Theses & Dissertations

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Adherence to Benzathine Prophylaxis Among Rheumatic Fever and Rheumatic Heart Disease Patients Attending Outpatient Clinic at Lira Regional Referral Hospital
(Lira University, 2022) Atala, Jenifer; Omech, Bernard; Obura, Bonniface
Background:Secondary prevention of Rheumatic fever and Rheumatic Heart Disease with 3-4 weekly Benzathine prophylaxis is the most effective strategy in preventing disease progression and complications. Efficacy of this regimen is dependent on its rational use. However, adherence to Benzathine prophylaxis worldwide is suboptimal. Magnitude and impact of poor adherence is higher in developing countries. Methods: A retrospective cohort study design using mixed methods was done. To acquire information on adherence to monthly BPG injections, the quantitative component involved a retrospective chart review of secondary data extracted from the Lira RHD Registry. The primary information was qualitative, obtained from key informant and in-depth interviews with RHD patients, care givers, and healthcare professionals respectively. Utilizing a logistic regression model, data was evaluated. Predictors that were at alpha=0.2 were considered significant at bivariate analysis and submitted to multivariate analysis. A significant threshold was set at 0.05 and 95% confidence interval. Thematic analysis using both inductive and deductive coding was used to analyze qualitative data. Results: Overall, 57.8% (89/154) of patients adhered to their benzathine prophylactic regimen. Majority of participants had at least primary education (84/153). Those with tertiary education were 2.6 times more likely to adhere to Benzathine penicillin prophylaxis. (AOR 2.69, 95% CI: 1.00-7.3, P value 0.049). Demand side factors associated with adherence included logistics involved, suboptimal communication, patient related factors and condition related factors whereas supply side factors included medicine stockout, human resource related challenges, costs involved and poor provider client relationship. Conclusion: Adherence was sub-optimal. To address some of the issues impacting adherence to BPG prophylaxis among these patients, it is necessary to address the demand side and supply side factors associated with adherence to BPG, such as training of healthcare professionals and strengthening the sensitization and health education of patients and their caregivers on the need for the monthly BPG injections in relation to their condition.
Uptake of Integrated Community Case Management and Associated Factors Among Caregivers of Children Under Five Years in Apac District
(Lira University, 2022) Eluk, Job; Omech, Bernard; Akello, Anne Ruth
Background: Globally, child mortality remains a public health concern with 38 deaths per 1000 live births and accounting for 5.2 million deaths in children under 5 years, with Sub-Saharan Africa region having the highest figure of 76 deaths per 1,000 live births that is equivalent to one child in 13 dying before reaching age five in 2019. In Uganda, the child mortality rate has reduced gradually from 191 deaths per 1000 live births to 45.8 deaths per 1000 live births in 2019. Objective: To determine the Uptake of integrated community case management of childhood illnesses and associated factors among caregivers of children under five years in Apac district. Methods: This was a cross-sectional study using quantitative methods, 403 family caregivers of children under five in Apac District. Data was collected using a semi-structured questionnaire on Uptake, associated factors, and perceptions of caregivers towards ICCM services. Data was analyzed using STATA version 15.1. Results: The majority of the caregivers were female 337 (83.6%), with a mean age of 27.7 years and standard deviation of 6.64 years, attained primary education, 253(62.8%), Christians, 393 (97.5%), and married 346 (85.9%) were married. The level of Uptake of ICCM services was 38.7% (156/403). Results of the study indicate that the child’s illness (p=0.01, AOR=3.5(2.1-7.2), knowledge of ICCM (P<0.01, AOR12.1 (1.7-87), timely services (p<0.001, AOR (12.7(3.4-47), and referral by VHT (P<0.01, AOR 4.0(1.4-11.0). were statistically significant. Conclusion: The Uptake level of ICCM services provided by the VHTs was low, though caregivers had a good perception of ICCM services and child referral to health facilities by VHT. To improve Uptake of ICCM services, there is a need to provide more information regarding ICCM within the community.
