Global health research abstracts: November '23.

The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.

Global Health research abstracts: October '23.

The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.

Impact of the Mbarara University of Science and Technology residency training on increasing access to specialty care workforce.

Graduate tracer studies provide an avenue for assessing the impact of residency training on the distribution and access to specialty care and exploring job and professional satisfaction of alumnus. This study examined how the Mbarara University of Science and Technology (MUST) clinical residency training program influenced the spatial distribution and career paths of specialists. We conducted a mixed methods study involving an online survey and 12 in-depth interviews (IDIs) from June to September 2022. The online survey was distributed to a convenient sample of clinical residency alumnus from MUST via email and Whatsapp groups. Alumnus were mapped across the countries of current work in QGIS (version 3.16.3) using GPS coordinates. Descriptive and thematic analyses were also conducted. Ninety-five alumni (34.3%) responded to the tracer survey. The majority were males (80%), aged 31-40 years (69%), and Ugandans (72%). Most graduated after 2018 (83%) as obstetricians/gynecologists (38%) and general surgeons (19%). There was uneven distribution of specialists across Uganda and the East-African community-with significant concentration in urban cities of Uganda at specialized hospitals and academic institutions. Residency training helped prepare and equip alumnus with competencies relevant to their current work tasks (48%) and other spheres of life (45%). All respondents were currently employed, with the majority engaged in clinical practice (82%) and had obtained their first employment within six months after graduation (76%). The qualitative interviews revealed the reported ease in finding jobs after the training and the relevance of the training in enhancing the alumnus' ability to impact those they serve in teaching, research, management, and clinical care. Graduates cited low payment, limited resources, and slow career advancement concerns. Residency training improves the graduates' professional/career growth and the quality of health care services. Strategic specialty training addressing imbalances in subspecialties and rural areas coverage could optimize access to specialist services.

The role of emergency medicine interest groups in the development of emergency medicine: A case of Mbarara University of Science and Technology-Emergency Medicine Interest Group (MUST-EMIG) in Uganda.

Introduction: Emergency medicine (EM) is a new specialty in Uganda. There is no current formal EM undergraduate curriculum. The Mbarara University of Science and Technology Emergency Medicine Interest Group (MUST-EMIG) was established to bridge this gap. This survey was done to assess the contributions of MUST-EMIG. Objectives of the study were to: discover students' reasons for joining the MUST-EMIG; assess whether interest in learning emergency medicine was affected by participation in MUST-EMIG; evaluate plans to pursue emergency medicine as a specialty before and after joining MUST-EMIG; determine whether MUST-EMIG affected students' perception of emergency medicine's importance in Uganda's health care system; and elicit feedback from students on their experience as members of MUST-EMIG. Methods: The MUST-EMIG executive developed a membership survey which was reviewed by MUST-EMIG's faculty advisor for suitability. Members of MUST-EMIG were voluntarily asked to participate in the online survey. Results of the survey were summarized using descriptive statistics and thematic analysis. Results: 49 responses (46.7% response rate) were collected and analyzed. Participants included 29 (59.2%) male and 20 (40.8%) female medical students. The majority of participants were fourth year students 22 (44.9%). 44 (89.8%) students joined MUST-EMIG to learn how to handle medical emergencies, and expressed a desire of at least 6/10 to learn more about emergency medicine after utilizing opportunities provided by MUST-EMIG. Overall, students had a good experience with MUST-EMIG. They reported that our interest group had provided them networking, unique learning, and leadership opportunities. Having an EMIG significantly affects students' desire to pursue a career in emergency medicine and their perception of the relevance of emergency medicine. Discussion: An EMIG helps develop interest of medical students in emergency medicine. Students passionate about emergency medicine need to be supported to help them preserve and further develop this passion.

Description and analysis of the emergency obstetric interfacility ambulance transfers (IFTs) to Kawempe National Referral Hospital in Uganda.

