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Item Access to family planning services and associated factors among young people in Lira city northern Uganda(BMC Public Health, 2024) Kigongo, Eustes; Tumwesigye, Raymond; Anyolitho, Maxson Kenneth; Musinguzi, Marvin; Kwizera, Gad; Achan, Everlyne; Nabasirye, Caroline Kambugu; Udho, Samson; Kabunga, Amir; Omech, BernardBackground Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda. Methods and materials A mixed-methods study was conducted in March to April 2022. Quantitative data were collected using a structured questionnaire from 553 participants aged 15–24 years. Qualitative data were obtained through in-depth interviews and focus group discussions. Data analysis included univariate, bivariate, and multivariate analyses for quantitative data, while interpretative phenomenological analysis was used for qualitative data. Results Overall, 31.7% of the respondents had a good perceived access to family planning services, with 64.6% reporting perceived availability of FP methods. Challenges included lack of privacy (57.7%), fear of mistreatment (77.2%), and decision-making difficulties (66.2%). Among females, good perceived access to FP services was less likely among urban residents (AOR: 0.22, 95% CI: 0.09–0.53), Christian respondents (AOR: 0.51, 95% CI: 0.01–0.36), Muslim respondents (AOR: 0.07, 95% CI: 0.01–0.55) and respondents with poor attitude to FP services (AOR: 0.39, 95% CI: 0.24–0.64), but more likely among respondents with a sexual a partner (AOR: 4.48, 95% CI: 2.60–7.75). Among males, good perceived access to FP services was less likely among respondents living with parents (AOR: 0.19, 95% CI: 0.05–0.67) but more likely among respondents with good knowledge of FP services (AOR: 2.28, 95% CI: 1.02–5.32). Qualitative findings showed that three themes emerged; knowledge of family planning methods, beliefs about youth contraception and, friendliness of family planning services. Conclusion The study revealed a substantial gap in perceived access to family planning services among young people in Lira City. Barriers include privacy concerns, fear of mistreatment, and decision-making difficulties. Tailored interventions addressing urban access, religious beliefs for females, and knowledge enhancement for males are essential. Positive aspects like diverse FP methods and physical accessibility provide a foundation for targeted interventions. Youth-friendly services, comprehensive sexual education, and further research are emphasized for a nuanced understanding and effective interventions in Northern Uganda. Keywords Access, Contraception, Family planning, Youths, Young peopleItem Assessing factors associated with CD4 cell absolute count in patients at Gulu Regional Referral Hospital: A case study by Marc Sam Opollo, Uganda(South American Journal of Public Health, 2014) Opollo, Marc SamBackground: This study is set to assess individual, environmental and medication factors associated with CD4 cell count in patients attending HIV/AIDS treatment and care clinic in Gulu Regional Referral Hospital. Gulu Regional Referral Hospital is located in the northern district of Gulu. Gulu Regional Referral Hospital performs CD4 cell counts to monitor HIV +ve patients. Methodology: A cross-sectional study, with study population of Gulu and target population being HIV +ve patients attending HIV clinic in Gulu Regional Referral Hospital. Systematic random sampling will be used. Questionnaires will be administered to patients after informed consent. Results: will be presented in Texts, Tables, Graphs.Item Cholera epidemic amidst the COVID-19 pandemic in Moroto district, Uganda: Hurdles and opportunities for control(PLOS Glob Public Health, 2022) Orishaba, Philip; Opollo, Marc Sam; Nalwadda, Christine; Muruta, Allan; Makumbi, Issa; Kabali, Kenneth; Nakinsige, Anne; Lotee, Phillip; Okware, Samuel I.; Bwire, GodfreyIntroduction On 21st March 2020, the first COVID-19 case was detected in Uganda and a COVID-19 pan demic declared. On the same date, a nationwide lockdown was instituted in response to the pandemic. Subsequently, more cases were detected amongst the returning international travelers as the disease continued to spread across the country. On May 14th, 2020, a chol era epidemic was confirmed in Moroto district at a time when the district had registered sev eral COVID-19 cases and was in lockdown. This study aimed to describe the cholera epidemic and response activities during the COVID-19 pandemic as well as the hurdles and opportunities for cholera control encountered during the response. Materials and methods In a cross-sectional study design, we reviewed Moroto district’s weekly epidemiological rec ords on cholera and COVID-19 from April to July 2020. We obtained additional information through a review of the outbreak investigation and control reports. Data were analyzed and presented in frequencies, proportions, attack rates, case fatality rates, graphs, and maps. Results As of June 28th, 2020, 458 cases presenting with severe diarrhea and/or vomiting were line listed in Moroto district. The most affected age group was 15–30 years, 30.1% (138/458). The females, 59.0% [270/458], were the majority. The Case Fatality Rate (CFR) was 0.4% (2/458). Whereas home use