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.
Association Factors with Nutrient Intake and Nutritional Status of HIV Positive Breastfeeding Mothers in Apac District
(Lira University, 2023) Victoria, Atim Sharon; Bonny, Aloka
Introduction: Malnutrition among HIV/AIDS patients is a major challenge to the attainment of the sustainable development goals. This is important since severe malnutrition creates increased strain on the already overstained healthcare system once these patients are admitted. HIV infection causes excess nutrient loss and malabsorption, further increasing the nutritional requirements of HIV-infected lactating women. As a result, A HIV-infected lactating woman is a greater nutritional risk than a non-HIV-infected counterpart. While other students establish maternal under nutrition and associated factors in different parts of the world, few studies in Uganda highlighted the issue on predictors of nutrient intake and nutritional status among HIV positive breastfeeding women. Therefore, this study aimed at determining the associated factors with nutrient intake and nutrition status of HIV positive breastfeeding mothers in Apac district. Method: A cross-sectional study involving 224 HIV positive breastfeeding mothers was conducted. A pre-tested 24-hour recall questionnaire, using dietary diversity score for women (DDS-W) was used to collect the data. The nutritional status was assessed using body mass index (BMI), while the nutrient intake was assessed by entering the actual intakes into an excel sheet to calculate the total nutrient intake per individual from which mean nutrient intake and mean adequacy ratio (MAR) was finally calculated. The data was analyzed using Stata version 14 at univariate, bivariate and multivariate levels. Results: A total of 10.3% of participants were undernourished, with dietary score of 4.3 food groups while 21% had dietary diversity score. The participants were able to meet 61% of their recommended micro nutrition intake, with intake of energy, lipids, zinc, calcium, vitamins A, C, B6, and B12 below recommendations. The factors associated with nutritional status were material age [AOR =1.94, 95% CI (1.05-3.59)], presence of market [AOR =0.42, 95% CI (0.223-0.784)], means of obtaining food (AOR= 0.55, 95% CI (0.234-0.94)) and presence of cultural food taboos [AOR= 0.44, 95% CI (0.136-0.998)]. Factors associated with nutrient intake were presence of market [p=0.018, 95% ci (0.010-0104)], income [p=0.010, 95% CI (0.007-0.048)], DDS [p< 0.001, 95% CI (0.022-0.058)] and household head [p=0.049, 95% CI (-0.095-0.001)]. Conclusion: There prevalence of under nutrition among HIV positive Breastfeeding mothers in Apac district, coupled with poor dietary diversity score and low micronutrient intake. Interventions increasing DDS, nutrition education and income should be promoted. Key Words: Nutrient, Intake, Nutritional status, HIV, Positive, Breastfeeding, mothers
Attempted Suicide: Lived Experiences of Refugees in Rhino Camp, West Nile Uganda
(Lira University, 2023) Robinson, Ojwok; Judith, Abal Akello
Introduction: Suicide is among the leading source of death universally and every year, more people die as a result of suicide than HIV, malaria breast cancer, war and homicide. Sucide rates are high among vulnerable groups who experience discrimination, such as refugees and migrants. Purpose: This study explored the lived experiences of refugees who attempted suicide in Rhino Camp, West Nile, Uganda, using Thomas Joiner’s Interpersonal Theory of Suicide Attempts as a theoretical framework. Methods: This study employed an interpretative phenomenological Research design and purposive sampling techniques to choose participants, the study population consisted of 15 participants (7 Key Informants and 8 Suicide Survivors) to ensure in-depth analysis of qualitative data. Face to face interviews using in depth interview guide and observations were used to gather data. The study data were collected between June - July 2023. Result: Data saturation was reached after 13th interviews. Thirteen themes emerged from the data: 1) Domestic Violence and relationship, 2) mental illness, 3) Financial difficulties, and 4) Inadequate food deliveries 5) Traumatic past, 6) Psychological distress, 7) Social isolation, and 8) Cultural stigma, 9) Community and family support, 10) Role of Religious, Cultural, and Opinion or other leaders, 11) Health facilities support, 12) Coping mechanisms, and 13) Psychosocial Support Providers. Conclusions: The lived experiences of refugee suicide survivors and themes identified enhanced scholarly understanding regarding the experience of refugee suicide survivors. This important information can help us develop strategies to prevent suicide among the refugee population and to provide support for suicide attempt survivors. Mental health professional and counsellors can use the results of this study to effectively support refugee suicide survivors. A rich comprehension of survivor experience can assist and empower mental health professionals to provide, effective psychoeducation and interventions and informed support to suicide survivors. Clinicians and policy makers need to remain open-minded about how attempt survivors might view their experience. Key words: Suicide, Refugees, Lived experiences, Mental Health, Rhino Camp
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.
