Journal Articles (Health)

Permanent URI for this collectionhttp://hdl.handle.net/20.500.12280/235

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Effects of school closures in COVID-19 era: evidence from Uganda Martyrs University
(Simon Fraser University, 2021-07-28) Omona, Kizito
As of March 1st, 2020, many governments embarked on nationwide school closures due to the deadly coronavirus pandemic. As the month of March came to an end, about 185 countries across the globe had closed their schools. This affected about 90% of the world’s students and Africa was significantly hit by this closure. The speed of these closures and the rapid move to distance learning gave very little time for planning or any other alternative form of learning. In Uganda, the education of 15 million children and students was disrupted. Learners had to spend the majority of their time at home playing, helping their parents with chores, engaging in agriculture and also spare some hours a day to study. The education of learners was impacted greatly. In urban areas, some learners relied on lessons available online, televisions and radios, while in rural areas, learners had to fall back on their notebooks and printed learning materials provided by the government. The objective of this study was to ascertain the effects of school closure on different stakeholders. A qualitative phenomenological study was carried out. A sample of eight lecturers, eight students, four administrators and four community members were purposively recruited for the study. The results show that the impact of the closures on teachers resulted in: (1) leaving the teaching profession, and (2) financial distress. On the part of learners, the effect was a disruption of learning. Schooling provides essential learning and when schools closed, learners were deprived of opportunities for growth and development. The disadvantage of the disruption was disproportionate for under-privileged learners who tend to have fewer educational opportunities, apart from being in schools. Undoing the effects of learning disruption may require years in Uganda.
Assessment of the accuracy of malaria microscopy in private health facilities in Entebbe Municipality, Uganda: a cross-sectional study
(BMC Springer Nature, 2021-06-06) Mutabazi, Tobius; Arinaitwe, Emmanuel; Ndyabakira, Alex; Sendaula, Emmanuel; Kakeeto, Alex; Okimat, Paul; Orishaba, Philip; Katongole, Simon Peter; Mpimbaza, Arthur; Byakika‑Kibwika, Pauline; Karamagi, Charles; Nakayaga Kalyango, Joan; Kamya, Moses R.; Dorsey, Grant; Nankabirwa, Joaniter I.
Although microscopy remains the gold standard for malaria diagnosis, little is known about its accu‑ racy in the private health facilities in Uganda. This study evaluated the accuracy of malaria microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda. Between April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility-based smear results were recorded from the participant’s consultation notes, and a research slide was obtained for expert microscopy during exit interview. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant’s clinic visit. The test positivity rate of malaria parasitaemia was 15.0% by expert microscopy. The sensitivity, specifc‑ ity and negative predictive value of the facility-based microscopy were high (95.8%, 90.1 and 99.2%, respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; (1) who had less than 5 years’ experience in reading malaria smears (adjusted Odds Ratio [aOR]=9.74, 95% confdence interval [CI] (1.06–89.5), p-value=0.04), and (2) who was examining less than 5 smears a day (aOR=38.8, 95% CI 9.65–156, p-value<0.001). The accuracy of malaria microscopy in this setting was high, although one third of the patients diag‑ nosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In-service training may be sufcient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector where accuracy is still poor
Factors associated with retention of health workers in remote public health centers in Northern Uganda: a cross-sectional study
(BMC Springer Nature, 2023-10-17) Twineamatsiko, Andrew; Mugenyi, Nathan; Kuteesa, Yvonne Nabachwa; Ejalu, David Livingstone
Health worker retention in remote and hard-to-reach areas remains a threat in most low- and middleincome countries, and this negatively impacts health service delivery. The health workforce inequity is catastrophic for countries like Uganda that still has a low health worker to patient ratio, and remote areas like Lira District that is still recovering from a long-term civil war. This study explores factors associated with retention of health workers in remote public health centers in Lira district in Northern Uganda. A descriptive cross-sectional study with quantitative methods of data collection was used among health workers namely; doctors, clinical ofcers, nurses, midwives, pharmacists and, laboratory technicians. The study utilized a structured questionnaire with closed ended questions to obtain quantitative information. Most of the respondents were females (62.90%), married (84.62%), with certifcate level (55.74%), and nurses as qualifcation (36.60%) as well as attached to Health Center 3 level (61.28%). Signifcant individual factors associated with retention included having a certifcate as highest level of education, staying with family, and working at facility for 6 or more years. The health system factors were good physical state of facility, equipment availability, availability of sundries, feeling comfortable with rotations, receiving adequate support from staf, feeling valued and respected by colleagues at workplace and access to incentives while career factors were job satisfaction, job motivation, promotion, and further training on scholarship. The study established that indeed several individual and social demographics, health system and careerrelated factors are signifcantly associated with retention of Health workers in the rural public health facilities and these are critical policy recommendations for establishing retention guidelines in a national human resources for health manual.