of contaminated water following the vandalization of the only clean water source in Natapar Kocuc village, Moroto district, could have elicited the epi demic, implementing COVID-19 preventive and control measures presented some hurdles and opportunities for cholera control. The significant hurdles were observing the COVID-19 control measures such as social distancing, wearing of masks, and limited time in the com munity due to the need to observe curfew rules starting at 6.00 pm. The opportunities from COVID-19 measures complementary to cholera control measures included frequent hand washing, travel restrictions within the district & surrounding areas, and closure of markets. Conclusion COVID-19 preventive and control measures such as social distancing, wearing of masks, and curfew rules may be a hurdle to cholera control whereas frequent hand washing, travel restrictions within the district & surrounding areas, and closure of markets may present opportunities for cholera control. Other settings experiencing concurrent cholera and COVID-19 outbreaks can borrow lessons from this study.Item Empowering communities through citizen science and participatory action research: implementation of a schistosomiasis communication campaign in Uganda(Humanities and Social Sciences Communications, 2024) Anyolitho, Maxson Kenneth; Huyse, Tine; Masquillier, Caroline; Nyakato, Viola Nilah; Poels, KarolienSchistosomiasis is a water-related disease strongly linked with high-risk water and sanitation practices perpetuating disease transmission. In Uganda, despite health education and sensitisation efforts through communication campaigns by the Ministry of Health to reduce schistosomiasis prevalence, common risky practices still pose a challenge, especially among endemic communities. Here, we steered away from the conventional top-down approach to communication campaigns and explored alternative methods. We employed citizen science (CS) and other participatory action research (PAR) techniques as a bottom-up approach to co-design and implement a communication campaign among communities of western Uganda, to achieve a more tangible outcome of behaviour change for preventing schistosomiasis. We collected qualitative data using data party, world café, prioritisation and ranking, focus group discussion, and key informant interviews from 378 purposively selected individuals and analysed it using a thematic analysis model. Community volunteers, community radios and local leaders were the most preferred channels for passing schistosomiasis information identified by participants. Lack of access to safe water and healthcare services, open defecation, and inadequate knowledge of schistosomiasis are some of the most pressing problems prioritised. Door-to-door visits by citizen scientists (CSs), community meetings, drama, and tournaments were the channels proposed by CSs and community groups during the co-design workshops. Over 1000 households and about 9000 community members were directly reached using the channels. Endemic communities prefer receiving schistosomiasis information using local channels instead of conventional ones. Combining citizen science with other PAR approaches empowers communities to interpret research findings in their contexts and take charge of the interventions. As such, clear and simple message coverage and a high audience turn-up can be achieved. A follow-up study is needed to evaluate the process and impact of the communication intervention on the citizen scientists and the community’s knowledge, attitudes, and practices regarding preventive measures.Item Factors associated with DPT 1-3 vaccine dropout in Kabarole district(International Journal of Infectious Diseases, 2010) Opollo, M.-S.; Makumbi, F.; Mukanga, D.; Namusisi, O.; Ayebazibwe, N.; Tweheyo, R.Background: Among the top ten causes of poor health in the district are complications due to vaccine preventable diseases notably diphtheria, pertussis and tetanus (DPT). In 2008, the DPT dropout rate in Kabarole was high (18%). This study assessed the service, community and individual factors associated with DPT1-3 dropout in Kabarole District. Methods: A cross sectional study using cluster sampling was employed. Two clusters at parish level (rural and urban) each from a county in the district were selected by sim ple random sampling and all villages therein were studied. A total of 230 children (115 from either cluster) were recruited and their parent or guardian interviewed. Cross-tabulations and chi-square tests were used to determine the strength of associations between independent variables and the outcome. Binary logistic regression was done to adjust for potential confounders and identify independent predic tors. Key informant interviews were held with in-charges of health units. Qualitative data was analysed manually using thematic approach and results presented in the form of text. Results: Factors found to be associated with DPT1-3 dropout were; lack of caretaker knowledge about DPT dosage, (adj. OR = 8.2; 95% CI: 3.12, 21.53); Child’s Birth Order, 6th and above (adj. OR = 3.0; 95% CI: 0.80, 11.05); Child Birth Order 2-3 (adj. OR = 2.2; 95% CI: 0.70, 6.71); Child age group 31-36 compared to 12-18 (adj. OR = 2.5; 95% CI: 0.81, 7.84). However, Rural residence (OR = 1.2; 95% CI: 0.56, 2.57); and Child without immunisation card (OR = 4.4; 95% CI: 0.35, 39.86) were not significantly associated with DPT dropout. Conclusion: The current DPT1-3 dropout prevalence in Kabarole is still high but dropping (13.7%). DPT 1-3 dropout is associated with caretaker lack of knowledge of number of dosages a child should receive and involvement of religious leaders, long travel distance to point of accessing transport means, and convenient time for immunisation. Findings from this study can be used to improve DPT immunisation services. Specific campaigns on DPT immunisation through home visits, involving community leaders and full day immunisation can help further reduce the dropout rateItem Factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City, Northern Uganda: a facility-based cross- sectional study(BMJ, 2023) Acup, Walter; Opollo, Marc Sam; Akullo, Betty Nancy; Musinguzi, Marvin; Kigongo, Eustes; Opio, Bosco; Kabunga, AmirObjective This study aimed at assessing factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City. Design A cross-sectional study. Settings The study was conducted in health facilities offering ANC services in Lira City, Northern Uganda. Participants The study was among 368 pregnant mothers attending their first ANC in the three selected facilities (Lira Regional Referral Hospital, Ober Health Center IV and Pentecostal Assembly of God Mission Health Center IV) in Lira City. Primary and secondary outcome measures Level of first ANC attendance within 12 weeks of pregnancy and associated factors. Results Early ANC attendance was 36.1%. Women who were: unmarried (adjusted OR (aOR): 0.40, 95% CI: 0.16 to 0.99), took >2 hours to reach a health facility (aOR: 0.21, 95% CI: 0.07 to 0.62), or not visited by village health teams or healthcare workers at home (aOR: 0.33, 95% CI: 0.12 to 0.92) were less likely to attend their first ANC early. On the other hand, women who were: not knowing first that ANC guides parents on infant care (aOR: 2.22, 95% CI: 1.06 to 4.67); pregnant without consent of spouse (aOR: 4.29, 95% CI: 1.75 to 10.55); attending ANC from a private facility (aOR: 2.89, 95% CI: 1.27 to 6.15); and having two to three healthcare workers present at the ANC clinic (aOR: 1.79, 95% CI: 1.03 to 3.13) were more likely to attend ANC early. Conclusions Despite the fact that the WHO recommends that all women begin ANC within 12 weeks after conception, Lira City in Northern Uganda had a low overall incidence of timely ANC initiation. Being unmarried, distance to reach a health facility, and being visited by village health teams or healthcare workers at home were all linked to timely ANC commencement. As a result, intervention efforts should concentrate on the highlighted determinants in order to promote ANC initiation in Lira City, Northern Uganda. This can be accomplished by providing information and education to the community on the timing and necessity of ANC in Northern Uganda.Item Health-seeking behaviour regarding schistosomiasis treatment in the absence of a mass drug administration (MDA) program: the case of endemic communities along Lake Albert in Western Uganda(BMC Public Health, 2023) Anyolitho, Maxson Kenneth; Nyakato, Viola Nilah; Huyse, Tine; Poels, Karolien; Masquillier, CarolineIntroduction Schistosomiasis poses a serious public health problem and a social challenge affecting over 240 million people, the majority of whom live in sub-Saharan Africa. The World Health Organization (WHO) recommends praziquantel (PZQ) drug treatment through regular mass drug administration (MDA) accompanied by social mobilisation and health education and sensitisation. With social mobilisation and health education and sensitisation, there is bound to be increased demand for the PZQ, especially in the case of endemic communities. However, it is not clear where communities go for PZQ treatment in the absence of PZQ MDA. We explored the health-seeking behaviours regarding schistosomiasis treatment among communities along Lake Albert in Western Uganda when MDA had delayed, to inform a review of the implementation policy for the achievement of the WHO’s 2030 target of 75% coverage and uptake. Methods and materials We conducted a community-based qualitative study in Kagadi and Ntoroko, an endemic community in January and February 2020. We interviewed 12 individuals: local leaders, village health teams, and health workers, and conducted 28 focus group discussion sessions with 251 purposively selected community members. The audio recordings of the data were transcribed and analyzed using a thematic analysis model. Results Generally, participants seldom seek medication for schistosomiasis-related signs and symptoms from government hospitals and health centres II, III and IV. Instead, they rely on community volunteers such as VHTs, private facilities, such as clinics and drug shops nearby, or traditional sources (e.g. witch doctors and herbalists). Results show that factors influencing people to seek treatment from sources other than the government are: the absence of PZQ drugs in the government health facility; health workers’ negative attitude towards patients; long distances to the government hospitals and health facilities; poor and inaccessible roads; medication-related