Browsing by Author "Kiguli, Juliet"

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Cultural beliefs and practices on perinatal death: a qualitative study among the Lango community in Northern Uganda
(Springer Link, 2023-04-03) Ojok Arach, Anna Agnes; Nakasujja, Noeline; Rujumba, Joseph; Mukunya, David; Odongkara, Beatrice; Musaba, Milton W.; Napyo, Agnes; Tumwine, James K.; Nankabirwa, Victoria; Ndeezi, Grace; Kiguli, Juliet
Perinatal death has profound psychosocial efects on women and their families. Sociocultural contexts infuence the burden, rituals and bereaved’s support. Little is known about cultural beliefs and practices related to perinatal death. This study explored the cultural perspectives of the Lango community on perinatal death. This study utilised a focused ethnographic design anchored on a symbolic interactionist framework to understand the meanings attached to beliefs and practices on stillbirth or neonatal death among the Lango community in Lira District, Northern Uganda. Participants were sampled purposively for FGD while key informants were identifed through snowballing technique. Data were audio recorded in Lango, transcribed, and later translated, a codebook was developed and data entered into Atlas. ti version 8.4.26 and then coded. It was analysed both deductively and inductively into themes. Stillbirth and early neonatal death both attract similar rituals as would an older child. Burial is not rushed and is attended by family members and close friends. Stillbirths and children that die before naming are buried without names. Bereaved families are comforted and encouraged about future pregnancies. Currently, Lango associates the deaths to biomedical explanations such as teenage pregnancies, inadequate pregnancy care, health system challenges and poor health-seeking behaviour, unlike previously when they were attributed to consequences of unacceptable social behaviours, superstitious beliefs and witchcraft. Antenatal care and health facility childbirths are currently preferred over traditional practices for good pregnancy outcomes. Stillbirth or early neonatal death is viewed as the death of a child, diferent from other settings. Thus, rituals are performed to honour, create memory, and maintain the connection with deceased babies. Bereaved parents are supported. Health care workers need to provide culturally sensitive support to parents after perinatal loss. The prevailing beliefs of perinatal death cause in terms of biomedical explanations consistent with known determinants and preference for health facility care for prevention creates an opportunity for improving perinatal health.
Factors Associated with Uptake of Contraceptives among HIV Positive Women on Dolutegravir based Anti-Retroviral Treatment at Health Centres of Kampala Capital City Authority. A cross sectional study in Uganda.
(Research Square, 2021) Mbabazi, Leah; Nabaggala, Mariah Sarah; Kiwanuka, Suzanne; Kiguli, Juliet; Okoboi, Stephen; Laker, Eva; Castelnuovo, Barbara; Lamorde, Mohammed; Kiconco, Arthur; Mathius, Amperiize
Background In May 2018, the World Health Organisation issued a teratogenicity alert for HIV positive women using dolutegravir (DTG) and emphasised increased integration of sexual and reproductive services into HIV care to meet contraceptive needs of HIV positive women. However, there are scarce data on the impact of this guidance on contraceptive uptake. Objective To investigate the uptake of contraceptives and the factors affecting the uptake of contraceptive services among the HIV positive women of reproductive age who use DTG. Methods A cross-sectional survey was conducted from April 2019 to July 2019, in five government clinics in central Uganda where DTG was offered as the preferred first-line antiretroviral treatment (ART) regimen. We randomly selected 359 non-pregnant women aged 15-49 years using DTG-based regimens. We used interviewer administered questionnaires to collect data on demographics, contraceptive use, social and health system factors. We defined contraceptive uptake as the proportion of women using any method of contraception divided by the total number of women on DTG during the review period. We described patients’ characteristics using descriptive statistics. Factors associated with contraceptive uptake were investigated using Poisson regression at multivariable analysis (STATA 14). Results Of the 359 participants, the mean age was 37(SD=6.8), half 50.7% had attained primary level of education and average monthly income <100,000Ushs. The overall level of Contraceptive uptake was 38.4%, modern contraceptive uptake was 37.6% and 96.4% of the participants had knowledge of contraceptives. The most utilised method was the injectable at 58.4% followed by condoms 15%, IUD 10.7%, pills 6.4%, implants 5.4%, and least used was sterilization at 0.7%. Predictor factors that increased likelihood of contraceptive uptake were; religion of others category AIRR=1.53(95% CI: 1.01, 2.29) and parity 3-4 children AIRR=1.48(95% CI: 1.14, 1.92). Reduced rates were observed for age 40-49 years AIRR=0.45(95% CI: 0.21, 0.94), unemployment AIRR 0.63(95% CI: 0.42, 0.94), not discussing FP with partner AIRR=0.39(95% CI: 0.29, 0.52) and not receiving FP counselling AIRR=2.86 (95% CI: 0.12, 0.73). Non-significant variables were facility, education level, marital status, sexual activity, experienced side effects of FP and knowledge on both contraceptives and DTG. Conclusion This study shows a low-level uptake of contraceptives and injectable was the most used method. It also indicated that FP counselling and partner discussion on FP increased contraceptive uptake. Therefore, more strategies should be put in place to increase male involvement in family planning programs and scale up the integration of family planning services into HIV care and management programs.