Antiviral use among hepatitis B infected patients in a low resource setting in Africa: a case study of West Nile, Uganda
(PubMed, 2023-06) Seremba, Emmanuel; Wandera, Claude; Ssekitoleko, Richard; Nankya-Mutyoba, Joan; Nyeko, Filbert; Amandua, Jacinto; Ejalu, David; Omale, William; Ocama, Ponsiano
Failure to access antiviral medications is a leading cause of hepatitis B (HBV)-associated morbidity and mortality in sub-Saharan Africa (SSA). Despite guideline availability, SSA is not on course to meet its elimination targets. We characterized factors associated with antiviral medication use and challenges to offering chronic care in a large Ugandan institution. We abstracted HBV care data. 2,175/2,209 (98.5%) had HBV-infection. Most participants were men [1,197 (55%)]; median (IQR) age 27 years (19-35); 388/1689 (23.0%) had cirrhosis by sonography and 141/2175 (6.5%) by the aspartate aminotransferase to platelet ratio index (APRI) score ≥2. Of the eligible, 20/141 (14.2%) with APRI score ≥2 and 24/388 (6.2%) with sonographic evidence of liver cirrhosis were not on antiviral medications. Overall, 1,106 (51%) were on medications though 65.8% had not been fully investigated. In multivariate analysis, age ≥35 years [OR (95% CI) = 1.52 (1.01-2.28), p=0.043], APRI ≥2 [OR (95% CI) =1.79 (1.48- 2.16), p<0.001], hepatitis B viral load >2,000IU/mL [OR (95% CI) = 6.22 (5.08-7.62), p<0.001] were associated with antiviral medications use. Over half of participants in care had not been fully evaluated although on treatment and many eligible patients did not access medications. There is need to bridge these gaps for SSA to realise its HBV elimination goals.
Feasibility and acceptability of integrating hepatitis B care into routine HIV services: a qualitative study among health care providers and patients in West Nile region, Uganda
(BMC Springer Nature, 2023-01-20) Mutyoba, Joan Nankya; Wandera, Claude; Ejalu, David; Seremba, Emmanuel; Beyagira, Rachel; Amandua, Jacinto; Mugagga, Kaggwa; Kambugu, Andrew; Muganzi, Alex; Easterbrook, Philippa; Ocama, Ponsiano
Despite facing a dual burden of HBV and HIV, Africa lacks experience in ofering integrated care for HIV and HBV. To contextualize individual and group-level feasibility and acceptability of an integrated HIV/HBV care model, we explored perspectives of health care providers and care recipients on feasibility and acceptability of integration. In two regional hospitals of West Nile region, we performed a demonstration project to assess feasibility and acceptability of merging the care of HBV-monoinfected patients with existing HIV care system. Using interviews with health care providers as key informants, and 6 focus groups discussions with 3 groups of patients, we explored feasibility [(i)whether integration is perceived to ft within the existing healthcare infrastructure, (ii) perceived ease of implementation of HIV/HBV integrated care, and (iii) perceived sustainability of integration] and acceptability [whether the HIV/HBV care model is perceived as (i) suitable, (ii) satisfying and attractive (iii) there is perceived demand, need and intention to recommend its use]. We audio-recorded the interviews and data was analysed using framework analysis. The following themes emerged from the data (i) integrating HBV into HIV care is perceived to be feasible, ft and benefcial, after making requisite adjustments (ii) integration is acceptable due to the need for both free treatment and anticipated collaboration between HIV and HBV clients in terms of peer-support (iii) there are concerns about the likely rise in stigma and the lack of community awareness about integrated care. The integrated HIV/HBV care model is feasible and acceptable among both providers and recipients. Necessary adjustments to the existing care system, including training, for community sensitization on the reasons and signifcance of integration are required.
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.
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.
Malaria prevalence and associated risk factors among Batwa indigenous people of Kanungu District in Southwestern Uganda: does “place” matter?
