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Perkins JM, Kakuhikire B, Baguma C, Jeon S, Walker SF, Dongre R, Kyokunda V, Juliet M, Satinsky EN, Comfort AB, Siedner MJ, Ashaba S, Tsai AC. Male circumcision uptake and misperceived norms about male circumcision: Cross-sectional, population-based study in rural Uganda. J Glob Health 2023; 13:04149. [PMID: 38112224 PMCID: PMC10731132 DOI: 10.7189/jogh.13.04149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Background Over the past decade, 15 high-priority countries in eastern and southern Africa have promoted voluntary medical male circumcision for human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevention. The prevalence of male circumcision in Uganda nearly doubled from 26% in 2011 to 43% in 2016, but remains below the 2020 target level. Little is known about how common male circumcision is perceived to be, how accurate such perceptions are, and whether they are associated with men's own circumcision uptake. Methods We conducted a cross-sectional study of all adult residents of eight villages in Rwampara District, southwestern Uganda in 2020-2022. We elicited their perceptions of the adult male circumcision prevalence within their village: >50% (most men), 10% to <50% (some), <10%, (few to none), or do not know. We compared their perceived norms to the aggregated prevalence of circumcision reported in these villages. We used a modified multivariable Poisson regression model to estimate the association between perceived norms and personal circumcision uptake among men. Results We surveyed 1566 participants (91% response rate): 698 men and 868 women. Among the men, 167 (27%) reported being circumcised, including 167/444 (38%) men <50 years of age. Approximately one-fourth of the population (189 (27%) men and 177 (20%) women) believed that few to no men in their own village had been circumcised. In a multivariable regression model, men who underestimated the prevalence of male circumcision were less likely to be circumcised themselves (adjusted relative risk (aRR) = 0.51; 95% confidence interval (CI) = 0.37-0.83). Conclusions In this population-based study in rural Uganda, one-fourth of men underestimated the prevalence of male circumcision. Men who underestimated the extent of circumcision uptake were themselves less likely to be circumcised. If the observed association is causal and underestimates within the population contribute to low uptake, then interventions correcting these misperceived norms could increase uptake of voluntary medical male circumcision.
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Affiliation(s)
- Jessica M Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sehee Jeon
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Sarah F Walker
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Rohit Dongre
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Viola Kyokunda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mercy Juliet
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N Satinsky
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alison B Comfort
- Bixby Center for Global Reproductive Health, University of California, San Franciso, California, USA
| | - Mark J Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kim AW, Rieder AD, Cooper-Vince CE, Kakuhikire B, Baguma C, Satinsky EN, Perkins JM, Kiconco A, Namara EB, Rasmussen JD, Ashaba S, Bangsberg DR, Tsai AC, Puffer ES. Maternal adverse childhood experiences, child mental health, and the mediating effect of maternal depression: A cross-sectional, population-based study in rural, southwestern Uganda. Am J Biol Anthropol 2023; 182:19-31. [PMID: 37212482 PMCID: PMC10524293 DOI: 10.1002/ajpa.24758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/09/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES This study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health. METHODS Data come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their children's mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis. RESULTS Among 218 mother-child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership. CONCLUSIONS Maternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families.
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Affiliation(s)
- Andrew Wooyoung Kim
- Department of Anthropology, University of California, Berkeley, California, USA
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amber D Rieder
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Jessica M Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Institute of Global Health, Nashville, Tennessee, USA
| | - Allen Kiconco
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health and Science University - Portland State University School of Public Health, Portland, Oregon, USA
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Eve S Puffer
- Duke Global Health Institute, Durham, North Carolina, USA
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Perkins JM, Kakuhikire B, Baguma C, Evans CQ, Rasmussen JD, Satinsky EN, Kyokunda V, Juliet M, Ninsiima I, Bangsberg DR, Tsai AC. Cigarette smoking and misperceived norms among adults in rural Uganda: a population-based study. Tob Control 2023; 32:652-656. [PMID: 34930809 PMCID: PMC9207154 DOI: 10.1136/tobaccocontrol-2021-056470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about perceived norms about cigarette smoking in Uganda or the extent to which perceptions drive personal cigarette smoking behaviour. METHODS We conducted a cross-sectional study in 2016-2018 that targeted all adults who resided within eight villages in Rwampara District, southwestern Uganda. Personal cigarette smoking frequency was elicited by self-report. We also asked participants what they believed to be the cigarette smoking frequency of most other adult men and women in their villages (i.e., perceived norms). Frequent cigarette smoking was defined as 4+ times/week. We compared perceived norms to cigarette smoking frequency reports aggregated at the village level. We used multivariable Poisson regression to estimate the association between perceived norms and personal cigarette smoking behaviour. RESULTS Among 1626 participants (91% response rate), 92 of 719 men (13%) and 6 of 907 women (0.7%) reported frequent smoking. However, 1030 (63%) incorrectly believed most men in their villages smoked cigarettes frequently. Additionally, 116 (7%) incorrectly believed that most women in their villages smoked cigarettes frequently. These misperceptions were pervasive across social strata. Men who misperceived frequent cigarette smoking as the norm among other men in their villages were more likely to smoke frequently themselves (adjusted relative risk=1.49; 95% CI, 1.13 to 1.97). CONCLUSIONS Most adults overestimated cigarette smoking frequency among village peers. Men who incorrectly believed that frequent smoking was the norm were more likely to engage in frequent smoking themselves. Applying a 'social norms approach' intervention by promoting existing healthy norms may prevent smoking initiation or motivate reductions in smoking among men in rural Uganda.
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Affiliation(s)
- Jessica M Perkins
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bernard Kakuhikire
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Charles Baguma
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Claire Q Evans
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Viola Kyokunda
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mercy Juliet
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Immaculate Ninsiima
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - David R Bangsberg
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health & Science University - Portland State University School of Public Health, Portland, Oregon, USA
| | - Alexander C Tsai
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
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Perkins JM, Kakuhikire B, Baguma C, Jeon S, Walker SF, Dongre R, Kyokunda V, Juliet M, Satinsky EN, Comfort AB, Siedner M, Ashaba S, Tsai AC. Perceived norms about male circumcision and personal circumcision status: a cross-sectional, population-based study in rural Uganda. medRxiv 2023:2023.04.24.23288996. [PMID: 37163008 PMCID: PMC10168507 DOI: 10.1101/2023.04.24.23288996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Introduction Over the past decade, 15 high-priority countries in eastern and southern Africa have promoted voluntary medical male circucmsion for HIV and STI prevention. Despite male circumcision prevalence in Uganda nearly doubling from 26% in 2011 to 43% in 2016, it remained below the target level by 2020. Little is known about perceived norms of male circumcision and their association with circumcision uptake among men. Methods We conducted a cross-sectional study targeting all adult residents across eight villages in Rwampara District, southwestern Uganda in 2020-2022. We compared what men and women reported as the adult male circumcision prevalence within their village (perceived norm: >50% (most), 10% to <50% (some), <10%, (few), or do not know) to the aggregated prevalence of circumcision as reported by men aged <50 years. We used a modified multivariable Poisson regression model to estimate the association between perceived norms about male circumcision uptake and personal circumcision status among men. Results Overall, 167 (38%) men < 50 years old were circumcised (and 27% of all men were circumcised). Among all 1566 participants (91% response rate), 189 (27%) men and 177 (20%) women underestimated the male circumcision prevalence, thinking that few men in their own village had been circumcised. Additionally, 10% of men and 25% of women reported not knowing the prevalence. Men who underestimated the prevalence were less likely to be circumcised (aRR = 0.51, 95% CI 0.37 to 0.83) compared to those who thought that some village men were circumcised, adjusting for perceived personal risk of HIV, whether any same-household women thought most men were circumcised, and other sociodemographic factors. Conclusions Across eight villages, a quarter of the population underestimated the local prevalence of male circumcision. Men who underestimated circumcision uptake were less likely to be circumcised. Future research should evaluate norms-based approaches to promoting male circumcision uptake. Strategies may include disseminating messages about the increasing prevalence of adult male circumcision uptake in Uganda and providing personalized normative feedback to men who underestimated local rates about how uptake is greater than they thought.
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Affiliation(s)
- Jessica M. Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sehee Jeon
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
| | - Sarah F. Walker
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
| | - Rohit Dongre
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
| | - Viola Kyokunda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mercy Juliet
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N. Satinsky
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | - Alison B. Comfort
- Bixby Center for Global Reproductive Health, University of California, San Franciso, USA
| | - Mark Siedner
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute, Massachusetts General Hospital, Boston MA USA
| | | | - Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute, Massachusetts General Hospital, Boston MA USA
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McNeill J, Okello S, Sentongo R, Kakuhikire B, Tsai AC, Christiani DC, Zanni MV, Siedner MJ, North CM. Chronic Human Immunodeficiency Virus Infection Is Associated with Accelerated Decline of Forced Expiratory Volume in 1 Second among Women but Not among Men: A Longitudinal Cohort Study in Uganda. Ann Am Thorac Soc 2022; 19:1779-1783. [PMID: 35767026 PMCID: PMC9753523 DOI: 10.1513/annalsats.202111-1275rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jenna McNeill
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Samson Okello
- Mbarara University of Science and TechnologyMbarara, Uganda
- Harvard T.H. Chan School of Public HealthBoston, Massachusetts
| | - Ruth Sentongo
- Mbarara University of Science and TechnologyMbarara, Uganda
| | | | - Alexander C. Tsai
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - David C. Christiani
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
- Harvard T.H. Chan School of Public HealthBoston, Massachusetts
| | | | - Mark J. Siedner
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
- Mbarara University of Science and TechnologyMbarara, Uganda
| | - Crystal M. North
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
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Nardell MF, Adeoti O, Peters C, Kakuhikire B, Govathson-Mandimika C, Long L, Pascoe S, Tsai AC, Katz IT. Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis. J Int AIDS Soc 2022; 25:e25889. [PMID: 35324089 PMCID: PMC8944222 DOI: 10.1002/jia2.25889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
Introduction Men are missing along the HIV care continuum. However, the estimated proportions of men in sub‐Saharan Africa meeting the UNAIDS 95‐95‐95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95‐95‐95 goals across studies in sub‐Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. Methods We systematically searched PubMed and Embase for peer‐reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95‐95‐95 goal in sub‐Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion‐Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta‐synthesis. Results and discussion We screened 14,896 studies and included 129 studies in the meta‐analysis, compiling data over the data collection period. Forty‐seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41–0.58; range, 0.09–0.97]) or not being on treatment (0.58 [95% CI, 0.51–0.65; range, 0.07–0.97]), while over three‐quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77–0.81; range, 0.39–0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta‐synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. Conclusions Psychosocial and systems‐level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.
