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Koyratty N, Ntozini R, Mbuya MNN, Jones AD, Schuster RC, Kordas K, Li CS, Tavengwa NV, Majo FD, Humphrey J, Smith LE. Growth and growth trajectory among infants in early life: contributions of food insecurity and water insecurity in rural Zimbabwe. BMJ Nutr Prev Health 2022; 5:332-343. [PMID: 36619329 PMCID: PMC9813639 DOI: 10.1136/bmjnph-2022-000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1-M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=-0.09; 95% -0.19 to -0.13). From M6 to M18, poor food access was associated with lower LAZ (β=-0.11; 95% -0.20 to -0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.
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Affiliation(s)
- Nadia Koyratty
- Department of Poverty, Health and Nutrition, International Food Policy Research Institute, Washington DC, Washington DC, USA
| | - Robert Ntozini
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mduduzi NN Mbuya
- Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - Chin-Shang Li
- School of Nursing, University at Buffalo, Buffalo, NY, USA
| | - Naume V Tavengwa
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura E Smith
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
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Kaggwa MM, Najjuka SM, Bongomin F, Mamun MA, Griffiths MD. Prevalence of depression in Uganda: A systematic review and meta-analysis. PLoS One 2022; 17:e0276552. [PMID: 36264962 PMCID: PMC9584512 DOI: 10.1371/journal.pone.0276552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
Background Depression is one of the most studied mental health disorders, with varying prevalence rates reported across study populations in Uganda. A systematic review and meta-analysis was carried out to determine the pooled prevalence of depression and the prevalence of depression across different study populations in the country. Methods Papers for the review were retrieved from PubMed, Scopus, PsycINFO, African Journal OnLine, and Google Scholar databases. All included papers were observational studies regarding depression prevalence in Uganda, published before September 2021. The Joanna Briggs Institute Checklist for Prevalence Studies was used to evaluate the risk of bias and quality of the included papers, and depression pooled prevalence was determined using a random-effects meta-analysis. Results A total of 127 studies comprising 123,859 individuals were identified. Most studies were conducted among individuals living with HIV (n = 43; 33.9%), and the most frequently used instrument for assessing depression was the Depression sub-section of the Hopkins Symptom Checklist (n = 34). The pooled prevalence of depression was 30.2% (95% confidence interval [CI]: 26.7–34.1, I2 = 99.80, p<0.001). The prevalence of depression was higher during the COVID-19 pandemic than during the pre-pandemic period (48.1% vs. 29.3%, p = 0.021). Refugees had the highest prevalence of depression (67.6%; eight studies), followed by war victims (36.0%; 12 studies), individuals living with HIV (28.2%; 43 studies), postpartum or pregnant mothers (26.9%; seven studies), university students (26.9%; four studies), children and adolescents (23.6%; 10 studies), and caregivers of patients (18.5%; six studies). Limitation Significantly high levels of heterogeneity among the studies included. Conclusion Almost one in three individuals in Uganda has depression, with the refugee population being disproportionately affected. Targeted models for depression screening and management across various populations across the country are recommended. Trial registration Protocol registered with PROSPERO (CRD42022310122).
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda
- African Centre for Suicide Prevention and Research, Mbarara, Uganda
- Department of Psychiatry and Behavioural Neurosciences, Forensic Psychiatry Program, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Sarah Maria Najjuka
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
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Rosinger AY, Bethancourt HJ, Young SL, Schultz AF. The embodiment of water insecurity: Injuries and chronic stress in lowland Bolivia. Soc Sci Med 2021; 291:114490. [PMID: 34662760 PMCID: PMC8671240 DOI: 10.1016/j.socscimed.2021.114490] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/25/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022]
Abstract
Water is critical to health and wellbeing. Studies have theorized that problems with water can become embodied, yet few studies have quantified this. Therefore, we first sought to understand the lowland Bolivian water environment of Tsimane' forager-horticulturalists. We assessed the water environment holistically, using objective measures of water quality and water services (Joint Monitoring Programme's drinking water services ladder) and subjective measures, including perceived water safety and water insecurity experiences [Household Water Insecurity Experiences Scale (HWISE)]. We tested how water service levels, perceived water safety, and water fetching frequency were associated with HWISE scores using Tobit regression models among 270 households. We then tested if and how water becomes embodied via self-reported water-related injury and a chronic stress biomarker, hair cortisol concentration (HCC). Results demonstrated that, compared with households using surface water, households with basic water services had HWISE scores 1.59-pts lower (SE = 0.29; P < 0.001). Ingestion of water perceived to be "bad" and more daily water-fetching trips were associated with higher HWISE scores. Twenty percent of households reported prior water-related injuries, with women most commonly injured. In logistic regressions, each point higher HWISE score was associated with 28% (95%CI:1.16-1.41; P < 0.001) higher odds of injury. Basic water services compared to surface water was associated with 48% lower odds (OR = 0.52; 95%CI:0.33-0.82; P = 0.005) of injury. Finally, using linear regressions among 332 adults, HWISE scores were not associated with HCC. Past water-related injury was associated with higher HCC (Beta = 0.31; SE = 0.09; P = 0.029) among women, but not men. Relying on unimproved water services compared to surface was associated with 46.2% higher HCC for women (Beta=0.38; SE=0.14; P=0.048) and 55.3% higher HCC for men (Beta=0.44; SE=0.15; P=0.044), respectively. Overall, our findings demonstrate that water insecurity can become embodied through water-related injuries and elevated HCC. Improving water service levels through an equity lens may help ameliorate water insecurity and its accompanying negative health effects.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, 16802, USA; Department of Anthropology, Pennsylvania State University, State College, PA, 16802, USA.
