Student's Journal of Health Research Africa
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Medication adherence and its determinants in patients with schizophrenia: A cross-sectional observational study.
Get PDFBackground: Medication adherence is critical for optimal clinical outcomes in schizophrenia. Non-adherence contributes to symptom relapse, increased hospitalizations, and poor functional recovery. Identifying the factors associated with adherence may guide targeted interventions.
Objectives: To assess the level of medication adherence among patients with schizophrenia and to identify sociodemographic and clinical factors associated with poor adherence.
Methods: This cross-sectional observational study was conducted on 100 patients diagnosed with schizophrenia attending the psychiatry outpatient department of a tertiary care hospital. Medication adherence was measured using the Medication Adherence Rating Scale (MARS). Sociodemographic data, clinical history, and relevant correlates such as insight, substance use, and family support were recorded. Statistical analyses included chi-square tests, t-tests.
Results: Among the 100 patients, 37% exhibited high adherence, 26% showed moderate adherence, and 37% had low adherence, with a mean MARS score of 5.6 ± 2.3. Poor adherence was more frequent among unemployed and less-educated individuals, whereas no significant associations were noted with age or marital status. Clinically, poor adherence was significantly linked to longer illness duration (p = 0.002), poor insight (p < 0.001), absence of family support (p = 0.001), and concurrent substance use (p = 0.003). Multivariate analysis further confirmed poor insight (AOR = 5.61, p < 0.001), illness duration beyond five years (AOR = 2.84, p = 0.015), substance abuse (AOR = 2.91, p = 0.023), and lack of family support (AOR = 3.42, p = 0.025) as independent predictors of poor adherence.
Conclusions: The findings highlight a high burden of non-adherence in schizophrenia, predominantly influenced by modifiable psychosocial and clinical factors. Interventions must be tailored to improve insight, support systems, and address substance use.
Recommendations: Early psychoeducation, active caregiver engagement, and dual diagnosis interventions are essential strategies to enhance adherence and prevent relapse among patients with chronic schizophrenia
Patient satisfaction after total knee arthroplasty: A retrospective observational study.
Get PDFBackground:Patient satisfaction is a key measure of total knee arthroplasty (TKA) success. Despite advances, up to 19% remain dissatisfied. This study assessed satisfaction, functional improvement, and influencing factors in an Indian cohort using the Oxford Knee Score (OKS) and Kellgren–Lawrence (KL) grading.
Methods:
A retro-prospective observational study was conducted on 243 patients (301 knees) undergoing unilateral or bilateral primary TKA between September 2014 and November 2016 at a tertiary care hospital. Demographic data, comorbidities, diagnosis, and postoperative complications were recorded. Functional outcomes were assessed using pre- and postoperative OKS at ≥12 months follow-up. Satisfaction rates were documented using direct patient responses. Statistical analysis included chi-square and t-tests, with significance set at p < 0.05.
Results:
Of 243 patients, 74.9% were female, and the mean age was 63.5 ± 7.50 years. Overall, 85.6% reported satisfaction with surgery. Satisfaction rates did not significantly differ by gender (p = 0.928) or age group (p = 0.216). Comorbidities influenced satisfaction: diabetes (76.3% vs. 88.6%, p = 0.033) and hypertension (80.7% vs. 91.7%, p = 0.026) were associated with lower satisfaction.
In KL grade III knees, mean preoperative OKS improved from 18.5 ± 1.78 to 35.6 ± 4.44, and in KL grade IV knees, from 14.5 ± 2.44 to 33.1 ± 6.07 (p < 0.001 for both). Satisfied KL grade IV knees showed a greater mean improvement in OKS (21.2 ± 2.75) compared to grade III (18.1 ± 2.22, p < 0.001), despite poorer baseline scores.
Conclusion:
High satisfaction rates were observed after TKA, with significant functional improvement across KL grades. Diabetes, hypertension, and lower preoperative OKS were associated with reduced satisfaction. Functional gain was greater in advanced KL grade osteoarthritis.
Recommendations:
Comorbidity optimization, patient education, and tailored postoperative rehabilitation should be prioritized to enhance satisfaction and functional outcomes after TKA
Prevalence and factors associated with suboptimal adherence to dolutegravir-based regimens among people living with HIV in a specialized clinic in Kampala, Uganda. A cross-sectional study.
Get PDFBackground: In Uganda, 54% of people living with HIV(PLHIV) on first-line Antiretroviral Therapy (ART) were taking dolutegravir-based regimens. This study aimed to determine the prevalence and factors associated with suboptimal adherence to dolutegravir-based regimens among PLHIV at a specialized clinic in Uganda.
