in PCP. Adding HHCI to PCF was not cost effective for detecting TB compared to PCF alone. Therefore, PCF remains the ideal and cost-effective strategy for low- resource countries like Uganda. Keywords: Cost-effectiveness, Yield, NNS, Tuberculosis, Household contact investigation, Passive case Findings, South western Uganda.Item Cost-Effectiveness Analysis of Adding Tuberculosis Household Contact Investigation On Passive Case Finding Strategy in Southwestern Uganda(Lira University, 2022) Odongo, Dickens; Omech, Bernard; Acanga, AlfredBackground: The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of TB. A household contact investigation is an alternative approach. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HHCI) to the passive case-finding (PCF) strategy in the Tuberculosis control program in Southwestern Uganda. Methods: The study utilized decision-analytic modeling and bottom-up costing (ingredients) methods. The study obtained cost and probability estimates from National TB program data, activity costs, published literature, and expert opinions. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntungamo, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of actual TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients diagnosed over the screen. The incremental cost-effectiveness ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. Results: The TB screening yields were 0.52% (1496/289140) for HHCI and 5.8% (197/3414) for PCF. HHCI yield among children 0-14 Vs. 15+ years [6.2% Vs.5.4%] P=0.04. The yield among PLHIV Vs. HIV-negative [15.8% Vs.5.3%] P=0.03 in HHCI. The PCF yield in men Vs. Women [1.12% Vs.0.28%] P<0.01. The NNS in PCF was 193 [95% CI: 186–294] and 17 [95% CI: 14-22] in HHCI. The unit costs of detecting a TB case were US$ 204.22 for PCF and US$ 315.07 for HHCI. Patient and caregiver costs are five times in PCF than HHCI [US$ 26.37 Vs. US$ 5.42]. Under the study baseline assumption, adding HHCI to PCF strategies was not cost-effective at US$ 3,596.94 per additional case detected. Conclusion: HHCI improves access to TB diagnosis in children 0-14 years and PLHIV; however, PCF improves access to TB diagnosis among men. The unit cost of detecting one TB case in HHCI was higher than in PCF. Adding HHCI to PCF was not cost-effective for detecting TB compared to PCF alone. Therefore, PCF remains the ideal and cost-effective strategy for low-resource countries like Uganda.Item Effects of Covid-19 On Utilization of Adolescent and Youth Friendly Health Services in Lira District.(Lira University, 2022) Oyella, Linda Mary; Omech, Bernard; Ojuka, EdwardPurpose: This study assessed the effects of covid-19 on utilization of adolescent and youth friendly services in Lira district. Objectives: To assess the effects of covid-19 and factors affecting the extent of utilization of adolescent and youth friendly services in Lira district. Methods: This was a quantitative cross-sectional study utilizing both primary and secondary data from two H/C IVs (Amac and Ogur) in Lira district. Primary data was collected using a semi-structured questionnaire and review of secondary data on utilization of adolescent and youth friendly services from facility records before and during the covid-19 period was used. Simple random sampling technique was used and data was analyzed using STATA version 15. Results: A total of 296 female participants were recruited of which the median age was 15 years (IQR 12-18). Majority of the participants were; Students (62.7%), from rural areas (94.5%), never married (70.6%), had attained primary education as the highest level (91.6%), and belong to catholic or Anglican religion (80%). Utilization of AFHS was 40% lower during the lockdown period (IRR=0.60, CI: 38%-95%) in comparison to the pre-covid-19 period. Being an adolescent girl of older age (AOR: 3.82, C.I: 2.31, 6.32) and being unmarried (AOR: 0.69, C.I:0.53, 0.88) were highly associated with use of adolescent friendly services. Conclusion: COVID 19 lockdown caused significant decline in utilization of AFHS in Lira. Preparedness plans and strategies for adolescent girls are required to sustain services during pandemics to mitigate adverse health outcomes.Item Glycaemic, blood pressure and lowdensity lipoprotein-cholesterol