| | - Hilary J Bethancourt
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, 16802, USA; Department of Anthropology, Northwestern University, Evanston, IL, USA; Anthropology Institute for Policy Research, Northwestern University, IL, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA; Anthropology Institute for Policy Research, Northwestern University, IL, USA
| | - Alan F Schultz
- Centro Boliviano de Investigación y Desarrollo Socio Integral, San Borja, Bolivia
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Ho EW, Strohmeier-Breuning S, Rossanese M, Charron D, Pennise D, Graham JP. Diverse Health, Gender and Economic Impacts from Domestic Transport of Water and Solid Fuel: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910355. [PMID: 34639655 PMCID: PMC8507830 DOI: 10.3390/ijerph181910355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
(1) Background: Water and solid fuel collection and transport are domestic duties for millions of households across the globe. People in areas with limited or no access to safely managed sources of water and household energy must fetch these resources on a frequent basis. The health, gender, and economic impacts associated with water and solid fuel collection labor have not been systematically reviewed. (2) Methods: Studies were identified through database searches and included using a list of inclusion and exclusion criteria. Studies were summarized and grouped into one of eight thematic categories. (4) Conclusions: The findings suggest that a diverse and heavy health burden is associated with water and solid fuel collection and transport. The literature also suggests that the provision of safely managed and accessible water and improved fuel options can mitigate these negative outcomes. Filling research gaps and utilizing results to guide policy and funding would likely be an effective way to ensure low- and middle-income countries are not left behind as the world strives to meet the sustainable development goals.
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Affiliation(s)
- Erica W. Ho
- Berkeley School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA 94720, USA;
| | - Sophia Strohmeier-Breuning
- Department of Public Health Sciences, UC Davis School of Medicine, University of California-Davis, Davis, CA 95616, USA;
| | - Madeleine Rossanese
- Berkeley Air Monitoring Group, Berkeley, CA 94704, USA; (M.R.); (D.C.); (D.P.)
| | - Dana Charron
- Berkeley Air Monitoring Group, Berkeley, CA 94704, USA; (M.R.); (D.C.); (D.P.)
| | - David Pennise
- Berkeley Air Monitoring Group, Berkeley, CA 94704, USA; (M.R.); (D.C.); (D.P.)
| | - Jay P. Graham
- Berkeley School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA 94720, USA;
- Correspondence:
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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] [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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Sohns A, Ford JD, Adamowski J, Robinson BE. Participatory Modeling of Water Vulnerability in Remote Alaskan Households Using Causal Loop Diagrams. ENVIRONMENTAL MANAGEMENT 2021; 67:26-42. [PMID: 33165646 DOI: 10.1007/s00267-020-01387-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
Despite perceptions of high water availability, adequate access to sufficient water resources remains a major challenge in Alaska. This paper uses a participatory modeling approach to investigate household water vulnerability in remote Alaska and to examine factors that affect water availability and water access. Specifically, the work asks: how do water policy stakeholders conceptualize the key processes that affect household water vulnerability in the context of rural Alaska? Fourteen water policy stakeholders participated in the modeling process, which included defining the problem of household water vulnerability and constructing individual causal loop diagrams (CLDs) that represent their conceptualization of household water vulnerability. Individual CLDs were subsequently combined and five sub-models emerged: environmental, economic, infrastructure, social, and health. The environmental and economic sub-models of the CLD are explored in depth. In the environmental sub-model, climate change and environmental barriers due to geography influence household water vulnerability. In the economic sub-model, four processes and one feedback loop affect household water vulnerability, including operations and maintenance funding, the strength of the rural Alaskan economy, and the impact of regulations. To overcome household water vulnerability and make households more resilient, stakeholders highlighted policy solutions under five themes: economics, social, regulatory, technological, and environmental.