Hurdles and opportunities for newborn care in rural Uganda
(Elsevier, 2011-12-01) Byaruhanga, Romano; Nsungwa-Sabiiti, J; Kiguli, Juliet; Balyeku, Andrew; Nsabagasani, Xavier; Peterson, Stefan
Introduction a set of evidence-based delivery and neonatal practices have the potential to reduce neonatal mortality substantially. However, resistance to the acceptance and adoption of these practices may still be a problem and challenge in the rural community in Uganda. Objectives to explore the acceptability and feasibility of the newborn care practices at household and family level in the rural communities in different regions of Uganda with regards to birth asphyxia, thermo-protection and cord care. Methods a qualitative design using in-depth interviews and focus group discussions were used. Participants were purposively selected from rural communities in three districts. Six in-depth interviews targeting traditional birth attendants and nine focus group discussions composed of 10–15 participants among post childbirth mothers, elderly caregivers and partners or fathers of recently delivered mothers were conducted. All the mothers involved has had normal vaginal deliveries in the rural community with unskilled birth attendants. Latent content analysis was used. Findings two main themes emerged from the interviews: ‘Barriers to change’ and ‘Windows of opportunities’. Some of the recommended newborn practices were deemed to conflict with traditional and cultural practices. Promotion of delayed bathing as a thermo-protection measure, dry cord care were unlikely to be accepted and spiritual beliefs were attached to use of local herbs for bathing or smearing of the baby’s skin. However, several aspects of thermo-protection of the newborn, breast feeding, taking newborns for immunisation were in agreement with biomedical recommendations, and positive aspects of newborn care were noticed with the traditional birth attendants. Conclusions some of the evidence based practices may be accepted after modification. Behaviour change communication messages need to address the community norms in the country. The involvement of other newborn caregivers than the mother at the household and the community early during pregnancy may influence change of behaviour related to the adoption of the recommended newborn care practices.
Nutritional Recovery Outcome among Moderately Malnourished Under-five Children in Communities Implementing Positive Deviance - Hearth or Community Health Workers’ Nutrition Promotion Approaches in Karusi and Kirundo Provinces, Burundi
(African Journals Online, 2017) Inamahoro, Chantal; Kiguli, Juliet; Makumbi, Fredrick Edward; Wamuyu-Maina, Gakenia; Wamani, Henry
The Positive Deviance - Hearth (PD-H) approach is important in controlling malnutrition; however, there is limited data on its effect in improving nutrition status. Objective: To assess the effect of PD-H and community health worker nutrition promotion (CHWNP) in improving nutrition status and recovery among the moderately malnourished under-five (MMU5) children in Burundi. Methodology: PD-H and CHWNP approaches were used in Karusi and Kirundo provinces, respectively. MMU5 children were enrolled at baseline for the intervention (PD-H, (358) and usual care (CHWNP, (310). Haemoglobin level and anthropometric indicators (MUAC, wasting, underweight and stunting) were taken at baseline for 12, 60 and 120 days. Changes in nutritional recovery were compared within groups exposed to each approach using ANOVA for continuous outcomes and chi-square for categorical outcomes. Further analysis compared changes between the two groups exposed to the two approaches using random effects logistic models for binary outcomes and mixed effect models for continuous outcomes. Results: The MMU5 children discharged cured after 60 days and at 120 days follow-up. When compared with the baseline, this was statistically significant in both CHWNP and PDH groups on anthropometric indicators (wasting, underweight, stunting, MUAC and weight) but not anaemia. After controlling for socio-demographic factors, MMU5 enrolled in CHWNP were more likely to be discharged cured than those in PD-H with respect to moderate wasting (AOR=2.74, 95% CI= 1.19-6.29), underweight (AOR=1.56, 95% CI= 1.01-2.43) as well as MUAC (AOR=1.21, 95% CI= 0.49-3.00). Conclusion: Both CHWNP and PD-H significantly improved nutrition status and recovery. However, the proportion of those who recovered was significantly larger in CHWNP compared to PD-H.