costs; and negative perceptions of the PZQ drug. Conclusions Availability and accessibility of PZQ seem to be a big challenge. PZQ uptake is further hampered by health systems and community-related and socio-cultural factors. Thus there is a need to bring schistosomiasis drug treatment and services closer to endemic communities, stock nearby facilities with PZQ and encourage endemic communities to take the drug. Contextualised awareness-raising campaigns are needed to debunk myths and misconceptions surrounding the drug. Keywords Health-seeking behaviour, Mass drug administration, Endemic, Communities, Lake Albert, Praziquantel, Schistosomiasis, UgandaItem HIV Type 1 Disease Progression to AIDS and Death in a Rural Ugandan Cohort Is Primarily Dependent on Viral Load Despite Variable Subtype and T-Cell Immune Activation Levels(The Journal of infectious diseases, 2015) Eller, Michael A.; Opollo, Marc S.; Liu, Michelle; Redd, Andrew D.; Leigh, Anne Eller; Kityo, Cissy; Kayiwa, Joshua; Laeyendecker, Oliver; Wawer, Maria J.; Milazzo, Mark; Kiwanuka, Noah; Gray, Ronald H.; Serwadda, David; Sewankambo, Nelson K.; Quinn, Thomas C.; Michael, Nelson L.; Wabwire-Mangen, Fred; Sandberg, Johan K.; Robb, Merlin L.Background. Untreated human immunodeficiency virus type 1 (HIV) infection is associated with persistent im mune activation, which is an independent driver of disease progression in European and United States cohorts. In Uganda, HIV-1 subtypes A and D and recombinant AD viruses predominate and exhibit differential rates of disease progression. Methods. HIV-1 seroconverters (n = 156) from rural Uganda were evaluated to assess the effects of T-cell acti vation, viral load, and viral subtype on disease progression during clinical follow-up. Results. The frequency of activated T cells was increased in HIV-1–infected Ugandans, compared with commu nity matched uninfected individuals, but did not differ significantly between viral subtypes. Higher HIV-1 load, sub type D, older age, and high T-cell activation levels were associated with faster disease progression to AIDS or death. In a multivariate Cox regression analysis, HIV-1 load was the strongest predictor of progression, with subtype also contributing. T-cell activation did not emerge an independent predictor of disease progression from this particular cohort. Conclusions. These findings suggest that the independent contribution of T-cell activation on morbidity and mortality observed in European and North American cohorts may not be directly translated to the HIV epidemic in East Africa. In this setting, HIV-1 load appears to be the primary determinant of disease progression. Keywords. HIV-1; AIDS; subtype D; immune activation; PD-1; viral load.Item Induction of HIV-specific functional immune responses by a multiclade HIV-1 DNA vaccine candidate in healthy Ugandans(Vaccine, 2007) Eller, Michael A.; Eller, Leigh Anne; Opollo, Marc S.; Ouma, Benson J.; Oballah, Peter O.; Galley, Lynee; Karnasuta, Chitraporn; Kim, Silvia Ratto; Robb, Merlin L.; Michael, Nelson L.; Kibuuka, Hannah; Wabwire-Mangen, Fred; Graham, Barney S.; Birx, Deborah L.; de Souza, Mark S.; Cox, Josephine H.A phase I randomized, double blind, placebo-controlled trial to assess the immunogenicity of a multiclade HIV-1 DNA plasmid vaccine was conducted in 31 HIV-1-negative Ugandans. Following immunization with DNA at 0, 1, and 2 months, the frequency of HIV-specific immune responses was assessed up to 10 months using a standard chromium release assay (CRA), lymphoproliferative assay (LPA), and antibody dependent cell-mediated cytotoxicity assay (ADCC). Seven of 15 (47%) vaccinees demonstrated CTL activity using the CRA to HIV-1 Env B with responses observed 1 month following the second vaccination and as late as 7 months following complete immunization. Additionally, lymphoproliferative reponses were observed in 14/15 vaccinees against p24. No CTL or LPA responses were observed at baseline or in the placebo group. ADCC activity was minimally induced by DNA vaccination. This study demonstrates that immunization with DNA alone induces CTL and lymphoproliferative responses in a population that will participate in a phase IIb study evaluating HIV-1 DNA priming followed by boosting with a replication-defective recombinant adenovirus vector. Keywords: DNA vaccine; HIV-1; CTL; LPA; ADCCItem Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done(Tropical Medicine and Infectious Disease, 2021) Opollo, Marc Sam; Otim, Tom Charles; Kizito, Walter; Thekkur,Pruthu; Kumar, Ajay M. V. ; Kitutu, Freddy Eric; Kisame, Rogers; Zolfo, MariaGlobally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobialresistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, crosssectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.Item Knowledge, attitudes, and practices regarding schistosomiasis infection and prevention: A mixed-methods study among endemic communities of western Uganda(PLOS NEGLECTED TROPICAL DISEASES, 2022) Anyolitho, Maxson Kenneth; Poels, Karolien; Huyse, Tine; Tumusiime, Julius; Mugabi, Faith; Tolo, Casim Umba; Masquillier, Caroline; Nyakato, Viola NilahSchistosomiasis is one of the leading neglected tropical diseases, second to malaria in prevalence. In Uganda, more than 10 million people (25.6%) are