Search

Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.

Mariam Nabwire,1 Annettee Nakimuli,1 Noeline Nakasujja,2 Richard Migisha,3,4 Charles Kiggundu1, †1Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 3Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda; 4Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda†Charles Kiggundu passed away on 29th December 2020Correspondence: Mariam Nabwire, Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, Tel +256 756600593 ; +256 775834405, Email nabwirem@yahoo.comBackground: Anxiety disorders in pregnancy are common and represent a global concern. However, data regarding the magnitude of anxiety among pregnant women in Uganda are limited, and yet, these data could pave way for implementing effective mitigation measures. We determined the prevalence of anxiety disorders and associated factors among pregnant women at Mulago Hospital Uganda.Methods: A cross-sectional study was conducted among pregnant women attending antenatal care clinic at Mulago Hospital between September and November 2015. Systematic sampling was used to enroll eligible women. An interviewer-administered demographic questionnaire and the Hamilton Anxiety Rating Scale for Antenatal Anxiety (HAMA-A) scale were used to assess demographic features and anxiety, respectively. Women with HAMA-A score ≥ 17 were considered to have anxiety disorder. Factors associated with anxiety disorders were determined using multivariate logistic regression.Results: A total of 501 pregnant women were enrolled into the study; the prevalence of anxiety disorders was 13% (n=65; 95% CI: 9.8– 15.7%). Factors that were significantly associated with anxiety disorders were low income of the partic

BackgroundCOVID-19-related lockdowns and other public health measures may have differentially affected the quality of life (QOL) of older people with and without human immunodeficiency virus (HIV) in rural Uganda.MethodsThe Quality of Life and Aging with HIV in Rural Uganda study enrolled people with and without HIV aged over 49 from October 2020 to October 2021. We collected data on COVID-19-related stressors (behavior changes, concerns, interruptions in health care, income, and food) and the participants' QOL. We used linear regression to estimate the associations between COVID-19-related stressors and QOL, adjusting for demographic characteristics, mental and physical health, and time before vs after the lockdown during the second COVID-19 wave in Uganda. Interaction between HIV and COVID-19-related stressors evaluated effect modification.ResultsWe analyzed complete data from 562 participants. Mean age was 58 (standard deviation (SD) = 7); 265 (47%) participants were female, 386 (69%) were married, 279 (50%) had HIV, and 400 (71%) were farmers. Those making ≥5 COVID-19-related behavior changes compared to those making ≤2 had worse general QOL (estimated linear regression coefficient (b) = - 4.77; 95% confidence interval (CI) = -6.61, -2.94) and health-related QOL (b = -4.60; 95% CI = -8.69, -0.51). Having access to sufficient food after the start of the COVID-19 pandemic (b = 3.10, 95% CI = 1.54, 4.66) and being interviewed after the start of the second lockdown (b = 2.79, 95% CI = 1.30, 4.28) were associated with better general QOL. Having HIV was associated with better health-related QOL (b = 5.67, 95% CI = 2.91,8.42). HIV was not associated with, nor did it modify the association of COVID-19-related stressors with general QOL.ConclusionsIn the context of the COVID-19 pandemic in an HIV-endemic, low-resource setting, there was reduced QOL among older Ugandans making multiple COVID-19 related behavioral changes. Nonetheless, good QOL during the second COVID-19 w

Noeline Nakasujja,1 Rhona Baingana,2 Joy Gumikiriza,1 Moses Galukande3 1Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Biochemistry, College of Health Sciences, Makerere University, Kampala, Uganda; 3Department of Surgery, College of Health Sciences, Makerere University, Kampala, UgandaCorrespondence: Noeline NakasujjaDepartment of Psychiatry, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, UgandaEmail drnoeline@yahoo.comBackground: Motivation to pursue health professions education may stem from external incentives such as wealth, fame, and popularity. For others it is for internal reasons like the desire to serve society. In this study, we aimed to identify what influences students’ choice for an undergraduate health professions program at Makerere University College of Health Sciences (MakCHS).Methods: A cross-sectional qualitative study was conducted among first-year undergraduate students pursuing bachelor degrees in medicine and surgery (MBChB), nursing (BNur), pharmacy (BPharm), medical radiology (BMR), and dental surgery (BDS). A self-administered questionnaire with open-ended questions was distributed to the students during a tutorial session in the second week of the first semester (academic year 2010/2011). Completed questionnaires were entered into a Microsoft Access database. Median (Interquartile range-IQR) and frequencies of respondents were used to describe the study sample. Content analysis with emergent coding was used to analyze the qualitative data.Results: Overall, 145 students (response rate = 72%, N = 201) with a median age of 20 (IQR: 19– 20) years responded to the study. The majority of the participants were male (75.2%, n = 109), and were pursuing MBChB (65.5%, n = 91). Two themes identified showed that students appeared to be motivated by internal motivation and external motivation factors. Personal desire, and a calling to serve, were the significant i