(Scientific Research Publishing, 2023-07-27) Namanya, Didacus B.; Bikaitwoha, Everd M.; Berrang-Ford, Lea; Kiconco, Arthur; Napyo, Agnes Kasede
Malaria is an important disease, causing high morbidity and mortality, especially in Sub-Saharan Africa. Measuring malaria prevalence using malaria rapid diagnostic tests (mRDTs), particularly among a vulnerable population sub-group, is a vital public health step in discovering effective methods of prevention and control. This study set out to examine the association between “place” and other risk factors with malaria prevalence among Batwa Indigenous People (IP). An analytical cross-sectional study design was implemented. Two surveys January 2014 (n = 572) and April 2014 (n = 541) involving interviews and testing for malaria using mRDTs were conducted in 10 Batwa settlements where a total of 1113 Batwa of all ages were surveyed and tested. The data were first compiled in MS Excel and then imported and analyzed using STATA ver.14. Descriptive statistics, were generated, followed by bivariable and multivariable regression model analysis to establish associations between the predictor and outcome variables with p ≤ 0.05 considered statistically significant. Overall prevalence was 13.94% (n = 146). There is a significant relationship between settlement (place) and malaria prevalence AOR 11.7, 95% CI (1.38 - 98.93), p-value = 0.02. More males 16.97% (n = 84) tested positive compared to females 11.23% (n = 62) but there was no statistically significant association between gender and mRDT (p-value > 0.005). Children less than 5 years registered high prevalence and there was a significant relationship between age and mRDT (p-value ≤ 0.005). Wealth proxy indicators showed no association with prevalence p-value = 0.390. Season had no association with prevalence (p-value = 0.80). However, the proportion of the day spent in the forest/woodlands was significantly associated with malaria prevalence COR 12.83, 95% CI (1.14 - 143.73) p-value = 0.04. Low elevation was significantly associated with malaria prevalence COR 2.42, 95% CI (1.32 - 4.41), p = 0.004 but sleeping under a net and level of education did not show any association with malaria prevalence. This study highlights the importance of place in predicting malaria prevalence among Batwa Indigenous People a marginalized and remortely located sub-population. This study has shown that place matters in determining malaria prevalence. However, other factors like age, elevation and gender also contribute to malaria prevalence. Batwa have higher prevalence than the national and even non-indigenous populations in the same district. We recommend targeting hotspots intervention approach since it has proven reasonable impact on reducing malaria prevalence.
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.
A qualitative exploration of the psychosocial factors affecting antiretroviral therapy adherence among HIV infected young adults in Eastern Uganda
(medRxiv preprint, 2023-02-07) Twekambe, Easton; Epuitai, Joshua; Kawala, Enid Kagoya; Namanya, Vian; Ayikobua, Emmanuel Tiyo; Obakiro, Samuel Baker; Napyo, Agnes; Kiyimba, Kenedy
The use of anti-retroviral therapy (ART) in management and prevention of HIV/AIDS epidemic is a globally accepted strategy. In Uganda, despite the efforts to increase uptake of ART, adherence remains a huge challenge. This study, therefore, was conducted to explore psychosocial factors which influenced non-adherence to ART among young adults in Eastern Uganda. This was an exploratory qualitative study conducted at the ART clinic of Mbale Regional Referral Hospital. A total of in-depth interviews with young adults who had defaulted from taking ART drugs were conducted. Also, five key-informant interviews were conducted among the healthcare workers in the hospital. Thematic analysis approach was followed to analyze the data using NVIVO software (version 11). Non-adherence to ART was perceived to result from poor social support, poor coping mechanisms, unpredictable and busy work schedules, poverty, incompatible religious beliefs and practices. The poor social support factors included poor caregiver support, non-disclosure of HIV status, stigma and discrimination while factors linked to poor coping mechanisms included alcohol and substance abuse, psychosocial stress, depression, forgetfulness and feelings of self-hatred. Poverty limits access to treatment and basic needs including transportation to health facilities. Long waiting time at the ART clinic was the healthcare system factor which was thought to cause non-adherence among young adults Non-adherence to ART at Mbale Regional Referral Hospital in Eastern Uganda is attributed to various psychosocial factors such as stigma and discrimination, mental health problems, work related problems and low socio-economic status, religious beliefs and poor knowledge, long waiting time in ART clinic and poor family support. Psychosocial counselling should therefore target the perceived causes of ART non-adherence so as to improve the adherence /compliance to ART.
