Journal Articles (Health)
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Item Non-uptake of COVID-19 vaccines and reasons for non-uptake among healthcare workers in Uganda: a cross-sectional study(BioMed Central Ltd - Springer Nature, 2024-05-25) Kyakuwa, Nasimu; Abaasa, Andrew; Mpooya, Simon; Kalutte, Hamza; Atuhairwe, Christine; Perez, Laurent; Kikaire, BernardBackground Vaccines play a crucial role in eradicating and containing disease outbreaks. Therefore, understanding the reasons behind vaccine refusal and associated factors is essential for improving vaccine acceptance rates. Our objective was to examine the determinants of COVID-19 vaccine non-uptake and explore the reasons for non-uptake among healthcare workers (HCWs) in Uganda. Methods Between July and August 2021, we conducted a cross-sectional study among healthcare workers in primary healthcare facilities (private and government) in Entebbe Municipality, Uganda. Participants were recruited using convenience sampling, and consenting individuals received credentials to access an electronic database and complete a structured questionnaire. There were no established HCWs contact registers in the municipality, and the study was conducted during a national lock down, therefore, the HCWs who were on duty at the time of the study were approached. The survey questions were based on the ‘3Cs’ model of vaccine hesitancy and focused on confidence, convenience, and complacency factors. Non-uptake of vaccines was defined as not having received any of the available vaccines in the country. We employed counts, percentages, and simple logit models to summarize the reasons for non-uptake of COVID-19 vaccines and to identify associated factors. Results The study recruited 360 HCWs, 61.7% of whom were female, with an average age of 31 years (SD = 7.9). Among them, 124 (34.4%) healthcare workers did not receive any COVID-19 vaccine. Non-uptake of COVID-19 vaccines was independently associated with several factors, including age [35 + years adjusted odds ratio (aOR) = 0.30, 95% CI: 0.13–0.66 compared with 18–24 years], facility ownership [government, aOR = 0.22 (0.10–0.49) compared with private not-for-profit], previous testing for coronavirus [yes, aOR = 0.35 (0.19–0.65)], and previous involvement in COVID-19 vaccine activities [yes, aOR = 0.17 (0.10–0.29)]. The primary reasons cited for non-uptake of COVID-19 vaccines were related to a lack of confidence in the vaccines, such as concerns about side effects (79.8%) and the need for more time to understand the vaccines (89.5%), as well as the importance of weighing benefits and risks (84.7%) before being vaccinated. A smaller proportion, approximately 23%, cited reasons related to complacency and lack of convenience in accessing vaccination services. Conclusion The high proportion of non-uptake of COVID-19 vaccines among this population primarily stems from a lack of confidence and trust in the vaccines, coupled with insufficient time allowed for users to make informed decisions. This underscores the urgent need for ongoing monitoring and trend analysis of vaccine non-uptake to guide the development and implementation of strategies aimed at building and sustaining vaccine confidence. Adequate time should be allowed to explain benefits of vaccination to the population to allay fears that might exist before actual vaccination is rolled out.Item High uptake of COVID-19 vaccines among healthcare workers in urban Uganda(PLOS, 2024-04-16) Kyakuwa, Nasimu; Kimbugwe, Geofrey; Nakanjako, Flavia; Kalute, Hamza; Mpooya, Simon; Atuhairwe, Christine; Perez, Laurent; Kikaire, BernardObjectives The aim of the study was to describe the facilitators, barriers to and level of uptake of COVID-19 vaccines among healthcare workers in primary healthcare facilities in an urban setting in Uganda. Materials and methods We conducted a cross-sectional study among HCWs in private and public health facilities in Entebbe municipality between July 2021 and August 2021. Data was collected using a structured questionnaire that was shared, via an online link, to consented participants. Uptake of the vaccines among healthcare workers was analysed as proportions, and logistic regression was used to analyse barriers and facilitators to uptake of COVID-19 vaccines. Results The study enrolled 360 participants, with 61.7% (n = 222) females. A total of 236 (65.6%) healthcare workers had received at least one dose of COVID-19 vaccine, with higher uptake among females 64% (n = 151). Age above 40 years (OR 2.16), working in a government healthcare facility (OR 3.12), participating in COVID-19 vaccine related activities (OR 4.62), and having tested for SARS-COV-2 (OR 3.05) increased the odds of having been vaccinated. Working in small roadside clinics reduced the odds of being vaccinated by almost 70%, while HCWs in government health services were 3.1 times more likely to have been vaccinated. History of having cared for a COVID-19 patient and having a positive SARS-COV-2 test result did not influence the uptake of the vaccines in the study population. Conclusion Vaccine uptake among HCWs was close to the World Health Organisation (WHO) recommended uptake of 70% by mid-2022Item COVID-19 vaccine uptake and associated factors among individuals living in a peri-urban area in Uganda: a cross-sectional study(PubMed Central - Public Library of Science, 2024-11-04) Nanteza, Bridget Mary; Nanyonjo, Gertrude; Kyakuwa, Nasimu; Nakanjako, Flavia; Kalute, Hamza; Atuhairwe, Christine; Watera, Christine; Ssemwanga, DeogratiusIntroduction: The Corona virus disease (COVID-19) is a respiratory illness that is caused by SARS-CoV-2 virus. This virus was first reported in China in December 2019. It then spread to all countries and from March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In Uganda, the disease was first reported in March 