Browsing by Author "Mukunya, David"

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Awareness, perceptions and challenges among public transport operators during the implementation of COVID-19 preventive measures in eastern Uganda: a qualitative study
(National Library of Medicine, 2023-10-09) Napyo, Agnes; Hopp, Leah; Mukunya, David; Soita, David; Matovu, Joseph KB
Public transportation plays a vital role in increasing transmission of COVID-19 due to the high-risk confined spaces in vehicles. It is therefore very crucial to employ the use of COVID-19 prevention measures during the use of public transportation to reduce risk of COVID-19 transmission. The success of the implementation and use of these measures depends largely on the public transportation users. We aimed at exploring the awareness, perceptions and challenges among public transport operators during the implementation of COVID-19 preventive measures in Eastern Uganda. This qualitative study was done in Eastern Uganda between January and February 2021. We conducted four focus group discussions, six in-depth interviews and three key informant interviews to document the awareness, perceptions and challenges faced by public transport operators including 10 boda boda riders, 19 taxi operators and 11 truck (cargo) transporters. All interviews were audio-recorded, transcribed verbatim, and analyzed using NVIVO software Version 12 plus using a thematic framework approach. Generally public transport operators were aware of that COVID-19 exists, its symptoms, how it’s transmitted and ways in which it can be prevented.. However, they were not aware of what causes it and had misconceptions that it’s spread through food and mosquitoes. Meanwhile some participants perceived COVID-19 as non-existent and that it was manufactured as a biological weapon. Some COVID-19 measures were perceived as having worked well during the pandemic like putting sanctions at the country borders, vaccination, observing hand hygiene, wearing a face mask, avoiding to touch the ‘soft parts’, quarantining in a hospital setting and social distancing. The COVID-19 preventive measures perceived as having not worked well were: home isolation, covid vaccination, using alcohol-based hand sanitizer, setting up curfew time, wearing a face mask, and reducing the number of passengers in the taxis and other public transportation vehicles. Challenges faced were mainly: financial loss resulting from reduction of passengers that used public transportation and setting up of curfew time, passengers not being able to use alcohol base hand sanitizer due to religious beliefs, loss of trust in public transportation by the public, hostility and defiance from passengers, competition for passengers among public transport operators and being mistreated by implementers of COVID-19 preventive measures like police. Various key players in the implementation of COVID-19 preventive measures included: the government, health workers, media, leaders in public transport and the police. Our study brings to light insights on the likely challenges that impede the use of preventive measures in public transportation use during an epidemic / pandemic like COVID-19 which could potentially escalate transmission. Focus should be put to the demystification of myths on COVID-19. Public transport passengers should be sensitized on risk of COVID-19 transmission during public transportation use and on the importance of complying with COVID-19 preventive measures. We recommend further exploration on the challenges faced by the public transportation passengers in implementing preventive measures in the event of an epidemic like COVID-19.
COVID-19 vaccine hesitancy among health workers in rural Uganda: A mixed methods study
(Science Direct-Elsevier, 2023-04-01) Ouni, Patrick Diox; Namulondo, Racheal; Wanume, Benon; Okia, David; Olupot Olupot, Peter; Nantale, Ritah; Matovu, Joseph K.B.; Napyo, Agnes; Lubaale, Yovani A. Moses; Nshakira, Nathan; Mukunya, David
COVID-19 vaccination is the latest preventive intervention strategy in an attempt to control the global pandemic. Its efficacy has come under scrutiny because of break through infections among the vaccinated and need for booster doses. Besides, although health workers were prioritized for COVID-19 vaccine in most countries, anecdotal evidence points to high levels of reluctance to take the vaccine among health workers. We assessed COVID-19 vaccine hesitancy among health workers in Dokolo district, northern Uganda. This was a mixed-method, cross-sectional descriptive study. A customised self-administered data collection tool was used to collect quantitative data on characteristics, vaccination status and factors for or rejection of vaccine uptake. We conducted multivariable logistic regression to assess the association between selected exposures and vaccine hesitancy using Stata version 15. Conversely, qualitative data were collected using key informant interviews (KIIs) among 15 participants that were purposively selected. Data were analysed using thematic content analysis with the help of NVivo 12.0.Of the 346 health workers enrolled, (13.3% [46/346]) were vaccine hesitant. Factors associated with vaccine hesitancy included fear of side effects (Adjusted Odds Ratio [AOR]: 2.55; 95% Confidence Interval [95%CI]: 1.00, 6.49) and health workers’ lack of trust in the information provided by health authorities (AOR: 6.74; 95% CI: 2.43, 18.72). Similar factors were associated with vaccine hesitancy when we used the vaccine hesitancy score. Fear of side effects, distrust in vaccine stakeholders, and lack of trust in the vaccine were barriers to COVID-19 vaccination among health workers. A small proportion of health workers were found to be hesitant to take the COVID-19 vaccine in this study. The paucity of COVID-19 vaccine safety information, which eroded the health workers’ trust in the information they received on the vaccine, was responsible for health workers hesitancy to take up the vaccine in Uganda.