Background: In Uganda, a previous study reported high HIV prevalence in persons with severe mental illness (SMI) compared to the general population, suggesting that persons with SMI might constitute a high-risk group for HIV. However, the study included first-time psychiatric admissions only, a group whose HIV prevalence may not reflect the prevalence in persons with SMI in general. We determined prevalence and correlates of HIV in both first-time and previous psychiatric admissions, in a psychiatric hospital in Uganda. Methods: Cross-sectional study of HIV status in persons consecutively discharged from psychiatric admission wards in Butabika hospital, Uganda. Inclusion criteria: age 18-49 years; schizophrenia, bipolar disorder, depression, or other non-substance-use-related psychosis; Luganda or English proficiency. Exclusion criterion: Mental incapacity to give informed consent. Participants were HIV-tested, and interviewed using a structured questionnaire. Data were analysed using logistic regression. Results: HIV prevalence was 11.3% (CI 8.8-13.8) overall, 7.3% (CI 4.1-10.5) in men and 14.3% (CI 10.6-18.0) in women. Females had higher risk of HIV infection than males (OR 2.10; CI 1.20-3.67), after adjustment for age. Older patients had higher risk of HIV infection than younger patients (40-49 vs. 18-29 years: OR 2.34; CI 1.27-4.32), after adjustment for sex. Place of residence, marital status, income, education, occupation, psychiatric diagnosis and history of previous admission were not associated with HIV infection, after adjustment for sex and age. The above associations did not significantly differ between men and women. Conclusions: Persons admitted for SMI in Uganda have higher HIV prevalence than persons in the general population, irrespective of previous admissions. The excess HIV prevalence is mainly confined to women. The findings call for the integration of HIV prevention, testing and care with mental health services in settings with generalized HIV

Introduction: HIV infection is known to cause neuro-psychiatric disturbances whose prevalence ranges between 74-83%. The prevalence of HIV in patients with psychosis has been found at 18%. Cognitive dysfunction occurs in 37% of HIV individuals with advanced HIV/AIDS even after the initiation of antiretroviral therapy. This thesis presents the feasibility of a rapid screening test for HIV dementia in a resource limited setting; the nature of HIV related psychoses and the impact of HIV infection on the cognitive function of patients with and without psychosis. Methods: Four studies (1-IV) were conducted using multiple methods. We determined the validity of the International HIV Dementia Scale (IHDS) through administering standardized neurological and neuropsychological assessments to 66 HIV-positive individuals in the USA, 81 HIV positive individuals and 100 HIV negative individuals in Uganda (Study I). We recruited 102 HIV positive individuals from the Infectious Diseases Institute and 25 HIV negative individuals from the AIDS Information Centre. Depression and cognitive function were assessed at 0, 3 and 6 months (Study II). One hundred and fifty six HIV positive and 322 HIV negative patients with psychosis were consecutively recruited from two national referral hospitals. Psychiatric, physical, and laboratory assessments were conducted at 0, 3 and 6 months (Study III & Study IV). Data was analyzed using univariate, bivariate and multivariable methods including linear and logistic regression analysis to test for predictors of the different types of psychosis and the relationship to cognitive impairment. Results: The sensitivity and specificity for HIV dementia with the IHDS was 80% and 57% in the US part of the study, and 80% and 55% in the Uganda part of the study (I). We found higher scores (equal to or greater than 16) on the Centre for Epidemiologic Depression Scale in the HIV-positive group at all 3 clinic visits (54% vs 28%; 36% vs 13%; and 30% vs 24% respecti