Knowledge, Attitude and Practices on Water, Sanitation and Hygiene among the Community in Lira District
(Lira University, 2022) Akullu, Milly Grace; Akech, Stella Immaculate; Kigongo, Eustes
Background: In Uganda, more than half of the households use unimproved sanitation facilities, with only 19% of the households owning improved facilities, leading to the prevalence of sanitation-related diseases among the general population. The Government of Uganda has implemented community-led total sanitation by engaging the community in sustaining their own sanitation. The study assessed the knowledge, attitudes and practices among the community regarding WASH following the implementation of the CLTS program in Lira District. Methods: The study employed a cross-sectional design. Data was collected from 528 respondents using a close-ended questionnaires and analyzed using STATA version 17 at univariate, bivariate, and multivariate levels. Results: According to the study, the majority of the respondents (181;35.6%) were between the ages of 18 and 30, male (305;57.9%), and had a primary education (371;70.1%). The study also found out that earning between 50,000 and 100,000 Ugandan shillings (AOR=0.39, CI: 0.19-0.83), not knowing ways of preventing water borne diseases (AOR=0.29, CI: 0.14-0.61), not feeling the importance of having hand washing facilities (AOR=0.14, CI: 0.06-0.36) and not having a tippy tap (AOR=0.33, CI: 0.17-0.66) were associated with poor wash practices. Conclusion: Therefore, the researcher concluded that the WASH practices of community members were suboptimal and below the MOH target of the appropriate hygiene practice of WASH. Recommendations: Through this finding, better interventions and policies to reduce the burden of WASH related diseases be intensified, and also there is a need to intensify sensitization on water-related diseases and prevention, as well as enforce the installation, use and sustainability of hand washing facilities among the community in Lira District. Key words: Knowledge, Attitude, Practices on Water, Sanitation and Hygiene
Factors associated with HIV Virological non-suppression among adults receiving Anti-Retroviral Therapy at Lira Regional Referral Hospital, Northern Uganda
(Lira University, 2022) Niyongira, Joseph Nturo; Opollo, Marc Sam
Background: By 2030, all adults with HIV will have been dragonized, will be receiving Antiretroviral Therapy (ART), and will have achieved viral load suppression. These goals form the global effort to stop new HIV infections, increase treatment coverage, and end aids-related deaths. This study investigated the variables that affect HIV RNA viral load suppression among adults living with HIV at Lira Regional Referral Hospital in Uganda. Methods: For this mixed-methods study, data was collected using a data extraction form, a semi structured questionnaire, and a key informant interview guide. STATA 17 was used to analyze the quantitative data, and the thematic method was used to analyze the qualitative data. The results were presented in charts, tables, and themes for quantitative data and qualitative data respectively. Results: Of the 425 respondents, 235 (55.3%) were female and 190 (44.7%) were male. The majority, 208 (48.9%) were between the ages of 31 and 40. Of those, 238 (56%) had at least primary education, and 264 (62.1%) were married. The prevalence of HIV RNA viral non suppression was at 8.5% among adults living with HIV and 91.5% were HIN RNA virologically suppressed. Recent cd4 counts, baseline viral load, and WHO clinical stage were significantly associated with HIV RNA virological suppression. In addition to that, adherence (a OR=1.00, 95% CI: 0.004-0.07, P=0.001) was associated with HIV RNA virological non-suppression. Qualitatively, results revealed that status disclosure is always done by close relatives of the victims, stigma, and discrimination were not common in the community. Conclusion: There is a need for strategies on how to promote drug adherence among adults living with HIV rather than just providing the treatment, as viral load suppression is related to baseline viral load, CD4, marital status, and drug adherence. In this study, monitoring the immunological response through scheduled CD4 and viral load tests is critical for maintaining patients’ immunity and preventing disease progression. Intensive adherence support and counselling should conclusively be provided through the effective implementation of ART programs by providers to enhance viral suppression and ensure the quality of care and treatment. Keywords: Non-Suppression, Adults Living with HIV, and Antiretroviral Therapy
Partograph Documentation: Barriers and Faciltators Among Skilled Health Personnel in Lamwo District, Northern Uganda
(Lira University, 2022) Lokwang, Paul Pax; Udho, Samson; Auma, Anna Grace
Background: Appropriate use of partograph is significantly associated with improved maternal and neonatal outcomes of labour and that is why the World Health Organization recommends its universal use during labour. However, the extent of partograph documentation and the barriers and facilitators to partograph documentation by skilled health personnel in Lamwo district is not well documented. This study aimed to assess the level of partograph documentation and explore the barriers and facilitators to partograph documentation by skilled health personnel in Lamwo district, northern Uganda. Methods: This was a parallel convergent mixed methods study conducted in 10 purposively sampled health facilities in Lamwo district. We retrospectively reviewed 328 randomly sampled partographs and conducted 18 key informant interviews and 8 Focused Group Discussions with purposively sampled skilled health personnel. The partographs were reviewed using a checklist while FGD and KII guides were used for FGDs and KIIs respectively. Quantitative data were analysed descriptively while qualitative data were analyzed thematically. Results: The overall documentation of partograph according to the WHO recommended standard was at 54.3% while maternal and fetal components of the partograph were documented at 58% and 95% respectively. The identified barriers to standard partograph documentation were heavy workload, lack of knowledge and skills, negative attitude, lack of equipment and supplies, and negative perception. The identified facilitators were being knowledgeable and skilled, adequate human resource, availability of equipment, supportive supervision, and a positive attitude. Conclusion: Standard partograph documentation by skilled health personnel in Lamwo district is still suboptimal owed to various factors. The ministry of Health and supporting partners should create an enabling environment and build capacity of skilled health personnel to strengthen Partograph documentation in the district.