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.
Decreased renal function among children born to women with obstructed labour in Eastern Uganda: a cohort study
(BMC Springer Nature, 2024-03-28) Mukunya, David; Oguttu, Faith; Nambozo, Brendah; Nantale, Ritah; Makoko, Brian Tonny; Napyo, Agnes; Tumuhamye, Josephine; Wani, Solomon; Auma, Prossy; Atim, Ketty; Nahurira, Doreck; Okello, Dedan; Wamulugwa, Joan; Ssegawa, Lawrence; Wandabwa, Julius; Kiguli, Sarah; Chebet, Martin; Musaba, Milton W.
Over two million children and adolescents suffer from chronic kidney disease globally. Early childhood insults such as birth asphyxia could be risk factors for chronic kidney disease in later life. Our study aimed to assess renal function among children aged two to four years, born to women with obstructed labour. We followed up 144 children aged two to four years, born to women with obstructed labor at Mbale regional referral hospital in Eastern Uganda. We used serum creatinine to calculate estimated glomerular filtration rate (eGFR) using the Schwartz formula. We defined decreased renal function as eGFR less than 90 ml/min/1.73m2 . The mean age of the children was 2.8 years, standard deviation (SD) of 0.4 years. Majority of the children were male (96/144: 66.7%). The mean umbilical lactate level at birth among the study participants was 8.9 mmol/L with a standard deviation (SD) of 5.0. eGFR of the children ranged from 55 to 163 ml/min/1.73m2 , mean 85.8±SD 15.9. Nearly one third of the children (45/144) had normal eGFR (>90 ml/Min/1.73m2 ), two thirds (97/144) had a mild decrease of eGFR (60–89 ml/Min/1.73m2 ), and only two children had a moderate decrease of eGFR (<60 ml/Min/1.73m2 ). Overall incidence of reduced eGFR was 68.8% [(99/144): 95% CI (60.6 to 75.9)]. We observed a high incidence of reduced renal function among children born to women with obstructed labour. We recommend routine follow up of children born to women with obstructed labour and add our voices to those calling for improved intra-partum and peripartum care.
Effect of COVID-19 lock down on teenage pregnancies in Northern Uganda: an interrupted time series analysis
(Springer Link, 2023-11-04) Alunyo, Jimmy Patrick; Mukunya, David; Napyo, Agnes; K. B. Matovu, Joseph; Okia, David; Benon, Wanume; Okello, Francis; Tuwa, Ally Hassan; Wenani, Daniel; Okibure, Ambrose; Omara, Godfrey; Olupot-Olupot, Peter
Pregnancy and childbirth complications are the leading cause of death among girls aged 15–19 years globally, with low- and middle-income countries (LMICs) accounting for 99% of global maternal deaths of women aged 15–49 years. Despite teenage pregnancies declining in many developing countries in recent years, the COVID-19 period intensified the problem and altered the trend for most countries. We determined the effect of the COVID-19 lockdown on the teenage pregnancy trend in Pakwach district, Uganda, to understand its magnitude in our study population. Using interrupted time series analysis (ITS), sometimes known as quasi-experimental time series analysis. We constructed a time series of the first ANC service utilization records for girls aged 10–19 years in Pakwach district, Uganda, and conducted an interrupted series analysis. We compared the two periods of March 2019 to March 2020 and March 2020 to March 2021. We used Stata 15 to conduct our analysis, performed OLS, and plotted the results. The teenage pregnancy trend before the lockdown was decreasing by − 0.203 pregnancies per month, but in the first month after the institution of the lockdown (March 20, 2020), there was an increase in the teenage pregnancy rate of 13.9 pregnancies [95% CI: − 33.6 to 61.5], which corresponds to an increase in the monthly trend in teenage pregnancies (relative to the period before the COVID-19 lockdown trend) of 1.53 girls per month. Teenage pregnancies increased during the lockdown. This slight increase depicted the impact of the pandemic on the teenage pregnancy trend associated with the COVID-19 outbreak. The government needs to focus on intervention to reduce this trend and avoid any further increases.
