BackgroundThe 20 year war in northern Uganda between the Lord's Resistance Army and the Ugandan government has resulted in the displacement of up to 2 million people within Uganda. The purpose of the study was to measure rates of post-traumatic stress disorder (PTSD) and depression amongst these internally displaced persons (IDPs), and investigate associated demographic and trauma exposure risk factors.MethodsA cross-sectional multi-staged, random cluster survey with 1210 adult IDPs was conducted in November 2006 in Gulu and Amuru districts of northern Uganda. Levels of exposure to traumatic events and PTSD were measured using the Harvard Trauma Questionnaire (original version), and levels of depression were measured using the Hopkins Symptom Checklist-25. Multivariate logistic regression was used to analyse the association of demographic and trauma exposure variables on the outcomes of PTSD and depression.ResultsOver half (54%) of the respondents met symptom criteria for PTSD, and over two thirds (67%) of respondents met symptom criteria for depression. Over half (58%) of respondents had experienced 8 or more of the 16 trauma events covered in the questionnaire. Factors strongly linked with PTSD and depression included gender, marital status, distance of displacement, experiencing ill health without medical care, experiencing rape or sexual abuse, experiencing lack of food or water, and experiencing higher rates of trauma exposure.ConclusionThis study provides evidence of exposure to traumatic events and deprivation of essential goods and services suffered by IDPs, and the resultant effect this has upon their mental health. Protection and social and psychological assistance are urgently required to help IDPs in northern Uganda re-build their lives.

BackgroundThere are limited data on the prevalence and approaches to screening for depression among pregnant women living in resource poor settings with high HIV burden.MethodsWe studied the reliability and accuracy of the Center for Epidemiologic Studies Depression (CES-D) scale in 123 (36 HIV-infected and 87 -uninfected) pregnant women receiving antenatal care at Gulu Regional Referral Hospital, Uganda. CES-D scores were compared to results from the psychiatrist-administered Mini-International Neuropsychiatric Interview (MINI) for current major depressive disorder (MDD), a “gold standard” for assessing depression. We employed measures of internal consistency (Cronbach’s alpha), and criterion validity [Area Under the Receiver Operating Characteristic Curve (AUROC), sensitivity (Se), specificity (Sp), and positive predictive value (PPV)] to evaluate the reliability and validity of the CES-D scale.Results35.8% of respondents were currently experiencing an MDD, as defined from outputs of the MINI-depression module. The CES-D had high internal consistency (Cronbach’s alpha = 0.92) and good discriminatory ability in detecting MINI-defined current MDDs (AUROC = 0.82). The optimum CES-D cutoff score for the identification of probable MDD was between 16 and 17. A CES-D cutoff score of 17, corresponding to Se, Sp, and PPV values of 72.7%, 78.5%, and 76.5%, is proposed for adoption in this population and performs well for HIV-infected and -uninfected women. After adjusting for baseline differences between the HIV subgroups (maternal age and marital status), HIV-infected pregnant women scored 6.2 points higher on the CES-D than HIV-uninfected women (p = 0.032).ConclusionsThe CES-D is a suitable instrument for screening for probable major depression among pregnant women of mixed HIV status attending antenatal services in northern Uganda.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0303-y) contains supplementary material, which is available to authorized users.

BackgroundAlcohol use may be a coping mechanism for the stressors related to forced displacement. The aim of this study was to investigate levels and determinants of alcohol disorder amongst internally displaced persons (IDPs) in northern Uganda.MethodsA cross-sectional survey with 1206 adult IDPs was conducted in Gulu and Amuru districts. Alcohol disorder was measured using the AUDIT instrument. Multivariate logistic regression was used to explore demographic, socio-economic, displacement and trauma exposure determinants of alcohol disorder.FindingsThe prevalence of probable alcohol disorder was 17% of all respondents, and 66% amongst those who drank alcohol once a month or more frequently. Factors associated with alcohol disorder included men compared to women, older age, and experiencing a higher number of traumatic events. These findings can help identify potentially vulnerable groups and target responses more effectively.