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Affiliation(s)
- Maria F Nardell
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Oluwatomi Adeoti
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Carson Peters
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Bernard Kakuhikire
- Faculty of Business and Management Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caroline Govathson-Mandimika
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander C Tsai
- Harvard Medical School, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Global Health Institute, Cambridge, Massachusetts, USA
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Perkins JM, Kakuhikire B, Baguma C, Meadows M, Evans CQ, Jurinsky J, Rasmussen JD, Satinsky EN, Ayebare P, Kyokunda V, Juliet M, Bangsberg DR, Tsai AC. Perceived and misperceived norms about khat and/or cannabis use among adults in southwest Uganda. Int J Drug Policy 2022; 101:103527. [PMID: 34890907 PMCID: PMC9272912 DOI: 10.1016/j.drugpo.2021.103527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies from high-income contexts have found evidence that norms about substance use are misperceived. The accuracy of perceived norms about khat and cannabis use in Uganda have not previously been described. METHODS We conducted a population-based study targeting all resident adults across eight villages in southwestern Uganda. Personal khat and/or cannabis use frequency was based on self-report. We measured perceived norms about substance use by eliciting individuals' perceptions about how often most other adult men and most other adult women in their villages used these substances. We compared perceived norms to aggregated village rates of use to assess the extent to which norms were misperceived. We used multivariable Poisson regression to estimate correlates of misperceived norms. RESULTS Among 1626 participants (91% response rate), only 29 men (4%) and 9 women (1%) reported any lifetime use of khat and/or cannabis. However, 695 participants (43%) did not think lifetime abstinence was the norm among men in their villages, and 256 participants (16%) did not think lifetime abstinence was the norm among women. Moreover, 219 participants (13%) incorrectly believed most men in their village regularly used khat and/or cannabis (≥4 times per week). Misperceived norms were present across subgroups and were correlated with larger social networks, symptoms of depression, loneliness, and younger age. CONCLUSION In this study of all adults across 8 villages in rural Uganda, many participants misperceived norms about khat and/or cannabis use. Providing accurate information about prevailing norms in the local population may help prevent initiation of khat and/or cannabis use among adults in this context.
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Affiliation(s)
- Jessica M Perkins
- Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA; Vanderbilt Institute of Global Health, 2525 West End Avenue, Nashville, TN 37203, USA.
| | - Bernard Kakuhikire
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Charles Baguma
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Meredith Meadows
- Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA
| | - Claire Q Evans
- Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA
| | - Jordan Jurinsky
- Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA
| | | | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Boston, MA 02114, USA
| | - Patience Ayebare
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Viola Kyokunda
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Mercy Juliet
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - David R Bangsberg
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda; Oregon Health & Science University-Portland State University School of Public Health, 1880 SW 6th Ave, Portland, OR 97201, USA
| | - Alexander C Tsai
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda; Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Mongan Institute, Massachusetts General Hospital, 100 Cambridge St Suite 1600, Boston, MA 02114, USA
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Jurinsky J, Perkins JM, Kakuhikire B, Nyakato VN, Baguma C, Rasmussen JD, Satinsky EN, Ahereza P, Kananura J, Audet CM, Bangsberg DR, Tsai AC. Ease of marital communication and depressive symptom severity among men and women in rural Uganda: cross-sectional, whole-population study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:343-352. [PMID: 34355265 PMCID: PMC8792190 DOI: 10.1007/s00127-021-02135-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Depression is a major contributor to the global burden of disease. The extent to which marital communication may influence depression in contexts with little mental health support is unknown. METHODS We conducted a whole-population study of married adult residents of eight villages in a rural region of southwestern Uganda. Depression symptom severity was measured using a modified version of the Hopkins Symptom Checklist for Depression, with > 1.75 classified as a positive screen for probable depression. Respondents were asked to report about ease of marital communication ('never easy', 'easy once in a while', 'easy most of the time' or 'always easy'). Sex-stratified, multivariable Poisson regression models were fit to estimate the association between depression symptom severity and marital communication. RESULTS Among 492 female and 447 male participants (response rate = 96%), 23 women and 5 men reported communication as 'never easy' and 154 women and 72 men reported it as 'easy once in a while'. Reporting communication as 'never easy' was associated with an increased risk of probable depression among women (adjusted relative risk [ARR], 2.06; 95% confidence interval [CI], 1.08-3.93, p = 0.028) and among men (ARR, 7.10; 95% CI 1.70-29.56, p = 0.007). CONCLUSION In this whole-population study of married adults in rural Uganda, difficulty of marital communication was associated with depression symptom severity. Additional research is needed to assess whether communication training facilitated by local leaders or incorporated into couples-based services might be a novel pathway to address mental health burden.
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Affiliation(s)
| | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, TN, USA,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,Corresponding author: Dr. Jessica M. Perkins, , Phone: (615) 875-3289, Fax: 615-343-2661
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,University of Witwatersrand, Johannesburg, South Africa
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda,Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda,Center for Global Health, Massachusetts General Hospital, Boston MA USA,Harvard Medical School, Boston, MA, USA,Mongan Institute, Massachusetts General Hospital, Boston MA USA
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Gilbert RF, Cichowitz C, Bibangambah P, Kim JH, Hemphill LC, Yang IT, Sentongo RN, Kakuhikire B, Christiani DC, Tsai AC, Okello S, Siedner MJ, North CM. Lung function and atherosclerosis: a cross-sectional study of multimorbidity in rural Uganda. BMC Pulm Med 2022; 22:12. [PMID: 34983492 PMCID: PMC8728924 DOI: 10.1186/s12890-021-01792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure. METHODS We measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV1) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status. RESULTS Of 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV1 was associated with increased cIMT (β = 0.006 per 200 mL FEV1 decrease; 95% CI 0.002 to 0.011, p = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV1 and cIMT. CONCLUSIONS Impaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa.
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Affiliation(s)
- Rebecca F Gilbert
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA
| | - Cody Cichowitz
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA
| | | | - June-Ho Kim
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Linda C Hemphill
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Ruth N Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David C Christiani
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alexander C Tsai
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, MA, USA
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, MA, USA
| | - Crystal M North
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, USA.
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10
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Perkins JM, Kakuhikire B, Baguma C, Jurinsky J, Rasmussen JD, Satinsky EN, Namara E, Ahereza P, Kyokunda V, Perkins HW, Hahn JA, Bangsberg DR, Tsai AC. Overestimation of alcohol consumption norms as a driver of alcohol consumption: a whole-population network study of men across eight villages in rural, southwestern Uganda. Addiction 2022; 117:68-81. [PMID: 34159646 PMCID: PMC8759576 DOI: 10.1111/add.15615] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/20/2021] [Accepted: 05/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Little is known about how perceived norms about alcohol consumption may influence high alcohol consumption rates in Uganda. This study estimated the accuracy of perceived norms about men's alcohol consumption and estimated the association between perceived norms and personal alcohol consumption. DESIGN Cross-sectional, whole-population, sociocentric social network study. SETTING Eight rural villages in Rwampara District, southwestern Uganda in 2016-18. PARTICIPANTS A total of 719 men aged 18 years and older (representing 91% of permanent resident men). MEASUREMENTS Self-reported frequent (≥ 4 days per week) and heavy alcohol consumption (six or more drinks on one occasion, more than three occasions of intoxication, or spending an excessive amount on alcohol). Participants also reported whether they thought most other men in their village engaged in frequent and heavy alcohol consumption (perceived norms). Using the network study design, we calculated alcohol consumption behavior within villages and social networks. Perceived norms were compared with aggregated self-reports. Multivariable Poisson regression models were used to estimate the association between perceived norms and individual behavior. FINDINGS Throughout villages, frequent and heavy alcohol consumption ranged from 7 to 37%. However, 527 (74%) participants perceived, contrary to fact, that most other men in their villages frequently consumed alcohol, and 576 (81%) perceived that most others heavily consumed alcohol. Overestimation of alcohol consumption by others was pervasive among socio-demographic subgroups and was present irrespective of the actual consumption behavior at the village level and within social networks. Men who misperceived these alcohol consumption behaviors as being common were more likely to engage in frequent [adjusted relative risk (aRR) = 3.98; 95% confidence interval (CI) = 1.69-9.34) and heavy (aRR = 4.75; 95% CI = 2.33-9.69) alcohol consumption themselves. CONCLUSIONS Most men in eight rural Ugandan villages incorrectly thought that frequent and heavy alcohol consumption were common among men in their villages. These misperceived norms had a strong positive association with individual drinking behavior.
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Affiliation(s)
- Jessica M. Perkins
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA,Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,Corresponding author: Dr. Jessica M. Perkins, , Phone: (615) 875-3289, Fax: 615-343-2661
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jordan Jurinsky
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | - Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | | | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Viola Kyokunda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Judith A. Hahn
- University of California at San Francisco, San Francisco, CA, USA
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda,Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda,Center for Global Health, Massachusetts General Hospital, Boston MA USA,Harvard Medical School, Boston, MA, USA,Mongan Institute, Massachusetts General Hospital, Boston MA USA
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11
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Joseph NT, Namuli A, Kakuhikire B, Baguma C, Juliet M, Ayebare P, Ahereza P, Tsai AC, Siedner MJ, Randall TR, Ngonzi J, Boatin AA. Implementing community-based human papillomavirus self-sampling with SMS text follow-up for cervical cancer screening in rural, southwestern Uganda. J Glob Health 2021; 11:04036. [PMID: 35003710 PMCID: PMC8709902 DOI: 10.7189/jogh.11.04036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Self-collected HPV screening may improve cervical cancer screening coverage in low resource countries, yet data guiding implementation and follow-up of abnormal results are sparse. METHODS This is a prospective cohort implementation study of HPV self-testing program in Mbarara, Uganda with mobile phones to facilitate result notification and referral for treatment at a regional hospital. The effectiveness of the interventions was analyzed using Proctor's model of implementation. Women were interviewed following screening and at 6 months to assess acceptability and barriers to follow-up. Data were analyzed using descriptive statistics. RESULTS 159 of 194 (82%) of eligible women underwent HPV self-sampling; of these, 27 (17%) returned positive for high-risk HPV subtypes. We sent SMS messages providing test results and follow-up instructions to all participants. Seventeen (63%) hrHPV-positive participants reported receiving SMS text instructions for follow-up, of whom 6 (35%) presented for follow-up. The most common reasons for not returning were: lack of transportation (n = 11), disbelief of results (n = 5), lack of childcare (n = 4), and lack of symptoms (n = 3). Confidence in test results was higher for self-screening compared to VIA (Likert score 4.8 vs 4.4, P = 0.001). CONCLUSIONS Despite the use of SMS text-based referrals, only one-third of women presented for clinical follow-up after abnormal HPV testing.