Factors associated with teenage pregnancies during the Covid-19 period in Pakwach district, Northern Uganda: a case-control study
(medRxiv preprint, 2023-09-14) Alunyo, Jimmy Patrick; Mukunya, David; Napyo, Agnes; Matovu, Joseph KB; Okia, David; Wanume, Benon; Okello, Francis; Tuwa, Ally Hassan; Wenani, Daniel; Okibure, Ambrose; Omara, Godfrey; Olupot-Olupot, Peter
Teenage pregnancy rates have globally decreased over the years, but remain high, especially in low- and middle-income countries (LMICs). Among girls aged 15-19, teenage pregnancy remains the leading cause of death and a significant barrier to education and productivity. Its prevalence underscores concern about the sexual and reproductive health of youth. However, limited data exist regarding factors contributing to its rise during the COVID19 pandemic in Uganda. This study explores the factors associated with teenage pregnancy in Pakwach district during this period. We conducted a matched case-control study, enrolling 362 teenage girls aged 10-19 years, divided into two groups: 181 pregnant teenagers and 181 not pregnant teenagers. We collected exposure data from both groups using questionnaires to evaluate factors associated with teenage pregnancy. The study period covered March 2020 to January 2021, coinciding with lockdown measures. During the COVID-19 lockdown, teenage pregnancies were only associated with having exclusively female peers (AOR 3.0, 95% CI: 0.1-104.4). Conversely, having a Radio/TV at home (AOR 0.2, 95% CI: 0.1-0.6), age at first sexual encounter (AOR 0.1, 95% CI: 0.03-0.9), considering teenage pregnancy as sexual abuse (AOR 0.1, 95% CI: 0.02-0.4), feeling comfortable asking questions during consultations (AOR 0.5, 95% CI: 0.2-1.3), and ensuring sufficient privacy during consultations were protective against teenage pregnancy. The factors contributing to increased teenage pregnancies during the COVID-19 pandemic were consistent with long-standing contextual factors associated with teenage pregnancy. The lockdown environment may have slightly exacerbated these factors, but no direct association was observed. Only having female peers was linked to teenage pregnancy during the lockdown. Conversely, having access to a radio/TV at home and other healthcare system-related factors offered protection. Therefore, interventions should prioritize providing comprehensive information on the risks of teenage pregnancy during any lockdown scenario.
High burden of neurodevelopmental delay among children born to women with obstructed labour in Eastern Uganda: a cohort study
(MDPI, 2023-02-16) Chebet, Martin; Musaba, Milton W.; Mukunya, David; Makoko, Brian; Napyo, Agnes; Nantale, Ritah; Auma, Proscovia; Atim, Ketty; Nahurira, Doreck; Lee, Seungwon; Okello, Dedan; Ssegawa, Lawrence; Bromley, Kieran; Burgoine, Kathy; Ndeezi, Grace; Tumwine K., James; Wandambwa, Julius; Kiguli, Sarah
Over 250 million infants in low and middle-income countries do not fulfill their neurodevelopment potential. In this study, we assessed the incidence and risk factors for neurodevelopmental delay (NDD) among children born following obstructed labor in Eastern Uganda. Between October 2021 and April 2022, we conducted a cohort study of 155 children (aged 25 to 44 months), born at term and assessed their neurodevelopment using the Malawi Developmental Assessment Tool. We assessed the gross motor, fine motor, language and social domains of neurodevelopment. The incidence of neurodevelopmental delay by 25 to 44 months was 67.7% (105/155) (95% CI: 59.8–75.0). Children belonging to the poorest wealth quintile had 83% higher risk of NDD compared to children belonging to the richest quintile (ARR (Adjusted Risk Ratio): 1.83; 95% CI (Confidence Interval): [1.13, 2.94]). Children fed the recommended meal diversity had 25% lower risk of neurodevelopmental delay compared to children who did not (ARR: 0.75; 95% CI: [0.60, 0.94]). Children who were exclusively breastfed for the first 6 months had 27% lower risk of neurodevelopmental delay compared to children who were not (ARR: 0.73; 95% CI: [0.56, 0.96]). We recommend that infants born following obstructed labor undergo neurodevelopmental delay screening.