Risk Factors for Maternal Anemia Among Women Attending Antenatal Care in Moroto Regional Referral Hospital. Case-Control Study
(Lira University, 2022) Emina, Godfrey; Omech, Bernard; Puleh, Sean Steven
Background: Maternal Anemia remains a significant public health problem mainly because of its association with poor maternal and fetal outcomes. The study aimed o to assess the association between risk factors and maternal anemia among women attending antenatal care at Moroto Regional Referral Hospital. Methods: A case-control study was conducted among 100 (50 cases and 50 controls) Pregnant women between November 2021 to march 2022. Cases were pregnant women whose hemoglobin level was less than 11 g/dl at their first antenatal care visits and Controls were pregnant women whose hemoglobin level was 11 g/dl and above. Data was collected using a semi-structured interviewer-administered questionnaire and analyzed using Stata version 15.0. A bivariate and multivariate logistic regression model was used to identify the risk factors for anemia among pregnant women. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value were used to identify the significant association. Results: The independent risk/protective factors were; residential area, Wealth category, education level (AOR=0.16, 95% CI: 0.03, -0.89), Dietary diversity score (DDS) (AOR=0.51, 95% CI: 0.14 -1.82) and gestational age (AOR=3.78, 95%CI: 1.36,10.55). Conclusion: In this study, the protective factors were; residing in an urban residential area, high education levels, high wealth category, and high dietary diversity. Increasing gestational age was a risk factor. Prevention strategies should include improving livelihood and household income for women of reproductive age, advocating for and encouraging girl child education, community-based health education and counseling on nutrition, and improved household DDS
Factors influencing uptake of childhood Immunization Services among Caretakers of Children Aged 10-18 Months in Lira City
(Lira University, 2022) Abor, Jasper; Kabunga, Amir; Nabasirye, Carol
Background: The routine immunization services in Uganda ensures that that by the time a child is celebrating the first birth day, complete vaccination is vaccination is achieved. The factors influencing uptake to the services has been rarely explored. This study investigated the factors influencing uptake of childhood immunization services in Lira city. Participants and methods: This was a descriptive cross-sectional study which used quantitative method where data was obtained using a questionnaire from 420 caretakers of children aged 10—18 months who consented and had a child health card. Univariate analysis provided description of the variables while bivariate analysis compared the dependent variable with specific predictor variables to predict associations. Logistic regression model was used to identify significant factors influencing uptake of childhood vaccination (P-values less than 0.05). Results: The study result indicated that majority, 365(87.0%) of caretakers had their children fully immunized. The findings showed that caretakers who knew that vaccination starts immediately after birth were associated with increased odds of full childhood immunization (AOR: 5.65;95% CI: 1.82-17.55; p < 0.003). The study result also revealed information on next immunization appointments (AOR: 3.45;95% CI: 1.16-10.29; p < 0.03) and those given mosquito nets (AOR: 2.15;95% CI: 1.18-3.90; p < 0.01) were associated with increased odds of full childhood immunization Conclusion: These study findings indicated that high vaccination coverage was strongly associated with provision of health education on childhood vaccination and incentives to the caregivers. The health education provided adequate information for the caretakers about the importance of completing child’s vaccination. It is vital that local programmatic interventions should be put in place to strengthen these areas in order to improve uptake of routine immunization services by caretakers of children.
Contribution of Community Support Group to Home-Based Care of Persons Living with HIV and AIDS in Lira District: A Case of Amach Town Council and Amach Sub County
(Lira University, 2022) Auma, Zamaradi; Obici, Gilbert
Background: This study examined the contribution of community support groups on home based care to persons living with HIV (PLHIV) in Lira District. Specifically, the study examined the contribution of community support group on adherence to Anti-Retroviral Therapy (ART) for PLHIV, analyzed the contribution of community support groups on nutrition support to PLHIV, and examined the contribution of community support groups on palliative care to PLHIV. Methods: The study adopted a cross-sectional study design, which employed a mixed methods approach of both quantitative and qualitative methods. The study population consisted of 577 participants. Both simple random sampling technique and purposive sampling, were used to select a sample size of 226 respondents. The researcher used self-administered questionnaires to collect quantitative data and an interview guide to collect qualitative data. Descriptive statistics (mean, and standard deviation), and inferential statistics (correlation and regression) were used to analyze numerical data. Content analysis was used to analyse qualitative data from interviews to supplement quantitative data. Results: The findings suggested that community support group (mean=4.959, SD=0.5393) helps in enhancing home based care for PLHIV in Lira District. The study further revealed that community support group had a significant effect on adherence to ART (β=0.641, p<0.05), nutrition support (β=0.581, p<0.05) and palliative care (β=0.638, p<0.05). Conclusion: The study concludes that community support group significantly affects home based care for PLHIV in Lira District, Northern Uganda. This study contributes an original and empirical evidence of the association between community support group and home based care to PLHIV in Lira District. Recommendation: Therefore, for improved home based care to PLHIV, Lira District Local Government is encouraged to mobilize the local community to form community support groups so that they can be in position to give support to PLHIV in Lira District. Keywords: Community Support Group, Home-Based Care, and Persons Living with HIV and AIDS
Effects of Covid-19 On Utilization of Adolescent and Youth Friendly Health Services in Lira District.
