Summary of Ph D Thesis : Dr. Joshua Tugumisirize
Title of Thesis:
Depression among Malawian and Ugandan women: A primary Health Care based
comparative study.
DR Tugumisirize presented his thesis in form of a monograph according to the old
Makerere guidelines.
Accepted 14th May 2007.
The international literature shows that there are wide variations in the prevalence of
depression among women, who are frequent attendees of primary health care facilities. It
has been suggested that cultural factors may be responsible for wide variations in the rate
of depression in women. This cross cultural study was carried out to determine the
influence of cultural factors on the experience and expression of depressive symptoms
and illness. The objectives were a) to explore the lexica of emotion, cultural idioms and
metaphors of distress in selected lay people in Uganda Malawi b) to validate the
Tumbuka, Chichewa and Luganda versions of Edinburgh Depression Scale (EDS) and
General Health Questionnaire (GHQ 12) and c) to determine and compare the prevalence
of depression in women attending primary health care facilities in Mzuzu, northern
Malawi (patlineal culture) and Wakiso Uganda (patrilineal culture), Mulanje, southern
Malawi (matrilineal culture)
The main findings:
Tugumisirize found that although patients with psychological problems usually present
with physical symptoms, in the three languages studied: Tumbuka , in Mzuzu , northern
Malawi; Chichewa, Mulanje, southern Malawi and Luganda, Wakiso, Uganda , each had
a rich vocabulary for emotional words , phrases, metaphors and idioms for expression of
sadness, misery and sorrow, associated with grief and bereavement. The vocabulary for
expression of grief and bereavement is very similar to the vocabulary for expression of
depressive illness. The key words in Luganda are okwetamwa (to be fed up), okwekyawa
(to be disgusted with oneself) okwekubagiza (to feel sorry; self –pity) okwenyamira (to
cause to be sad), enyiike (angst);okulowooza (to think a lot); an in Tumbuka kuwa na ,
depressed chitima (sad), chitima chikulu chomene (very sad) kuwa nkope (low mood or
look depressed) kusweka mtima (broken heart) , kugongowa na chitima (become sad and
hopeless) , wakuba na nthumazi ( feel guilty); wakuaneka wa chitima (look miserable)
and kudandaula (worried) and in Chichewa: kutaya mtima (hopelessness or despair),
kusauka mtima (feel guilty, not at ease), ndikusaka nazo mu mtima (unsettled in mind,
heartache), kukhumudwa (depressed) ndapsyinjika (depressed, maganizo otaya mtima
(feeling hopeless and suicidal).
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The Tumbuka, Chichwa and Luganda versions of Edinburgh Depression Scale (EDS) and
General Health Questionnaire (GHQ 12) were shown to be valid tools for screening for
depressive illness and psychological distress although they showed variable thresholds.
Using a combination of EDS and GHQ 12 to screen for depressive symptoms and
psychological distress and subsequent standardized psychiatric interview it was found
that there was a gradient severity of depressive symptoms and depressive disorders with
more severe depressive disorder in the patrilneal women from Wakiso, Uganda (27.8%)
and Mzuzu , Northern Malawi (16.6%) than women from the matrilineal settings in
Mulanje, Southern Malawi (9.9%) .The main factors associated with depressive illness
were coercive sex (for women in Mulanje, and Mzuzu) , debt burden and marital conflict
for women in Mzuzu and domineering spouse for women in Wakiso)
There are important implications of results from this study. There is a substantial unmet
need for diagnosis and treatment of depressive disorders in women. The gap in treatment
can be addressed by development and regular use of glossaries in different languages of
emotional terms and idioms of distress. Interview guides based on local concepts of
depression and psychological distress may help. Use of EDS and GHQ12 should be
encouraged, as they a good predictors of functional impairment. The study also
demonstrates a link between poverty, women empowerment and spousal violence. All
health care providers need appropriate knowledge and skills to be able to manage patients
with these problems. Unless the lay public become aware of the nature and
manifestations of depressive illness, the health care providers will not change practices.
Strategies for increasing public awareness and to create demand for mental health care
service should be considers. Lastly, all curricular for health care providers should include
gender and mental health.
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