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Jarab AS, Al-Qerem W, Almomani N, Abu Heshmeh S, Mukattash TL, Al Hamarneh YN. Colorectal cancer screening among the public: knowledge, attitudes, and the perceived barriers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2578-2592. [PMID: 37730203 DOI: 10.1080/09603123.2023.2260320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023]
Abstract
Colorectal cancer (CRC)1 screening tests help in early detection of CRC and improve disease prognosis. This study aimed to assess knowledge, attitude, and barriers to CRC screening and the associated factors among the general population in Jordan. A validated self-administered online survey was distributed on 1542 individuals in Jordan. The participants (n = 1542) reported several barriers and demonstrated insufficient knowledge but positive attitude towards CRC screening. Older age (OR = 1.021, 95% CI = 1.010-1.032, P < 0.001), working in medical field (OR = 3.198, 95% CI = 2.499-4.092, P < 0.001), family history of cancer (OR = 1.248, 95% CI = 1.002-1.555, P < 0.05), and knowing someone with CRC (OR = 1.601, 95% CI = 1.186-2.161, P < 0.01) were significantly associated with higher knowledge. Personal history of CRC (OR = 3.157, 95% CI = 1.188-8.387, P < 0.05), and high knowledge of CRC (OR = 2.795, 95% CI = 2.242-3.484, P < 0.001) were significantly associated with the positive attitude. Future healthcare programs should devise effective techniques to improve public understanding and perception of CRC screening and overcome the identified barriers.
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Affiliation(s)
- Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- College of Pharmacy, AL Ain University, Abu Dhabi, United Arab Emirates
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Nadeen Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shrouq Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Yazid N Al Hamarneh
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Almarshoodi K, Echevarria C, Kassem A, Mahboub B, Salameh L, Ward C. An International Validation of the "DECAF Score" to Predict Disease Severity and Hospital Mortality in Acute Exacerbation of COPD in the UAE. Hosp Pharm 2024; 59:234-240. [PMID: 38450352 PMCID: PMC10913885 DOI: 10.1177/00185787231209218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
The DECAF score (the Dyspnea, Eosinopenia, Consolidation, Academia, and Atrial fibrillation score) has been adopted in some hospitals to predict the severity of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). However, DECAF score has not been widely evaluated or used in Middle Eastern countries. The present study aimed to validate the DECAF score for predicting in-hospital mortality in patients with AECOPD in the United Arab Emirates (UAE). This was a retrospective, observational study conducted in 19 hospitals in the UAE. Data were retrieved from the electronic records of patients admitted for AECOPD in 17 hospitals across the country. Patients aged more than 35 years who were diagnosed with AECOPD were included in the study. The validation of the DECAF Score for inpatient death, 30-days death, and 90-day readmission was conducted using the Area Under the Receiver Operator curve (AUROC). The AUROCDECAF curves for inpatient death, 30-days death, and 90-day readmission were 0.8 (95% CI: 0.8-0.9), 0.8 (95% CI: 0.7-0.8), and 0.8 (95% CI: 0.8-0.8), respectively. The model was a satisfactory fit to the data (Hosmer-Lemeshow statistic = 0.195, Nagelkerke R2 = 31.7%). There were significant differences in means of length of stay across patients with different DECAF score (P = .008). Patients with a DECAF score of 6 had the highest mean length of stay, which was 29.8 ± 31.4 days. Patients with a DECAF score of 0 had the lowest mean length of stay, which was 3.6 ± 2.0 days. The DECAF score is a strong predictive tool for inpatient death, 30 days mortality and 90-day readmission in UAE hospital settings. The DECAF score is an effective tool for predicating mortality and other disease outcomes in patients with AECOPD in the UAE; hence, clinicians would be more empowered to make appropriate clinical decisions by using the DECAF score.