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Affiliation(s)
- Naima T Joseph
- Department of Obstetrics and Gynecology, Beth Isreal Deaconness Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alexcer Namuli
- Department of Obstetrics & Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mercy Juliet
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Mark J Siedner
- Harvard Medical School, Boston, MA, USA
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas R Randall
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Ngonzi
- Department of Obstetrics & Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adeline A Boatin
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
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12
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Tsai AC, Kakuhikire B, Perkins JM, Downey JM, Baguma C, Satinsky EN, Gumisiriza P, Kananura J, Bangsberg DR. Normative vs personal attitudes toward persons with HIV, and the mediating role of perceived HIV stigma in rural Uganda. J Glob Health 2021; 11:04956. [PMID: 34552725 PMCID: PMC8442577 DOI: 10.7189/jogh.11.04056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background HIV stigma has well-documented negative impacts on HIV testing, transmission risk behavior, initiation of and adherence to antiretroviral therapy, and retention in care. We sought to assess the extent to which anticipated HIV stigma is based on misperceptions of normative attitudes toward persons with HIV, and to determine whether persons with HIV have stronger misperceptions compared with HIV-negative persons or persons of unknown serostatus. We also sought to estimate the association between normative attitudes about persons with HIV and personal attitudes about persons with HIV, and to determine the extent to which anticipated stigma mediates this association. Methods We conducted a whole-population survey of 1776 persons living in 8 rural villages in southwestern Uganda. Negative attitudes toward persons with HIV, and anticipated stigma, were measured using a newly validated 15-item scale measuring multiple dimensions of HIV stigma, including social distance, blaming attitudes, and concerns about reciprocity. We used multivariable regression to estimate the association between normative attitudes about persons with HIV and personal attitudes toward persons with HIV, and to determine the extent to which perceptions of normative attitudes (anticipated stigma) mediated this association. Results Study participants believed that negative attitudes toward persons with HIV were more pervasive than they actually are. Perceptions of the extent to which these negative attitudes are normative mediated more than one-third of the association between normative attitudes and their personal attitudes. In contrast to what we originally hypothesized, persons with HIV were less likely to misperceive these norms and perceived normative attitudes to be less stigmatizing than did others in the general population. Conclusions Interventions designed to accurately describe normative attitudes toward persons with HIV may reduce HIV stigma without directly focusing on the educational components that are typically embedded in anti-stigma interventions.
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Affiliation(s)
- Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda.,Oregon Health Sciences University-Portland State University School of Public Health, Portland, Oregon, USA
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13
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Kim AW, Kakuhikire B, Baguma C, North CM, Satinsky EN, Perkins JM, Ayebare P, Kiconco A, Namara EB, Bangsberg DR, Siedner MJ, Tsai AC. Adverse childhood experiences and adult cardiometabolic risk factors and disease outcomes: Cross-sectional, population-based study of adults in rural Uganda. J Glob Health 2021; 11:04035. [PMID: 34386213 PMCID: PMC8325920 DOI: 10.7189/jogh.11.04035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Cardiovascular diseases (CVD) pose a major threat to public health in sub-Saharan African communities, where the burden of these classes of illnesses is expected to double by 2030. Growing research suggests that past developmental experiences and early life conditions may also elevate CVD risk throughout the life course. Greater childhood stress and adversity are consistently associated with a range of adult CVDs and associated risk factors, yet little research exists on the long-term effects of early life stress on adult physical health outcomes, especially CVD risk, in sub-Saharan African contexts. This study aims to evaluate the associations between adverse childhood experiences and adult cardiometabolic risk factors and health outcomes in a population-based study of adults living in Mbarara, a rural region of southwestern Uganda. Methods Data come from an ongoing, whole-population social network cohort study of adults living in the eight villages of Nyakabare Parish, Mbarara. A modified version of the Adverse Childhood Experiences-International Questionnaire (ACEs) assessed past exposure to physical, emotional, and sexual adversity. Participants also took part in a health fair where medical histories on cardiometabolic risk factors and cardiovascular diseases were gathered. Multiple logistic regression models estimated the associations between ACEs and cardiometabolic risk factors and health outcomes. Results Data were available on 545 adults. The average number of ACEs was 4.9 out of a possible 16. The cumulative number of ACEs were associated with having a history of heart attack and/or heart failure (adjusted odds ratio (AOR) = 1.11, 95% confidence interval (CI) = 0.999-1.234, P = 0.051), but the estimated association was not statistically significant. ACEs did not have statistically significant associations with any others measures of adult cardiometabolic risk and CVD. Conclusions Adverse childhood experiences are not associated with a range of adult cardiometabolic risk factors and health outcomes in this sample of rural Ugandan adults. Further research in this sample is necessary to identify the pathways that may motivate these null relationship and possibly protect against adverse cardiometabolic and cardiovascular health outcomes.
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Affiliation(s)
- Andrew Wooyoung Kim
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Crystal M North
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Allen Kiconco
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda.,Oregon Health and Science University - Portland State University School of Public Health, Portland, Oregon, USA
| | - Mark J Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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14
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Kakuhikire B, Satinsky EN, Baguma C, Rasmussen JD, Perkins JM, Gumisiriza P, Juliet M, Ayebare P, Mushavi RC, Burns BFO, Evans CQ, Siedner MJ, Bangsberg DR, Tsai AC. Correlates of attendance at community engagement meetings held in advance of bio-behavioral research studies: A longitudinal, sociocentric social network study in rural Uganda. PLoS Med 2021; 18:e1003705. [PMID: 34270581 PMCID: PMC8323877 DOI: 10.1371/journal.pmed.1003705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/30/2021] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Community engagement is central to the conduct of health-related research studies as a way to determine priorities, inform study design and implementation, increase recruitment and retention, build relationships, and ensure that research meets the goals of the community. Community sensitization meetings, a form of community engagement, are often held prior to the initiation of research studies to provide information about upcoming study activities and resolve concerns in consultation with potential participants. This study estimated demographic, health, economic, and social network correlates of attendance at community sensitization meetings held in advance of a whole-population, combined behavioral, and biomedical research study in rural Uganda. METHODS AND FINDINGS Research assistants collected survey data from 1,630 adults participating in an ongoing sociocentric social network cohort study conducted in a rural region of southwestern Uganda. These community survey data, collected between 2016 and 2018, were linked to attendance logs from community sensitization meetings held in 2018 and 2019 before the subsequent community survey and community health fair. Of all participants, 264 (16%) attended a community sensitization meeting before the community survey, 464 (28%) attended a meeting before the community health fair, 558 (34%) attended a meeting before either study activity (survey or health fair), and 170 (10%) attended a meeting before both study activities (survey and health fair). Using multivariable Poisson regression models, we estimated correlates of attendance at community sensitization meetings. Attendance was more likely among study participants who were women (adjusted relative risk [ARR]health fair = 1.71, 95% confidence interval [CI], 1.32 to 2.21, p < 0.001), older age (ARRsurvey = 1.02 per year, 95% CI, 1.01 to 1.02, p < 0.001; ARRhealth fair = 1.02 per year, 95% CI, 1.01 to 1.02, p < 0.001), married (ARRsurvey = 1.74, 95% CI, 1.29 to 2.35, p < 0.001; ARRhealth fair = 1.41, 95% CI, 1.13 to 1.76, p = 0.002), and members of more community groups (ARRsurvey = 1.26 per group, 95% CI, 1.10 to 1.44, p = 0.001; ARRhealth fair = 1.26 per group, 95% CI, 1.12 to 1.43, p < 0.001). Attendance was less likely among study participants who lived farther from meeting locations (ARRsurvey = 0.54 per kilometer, 95% CI, 0.30 to 0.97, p = 0.041; ARRhealth fair = 0.57 per kilometer, 95% CI, 0.38 to 0.86, p = 0.007). Leveraging the cohort's sociocentric design, social network analyses suggested that information conveyed during community sensitization meetings could reach a broader group of potential study participants through attendees' social network and household connections. Study limitations include lack of detailed data on reasons for attendance/nonattendance at community sensitization meetings; achieving a representative sample of community members was not an explicit aim of the study; and generalizability may not extend beyond this study setting. CONCLUSIONS In this longitudinal, sociocentric social network study conducted in rural Uganda, we observed that older age, female sex, being married, membership in more community groups, and geographical proximity to meeting locations were correlated with attendance at community sensitization meetings held in advance of bio-behavioral research activities. Information conveyed during meetings could have reached a broader portion of the population through attendees' social network and household connections. To ensure broader input and potentially increase participation in health-related research studies, the dissemination of research-related information through community sensitization meetings may need to target members of underrepresented groups.
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Affiliation(s)
| | - Emily N. Satinsky
- Department of Psychology, University of Southern California, Los Angeles, California, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justin D. Rasmussen
- Department of Psychology, Duke University, Durham, North Carolina, United States of America
| | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | | | - Mercy Juliet
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rumbidzai C. Mushavi
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bridget F. O. Burns
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Boston, Massachusetts, United States of America
| | - Claire Q. Evans
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Mark J. Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health and Science University - Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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15
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Siedner MJ, Bibangambah P, Kim J, Lankowski A, Chang JL, Yang IT, Kwon DS, North CM, Triant VA, Longenecker C, Ghoshhajra B, Peck RN, Sentongo RN, Gilbert R, Kakuhikire B, Boum Y, Haberer JE, Martin JN, Tracy R, Hunt PW, Bangsberg DR, Tsai AC, Hemphill LC, Okello S. Treated HIV Infection and Progression of Carotid Atherosclerosis in Rural Uganda: A Prospective Observational Cohort Study. J Am Heart Assoc 2021; 10:e019994. [PMID: 34096320 PMCID: PMC8477876 DOI: 10.1161/jaha.120.019994] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Although ≈70% of the world's population of people living with HIV reside in sub-Saharan Africa, there are minimal prospective data on the contributions of HIV infection to atherosclerosis in the region. Methods and Results We conducted a prospective observational cohort study of people living with HIV on antiretroviral therapy >40 years of age in rural Uganda, along with population-based comparators not infected with HIV. We collected data on cardiovascular disease risk factors and carotid ultrasound measurements annually. We fitted linear mixed effects models, adjusted for cardiovascular disease risk factors, to estimate the association between HIV serostatus and progression of carotid intima media thickness (cIMT). We enrolled 155 people living with HIV and 154 individuals not infected with HIV and collected cIMT images at 1045 visits during a median of 4 annual visits per participant (interquartile range 3-4, range 1-5). Age (median 50.9 years) and sex (49% female) were similar by HIV serostatus. At enrollment, there was no difference in mean cIMT by HIV serostatus (0.665 versus 0.680 mm, P=0.15). In multivariable models, increasing age, blood pressure, and non-high-density lipoprotein cholesterol were associated with greater cIMT (P<0.05), however change in cIMT per year was also no different by HIV serostatus (0.004 mm/year for HIV negative [95% CI, 0.001-0.007 mm], 0.006 mm/year for people living with HIV [95% CI, 0.003-0.008 mm], HIV×time interaction P=0.25). Conclusions In rural Uganda, treated HIV infection was not associated with faster cIMT progression. These results do not support classification of treated HIV infection as a risk factor for subclinical atherosclerosis progression in rural sub-Saharan Africa. Registration URL: https://www.ClinicalTrials.gov; Unique identifier: NCT02445079.