Introduction: In Uganda, 2% of women die from maternal causes with a mortality rate of 336 maternal deaths per 100,000 live births. According to the World Health Organization Uganda is one of the top three contributors to maternal mortality in sub-Saharan Africa. Uganda has parallel weak ambulance systems, government, and non-government-owned, that transport obstetric emergencies to higher-level facilities. These two operations lack standards of medical care and inter-facility transfer (IFT) protocols to direct care. Limited studies exist which assess the state of Emergency Care Services in Uganda and none has been performed to assess the ambulance referral services utilized to address obstetric emergencies. Objective: The present study was performed to describe the ambulance transfer processes of obstetric emergencies by analyzing cases arriving at Kawempe National Referral Hospital (KNRH) from outlying health facilities. Methods: The study was based at KNRH in Kampala, Uganda. It was a descriptive and analytic cross-sectional study. Trained research assistants enrolled participating patients who met the inclusion criteria consecutively on arrival by ambulance at the hospital. Utilizing a questionnaire, quantitative data was collected from the ambulance driver, the sending facility referral form, and the receiving hospital's ambulance log book for each case. The sample size was 215. Results: The median age was 27 years and the majority of patients were referred because of hypertensive disorders (34.9%), obstructed labor (26.5%) and hemorrhage (20.9%). The median total response time for transfer of obstetric emergencies was 50 min, from ambulance activation until the mother was received at KNRH. Differences were identified between government and non-government-owned ambulances in regards to the method of activation, medical escort staffing, number of vital signs recorded, and ambulance onboard medical care. Ambulances parked at the facility took the shortest transfer time and EMT-supported ambulances had the greatest number of vital signs taken. Conclusions: Recommendations are to develop an integrated ambulance system for both government and non-government ambulances with standards especially in regards to standardized scripted call-center calls analysis, dispatch activation time, response-to-patient time, and trained ambulance professional staffing and medical care whenever in patient transport mode.

Problematic use of the internet, smartphones, and social media among medical students and relationship with depression: An exploratory study.

BACKGROUND: Students in sub-Saharan African countries experienced online classes for the first time during the COVID-19 pandemic. For some individuals, greater online engagement can lead to online dependency, which can be associated with depression. The present study explored the association between problematic use of the internet, social media, and smartphones with depression symptoms among Ugandan medical students. METHODS: A pilot study was conducted among 269 medical students at a Ugandan public university. Using a survey, data were collected regarding socio-demographic factors, lifestyle, online use behaviors, smartphone addiction, social media addiction, and internet addiction. Hierarchical linear regression models were performed to explore the associations of different forms of online addiction with depression symptom severity. RESULTS: The findings indicated that 16.73% of the medical students had moderate to severe depression symptoms. The prevalence of being at risk of (i) smartphone addiction was 45.72%, (ii) social media addiction was 74.34%, and (iii) internet addiction use was 8.55%. Online use behaviors (e.g., average hours spent online, types of social media platforms used, the purpose for internet use) and online-related addictions (to smartphones, social media, and the internet) predicted approximately 8% and 10% of the severity of depression symptoms, respectively. However, over the past two weeks, life stressors had the highest predictability for depression (35.9%). The final model predicted a total of 51.9% variance for depression symptoms. In the final model, romantic relationship problems (ß = 2.30, S.E = 0.58; p<0.01) and academic performance problems (ß = 1.76, S.E = 0.60; p<0.01) over the past two weeks; and increased internet addiction severity (ß = 0.05, S.E = 0.02; p<0.01) was associated with significantly increased depression symptom severity, whereas Twitter use was associated with reduced depression symptom severity (ß = 1.88, S.E = 0.57; p<0.05). CONCLUSION: Despite life stressors being the largest predictor of depression symptom score severity, problematic online use also contributed significantly. Therefore, it is recommended that medical students' mental health care services consider digital wellbeing and its relationship with problematic online use as part of a more holistic depression prevention and resilience program.

Undergraduate Learning in the COVID-19 Pandemic: Lessons Learned and Ways Forward.