Introduction: HIV infection is known to cause neuro-psychiatric disturbances whose prevalence ranges between 74-83%. The prevalence of HIV in patients with psychosis has been found at 18%. Cognitive dysfunction occurs in 37% of HIV individuals with advanced HIV/AIDS even after the initiation of antiretroviral therapy. This thesis presents the feasibility of a rapid screening test for HIV dementia in a resource limited setting; the nature of HIV related psychoses and the impact of HIV infection on the cognitive function of patients with and without psychosis. Methods: Four studies (1-IV) were conducted using multiple methods. We determined the validity of the International HIV Dementia Scale (IHDS) through administering standardized neurological and neuropsychological assessments to 66 HIV-positive individuals in the USA, 81 HIV positive individuals and 100 HIV negative individuals in Uganda (Study I). We recruited 102 HIV positive individuals from the Infectious Diseases Institute and 25 HIV negative individuals from the AIDS Information Centre. Depression and cognitive function were assessed at 0, 3 and 6 months (Study II). One hundred and fifty six HIV positive and 322 HIV negative patients with psychosis were consecutively recruited from two national referral hospitals. Psychiatric, physical, and laboratory assessments were conducted at 0, 3 and 6 months (Study III & Study IV). Data was analyzed using univariate, bivariate and multivariable methods including linear and logistic regression analysis to test for predictors of the different types of psychosis and the relationship to cognitive impairment. Results: The sensitivity and specificity for HIV dementia with the IHDS was 80% and 57% in the US part of the study, and 80% and 55% in the Uganda part of the study (I). We found higher scores (equal to or greater than 16) on the Centre for Epidemiologic Depression Scale in the HIV-positive group at all 3 clinic visits (54% vs 28%; 36% vs 13%; and 30% vs 24% respecti

Introduction: HIV infection is known to cause neuro-psychiatric disturbances whose prevalence ranges between 74-83%. The prevalence of HIV in patients with psychosis has been found at 18%. Cognitive dysfunction occurs in 37% of HIV individuals with advanced HIV/AIDS even after the initiation of antiretroviral therapy. This thesis presents the feasibility of a rapid screening test for HIV dementia in a resource limited setting; the nature of HIV related psychoses and the impact of HIV infection on the cognitive function of patients with and without psychosis. Methods: Four studies (1-IV) were conducted using multiple methods. We determined the validity of the International HIV Dementia Scale (IHDS) through administering standardized neurological and neuropsychological assessments to 66 HIV-positive individuals in the USA, 81 HIV positive individuals and 100 HIV negative individuals in Uganda (Study I). We recruited 102 HIV positive individuals from the Infectious Diseases Institute and 25 HIV negative individuals from the AIDS Information Centre. Depression and cognitive function were assessed at 0, 3 and 6 months (Study II). One hundred and fifty six HIV positive and 322 HIV negative patients with psychosis were consecutively recruited from two national referral hospitals. Psychiatric, physical, and laboratory assessments were conducted at 0, 3 and 6 months (Study III & Study IV). Data was analyzed using univariate, bivariate and multivariable methods including linear and logistic regression analysis to test for predictors of the different types of psychosis and the relationship to cognitive impairment. Results: The sensitivity and specificity for HIV dementia with the IHDS was 80% and 57% in the US part of the study, and 80% and 55% in the Uganda part of the study (I). We found higher scores (equal to or greater than 16) on the Centre for Epidemiologic Depression Scale in the HIV-positive group at all 3 clinic visits (54% vs 28%; 36% vs 13%; and 30% vs 24% respecti

Introduction: HIV infection is known to cause neuro-psychiatric disturbances whose prevalence ranges between 74-83%. The prevalence of HIV in patients with psychosis has been found at 18%. Cognitive dysfunction occurs in 37% of HIV individuals with advanced HIV/AIDS even after the initiation of antiretroviral therapy. This thesis presents the feasibility of a rapid screening test for HIV dementia in a resource limited setting; the nature of HIV related psychoses and the impact of HIV infection on the cognitive function of patients with and without psychosis. Methods: Four studies (1-IV) were conducted using multiple methods. We determined the validity of the International HIV Dementia Scale (IHDS) through administering standardized neurological and neuropsychological assessments to 66 HIV-positive individuals in the USA, 81 HIV positive individuals and 100 HIV negative individuals in Uganda (Study I). We recruited 102 HIV positive individuals from the Infectious Diseases Institute and 25 HIV negative individuals from the AIDS Information Centre. Depression and cognitive function were assessed at 0, 3 and 6 months (Study II). One hundred and fifty six HIV positive and 322 HIV negative patients with psychosis were consecutively recruited from two national referral hospitals. Psychiatric, physical, and laboratory assessments were conducted at 0, 3 and 6 months (Study III & Study IV). Data was analyzed using univariate, bivariate and multivariable methods including linear and logistic regression analysis to test for predictors of the different types of psychosis and the relationship to cognitive impairment. Results: The sensitivity and specificity for HIV dementia with the IHDS was 80% and 57% in the US part of the study, and 80% and 55% in the Uganda part of the study (I). We found higher scores (equal to or greater than 16) on the Centre for Epidemiologic Depression Scale in the HIV-positive group at all 3 clinic visits (54% vs 28%; 36% vs 13%; and 30% vs 24% respecti