control among patients with diabetes mellitus in a specialised clinic in Botswana: a cross-sectional study(BMJ Open, 2019) Mwita, Julius Chacha; Francis, Joel M; Omech, Bernard; Botsile, Elizabeth; Oyewo, Aderonke; Mokgwathi, Matshidiso; Molefe-Baikai, Onkabetse Julia; Godman, Brian; Tshikuka, Jose-GabyObjective Control of glycaemic, hypertension and lowdensity lipoprotein-cholesterol (LDL-C) among patients with type 2 diabetes mellitus (T2DM) is vital for the prevention of cardiovascular diseases. The current study was an audit of glycaemic, hypertension and LDL-C control among ambulant patients with T2DM in Botswana. Also, the study aimed at assessing factors associated with attaining optimal glycaemic, hypertension and LDL-C therapeutic goals. Design A cross-sectional study. Setting A specialised public diabetes clinic in Gaborone, Botswana. Participants Patients with T2DM who had attended the clinic for ≥3 months between August 2017 and February 2018. Primary outcome measure The proportion of patients with optimal glycaemic (HbA1c<7%), hypertension (blood pressure <140/90 mm Hg) and LDL-C (<1.8 mmol/L) control. Results The proportions of patients meeting optimal targets were 32.3% for glycaemic, 54.2% for hypertension and 20.4% for LDL-C. Age≥ 50 years was positively associated with optimal glycaemic control (adjusted OR [AOR] 5.79; 95% CI 1.08 to 31.14). On the other hand, an increase in diabetes duration was inversely associated with optimal glycemic control (AOR 0.91; 95% CI 0.85 to 0.98). Being on an ACE inhibitor was inversely associated with optimal hypertension control (AOR 0.35; 95% CI 0.14 to 0.85). Being female was inversely associated with optimal LDL-C control (AOR 0.24; 95% CI (0.09 - 0.59). Conclusion Patients with T2DM in Gaborone, Botswana, presented with suboptimal control of recommended glycaemic, hypertension and LDL-C targets. These findings call for urgent individual and health systems interventions to address key determinants of the recommended therapeutic targets among patients with diabetes in this setting.Item Health System Responsiveness for Persons with HIV and Disability in South Western Uganda(Dovepress, 2023) Kibet, Emmanuel; Namirimu, Florence; Nakazibwe, Felista; Kyagera, Arnold Zironda; Ayebazibwe, Disan; Omech, BernardBackground: Inequitable access to Human Immunodeficiency Virus/Acquired Immune Syndrome (HIV/AIDS) Treatment and Care Services (HATCS) for People With Disabilities (PWD) is a hurdle to ending the pandemic by 2030. The aim of this study was to evaluate the Health System’s Responsiveness (HSR) and associated factors for PWD attending HATCS at health facilities in South Western Uganda. Methods: Between February and April 2022, we enrolled a total of 106 people with disabilities for a quantitative study and 14 key informants from selected primary care HIV clinics. The World Health Organization Multi-country study’s disability assessment schedules 2.0 and Health system responsiveness (HSR) questionnaire were adopted to measure the level of disabilities and respon- siveness, respectively. The level of HSR was evaluated using descriptive analysis. The association between socio-demographics, level of disabilities and HSR was evaluated through binary and multivariable logistic regression. The qualitative data were collected from 14 key informants using interview guide and analyzed according to thematic areas (deductive approaches). Results: Overall, Health system responsiveness (HSR) was at 47.62% being acceptable to people living with HIV and Disabilities in south western Uganda. Across different domains, the best performance was reported in social consideration (68.57%) and autonomy (67.62%). The least performance was registered in dignity (2.83%), confidentiality (2.91%), prompt Attention (17.35%) and Choices (30.48%). Whereas performance in communications (53.92%) and quality of basic amenities (42.27%) were average. There were no socio-demographics or disability variables that were predictive of HATCS responsiveness. PWDs experienced lack of social support, poor communication, stigma and discrimination during the HATCs services. On the other hand, the health-care providers felt frustrated by their inability to communicate effectively with PWDs and meet