The SARS-CoV-2 coronavirus (COVID-19) pandemic is in constant evolution, much like the virus, and we must learn to adapt our undergraduate education and learning strategies to enable students to complete their studies. This narrative review focuses on what is currently known about the face-to-face and e-learning strategies of undergraduate medical students in resource-limited settings during the COVID-19 pandemic. The majority of studies, involving health professional students, took place in 2020. Few involved educators. Students have faced challenges with the transition to remote learning, for which a couple of interventions have been devised. Bridging the gap in access and utilisation of remote learning might have required more time, however, the COVID-19 pandemic has accelerated the learning curve and the transition from in-person to online learning.

Exploring adverse childhood experiences (ACEs) among Ugandan university students: its associations with academic performance, depression, and suicidal ideations.

BACKGROUND: Adverse childhood experiences (ACEs) among university students have been linked to a variety of factors and have been shown to have a dose-response relationship with adult health and behavior. OBJECTIVE: To investigate the effect of exposure to ACEs on academic performance, depression, and suicidal ideations among university students. METHODS: A cross-sectional survey among university students at a public university in southwestern Uganda was conducted in 2021, integrating the Adverse Childhood Experiences International Questionnaire for assessing ACEs, the Patient Health Questionnaire for assessing depression symptoms and suicidal ideations, and questions assessing the family structure and academic performance as adopted from similar studies. Regression analysis was performed, and 3 models were generated to answer the study hypotheses. RESULTS: A total of 653 undergraduate university students with a mean age of 22.80 (± 3.16) years were recruited. Almost all students (99.8%) experienced one or more ACEs, with physical abuse being the common ACE reported. The average depression symptom severity was statistically higher among individuals who experienced any form of ACEs. No relationship was observed between the ACEs experienced and self-rated academic performance. Similarly, on regression analysis, the cumulative number of ACEs was not associated with self-rated academic performance (ß = - 0.007; 95% CI - 0.031 to 0.016; p = 0.558). However, the cumulative number of ACEs was positively associated with depression symptom severity (ß = 0.684; 95% CI 0.531-0.837; p < 0.001), as well as increased the likelihood of suicidal ideations (aOR = 1.264; 95% CI 01.090-1.465; p < 0.001). CONCLUSIONS: The burden of ACEs is exceedingly high among Ugandan university students, highlighting the urgency in strengthening effective child protection strategies to protect Uganda's rapidly growing population from mental ill-health and avoid future psychological disability, a burden to the healthcare system. The study's findings will also be useful to practitioners/policymakers working to prevent/limit child maltreatment globally.

Risky sexual behaviours among Ugandan university students: A pilot study exploring the role of adverse childhood experiences, substance use history, and family environment.

BACKGROUND: University students are known to have risky sexual behaviours (RSBs). The severity of the RSB is influenced by many factors, including the family environment, exposure to adverse childhood events (ACEs), and the use of addictive substances. However, there is limited information about the influence of ACEs and the family environment of these students in low-and medium-income countries (LMICs). Therefore, a pilot study was conducted among university students from a LMIC, Uganda. METHODS: The present study comprised a cross-sectional online survey among Ugandan students at a public university (N = 316; 75% male; 52.2% aged between 18-22 years). The survey included questions relating to socio-demographic information, family environmental information, the Sexual Risk Survey (SRS), and the Adverse Childhood Experiences-International Questionnaire (ACE-IQ). RESULTS: Over half (53.8%) reported having had sexual intercourse. Males reported over two times higher mean total SRS score compared to females (χ2 = 4.06, p = 0.044). Approximately one-sixth of the sample had drunk alcohol or used illicit psychoactive substances in the past six months (16.1%). Among four regression analysis models, sociodemographic variables predicted the highest variance (13%), followed by family environment variables (10%), and both psychoactive substance use history (past six months) and ACEs individually explained approximately 5% variance in total SRS score, with the final model predicting 33% of the variance in RSB. CONCLUSIONS: The present study demonstrated a gender disparity with males involved in more RSB than females, as has been reported in most previous RSB studies. Family environment, sociodemographic factors, substance use, and ACEs all appear to contribute to RSB among university students. These findings will benefit other researchers exploring factors associated with RSB among university students and will help develop interventions to reduce RSB to protect students from unwanted pregnancies, sexually transmitted diseases, and HIV/AIDS.