currently infected, with prevalence in some areas as high as 90%, and more than 55% of the population is at risk. The most at-risk populations are the fishing communities and school-aged children. Despite the government’s prevention and control programs such as mass drug administration (MDA) and sensitization, infections and re-infections have continued to occur, even in areas where MDA has been implemented. Previous studies have linked this with risky behavior. However, information from western Uganda is inadequate. We conducted a mixed-methods study to assess community knowledge, attitudes, and practices, and to understand their opinions and perspectives regarding the disease. The study found that, whereas there is adequate knowledge of schistosomiasis and although there is a positive attitude toward avoiding water contact and the use of latrines, it is difficult to do so, something that could explain the persistent risky practices. The risky practices could also be compounded by myths and misconceptions surrounding the disease. These findings shall form the basis for the design and implementation of contextualized, community-based, participatory communication tools for behavior change. Community involvement in schistosomiasis prevention programs could lead to increased awareness about disease prevention and could debunk existing myths and misconceptions, thereby improving behaviors, practices, and habits, ultimately lowering infection.Item Maternal mental health screening and management by health workers in southwestern Uganda: a qualitative analysis of knowledge, practices, and challenges(BMC Pregnancy and Childbirth, 2023) Nakidde, Gladys; Kumakech, Edward; Mugisha, John. F.Background Maternal mental health (MMH) problems, such as perinatal depression, maternal anxiety, suicide ideation and puerperal psychosis among others, have a significant impact on maternal morbidity and mortality, as well as the health and development of children. One in every four pregnant women and one in every five postpartum women in low-income countries, suffer from maternal mental health (MMH) problems. Despite this, MMH screening, diagnosis, and reporting remain scanty in Uganda. Consequently, this study aimed to investigate the knowledge, practices, and impediments that maternity care workers face when screening and managing women with maternal mental health disorders in health facilities in south-western Uganda. Methods In-depth interviews were conducted with 22 health-care professionals who work in maternity care departments in primary and tertiary healthcare facilities in southwestern Uganda to investigate their medical knowledge, clinical practices, and challenges related to the screening and management of maternal mental health problems. Using qualitative content analysis, distinct categories and subcategories were found. Results Medical staff especially midwives lacked specialized training in screening and managing women with maternal mental health problems They screened and managed MMH problems solely based on history and physical examination, and they referred nearly every mother displaying signs of mental illness because they felt ill-prepared to handle them. On the other hand, medical staff with some level of specialized training in mental health particularly staff working in mental health units, were more likely to use a mental health screening tool in addition to history and physical examination; and to treat any women exhibiting signs and symptoms of maternal mental problems without referring them. Lack of in-service training on maternal mental health, poorly coordinated referral systems, reluctance of mentally ill to visit medical facilities, scarcity of mental health specialists, and shortage of relevant medications were identified as the major challenges. Age, experience level, or gender had no effect on screening or management practices. Conclusions The results suggest that specialized training in mental health, and particularly maternal mental health, is essential for the effective screening and management of maternal mental health conditions in South Western Uganda. Keywords Maternal Mental problems, Puerperal psychosis, Maternal mental health, Sub-saharan Africa, Uganda, Maternal depression, Maternal anxiety, Maternal mental healthItem Maternal mental health screening and management by health workers in southwestern Uganda: a qualitative analysis of knowledge, practices, and challenges(BMC Pregnancy and Childbirth, 2023) Nakidde, Gladys; Kumakech, Edward; Mugisha, John. F.Background Maternal mental health (MMH) problems, such as perinatal depression, maternal anxiety, suicide ideation and puerperal psychosis among others, have a significant impact on maternal morbidity and mortality, as well as the health and development of children. One in every four pregnant women and one in every five postpartum women in low-income countries, suffer from maternal mental health (MMH) problems. Despite this, MMH screening, diagnosis, and reporting remain scanty in Uganda. Consequently, this study aimed to investigate the knowledge, practices, and impediments that maternity care workers face when screening and managing women with maternal mental health disorders in health facilities in south-western Uganda. Methods