Human health and economic impact of neurocysticercosis in Uganda.

OBJECTIVE: Neurocysticercosis (NCC), caused by the pork tapeworm Taenia solium, is a major cause of acquired epilepsy in endemic regions. The Republic of Uganda, one of the great-lakes nations in East Africa, has undergone major strives of political instability in the past century, impeding control of T. solium and other foodborne diseases. Building on data on the epidemiology of NCC, we aimed to assess the health and economic impact of NCC-associated epilepsy and headache in Uganda. METHODS: We used DisMod II to generate an internally consistent, complete and age-stratified set of epidemiological parameters for NCC epilepsy, and subsequently modelled the NCC headache incidence from the NCC epilepsy incidence. The health impact of both conditions was quantified in terms of Disability-Adjusted Life Years (DALYs), while the economic impact was quantified as the cost of illness associated with direct healthcare costs, patient costs and productivity losses. For both assessments, we adopted an incidence perspective and used 2010 as reference year. Uncertainty was propagated using 100,000 Monte Carlo simulations. RESULTS: In 2010, NCC was estimated to cause more than 9000 (CI: 7685-11,071) new cases of epilepsy and nearly 1500 new cases of headache, eventually leading to nearly 3000 deaths. Overall, it was estimated that NCC led to more than 170,000 DALYs (5.2 per 1000 person years; 16 per incident case) and an economic loss of more than USD 75 million (8000 per incident case). Non-fatal health outcomes were the largest contributors to the overall health impact, while productivity losses dominated the NCC cost of illness. CONCLUSIONS: NCC imposes a substantial burden on public health and the economy in Uganda with poor attention given to this public health problem. Increased awareness among governments, international agencies, and general public, as well as targeted intervention studies using a One Health approach are needed to reduce the significant burden of NCC in Uganda.

Characteristics of people with epilepsy in three Eastern African countries - a pooled analysis.

BACKGROUND: Epilepsy is one of the most common neurological disorders worldwide. Yet, its treatment gap is large in some areas and especially in sub-Saharan Africa data on clinical, radiological and semiological characteristics, as well as on treatment of persons with epilepsy (PWE) are still scarce. METHODS: We pooled data from four cross-sectional studies on epilepsy in eastern Africa. Two studies from Malawi and Uganda were community-based; two studies in Tanzania (urban Dar es Salaam and rural Haydom) were hospital-based. Clinical characteristics of PWE were assessed by the same questionnaire. Additionally, data on treatment were collected and computed tomography (CT) scans were performed. RESULTS: Overall, 1179 PWE were included in our analysis (581 (49.3%) female, median age 22 years (IQR 15-32 years)). Up to 25% of the patients had focal onset seizures. Those showed a higher rate of remarkable CT scan findings, with especially post-ischaemic and neurocysticercosis-associated lesions, compared to PWE with generalized onset seizures (35.1% vs. 20%). The majority of the patients experienced tonic-clonic seizures (70-85%). Only 67-78% of PWE received anti-seizure medication (ASM) treatment in the community-based studies, mostly monotherapy with phenobarbital, phenytoin or carbamazepine. Yet, underdosage was frequent and a large proportion of PWE received alternative non-ASM treatment consisting of herbal treatment (up to 83%) and/or scarification (up to 20%). CONCLUSIONS: Epilepsy is common in sub-Saharan Africa, often caused by neurocysticercosis or ischaemic strokes. PWE suffer from high seizure rates and subsequent injuries, as well as from socio-economic consequences due to insufficient ASM treatment. This pooled analysis illustrates the need for structural programmes for adequate identification, education, assessment and treatment of PWE in sub-Saharan Africa.

Post-conflict household structures and underweight: a multilevel analysis of a community-based study in northern Uganda.