Antimicrobial resistance and rational use of medicine: knowledge, perceptions, and training of clinical health professions students in Uganda.

BACKGROUND: Antimicrobial resistance (AMR) is an important global health concern, projected to contribute to significant mortality, particularly in developing countries. This study aimed to determine the knowledge, perceptions of clinical health professions students towards antimicrobial resistance and rational use of medicine and confidence level to prescribe antimicrobials. METHODS: An online descriptive cross-sectional survey was conducted among clinical health professions students across 9 medical schools in Uganda. A semi-structured questionnaire using Kobo Toolbox form was shared among participants via WhatsApp Messenger (Meta, California, USA). Knowledge was categorized using modified Bloom's cut-off. One-way ANOVA, Chi-square or Fisher's exact test, and logistic regression were used to assess the association between dependent and independent variables. A p < 0.05 was considered statistically significant. RESULTS: We surveyed 681 participants, most were pursuing a Bachelor of Medicine and Surgery degree (n = 433, 63.6%), with a mean age of 24 (standard deviation: 3.6) years. Most participants (n = 596, 87.5%) had sufficient knowledge about antimicrobial resistance with a mean score of 85 ± 14.2%. There was a significant difference in mean knowledge scores of year 4 (86.6%) compared to year 3 (82.4%) (p = 0.002) and year 5 (88.0%) compared to year 3 (82.4%) (p < 0.001). Most participants (n = 456, 66.9%), were confident on making an accurate diagnosis of infection, and choosing the correct antimicrobial agent to use (n = 484, 71.1%). CONCLUSION: Health profession students exhibited good knowledge on antimicrobial resistance and high self-perceived confidence that should be leveraged to foster better future antimicrobial prescription practices. However, they still agreed that a separated course unit on AMR is necessary which responsible authorities should consider to consolidate the efforts.

Factors Associated with Medical Students' Career Choices Regarding Internal Medicine in Uganda.

Background: There is an unmet need for internal medicine physicians in Uganda owing to the growing burden of diseases. This study aimed at evaluating the factors associated with career choices of undergraduate medical students regarding internal medicine in Uganda. Methods: We conducted a cross-sectional study in the first 3 weeks of October 2021 via WhatsApp messenger. Medical students in the 3rd to 5th year of study who had completed internal medicine clinical rotations and pursuing a Bachelor of Medicine and Bachelor of Surgery (MBChB) degree at 7 Ugandan universities (4 public and 3 private) were enrolled. Multivariable logistic regression model was constructed to determine factors associated with a career choice in internal medicine. Results: We enrolled 418 participants, median age was 24 (interquartile range (IQR): 23-26) years, 67.7% were male, and 36.1% had a family member or relative who was a doctor. Most of the students (84.0%) were interested in research. The top three most preferred specialties were internal medicine (52.6%), surgery (51.2%), and obstetrics and gynaecology (51.0%). Overall, 186 (44.5%) participants reported plans to pursue a Master of Medicine degree in internal medicine. Interest in research was the only factor independently associated with 2.5-fold higher odds of pursuing a career in internal medicine (adjusted odds ratio: 2.5, 95% CI: 1.4-4.6, p = 0.003). About 73% of the participants strongly agreed that internal medicine requires wide reading. Conclusion: There is a strong interest to pursue a career in internal medicine among Ugandan medical students. We recommend an increase in training opportunities in Internal Medicine, especially in view of the growing disease burden and increasing population growth.

A survey of the knowledge and practices of nursing students of Mbarara University of Science and Technology around Monitoring Fluid Requirements for burns patients on surgical ward at Mbarara Regional Referral Hospital.