their need for social support. Conclusion: HSR was comparatively low, with dignity, confidentiality, prompt attention, and choice ranking worst. To address the universal and legitimate requirements of PWDs in accessing care, urgent initiatives are required to create awareness among all stakeholders. Keywords: HIV/AIDS, disability, health system responsiveness, UgandaItem Knowledge of alcohol-disease links and sociodemographic factors as predictors of support for alcohol-related policies among university students in Botswana(Drugs: Education, Prevention and Policy, 2019) Amone-P’Olak, Kennedy; Chilunga, Wilfred; Omech, Bernard; Renison Opondo, PhillipBackground: Worldwide, harmful alcohol use is causally related to about 60 diseases and is linked to about 3.3 million deaths annually. Yet, awareness of alcohol-disease links is low. Objective: This study aims to assess socio-demographic characteristics and knowledge of alcoholdisease links as predictors of support for alcohol-related policies. Methods: A survey of 615 university students (age¼19.8; SD¼1.6; 18–25) in Botswana assessed alcohol use and knowledge of alcohol-disease links as predictors of support for alcohol-related policies. T-tests and regression analyses were performed to estimate differences and predictors. Results: Forty per cent of respondents (n¼245) use alcohol, 38% (n¼93) of whom were hazardous users. Awareness of alcohol-disease links was low for diabetes (39%) and cancer (41%) but high for liver cirrhosis (89%) and injuries (87%). Female gender (relative to male) (b¼0.19, 95% CI: 0.11, 0.27), harmful alcohol use (b¼ 0.49, 95% CI: 0.56, 0.42), higher maternal education (b¼0.11, 95% CI: 0.02, 0.18), and more knowledge of alcohol-disease links (b¼0.13, 95% CI: 0.05, 0.21) predicted support for policies. Conclusions: Awareness of alcohol-disease links was low. Support for policies was predicted by being female (relative to male), reporting no harmful alcohol use, having more educated mothers, and knowledge of alcohol-disease links. Improving awareness of alcohol-disease links could be an effective intervention to increase support for alcohol-related policies.Item The mediating role of self-control on the relations between adverse childhood experiences and substance use among adolescents in Uganda(Frontiers in Psychology, 2024) Namusoke, Jane; Amone-P’Olak, Kennedy; Nakanwagi, Carol Chosen; Kibedi, Henry; Mayengo, Nathaniel; Ssenyonga, Joseph; Omech, BernardObjective: Adverse childhood experiences (ACEs) are established risk factors for undesirable consequences in adolescence and early adulthood, including substance use and a lack of self-control. Based on the Social Bonds Theory (SBT), this study aims to expand our knowledge of the pathways from ACEs and self-control to substance use in adolescence and early adulthood. Methods: The extent to which self-control mediates the association between ACEs and substance use was examined in a cross-sectional survey of 358 adolescents and young adults (N = 234, 65.5% girls, mean age 17.7, SD 0.58, range 15–18). Data were gathered using the Adverse Childhood Experiences (ACE-10) questionnaire, the Drug Abuse Screening Test (DAST-10), and the 10- item self-control scale to assess childhood adversity, substance use, and selfcontrol, respectively. Results: ACEs were widely reported and significantly associated with substance use and a lack of self-control. Self-control strongly predicted substance use, independent of ACEs. Among those reporting no ACEs, one to two, three to four, and five or more, there were significant variations in the respondents’ substance use (F(3, 400) = 12.69, p = 0.001). Self-control explained 51.2% (95% confidence interval [CI]: 41, 61%) of the associations between ACEs and substance use as assessed by linear regression. Conclusion: Self-control is key to understanding why adolescents and young adults with a history of childhood adversity indulge in substance use. Therefore, there is a need to advocate for psychological interventions such as cognitive and behavioural therapy that have demonstrated efficacy in promoting selfcontrol in adolescents and young adults. KEYWORDS adverse childhood experiences, substance use, self-control, adolescents, UgandaItem Novel Education Modules