Barriers to enrolment of clients into community client led anti-retroviral therapy delivery (CCLAD) in selected health facilities in Kasese District, Uganda
(African Journals Online (AJOL), 2024-04-08) Omona, Kizito; Bwogi Kanyerezi, Alex
Community Client Led Anti-retroviral therapy Delivery (CCLAD) Model has been associated with increased community participation and ownership, which leads to better treatment outcomes with reduced workload and increased client satisfaction of health services. To explore the barriers to enrolment of eligible clients into CCLAD in selected health facilities in Kasese District, Uganda. Analytical cross-sectional study utilizing mixed method approach was conducted among 384 PLWHIV attending public health facilities of Kasese District. Sampling was done by simple random sampling method. Data was collected using researcher-administered questionnaire method and interview guide. Most of the respondents 253(65.9%) had not yet enrolled into CCLAD. This was due to some client-related factors such as non-disclosure of HIV sero-status (p=0.040), person to whom HIV sero-status was disclosed to (p=0.009), not having ever heard about CCLAD (p=0.000), incorrect description of CCLAD (p=0.000), limited knowledge of advantages of CCLAD (p=0.000) or disadvantages of CCLAD (p=0.003). Other barriers were; failure to have access to organizations or groups that support PLWHIV to get treatment (p=0.025) and duration of ART refills [AOR=1.637, 95% CI (0.820 – 3.270)]. Adoption of CCLAD model among PLWHIV in Kasese District is still low.
“I use strawberry flavoured condoms during my periods”: safe sex practices and STI screening behaviours among female sex workers in Gulu City, Uganda
(M|DPI, 2023-08-28) Bongomin, Felix; Kibone, Winnie; Pebolo, Pebalo Francis; Laker, Fiona Gladys; Okot, Jerom; Ocaka Kaducu, Felix; Madraa, Grace; Labongo Loum, Constantine Steven; Awor, Silvia; Napyo, Agnes; Musoke, David; Ouma, Simple
Background: Female sex workers (FSWs) are at a higher risk of contracting and transmitting HIV and other sexually transmitted infections (STIs). We aimed to explore the sexual behaviour, knowledge and attitudes towards STIs, barriers, support and intervention for STI screening. Methods: In this community-based, concurrent quantitative–qualitative, exploratory mixed-methods study, we administered 87 semi-structured quantitative and six in-depth interviews to purposively select FSWs in Gulu City, Uganda. The qualitative methodology was based on descriptive phenomenology. Results: The quantitative study included 87 FSWs, with a median age of 28 years. Overall, 87.4% (n = 76) participants reported condom use during their last sexual encounter. Eighty-three (95.4%) participants were aware of their HIV status, with 6% (n = 5) reporting being HIV-positive. Seventy-six (87.4%) participants reported contracting at least one STI during sex work. In addition, 66.7% (n = 58) of the participants reported being screened for STIs in the past three months, with vulvovaginal candidiasis (55.3%, n = 42) and syphilis (32.9%, n = 25) being the most common STIs. However, only 2.3% (n = 2) of the participants reported current STIs symptoms. In the qualitative study, the main themes encompassed sexual behaviour, including condom-use negotiation strategies and challenges, as well as screening facilitators and barriers. Condom-use negotiation tactics involved leveraging health-risk information, increased charges for unprotected sex, and outright refusal. Complex challenges included limited agency in promoting safe sex due to economic reliance, vulnerability to violence, and difficulties in controlling the sexual environment. Facilitators for regular screening included social influences, emotional relief, established testing habits, and accessible clinics, while barriers encompassed cost, stigma, doubts about test accuracy, and inconvenient clinic hours. Conclusions: FSWs face significant vulnerabilities in Gulu City, Uganda, regarding STIs. While encouraging trends such as high HIV awareness and condom usage were observed, persistent challenges in STI screening, negotiation of safe sex practices, and access to prevention and treatment remain evident. To address these concerns, targeted interventions should be developed to enhance STI screening accessibility, empower sex workers with effective negotiation skills, and provide comprehensive support for STI prevention and treatment, thereby contributing to improved overall sexual health and well-being among this marginalized population.
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.
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.
"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.
Rethinking the security-development nexus in the context of human security
(Everant Publishers Ltd, 2023-05-07) Asiimwe Muchwa, Solomon
This paper sought to reshape the discourse on the security-development nexus. The paper indicts the former discourse that is based on the traditional conceptualization of security and development and demonstrates the extent to which such a discourse is intellectually bereft in achieving security and development. In that sense, the paper undergirds the new discourse presented in this paper on the security-development nexus with the concepts of human security and human development, and their interactions and mutual effects and influences. It is anchored on the conviction that since a discussion of security and development makes better sense if it is focused on the individual, the nexus of security and development should also be brought to the level of the individual; hence, this paper discusses the human security-human development nexus.
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.
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.
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.
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.

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