"I thought I was going to die": experiences of COVID-19 patients managed at home in Uganda
(PLOS, 2023-12-12) Nakireka, Susan; Mukunya, David; Tumuhaise, Crescent; Olum, Ronald; Namulema, Edith; Napyo, Agnes; Serwanja, Quraish; Ingabire, Prossie Merab; Muyinda, Asad; Bongomin, Felix; Musaba, Milton; Mutaki, Vivian; Nantale, Ritah; Akunguru, Phillip; Ainembabazi, Rozen; Nomujuni, Derrick; Olwit, William; Nakawunde, Aisha; Nyiramugisha, Specioza; Pamela, Mwa Aol; Rujumba, Joseph; Munabi, Ian; Kiguli, Sarah
In Uganda, approximately 170,000 confirmed COVID-19 cases and 3,630 deaths have been reported as of January 2023. At the start of the second COVID-19 wave, the Ugandan health system was overwhelmed with a sudden increase in the number of COVID-19 patients who needed care, and the Ministry of Health resorted to home-based isolation and care for patients with mild to moderate disease. Before its rollout, the COVID-19 home-based care strategy had neither been piloted nor tested in Uganda. To explore the experiences of COVID-19 patients managed at home in Uganda. This was a qualitative study that was conducted to explore the lived experiences of COVID-19 patients managed at home. The study was carried out among patients who presented to three hospitals that were designated for treating COVID-19 patients in Uganda. COVID-19 patients diagnosed at these hospitals and managed at home were followed up and contacted for in-depth telephone interviews. The data were analysed using thematic content analysis with the aid of NVIVO 12.0.0 (QRS International, Cambridge, MA). Participants experienced feelings of fear and anxiety: fear of death, fear of losing jobs, fear of infecting loved ones and fear of adverse events such as loss of libido. Participants also reported feelings of loneliness, hopelessness and depression on top of the debilitating and sometimes worsening symptoms. In addition to conventional medicines, participants took various kinds of home remedies and herbal concoctions to alleviate their symptoms. Furthermore, COVID-19 care resulted in a high economic burden, which persisted after the COVID-19 illness. Stigma was a major theme reported by participants. Participants recommended that COVID-19 care should include counselling before testing and during and after the illness to combat the fear and stigma associated with the diagnosis. Another recommendation was that health workers should carry out home visits to patients undergoing home-based care and that COVID-19 treatment should be free of charge. COVID-19 home-based care was associated with fear, anxiety, loneliness, depression, economic loss and stigma. Policymakers should consider various home-based follow-up strategies and strengthen counselling of COVID-19 patients at all stages of care.
Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial
(BMC Springer Nature, 2023-04-18) Musaba, Milton W.; Nambozo, Brendah; Mukunya, David; Wandabwa, Julius; Barageine, Justus K.; Kiondo, Paul; Napyo, Agnes; Sserwanja, Quraish; Weeks, Andrew D; Tumwine, James K; Ndeezi, Grace
In high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths. This was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices. Perinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1–130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h.Maternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths.
Prevalence and predictors of delayed initiation of breastfeeding among postnatal women at a tertiary hospital in Eastern Uganda: a cross-sectional study
(Springer Link, 2023-04-14) Kusasira, Loyce; Mukunya, David; Obakiro, Samuel; Kenedy, Kiyimba; Rebecca, Nekaka; Ssenyonga, Lydia; Immaculate, Mbwali; Napyo, Agnes
The rates for the delayed initiation of breastfeeding in Uganda remain unacceptably high between 30% and 80%. The reasons for this are not well understood. We aimed to determine the prevalence and predictors for the delayed initiation of breastfeeding in Eastern Uganda. Methods This study employed a cross-sectional study design. A total of 404 mother-infant pairs were enrolled onto the study between July and November, 2020 at Mbale regional referral hospital (MRRH). They were interviewed on socio-demographic related, infant-related, labour and delivery characteristics using a structured questionnaire. We estimated adjusted odds ratios using multivariable logistic regression models. All variables with p<0.25 at the bivariate level were included in the initial model at the multivariate analysis. All variables with p<0.1 and those of biological or epidemiologic plausibility (from previous studies) were included in the second model. The variables with odds ratios greater than 1 were considered as risk factors; otherwise they were protective against the delayed initiation of breastfeeding. Results The rate of delayed initiation of breastfeeding was 70% (n=283/404, 95% CI: 65.3 – 74.4%). The factors that were associated with delayed initiation of breastfeeding were maternal charateristics including: being single (AOR=0.37; 95%CI: 0.19–0.74), receiving antenatal care for less than 3 times (AOR=1.85, 95%CI: 1.07–3.19) undergoing a caesarean section (AOR=2.07; 95%CI: 1.3–3.19) and having a difficult labour (AOR=2.05; 95%CI: 1.25–3.35). Infant characteristics included: having a health issue at birth (AOR=9.8; 95%CI: 2.94–32.98). Conclusions The proportion of infants that do not achieve early initiation of breastfeeding in this setting remains high. Women at high risk of delaying the initiation of breastfeeding include those who: deliver by caesarean section, do not receive antenatal care and have labour difficulties. Infants at risk of not achieving early initiation of breastfeeding include those that have a health issue at birth. We recommend increased support for women who undergo caesarean section in the early initiation of breastfeeding. Breastfeeding support can be initiated in the recovery room after caesarean delivery or in the operating theatre. The importance of antenatal care attendance should be emphasized during health education classes. Infants with any form of health issue at birth should particularly be given attention to ensure breastfeeding is initiated early.