(Lira University, 2022) Oyella, Linda Mary; Omech, Bernard; Ojuka, Edward
Purpose: This study assessed the effects of covid-19 on utilization of adolescent and youth friendly services in Lira district. Objectives: To assess the effects of covid-19 and factors affecting the extent of utilization of adolescent and youth friendly services in Lira district. Methods: This was a quantitative cross-sectional study utilizing both primary and secondary data from two H/C IVs (Amac and Ogur) in Lira district. Primary data was collected using a semi-structured questionnaire and review of secondary data on utilization of adolescent and youth friendly services from facility records before and during the covid-19 period was used. Simple random sampling technique was used and data was analyzed using STATA version 15. Results: A total of 296 female participants were recruited of which the median age was 15 years (IQR 12-18). Majority of the participants were; Students (62.7%), from rural areas (94.5%), never married (70.6%), had attained primary education as the highest level (91.6%), and belong to catholic or Anglican religion (80%). Utilization of AFHS was 40% lower during the lockdown period (IRR=0.60, CI: 38%-95%) in comparison to the pre-covid-19 period. Being an adolescent girl of older age (AOR: 3.82, C.I: 2.31, 6.32) and being unmarried (AOR: 0.69, C.I:0.53, 0.88) were highly associated with use of adolescent friendly services. Conclusion: COVID 19 lockdown caused significant decline in utilization of AFHS in Lira. Preparedness plans and strategies for adolescent girls are required to sustain services during pandemics to mitigate adverse health outcomes.
Household’s Willingness to Pay for Improved Solid Waste Collection Services in Lira City, Northern Uganda
(Lira University, 2022) Apio, Everline; Akello, Anne Ruth; Acanga, Alfred
Background: Waste management still remains a big challenge in most urban cities in Uganda including Lira City. This poses a great threat to human kind and the environment. Accordingly, household willingness to pay for solid waste services is paramount for better improvement of SWM at the community. Therefore, this study assessed factors influencing household’s willingness to pay for solid waste collection for disposal in Lira City. Methods: To achieve the study objectives, a survey was conducted utilizing a structured questionnaire to collect quantitative data from 585 randomly selected household heads. Key informant interview was conducted with City Environmental Officers, City Clerk, City Division Health Inspectors, Managers of Private Garbage Collecting Companies, Division Drivers and Staff Engaged in Solid Waste Collection and Market Vendors to supplement quantitative data. Descriptive analysis was used to ascertain the solid waste management practices used by the households and to determine the level of willingness to pay for improved waste collection in Lira City by the residents. The factors influencing household’s willingness to pay were analyzed using a binary logistic model. Results: The findings revealed that, 48.12% of the 585 household heads were willing to pay for improved solid waste collection services and the average amount household heads were to pay for improved solid waste collection services was UGX 3012≠ (0.84$) per month, according to the study, education level, occupation, distance to waste collection sites, and awareness of solid waste environmental concerns were all factors that influenced the amount that households were prepared to pay. Recommendations: As a result of the study findings, it was recommended that residents in Lira City be educated about the importance of effective solid waste management. Secondly, a thriving solid waste collection system should be built in the city, lest the environment’s and human population’s health will be jeopardized. Keywords: Household, Willingness to Pay, and Improved Solid Waste Collection Services
Retention and associated factors among HIV patients enrolled on ART through Assisted Partner Notification Services at Lira Regional Referral Hospital
(Lira University, 2022) Ayoo, Christine; Omech, Benard; Opio, Bosco
Background: Assisted Partner Notification is a public health strategy used to curb the spread of STIs and HIV/AIDS through testing and treating sexual partners of infected index cases and ensuring their retention in care. Retention of PLHIVs in LRRH still remains a challenge attributed to patients relocating to other places, forgetfulness, long distance, denial of treatment among others. Objective: to assess the level of retention and associated factors among HIV patients enrolled on ART through assisted partner notification services at LRRH. Methods: This was a cross-sectional study using a quantitative method. Data was collected using semi-structured questionnaire for a sample size of 424. Quantitative data was entered, cleaned and analyzed using SPSS version 16.0 at Univariate, Bivariate and Multivariate Level. Results: Retention level among HIV patients enrolled on ART through APNs was at 77% (327/424) … factors that were associated with this retention level included; gender (AOR 0.37 CI=0.21-0.64), marital status (AOR 2.31 CI=1.37-4.00), linkage to care (AOR 7.40 CI=2.77- 19.67), stigma (AOR 1.74 CI=1.00-3.00), and pill burden (AOR 2.37 CI=1.151-4.867). Conclusion: Retention level of HIV patients enrolled on ART through APNs at LRRH was fair at 77% according to ministry of health. The factors associated with retention level in this study includes; gender, marital status, stigma, linkage to care and pill burden. Recommendation: MoH and policy makers should strengthen their social behavioral change strategies targeting sexual partners and male engagement in HIV care. Keywords: Retention, HIV patients, ART, and Assisted Partner Notification Services