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Affiliation(s)
| | | | - Abeer Kassem
- Emirates Health Services, Ras AlKhaima, United Arab Emirates
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Kong CH, Cho K, Min JW, Kim JY, Park K, Kim DY, Jeon M, Kang WC, Jung SY, Lee JY, Ryu JH. Oleanolic acid alleviates the extrapyramidal symptoms and cognitive impairment induced by haloperidol through the striatal PKA signaling pathway in mice. Biomed Pharmacother 2023; 168:115639. [PMID: 37812895 DOI: 10.1016/j.biopha.2023.115639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023] Open
Abstract
Haloperidol, one of the representative typical antipsychotics, is on the market for schizophrenia but shows severe adverse effects such as extrapyramidal symptoms (EPS) or cognitive impairments. Oleanolic acid (OA) is known to be effective for tardive dyskinesia which is induced by long-term treatment with L-DOPA. This study aimed to investigate whether OA could ameliorate EPS or cognitive impairment induced by haloperidol. The balance beam, catalepsy response, rotarod and vacuous chewing movement (VCM) tests were performed to measure EPS and the novel object recognition test was used to estimate haloperidol-induced cognitive impairment. Levels of dopamine and acetylcholine, the phosphorylation levels of c-AMP-dependent protein kinase A (PKA) and its downstream signaling molecules were measured in the striatum. OA significantly attenuated EPS and cognitive impairment induced by haloperidol without affecting its antipsychotic properties. Valbenazine only ameliorated VCM. Also, OA normalised the levels of dopamine and acetylcholine in the striatum which were increased by haloperidol. Furthermore, the increased phosphorylated PKA, extracellular signal-regulated kinase (ERK) and cAMP response element-binding protein (CREB) levels and c-FOS expression level induced by haloperidol were significantly decreased by OA in the striatum. In addition, cataleptic behaviour of haloperidol was reversed by sub-effective dose of H-89 with OA. These results suggest that OA can alleviate EPS and cognitive impairment induced by antipsychotics without interfering with antipsychotic properties via regulating neurotransmitter levels and the PKA signaling pathway in the striatum. Therefore, OA is a potential candidate for treating EPS and cognitive impairment induced by antipsychotics.
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Affiliation(s)
- Chang Hyeon Kong
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Kyungnam Cho
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Ji Won Min
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jae Youn Kim
- Department of Integrated Drug Development and Natural Products, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Keontae Park
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Do Yeon Kim
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Mijin Jeon
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Woo Chang Kang
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Seo Yun Jung
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jae Yeol Lee
- Department of Chemistry, College of Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jong Hoon Ryu
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Oriental Pharmaceutical Science, Kyung Hee University, Seoul 02447, Republic of Korea.
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Jarab AS, Hamam HW, Al-Qerem WA, Heshmeh SRA, Mukattash TL, Alefishat EA. Health-related quality of life and its associated factors among outpatients with heart failure: a cross-sectional study. Health Qual Life Outcomes 2023; 21:73. [PMID: 37443053 DOI: 10.1186/s12955-023-02142-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Heart Failure (HF) is a chronic disease associated with life-limiting symptoms that could negatively impact patients' health-related quality of life (HRQOL). This study aimed to evaluate HRQOL and explore the factors associated with poor HRQOL among patients with HF in Jordan. METHODS This cross-sectional study used the validated Arabic version of the Minnesota Living with Heart Failure Questionnaire to assess HRQOL in outpatients with HF visiting cardiology clinics at two public hospitals in Jordan. Variables were collected from medical records and custom-designed questionnaires, including socio-demographics, biomedical variables, and disease and medication characteristics. Ordinal regression analysis was used to explore variables associated with poor HRQOL among HF patients. RESULTS Ordinal regression analysis showed that the number of HF medications (P < 0.05) and not taking a loop diuretic (P < 0.05) significantly increased HRQOL, while the number of other chronic diseases (P < 0.05), stage III/IV of HF (P < 0.01), low monthly income (P < 0.05), and being unsatisfied with the prescribed medications (P < 0.05) significantly decreased HRQOL of HF patients. CONCLUSIONS Although the current study demonstrated low HRQOL among patients with HF in Jordan, HRQOL has a considerable opportunity for improvement in those patients. Variables identified in the present study, including low monthly income, higher New York Heart Association (NYHA) classes, a higher number of comorbidities, and/or taking a loop diuretic, should be considered in future intervention programs, aiming to improve HRQOL in patients with HF.