In-depth interviews were conducted with 22 health-care professionals who work in maternity care departments in primary and tertiary healthcare facilities in southwestern Uganda to investigate their medical knowledge, clinical practices, and challenges related to the screening and management of maternal mental health problems. Using qualitative content analysis, distinct categories and subcategories were found. Results Medical staff especially midwives lacked specialized training in screening and managing women with maternal mental health problems They screened and managed MMH problems solely based on history and physical examination, and they referred nearly every mother displaying signs of mental illness because they felt ill-prepared to handle them. On the other hand, medical staff with some level of specialized training in mental health particularly staff working in mental health units, were more likely to use a mental health screening tool in addition to history and physical examination; and to treat any women exhibiting signs and symptoms of maternal mental problems without referring them. Lack of in-service training on maternal mental health, poorly coordinated referral systems, reluctance of mentally ill to visit medical facilities, scarcity of mental health specialists, and shortage of relevant medications were identified as the major challenges. Age, experience level, or gender had no effect on screening or management practices. Conclusions The results suggest that specialized training in mental health, and particularly maternal mental health, is essential for the effective screening and management of maternal mental health conditions in South Western Uganda. Keywords Maternal Mental problems, Puerperal psychosis, Maternal mental health, Sub-saharan Africa, Uganda, Maternal depression, Maternal anxiety, Maternal mental healthItem The mediating role of self-control on the relations between adverse childhood experiences and substance use among adolescents in Uganda(Frontiers in Psychology, 2024) Namusoke, Jane; Amone-P’Olak, Kennedy; Nakanwagi, Carol Chosen; Kibedi, Henry; Mayengo, Nathaniel; Ssenyonga, Joseph; Omech, BernardObjective: Adverse childhood experiences (ACEs) are established risk factors for undesirable consequences in adolescence and early adulthood, including substance use and a lack of self-control. Based on the Social Bonds Theory (SBT), this study aims to expand our knowledge of the pathways from ACEs and self-control to substance use in adolescence and early adulthood. Methods: The extent to which self-control mediates the association between ACEs and substance use was examined in a cross-sectional survey of 358 adolescents and young adults (N = 234, 65.5% girls, mean age 17.7, SD 0.58, range 15–18). Data were gathered using the Adverse Childhood Experiences (ACE-10) questionnaire, the Drug Abuse Screening Test (DAST-10), and the 10- item self-control scale to assess childhood adversity, substance use, and selfcontrol, respectively. Results: ACEs were widely reported and significantly associated with substance use and a lack of self-control. Self-control strongly predicted substance use, independent of ACEs. Among those reporting no ACEs, one to two, three to four, and five or more, there were significant variations in the respondents’ substance use (F(3, 400) = 12.69, p = 0.001). Self-control explained 51.2% (95% confidence interval [CI]: 41, 61%) of the associations between ACEs and substance use as assessed by linear regression. Conclusion: Self-control is key to understanding why adolescents and young adults with a history of childhood adversity indulge in substance use. Therefore, there is a need to advocate for psychological interventions such as cognitive and behavioural therapy that have demonstrated efficacy in promoting selfcontrol in adolescents and young adults. KEYWORDS adverse childhood experiences, substance use, self-control, adolescents, UgandaItem Parents’ Readiness to Vaccinate Their Children Aged 5 to 17 Years Against Covid-19 and Its Associated Factors in Lira District, Uganda(Pediatric Health, Medicine and Therapeutics, 2023) Puleh, Sean Steven; Kigongo, Eustes; Opio, Innocent Ojok; Akech, Stella Immaculate; Opollo, Marc Sam; Achan, Everlyne; Acen, Joy; Anyolitho, Maxson Kenneth; Acup, Walter; Amir, KabungaBackground: Data on parents’ readiness to vaccinate their children aged 5 to 17 years against COVID-19 is still scarce. This study assessed parents’ readiness to vaccinate their children aged 5 to 17 years against COVID-19 and factors associated in Lira district, Uganda. Methods and Materials: A cross-sectional survey employing quantitative methods was conducted between October and November 2022 among 578 parents of children aged 5–17 years in 3 sub-counties in Lira district. An interviewer-administered questionnaire was used to collect data. Data was analyzed using descriptive statistics including means, percentages, frequencies, and odds ratios. Logistic regression was used to determine associations between the factors and the readiness of parents at a 95% level of significance. Results: Out of 634 participants, 578 responded to the questionnaire, giving a response rate of 91.2%. The majority of the parents (327, 56.8%) were female, had children aged between 