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Affiliation(s)
- Mark J. Siedner
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA,Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Prossy Bibangambah
- Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - June‐Ho Kim
- Department of MedicineHarvard Medical SchoolBostonMA,Department of MedicineBrigham and Women's HospitalBostonMA
| | - Alexander Lankowski
- Department of MedicineUniversity of WashingtonSeattleWA,Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWA
| | - Jonathan L. Chang
- Department of MedicineHarvard Medical SchoolBostonMA,Department of MedicineBrigham and Women's HospitalBostonMA
| | - Isabelle T. Yang
- Department of MedicineGeisel School of Medicine at DartmouthHanoverNH
| | - Douglas S. Kwon
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA,Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and HarvardCambridgeMA
| | - Crystal M. North
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | - Virginia A. Triant
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | | | - Brian Ghoshhajra
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | - Robert N. Peck
- Center for Global HealthWeill Cornell Medical CollegeNew YorkNY
| | - Ruth N. Sentongo
- Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Rebecca Gilbert
- Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | - Bernard Kakuhikire
- Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Yap Boum
- Epicentre Research BaseMbararaUganda
| | - Jessica E. Haberer
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | | | - Russell Tracy
- Department of Pathology and Laboratory MedicineUniversity of VermontBurlingtonVT
| | - Peter W. Hunt
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
| | | | - Alexander C. Tsai
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA,Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Linda C. Hemphill
- Department of MedicineHarvard Medical SchoolBostonMA,Departments of Medicine and PsychiatryMassachusetts General HospitalBostonMA
| | - Samson Okello
- Faculty of MedicineMbarara University of Science and TechnologyMbararaUganda
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Weil AA, Debela MD, Muyanja DM, Kakuhikire B, Baguma C, Bangsberg DR, Tsai AC, Lai PS. Correction: Gut carriage of antimicrobial resistance genes in women exposed to small-scale poultry farms in rural Uganda: A feasibility study. PLoS One 2021; 16:e0252261. [PMID: 34015055 PMCID: PMC8136737 DOI: 10.1371/journal.pone.0252261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Satinsky EN, Kakuhikire B, Baguma C, Rasmussen JD, Ashaba S, Cooper-Vince CE, Perkins JM, Kiconco A, Namara EB, Bangsberg DR, Tsai AC. Adverse childhood experiences, adult depression, and suicidal ideation in rural Uganda: A cross-sectional, population-based study. PLoS Med 2021; 18:e1003642. [PMID: 33979329 PMCID: PMC8153443 DOI: 10.1371/journal.pmed.1003642] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 05/26/2021] [Accepted: 04/29/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Depression is recognized globally as a leading cause of disability. Early-life adverse childhood experiences (ACEs) have been shown to have robust associations with poor mental health during adulthood. These effects may be cumulative, whereby a greater number of ACEs are progressively associated with worse outcomes. This study aimed to estimate the associations between ACEs and adult depression and suicidal ideation in a cross-sectional, population-based study of adults in Uganda. METHODS AND FINDINGS Between 2016 and 2018, research assistants visited the homes of 1,626 adult residents of Nyakabare Parish, a rural area in southwestern Uganda. ACEs were assessed using a modified version of the Adverse Childhood Experiences-International Questionnaire, and depression symptom severity and suicidal ideation were assessed using the Hopkins Symptom Checklist for Depression (HSCL-D). We applied a validated algorithm to determine major depressive disorder diagnoses. Overall, 1,458 participants (90%) had experienced at least one ACE, 159 participants (10%) met criteria for major depressive disorder, and 28 participants (1.7%) reported suicidal ideation. We fitted regression models to estimate the associations between cumulative number of ACEs and depression symptom severity (linear regression model) and major depressive disorder and suicidal ideation (Poisson regression models). In multivariable regression models adjusted for age, sex, primary school completion, marital status, self-reported HIV status, and household asset wealth, the cumulative number of ACEs was associated with greater depression symptom severity (b = 0.050; 95% confidence interval [CI], 0.039-0.061, p < 0.001) and increased risk for major depressive disorder (adjusted relative risk [ARR] = 1.190; 95% CI, 1.109-1.276; p < 0.001) and suicidal ideation (ARR = 1.146; 95% CI, 1.001-1.311; p = 0.048). We assessed the robustness of our findings by probing for nonlinearities and conducting analyses stratified by age. The limitations of the study include the reliance on retrospective self-report as well as the focus on ACEs that occurred within the household. CONCLUSIONS In this whole-population, cross-sectional study of adults in rural Uganda, the cumulative number of ACEs had statistically significant associations with depression symptom severity, major depressive disorder, and suicidal ideation. These findings highlight the importance of developing and implementing policies and programs that safeguard children, promote mental health, and prevent trajectories toward psychosocial disability.
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Affiliation(s)
- Emily N. Satinsky
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Allen Kiconco
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health and Science University—Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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18
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Weil AA, Debela MD, Muyanja DM, Kakuhikire B, Baguma C, Bangsberg DR, Tsai AC, Lai PS. Gut carriage of antimicrobial resistance genes in women exposed to small-scale poultry farms in rural Uganda: A feasibility study. PLoS One 2020; 15:e0229699. [PMID: 32525954 PMCID: PMC7289395 DOI: 10.1371/journal.pone.0229699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/19/2020] [Indexed: 01/21/2023] Open
Abstract
Background Antibiotic use for livestock is presumed to be a contributor to the acquisition of antimicrobial resistance (AMR) genes in humans, yet studies do not capture AMR data before and after livestock introduction. Methods We performed a feasibility study by recruiting a subset of women in a delayed-start randomized controlled trial of small-scale chicken farming to examine the prevalence of clinically-relevant AMR genes. Stool samples were obtained at baseline and one year post-randomization from five intervention women who received chickens at the start of the study, six control women who did not receive chickens until the end of the study, and from chickens provided to the control group at the end of the study. Stool was screened for 87 clinically significant AMR genes using a commercially available qPCR array (Qiagen). Results Chickens harbored 23 AMR genes from classes found in humans as well as additional vancomycin and β-lactamase resistance genes. AMR patterns between intervention and control women appeared more similar at baseline than one year post randomization (PERMANOVA R2 = 0.081, p = 0.61 at baseline, R2 = 0.186, p = 0.09 at 12 months) Women in the control group who had direct contact with the chickens sampled in the study had greater similarities in AMR gene patterns to chickens than those in the intervention group who did not have direct contact with chickens sampled (p = 0.01). However, at one year there was a trend towards increased similarity in AMR patterns between humans in both groups and the chickens sampled (p = 0.06). Conclusions Studies designed to evaluate human AMR genes in the setting of animal exposure should account for high baseline AMR rates. Concomitant collection of animal, human, and environmental samples over time is recommended to determine the directionality and source of AMR genes. Trial registration ClinicalTrials.gov Identifier NCT02619227.
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Affiliation(s)
- Ana A. Weil
- Department of Medicine, Massachusetts General Hospital Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Meti D. Debela
- Department of Medicine, Massachusetts General Hospital Boston, Boston, Massachusetts, United States of America
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health & Science University, Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Alexander C. Tsai
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Peggy S. Lai
- Department of Medicine, Massachusetts General Hospital Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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Smith ML, Kakuhikire B, Baguma C, Rasmussen JD, Bangsberg DR, Tsai AC. Do household asset wealth measurements depend on who is surveyed? Asset reporting concordance within multi-adult households in rural Uganda. J Glob Health 2020; 10:010412. [PMID: 32373331 PMCID: PMC7183212 DOI: 10.7189/jogh.10.010412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In resource-limited settings, the Filmer & Pritchett asset index is frequently used to measure household economic status. Little is known about how its validity is affected by differential reporting or recall within households. METHODS As part of a whole-population survey in a rural region of southwestern Uganda, we elicited household asset information from married dyads (404 men and 404 matched women) residing within the same households. We assessed the extent to which the asset index yielded differing measures of relative household wealth, depending on whether the husband's or wife's survey data were used in its calculation. To estimate agreement, we used Cohen's κ for binary and categorical variables, and Cronbach's α for continuous variables. We also assessed the extent to which asset wealth quintiles assigned based on husbands' vs wives' reporting were concordant, and whether discordance was related to demographic characteristics. RESULTS For most individual assets, agreement ranged from moderate to very good. Asset index scores based on husbands' vs wives' reporting were positively correlated (Pearson r = 0.85). Corresponding wealth quintiles were moderately concordant (weighted κ = 0.65); 171 households (43%) differed by one or more quintiles when the husbands' vs wives' reporting was used, and 43 (11%) differed by two or more quintiles. Concordance in asset wealth quintile could not be explained by joint educational attainment, age, or age difference. CONCLUSIONS There is significant intra-household variability in household asset reporting that can materially affect how households are classified on a widely used measure of relative household asset wealth.
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Affiliation(s)
- Meghan L Smith
- Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David R Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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20
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Mushavi RC, Burns BFO, Kakuhikire B, Owembabazi M, Vořechovská D, McDonough AQ, Cooper-Vince CE, Baguma C, Rasmussen JD, Bangsberg DR, Tsai AC. "When you have no water, it means you have no peace": A mixed-methods, whole-population study of water insecurity and depression in rural Uganda. Soc Sci Med 2020; 245:112561. [PMID: 31790879 PMCID: PMC6936324 DOI: 10.1016/j.socscimed.2019.112561] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/03/2019] [Accepted: 09/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Lack of access to clean water has well known implications for communicable disease risks, but the broader construct of water insecurity is little studied, and its mental health impacts are even less well understood. METHODS AND FINDINGS We conducted a mixed-methods, whole-population study in rural Uganda to estimate the association between water insecurity and depression symptom severity, and to identify the mechanisms underlying the observed association. The whole-population sample included 1776 adults (response rate, 91.5%). Depression symptom severity was measured using a modified 15-item Hopkins Symptom Checklist for Depression. Water insecurity was measured with a locally validated 8-item Household Water Insecurity Access Scale. We fitted multivariable linear and Poisson regression models to the data to estimate the association between water insecurity and depression symptom severity, adjusting for age, marital status, self-reported overall health, household asset wealth, and educational attainment. These models showed that water insecurity was associated with depression symptom severity (b = 0.009; 95% confidence interval [CI], 0.004-0.15) and that the estimated association was larger among men (b = 0.012; 95% CI, 0.008-0.015) than among women (b = 0.008; 95% CI, 0.004-0.012. We conducted qualitative interviews with a sub-group of 30 participants, focusing on women given their traditional role in household water procurement in the Ugandan context. Qualitative analysis, following an inductive approach, showed that water insecurity led to "choice-less-ness" and undesirable social outcomes, which in turn led to emotional distress. These pathways were amplified by gender-unequal norms. CONCLUSIONS Among men and women in rural Uganda, the association between water insecurity and depression symptom severity is statistically significant, substantive in magnitude, and robust to potential confounding. Data from the qualitative interviews provide key narratives that reveal the mechanisms through which women's lived experiences with water insecurity may lead to emotional distress.