Methods: A cross-sectional study was conducted at a specialized HIV clinic in Kampala, Uganda, from July to August 2022. Quantitative data were collected using questionnaires and data abstraction tools from 366 consecutively sampled and consented PLHIV. Adherence was measured using a modified Morisky Medication Adherence Scale, which consisted of 9 questions. Qualitative data were collected using in-depth interviews among 13 purposively sampled, consented participants. Quantitative data were analysed using modified Poisson regression in STATA 14 to obtain factors associated with suboptimal adherence at the 5% level of significance. Qualitative data were analyzed using thematic analysis in Open Code version 4.03.
Results: The median age of participants was 44 (IQR: 35 to 52), while 64.8% (237/366) were female. The prevalence of suboptimal adherence to dolutegravir-based regimens was 49% (179/366; 95%Confidence Interval (CI): 44, 54). Alcohol consumption (adjusted Prevalence Ratio (aPR): 1.25; 95%CI: 1.012, 1.543), and unemployment (aPR: 1.27; 95%CI: 1.002, 1.609) were associated with a higher likelihood of suboptimal adherence while the lack of social support (aPR: 0.78; 95%CI: 0.619, 0.993), and talking to the doctor in case of a health problem (aPR: 0.44; 95%CI: 0.307, 1.270) were protective against suboptimal adherence, to dolutegravir-based ART regimens. Barriers to dolutegravir adherence included unemployment, lack of social support, alcohol consumption, and inadequate counseling.
Conclusion: Suboptimal adherence to dolutegravir-based ART was high. Alcohol consumption, unemployment, lack of social support, and inadequate counselling influenced dolutegravir adherence.
Recommendations: Start-up projects to address unemployment should be implemented for PLHIV. Dolutegravir-related virological failure resulting from non-adherence in PLHIV should be investigated
Perceptions of district residency programme among postgraduate medical students: A cross-sectional study.
Get PDFBackground:
The National Medical Commission (NMC) introduced the District Residency Programme (DRP) to strengthen postgraduate medical education through mandatory postings in district hospitals. It aims to enhance clinical exposure, decision-making, and understanding of public health systems while addressing workforce gaps in underserved regions.
Objectives:
To evaluate postgraduate students’ perceptions of the DRP, focusing on its educational value, challenges, and areas for improvement.
Methods:
A cross-sectional study was conducted among 217 postgraduate students of Sri Venkateswara Medical College, Tirupati, who had completed DRP postings. Data were collected using a validated questionnaire. Quantitative data were analyzed with descriptive statistics, Chi-square tests, and t-tests; qualitative responses underwent thematic analysis.
Results:
Most participants were aged 26–30 years (68.5%), with females slightly outnumbering males (53.0% vs. 47.0%). The majority (91.2%) were posted with specialty teams, 88.0% contributed to diagnostic services, and 76.5% reported mentorship. About 67.3% believed DRP would benefit future practice, and 61.8% considered it essential. Areas for improvement included limited access to remote academic activities (44.2% had provision, 55.8% did not) and inconsistent exposure to national health programmes, which several students highlighted as gaps requiring attention.
Conclusion:
Students valued DRP for clinical exposure, teamwork, and service orientation, but highlighted challenges in academic integration and applicability to non-clinical disciplines.
Recommendations:
Structured mentorship, digital learning, and specialty-specific models are recommended for sustainability
Socio-economic determinants and mortality patterns among children with spina bifida at Ruharo Mission Hospital, Western Uganda: A retrospective cross-sectional study.
Get PDFBackground
Spina Bifida (SB) is a significant cause of childhood morbidity and mortality in low-resource settings like Uganda. While clinical management is crucial, the role of socioeconomic determinants on survival outcomes remains underexplored. This study investigates the association between socioeconomic factors and mortality patterns among children with SB in Western Uganda.
Methods
A retrospective study design with a mixed-methods approach was conducted, a review of 152 medical records of children with SB (2013–2023) with qualitative focus group discussions involving 20 caregivers and 15 health workers. Quantitative data were analyzed using descriptive statistics, Firth logistic regression, and Kaplan-Meier survival analysis. Qualitative data were analysed thematically.