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Affiliation(s)
- Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
- College of Pharmacy, Al Ain University, Abu Dhabi, UAE
| | - Hanan W Hamam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Walid A Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman, 11733, Jordan
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Eman A Alefishat
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates.
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, 11942, Jordan.
- Center For Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates.
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Singh G, Magny S, Singh H, Singh S, Virk IS. Differentiating Between Lithium Tremors and Extrapyramidal Tremors in a Patient on Long-Term Antipsychotics and Lithium Medication. Cureus 2023; 15:e42406. [PMID: 37637665 PMCID: PMC10447632 DOI: 10.7759/cureus.42406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Tremors are characterized by involuntary rhythmic shaking movement in different regions of the body. Tremors can manifest in various forms and have various causes, including the use of drugs such as lithium and antipsychotic medication. In a clinical setting, it is vital to understand the varieties of tremors presented and administer the appropriate pharmacotherapy needed. We present a case of a patient that has been experiencing fine tremors while on antipsychotics and lithium medication for the past year. We address differentiating the tremors while proposing managing the effects based on their mechanisms of action.
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Affiliation(s)
- Gurraj Singh
- Psychiatry, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Sherlyne Magny
- Medicine, American University of Integrative Sciences School of Medicine, Bridgetown, BRB
| | - Harsehaj Singh
- Psychiatry, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Sukhnoor Singh
- Psychiatry, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Inderpreet S Virk
- Psychiatry, California Department of Corrections and Rehabilitation, Vacaville, USA
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Watanabe M, Tu TTH, Takao C, Maeda C, Nayanar GK, Tominaga R, Kimura Y, Takenoshita M, Yoshikawa T, Sumi K, Sumi S, Motomura H, Nagamine T, Toyofuku A. Case series of drug-induced open bite: Extrapyramidal symptoms related to psychotropic medications. Front Psychiatry 2023; 14:1137917. [PMID: 37056404 PMCID: PMC10086329 DOI: 10.3389/fpsyt.2023.1137917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/28/2023] [Indexed: 04/15/2023] Open
Abstract
Introduction Drug-induced open bite is one of the extrapyramidal symptoms with abnormal tonus of muscles and is rarely recognized in dentistry. This is a retrospective case study to investigate clinical characteristics including detailed complaints in patients with drug-induced open bite. Methods Of the outpatients who first visited the psychosomatic dental clinic at the Tokyo Medical and Dental University Hospital between September 2013 and September 2022, the patients diagnosed with drug-induced open bite were involved in this study. The clinical characteristics including sex, age, detailed complaints, duration of illness, abnormal findings, psychotropic medications, and other medications that were taken at the first examination, psychiatric comorbidities, the duration of psychiatric diseases, and other medical histories were collected retrospectively by reviewing their medical chart. Results Drug-induced open bite was found in 11 patients [women: 7, men: 4, median of age: 49 (36.5, 53) years old]. Difficulty in eating especially chewing was the major complaint (9/11, 81.6%) with the duration of illness as 48.0 (16.5, 66) months. Various degrees of open bite were observed. While some showed no occlusal contact on frontal teeth, some showed occlusal contact only on the second molars; moreover, the jaw showed a horizontal slide in a few patients. Three cases could be followed up for prognosis; while in one case the drug-induced open bite improved with 6 months of follow-up, two cases did not improve, and one showed extrusion of molars. All of them had psychiatric comorbidities with the most common diagnosis being schizophrenia (n = 5) and depression (n = 5) followed by insomnia (n = 1) and autism spectrum disorder (n = 1) including duplicated diagnosis. Nine patients (81.6%) had been undergoing treatment with antipsychotics of which three patients were also taking antidepressants. Discussion Although a drug-induced open bite is a rare symptom, prudent medical interviews about symptoms, psychiatric comorbidities, and psychotropic medication history besides oral assessment are necessary to provide a precise diagnosis and appropriate management in collaboration between dentists and psychiatrists.