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Affiliation(s)
- Rumbidzai C Mushavi
- Harvard Medical School, Boston, USA; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, USA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA.
| | - Bridget F O Burns
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA
| | | | | | | | - Amy Q McDonough
- Center for Global Health, Massachusetts General Hospital, Boston, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justin D Rasmussen
- Center for Global Health, Massachusetts General Hospital, Boston, USA; Department of Psychology & Neuroscience, Duke University, Durham, USA
| | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda; Oregon Health and Science University-Portland State University School of Public Health, Portland, USA
| | - Alexander C Tsai
- Harvard Medical School, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA; Mbarara University of Science and Technology, Mbarara, Uganda; Harvard Center for Population and Development Studies, Cambridge, USA
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21
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Rasmussen JD, Kakuhikire B, Baguma C, Ashaba S, Cooper-Vince CE, Perkins JM, Bangsberg DR, Tsai AC. Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda. PLoS Med 2019; 16:e1002908. [PMID: 31539373 PMCID: PMC6754129 DOI: 10.1371/journal.pmed.1002908] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/20/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness. METHODS AND FINDINGS Study participants were randomly assigned to receive a vignette describing a typical woman (control condition) or one of nine variants describing a different symptom presentation (suggestive of schizophrenia, bipolar, or major depression) and treatment course (no treatment, treatment with remission, or treatment with remission followed by subsequent relapse). Participants then answered questions about personal beliefs and perceived norms in three domains of stigma: willingness to have the woman marry into their family, belief that she is receiving divine punishment, and belief that she brings shame on her family. We used multivariable Poisson and ordered logit regression models to estimate the causal effect of vignette treatment assignment on each stigma-related outcome. Of the participants randomized, 1,355 were successfully interviewed (76%) from November 2016 to June 2018. Roughly half of respondents were women (56%), half had completed primary school (57%), and two-thirds were married or cohabiting (64%). The mean age was 42 years. Across all types of mental illness and treatment scenarios, relative to the control vignette (22%-30%), substantially more study participants believed the woman in the vignette was receiving divine punishment (31%-54%) or believed she brought shame on her family (51%-73%), and most were unwilling to have her marry into their families (80%-88%). In multivariable Poisson regression models, vignette portrayals of untreated mental illness, relative to the control condition, increased the risk that study participants endorsed stigmatizing personal beliefs about mental illness and about persons with mental illness, irrespective of mental illness type (adjusted risk ratios [ARRs] varied from 1.7-3.1, all p < 0.001). Portrayals of effectively treated mental illness or treatment followed by subsequent relapse also increased the risk of responses indicating stigmatizing personal beliefs relative to control (ARRs varied from 1.5-3.0, all p < 0.001). The magnitudes of the estimates suggested that portrayals of initially effective treatment (whether followed by relapse or not) had little moderating influence on stigmatizing responses relative to vignettes portraying untreated mental illness. Responses to questions about perceived norms followed similar patterns. The primary limitations of this study are that the vignettes may have omitted context that could have influenced stigma and that generalizability beyond rural Uganda may be limited. CONCLUSIONS In a population-based, randomized survey experiment conducted in rural southwestern Uganda, portrayals of effectively treated mental illness did not appear to reduce endorsement of stigmatizing beliefs about mental illness or about persons with mental illness. These findings run counter to evidence from the United States. Further research is necessary to understand the relationship between mental illness treatment and stigmatizing attitudes in Uganda and other countries worldwide. TRIAL REGISTRATION The experimental procedures for this study were registered with ClinicalTrials.gov as "Measuring Beliefs and Norms About Persons With Mental Illness" (NCT03656770).
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Affiliation(s)
- Justin D. Rasmussen
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Duke University, Durham, North Carolina, United States of America
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health Sciences University–Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Alexander C. Tsai
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
- Harvard Medical School, Boston, Massachusetts, United States of America
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22
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North CM, MacNaughton P, Lai PS, Vallarino J, Okello S, Kakuhikire B, Tsai AC, Castro MC, Siedner MJ, Allen JG, Christiani DC. Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study. Environ Health 2019; 18:73. [PMID: 31429759 PMCID: PMC6701123 DOI: 10.1186/s12940-019-0517-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 08/12/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND Most of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. The lack of air quality monitoring networks in these settings limits progress in measuring global disparities in pollution-related health. Personal carbon monoxide monitoring may identify sub-populations at heightened risk for air pollution-associated respiratory morbidity in regions of the world where the financial cost of air quality monitoring networks is prohibitive. METHODS From September 2015 through May 2017, we measured 48-h ambulatory carbon monoxide (CO) exposure in a longitudinal cohort of HIV-infected and uninfected adults in rural southwestern Uganda. We fit generalized mixed effects models to identify correlates of CO exposure exceeding international air quality thresholds, quantify the relationship between CO exposure and respiratory symptoms, and explore potential effect modification by sex and HIV serostatus. RESULTS Two hundred and sixty study participants completed 419 sampling periods. Personal CO exposure exceeded international thresholds for 50 (19%) participants. In covariate-adjusted models, living in a home where charcoal was the main cooking fuel was associated with CO exposure exceeding international thresholds (adjusted odds ratio [AOR] 11.3, 95% confidence interval [95%CI] 4.7-27.4). In sex-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among women (AOR 3.3, 95%CI 1.1-10.0) but not men (AOR 1.3, 95%CI 0.4-4.4). In HIV-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among HIV-infected (AOR 2.5, 95%CI 1.01-6.0) but not HIV-uninfected (AOR 1.4, 95%CI 0.1-14.4) participants. CONCLUSIONS In a cohort in rural Uganda, personal CO exposure frequently exceeded international thresholds, correlated with biomass exposure, and was associated with respiratory symptoms among women and people living with HIV. Our results provide support for the use of ambulatory CO monitoring as a low-cost, feasible method to identify subgroups with heightened vulnerability to pollution-related respiratory morbidity in resource-limited settings and identify subgroups that may have increased susceptibility to pollution-associated respiratory morbidity.
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Affiliation(s)
- Crystal M. North
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | | | - Peggy S. Lai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Jose Vallarino
- Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Samson Okello
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- University of Virginia Health System, Charlottesville, USA
| | | | - Alexander C. Tsai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard Medical School, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Mark J. Siedner
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard Medical School, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph G. Allen
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - David C. Christiani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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23
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Smith ML, Kakuhikire B, Baguma C, Rasmussen JD, Perkins JM, Cooper-Vince C, Venkataramani AS, Ashaba S, Bangsberg DR, Tsai AC. Relative wealth, subjective social status, and their associations with depression: Cross-sectional, population-based study in rural Uganda. SSM Popul Health 2019; 8:100448. [PMID: 31338411 PMCID: PMC6626875 DOI: 10.1016/j.ssmph.2019.100448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/13/2019] [Accepted: 07/06/2019] [Indexed: 01/24/2023] Open
Abstract
Depression is a leading cause of disability worldwide, and has been found to be a consistent correlate of socioeconomic status (SES). The relative deprivation hypothesis proposes that one mechanism linking SES to health involves social comparisons, suggesting that relative SES rather than absolute SES is of primary importance in determining health status. Using data from a whole-population sample of 1,620 participants residing in rural southwestern Uganda, we estimated the independent associations between objective and subjective relative wealth and probable depression, as measured by the depression subscale of the Hopkins Symptom Checklist (HSCLD). Objective relative wealth was measured by an asset index based on information about housing characteristics and household possessions, which was used to rank study participants into quintiles (within each village) of relative household asset wealth. Subjective relative wealth was measured by a single question asking participants to rate their wealth, on a 5-point Likert scale, relative to others in their village. Within the population, 460 study participants (28.4%) screened positive for probable depression. Using Poisson regression with cluster-robust error variance, we found that subjective relative wealth was associated with probable depression, adjusting for objective relative wealth and other covariates (adjusted relative risk [aRR] comparing lowest vs. highest level of subjective relative wealth = 1.90, 95% confidence interval [CI]: 1.18, 3.06). Objective relative wealth was not associated with probable depression (aRR comparing lowest vs. highest quintile of objective relative wealth = 1.09, 95% CI: 0.77, 1.55). These results suggest that, in this context, subjective relative wealth is a stronger correlate of mental health status compared with objective relative wealth. Our findings are potentially consistent with the relative deprivation hypothesis, but more research is needed to explain how relative differences in wealth are (accurately or inaccurately) perceived and to elucidate the implications of these perceptions for health outcomes.
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Affiliation(s)
- Meghan L. Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | | | | | - David R. Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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24
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Okello S, Kim JH, Sentongo RN, Tracy R, Tsai AC, Kakuhikire B, Siedner MJ. Blood pressure trajectories and the mediated effects of body mass index and HIV-related inflammation in a mixed cohort of people with and without HIV in rural Uganda. J Clin Hypertens (Greenwich) 2019; 21:1230-1241. [PMID: 31278845 DOI: 10.1111/jch.13621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/31/2019] [Accepted: 06/19/2019] [Indexed: 11/27/2022]
Abstract
We sought to describe changes in blood pressure and estimate the effect of HIV on blood pressure (BP) over 4 years of observation in a cohort of 155 HIV-infected adults (≥40 years) on antiretroviral therapy (ART) and 154 sex- and age-quartile-matched, population-based, HIV-uninfected controls for four years in rural Uganda, we compared changes in blood pressure (BP) by HIV serostatus and tested whether body mass index and inflammation (high-sensitivity C-reactive protein and interleukin-6) and immune activation (sCD14 and sCD163) mediated the effects of HIV on BP using hierarchical multivariate and two-stage parametric regression models. Overall HIV-uninfected participants had higher mean BP than HIV-infected counterparts (differences in trend P < 0.0001 for diastolic BP and P = 0.164 for systolic BP). After initial declines in BP in both groups between years 1 and 2, BP moderately increased in both groups through year 4, with greater change over time observed in the HIV-uninfected group. Body mass index mediated 72% (95%CI 57, 97) of the association between HIV and systolic BP. We found a minimal mediating effect of sCD14 on the relationship between HIV and SBP (9%, 95% CI 5%, 21%), but found no association between other HIV-related biomarkers. Over four years of observation, HIV-infected people in rural Uganda have lower BP than HIV-uninfected counterparts despite having higher levels of inflammation. BMI, rather than measures of HIV-associated inflammation, explained a majority of the difference in BP observed.