2020 and COVID-19 vaccines became available by January 2021. Although COVID-19 vaccines were available in Uganda, uptake remained low. The aim of this study was to establish COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda. Methods: This was a cross-sectional study conducted among 127 men and 263 women who reside in Entebbe City, Uganda. Data was collected on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine using interviewer administered questionnaires. Uptake of COVID-19 vaccine was defined as the proportion of participants who had received at least one dose of the COVID-19 vaccine. We used descriptive statistics to estimate awareness of COVID-19 vaccines. The 'chi-square test' and 'modified Poisson regression' were used to assess variations in uptake of COVID-19 vaccines among respondents and their socio-demographics as well as other characteristics. Results: Ninety-nine percent (388 out of 390) of the study population were aware of at least one brand of COVID-19 vaccines in the country. Thirty-five percent (138 out of 390) knew that the vaccine immunity was achieved 14 days after the 2nd dose and 98.7% (385 out of 390) admitted that observing the standard operating procedure for COVID-19 infection prevention was necessary after vaccination. There was a gap in knowledge on vaccine safety reported by 74.6% (291 out of 390) participants. Some participants 37.2% (145 out of 390) had concerns about the vaccine. Of these, 57.9% (84 out of 145) believed that the vaccines were not helpful; and 30.3% (44 out of 145) feared serious side effects. Sixty-six percent (257 out of 390) believed that vaccines were not working and 79.0% (308 out of 390) admitted that vaccines were promoted for financial gain. At the time of performing the study, 36.2% and 22.3% had received the 1st and 2nd dose respectively. The main sources of information on COVID-19 vaccine were television (TV) and social media (p-value 0.001). In a multivariate model, COVID-19 vaccine acceptability was associated with salaried and self-employment (p-value 0.046). The other predicative factors were awareness of the COVID-19 vaccine (p-value <0.001) and having vaccine concerns (p-value 0.013). Conclusion: Uptake of COVID-19 vaccination in Entebbe community was low, partly attributed to knowledge gaps and concerns about vaccine safety and effectiveness. This highlights the need to enhance dissemination of information about COVID-19 vaccine. The lessons learnt in this study would be relevant for other emerging infections by informing vaccination implementation programs in similar settings.Item Determinants of Late HIV Diagnosis and Advanced HIV Disease Among People Living with HIV in Tanzania(Dovepress - Taylor & Francis, 2024-08-26) Bendera, Anderson; Baryomuntebe, Mugisha Deogratias; Uchechukwu, Nwanna Kevin; Nanyingi, Miisa; Kinengyere, Bemanya Patience; Mujeeb, Salaam; Sulle, Jachi EstherBackground: About half of people infected with Human Immunodeficiency Virus (HIV) often present late for care, resulting in higher healthcare costs, undesired treatment outcomes, and ongoing HIV transmission. This study aimed to assess the prevalence and determinants of late HIV diagnosis and advanced HIV disease (AHD) in Tanzania. Methods: Data were obtained from the 2016-17 Tanzania HIV impact survey. We included 677 newly diagnosed people living with HIV. Late HIV diagnosis and AHD were defined as having a CD4 cell count below 350 cells/µL or 200 cells/µL at diagnosis, respectively. Bivariate and multivariable logistic regression models were fitted to identify the determinants of late HIV diagnosis or AHD. Results: The mean age of the participants was 37.8 years (SD, 12.4). About two-thirds were women (62.6%). The prevalence of late HIV diagnosis was 42.4%, whereas the prevalence of AHD was 17.7%. Factors associated with late HIV diagnosis included age 31-40 years (adjusted odds ratio [aOR] = 1.72, 95% confidence interval [CI]: 1.14-2.60), age ≥41 years (aOR = 1.79, 95% CI: 1.16-2.76), male sex (aOR = 1.88, 95% CI: 1.29-2.73), and active syphilis infection (aOR=2.63, 95% CI: 1.20-5.76). Factors associated with AHD were age 31-40 years (aOR = 2.12, 95% CI: 1.18-3.81), age ≥41 years (aOR = 2.42, 95% CI: 1.32-4.41), male sex (aOR = 1.77, 95% CI: 1.09-2.87), formal education (aOR = 0.49, 95% CI: 0.30-0.81) and active syphilis infection (aOR = 2.49, 95% CI: 1.07-5.77). Conclusion: Late HIV diagnosis and AHD are prevalent among newly diagnosed people living with HIV in Tanzania. Specific subgroups are more likely to present late for HIV care, including middle-aged and older adults, men, illiterate individuals, and those with active syphilis and HIV co-infection. Therefore, we recommend expanding HIV testing services and implementing targeted interventions to improve early access and enrollment in HIV care.Item Experiences of mothers receiving male midwives’ assistance during childbirth in Kween District, Uganda(African Journal Online - Womens's Health and Action Research Centre (WHARC), 2024) Soyekwo, S. Wilfred; Tumuhaise, Criscent; Ndibazza, JulietThis study explored the perceptions and experiences of mothers who were cared for by male midwives (MMWs) during delivery in Kween District. The study utilized a qualitative phenomenological approach to document responses of participants. Data was collected from three health facilities that had male midwives delivering mothers at the time of the study, and targeted postnatal mothers 18-49 years who had been delivered by a MMW in the last 6 months. Thirty-three mothers participated in the study: 15 in individual in-depth interviews and 18 in three focused group discussions. Collected data were transcribed in word, coded in excel and exported to Atlas.t 7 for analysis. Thematic and content analysis were utilized to derive insights from the data collected. The results showed that