Addressing the Underrepresentation of Skin of Color in Dermatology Training(Journal of Cutaneous Medicine and Surgery, 2021) Slaught, Christa; Madu, Pamela; Chang, Aileen Y.; Williams, Victoria L.; Kebaetse, Masego B.; Nkomazana, Oathokwa; Molefe-Baikai, Onkabetse Julia; Bekele, Negussie A.; Omech, Bernard; Kellman, Philip J.; Krasne, Sally; Kovarik, Carrie L.Background: Representative images of pathology in patients with skin of color are lacking in most medical education resources. This particularly affects training in dermatology, which relies heavily on the use of images to teach pattern recognition. The presentation of skin pathology can vary greatly among different skin tones, and this lack of representation of dark skin phototypes challenges providers’ abilities to provide quality care to patients of color. In Botswana and other countries in sub-Saharan Africa, this challenge is further compounded by limited resources and access to dermatologists. There is a need for improved and accessible educational resources to train medical students and local medical providers in basic skin lesion description and diagnosis. Objectives: We examined whether online Perceptual and Adaptive Learning Modules (PALMs) composed of representative dark skin images could efficiently train University of Botswana medical students to more accurately describe and diagnose common skin conditions in their community. Methods: Year 4 and 5 medical students voluntarily completed PALMs that teach skin morphology, configuration, and distribution terminology and diagnosis of the most common dermatologic conditions in their community. Pre-tests, post-tests and delayed-tests assessed knowledge acquisition and retention. Results: PALMs training produced statistically significant (P < .0001) improvements in accuracy and fluency with large effect sizes (1.5, 3.7) and good retention after a 12.5-21-week median delay. Limitations were a self-selected group of students, a single institution, slow internet connections, and high drop-out rates. Conclusions: Overall, population-specific PALMs are a useful tool for efficient development of pattern recognition in skin disease description and diagnosis.Item Outcomes and Factors associated with Multi-Drug Resistant Tuberculosis (MDR-TB) among Tuberculosis Patients attending Lira Regional Referral Hospital(Lira University, 2023) Abor, Daniel; Opio, Bosco; Omech, BernardBackground: Multi-Drug Resistant Tuberculosis (MDR-TB) remains a Public Health challenge in low resources countries. Uganda is still among the countries estimated by WHO to have incidences of MDR TB of at least 1000 cases. The burden of MDR-TB in Lango Sub- Region is high and yet its risk factors and treatment outcomes remain unknown. This study assessed treatment outcomes, factors associated with MDR-TB and MDR-TB patients’ experiences with health system services among TB patients in Lira Regional Referral Hospital (LRRH) from January 2020 to December, 2022. Methods: A cross sectional study involving quantitative and qualitative study was conducted among TB patients with treatment outcomes at LRRH from January 2020 to December 2022. Eligible participants were screened for MDR-TB and the independent variables which included; socio-demographics, clinical presentation, co-infections and morbidities. Descriptive statistics was used to determine treatment outcomes. Bivariate and multivariate analysis were done to determine predictors of MDR-TB. Key informant interviews for MDR-TB were done and analyzed manually to evaluate MDR-TB patients’ experiences. Results: Out of the 762 TB patients, 10.63% had MDR-TB. Higher proportions were males, 67.32% (513/762) and majority of the participants aged 30-45 years (38.58). among MDR patients, 38.27% (31/81) completed treatment, 30.86% (25/81) got cured, 18.52% (15/81) were lost to follow-up, and 12.35% (10/81) died. Distance of > 10km for LRRH (aOR=2.64, 95% CI: 1.45-5.17) and patients without previous tb treatment (aOR =0.03, 95% CI: 0.02-0.07) significantly predicted MDR-TB. Drugs’ side effects, additional financial and nutritional support were also key findings in qualitative reports. Conclusion: Higher proportions had favorable outcome. Distance of > 10km, previous TB treatment was associated with