BACKGROUND: There is a high mortality of burns especially in low- and middle-income countries which already have less developed healthcare systems. Besides, little is known about nursing students' knowledge and practices towards the need to monitor fluid requirements in admitted burns patients. OBJECTIVE: To assess the knowledge and practices of nursing students regarding monitoring fluid requirements for hospitalised paediatrics and adult burn patients on the surgical ward at Mbarara regional referral hospital. METHODS: We conducted an online descriptive cross-sectional study among clinical nursing students at Mbarara University of Science and Technology (MUST) during September and November 2021. We assessed knowledge and practices using an adapted questionnaire. Summary statistics were then used to describe the data. RESULTS: Thirty-seven nursing students (64.9% response rate) participated in our survey. Twenty one (56.8%) were female and had a modal age range of 20-24 years. Nineteen (51.4%) of the students were BNC (Bachelor of Nursing Completion) students, with the rest being BNS (Bachelor of Nursing). More than 75% of students correctly answered each of two out of the ten questions. More than three quarters of the students reported having done each of six out of the eleven practices surveyed. CONCLUSION: Nursing students had poor knowledge and fair satisfactory practices regarding monitoring of the fluid requirements in burns patients. More similar studies are needed to survey more nursing students on this topic and to henceforth evaluate the need for periodic re-trainings and reassessment of clinical skills of nursing students.

Prevalence and Factors Associated With Depression and Suicidal Ideation During the COVID-19 Pandemic Among University Students in Uganda: A Cross-Sectional Study.

Background: The COVID-19 pandemic has negatively impacted psychosocial well-being and mental health of students across the world. Although students are vulnerable to depression and suicidal ideation, few studies have been conducted in Uganda. This study aimed to determine the prevalence of depression and suicidal ideation, and associated factors among undergraduate university students in Uganda. Methods: A cross-sectional study was conducted among undergraduates [N = 540; 363 males; mean age = 23.3 (± 2.64) years] recruited from four universities using an online questionnaire that explored sociodemographic factors, depression, and other associated factors. The Patient Health Questionnaire (PHQ-9) was used to assess depression, and Item 9 was used to assess suicidal ideation in the past 2 weeks. Multivariable logistic regression analyses were performed to determine the factors associated with depression and suicidal ideation. Results: The prevalence of moderate to severe depression was 20% (n = 108) (cut-off: 10/27 based on the PHQ-9), and the prevalence of past-2-week suicidal ideation was 13.89% (n = 75) (cut-off: 1/3 based on the PHQ-9 Item 9). About half of the individuals who screened positive for depression had suicidal ideation. Factors associated with depression were: having relationship issues [adjusted odds ratio (aOR) = 1.79, 95% confidence interval (CI) = 1.13-2.81, p = 0.012], and having a history of sexual abuse (aOR = 2.06, 95% CI = 1.10-3.84, p = 0.023). Factors associated with reducing the risk of depression were: satisfaction with current academic performance (aOR = 0.50, 95% CI = 0.32-0.79, p = 0.003), and being in the fifth year of academic study (aOR = 0.16, 95% CI = 0.03-0.73, p = 0.018). Factors associated with suicidal ideation were: smoking cigarettes and/or marijuana (aOR = 4.83, 95% CI = 1.10-21.12, p = 0.037), and having financial tuition constraints (aOR = 1.85, 95% CI = 1.08-3.16, p = 0.024), However, satisfaction with current academic performance reduced the likelihood of suicidal ideation (aOR = 0.40, 95% CI = 0.23-0.70, p = 0.001). Conclusion: Approximately one-fifth of undergraduate university students were moderately to severely depressed, especially those who had relationship issues and those with a history of sexual abuse. Suicidal ideation was common among smokers and those having financial tuition constraints. Therefore, it is recommended that the university authorities implement measures to provide psychological support for the students with problems concerning financial tuition constraints, relationships, and sexual abuse. Also, all students with depression should be screened for suicidality.