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Affiliation(s)
- Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health Systems, Charlottesville, Virginia, USA.,Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - June-Ho Kim
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ruth N Sentongo
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Russell Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Alexander C Tsai
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard Kakuhikire
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Human Resource Management, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Reid MJ, Ma Y, Golovaty I, Okello S, Sentongo R, Feng M, Tsai AC, Kakuhikire B, Tracy R, Hunt PW, Siedner M, Tien PC. Association of Gut Intestinal Integrity and Inflammation with Insulin Resistance in Adults Living with HIV in Uganda. AIDS Patient Care STDS 2019; 33:299-307. [PMID: 31188016 DOI: 10.1089/apc.2019.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We conducted a cross-sectional study of 148 HIV+ on HIV antiretroviral therapy and 149 HIV- adults in Mbarara, Uganda, to estimate the association between HIV infection and homeostasis model assessment of insulin resistance (HOMA-IR) using multivariable regression analysis. In addition, we evaluated whether intestinal fatty acid-binding protein (I-FABP), monocyte activation markers soluble (s)CD14 and sCD163, and proinflammatory cytokine interleukin 6 (IL-6) mediated this association. HOMA-IR was greater among HIV+ than HIV- adults [median (interquartile range): 1.3 (0.7-2.5) vs. 0.9 (0.5-2.4); p = 0.008]. In models adjusted for sociodemographic variables, diet, hypertension, and smoking history, HIV infection was associated with 37% [95% confidence intervals (95% CIs): 5-77] greater HOMA-IR compared with HIV- participants. The magnitude of association was greater when I-FABP was included as a covariate although the additive effect was modest (40% CI: 8-82). By contrast adding sCD14 to the model was associated with greater HOMA-IR (59%; 95% CI: 21-109) among HIV+ participants compared with HIV- participants. Among HIV+ participants, greater CD4 nadir was non-significantly associated with greater HOMA-IR (22%; 95% CI: -2 to 52). Each 5-unit increase in body mass index (BMI; 49% greater HOMA-IR; 95% CI: 18-87) and female sex (71%; 95% CI: 17-150) remained associated in adjusted models. In this study of mainly normal-weight Ugandan adults, HIV infection, female sex, and greater BMI were all associated with greater insulin resistance (IR). This association was strengthened modestly after adjustment for sCD14, suggesting possible distinct immune pathways to IR that are independent of HIV or related to inflammatory changes occurring on HIV treatment.
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Affiliation(s)
- Michael J.A. Reid
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Yifei Ma
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Iya Golovaty
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Maggie Feng
- Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Peter W. Hunt
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Department of Experimental Medicine, University of California, San Francisco, San Francisco, California
| | - Mark Siedner
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California
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North CM, Kakuhikire B, Vořechovská D, Hausammann-Kigozi S, McDonough AQ, Downey J, Christiani DC, Tsai AC, Siedner MJ. Prevalence and correlates of chronic obstructive pulmonary disease and chronic respiratory symptoms in rural southwestern Uganda: a cross-sectional, population-based study. J Glob Health 2019; 9:010434. [PMID: 31217961 PMCID: PMC6571107 DOI: 10.7189/jogh.09.010434] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background The global burden of chronic obstructive pulmonary disease (COPD) disproportionately affects resource-limited settings such as sub-Saharan Africa (SSA), but population-based prevalence estimates in SSA are rare. We aimed to estimate the population prevalence of COPD and chronic respiratory symptoms in rural southwestern Uganda. Methods Adults at least 18 years of age who participated in a population-wide census in rural southwestern Uganda completed respiratory questionnaires and lung function testing with bronchodilator challenge at health screening events in June 2015. We defined COPD as post-bronchodilator forced expiratory volume in one second to forced vital capacity ratio less than the lower limit of normal. We fit multivariable linear and log binomial regression models to estimate correlates of abnormal lung function and respiratory symptoms, respectively. We included inverse probability of sampling weights in models to facilitate population-level estimates. Results Forty-six percent of census participants (843/1814) completed respiratory questionnaires and spirometry, of which 565 (67%) met acceptability standards. COPD and respiratory symptom population prevalence were 2% (95% confidence interval (CI) = 1%-3%) and 30% (95% CI = 25%-36%), respectively. Respiratory symptoms were more prevalent and lung function was lower among women and ever-smokers (P < 0.05). HIV serostatus was associated with neither respiratory symptoms nor lung function. Conclusions COPD population prevalence was low despite prevalent respiratory symptoms. This work adds to the growing body of literature depicting lower-than-expected COPD prevalence estimates in SSA and raises questions about whether the high respiratory symptom burden in rural southwestern Uganda represents underlying structural lung disease not identified by screening spirometry.
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Affiliation(s)
- Crystal M North
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | | | | | | | - David C Christiani
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Alexander C Tsai
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Mbarara University of Science and Technology, Mbarara, Uganda
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Perkins JM, Krezanoski P, Takada S, Kakuhikire B, Batwala V, Tsai AC, Christakis NA, Bangsberg DR. Social norms, misperceptions, and mosquito net use: a population-based, cross-sectional study in rural Uganda. Malar J 2019; 18:189. [PMID: 31159821 PMCID: PMC6547474 DOI: 10.1186/s12936-019-2798-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/03/2019] [Indexed: 11/21/2022] Open
Abstract
Background Mosquito net use is an essential part of malaria prevention. Although previous research has shown that many people sleep under a mosquito net in endemic areas, it is unknown whether people underestimate how common it is to sleep under a net every night. Furthermore, perceived social norms about whether most others sleep under a mosquito net every night may contribute to personally sleeping under a net, given decades of research showing that people often mimic others’ behaviours. Methods Population-based data were collected from 1669 adults across eight villages in one rural parish in southwestern Uganda. Individuals’ perception about whether most adults in their community sleep under a mosquito net every night was compared with whether daily mosquito net use was the actual norm in their community to identify the extent of norm misperception. The association between whether an individual perceived daily mosquito net use to be the norm and personal mosquito net use was assessed while adjusting for the ratio of nets:people in the household and other factors. Results Although the majority (65%) of participants reported sleeping under a mosquito net every night (and 75% did so among the 86% of people with at least one net), one-quarter of participants thought that most adults in their community did not sleep under a mosquito net every night. Another 8% were unsure how many nights per week most adults in their community sleep under a mosquito net. Participants who perceived that daily mosquito net use was the norm were 2.94 times more likely to report personally sleeping under a mosquito net every night (95% CI 2.09–4.14, p < 0.001) compared to participants who thought doing so was not normative, adjusting for other factors. Conclusions Results suggest an opportunity for anti-malarial interventions to reduce misperceptions about mosquito net use norms and emphasize the commonness of daily mosquito net use in malaria-endemic regions. If people correctly perceive most others to sleep under a net every night, then they may personally do so when possible and support others to do so too.
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Affiliation(s)
- Jessica M Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, 37203, USA. .,Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, 37203, USA.
| | - Paul Krezanoski
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Sae Takada
- National Clinician Scholars Program UCLA, Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, USA.,VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, San Diego, CA, USA
| | | | - Vincent Batwala
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda.,Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, USA
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda.,Oregon Health & Science University, Portland State University School of Public Health, Portland, OR, USA
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28
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Magodoro IM, Feng M, North CM, Vořechovská D, Kraemer JD, Kakuhikire B, Bangsberg D, Tsai AC, Siedner MJ. Female sex and cardiovascular disease risk in rural Uganda: a cross-sectional, population-based study. BMC Cardiovasc Disord 2019; 19:96. [PMID: 31023227 PMCID: PMC6485175 DOI: 10.1186/s12872-019-1072-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 04/09/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Sex-based differences in cardiovascular disease (CVD) burden are widely acknowledged, with male sex considered a risk factor in high-income settings. However, these relationships have not been examined in sub-Saharan Africa (SSA). We aimed to apply the American Heart Association (AHA) ideal cardiovascular health (CVH) tool modified by the addition of C-reactive protein (CRP) to examine potential sex-based differences in the prevalence of CVD risk in rural Uganda. METHODS In a cross-sectional study nested within a population-wide census, 857 community-living adults completed physical and laboratory-based assessments to calculate individual ideal CVH metrics including an eight category for CRP levels. We summarized sex-specific ideal CVH indices, fitting ordinal logistic regression models to identify correlates of improving CVH. As secondary outcomes, we assessed subscales of ideal CVH behaviours and factors. Models included inverse probability of sampling weights to determine population-level estimates. RESULTS The weighted-population mean age was 39.2 (1.2) years with 52.0 (3.7) % females. Women had ideal scores in smoking (80.4% vs. 68.0%; p < 0.001) and dietary intake (26.7% vs. 16.8%; p = 0.037) versus men, but the opposite in body mass index (47.3% vs. 84.4%; p < 0.001), glycated hemoglobin (87.4% vs. 95.2%; p = 0.001), total cholesterol (80.2% vs. 85.0%; p = 0.039) and CRP (30.8% vs. 49.7%; p = 0.009). Overall, significantly more men than women were classified as having optimal cardiovascular health (6-8 metrics attaining ideal level) (39.7% vs. 29.0%; p = 0.025). In adjusted models, female sex was correlated with lower CVH health factors sub-scales but higher ideal CVH behaviors. CONCLUSIONS Contrary to findings in much of the world, female sex in rural SSA is associated with worse ideal CVH profiles, despite women having better indices for ideal CVH behaviors. Future work should assess the potential role of socio-behavioural sex-specific risk factors for ideal CVH in SSA, and better define the downstream consequences of these differences.
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Affiliation(s)
- Itai M Magodoro
- Harvard Medical School, 125 Shattuck St, Boston, MA, 02115, USA.
- Massachusetts General Hospital, Boston, MA, USA.
| | - Maggie Feng
- Massachusetts General Hospital, Boston, MA, USA
| | - Crystal M North
- Harvard Medical School, 125 Shattuck St, Boston, MA, 02115, USA
- Massachusetts General Hospital, Boston, MA, USA
| | | | - John D Kraemer
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | | | - David Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Alexander C Tsai
- Harvard Medical School, 125 Shattuck St, Boston, MA, 02115, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Mark J Siedner
- Harvard Medical School, 125 Shattuck St, Boston, MA, 02115, USA
- Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science & Technology, Mbarara, Uganda
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
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Manne-Goehler J, Kakuhikire B, Abaasabyoona S, Bärnighausen TW, Okello S, Tsai AC, Siedner MJ. Depressive Symptoms Before and After Antiretroviral Therapy Initiation Among Older-Aged Individuals in Rural Uganda. AIDS Behav 2019; 23:564-571. [PMID: 30229388 DOI: 10.1007/s10461-018-2273-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study aims to characterize associations between depression symptom severity and HIV infection, both prior to and in years after ART initiation, among older adults. The Ugandan Non-Communicable Diseases & Aging Cohort Study (UGANDAC) is a study of 154 PLWH on ART and 142 community-based, HIV-negative controls. The Hopkins Checklist (HSCL), a 15-item depression scale, was used to screen for depression. We estimate differences in depressive symptoms by HIV and ART status and use multivariable log binomial regression to quantify differences in probable depression between PLWH on ART. HIV-infected and HIV-uninfected participants had a similar age (mean 52.0 vs. 51.9, p = 0.854) and sex distribution (47.4 vs. 47.9% female, p = 0.934). PLWH on ART had lower depression symptom severity than HIV-uninfected controls (mean score: 1.50 vs. 1.60, p = 0.006) and a lower prevalence of probable depression (21.4 vs. 33.8%, p = 0.017). Among 102 PLWH with pre-ART depression screening scores available, their mean depression symptom severity was similar to HIV-uninfected participants (mean 1.56 vs. 1.60, p = 0.512). In adjusted models, PLWH on ART had a lower prevalence of probable depression than HIV-negative controls [adjusted prevalence ratio: 0.68 (95% CI 0.47-0.99)]. In an observational cohort of PLWH over 40 on long-term ART and matched, community-based HIV-uninfected controls in rural Uganda, we found a lower prevalence of self-reported depression among aging PLWH on ART.