Water, Sanitation and Hygiene Risk Factors associated with Diarrhoeal Diseases among Children under Five years in Lira City
(Lira University, 2022) Auma, Brenda; Opio, Bosco
Introduction: In developing countries like Uganda; diarrhea in children under five is one of the leading causes of illness and mortality. The country has the highest prevalence of diarrheal diseases among children under five of 22% in East Africa. This study assessed the water, sanitation and hygiene factors associated with diarrheal disease among children under five years in Lira City. Methodology: This was a quantitative community-based cross-sectional survey conducted between August and September 2022. Information on socio-demographic characteristics, water, sanitation, hand washing practices and diarrhea history was obtained from 492 mothers/caregivers of children under the age of five years using a semi-structured interviewer administered questionnaire. Data was analyzed at three levels using STATA (Stata Corp LLC, TX and USA) version 17 software. Descriptive statistics, univariate logistic and multivariate logistic regression analyses were used. Results: Among 492 children under-five, the prevalence of diarrhea was 142 (29.3%). Being a child under four years of age (AOR=0.14, CI: 0.04-0.58), eating food not stored in refrigerators (AOR=0.15, CI:0.03-0.76), living in households practicing open dumping of wastage (OR=6.57, CI:1.63-26.4), and living in a household with a rubbish pit not filled fully (OR=2.84, CI:1.36-5.94) were significantly associated with diarrhea among children under five in Lira City. Conclusion: The prevalence of diarrhea among under-five is high in Lira City. The socio demographic, sanitation, hygiene and environmental factors were found to be associated with diarrhea. Community sensitization on water, sanitation and hygiene risk factors is needed. Keywords: Water, Hygiene, Sanitation, Lira City and Diarrhea
Factors Associated with Intrauterine Device use among Women of Reproductive age attending Family Planning Clinics at Mbale District
(Lira University, 2022) Ayeko, Jackson; Kumakech, Edward; Acen, Joy
Background: Intrauterine Contraceptive Device (IUCD) is among the most effective contraceptive methods in the market with increasing use globally. The use is predominant in few parts of the world, with sub-Saharan Africa relying on other methods. In Uganda, IUCD utilization remains very low at 1.5% compared to other methods despite several interventions by the government. The objective of this study was to determine the factors associated with IUCD use among women of reproductive age attending family planning clinics in selected public health facilities within Mbale District. Methodology: A facility based cross-sectional study was used among randomly selected women who came to obtain different contraceptive methods in the selected public health facilities. Information was obtained face-to-face by trained research assistants using a pre-coded structured questionnaire. Factors associated with IUCD use were identified by multi-variable binary logistic regression models using the backward stepwise method. Results: After running multi-variable binary logistic regression, IUCD use was associated with women who were employed (Adjusted OR=14.00, 95% CI;2.80-70.07), those who wanted to wait for 6-10 years before having the next pregnancy (Adjusted OR=12.19, 95% CI;1.35-110.08), and those who thought IUCD was associated with cancer (Adjusted OR=0.15, 95% CI;0.03-0.68). Conclusion: In conclusion, the study re-enforced the need to reach out with contraceptive methods especially IUCD to women who have a busy schedule and also points out the need for proper counselling to ensure that women who plan to stay for long should be counselled to also consider IUCD use which has a longer duration of action. Further, proper health education is needed through different channels to address the issues of myths and misconceptions which hinders utilization of IUCD. Keywords: Intrauterine Device, Women of Reproductive age, Family Planning Clinics, and Family Planning
Cervical Cancer Screening Uptake and associated factors among HIV positive women at Antiretroviral-Clinic of Lira Regional Referral Hospital
(Lira University, 2022) Kagenda, Gabriel Atwoki; Acio, Christine
t 305 participants (women receiving care from an Antiretroviral-Clinic in LRRH), between July 2022 and October 2022 was conducted in Lira Regional Referral Hospital. Data entries from questionnaires were captured in Microsoft excel version 2013 and exported to and analyzed in STATA version 15, at a confidence level of 95%. Logistic regression analysis was used to determine association between cervical cancer screening uptake and risk factors. Risk factors that show significant association with bivariate analysis were further subjected to multivariate analysis. Results: This study found that a significant number of the respondents had ever screened for cervical cancer (69%). Although other factors such as age, education level, religion and parity did not have significant impact, marital status, perceived barrier and chronic disease condition had scientifically significant associations with uptake of cervical cancer screening among respondents (AOR=0.19, 96% CI=0.064-0.560; AOR=9.63, 95% CI=3.81-26.36; AOR=06.34,95% CI=4.23- 13.56) respectively. Besides, compliance to guidelines for yearly screening for cervical cancer for women living with HIV was at 18.36%. Conclusion: The overall uptake of cervical cancer screening among the participants was relatively high (69%). However, compliance to guidelines was poor, with only 18.36% respondents attending to yearly screening as recommended by Ministry of Health. Key words: Cervical Cancer, Cervical Cancer Screening, HIV positive women, and Antiretroviral-Clinic