Background: Globally, there are over 24 million internally displaced persons (IDPs) who have fled their homes due to violence and insecurity but who remain within their own country. There have been up to 2 million IDPs in northern Uganda alone. The objective of this study was to investigate factors associated with mental and physical health status of IDPs in northern Uganda. Methods: A cross-sectional survey was conducted in November 2006 in IDP camps in the Gulu and Amuru districts of northern Uganda. The study outcome of physical and mental health was measured using the SF-8 instrument, which produces physical (PCS) and mental (MCS) component summary measures. Independent demographic, socio-economic, and trauma exposure (using the Harvard Trauma Questionnaire) variables were also measured. Multivariate regression linear regression analysis was conducted to investigate associations of the independent variables on the PCS and MCS outcomes. Results: 1206 interviews were completed. The respective mean PCS and MCS scores were 42.2 (95% CI 41.32 to 43.10) and 39.3 (95% CI 38.42 to 40.13), well below the instrument norm of 50, indicating poor health. Variables with negative associations with physical or mental health included gender, age, marital status, income, distance of camp from home areas, food security, soap availability, and sense of safety in the camp. A number of individual trauma variables and the frequency of trauma exposure also had negative associations with physical and mental health. Conclusions: This study provides evidence on the impact on health of deprivation of basic goods and services, traumatic events, and fear and uncertainty amongst displaced and crisis affected populations.

Background: The SF-8 is a health-related quality of life instrument that could provide a useful means of assessing general physical and mental health amongst populations affected by conflict. The purpose of this study was to test the validity and reliability of the SF-8 with a conflict-affected population in northern Uganda.

Introduction: Limited data exist on prenatal depression in in high HIV burden resource‐poor settings. Population: 403 pregnant clinic attendees at Gulu Hospital, Uganda. HIV (+) women were oversampled in a ratio of 1 HIV (+): 2 HIV (‐). Methods. Depression was assessed using the Center for Epidemiological Studies‐Depression (CESD) scale. Maternal food insecurity (FI) was evaluated using an individually focused Food Insecurity Access Scale, anemia using a Hemocue® hemoglobinometer, and social support using the 10 item version of the Duke‐UNC functional social support instrument. We performed bivariate and multivariate analyses to identify variables associated with CESD scores keeping those with p <0.05 as well as theoretically or contextually important variables in the final model. Results: CESD scores ranged from 0‐57 (mean 20 + 13.2SD). 62.3% of study women had a major depressive episode (CESD score 蠅15). While being HIV (+) was linked to higher CESD scores in bivariate analyses, in multivariate linear regression maternal food insecurity (β=+0.663) and age (β=+0.227) were the only factors associated with higher CESD scores. Maternal social support (β=‐1.209) and higher hemoglobin (β=‐0.927) were linked to lower CESD scores. Conclusion: Interventions targeting depressed pregnant Ugandan women should better understand how age, food insecurity, anemia, and social support influence prenatal depression. Grant Funding Source: Supported by USAID Feed the Future grant to Tufts University

2 figures omitted HYPOTHERMIA IS THE UNINTENTIONAL lowering of core body temperature to Ͻ95°F (Ͻ35°C). 1 Core body temperature normally is maintained at 97.7°F (36.5°C). 2 Most hypothermia-related deaths occur during the winter in states that have moderate to severe cold temperatures (e.g., Alaska, Illinois, New York, and Pennsylvania). 3 During 1979-1998, New York had the second highest number of hypothermia-related deaths in the United States. This report presents case reports of four hypothermia-related deaths during January 1999-March 2000 in Suffolk County (1999 population: 1,383,847), the largest county in New York excluding New York City, and summarizes hypothermia-related deaths in the United States during 1979-1998. Such deaths can be prevented by educating health-care providers and the public to identify persons at risk for hypothermia. Case Reports Case 1. On December 15, 1998, an 89-year-old woman with a history of wandering was noticed missing from the adult home facility where she resided and was found shivering in 1 foot of water at the edge of a pond on the property. The temperature that day ranged from 23°F-54°F (−5°C-12.2°C). On admission to a hospital, her rectal temperature was 95°F (35°C). Her