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Affiliation(s)
- Jennifer Manne-Goehler
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | | | - Till W Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital Center for Global Health, Harvard Medical School, Boston, MA, USA
| | - Mark J Siedner
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital Center for Global Health, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
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30
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Abstract
People living with HIV (PLWH) are more likely to smoke compared to HIV-uninfected counterparts, but little is known about smoking behaviors in sub-Saharan Africa. To address this gap in knowledge, we characterized smoking cessation patterns among people living with HIV (PLWH) compared to HIV-uninfected individuals in rural Uganda. PLWH were at least 40 years of age and on antiretroviral therapy for at least three years, and HIV-uninfected individuals were recruited from the clinical catchment area. Our primary outcome of interest was smoking cessation, which was assessed using an adapted WHO STEPS smoking questionnaire. We fit Cox proportional hazards models to compare time to smoking cessation between PLWH pre-care, PLWH in care, and HIV-uninfected individuals. We found that, compared to HIV-uninfected individuals, PLWH in care were less likely to have ever smoked (40% vs. 49%, p = 0.04). The combined sample of 267 ever-smokers had a median age of 56 (IQR 49-68), 56% (n = 150) were male, and 26% (n = 70) were current smokers. In time-to-event analyses, HIV-uninfected individuals and PLWH prior to clinic enrollment ceased smoking at similar rates (HR 0.8, 95% CI 0.5-1.2). However, after enrolling in HIV care, PLWH had a hazard of smoking cessation over twice that of HIV-uninfected individuals and three times that of PLWH prior to enrollment (HR 2.4, 95% CI 1.3-4.6, p = 0.005 and HR 3.0, 95% CI 1.6-5.5, p = 0.001, respectively). In summary, we observed high rates of smoking cessation among PLWH after engagement in HIV care in rural Uganda. While we hypothesize that greater access to primary care services and health counseling might contribute, future studies should better investigate the mechanism of this association.
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Affiliation(s)
- Julian A. Mitton
- Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Crystal M. North
- Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Daniel Muyanja
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samson Okello
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Medicine, University of Virginia, Charlottesville, USA
| | - Dagmar Vořechovská
- Department of Global Health, Massachusetts General Hospital, Boston, USA
| | - Bernard Kakuhikire
- Institute of Management Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C. Tsai
- Department of Global Health, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Mark J. Siedner
- Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Global Health, Massachusetts General Hospital, Boston, USA
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31
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Debela MD, Muyanja DM, Kakuhikire B, Baguma C, Bangsberg DR, Tsai AC, Weil AA, Lai PS. 1207. Acquisition and Quantification of Antimicrobial Resistance Genes in the Gut Microbiome of Ugandan Women Exposed to Small-Scale Chicken Farming. Open Forum Infect Dis 2018. [PMCID: PMC6252553 DOI: 10.1093/ofid/ofy210.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Antibiotic use in livestock farming is thought to be a major contributor to the spread of antimicrobial resistance (AMR) genes in humans. However, quantitative data in this in this field are rare. To address this gap in the literature, we examined the prevalence of clinically important AMR genes before and after the introduction of chicken farming among women in rural Uganda. Methods We recruited a subset of women participating in a waitlist-randomized controlled trial of small-scale hybrid chicken farming in rural Uganda. Tetracycline is routinely administered to chicks during brooding. Stool samples before and one year after chicken introduction were obtained from six women randomized to the control arm, from five women randomized to the intervention arm, and from chickens. Microbial DNA was extracted from chicken and human stool and screened for 87 AMR genes using validated qPCR arrays (Qiagen). Results The median age was 35 years. At baseline, 10 of the women reported animal contact, most commonly goats (n = 8), free ranging village chickens (n = 7), cats (n = 4), and dogs (n = 4). During baseline testing of the women’s stool, we detected 18 genes conferring AMR to aminoglycosides, fluoroquinolones, macrolides, lincosamides, streptogramin B, Class A-C β-lactamases and tetracycline efflux pumps. Chickens harbored 23 AMR genes from the same classes as found in humans, and were also found to have vancomycin resistance genes (Van B and C) and Group D β-lactamases (OXA-58 and OXA-10). At one year, six new AMR genes emerged in controls, including one present in chickens; CTX-M-1, a Class A β-lactamase. In contrast, seven new AMR genes emerged in the intervention group, including four present in chickens: SHV, SHV(238G240E), (Class A β lactamases) and QnrS, QnrB-5 (fluoroquinolone resistance genes). Two AMR genes gained by both control and intervention groups were not present in chickens. Conclusion Women exposed to small-scale chicken farming acquired more AMR genes compared with unexposed participants. Chickens harbored many of the genes that emerged in humans. Introduction of antibiotic-treated animals may result in the transfer of AMR genes from animals to humans, even among humans exposed to a wide range of animals at baseline. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Meti D Debela
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - David R Bangsberg
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon
| | - Alexander C Tsai
- Harvard Medical School, Boston, Massachusetts
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Ana A Weil
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Peggy S Lai
- Harvard Medical School, Boston, Massachusetts
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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32
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Muthalaly RG, Koplan BA, Albano A, North C, Campbell JI, Kakuhikire B, Vořechovská D, Kraemer JD, Tsai AC, Siedner MJ. Low population prevalence of atrial fibrillation in rural Uganda: A community-based cross-sectional study. Int J Cardiol 2018; 271:87-91. [PMID: 29859712 PMCID: PMC6143408 DOI: 10.1016/j.ijcard.2018.05.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/01/2018] [Accepted: 05/21/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Atrial fibrillation (AF) is a major risk factor for stroke, which is the leading cause of cardiovascular mortality in sub-Saharan Africa. However, there is limited population-based epidemiological data on AF in sub-Saharan Africa. We sought to estimate the prevalence and correlates of AF in rural Uganda. METHODS We conducted a cross-sectional study using community health fairs in 2015 targeting eight villages in rural Uganda. Study participants completed a medical history, a clinical exam, blood collection, and 12‑lead electrocardiographic (ECG) screening. Of 1814 participants enrolled in a parent cohort study that includes 98% of adults residing in the geographic area, 856 attended a health fair and were included in this study. Our primary outcome was AF or atrial flutter. We modelled population prevalence of the outcome with inverse probability of treatment weighting using data collected from the full population. RESULTS 856 (47.2%) adults in the area attended a health fair and were included in the analysis. Health fair attendees were older (42 vs 34 years, P < 0.0001), in worse self-reported health (P < 0.0001) and more likely to be female (62% vs 49%, P < 0. 0001) compared with non-attendees. After applying weights, the estimated population mean age was 37.7 ± 14.9 years. 15% of the population was overweight or obese and 1.9% had left atrial enlargement on ECG. Despite this, the weighted estimate of AF was 0% (95%CI 0-0.54%). CONCLUSIONS AF appears less prevalent in rural Uganda than in developed countries. The explanations for this finding may be genetic, environmental or related to survivorship bias.
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Affiliation(s)
- Rahul G Muthalaly
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Bruce A Koplan
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Crystal North
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey I Campbell
- Harvard Medical School, Boston, MA, USA; Boston Medical Center, Boston, MA, USA
| | | | | | - John D Kraemer
- Department of Health Systems Administration, Georgetown University, Washington D.C., USA
| | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Mbarara University of Science & Technology, Mbarara, Uganda
| | - Mark J Siedner
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Mbarara University of Science & Technology, Mbarara, Uganda.
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Cooper-Vince CE, Arachy H, Kakuhikire B, Vořechovská D, Mushavi RC, Baguma C, McDonough AQ, Bangsberg DR, Tsai AC. Water insecurity and gendered risk for depression in rural Uganda: a hotspot analysis. BMC Public Health 2018; 18:1143. [PMID: 30257659 PMCID: PMC6158871 DOI: 10.1186/s12889-018-6043-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/18/2018] [Indexed: 12/25/2022] Open
Abstract
Background Water insecurity is linked to depression in low- and middle-income countries (LMICs), though it remains unclear how geospatial clustering of water insecurity in rural regions is associated with risk for depression. Methods We conducted a population-based survey of a rural parish in southwestern Uganda (N = 1603) to evaluate the joint geospatial clustering of water insecurity and risk for depression among men and women living in rural Uganda. Results Geospatial clustering of self-reported water insecurity and depressive symptoms was found to be present among both men and women. Depression hotspots were more often observed near water insecurity hotspots among women, relative to men. Multivariable regression revealed that residing in a water insecurity hotspot significantly increased risk for depressive symptoms among women, but not among men. Conclusions Residing in a water insecurity hotspot is associated with greater risk for probable depression among women, but not among men, pointing to the need for focused depression screening among women residing in water insecure households.
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Affiliation(s)
| | - Hawk Arachy
- Department of Environmental Management, Harvard University, Cambridge, USA
| | | | | | | | - Charles Baguma
- Mbarara University Science and Technology, Mbarara, Uganda
| | - Amy Q McDonough
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - David R Bangsberg
- Mbarara University Science and Technology, Mbarara, Uganda.,Oregon Health Sciences University-Portland State University School of Public Health, Portland, USA
| | - Alexander C Tsai
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, USA.,Mbarara University Science and Technology, Mbarara, Uganda
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34
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Shakya HB, Perkins JM, Traeger M, Tsai AC, Bangsberg DR, Kakuhikire B, Christakis NA. Social network correlates of IPV acceptance in rural Honduras and rural Uganda. SSM Popul Health 2018; 4:236-243. [PMID: 29854907 PMCID: PMC5976860 DOI: 10.1016/j.ssmph.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 12/21/2022] Open
Abstract
We investigated the household-level social network correlates of acceptance of intimate partner violence (IPV) in rural, agrarian settings of Honduras and Uganda, two low-income countries with unequal access to resources based upon gender. We collected complete social network data in each location (Honduras in 2014 and Uganda in 2012), across a diverse range of relationships, and then created a measure of household cohesion by calculating the degree to which members of a household nominated each other as important social connections. Our measure of IPV acceptance was based on 4 questions from the Demographic Health Survey to assess the conditions under which a person believes that it is acceptable for a man to perpetrate physical violence against his wife or partner and we coded a person as positive on IPV acceptance if they answered positively to any of the four questions. We used logistic regression to calculate the odds that an individual accepted IPV given (1) household level cohesion and (2) the proportion of the household that accepts IPV. We found individuals from more cohesive households were less likely to accept IPV controlling for the overall level of IPV acceptance in the household. Nevertheless, those in households more accepting of IPV were more likely to personally accept IPV. In stratified analyses, when household IPV acceptance was especially high, the benefit of household cohesion with respect to IPV was attenuated. The design and implementation of interventions to prevent IPV should consider household structure and norms rather than focusing only on individuals or couples. Attitudes towards intimate partner violence are associated with its perpetration. Social cohesion has been shown to be protective against violence. We look at household cohesion and violence acceptance in Honduras and Uganda. Those within socially cohesive household are less likely to accept partner violence. This finding depends on the level of violence acceptance within the household.