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
Cervical Cancer Screening Uptake and associated factors among women of reproductive age (21-49 years) attending Amach Health Centre-IV in Lira District
(Lira University, 2023) Kasongo, Joseph; Kumakech, Edward; Kigongo, Eustes
Background: Cervical cancer is a significant global health concern, ranking as the fourth most common cancer among women worldwide. Fortunately, early screening and effective management can prevent its progression. However, the uptake of cervical cancer screening varies across different regions, remaining suboptimal in developing countries such as Uganda. This study aimed to assess the level of cervical cancer screening uptake and identify associated factors among women aged 21 to 49 years attending Amach Health Centre in Lira district, Uganda. Methodology: A mixed methods approach was employed, combining quantitative and qualitative data collection techniques. The study included 312 randomly selected women who participated in face-to-face interviews using structured questionnaires and key informant interviews with health workers. The data was analyzed using STATA software, including descriptive statistics, chi-square tests, and logistic regression. Results: The findings revealed that only 44.8% of the 310 interviewed women had ever undergone cervical cancer screening. The predictors of cervical cancer screening include: not being in a marital relationship (Apr: 2.767, 95% CI: 1.463-5.231, p=0.002), poor knowledge about cervical cancer (Apr: 0.561, 95% CI: 0.374-0.843, p=0.005), not being familiar with screening modalities (Apr: 0.653, 95% CI: 0.441-0.966, p=0.33), and women whose decisions were made by their spouses (Apr: 0.510, 95% CI: 0.271-0.961, p=0.05). Conclusion: About 4 in 10 women had undergone cervical cancer screening by the time of the study. This study underscores the importance of addressing barriers to cervical cancer screening in Uganda, particularly among women of reproductive age in rural areas. Recommendations should target improving access to cervical cancer screening through sensitization of the community and making services available. Keywords: Cervical Cancer Screening Uptake, Women, Reproductive Age
Community and Health System Factors Associated with Parental Readiness for Human Papilloma Virus Vaccination Uptake Among Adolescents in Lira District
(Lira University, 2023) James, Ogwal C., K.; Dr. Sam, Opolo Marc
Background: High vaccination rates against Human Papilloma Virus (HPV) is a milestone in primary prevention of cervical cancer. With an increasing number of cases and deaths in the country among women hover, like many other countries around the globe, Uganda has had a high number of district (over 90%) who were underperforming in HPV vaccine uptake among adolescent girls. Despite the safe, effective, and opportunities for free vaccine delivery in health – care settings, Lira district still have very low HPV vaccine uptakes of 17.4% less than national target 80%. Objective: To assess community and health system factors associated with parental PHV vaccine uptake among female adolescent age (9 to 15) years in Lira district. Methods: This study was a crossed-sectional design employing explanatory sequential quantitative and qualitative methods of data collection. The phenomenology design was used for qualitative approach. Additionally, quantitative research generates factual information that can be readily communicated through statistics and figures and from which one can draw factual conclusions. Structured questionnaire was used to parent/guardians of girls age (9 to 15) years and some health workers from some selected health facilities. A total of 577 participants were interviewed and data processed. Results: The study shown that, majority (61.2%) of the 577 interviewed participants were not aware of HPV vaccine and 38.8% reported being ready to vaccinate their adolescent girls age (9 to 15) years. There was statistical significance association with parental readiness to vaccinate adolescent girls age (9 to 15) years: level of formal education (x2=55.4, df=3, p<0.001); and occupation (x2=6.76 df=2, p=0.034). Community factors significantly associated the willingness of parents to immunize their teenage daughters are: family history of cervical cancer (x2=18.5, df=1, p<0.001); get information about HPV vaccination (x2=470.6, df=1, p<0.001) and knowledge about HPV vaccination (x2=184.1, df=2, p<0.001). The study considers variables such as the level of formal education, material status, family history of cervical cancer, knowledge about HPV vaccination, and income level. The adjusted odds ratios (AOR) indicate that parents with tertiary education are 2.25 times likely to be ready (AOR=2.25, p=0.01) while unmarried individuals are 0.47 times likely to be ready (AOR=0.47, p=0.009), those without a family history of cervical cancer are 0.36 times likely (AOR=0.36, p<0.001 and parents with poor knowledge about HPV vaccination are 0.05 likely to be ready (AOR=0.05, p<0.001). Distance, health staffs’ attitude, parents’ level of education, misconception, parents, occupation and vaccine shortage were the common barriers of HPV vaccine uptakes reported. Conclusion: HPV vaccine uptakes readiness was low (38.8%) below the national threshold of (80%) due to association factors and barriers which were program based, beneficiaries and health care provider related. Addressing them such as creation of awareness, outreaches, trainings to health staff, steady vaccine supply and mobile survives revival, staffing and using leaders as an access strategy shall increase uptake of HPV vaccine Key words: Community, Health, System, Parental, Readiness, Human, Papilloma, Virus, Vaccination, Adolescents .
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
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.
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.