Results
The study revealed a high mortality rate of 65.1% (99/152). Multivariate analysis identified key socioeconomic determinants significantly associated with increased mortality: caregiver unemployment (β=1.53, OR=4.62, p=0.045), use of unprotected water sources (β=2.18, OR=8.83, p<0.001), and living 5-10 km from the health facility (β=4.42, OR=83.7, p=0.007). Most deaths (49.5%) occurred in infancy (1-11 months). Survival analysis showed a median survival time of 3-4 years, with infections being the leading cause of early death. Qualitative findings from caregivers and health workers highlighted family financial constraints, stigma, transportation barriers, and health system gaps (e.g., shortages of supplies and specialists) as critical challenges.
Conclusion
Mortality among children with Spina Bifida in Western Uganda is high and is profoundly influenced by modifiable socioeconomic determinants. Caregiver unemployment, poor water and sanitation, and geographical barriers to healthcare are significant predictors of mortality among children with SB.
Recommendations
Effective interventions must extend beyond clinical care to include socioeconomic support, inclusive livelihood interventions, such as financial protection schemes, income-generating activities, improved WASH infrastructure, decentralization of services, and community sensitization to reduce stigma. A multi-sectoral approach is essential to improve survival and quality of life for this vulnerable population of children with SB
Investigating the prevalence of coagulation abnormalities in hospitalized Covid-19 patients: A retrospective laboratory analysis.
Get PDFIntroductionCoronavirus disease 2019 (COVID-19) has affected millions worldwide, with complications extending beyond respiratory illness to systemic effects, including coagulopathy. Abnormal coagulation patterns, most notably elevated fibrinogen and D-dimer levels, have been widely reported in hospitalized patients. While these abnormalities are recognized, their prevalence within different patient cohorts is not fully characterized. This study aimed to investigate the prevalence of coagulation abnormalities in hospitalized patients with confirmed COVID-19.
MethodsA retrospective laboratory-based study was conducted using hospital records of adults admitted with COVID-19. Available coagulation parameters—including fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT), and D-dimer—were reviewed. Abnormal results were classified according to institutional laboratory reference ranges. Data were analyzed to determine the frequency and distribution of these abnormalities among the study population.
ResultsA high prevalence of coagulation abnormalities was observed in hospitalized COVID-19 patients. Elevated D-dimer was the most frequent finding, followed by increased fibrinogen levels. Prolonged PT and aPTT were less common but present in a subset of patients. Patterns suggested that abnormalities in D-dimer and fibrinogen were more consistently observed than alterations in clotting times.
ConclusionCoagulation abnormalities are prevalent among hospitalized patients with COVID-19, with elevated D-dimer emerging as the most frequent laboratory finding. These results underscore the importance of routine coagulation monitoring in COVID-19 and provide a basis for future studies examining their clinical implications
Knowledge and barriers towards cervical cancer screening among female university students in Durban, KwaZulu-Natal
Get PDFBackground: Cervical cancer is the second most common cause of cancer-related deaths among women globally, predominantly affecting women in low- and middle-income countries, including South Africa. Despite being preventable through early screening and human papillomavirus (HPV) vaccination, cervical cancer awareness and screening rates remain low. Female university students often exhibit limited knowledge and face unique barriers that impede cervical cancer screening uptake. The purpose of this study was to evaluate the level of knowledge and explore the barriers to cervical cancer screening among female students at a University of Technology in Durban, KwaZulu-Natal, South Africa.
Methods: The research was conducted among female students across various faculties and academic levels at a University of Technology in Durban, KwaZulu Natal, South Africa. A quantitative, cross-sectional survey was conducted using a structured online questionnaire that examined student demographic profiles, knowledge of cervical cancer and HPV infection, and barriers to cervical cancer screening. A total of 131 female students were recruited, and data were analysed to identify knowledge gaps and barriers to screening uptake.
Results: The study found a high level of awareness of cervical cancer (90.1%) and HPV (71.8%), though significant knowledge gaps in specific risk factors and screening methods persisted. The primary barriers identified included fear of test results, lack of awareness, and logistical challenges, such as time and financial constraints. Discomfort with discussing screening results also varied, with discomfort more pronounced among younger and lower-year students.
Conclusion: Despite general awareness, significant barriers, including fear, insufficient knowledge, and logistical obstacles, limit cervical cancer screening uptake among female university students. This suggests that tailored interventions addressing knowledge gaps and providing practical support could improve screening rates and early detection, ultimately contributing to better health outcomes for young women in similar settings
Assessing the knowledge, attitude and practice on waste management among Mangosuthu University of Technology female students residing at Beverly Hills Residence.
Get PDFIntroduction: Waste management remains a critical concern in university settings, where both domestic and sanitary waste are generated in large quantities.