Factors Associated with Teenage Pregnancy Among Refugees and Host Nationals of Palabek Refugee Settlement, Lamwo District, Uganda.
(Lira University, 2022) Okiror, Emmanuel Okello; Acen, Joy; Sharon, Bright Amanya
Background: Uganda’s teenage pregnancy prevalence of 25% is remarkably high. However, in northern Uganda where Palabek Refugee Settlement is located, the prevalence is higher at 31%. Teenage pregnancy is a well-documented public health burden with an approximated sixteen million girls aged 15–19 years old giving birth each year; of these 12 million are from Sub-Saharan Africa and other developing regions and 10 million are unintended. Several environmental factors, including education, socio-economic status, local socio-cultural norms, the availability of contraceptives, and occupational opportunities affect refugees and host nationals alike. Because of the unique nature of the refugee community, factors driving the high prevalence of teenage pregnancy in this population need to be identified to devise context-specific preventive strategies. Aim: To determine the factors associated with teenage pregnancy among refugees and host nationals of Palabek Refugee settlement, Lamwo district, Uganda. Methods: This was a cross sectional study utilizing quantitative methods of data collection using a structured questionnaire as a data collection tool. The respondents were selected by simple random sampling. Data was entered into excel, cleaned, and loaded into SPSS V.26 for processing and analysis which was done at Univariate, bivariate and multivariate levels. Results: Refugees were two times more likely to getting pregnant than the host nationals (OR: 1.793, C.I; 1.092 to 2.943. The prevalence of teenage pregnancy among respondents was 41.7% and that of early marriages was 29.9%, an evidence of high prevalence of teenage marriages. The following factors were significantly associated with teenage pregnancy status – age group of the respondent, school attendance, marital status of the teenager, occupation of teenager, age at first sex, alcohol use, teenager’s mother’s level of education and person teenager lives with all with p < 0.001; media exposure (p=0.005); history of sexual abuse (p=0.049); whether parents of the teenager were divorced/separated or not (p<0.033) and cultural norms on sex (p=0.025). Conclusion: The burden of teenage pregnancy is still significant in these communities. The factors associated with teenage pregnancy in the refugee and host communities are not different from those in other contexts. Therefore adopting and or formulating strategies directed to mitigate these factors will help in reducing the soaring teenage pregnancies witnessed especially among the refugee populations.
Prevalence Of Malaria And Associated Tractors Among Children Under 5 Years Following Mass Net Campaign And Indoor Residual Spraying In Amolatar District
(Lira University, 2022) Orech, Sam; Akello, Anne Ruth
Mass LLINs distribution campaign and Indoor Residual Spraying (IRS) have been identified by the WHO as effective approaches for malaria prevention and control. Despite the scale up of interventions towards control and elimination of malaria, it’s still endemic in 91 countries worldwide with 3.3 billion people at risk of developing. In 2015, 212 million malaria cases occurred globally resulting into 429,000 deaths, 92% were in Africa. In 2019, 409,000 people died of malaria, mostly vulnerable children in sub-Saharan Africa. Methods A community based, cross-sectional research design using quantitative data collection method was used. Semi-structured questionnaire were employed. Bivariate and multivariate logistic regression analysis were done to identify factors associated to the prevalence of malaria among <5yrs. Results The intended respondents (238) were interviewed and up to 44.1% (105/238) children tested positive for malaria. At multivariate analysis, Children living with married caretakers (AOR=2.54, 95% CI=1.23-5.25) had statistically significant association with malaria prevalence, Children of caretakers with poor perception towards LLIN use had 68% increased odds of getting malaria. Whereas, children who stay far away from water bodies (AOR=0.07, 95% CI=0.01-0.56) had reduced odds of getting malaria Conclusions and recommendations Malaria remains the major public health problems among children under 5 years in Amolatar district. Children living with married caretakers, Caretakers with poor perception towards LLIN use and living near water bodies were the risk factors to malaria. DHTs to strengthen malaria prevention and control strategies among children <5 years, health information dissemination about eliminating stagnating water bodies, and addressing poor perception of mothers of children <5years.
