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Table 1 Summary of studies regarding child and adolescent mental health services in Uganda

From: Child and adolescent mental health services in Uganda

Study Study location Objective Methods Main results
A. Qualitative studies
Mugisha et al. 2020 [16] Masaka district, Central Uganda To explore health professionals’ perspectives on barriers to seeking treatment among orphan children and adolescents with HIV/AIDS and mental distress Semi-structured interviews with 15 health service managers and staff Barriers to seeking treatment identified:
family factors (caregivers with low or no education, lack of sufficient food to support care and treatment, lack of transport to reach health services, failure to buy drugs, family fatigue);
individual factors (lack of motivation/exhaustion, lack of knowledge);
community factors (stigma, lack of willingness to seek treatment, community failure to support families, community violence);
health systems-level factors (limited service capacity, overwhelming burden from other diseases, child- and adolescent-unfriendly services, lack of medication, understaffing, lack of integrated care)
Skylstad et al. 2019 [17] Mbale district, Eastern Uganda To explore parents’ perspectives regarding child mental health, from the recognition of symptoms to help-seeking Focus group discussions with 74 parents of children younger than 10 years in both urban and rural communities Parents and the formal health system evaluate and handle symptoms of mental illness differently
More mental health awareness is required to encourage parents to seek help for their child
Multiple providers, such as traditional healers, were sought after, due to there being multiple beliefs and explanations connected with mental health symptoms, causes and treatments
Loss of social support structures in the community
Akol et al. 2018 [11] Eastern Uganda To explore traditional healers’ views on their collaboration with biomedical health systems Semi structured in-depth interviews with 20 traditional healers with Child and Adolescent mental health experience Traditional healers expressed distrust in biomedical health systems and believed that their treatments were superior. There is a need to increase collaboration between the traditional and biomedical sectors of mental health care to improve access to CAMHS
Traditional healers should be able to recognize and refer children with mental health issues to CAMHS
Akol et al. 2015 [18] Kampala and Mbale, Eastern Uganda To explore strengths and weaknesses of CAMHS at national and district levels from a management perspective Semi-structured interviews with 7 public officials responsible for management and supervision of CAMHS at national level (Kampala) and district level (Mbale) Inadequate national mental health policies, inadequate
Child and adolescent mental health financing and services; a solution is to integrate child and adolescent mental health into primary health care and other sectors
CAMHS absent at lower-level health centres (primary health care centres)
Insufficient CAMHS workforce should be increased by both in-service and pre-service training
Health management information systems are insufficient for service planning
Okello et al. 2014 [19] Northern and Central Uganda To explore the mental health of young people in secondary schools in Northern and Central Uganda Focus group discussions with 78 13–24-year-olds from 4 secondary schools, former child soldiers There are key gaps in the knowledge and attitudes of young people (i.e., lack of knowledge about common mental health disorders, early signs of reduced functioning and poor mental health, and the link between substance use and mental illness) that need to be targeted by mental health interventions focused on young people
B. Quantitative Studies
Kivumbi et al. 2019 [20] Uganda To examine the effect of participating in a family-based economic strengthening intervention (child development account, mentorship programme and workshops on financial management and microenterprise development) on the mental health wellbeing of female adolescent orphans impacted by HIV/AIDS in rural Uganda Randomized trial consisting of female orphans aged 10–16 years. Intervention group (n = 516) received economic empowerment intervention in addition to standard care services for orphans, while control group (n = 273) received only standard care services Improvement in mental health functioning over time among female participants receiving the economic empowerment intervention
Akol et al. 2018 [21] Mbale and Sironko districts, Eastern Uganda To evaluate the effect of primary health care provider mhGAP training on the identification and treatment of CAMH disorders Randomized controlled trial. Intervention group (n = 18) clinics received mhGAP-oriented CAMH training based on the WHO mhGAP-IG (v1). Control group (n = 18 clinics) did not receive training The training increased identification and reporting of non-epilepsy CAMH cases by primary health care clinics, but this increase did not reach statistical significance
Akol et al. 2017 [22] Eastern Uganda To describe an in-service CAMH (Child and adolescent mental health) training for non-specialist health workers in Uganda and assess cadre-differentiated learning outcomes
To examine the possibility of integrating CAMH into primary health care to increase accessibility
Examined learning outcomes by pre- and post-training tests Intervention: 5 days of CAMH training for 36 non-specialist health workers Increased CAMH knowledge for both nurses and clinical officers
For the integration of CAMHS into primary health care, this kind of training should be offered
Ertl et al. 2011 [23] Northern Uganda To assess the efficacy of a community-based intervention targeting symptoms of PTSD in former child soldiers aged 12–25 Three randomized groups: narrative exposure therapy (n = 29), academic catch-up programme with elements of supportive counselling (n = 28), waiting list (n = 28) Reduction of PTSD severity and other mental health problems (such as depression, etc.) especially in the narrative exposure therapy group, but also in the academic catch-up group
Han et al. 2013 [24] Southwestern Uganda To examine whether an innovative family economic empowerment intervention addresses the mental health functioning of AIDS-affected children in communities heavily impacted by HIV/AIDS Randomized controlled trial among AIDS orphans in the last two years of primary school: intervention group (n = 179) received family economic empowerment interventions (promoting monetary savings for educational opportunities, financial management workshops, mentors) and the control group (n = 118) received standard aid (food aid, scholastic materials) Children receiving the intervention reported significant improvement in their mental health functioning
Ssewamala et al. 2009 [25] Uganda To evaluate the effect of an economic empowerment intervention on health and mental health functioning among AIDS-orphaned adolescents Randomized clinical trial consisting of AIDS orphaned children aged 11–17: intervention group (n = 131) received economic empowerment interventions (workshops, monthly mentorship programme, child development account), while control group (n = 137), received only usual care for orphaned children The treatment group was over twice as likely as the control group to rate their health as good or excellent, using the Tennessee Self-Concept Scale to measure self-esteem and mental health wellbeing
Due to the improvement in wellbeing in children and adolescents, including health and mental health functioning, which builds on the theory that positive links exist between assets and children’s wellbeing, there are implications for public policy and health programming for AIDS-orphaned adolescents, such as this economic empowerment intervention
Mixed-methods studies
Kleintjes et al. 2010 [26] Uganda, Ghana, South Africa and Zambia To report on the findings of a situational analysis of CAMH policy and services in Ghana, Uganda, South Africa and Zambia
To provide new knowledge regarding multisectoral approaches to breaking the cycle of poverty and mental ill-health in Africa
Quantitative study: WHO’s Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2 was used to collect information on mental health resources
Qualitative study: focus group discussions (n = 13) and semi-structured interviews (n = 62) with public sector policy-makers and planners, nongovernmental programme managers, mental health care users, religious leaders and representatives of development agencies, professional associations and unions, university and research institutions
CAMH-related legislation, policies, services, programmes and human resources are scarce
There is stigma around mental health, and it is given low priority, contributing to low levels of investment in CAMHS
A lack of attention to the impoverishing impact of mental disorders on children and adolescents and their families contributes to the burden