Introduction: HIV infection is known to cause neuro-psychiatric disturbances whose prevalence ranges between 74-83%. The prevalence of HIV in patients with psychosis has been found at 18%. Cognitive dysfunction occurs in 37% of HIV individuals with advanced HIV/AIDS even after the initiation of antiretroviral therapy. This thesis presents the feasibility of a rapid screening test for HIV dementia in a resource limited setting; the nature of HIV related psychoses and the impact of HIV infection on the cognitive function of patients with and without psychosis. Methods: Four studies (1-IV) were conducted using multiple methods. We determined the validity of the International HIV Dementia Scale (IHDS) through administering standardized neurological and neuropsychological assessments to 66 HIV-positive individuals in the USA, 81 HIV positive individuals and 100 HIV negative individuals in Uganda (Study I). We recruited 102 HIV positive individuals from the Infectious Diseases Institute and 25 HIV negative individuals from the AIDS Information Centre. Depression and cognitive function were assessed at 0, 3 and 6 months (Study II). One hundred and fifty six HIV positive and 322 HIV negative patients with psychosis were consecutively recruited from two national referral hospitals. Psychiatric, physical, and laboratory assessments were conducted at 0, 3 and 6 months (Study III & Study IV). Data was analyzed using univariate, bivariate and multivariable methods including linear and logistic regression analysis to test for predictors of the different types of psychosis and the relationship to cognitive impairment. Results: The sensitivity and specificity for HIV dementia with the IHDS was 80% and 57% in the US part of the study, and 80% and 55% in the Uganda part of the study (I). We found higher scores (equal to or greater than 16) on the Centre for Epidemiologic Depression Scale in the HIV-positive group at all 3 clinic visits (54% vs 28%; 36% vs 13%; and 30% vs 24% respecti

Introduction: HIV infection is known to cause neuro-psychiatric disturbances whose prevalence ranges between 74-83%. The prevalence of HIV in patients with psychosis has been found at 18%. Cognitive dysfunction occurs in 37% of HIV individuals with advanced HIV/AIDS even after the initiation of antiretroviral therapy. This thesis presents the feasibility of a rapid screening test for HIV dementia in a resource limited setting; the nature of HIV related psychoses and the impact of HIV infection on the cognitive function of patients with and without psychosis. Methods: Four studies (1-IV) were conducted using multiple methods. We determined the validity of the International HIV Dementia Scale (IHDS) through administering standardized neurological and neuropsychological assessments to 66 HIV-positive individuals in the USA, 81 HIV positive individuals and 100 HIV negative individuals in Uganda (Study I). We recruited 102 HIV positive individuals from the Infectious Diseases Institute and 25 HIV negative individuals from the AIDS Information Centre. Depression and cognitive function were assessed at 0, 3 and 6 months (Study II). One hundred and fifty six HIV positive and 322 HIV negative patients with psychosis were consecutively recruited from two national referral hospitals. Psychiatric, physical, and laboratory assessments were conducted at 0, 3 and 6 months (Study III & Study IV). Data was analyzed using univariate, bivariate and multivariable methods including linear and logistic regression analysis to test for predictors of the different types of psychosis and the relationship to cognitive impairment. Results: The sensitivity and specificity for HIV dementia with the IHDS was 80% and 57% in the US part of the study, and 80% and 55% in the Uganda part of the study (I). We found higher scores (equal to or greater than 16) on the Centre for Epidemiologic Depression Scale in the HIV-positive group at all 3 clinic visits (54% vs 28%; 36% vs 13%; and 30% vs 24% respecti

Introduction: HIV infection is known to cause neuro-psychiatric disturbances whose prevalence ranges between 74-83%. The prevalence of HIV in patients with psychosis has been found at 18%. Cognitive dysfunction occurs in 37% of HIV individuals with advanced HIV/AIDS even after the initiation of antiretroviral therapy. This thesis presents the feasibility of a rapid screening test for HIV dementia in a resource limited setting; the nature of HIV related psychoses and the impact of HIV infection on the cognitive function of patients with and without psychosis. Methods: Four studies (1-IV) were conducted using multiple methods. We determined the validity of the International HIV Dementia Scale (IHDS) through administering standardized neurological and neuropsychological assessments to 66 HIV-positive individuals in the USA, 81 HIV positive individuals and 100 HIV negative individuals in Uganda (Study I). We recruited 102 HIV positive individuals from the Infectious Diseases Institute and 25 HIV negative individuals from the AIDS Information Centre. Depression and cognitive function were assessed at 0, 3 and 6 months (Study II). One hundred and fifty six HIV positive and 322 HIV negative patients with psychosis were consecutively recruited from two national referral hospitals. Psychiatric, physical, and laboratory assessments were conducted at 0, 3 and 6 months (Study III & Study IV). Data was analyzed using univariate, bivariate and multivariable methods including linear and logistic regression analysis to test for predictors of the different types of psychosis and the relationship to cognitive impairment. Results: The sensitivity and specificity for HIV dementia with the IHDS was 80% and 57% in the US part of the study, and 80% and 55% in the Uganda part of the study (I). We found higher scores (equal to or greater than 16) on the Centre for Epidemiologic Depression Scale in the HIV-positive group at all 3 clinic visits (54% vs 28%; 36% vs 13%; and 30% vs 24% respecti