OBJECTIVE: To examine associations between household-level characteristics and underweight in a post-conflict population. DESIGN: Nutritional status of residents in the Gulu Health and Demographic Surveillance Site was obtained during a community-based cross-sectional study, ~6 years after the civil war. Household-level factors included headship, polygamy, household size, child-to-adult ratio, child crowding, living with a stunted or overweight person, deprived area, distance to health centre and socio-economic status. Multilevel logistic regression models examined associations of household and community factors with underweight, calculating OR, corresponding 95 % CI and intraclass correlation coefficients. Effect modification by gender and age was examined by interaction terms and stratified analyses. SETTING: Rural post-conflict area in northern Uganda. SUBJECTS: In total, 2799 households and 11 312 individuals were included, representing all age groups. RESULTS: Living in a female-headed v. male-headed household was associated (OR; 95 % CI) with higher odds for underweight among adult men (2·18; 1·11, 4·27) and girls <5 years (1·51; 0·97, 2·34), but lower odds among adolescent women aged 13-19 years (0·46; 0·22, 0·97). Higher odds was seen for residents living in deprived areas (1·37; 0·97, 1·94), with increasing distance to health services (P-trend <0·05) and among adult men living alone v. living in an average-sized household of seven members (3·23; 1·22, 8·59). Residents living in polygamous households had lower odds for underweight (0·79; 0·65, 0·97). CONCLUSIONS: The gender- and age-specific associations between household-level factors and underweight are likely to reflect local social capital structures. Adapting to these is crucial before implementing health and nutrition interventions.

Use of information and communication technology and retention of health workers in rural post-war conflict Northern Uganda: findings from a qualitative study.

BACKGROUND: Information and communication technologies have become a vital infrastructural asset for use in the retention of rural health workers. However, little is known about the potential influence of ICT use, perceptions of health workers on ICT in healthcare delivery, and contribution of ICT to health care providers' retention in rural and remote areas in rural post-war and conflict situations of northern Uganda. METHODS: Data from interviews were transcribed, coded and thematically analysed. RESULTS: Participants generally exhibited low confidence, knowledge and low ICT skills. Majority of participants, however, perceived ICT as beneficial in relation to job performance and health care provider retention in rural areas. Common barriers for the implementation and use of ICT in health centres were inadequate ICT knowledge and skills, poor Internet networks, inadequate computers, inadequate power supply, lack of Internet Modems and expensive access to outside computer centres. CONCLUSIONS: This qualitative study showed low confidence, poor knowledge and skills in ICT usage but positive perceptions about the benefits and contributions of ICT. These findings suggest the need for specific investment in ICT infrastructural development for health care providers in remote rural areas of northern Uganda.

Gender and age disparities in adult undernutrition in northern Uganda: high-risk groups not targeted by food aid programmes.

OBJECTIVE: To determine the prevalence of adult malnutrition and associated risk factors in a post-conflict area of northern Uganda. METHODS: A cross-sectional community survey was performed from September 2011 to June 2013. All registered residents in Gulu Health and Demographic Surveillance System aged 15 years and older were considered eligible. Trained field assistants collected anthropometric measurements (weight and height) and administered questionnaires with information on sociodemographic characteristics, food security, smoking and alcohol. Nutritional status was classified by body mass index. RESULTS: In total, 2062 men and 2924 women participated and were included in the analyses. The prevalence of underweight was 22.3% for men and 16.0% for women, whereas the prevalence of overweight was 1.5% for men and 7.6% for women. In men, underweight was associated with younger (15-19 years) and older age (>55 years) (P < 0.001), being divorced/separated [odds ratio (OR) = 1.91 (95% confidence interval (CI): 1.21-2.99] and smoking (OR = 2.13, 95% CI: 1.67-2.73). For women, underweight was associated with older age (P < 0.001) and hungry-gap rainy season (May-July) (OR = 1.33, 95% CI: 1.04-1.69). Widowed or divorced/separated women were not more likely to be underweight. No association was found between education, alcohol consumption or food security score and underweight. CONCLUSIONS: Our findings are not in line with the conventional target groups in nutritional programmes and highlight the importance of continuous health and nutritional assessments of all population groups that reflect local social determinants and family structures.

Sexual violence and general functioning among formerly abducted girls in Northern Uganda: the mediating roles of stigma and community relations--the WAYS study.

