{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T03:38:27Z","timestamp":1773373107301,"version":"3.50.1"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"S\/GAC","award":["1R25TW011213"],"award-info":[{"award-number":["1R25TW011213"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sickle Cell Disease (SCD) is a chronic genetic condition affecting approximately 112 per 100,000 live births globally, with adolescents being particularly vulnerable. Beyond its physical burden, SCD can significantly impact adolescents\u2019 mental health, particularly self-esteem. While positive coping strategies can mitigate these effects, data on self-esteem among adolescents with SCD in Uganda remain limited. The objective of this study was to determine the prevalence, associated factors, and coping mechanisms of low self-esteem among adolescents with SCD attending the Sickle Cell Clinic (SCC) at Mulago National Referral Hospital (MNRH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A sequential explanatory mixed-methods study was conducted at the SCC of MNRH from January to March 2024. Quantitative data were collected from 356 adolescents. Low self-esteem was defined as a total Rosenberg self-esteem score of less than 15. For analysis of factors associated with low self-esteem, modified Poisson regression with a log link and robust standard errors was used to estimate prevalence ratios (PRs) and their 95% CIs. Qualitative data on coping mechanisms were obtained through in-depth interviews with nine adolescents and three key informant interviews with health workers. Thematic analysis was done guided by the THRIVE framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of low self-esteem was 21.6% (95% CI: 17.6\u201326.3%). Lower prevalence of low self-esteem was observed among adolescents not frequently absent from school (aPR\u2009=\u20090.94, 95% CI 0.90\u20130.99, P\u2009=\u20090.011) and those without limitations to physical activity (aPR\u2009=\u20090.94, 95% CI 0.90\u20130.98, P\u2009=\u20090.005), while limited social engagement was associated with higher prevalence (aPR\u2009=\u20091.16, 95% CI 1.03\u20131.31, P\u2009=\u20090.014).\u201dCoping mechanisms reported by adolescents included adherence to medication, healthy eating and hydration, participation in social activities and hobbies, prayer, and peer awareness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adolescents with SCD are at considerable risk of low self-esteem, particularly those with limited physical activity, social involvement, and frequent school absenteeism. Interventions promoting healthy lifestyles, consistent medication use, peer support, and social engagement may help strengthen self-esteem in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344864","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T17:22:41Z","timestamp":1773336161000},"page":"e0344864","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low self-esteem in adolescents with sickle cell disease: Determinants and coping mechanisms; A mixed methods 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