Suicidal behaviours among Ugandan university students: a cross-sectional study.

BACKGROUND: Suicide remains the leading cause of death among university students often resulting from multiple physical and psychological challenges. Moreover, suicidal behaviours among students appear to have increased due to the COVID-19 pandemic according to some studies. OBJECTIVE: To explore the prevalence and associated factors for suicidal ideation, suicide plans, and suicide attempts among university students in Uganda. METHODS: Cross-sectional study data were collected from May to September 2021 from 540 undergraduate university students in south-western Uganda (363 males, mean age 23.3 years). Questions from the General Health Questionnaire (GHQ-28) were used to assess suicidal ideation, while other bespoke questions were used to assess suicide plans and attempts. The survey also investigated the suicide attempt/plan method, location of the suicidal activity, and reason for not enacting the suicide plan. Three independent regression analyses were used to determine the factors associated with different forms of suicidal behaviours. RESULTS: The prevalence of past-year suicidal behaviours was 31.85% for suicidal ideation, 8.15% for suicide plans, and 6.11% for suicide attempts. Having a chronic physical medical condition increased the likelihood of having all forms of suicidal behaviours. Suicidal ideation was associated with having difficulty paying university tuition fees. However, being in the fifth year of university education, and feeling satisfied with current academic grades reduced the likelihood of suicidal ideation. Individuals feeling satisfied with academic performance appeared to be a protective factor against having suicide plans. Suicide attempts were associated with having a history of sexual abuse and having difficulty paying university tuition fees. The most common method used for attempted suicide was a drug overdose, and the most common location for attempted suicide was their homes. CONCLUSION: University students have prevalent suicide behaviours especially among students with a chronic physical medical condition, a history of sexual abuse, and problems paying university tuition fees. Based on the present study, for students at risk, universities should provide appropriate interventions such as life skills education and suicide prevention techniques.

Basic life support, a necessary inclusion in the medical curriculum: a cross-sectional survey of knowledge and attitude in Uganda.

BACKGROUND: Uganda continues to depend on a health system without a well-defined emergency response system. This is in the face of the rising cases of out-of-hospital cardiac arrest contributed largely to the high incidence of road traffic accidents. Non-communicable diseases are also on the rise further increasing the incidence of cardiac arrest. Medical students are key players in the bid to strengthen the health system which warrants an assessment of their knowledge and attitude towards BLS inclusion in their study curriculum. METHODS: A descriptive cross-sectional study was conducted in 2021 among undergraduate medical students across eight public and private universities in Uganda. An online-based questionnaire was developed using Google forms and distributed via identified WhatsApp groups. Chi-square or Fisher's exact test and logistic regression were performed in STATA 15 to assess the association between knowledge of BLS and demographics. P < 0.05 was considered statistically significant. RESULTS: Out of the total 354 entries obtained, 351 were analyzed after eligibility screening. Of these, (n = 250, 71.2%) were male less than 25 years (n = 273, 77.8%). Less than half (n = 150, 42.7%) participants had undergone formal BLS training. Less than a third of participants (n = 103, 29.3%) had good knowledge (≥ 50%) with an overall score of 42.3 ± 12.4%. Age (p = 0.045), level of academic progress (p = 0.001), and prior BLS training (p = 0.033) were associated with good knowledge. Participants with prior training were more likely to have more BLS knowledge (aOR: 1.7, 95% CI: 1.1-2.7, p = 0.009). The majority (n = 348, 99.1%) believed that BLS was necessary and would wish (n = 343, 97.7%) to have it included in their curriculum. CONCLUSIONS: Undergraduate medical students have poor BLS knowledge but understand its importance. Institutions need to adopt practical teaching methods such as clinical exposures, field experience in collaboration with local implementers, and participating in community health promotion campaigns.