MDR-TB. drugs’ side effects, financial and nutritional support could affect treatment adherence. Keywords: Treatment Outcomes, Multi Drug Resistant Tuberculosis, Predictors and Referral HospitalItem Predictors of Somatic Symptomatology in War-Affected Youth in Northern Uganda: Findings from the WAYS Study(Psychological Studies, 2020) Amone-P’Olak, Kennedy; Omech, BernardWar experiences have been shown to have adverse long-term psychological sequelae. Nevertheless, the roles of different types of war events in predicting which mental health outcomes remain unclear. This study investigated the effects of different types of war events and socio-demographic characteristics on somatic symptoms in war-affected youth in Northern Uganda. A sample of 539 youth (mean age = 22.39; ± 2.03) participated in the study. Using maximum likelihood estimation in structural equation modelling, regression analyses were fitted to relate binary indicators of different types of war events to one latent factor capturing somatic symptoms. The results indicated that sex, marital status, and war types of ‘‘direct personal harm’’, ‘‘deaths’’, and ‘‘sexual abuse’’ independently and uniquely predicted somatic symptoms. Types of war events should be considered when planning interventions. Somatic symptoms may be a window into physical health and psychological sequelae. Implications for mental health service delivery are discussed.Item Presentation and mortality of patients hospitalised with acute heart failure in Botswana(Cardiovascular journal of Africa, 2017) Mwita, Julius Chacha; Dewhurst, Matthew J; Magafu, Mgaywa GMD; Goepamang, Monkgogi; Omech, Bernard; Majuta, Koketso Lister; Gaenamong, Marea; Palai, Tommy Baboloki; Mosepele, Mosepele; Mashalla, YohanaIntroduction: Heart failure is a common cause of hospitalisation and therefore contributes to in-hospital outcomes such as mortality. In this study we describe patient characteristics and outcomes of acute heart failure (AHF) in Botswana. Methods: Socio-demographic, clinical and laboratory data were collected from 193 consecutive patients admitted with AHF at Princess Marina Hospital in Gaborone between February 2014 and February 2015. The length of hospital stay and 30-, 90- and 180-day in-hospital mortality rates were assessed. Results: The mean age was 54 ± 17.1 years, and 53.9% of the patients were male. All patients were symptomatic (77.5% in NYHA functional class III or IV) and the majority (64.8%) presented with significant left ventricular dysfunction. The most common concomitant medical conditions were hypertension (54.9%), human immuno-deficiency virus (HIV) (33.9%), anaemia (23.3%) and prior diabetes mellitus (15.5%). Moderate to severe renal dysfunction was detected in 60 (31.1%) patients. Peripartum cardiomyopathy was one of the important causes of heart failure in female patients. The most commonly used treatment included furosemide (86%), beta-blockers (72.1%), angiotensin converting enzyme inhibitors (67.4%), spironolactone (59.9%), digoxin (22.1%), angiotensin receptor blockers (5.8%), nitrates (4.7%) and hydralazine (1.7%). The median length of stay was nine days, and the in-hospital mortality rate was 10.9%. Thirty-, 90- and 180-day case fatality rates were 14.7, 25.8 and 30.8%, respectively. Mortality at 180 days was significantly associated with increasing age, lower haemoglobin level, lower glomerular filtration rate, hyponatraemia, higher N-terminal pro-brain natriuretic peptide levels, and prolonged hospital stay. Conclusions: AHF is a major public health problem in Botswana, with high in-hospital and post-discharge mortality rates and prolonged hospital stays. Late and symptomatic presentation is common, and the most common aetiologies are preventable and/or treatable co-morbidities, including hypertension, diabetes mellitus, renal failure and HIV.Item Prevalence and correlates of teenage pregnancy among in-school teenagers during the COVID-19 pandemic in Hoima district western Uganda–A cross sectional community-based study(PLoS ONE, 2022) Musinguzi, Marvin; Kumakech, Edward; Auma, Anne Grace; Akello, Ruth Anne; Kigongo, Eustes; Tumwesigye, Raymond; Opio, Bosco; Kabunga, Amir; Omech, BernardBackground The COVID-19 pandemic related restrictions and lockdown