Study Objective: This study aimed to explore the knowledge, attitudes, and practices of waste management among female students residing at Mangosuthu University of Technology.
Methodology: A cross-sectional qualitative study was conducted with 66 randomly selected participants using structured questionnaires. Environmental checklists assessed hygiene conditions and waste infrastructure. Data were analyzed with Microsoft Excel, and Chi-squared tests evaluated associations between knowledge and practice, and attitude and practice.
Results: Of the 66 participants, 89.39 % were aware of waste-related health risks and proper disposal methods. However, consistent practice was lacking. Only 42.42 % recognized their ethical responsibility in waste management, with some viewing it solely as the duty of caretakers. Using the Chi-squared test, no significant association was found between knowledge and practice. Conversely, a significant link was observed between attitude and practice indicating that students with stronger beliefs in proper disposal were more likely to engage in correct waste management behaviors. Environmental assessments revealed poorer hygiene conditions during weekends compared to weekdays, with overfilled waste bins highlighting gaps in maintenance and oversight.
Conclusion: Despite possessing basic knowledge and positive attitudes toward waste management, students’ practical application is inconsistent. Environmental assessments pointed to hygiene and resource gaps across floors.
Recommendations: The study recommends targeted educational initiatives, improved waste infrastructure, and policy development to enhance sustainable waste practices within university residences. These measures could support a cleaner, healthier living environment and promote long-term behavioral change
Alcohol use disorder and its associated factors among patients with psychiatric conditions admitted at Kabale regional referral hospital, Southwestern Uganda. A cross-sectional study.
Get PDFBackground
Alcohol use disorder has been a public health concern globally. Although research in this area has been conducted, most studies have been conducted in high-income countries, with less research in low-income countries. This study sought to determine the prevalence of Alcohol Use Disorder (AUD) and its associated factors among patients with psychiatric conditions admitted at Kabale regional referral hospital, Southwestern Uganda.
Methodology
The study employed a cross-sectional design, utilizing a quantitative approach that involved collecting quantitative data. The statistical analyses were done using SPSS version 25.
Results
Results from this study revealed that 150 (63.6%) were male and 86 (36.4%) were female, and most participants, 132 (55.9%), scored between 0 and 7, indicating low-risk or non-hazardous alcohol use. An additional 58 participants (24.6%) scored 8–15, placing them at increasing risk and suggesting a pattern of alcohol consumption that could lead to health problems. Twelve participants (5.1%) scored between 16 and 19, categorizing them as higher risk, which is typically associated with harmful drinking behaviors. Notably, 34 participants (14.4%) scored 20 or above, indicating a probable alcohol use disorder (AUD). The study further revealed that factors like being male (p < 0.001), being raised by a single parent (p = 0.031), and tertiary education (p = 0.022) were significantly associated with AUD. Other factors were not significantly associated.
Conclusion
The study concludes that 14.4% of mental patients had likely AUD, as determined by the AUDIT instrument.
Recommendation
Mental health facilities should regularly use validated and standardized tools like the AUDIT to screen for AUD. There is also a need for community sensitization programs by the government, focusing on the risks of early alcohol use initiation and its long-term mental health consequences
Improving ART adherence among adolescents (10-19 years) living with HIV at Kityerera H/C IV.
Get PDFBackground
An adolescent is defined as a person aged 10-19 years. Adherence to a drug involves its uptake at the prescribed dose, frequency, and studies have described that it should be at least 95%. ART adherence is defined as the degree to which an individual adheres to taking the prescribed antiretroviral drugs. This project is about improving antiretroviral therapy adherence among adolescents (10-19 years) living with HIV at Kityerera Health Centre IV.
Project design
This project of improving ART adherence among adolescents (10-19 years) living with HIV at Kityerera Health Centre IV was designed following the project management cycle, which included situation analysis, problem tree analysis, gap analysis, and implementation.
Project outcome
According to Kityerera H/C IV (statistics,2022), 40% ALHIV had good ART adherence. By the end of the project in December 2021, 90% of ALHIV should have good ART adherence if the above strategies are implemented. This indicates that the goal of this project is to increase ART adherence among ALHIV in Kityerera H/C IV from 40% in January 2022 to 90% by December 2022. There has been a gradual increase from 40% to 55% by June 2022.
Conclusion
Improving ART adherence among ALHIV is important because it reduces morbidity and mortality among adolescents.
Recommendation
Strategies such as peer support groups, SMS reminders, and the use of CDDPs to deliver drugs should be used in the project. During the implementation stage, monitoring and mid-term evaluation should be done