12 and 15 years (266, 46.4%), and had completed primary education (351, 60.9%). Most of the parents were Christian (565, 98.4%), married (499, 86.6%), and had been vaccinated against COVID-19 (535, 92.6%). Results also indicated that 75.6% (ranging from 71.9% to 78.9%) of the parents were unwilling to vaccinate their children for the COVID-19 virus. The predictors of readiness were the age of the child (AOR: 2.02; 95% CI: 0.97–4.20; p=0.05) and lack of trust in the vaccine (AOR: 3.33; 95% CI: 1.95–5.71; p0.001). Conclusion: Our study shows that parents’ readiness to vaccinate their children aged 5 to 17 years was only 24.6%, which is suboptimal. The predictors of hesitancy were the age of the child and a lack of trust in the vaccine. Based on our results, the Ugandan authorities should provide health education interventions targeting parents to combat mistrust with respect to COVID-19 and the COVID-19 vaccine and highlight the benefits of the vaccines. Keywords: children, minors, hesitancy, readiness, vaccinationItem The Potential of Citizen- Driven Monitoring of Freshwater Snails in Schistosomiasis Research(Citizen Science: Theory and Practice, 2021) Brees, Jef; Huyse, Tine; Tumusiime, Julius; Kagoro-Rugunda, Grace; Namirembe, Daisy; Mugabi, Faith; Nyakato, Viola; Anyolitho, Maxson Kenneth; Tolo, Casim Umba; Jacobs, LiesbetSchistosomiasis is a tropical parasitic disease affecting more than 200 million people worldwide, predominantly in Africa. The World Health Organization recently highlighted the importance of targeted control of the freshwater snails acting as intermediate hosts for the parasites causing schistosomiasis. However, because of a shortage of trained experts and resources, detailed information on spatiotemporal snail distributions, which is needed for targeted control measures, is often missing. We explore the potential of citizen science to build these much-needed datasets through fine-grained, frequent snail sampling. We trained a network of 25 citizen scientists to weekly report on snail host abundances in 77 predefined water contact sites in and around Lake Albert (western Uganda). Snail abundance, together with marked GPS locations, water chemistry parameters, and photographs of the identified snails are recorded and submitted using the freely available mobile phone application KoBoToolbox. Trained researchers then engage in remote, semi-automatic validation of the submissions, after which there is an opportunity to provide targeted feedback to the citizen scientists. Five months after the operationalisation of the network, a total of 570 reports were submitted and personalized feedback was given, resulting in lasting improvements in subsequent reporting and snail genus identification. The preliminary results show the possibility of citizen science to independently obtain reliable data on the presence of schistosome snail hosts. We therefore argue that citizen-driven monitoring on a high spatiotemporal resolution could help to generate the much-needed data to support local targeted snail control measures in remote and/or resource-limited environments.Item Prevalence of dementia and its association with central nervous system infections among older persons in northern Uganda: cross-sectional community-based study(BMC Geriatrics, 2023) Benyumiza, Deo; Kumakech, Edward; Gutu, Jastine; Banihani, Jude; Mandap, Joshua; Talib, Zohray M; Wakida, Edith K; Maling, Samuel; Obua, CelestinoBackground Dementia is a condition in which there is deterioration in cognitive function beyond what might be expected from the usual consequence of biological aging. Few studies have been conducted on the prevalence of dementia and its association with central nervous system (CNS) infections among older persons in African settings, particularly in Uganda. Therefore, this study assessed the prevalence of dementia and its association with CNS infections among older persons in Lira District, northern Uganda. Methods This was a cross-sectional community-based study in Lira district northern Uganda. The study was conducted in March 2022 among 434 older persons aged 50 and above years who were selected by multistage sampling. Data were collected using an interviewer-administered questionnaire supplemented with information from participant’s medical records and a brief community screening instrument for dementia. The instrument classifies dementia into unlikely, probable or possible dementia. Data were entered in duplicate into EpiData version 3.0, then transferred to Statistical Package for Social Sciences (SPSS) version 23 for statistical analysis. Results Our study found almost one in four (23%) of the older persons in Lira district northern Uganda were suffering from probable or possible dementia. Our study further found that older persons in Lira district northern Uganda with a positive history of central nervous system infections (CNS) had nearly five times higher odds of having probable or possible dementia compared to their counterparts (cOR: 4.5; 2.76–7.23; p≤0.001). Being in advanced age of 70+years (aOR: 2.6; 1.6–4.3; p≤0.001), positive history of CNS infection particularly Herpes simplex virus-1 (aOR: 5.4; 1.4–20.5; p=0.013), and chronic headache (aOR: 1.9; 1.1–3.1; p=0.019) were independent predictors of