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Affiliation(s)
- Holly B Shakya
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Jessica M Perkins
- Department of Human and Organizational Development Peabody College, Vanderbilt University, PMB 90, 230 Appleton Place, Nashville, TN 37203, United States
| | - Margaret Traeger
- Department of Sociology, Yale Institute for Network Science, P.O. Box 208263, New Haven, CT 06520-8263, United States
| | - Alexander C Tsai
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow St, Cambridge, MA 02138, United States
| | - David R Bangsberg
- School of Public Health, Oregon Health and Science University and Portland State University, MC: GH230 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | | | - Nicholas A Christakis
- Department of Sociology, Yale Institute for Network Science, P.O. Box 208263, New Haven, CT 06520-8263, United States
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North CM, Allen JG, Okello S, Sentongo R, Kakuhikire B, Ryan ET, Tsai AC, Christiani DC, Siedner MJ. HIV Infection, Pulmonary Tuberculosis, and COPD in Rural Uganda: A Cross-Sectional Study. Lung 2018; 196:49-57. [PMID: 29260309 PMCID: PMC6261662 DOI: 10.1007/s00408-017-0080-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE HIV is associated with chronic obstructive pulmonary disease (COPD) in high resource settings. Similar relationships are less understood in low resource settings. We aimed to estimate the association between HIV infection, tuberculosis, and COPD in rural Uganda. METHODS The Uganda Non-communicable Diseases and Aging Cohort study observes people 40 years and older living with HIV (PLWH) on antiretroviral therapy, and population-based HIV-uninfected controls in rural Uganda. Participants completed respiratory questionnaires and post-bronchodilator spirometry. RESULTS Among 269 participants with spirometry, median age was 52 (IQR 48-55), 48% (n = 130) were ever-smokers, and few (3%, n = 9) reported a history of COPD or asthma. All participants with prior tuberculosis (7%, n = 18) were PLWH. Among 143 (53%) PLWH, median CD4 count was 477 cells/mm3 and 131 (92%) were virologically suppressed. FEV1 was lower among older individuals (- 0.5%pred/year, 95% CI 0.2-0.8, p < 0.01) and those with a history of tuberculosis (- 14.4%pred, 95% CI - 23.5 to - 5.3, p < 0.01). COPD was diagnosed in 9 (4%) participants, eight of whom (89%) were PLWH, six of whom (67%) had a history of tuberculosis, and all of whom (100%) were men. Among 287 participants with complete symptom questionnaires, respiratory symptoms were more likely among women (AOR 3.9, 95% CI 2.0-7.7, p < 0.001) and those in homes cooking with charcoal (AOR 3.2, 95% CI 1.4-7.4, p = 0.008). CONCLUSION In rural Uganda, COPD may be more prevalent among PLWH, men, and those with prior tuberculosis. Future research is needed to confirm these findings and evaluate their broader impacts on health.
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Affiliation(s)
- Crystal M North
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Joseph G Allen
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Edward T Ryan
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - David C Christiani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark J Siedner
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
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Perkins JM, Nyakato VN, Kakuhikire B, Mbabazi PK, Perkins HW, Tsai AC, Subramanian SV, Christakis NA, Bangsberg DR. Actual Versus Perceived HIV Testing Norms, and Personal HIV Testing Uptake: A Cross-Sectional, Population-Based Study in Rural Uganda. AIDS Behav 2018; 22:616-628. [PMID: 28233075 PMCID: PMC5568980 DOI: 10.1007/s10461-017-1691-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
HIV testing is an essential part of treatment and prevention. Using population-based data from 1664 adults across eight villages in rural Uganda, we assessed individuals' perception of the norm for HIV testing uptake in their village and compared it to the actual uptake norm. In addition, we examined how perception of the norm was associated with personal testing while adjusting for other factors. Although the majority of people had been tested for HIV across all villages, slightly more than half of men and women erroneously thought that the majority in their village had never been tested. They underestimated the prevalence of HIV testing uptake by 42 percentage points (s.d. = 17 percentage points), on average. Among men, perceiving that HIV testing was not normative was associated with never testing for HIV (AOR = 2.6; 95% CI 1.7-4.0, p < 0.001). Results suggest an opportunity for interventions to emphasize the commonness of HIV testing uptake.
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Affiliation(s)
- Jessica M Perkins
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Center for Population and Development Studies, Cambridge, MA, USA.
| | - Viola N Nyakato
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Pamela K Mbabazi
- Uganda National Council for Science & Technology, Kampala, Uganda
| | | | - Alexander C Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
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Muyanja D, Allen JG, Vallarino J, Valeri L, Kakuhikire B, Bangsberg DR, Christiani DC, Tsai AC, Lai PS. Kerosene lighting contributes to household air pollution in rural Uganda. Indoor Air 2017; 27:1022-1029. [PMID: 28267233 PMCID: PMC5568944 DOI: 10.1111/ina.12377] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/24/2017] [Indexed: 05/21/2023]
Abstract
The literature on the contribution of kerosene lighting to indoor air particulate concentrations is sparse. In rural Uganda, kitchens are almost universally located outside the main home, and kerosene is often used for lighting. In this study, we obtained longitudinal measures of particulate matter 2.5 microns or smaller in size (PM2.5 ) from living rooms and kitchens of 88 households in rural Uganda. Linear mixed-effects models with a random intercept for household were used to test the hypotheses that primary reported lighting source and kitchen location (indoor vs outdoor) are associated with PM2.5 levels. During initial testing, households reported using the following sources of lighting: open-wick kerosene (19.3%), hurricane kerosene (45.5%), battery-powered (33.0%), and solar (1.1%) lamps. During follow-up testing, these proportions changed to 29.5%, 35.2%, 18.2%, and 9.1%, respectively. Average ambient, living room, and kitchen PM2.5 levels were 20.2, 35.2, and 270.0 μg/m3 . Living rooms using open-wick kerosene lamps had the highest PM2.5 levels (55.3 μg/m3 ) compared to those using solar lighting (19.4 μg/m3 ; open wick vs solar, P=.01); 27.6% of homes using open-wick kerosene lamps met World Health Organization indoor air quality standards compared to 75.0% in homes using solar lighting.
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Affiliation(s)
- D Muyanja
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - J G Allen
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - J Vallarino
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - L Valeri
- Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - B Kakuhikire
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - D R Bangsberg
- Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, USA
| | - D C Christiani
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - A C Tsai
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - P S Lai
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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Kakuhikire B, Suquillo D, Atuhumuza E, Mushavi R, Perkins JM, Venkataramani AS, Weiser SD, Bangsberg DR, Tsai AC. A livelihood intervention to improve economic and psychosocial well-being in rural Uganda: Longitudinal pilot study. SAHARA J 2016; 13:162-9. [PMID: 27619011 PMCID: PMC5642427 DOI: 10.1080/17290376.2016.1230072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
HIV and poverty are inextricably intertwined in sub-Saharan Africa. Economic and livelihood intervention strategies have been suggested to help mitigate the adverse economic effects of HIV, but few intervention studies have focused specifically on HIV-positive persons. We conducted three pilot studies to assess a livelihood intervention consisting of an initial orientation and loan package of chickens and associated implements to create poultry microenterprises. We enrolled 15 HIV-positive and 22 HIV-negative participants and followed them for up to 18 months. Over the course of follow-up, participants achieved high chicken survival and loan repayment rates. Median monthly income increased, and severe food insecurity declined, although these changes were not statistically significant (P-values ranged from 0.11 to 0.68). In-depth interviews with a purposive sample of three HIV-positive participants identified a constellation of economic and psychosocial benefits, including improved social integration and reduced stigma.
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Affiliation(s)
- Bernard Kakuhikire
- MBA, is Senior Lecturer and Director of the Institute of Management Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Diego Suquillo
- MIB, is a resident tutor at Quincy House, Harvard College, Cambridge, MA, USA
| | - Elly Atuhumuza
- MSc, is a study coordinator at the Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Jessica M. Perkins
- PhD, MPH, is a postdoctoral research fellow in the Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Boston, MA, USA
| | | | - Sheri D. Weiser
- MD, MPH, is Associate Professor of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - David R. Bangsberg
- MD, MPH, is Founding Dean, Oregon Health Sciences University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- MD, is Assistant Professor of Psychiatry at Harvard Medical School, Boston, MA, USA
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Tsai AC, Kakuhikire B, Mushavi R, Vořechovská D, Perkins JM, McDonough AQ, Bangsberg DR. Population-based study of intra-household gender differences in water insecurity: reliability and validity of a survey instrument for use in rural Uganda. J Water Health 2016; 14:280-92. [PMID: 27105413 PMCID: PMC4843843 DOI: 10.2166/wh.2015.165] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Hundreds of millions of people worldwide lack adequate access to water. Water insecurity, which is defined as having limited or uncertain availability of safe water or the ability to acquire safe water in socially acceptable ways, is typically overlooked by development organizations focusing on water availability. To address the urgent need in the literature for validated measures of water insecurity, we conducted a population-based study in rural Uganda with 327 reproductive-age women and 204 linked men from the same households. We used a novel method of photo identification so that we could accurately elicit study participants' primary household water sources, thereby enabling us to identify water sources for objective water quality testing and distance/elevation measurement. Our psychometric analyses provided strong evidence of the internal structure, reliability, and validity of a new eight-item Household Water Insecurity Access Scale (HWIAS). Important intra-household gender differences in perceptions of water insecurity were observed, with men generally perceiving household water insecurity as being less severe compared to women. In summary, the HWIAS represents a reliable and valid measure of water insecurity, particularly among women, and may be useful for informing and evaluating interventions to improve water access in resource-limited settings.
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Affiliation(s)
- Alexander C Tsai
- Massachusetts General Hospital Global Health, Boston, Massachusetts, USA E-mail: ; Harvard Medical School, Boston, Massachusetts, USA; Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Dagmar Vořechovská
- Massachusetts General Hospital Global Health, Boston, Massachusetts, USA E-mail:
| | - Jessica M Perkins
- Massachusetts General Hospital Global Health, Boston, Massachusetts, USA E-mail: ; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amy Q McDonough
- Massachusetts General Hospital Global Health, Boston, Massachusetts, USA E-mail:
| | - David R Bangsberg
- Massachusetts General Hospital Global Health, Boston, Massachusetts, USA E-mail: ; Harvard Medical School, Boston, Massachusetts, USA; Mbarara University of Science and Technology, Mbarara, Uganda; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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