Fear of COVID-19 and the Media Influence on Herbal Medication Use in Uganda: A Cross-Sectional Study.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has created fear in people around the world. This has led to the widespread use of various herbal remedies in its prevention and treatment regardless of the paucity of scientific evidence about their safety and efficacy. This study assessed the fear of COVID-19 and the influence of media on the use of herbal medicine to prevent or treat COVID-19 in Uganda. METHODS: In the first 2 weeks of July 2021, a descriptive online cross-sectional study was carried out anonymously in the general population in Uganda. A validated questionnaire was used to collect data on herbal medicine use and the influence of media. Fear of COVID-19 was rated using the Fear of COVID-19 Scale (FCV-19S). RESULTS: We recruited 488 participants, 273 (55.9%) were female, with a median age of 25 (range: 18-73) years. Sixty-seven (57.8%) participants had a confirmed COVID-19 diagnosis. The mean FCV-19S score was 21.7 SD 5.9 with 53.3% reporting high levels of COVID-19 fear. About 57.4% of participants reported using herbal remedies either to prevent or treat COVID-19-like symptoms. Media was the main source of information, with more than 80% of the participants reporting seeing or accessing information about herbal medication use. Women (adjusted odds ratio (aOR): 1.74, 95% CI: 1.2-2.5, p=0.003) and people with a previously confirmed COVID-19 diagnosis (aOR: 3.1, 95% CI: 1.35-7.14, p=0.008) had a statistically significantly higher FCV-19S score. Being unemployed (aOR: 1.0, 95% CI: 1.1-2.3, p=0.008) and a female (aOR: 1.0, 95% CI: 1.1-2.3, p=0.012) were statistically significantly associated with herbal medicine use. Participants who used herbal remedies had a higher median FCV-19S score compared to non-users (23 versus 21, p<0.001). CONCLUSION: The use of herbal medicines to treat or prevent COVID-19 is a widespread practice among the general population in Uganda amidst the high levels of fear of COVID-19.

Prevalence of burnout among university students in low- and middle-income countries: A systematic review and meta-analysis.

BACKGROUND: Burnout is common among university students and may adversely affect academic performance. Little is known about the true burden of this preventable malady among university students in low-and-middle-income countries (LMICs). OBJECTIVES: This study aimed to systematically estimate the prevalence of burnout among university students in LMICs. METHODS: We searched PubMed, Google Scholar, CINAHL, Web of Science, African Journals Online, and Embase from the inception of each database until February 2021. Original studies were included. No study design or language restrictions were applied. A random-effects meta-analysis was performed using STATA version 16.0. Heterogeneity and publication bias were assessed using Q-statistics and funnel plots, respectively. RESULTS: Fifty-five unique articles, including a total of 27,940 (Female: 16,215, 58.0%) university students from 24 LMICs were included. The Maslach Burnout Inventory (MBI) was used in 43 studies (78.2%). The pooled prevalence of burnout was 12.1% (95% Confidence Interval (CI) 11.9-12.3; I2 = 99.7%, Q = 21,464.1, p = < 0.001). The pooled prevalence of emotional exhaustion (feelings of energy depletion), cynicism (negativism), and reduced professional efficacy were, 27.8% (95% CI 27.4-28.3; I2 = 98.17%. p = <0.001), 32.6 (95% CI: 32.0-33.1; I2: 99.5%; p = < 0.001), and 29.9% (95% CI: 28.8-30.9; I2: 98.1%; p = < 0.001), respectively. CONCLUSION: Nearly one-third of university students in LMICs experience burnout. More studies are needed to understand the causes of burnout in this key population. There is a need to validate freely available tools for use in these countries.

Suicide among Ugandan university students: evidence from media reports for 2010-2020.

University students are in transition to adulthood and face multiple challenges that may lead to suicide. They are reported to have a higher risk of suicide by the World Health Organization. As there is no national suicide database in Uganda, we analysed student suicide using the press/media reports of suicides published between 2010 and 2020. A total of deaths by 23 suicide were identified: 19 were males, relationship problems were the main suicide reason (n = 6) and hanging was the most frequently used suicide method (n = 7). A strategic intervention to tackle suicide risk among university students is warranted.