Factors associated with adherence to community-directed treatment with Ivermectin for Onchocerciasis control among adults in Pader District, Northern Uganda
(Lira University, 2023) Oyet, William Sam; Akello, Anne Ruth; Opollo, Marc Sam
Background: Onchocerciasis is caused by a filarial nematode, Onchocerca volvulus, and transmitted by a female black fly of the genus Simulium. Ivermectin Mass Drug administration (IVM MDA) is the primary strategy for controlling Onchocerciasis in the endemic countries including Uganda. Pader district commenced annual IVM MDA implementation in 2008 and semi-annual in 2012. From 2008 to 2022, no study has been conducted on the factors associated with adherence to Ivermectin treatment. The objective of this study was to determine the factors associated with adherence to Ivermectin treatment for Onchocerciasis control among adults in Pader district. Methodology: A cross-sectional study design that targeted 384 adults who received ivermectin mass drug administration in Pader, between July 2022 and October 2022 was conducted in Pader District. Data was analyzed in STATA version 17. Logistic regression was used to determine the factors associated with adherence to Ivermectin treatment. The factors that show significant association at bivariate analysis were further subjected to multivariate analysis (logistic regression) Results: The study found out that there was a high level of adherence (67.6%) to Ivermectin treatment in Pader district, with waiting time (AOR=44.1, CI:9.42-206.1), community involvement (AOR=7.19, CI: 1.37-37.8), received health education (AOR=0.09; CI: 0.02- 0.35), and CCDs trained (AOR=0.16, CI: 00.02-0.94) showed significant association with ivermectin treatment adherence among respondents. Conclusions: The community involvement, wasting time, health education received and training CCDs showed good adherence to Ivermectin treatment in Pader district. Keywords: Adherence, community-directed treatment, Ivermectin, Onchocerciasis control, adults, Pader District, Northern Uganda
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.
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
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
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.
Factors Influencing Contraceptive Use Among Teenage Girls 13-19 Years Old in Kole District.
(Lira University, 2023) Akello, Loy; Akullo, Betty Nancy; Nabasirye, Caroline
Introduction: Adolescent girls’ access to contraceptives is crucial for reducing unplanned pregnancies, abortions, and maternal deaths. Uganda faces challenges in meeting the sexual and reproductive health needs of adolescents, with Kole district particularly at risk of high teenage pregnancy complications. This study aimed to assess the prevalence and factors influencing contraceptive utilization among teenage girls in Kole district. Methods: The research design was a cross-sectional study, using a quantitative data collection method. The sample size of 289 was determined using the Kish (1965) formula. A multi-stage sampling technique was employed, randomly selecting two villages from each of the three sub-counties. Households within the villages were the unit of analysis, and participants was selected using simple random sampling. Data collection was done using a pretested questionnaire and analysed at univariate, bivariate and multivariate levels. Results: Results showed that 54.45% of the participants used contraceptives. Socio-cultural factors significantly influenced contraceptive use, with girls in supportive communities more likely to use contraceptives (AOR=0.28, 95% CI: 0.11-0.73, p=0.009). Health facility factors did not show significant associations. Fear of side effects was a significant barrier to contraceptive use (AOR=3.52, 95% CI: 1.51-8.19, p=0.004). Older teenage girls (17-19 years) were more likely to utilize contraceptives (AOR=5.49, 95% CI: 2.48-12.2, p<0.001). Conclusions: Improving contraceptive utilization among teenage girls in Kole requires multifaceted approaches that address socio-cultural factors that dispel fears related to side effects, and consider the unique needs of different age groups Recommendations: Addressing fear and age-related factors can promote contraceptive use among teenage girls. Keywords: Factors, Contraceptive use, Teenage girls.
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.
Factors Influencing Utilization of Cervical Cancer Screening among Women attending Maternal Child Health Services in Yumbe Regional Referral Hospital
(Lira University, 2023) Boniface, Otyama Ongwech; Sam, Marc, Opollo; Edward, Kumakech
Introduction: Cervical cancer remains a significant global health challenge, particularly in low- resource settings, where access to cervical cancer screening services in often limited. This study aimed to identify factors influencing the utilization of cervical cancer screening among women attending MCH at YRRH. Method: A cross-sectional design utilizing a mixed method of data collection (quantitative and qualitative) approaches was conducted among 422 women attending MCH at YRRH. Results: The findings showed that 12.3% of women had screened for cervical cancer. At bivariate levels, factors influencing screening utilization included limited use of contraceptive (p=0.001), not screening for STIs (p=0.001), living far from the health facility, (p=0.011) attaining tertiary and secondary education, (p=0.001 and p=0.040 respectively), being employed, (p=0.028), and income above and at median level p=0.005 and, p=0.006 respectively). At multivariate levels, attaining tertiary education was the most significant factor for cervical cancer screening utilization, (p=0.041). Women with tertiary education were 6.9 times likely to screen. Knowing the absence of screening equipment reduced the likelihood of utilization by 77%, (p=0.001). Not using contraceptives was associated with 72% likelihood of screening, (p=0.03). Non-smokers were 0.12 times likely to screening compared to smokers, (p=0.046) Conclusion: Finding from the study indicated a low level of cervical cancer screening among women, highlighting factors influencing cervical cancer screening utilization among women in YRRH. Recommendation: The study recommended for innovative way to reach out to communities with poor access to health care with the information about cervical cancer to improve the level of awareness. Key words: Influencing. Utilization, Cervical, Cancer, Screening, Women, Maternal, Child, Health, Services, Regional, Referral, Hospital
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
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

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