probable or possible dementia among participants in this study. Conclusion and recommendations Dementia is a common condition among older persons in Lira district northern Uganda with a prevalence of 23% in our study. Older persons with a positive history of CNS infection had higher odd of developing dementia compared to their counterparts. Having advanced age, cerebral malaria, Herpes simplex virus −1 (HSV-1) infections, and chronic headache were independent predictors for dementia. These results imply that health assessment for the risk of dementia should include screening for history of CNS conditions particularly cerebral malaria, HSV-1 and chronic headache. Keywords Dementia, Older persons, Central Nervous System infections, Northern UgandaItem A systematic review and meta-analysis of the prevalence of depression among breast cancer patients in Sub-Saharan Africa(Avicenna Journal of Neuro Psycho Physiology, 2023) Kabunga, Amir; Kigongo, Eustes; Musinguzi, Marvin; Tumwesigye, Raymond; Acup, WalterBackground: Breast cancer is linked to neuropsychiatric conditions, particularly depression, which lowers life expectancy. Studies from Sub-Saharan Africa, however, have revealed conflicting prevalence rates of depression. Objective: To assess the combined prevalence of breast cancer-related depression among patients in Sub-Saharan Africa. Methods: The following search terms—depression, depressive disorders, breast cancer, mammary cancer, mammary adenocarcinoma and breast carcinoma, and Sub-Saharan African—were used to conduct a systematic search for English articles on depression published in PubMed, Scopus, Web of Science, African Journal Online, and Google Scholar. A meta-command was used to combine the results of different studies on depression linked to breast cancer through a random effects model at a 95% confidence interval in Stata software (version 17). Results: After the elimination of duplicates, 9,272 articles were still found after the electronic search yielded 12051 results. A number of 19 articles were still available after abstract and title screening, and they underwent full-text screening. A number of 10 articles were removed for a variety of reasons, including the lack of the full text (n=2), incorrect publication type (n=2), and not reporting the full outcome of interest (n=6). In Sub-Saharan Africa, the combined prevalence of breast cancer patients was 60%. (95CI, 0.51-0.69). The prevalence rates of depression among breast cancer patients in East Africa, South Africa, and West Africa were reported as 64% (95CI, 0.51-0.75), 60% (95CI, 0.53-0.67), and 55%. (95CI, 0.36-0.73), respectively. Conclusion: In Sub-Saharan Africa, about 6 in 10 cancer patients experience depression. Since depression negatively affects the quality of life, it is important to properly diagnose depression in order to treat it effectively with the fewest possible side effects. Keywords: Breast cancer, Depression, Depressive disorders, Neuropsychiatric disorderItem Utilization of antiretroviral therapy services and associated factors among adolescents living with HIV in northern Uganda: A crosssectional study(PLoS ONE, 2023) Odongo, Innocent; Arim, Barbara; Ayer, Patrick; Murungi, Tom; Akullo, Susan; Aceng, Docus; Oboke, Henry; Kumakech, Edward; Obua, Celestino; Auma, Anna Grace; Nyeko, RichardBackground Suboptimal utilization of antiretroviral therapy (ART) services remains a problem among adolescents in low- and middle-income countries, which has a negative impact on their response to treatment and increases the risk of developing resistance. Optimal use is essential to enhancing treatment efficacy. We investigated the optimal use of ART service and predictors among adolescents living with HIV (ALHIV) in northern Uganda. Methods We used a cross-sectional study design to collect quantitative data from 293 ALHIV at three health facilities in Lira municipality, northern Uganda. We used an interviewer-administered questionnaire and data abstraction form. Data were analysed using SPSS version 23 software. Descriptive analysis and logistic regressions were performed to determine the relationship between the predictor and outcome variables. Statistical significance was determined at P-value<0.05 and the adjusted odds ratio with a 95% confidence interval was used. Results The level of utilization of ART services was suboptimal among 27.6% (81/293) of the participants, and only 63.1% (185/293) were virally suppressed. Of the participants who were optimally utilizing ART services, the majority 86.8% (184/212) were virally suppressed. Age 10– 14 years (aOR = 3.34), the presence of both parents (aOR = 1.85), parental and peer reminders (aOR = 2.91) and (aOR = 0.49) respectively, and being on ART for five years or less were the characteristics related with optimal utilization of ART services. Conclusions and recommendations Not all ALHIV used ART services to their full potential. However, factors such as participants’ age, the presence of both parents, reminders from parents and peers, and being on ART for some time were all related to the optimal use of ART services. There is a need for developing strategies to increase family and peer support with a focus on older adolescents if the 95-95-95 goal is to be achieved in this age group.