BACKGROUND: Although sexual violence in war is associated with long-term mental health problems, little is known about its association with general functioning and the factors that explain this association. This study aims to illuminate the path from sexual violence to poor functioning. The prevalence of sexual violence among formerly abducted girls in Northern Uganda was assessed as well as the extent to which stigma and community relations explain the association between sexual violence and general functioning. METHOD: In a cross-sectional analysis using data from the WAYS study (N = 210, baseline age 22.06, SD = 2.06, minimum-maximum 18-25), the extent of mediation of the association between sexual violence and general functioning was assessed in multiple regression models. RESULTS: Sexual violence was found to be associated with increased stigma, poor community relations, and poor general functioning. The association between sexual violence and general functioning was mediated by stigma and community relations. The bootstrap results indicated significant mediation by stigma of 47 % (95 % confidence interval [CI] 35 to 78 % and by community relations of 67 % (95 % CI: 52 to 78 %) in the association between sexual violence and general functioning. CONCLUSION: Thus, poor functioning among formerly abducted girls is largely mediated by stigma and poor community relations. However, due to the relatively small effect sizes of the associations, targeted interventions to prevent impaired functioning may have only modest benefits to the formerly abducted girls. Interventions to alleviate the toxic effects of sexual violence in formerly abducted girls would benefit from a holistic approach that targets stigma and poor relationships within communities.

Knowledge and attitudes of doctors towards e-health use in healthcare delivery in government and private hospitals in Northern Uganda: a cross-sectional study.

BACKGROUND: E-health is an essential information sharing tool in healthcare management and delivery worldwide. However, utilization of e-health may only be possible if healthcare professionals have positive attitudes towards e-health. This study aimed to determine the relationships between healthcare professionals' attitudes towards e-health, level of ICT skills and e-Health use in healthcare delivery in government and private hospitals in northern Uganda. METHODS: Cross-sectional survey design was used. Sixty-eight medical doctors in three government hospitals and four private hospitals in Northern Uganda participated in the study. A pretested self-administered questionnaire was used to collect the required data. Data was analysed using SPSS software Version 19. RESULTS: Out of the 68 respondents, 39 (57.4 %) reported access to computer and 29 (48.5 %) accessed Internet in the workplace. Majority of healthcare professionals had positive attitudes towards e-health attributes (mean 3.5). The level of skills was moderate (mean 3.66), and was the most important and significant predictor of ICT use among healthcare professionals (r = .522, p < .001); however, attitudes towards e-health attributes did not contribute significantly in predicting e-health use. CONCLUSIONS: The findings suggest need for hospitals managements to strengthen e-health services in healthcare delivery in Northern Uganda.

Mediators of the relation between war experiences and suicidal ideation among former child soldiers in Northern Uganda: the WAYS study.

BACKGROUND: Globally, suicide is a public health burden especially in the aftermath of war. Understanding the processes that define the path from previous war experiences (WE) to current suicidal ideation (SI) is crucial for defining opportunities for interventions. We assessed the extent to which different types of previous WE predict current SI and whether post-war hardships and depression mediate the relations between WE and SI among former child soldiers (FCS) in Northern Uganda. METHODS: We performed cross-sectional analyses with a sample of 539 FCS (61% male) participating in an on-going longitudinal study. The influence of various types of previous WE on current SI and mediation by post-war hardships and depression were assessed by regression analyses. RESULTS: The following types of war experiences: "witnessing violence", "direct personal harm", "deaths", "Involvement in hostilities", "sexual abuse" and "general war experiences" significantly predicted current SI in a univariable analyses whereas "direct personal harm", "involvement in hostilities", and "sexual abuse" independently predicted current SI in a multivariable analyses. General WE were linked to SI (ß = 0.18 (95% CI 0.10 to 0.25)) through post-war hardships (accounting for 69% of the variance in their relationship) and through depression/anxiety (ß = 0.17 (95% CI 0.12 to 0.22)) accounting for 65% of the variance in their relationship. The direct relationship between previous WE and current SI reduced but remained marginally significant (ß = .08, CI: (.01, .17) for depression/anxiety but not for post-war hardships (ß = .09, CI: (-.03, .20). CONCLUSION: Types of WE should be examined when assessing risks for SI. Interventions to reduce SI should aim to alleviate post-war hardships and treat depression/anxiety.

War experiences, general functioning and barriers to care among former child soldiers in Northern Uganda: the WAYS study.