The Uganda Newborn Study (UNEST): An Effectiveness Study on Improving Newborn Health and Survival in Rural Uganda Through a Community-based Intervention Linked to Health Facilities - Study Protocol for a Cluster Randomized Controlled Trial
(BioMed Central, 2012) Waiswa, Peter; Peterson, S Stefan; Namazzi, Gertrude; Ekirapa, Kiracho Elizabeth; Naikoba, Sarah; Byaruhanga, Romano; Kiguli, Juliet; Kallander, Karin; Tagoola, Abner; Nakakeeto, Margaret; Pariyo, George
Background Reducing neonatal-related deaths is one of the major bottlenecks to achieving Millennium Development Goal 4. Studies in Asia and South America have shown that neonatal mortality can be reduced through community-based interventions, but these have not been adapted to scalable intervention packages for sub-Saharan Africa where the culture, health system and policy environment is different. In Uganda, health outcomes are poor for both mothers and newborn babies. Policy opportunities for neonatal health include the new national Health Sector Strategic Plan, which now prioritizes newborn health including use of a community model through Village Health Teams (VHT). The aim of the present study is to adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and to evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda. Methods/Design Through formative research around evidence-based practices, and dialogue with policy and technical advisers, we constructed a home-based neonatal care package implemented by the responsible VHT member, effectively a Community Health Worker (CHW). This CHW was trained to identify pregnant women and make five home visits - two before and three just after birth - so that linkages will be made to facility care and targeted messages for home-care and care-seeking delivered. The project is improving care in health units to provide standardized care for the mother and the newborn in both intervention and comparison areas. The study is taking place in a new Demographic Surveillance Site in two rural districts, Iganga and Mayuge, in Uganda. It is a two-arm cluster randomized controlled design with 31 intervention and 32 control areas (villages). The comparison parishes receive the standard care already being provided by the district, but to the intervention villages are added a system for CHWs to visit the mother five times in her home during pregnancy and the neonatal period. Both areas benefit from a standardized strengthening of facility care for mothers and neonates. Discussion UNEST is designed to directly feed into the operationalization of maternal and newborn care in the national VHT strategy, thereby helping to inform scale-up in rural Uganda. The study is registered as a randomized controlled trial, number ISRCTN50321130.
Understanding Cervical Cancer: An Exploration of Lay Perceptions, Beliefs and Knowledge About Cervical Cancer Among the Acholi in Northern Uganda
(Springer Nature, 2014-07-15) Mwaka, Amos Deogratius; Okello, Sarikiaeli Elialilia; Kiguli, Juliet; Rutebemberwa, Elizeus
Background: Cervical cancer is the most common cancer affecting women in Uganda; yet community understanding of the disease is limited. We explored community perceptions, beliefs and knowledge about the local names, causes, symptoms, course, treatment, and prognosis of cervical cancer in order to inform targeted interventions to promote early help-seeking. Methods: Twenty four focus group discussions (FGD) with men and women aged 18 – 59 years and ten key informant interviews with persons aged ≥ 60 years were conducted at two sites in Gulu district between May and June 2012. A semi-structured interview guide informed by Kleinman’s illness explanatory model and literature on community awareness of cervical cancer was used to collect data. Data analysis was supported with use of ATLAS.ti 6.1 in coding, organizing and tracking data segments. We used content analysis technique in data analysis and organised data into a structured format under distinct themes and categories. Results: Cervical cancer was known by the local name “two remo”, meaning “an illness that manifests with bleeding.” Respondents believed that early onset of sexual activity, multiple male sexual partners and multi-parity cause cervical cancer. Respondents in half of FGDs also reported that use of condoms and family planning pills and injections cause cervical cancer. Symptoms of cervical cancer reported included vaginal bleeding, watery vaginal discharge and lower abdominal and waist pain. Respondents in most of the FGDs and key informants perceived cervical cancer as a chronic illness and that it can be treated with both modern and traditional medicines. The majority thought that cervical cancer treatment was supportive; the illness is not curable. Conclusions: While some lay beliefs about the causes of cervical cancer suggest some understanding of aetiology of the disease, other perceived causes particularly those related to use of family planning and condoms are potentially hurtful to public health. Awareness campaigns to promote early help-seeking for cervical cancer symptoms need to be culturally-sensitive and context-specific; and include messages on symptoms, risk factors, course, treatment and prognoses