Acceptance of the coronavirus disease-2019 vaccine among medical students in Uganda.

BACKGROUND: COVID-19 is still a major global threat for which vaccination remains the ultimate solution. Uganda reported 40,751 cases and 335 deaths as of 9 April 2021 and started its vaccination program among priority groups like health workers, teachers, those with chronic diseases among others in early March 2021. Unanimous uptake of the COVID-19 vaccine is required to subsequently avert its spread; therefore, we assessed COVID-19 vaccine acceptability, hesitancy, and associated factors among medical students in Uganda. METHODS: This study employed an online descriptive cross-sectional survey among medical students across 10 medical schools in Uganda. A structured questionnaire via Google Form was conveniently sent to eligible participants via WhatsApp. Each medical school had a coordinator who consistently shared the data tool in the WhatsApp groups. Chi-square or Fisher's exact test, and logistic regression were used to assess the association between vaccine acceptability with demographics, COVID-19 risk perception, and vaccine hesitancy. RESULTS: We surveyed 600 medical students, 377 (62.8%) were male. COVID-19 vaccine acceptability was 37.3% and vaccine hesitancy 30.7%. Factors associated with vaccine acceptability were being male (adjusted odds ratio (aOR) = 1.9, 95% CI 1.3-2.9, p=0.001) and being single (aOR= 2.1, 95% CI 1.1-3.9, p=0.022). Very high (aOR= 3.5, 95% CI 1.7-6.9, p<0.001) or moderate (aOR =2.2, 95% CI 1.2-4.1, p=0.008) perceived risk of getting COVID-19 in the future, receiving any vaccine in the past 5 years (aOR= 1.6, 95% CI 1.1-2.5, p=0.017), and COVID-19 vaccine hesitancy (aOR 0.6, 95% CI 0.4-0.9, p=0.036). CONCLUSIONS: This study revealed low levels of acceptance towards the COVID-19 vaccine among medical students, low self-perceived risks of COVID-19, and many had relied on social media that provided them with negative information. This poses an evident risk on the battle towards COVID-19 in the future especially when these future health professions are expected to be influencing decisions of the general public towards the same.

Cryptococcosis complicating diabetes mellitus: a scoping review.

BACKGROUND: A better understanding of the epidemiology of cryptococcal infection in HIV-negative individuals is an international research interest. Immune dysfunction in diabetes mellitus (DM) significantly increases the risk of acquiring and reactivation of infection due to Cryptococcus neoformans. Risk factors and outcomes of cryptococcosis in DM are not well documented. OBJECTIVE: The objective of this study was to determine the clinical characteristics and outcomes of cryptococcal infections in persons living with DM. METHODS: MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases were searched in November 2020. The searches covered the period between 1980 and 2020.We included studies that reported confirmed cryptococcosis in patients with DM. Reference lists of included articles were also searched, and additional studies were included if appropriate. No language restriction was applied. Single case reports, case series and original articles were included whereas review articles were excluded. RESULTS: A total of 28 studies (24 single case reports, 4 retrospectives) were included involving 47 unique patients from Asia (17 cases), North America (six cases), South America (three cases) and Africa (two cases). Men constituted 75% (n = 18) of the cases. Median age was 60.5 (range: 27-79) years. The majority of the patients had cryptococcal meningitis (68.1%, n = 32) followed by disseminated cryptococcosis (6.4%, n = 7), and others (isolated cutaneous disease one, peritonitis one, pleural one, thyroid one, adrenal one). Diagnosis was achieved through either culture and microscopy (38/47), cryptococcal antigen tests (9/47) or histopathology (9/47) singly or in a combination. All-cause mortality was 38.3% (n = 18). Among those with meningitis mortality was 36.2%. CONCLUSION: A wide spectrum of cryptococcal infections with varying severity occurs in DM. Mortality remains unacceptably high. There is a need for more studies to characterize better cryptococcal disease in DM.