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Affiliation(s)
- Antonia Sohns
- Department of Geography, McGill University, Montreal, QC, Canada.
| | - James D Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Jan Adamowski
- Department of Bioresource Engineering, McGill University, Montreal, QC, Canada
| | - Brian E Robinson
- Department of Geography, McGill University, Montreal, QC, Canada
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Wutich A, Brewis A, Tsai A. Water and mental health. WIRES WATER 2020; 7. [DOI: 10.1002/wat2.1461] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/21/2020] [Indexed: 08/30/2023]
Abstract
AbstractThere is a well‐established connection among water quality, sanitation, and physical health. The potentially important relationship between water and mental health is considerably less studied. Reviewing evidence from ethnography, geography, folklore, indigenous studies, rural medicine, drought research, and large‐n statistical studies, we argue there is now good theoretical rationale and growing evidence of water insecurity as a possible driver of mental ill‐health. Furthermore, some nascent evidence suggests that emotionally meaningful interactions with water might improve mental health outcomes. Leveraging these literatures, we address the many ways in which mental health outcomes are conceptualized and operationalized in water research, including as emotional distress, perceived stress, depressive symptoms, anxiety symptoms, somatic symptoms, and quality of life. We outline arguments supporting seven possible (and likely interlocking) mechanisms that could explain such a relationship: (a) material deprivation and related uncertainty, (b) shame of social failure, (c) worry about health threats, (d) loss of connections to people and places, (e) frustration around opportunity losses and restricted autonomy, (f) interpersonal conflict and intimate partner violence, and (g) institutional injustice or unfairness. However, we explain that as most existing studies are ethnographic, qualitative, or cross‐sectional, a causal relationship between water and mental ill‐health is yet to be confirmed empirically. More research on this topic is needed, particularly given that poorly understood connections may create barriers to achieving Sustainable Development Goals 3 (health) and 6 (water). We further suggest that tracking mental health indicators may provide unique and as‐yet underappreciated insights into the efficacy of water projects and other development interventions.This article is categorized under:
Engineering Water > Water, Health, and Sanitation
Human Water > Water as Imagined and Represented
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Affiliation(s)
- Amber Wutich
- School of Human Evolution & Social Change Arizona State University Tempe Arizona USA
| | - Alexandra Brewis
- School of Human Evolution & Social Change Arizona State University Tempe Arizona USA
| | - Alexander Tsai
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
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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: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [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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Ashaba S, Cooper-Vince CE, Vořechovská D, Rukundo GZ, Maling S, Akena D, Tsai AC. Community beliefs, HIV stigma, and depression among adolescents living with HIV in rural Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:169-180. [PMID: 31339461 DOI: 10.2989/16085906.2019.1637912] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The availability of and increased access to antiretroviral therapy (ART) has significantly reduced the morbidity and mortality associated with HIV. As a result, perinatally infected youth are increasingly able to reach adolescence. There is limited information about the psychosocial challenges facing adolescents living with HIV (ALWH) in rural settings of sub-Saharan Africa. We sought to understand psychosocial challenges facing ALWH in rural Uganda and their effects on mental health and HIV treatment outcomes. We conducted 5 focus group discussions and 40 one-on-one in-depth interviews in Mbarara, Uganda with adolescents (aged 13-17 years) and adult women caregivers. All interviews were audio-recorded, transcribed directly into English, and coded using thematic analysis to identify themes related to psychosocial adversities and mental health. Adversities faced by adolescents included negative community perceptions (perceived aggression, presumed early mortality), HIV stigma (enacted and internalized), vulnerability factors (loss of parents, poverty), and health challenges (depression, ART non-adherence). In the conceptual model that emerged from the findings, negative community perceptions (about perceived aggression or presumed early mortality) predisposed ALWH to experience enactments and internalization of stigma that led to depression and ART non-adherence. The data also identified several protective factors, including counselling, family and religious support, and timely serostatus disclosure. Interventions to correct community misperceptions about HIV can potentially reduce stigma and thereby improve physical and mental health outcomes of ALWH.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda
| | | | | | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere College of Health Sciences , Makerere , Uganda
| | - Alexander C Tsai
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda.,Massachusetts General Hospital , Boston , MA , USA.,Harvard Medical School , Boston , MA , USA
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Ashaba S, Cooper-Vince C, Vořechovská D, Maling S, Rukundo GZ, Akena D, Tsai AC. Development and validation of a 20-item screening scale to detect major depressive disorder among adolescents with HIV in rural Uganda: A mixed-methods study. SSM Popul Health 2018; 7:100332. [PMID: 30560198 PMCID: PMC6289958 DOI: 10.1016/j.ssmph.2018.100332] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/31/2018] [Accepted: 11/25/2018] [Indexed: 12/27/2022] Open
Abstract