BACKGROUND: Exposure to war is associated with considerable risks for long-term mental health problems (MHP) and poor functioning. Yet little is known about functioning and mental health service (MHS) use among former child soldiers (FCS). We assessed whether different categories of war experiences predict functioning and perceived need for, sources of and barriers to MHS among FCS. METHODS: Data were drawn from an on-going War-affected Youths (WAYS) cohort study of FCS in Uganda. Participants completed questionnaires about war experiences, functioning and perceived need for, sources of and barriers to MHS. Regression analyses and parametric tests were used to assess between-group differences. RESULTS: Deaths, material losses, threat to loved ones and sexual abuse significantly predicted poor functioning. FCS who received MHS function better than those who did not. Females reported more emotional and behavioural problems and needed MHS more than males. FCS who function poorly indicated more barriers to MHS than those who function well. Stigma, fear of family break-up and lack of health workers were identified as barriers to MHS. CONCLUSIONS: Various war experiences affect functioning differently. A significant need for MHS exists amidst barriers to MHS. Nevertheless, FCS are interested in receiving MHS and believe it would benefit them.

The influence of different types of war experiences on depression and anxiety in a Ugandan cohort of war-affected youth: the WAYS study.

BACKGROUND: War experiences (WE) are frequently associated with mental health problems. Whether different types of WE vary in predicting which problem, or how severe, in former child soldiers (FCS) remains unknown. METHODS: Using data from the first wave of an on-going longitudinal cohort study (the WAYS study), we investigated relations between types of WE and symptoms of depression/anxiety among FCS in Northern Uganda (N = 539, baseline age = 22.39; SD = 2.03, range 18-25). Using robust Maximum Likelihood estimation in SEM, regression analyses were performed to relate binary indicators of types of WE to a single latent factor capturing symptoms of depression/anxiety. RESULTS: SEM results showed that "direct personal harm", "witnessing violence", "deaths", "threat to loved ones", "involvement in hostilities", and "sexual abuse" indicators were related to reported symptoms of depression/anxiety irrespective of gender and age. Multivariable models revealed independent associations of "witnessing violence" (ß = 0.29, SE = 0.09, p < 0.001) and "deaths" (ß = 0.14, SE = 0.05, p < 0.001) with symptoms of depression/anxiety in both sexes. "Sexual abuse" (ß = 0.32, SE = 0.16, p < 0.001) independently predicted symptoms of depression/anxiety for female but not male youths whilst "threat to loved ones" (ß = 0.13, SE = 0.07, p < 0.05) independently predicted symptoms of depression/anxiety in male but not female youths. CONCLUSIONS: Dimensions of WE predicted symptoms of depression/anxiety differently, but it is hard to establish their causal status. Our findings suggest that it might be fruitful to consider such exposure variations of WE when designing interventions to mitigate the symptoms of depression/anxiety on male and female FCS.

A consortium approach to competency-based undergraduate medical education in Uganda: process, opportunities and challenges.

BACKGROUND: Uganda, like the rest of Africa, is faced with serious health challenges including human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS), other infectious diseases and increasing non-communicable diseases, yet it has a significant shortage of health workers. Even the few health workers available may lack desired competencies required to address current and future health challenges. Reducing Uganda's disease burden and addressing health challenges requires Ugandan medical schools to produce health workers with the necessary competencies. This study describes the process which a consortium of Ugandan medical schools and the Medical Education Partnership for Equitable Services to all Ugandans (MESAU) undertook to define the required competencies of graduating doctors in Uganda and implement competency-based medical education (CBME). METHODS: A retrospective qualitative study was conducted in which document analysis was used to collect data employing pre-defined checklists, in a desktop or secondary review of various documents. These included reports of MESAU meetings and workshops, reports from individual institutions as well as medical undergraduate curricula of the different institutions. Thematic analysis was used to extract patterns from the collected data. RESULTS: MESAU initiated the process of developing competencies for medical graduates in 2011 using a participatory approach of all stakeholders. The process involved consultative deliberations to identify priority health needs of Uganda and develop competencies to address these needs. Nine competence domain areas were collaboratively identified and agreed upon, and competencies developed in these domains. DISCUSSION: Key successes from the process include institutional collaboration, faculty development in CBME and initiating the implementation of CBME. The consortium approach strengthened institutional collaboration that led to the development of common competencies desired of all medical graduates to address priority health challenges in Uganda. It is important that the MESAU consortium continues engaging all stakeholders in medical education to support the implementation and sustainability of CBME in Uganda.

Nodding syndrome in northern Uganda: overview and community perspectives.