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Affiliation(s)
- Motoko Watanabe
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- *Correspondence: Motoko Watanabe
| | - Trang Thi Huyen Tu
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Chihiro Takao
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chizuko Maeda
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gayatri Krishnakumar Nayanar
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Risa Tominaga
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuyuki Kimura
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miho Takenoshita
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuya Yoshikawa
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Sumi
- Sumi Orthodontic Clinic, Saga, Japan
| | - Satoko Sumi
- Section of Pediatric Dentistry, Department of Oral Growth and Development, Fukuoka Dental College, Fukuoka, Japan
| | - Haruhiko Motomura
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiko Nagamine
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Psychiatric Internal Medicine, Sunlight Brain Research Center, Yamaguchi, Japan
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Sumi S, Nagamine T, Sumi K, Aijima R, Oka K, Toyofuku A. Case report: Open bite as an extrapyramidal side effect with aripiprazole, a dopamine partial agonist. Front Psychiatry 2022; 13:976387. [PMID: 36147978 PMCID: PMC9485676 DOI: 10.3389/fpsyt.2022.976387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Long-term, fixed-point posttreatment observation of orthodontically treated patients provided us with the opportunity to capture the onset, development, and improvement of open bite, a type of malocclusion. Based on the chronological sequence of events, i.e., a tendency for open bite to worsen with increasing aripiprazole dosage and to improve with decreasing dosage, it was inferred that the onset of malocclusion was caused by extrapyramidal symptoms related to aripiprazole dosage. Physicians should be aware of this side effect when prescribing aripiprazole to children and adolescents. Careful consideration of medication history is necessary when dentists treat open bite in children and adolescents.
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Affiliation(s)
- Satoko Sumi
- Section of Pediatric Dentistry, Department of Oral Growth and Development, Fukuoka Dental College, Fukuoka, Japan
| | - Takahiko Nagamine
- Sunlight Brain Research Center, Hofu, Japan.,Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Sumi
- Sumi Orthodontic Clinic, Saga, Japan
| | - Reona Aijima
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kyoko Oka
- Section of Pediatric Dentistry, Department of Oral Growth and Development, Fukuoka Dental College, Fukuoka, Japan
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Kaggwa MM, Nkola R, Najjuka SM, Bongomin F, Ashaba S, Mamun MA. Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System. Risk Manag Healthc Policy 2021; 14:2789-2795. [PMID: 34234593 PMCID: PMC8257062 DOI: 10.2147/rmhp.s314451] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/15/2021] [Indexed: 12/27/2022] Open
Abstract
Background The burden of substance use disorders is increasing in most countries in sub-Saharan Africa. Individuals with substance use disorders (eg, alcohol use disorder) are at high risk of manifesting extrapyramidal side effects or extrapyramidal symptoms (EPS) during treatment of alcohol-induced mental illness symptoms especially psychosis. EPS management poses a challenge since some of the drugs used for treating EPS have addictive properties. The knowledge about EPS diagnosis and treatment is not well distributed across the health system, with health workers at lower health facilities having least awareness. The present case gives details of a patient who developed EPS during the management of alcohol withdrawal symptoms. Case Details Following cessation of alcohol use, a 54-year-old man with alcohol use disorder presented with a one-week history of visual, auditory and tactile hallucinations, illusions, insomnia, extreme fear and irritability. He was managed with several daily doses of intramuscular chlorpromazine 100 mg, whenever he woke up aggressive from sedation from a peripheral health facility. Four days after his admission, he became mute, stiff, immobile, triple-flexed, tremulous and was drooling saliva. He was referred to a secondary facility for further management while on antipsychotic medication. Finally, he was referred to a tertiary facility, managed with tablets of benzhexol 5 mg twice daily and intravenous diazepam 20 mg per day. Daily follow-up was done using the extrapyramidal symptom rating scale (ESRS) for EPS. EPS symptoms resolved ten days after initiation of treatment. Conclusion EPS among individuals with addictive disorders poses a challenge in its management, especially in countries where the mental health care system is not well developed at lower-level health facilities. The mental health system has to prepare sustainable interventions to properly manage EPS among the growing population of individuals with addictive disorders through strengthening the mental health policy by training and equipping all health providers with knowledge and skills in managing EPS, increasing finances allocated for mental health and controlling the production and use of addictive substances.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rahel Nkola
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mohammed A Mamun
- CHINTA Research Bangladesh (Centre for Health Innovation, Networking, Training, Action and Research - Bangladesh), Dhaka, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
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