Background Depression is a major cause of disability among children and adolescents and is associated with elevated risks for substance abuse, HIV transmission risk behavior, and suicide. Among adolescents living with HIV (ALWH), depression undermines adherence to antiretroviral treatment, leading to poorer health outcomes. However, there are few instruments available for depression screening among ALWH in sub-Saharan Africa. Methods Using mixed methods we developed and validated a 20-item depression screening scale to be used among ALWH in rural Uganda. First, we conducted focus group discussions and in-depth interviews with adolescents and adult caregivers (n = 80) to elicit participant perspectives about mental health challenges facing HIV-affected children and adolescents. We generated an initial pool of 40 items, pilot tested it with ALWH and adolescents of unknown serostatus (n = 40), and then administered the items to a validation sample of ALWH (n = 224). Exploratory factor analysis was used to examine the factor structure of the scale. We evaluated the scale for its reliability, and validity. Results The mean age of the participants in the validation sample was 14.9 years (standard deviation [SD] 1.4), 131 (58%) were girls and 48 (21%) were orphans. Exploratory factor analysis revealed two factors related to affective and cognitive symptoms of depression. The 20-item depression scale was internally consistent (Cronbach’s alpha = 0.91) with moderate test-retest and inter-rater reliability. Construct validity was excellent, as demonstrated through correlation with related constructs like stigma (P< 0.001) and bullying (P< 0.001). At the optimized cutoff score, 64 (29%) participants screened positive for probable depression. Using the Mini-International Neuropsychiatric Interview for Children and Adolescents, we found that 37 participants (17%) were diagnosed with major depressive disorder. In reference to the criterion standard, the depression scale showed excellent discrimination (c-statistic = 0.84). Conclusion This new 20-item depression scale was reliable and valid for detecting major depressive disorder among ALWH in rural Uganda. There are few culturally- and age-appropriate screening scales for use among adolescents with HIV in sub-Saharan Africa. We used qualitative methods to generate new scale items, and adapted items from previously published depression screening scales. The items in the newly developed scale consist of well-known affective and cognitive symptoms of depression. The scale has adequate internal consistency, test-retest, and inter-rater reliability, and adequate evidence of construct and criterion-related validity.
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Affiliation(s)
| | - Christine Cooper-Vince
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Samuel Maling
- Mbarara University Science and Technology, Mbarara, Uganda
| | | | - Dickens Akena
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Alexander C Tsai
- Mbarara University Science and Technology, Mbarara, Uganda.,Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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11
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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: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [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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12
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Wutich A, Budds J, Eichelberger L, Geere J, Harris L, Horney J, Jepson W, Norman E, O'Reilly K, Pearson A, Shah S, Shinn J, Simpson K, Staddon C, Stoler J, Teodoro MP, Young S. Advancing methods for research on household water insecurity: Studying entitlements and capabilities, socio-cultural dynamics, and political processes, institutions and governance. ACTA ACUST UNITED AC 2017. [PMID: 29532811 DOI: 10.1016/j.wasec.2017.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Household water insecurity has serious implications for the health, livelihoods and wellbeing of people around the world. Existing methods to assess the state of household water insecurity focus largely on water quality, quantity or adequacy, source or reliability, and affordability. These methods have significant advantages in terms of their simplicity and comparability, but are widely recognized to oversimplify and underestimate the global burden of household water insecurity. In contrast, a broader definition of household water insecurity should include entitlements and human capabilities, sociocultural dynamics, and political institutions and processes. This paper proposes a mix of qualitative and quantitative methods that can be widely adopted across cultural, geographic, and demographic contexts to assess hard-to-measure dimensions of household water insecurity. In doing so, it critically evaluates existing methods for assessing household water insecurity and suggests ways in which methodological innovations advance a broader definition of household water insecurity.
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Affiliation(s)
- Amber Wutich
- School of Human Evolution & Social Change and Center for Global Health, Arizona State University
| | - Jessica Budds
- School of International Development, University of East Anglia
| | | | - Jo Geere
- School of Allied Health Professions, University of East Anglia
| | - Leila Harris
- Institute for Resources, Environment and Sustainability, University of British Columbia
| | - Jennifer Horney
- Department of Epidemiology and Biostatistics, Texas A&M University
| | | | - Emma Norman
- Native Environmental Science Program, Northwest Indian College
| | | | - Amber Pearson
- Department of Geography, Environment, and Spatial Sciences, Michigan State University
| | - Sameer Shah
- Institute for Resources, Environment and Sustainability, University of British Columbia
| | - Jamie Shinn
- Department of Geology & Geography, West Virginia University
| | - Karen Simpson
- Department of Geography and Environmental Management, University of West England Bristol
| | - Chad Staddon
- Department of Geography and Environmental Management, University of West England Bristol
| | - Justin Stoler
- Department of Geography and Regional Studies, University of Miami
| | | | - Sera Young
- Department of Anthropology, Northwestern University
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