perceptions varied significantly across participants. Respondents attached certain beliefs and perceptions that the delivery process is an intimate matter that should only be handled by fellow women. Fear and discomfort when touched by a MMW and discomfort by mothers’ partners, came out as strong viewpoints. However, there were strong experiences that MMWs demonstrated supportive, caring, respectful, sympathetic and passionate provision of care. These findings agree with several other studies reviewed during the study. Comprehensive sensitization focused on promoting the utilization of skilled birth attendants regardless of gender is necessary in reducing maternal mortality.Item Coverage of child disability detection, management, and rehabilitation health services in Central Uganda(The East African Health Research Commission, 2024-06-24) Akankwasa, Edith; Kamya, Willy; Sendijja, Moses; Mudoola, Janet; Lwenge, Mathias; Onzima, Anguyo DDM Robert; Katongole, Simon-PeterChild disability is a significant public health concern which impacts 1 in 20 children. Children with disabilities (CwDs) encounter deprivation of rights, biases in society, and a lack of access to necessary services, all of which are exacerbated by structural obstacles. This study assessed the coverage of child disability prevention, management and rehabilitation services in four districts of Central Uganda after two years of interventions to improve these services. The Lot Quality Assurance Sampling (LQAS) rapid health facility assessment method was employed to assess coverage of services based on sixteen indicators. The indicators were set based on constructs of: provision of disability-related services to CwDs; use of rehabilitation services; readiness of the health facilities (HFs) to provide basic disability management and rehabilitation services; community structures for linkage to disability management and rehabilitation services; psychosocial support provision; and upholding and protecting the rights of CwDs. A district-level decision rule was set based on 80% coverage target. Despite the interventions, the services have yet to provide the desired level of benefit to CwDs and their caregivers. Out of the sixteen indicators for healthcare service coverage for CwDs, only three attained the 80% coverage target. The findings suggest that greater focus by health service planners and project implementers is still needed, especially at the community and health facility levels to enhance the prevention, management and rehabilitation of CwDs. Psychosocial health services for caregivers of CwDs need special attention in order to achieve better service approaches.Item Determinants of hospital delivery among mothers attending post-natal mother-baby clinic services from January to August 2020: a cross-sectional study of Busia, Uganda(Taylor and Francis (Informa UK), 2025-06-11) Omona, Kizito; Ojok, Ritara, VincentIt is estimated that hospital delivery could reduce 16%–33% of maternal deaths. Despite the importance of delivering at health institutions, in many countries, mothers still prefer to give birth at home. The aim was to ascertain the determinants of hospital delivery among mothers attending post-natal mother-baby clinic services in Busia district. We used analytical cross-sectional design, with mixed method approach. A sample of 385respondent mothers were interviewed using semi-structured questionnaires. Two Focus Group Discussions (FGD) were held with mothers. Hospital delivery was at 82.6%, with most mothers delivering from government hospitals (50.9%) and private hospitals. Place of residence of mothers was associated with Hospital Delivery (X2 (1) = 1.515, p < 0.002). Mothers who lived in urban settings were 2.7times more likely to deliver from health facilities than mothers who lived in rural settings [cPR = 2.686, 95% CI (0.394–1.194)]. Husband’s educational level was a determinant of Hospital Delivery (X2 (3) = 2.054, p < 0.006). Mothers whose husbands had primary education, secondary education and tertiary education were 2.2 times, 1.5 times and 1.3 times more odd of delivering from health facility respectively. Hospital delivery in Busia was acceptably high. Women’s decision power enormously contributes to the choice of place of delivery.Item Effects of school closures in COVID-19 era: evidence from Uganda Martyrs University(Simon Fraser University, 2021-07-28) Omona, KizitoAs 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.Item 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 poorItem 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 LivingstoneHealth 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.Item 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, PonsianoFailure 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.Item 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, PonsianoDespite 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.Item 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, GraceIn 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.Item 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.Item 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 KasedeMalaria 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.Item 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, PeterTeenage 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.Item 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, KenedyThe 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.Item 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, AlexCommunity 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.Item “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, SimpleBackground: 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.Item 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 KBPublic 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.