Bacteriological Quality of Drinking Water and Associated Factors at Community Point Sources, in Arua District, Uganda.
(Lira University, 2022) Asiku, Norman; Akech, Stella Immaculate; Opio, Bosco
Introduction: This section summarizes the objectives, methodology, results and conclusions of the study. Background: Sufficient quantity and good quality of water is paramount for life. However, majority of the world’s population lack access to adequate and safe water. Every year, more than 3.4 million people die as a result of water-related diseases, and in Uganda, it is estimated that about 89,000 cases and 3,000 deaths occur annually due to cholera. Broad objective: To assess the bacteriological quality of drinking water and associated factors at community water source points in Arua District. Method: A cross-sectional study design was used, with Laboratory based experiment. Sample size of 140 was used. Dependent variable was the presence of the count of coliform forming units of bacteria on the filter membrane meanwhile independent variables were the hazard, pathway and indirect factors obtained through the sanitary inspection checklist. Data was entered into Excel spread sheet and imported for analysis to Stata/SE 15.0. Result: Majority (70.71%) of the water sources had bacteria, the predominant isolated indicator organism was total coliform. The following risk factors showed statistical association with bacteria presence in drinking water source; drainage for wastewater being defective with aOR of 19.7[5.34 72.72], parts of appliances being loose aOR of 10.7[2.52 45.92] and defective/lack of fence aOR of 9.2[2.43 34.96] all with P-value <0.001. Conclusion: Treatment of drinking water sources, regular water quality surveillance, cleaning, repairing spoiled appliance parts, fencing and repairing of spoiled fences among others to mitigate bacteriological contamination of water sources are required.
Cost-Effectiveness Analysis of adding Tuberculosis Household Contact Investigation on Passive Case Finding Strategy in South Western Uganda
(Lira University, 2022) Odongo, Dickens; Omech, Benard; Acanga, Alfred
Background: The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of TB. A household contact investigation is an alternative approach. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HHCI) to the passive case-finding (PCF) strategy in the Tuberculosis Control Program in southwestern Uganda. Methods: The study utilized decision-analytic modelling and bottom-up costing (ingredients) methods. The study obtained cost and probability estimates from national TB program data, activity costs, published literature, and expert opinions. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntugamo, Sheema and Rwampara districts. The primary effectiveness measure was the number of the actual TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients diagnosed over the screen. The Incremental Cost-Effectiveness Ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. Results: The TB screening yields were 0.52% (1496/289140) for HHCI and 5.8% (197/3414) for PCF. HHCI yield among children 0-14Vs. 15+ years (6.2% Vs.5.4%) p=0.04. the yield among PLHIV Vs HIV- negative (15.8% Vs. 5.3%) p=0.03 in HHCI. The PCF yield in men Vs. women (1.12% Vs. 0.28%) p<0.01. this NNS in PCF was 193 (95% CI: 186-294) and 17 (95% CI: 14-22) in HHCI. The unit costs of detecting a TB case were US$ 204.22 for PCF and US$ 315.07 for HHCI. Patient and caregiver costs are five times in PCF than HHCI (US$ 26.37 vs US$ 5.42). Under the study baseline assumption, adding HHCI to PCF strategies was not cost-effective at US$ 3,596.94 per additional case detected. Conclusion: HHCI improves access to TB diagnosis in children 0-14 years and PLHIV; however, PCF improves access to TB diagnosis among men. The unit cost of detecting one TB case in HHCI was higher than in PCF. Adding HHCI to PCF was not cost effective for detecting TB compared to PCF alone. Therefore, PCF remains the ideal and cost-effective strategy for low resource countries like Uganda. Keywords: Cost-Effectiveness, Yield, NNS, Tuberculosis, Household Contact Investigation, Passive Case Finding, Southwestern Uganda.
