SeeTheChild - Mental child health in Uganda

SeeTheChild (STC)- mental child health in Uganda is a research project on mental health among children in Eastern Uganda. It had four main objectives of which the first is closely linked to a larger study: PROMISE Saving Brains (SB) in Burkina Faso and Uganda. The other 3 objectives have independent quantitative and qualitative data collections. The SB study is a Grand Challenges Canada, Saving Brains program financed study. The funds facilitated a follow-up study of the trial cohort the PROMISE EBF study that was EU/RCN funded (Lancet, Tylleskar, T. 2011). So for STC, the first objective was to find the relationship between peer support for exclusive breastfeeding and outcomes in children aged 5-8 years on cognitive performance, mental health, growth, schooling and clinical characteristics (Plos One, JK Tumwine et al, 2018). We have found separation anxiety, PTSD and child alcoholism as most prevalent and that has been presented in conferences, the manuscripts are drafted. In short, no difference was found in cognitive performance, emotional health, school performance or growth at 5-8 years of age between those having gotten the Exclusive breastfeeding promotion intervention and those who had not. Looking more deeply into mental health issues in the PROMISE SB trial cohort, ICD10/DSM4 and DSM5 diagnostic tools were used. This will yield important information about the use of DSM5 in Uganda. 122 children scoring high on the Strengths and Difficulties questionnaire (SDQ) in the PROMISE SB study were assessed and emotional difficulties (depression and anxiety), post-traumatic stress disorder and child alcoholism was most frequently found. Those who scored high on SDQ had more mental health difficulties than 22 selected controls. Both the user and provider perspectives were assessed regarding the health system research. Both quantitative and qualitative data were collected. It was tested out how useful the WHO mhGAP tool was for detecting mental health issues in the primary health care sector. In short, the mental health services for children in the public health sector is largely underused. MhGAP is a good pedagogical tool, but the diagnostic practices and detection among health care workers is extremely low in Eastern Ugnada and a much more intensive approach than mhGAP is needed. Cadre from the public health system can successfully be trained in mhGAP, however, findings from this research doubt that will be sufficient for covering the needs in recognising and treating mental health problems in children. Traditional healers are receiving most of the cases and there is no recognition, nor any collaboration between the traditional and official public health sector. Mostly very severe symptoms, including those with a somatic presentation, makes parents search for help if they suspect mental health suffering in their children. The project is a collaboration between Makerere University with JK Tumwine and IMS Engebretsen, University of Bergen. This project has in addition to being a young scientist grant supported 2 PhDs, 1 Master and 1 Research track student: there were four women where three are from Uganda. Two take their degree at University of Bergen, Norway, and two at Makerere University in Kampala, Uganda. That was part of objective 4. The Norwegian research track student (Skylstad) focused on help seeking and child alcoholism from the user perspective. The UiB affiliated Ugandan PhD (Akol) candidate worked on child mental health from the provider perspective. The Ugandan PhD Joyce Nalungya was a researcher doctor in PROMISE SB and STC and is now working on her psychiatry clinical research project at Makerere. This project continues work within implementation research and clinical research on child alcoholism.

This research project will follow-up children in the cohort established through the PROMISE EBF cluster randomized trial in Burkina Faso and Uganda in the period 2006-2008 that RCN co-funded. The mother-infant pairs in the intervention clusters received p eer support for exclusive breastfeeding (EBF). EBF practices were doubled in the intervention clusters. The children will reach 5-7 years when this follow-up study commences. The follow-up study will evaluate the effect of peer counseling for EBF in the first six months of life on human capital formation particularly cognitive functioning and mental child health among children in the Promise-EBF trial. This study is named Promise SB and funded by Candadien Grand Challenges. A sub-study will be conducted within the Promise SB framework: SeeTheChild - Mental child health in Uganda. This study will establish prevalence estimates for the major mental child health conditions following internationally adopted guidelines and assess knowledge and treatment gaps in the public health services regarding children's mental health conditions found in the study catchment area. Capacity building within international mental child health will be promoted in collaboration with partners. The two s Methods Promise SB: A co mmunity based approach will be used for approaching caretaker-child pairs. Separate clinical units will be used to assess children's cognitive- and gross and fine motor skills, anthropometry, neuro-somatic assessment and laboratory tests. SeeTheChild: Mul ti-disciplinary team work will be used to assess children recruited according to a predefined threshold for mental health tentative diseases. Qualitative methods including focus group discussions, observations and interviews will be used to assess existin g mental health public health services within the Ugandan study catchment area. International capacity building in mental child health will be promoted. International research ethical standards will be followed.