The increasing prevalence of nodding syndrome in northern Uganda has generated a wide range of speculations with respect to etiology and natural history of and best possible medical treatment for this mysterious seizure disorder. Despite in-depth investigations by the United States Centers for Disease Control and Prevention and the Ministry of Health in Uganda, no clear causal factors have emerged. At the same time, northern Uganda communities are voicing concern for their lack of knowledge about nodding syndrome. The purpose of this commentary is to summarize northern Uganda community perceptions of this syndrome. These reflections demonstrate the need for larger investigations into the impact of nodding syndrome and other seizure disorders on local communities both in northern Uganda and throughout the world, in particular rural areas of resource poor countries.

Trends in HIV counseling and testing uptake among married individuals in Rakai, Uganda.

BACKGROUND: Despite efforts to promote HIV counseling and testing (HCT) among couples, few couples know their own or their partners' HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda. METHODS: We analysed data for 11,268 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples' HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used χ2 tests to assess linear trends in individual and couples' HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95% CI) associated with individual and couples' HCT uptake. Analysis was done using STATA version 11.0. RESULTS: Uptake of couples' HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (χ2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (χ2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (χ2 for trend = 18.16; P < 0.0001). Uptake of couples' HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95% CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95% CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95% CI: 1.26, 4.80). CONCLUSION: Uptake of couples' HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples' HCT, particularly among younger couples and those with no prior HCT.

Correction: Characteristics of people with epilepsy and Neurocysticercosis in three eastern African countries-A pooled analysis.

[This corrects the article DOI: 10.1371/journal.pntd.0010870.].

Characteristics of people with epilepsy and Neurocysticercosis in three eastern African countries-A pooled analysis.

BACKGROUND: Neurocysticercosis (NCC), a zoonotic disease caused by the pork tapeworm T. solium, represents one of the most common causes of secondary epilepsy but remains often undiagnosed due to lack of awareness and diagnostic facilities. METHODOLOGY: We pooled data from four cross-sectional studies on epilepsy and NCC in eastern Africa. Study sites were in Uganda, Malawi and in Tanzania (Dar es Salaam and Haydom). The study in Uganda and Malawi were community-based, the two studies in Tanzania were hospital-based. The same questionnaire was used for assessment of clinical characteristics of patients with epilepsy. Computed tomography (CT) scans and serological testing were performed in order to diagnose NCC. RESULTS: Overall, 1,179 people with epilepsy were included in our analysis. Of those, 941 PWE underwent CT scanning and were pooled for NCC analysis. Seventy patients were diagnosed with NCC, but NCC prevalence differed considerably between sites ranging from 2.0% (95%CI 0.4% to 3.6%) in Dar es Salaam to 17.5% (95%CI 12.4% to 22.6%) in Haydom. NCC prevalence did not show any association with sex but increased with age and was higher in rural than urban settings. In addition, being a farmer, non-Muslim, eating pork and living with pigs close by was associated with a higher NCC prevalence. PWE with NCC experienced their first epileptic seizure around 3 years later in life compared to PWE without NCC and their epileptic seizures seemed to be better controlled (p<0.001). There was no difference between focal onset seizures and focal signs on neurological examination in both groups (p = 0.49 and p = 0.92, respectively). The rT24H-EITB had a sensitivity for the detection of NCC of 70% (95% confidence interval [CI] 51 to 84%), the LLGP of 76% (95%CI 58 to 89%) and the antigen ELISA of 36% (95% CI 20 to 55%). CONCLUSIONS: NCC is prevalent among PWE in eastern Africa, although it may not be as common as previously stated. Demographic characteristics of PWE with NCC differed from those without NCC, but semiological characteristics and results on neurological examination did not differ compared to PWE without NCC. Interestingly, seizures seemed to be less frequent in PWE with NCC. Being aware of those differences and similarities may help triaging PWE for neuroimaging in order to establish a diagnosis of NCC.

Assessment of the relationship between life events with psychosocial competence of students in selected secondary schools in Northern and Central Uganda.