Etheldreda Nakimuli-Mpungu1,2, Noeline Nakasujja2, Howard Dickens Akena2, Steven Mpungu Kiwuwa3, Elly Katabira4, Elilialia Okello2, Chiadi Onyike5, Seggane Musisi21Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 2Departments of Psychiatry, 3Clinical Epidemiology and Biostatistics, 4Internal Medicine, Makerere College of Health Sciences, School of Medicine, Kampala, Uganda; 5Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Hospital, Baltimore, MD, USAPurpose: Patient retention in antiretroviral therapy (ART) programs in Sub-Saharan Africa is estimated at 60%. There is limited information on the effect of older age (>50 years) at ART initiation on patient retention in ART programs in Uganda. This study aimed to investigate demographic and clinical differences between older and younger human immunodeficiency virus (HIV)-positive individuals prior to ART initiation and then to assess the effect of older age at ART initiation on patient retention in an ART program.Methods: A retrospective chart review of all medical charts belonging to 773 HIV-positive individuals who initiated ART from January 2005 through July 2009 was conducted. Factors associated with older HIV-positive individuals were determined using simple and multivariate logistic regression. Survival analysis techniques were used to compare median survival times in the ART program between older and younger HIV-positive individuals. Cox regression models were used to assess the impact of older age on patient retention while adjusting for variables associated with both older age and patient retention.Results: Older HIV-positive individuals were significantly more likely to have a clinical diagnosis of HIV-related dementia (odds ratio [OR] = 7.65; P = 0.037), severe mental illness (OR = 1.28; P = 0.39), peripheral neuropathy, (OR = 3.76; P = 0.024), and HIV wasting syndrome (OR = 1.92; P = 0.023). Median survival time for older HIV-positive i

Introducción: El manejo de las condiciones físicas a largo plazo es un desafío a nivel mundial, absorbiendo un recursos mayoritarios a pesar de la importancia de los cuidados intensivos. El manejo de estas condiciones se realiza en gran medida en la atención primaria, por lo que las intervenciones para mejorar la atención primaria podrían tener un impacto enorme. Sin embargo, existen muy pocos datos sobre cómo hacer esto. La angustia mental es frecuentemente comórbida con problemas a largo plazo. condiciones físicas y puede afectar el comportamiento y la adherencia a la salud, lo que lleva a peores resultados. DIALOG+ es una intervención de bajo costo, centrada en el paciente y centrada en soluciones, que se utiliza en reuniones rutinarias entre pacientes y médicos y se ha demostrado que mejora los resultados en la atención de salud mental. Surge la pregunta sobre si también podría utilizarse en atención primaria para mejorar la calidad de vida y la salud mental de los pacientes. Pacientes con condiciones físicas de larga duración. Esto es particularmente importante para los países de ingresos bajos y medios. Países con recursos sanitarios limitados. Métodos: Se realizó un ensayo exploratorio no controlado en múltiples sitios en Bosnia y Herzegovina, Colombia y Uganda. La viabilidad se determinó mediante el reclutamiento, la retención y la finalización de la sesión. Los resultados de los pacientes (calidad de vida, síntomas de ansiedad y depresión, situación social objetiva) fueron evaluado al inicio y después de tres sesiones DIALOG+ aproximadamente mensuales. Resultados: Se inscribieron en el estudio un total de 117 pacientes, 25 en Bosnia y Herzegovina, 32 en Colombia, y 60 en Uganda. En cada país, se reclutó a más del 75% de los participantes previstos, con Tasas de retención superiores al 90% y finalización de la intervención superior al 92%. Los pacientes tenían significativamente mayor calidad de vida y menos síntomas de ansiedad y depresión en el seguimiento