Knowledge, Attitude and Practices on used Polythene Bags Disposal among Residents of Lira City
(Lira University, 2022) Adyero, Cecilia; Akello, Anne Ruth
Background: The improper disposal of used polythene bags waste remains a significant public health challenge worldwide. In Uganda, 53% of solid waste are generated in urban areas especially in households. Lira City passed a solid waste management ordinance in 2019 to support with solid waste management including the polythene bags, tried to use enforcement among others but the implementation of the strategies became a challenge since polythene bags are used as daily shopping bags, and also for packing food. This study was therefore to assess the knowledge, attitude and practices of lira city residents on the disposal of used polythene bags. Methodology: The study design used was cross sectional, employing both qualitative and quantitative methods of data collection and analysis among 421 randomly selected residents of Lira City. Data was collected using structured questionnaires, key interview guides via face-face interviews. Quantitative data analysis was done using STATA 17 summarized as frequencies, percentages, means and standard deviations. Pearson Chi square test was run for bivariate analysis, and odds ratios for regression and p-value of 0.05 reported significant. Qualitative data analysis was manually done using the Braun & Clarke (2016) 6 steps. Results: Overall response rate was 99.8%. disposal practices of residents were improper at 52.5%, a good number of the respondents, 179 (42.5%) were aged 18 to 28 years, were female 273 (64.9%), and the most common level of education attained was primary 147 (34.9%). Most of them were self-employed 173 (41.1%), married 285 (61.3%), and catholic 165 (35.2%) by religion. A majority, 78.9% had good knowledge of proper disposal of used polythene bags. Factors associated with used polythene bags disposal among residents in Lira City include age (aOR; 3.007, 1.074-8.417), sex (aOR; 1.2, 0.82-1.97), reduce injuries (aOR; 1.2, 0.38-4.15), drainage blockage (aOR; 3.04, 2.00-4.63), and human health problems (aOR; 1.7, 1.15-2.73). Conclusion: Good knowledge on disposal of used polythene bags was high, disposal practices were poor at 52.5%. KII reported a knowledge gap in managing used polythene bags which has become a major challenge in Lira City. “the waste management practices of the people in the peri urban areas of the city is very poor and it’s even worse with used polythene bags, and there is need for awareness creation on general waste management with emphasis on disposal of used polythene bags” KI-1 said. Key words: Knowledge, Attitude, Practices, Polythene Bags, Disposal, and Residents of Lira City
Factors Associated with First Antenatal Care Attendance Within Twelve Weeks of Pregnancy Among Women in Lira City
(Lira University, 2022) Acup, Walter; Marc, Sam Opollo; Akullo, Betty Nancy
Introduction: The World Health Organization (WHO) recommends all pregnant women attend first Antenatal care (ANC) within 12 weeks of pregnancy. However, most pregnant women (71%) in Uganda started first ANC after 12 weeks of pregnancy. This predisposes them to pregnancy complications and outcomes which makes it hard to reduce the current high maternal mortality ratio (MMR) of 336 deaths per 100,000 live births. This study aimed to assess factors associated with first ANC attendance within 12 weeks of pregnancy among women in Lira City. Methods: A cross-sectional study design was conducted among 368 pregnant mothers attending first ANC at Lira Regional Referral Hospital (LRRH), Pentecostal Assembly of God-Mission HC-IV, and Ober HC-IV. Data was collected using interviewer-administered structured questionnaires. In-depth interviews were used to collect qualitative data. A binary logistic regression analysis was computed to determine the association using crude and adjusted odds ratios at 95% confidence intervals. Independent variables with a p-value of less than 0.05 in the multivariable logistic regression model were considered significant Results: Of the 368 respondents interviewed, 36.1% reported first ANC within 12 weeks of pregnancy. Risk factors associated with first ANC attendance within 12 weeks of pregnancy were not being in a marital relationship (aOR:0.40, 95% CI:0.16-0.99), taking >2hours to reach health facility (aOR:0.21, 95% CI:0.07-0.62), not being visited by VHT/HW at home (aOR:0.33, 95% CI:0.12-0.92). Protective factors associated with first ANC attendance within 12 weeks of pregnancy were not knowing that first ANC guides parents on infant and child care (aOR:2.22, 95% CI:1.06-4.67), pregnancy not consented to by spouse (aOR:4.29, 95% CI:1.75-10.55), attending ANC from private health facility (aOR:2.89, 95% CI:1.27-6.15), and having 2-3 HWs present at ANC clinic (aOR:1.79, 95% CI:1.03-3.13). Conclusion: Majority of pregnant women initiate their first ANC visits late. Comparing this to the UDHS 2016, we can conclude that late ANC initiation is a major problem in countrywide. Therefore, Ministry of Health should improve on the staffing of midwives and nurses at all facilities, raising awareness through continues community mobilization and sensitization of the women, their husbands and the community at large about the importance of first and timely ANC attendance should be a priority through HW/VHTs.

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