INTRODUCTION: As they grow, young people transit through adolescence; a particularly challenging phase. Many go through without difficulties but some experience maladaptive responses in form of conduct and adjustment problems, pubertal challenges and life stress. Published research from the developed societies demonstrates consistent associations between young people's exposure to life events, psychosocial competence (PSC) and mental health problems. However, comparable research from income-constrained societies remains scarce. The purpose of this study was to determine the prevalence of life events in secondary school students and describe the relationship between life events and PSC in the same population. METHODS: This was a cross-sectional study. Participants were 2,902 randomly selected in Central and Northern Uganda. They responded to self-administered questionnaires on socio-demographics, life events and PSC. RESULTS: Northern Ugandan students were more likely to be susceptible to stress-related illness associated with major life events (p = < 0.01). Among students with a high susceptibility to stress related illness, those with low scores on self-efficacy (p = < 0.001), accurate self-assessment (p = < 0.001) and self-confidence (p = < 0.001) were mostly from the North. Students from Northern Uganda had experienced more negative events. Students with higher scores on empathy, emotional awareness, accurate self- assessment and self-confidence tended to have low distress. Students that had a low susceptibility to stress related illness (AOR = 1.97; 95% CI: 1.57 - 2.48); high scores on self-efficacy (AOR 1.37; 95% CI: 1.09 - 1.74), self-confidence (AOR 1.32; 95% CI: 1.02 - 1.72), and accurate self-assessment (AOR 2.19; 95% CI: 1.70 - 2.80) were mostly from northern Uganda. CONCLUSION: It is important to help students to cope with negative life events since an association exists between negative life events and PSC domains. PSC domains of empathy, emotional awareness, accurate self-assessment and self-confidence seem to be associated with lower distress levels, implying that these should be reinforced.

Perceived barriers to utilization of antenatal care services in northern Uganda: A qualitative study.

OBJECTIVE: Antenatal care (ANC) utilization remains a challenge in efforts to reduce maternal mortality and improve maternal health in Uganda. This study aimed to identify perceived barriers to utilization of ANC services in a rural post-conflict area in northern Uganda. METHODS: A qualitative study using in-depth interviews and focus group discussions of seventeen participants (pregnant women, health workers and a traditional birth attendant). The study was informed through a phenomenological approach to capture perceived barriers to utilization of ANC. The study was carried out in post-conflict Awach sub-county, Gulu District, northern Uganda. Data was analyzed using inductive conventional content analysis. RESULTS: The main perceived barriers to ANC utilization were identified as: poor quality of care, including poor attitude of health workers; socio-cultural practices not being successfully aligned to ANC; and lack of support from the husband, including difficulties in encouraging him to attend ANC. Additionally, institutional structures and procedures at the health centers in terms of compulsory HIV testing and material requirements and transportation were perceived to prevent some pregnant women from attending ANC. CONCLUSIONS: Identifying local barriers to ANC utilization are important and should be considered when planning ANC programs. We propose that future efforts should focus on how to ensure a good patient-provider relationship and perceived quality of care, and further how to improve inter-spousal communication and sensitization of husbands for increased involvement in ANC. We recommend more research on how socio-cultural context can meaningfully be aligned to ANC to improve maternal health and reduce maternal mortality.

A narrative analysis of the link between modern medicine and traditional medicine in Africa: a case of mental health in Uganda.

BACKGROUND: Traditional Medicine Practices (TMP) which are premised on indigenous knowledge and experiences within a local context of the culture and environment, are common place in low income countries. In Africa and in Uganda specifically, nearly 80% of the Ugandan population relies on TMP for the care of their mental health but they also use Modern Medicine. There are areas of departure between Traditional and Modern Medical practices in Africa that have been cited. What has attracted less research attention, are the areas of convergence. OBJECTIVE: This paper aims to critically examine the link between Modern Medicine and Traditional Healing Practices in Africa, citing Uganda as case example. METHOD: A Narrative literature review with critical element assessment was undertaken to identify documented points of departure, areas of common practice, and ways in which the two models can co-exist and work together through a carefully thought out integration. RESULTS: Points of departure between Modern Medicine and Traditional Medicine Practices are philosophical underpinnings of both practices, training of practitioners, and methods and ethics of work. Common areas of practice include human rights perspective, descriptions of mental illnesses, clinical diagnostic practice, particularly severer forms, intellectual property rights, and cross prescriptions. Exhibiting cultural humility and responsibility on the side of the Modern Medicine Practitioners is one of the ways to work together with TMPs. CONCLUSION: Points of departure are more documented and explicit and overshadow areas of common practice while the links between the two are mainly implicit but sadly unrecognized. Mental disorders are disorders of the brain and in neuroscience; the brain is culturally and socially constructed. Sociocultural issues therefore cannot be divorced from disorders of the brain and their management. For better patient outcome and patient-centered approach of care, it is necessary to acknowledge and enhance the links in teaching, clinical and policy level and carry out research on how the links could be improved.