measures had compromised the routine delivery and access of sexual and reproductive health and rights services to the population including the teenage girls. However, the teenage pregnancy rates during COVID-19 pandemic period were poorly documented. This study aimed at determining the prevalence and the factors associated with teenage pregnancy among in-school teenage girls during the COVID-19 pandemic period in Hoima District Uganda. Methods This was a descriptive cross-sectional study that employed quantitative research methods. A total of 314 in-school teenage girls aged 13–19 years were selected using a multi-stage sampling techniques. Interviewer-administered questionnaires were used to collect the data from the participant’s homes during the period December 2021-January 2022. Data analysis was done using univariate, bi-variate, and multivariate. Results The prevalence of teenage pregnancy among the in-school teenage girls in Hoima district Uganda was 30.6% [96/314]. Higher teenage pregnancy rates were prevalent among the unmarried teenage girls [aOR: 9.6; 95%CI: 4.64–19.87; p = 0.000], teenage girls studying from boarding schools [aOR 2.83, 95%CI 1.36–5.86, p = 0.005], contraceptive non-users [aOR: 2.54; 95%CI: 1.12–5.4; p = 0.015] and teenage girls involved in sex trade [aOR 3.16, 95%CI 1.5–6.7, p = 0.003]. The factors associated with the reduced likelihood for teenage pregnancy included being an adult teenage girl aged 18–19 years [aOR: 0.15; 95%CI: 0.07–0.32; p = 0.000] and not receiving sex education during the period [aOR 0.36, 95%CI 0.13– 0.62, p = 0.024]. Conclusion The results indicated that 3 out of 10 in-school teenage girls from Hoima district Uganda got pregnant during the COVID-19 pandemic period of 2021. Teenage pregnancy was prevalent among teenage girls who don’t use modern contraceptive methods and those involved in sex trade. Teenage pregnancy was however, less prevalent among adult teenage girls aged 18–19 years. The findings point to the need for health stakeholders to innovate creative policies, contingency plans and programmes aimed at delaying age for sexual activities, increasing contraceptive use and minimizing pregnancy risk from sex trade among in-school teenage girls during COVID-19 pandemics.Item Prevalence and Determinants of Asymptomatic Malaria Among Pregnant Women Attending Primary Health Care Services in Lira District / Lira City(Lira University, 2022) Acio, Harriet Sarah; Omech, Bernard; Oceng, Freda AmitoBackground: Asymptomatic malaria infection is a positive Rapid Diagnostic Test or blood smear for P. falciparum with no clinical signs or symptoms conclusive of Malaria. Most malaria infections among pregnant women in high or moderate transmission are asymptomatic, infected women may not seek treatment yet with a devastating consequences on both the mother and fetus and can progress to severe MIP by acting as reservoir of malaria infection. Objectives To assess the prevalence and determinants of asymptomatic Malaria among pregnant women attending services in PHC facilties in lira district/Lira City. Methods: The study used a descriptive cross-sectional design. Data was collected using a semi-structured questionnaire administered to pregnant women tested for asymptomatic MIP at their exit points. Analysised at three levels univariate, bivariate and multivariate respectively. Variables with p-values ˂0.05 were considered statistically significant factors influencing Asymtomatpic MIP on logistic regression. While qualitative data collected through key informat interview guide, analysised through content analysis. Results: Of the 267 respondents, 25.5% had asymptomatic malaria, living within Lira district (aOR=0.50,p=0.02,95% Cl=0.276-0.895) had a 50% incresed likilhood of asymptomatic MIP compared to living in Lira City, being aged 25-29 years (aOR=2.70, ,p=0.04,95% Cl=1.067-6.82) had a 2.70 odds of asymptomatic MIP compared to other age groups. Women from places where VHTs did,t know their roles (aOR=0.596, ,p=0.01,95% Cl=0.322-1.10) had a 0.4% incresed likilhood of asymptomatic MIP compared to others. Conclusion: High prevalence of asymptomatic malaria in Lira district compared to Lira City. Middle age mother were more than twice more likely to have assymptomic malaria.