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Female-controlled dual protection methods: Prevalence, predictors, experiences and perceptions among young women living with HIV in northern Uganda–A mixed-method study protocol
(PLoS ONE, 2023) Kumakech, Edward; Acen, Joy; Musinguzi, Marvin; Ebong, Doryn; Okello, James
Study background The use of dual protection methods among young women living with HIV (YWLHIV) aged 15–24 years in sub-Saharan Africa (SSA) is poorly researched despite the double risk of unintended pregnancy and HIV. Even more scanty is literature on the use of female-controlled dual protection methods. We propose to determine the female-controlled dual protection prevalence, and the predictors among YWLHIV in northern Uganda. The study will also explore the YWLHIV’s experiences and perceptions regarding the female-controlled dual protection methods. Materials and methods This study will employ a mixed-methods design. The study area will be Lira district and Lira city located in northern Uganda. The setting for recruitment of participants will be the public health facility–based anti-retroviral therapy (ART) clinics. These ART clinics serves a total of about 1,771 YWLHIV. A sample of 425 YWLHIV will be selected by stratified random sampling from the ART clinic registers. The three strata of interest will be the YWLHIV attending the ART clinic at referral hospitals, health centers level IV (primary healthcare centers), and health centers level III (dispensaries). The primary outcome will be the use of the femalecontrolled dual protection methods. The outcome will be measured by asking the YWLHIV ‘what methods under their control as YWLHIV do they use to protect against both unintended pregnancy and HIV during sexual intercourse with their male partners.’ The questionnaire also has measures for the unintended pregnancy, HIV status, and the potential predictors. Qualitative component of the study will be in-depth interviews of the participants about their experiences and perceptions regarding the female-controlled dual protection. methods. Data collection was still ongoing at the time of first submission of this study protocol to the journal (14th March 2023). The Statistical Package for Social Sciences (SPSS) version 23.0 will be used for the statistical analyses. Descriptive statistics, bivariate and multivariate regression analyses will be used to establish the prevalence, associated factors and the predictors of the outcome respectively. The statistical significance level of 5% and 95% confidence interval will be considered. In-depth interviews will be manually analyzed using a thematic analysis approach for codes, themes, and categories.
Uptake and Associated Factors of Male Contraceptive Method Use: A Community-Based Cross-Sectional Study in Northern Uganda
(Open Access Journal of Contraception, 2023) Tumwesigye, Raymond; Kigongo, Eustes; Nakiganga, Stella; Mbyariyehe, Godfred; Nabeshya, Joel; Kabunga, Amir; Musinguzi, Marvin; Migisha, Richard
Background: Uganda has one of the highest fertility rates in Sub-Saharan Africa (SSA). Improving contraceptive uptake in all genders, including males, may be critical to meeting family planning goals in such a setting. Yet, data on male contraception uptake and associated factors in SSA, including Uganda, are limited. We determined the uptake and associated factors of male contraception use in Lira City, Northern Uganda. Methods: We conducted a community-based cross-sectional study from November 12, 2022, to December 12, 2022, among men aged ≥18 years. We used multi-stage sampling to select participants from 12 cells of Lira City divisions of East and West. Data were collected using interviewer-administered structured questionnaires. We defined uptake in males who had used any contraceptive method, including periodic abstinence, withdrawal, condoms, and vasectomy in the previous four weeks. We performed modified Poisson regression to identify associated factors of male contraception uptake. Results: We recruited 401 participants with mean age of 30.4 (±9.3) years. Male contraceptive uptake was 46.4%, 95% CI: 41.5– 51.3%. Ever heard about male contraception (adjusted prevalence ratio [aPR] =1.73, 95% CI: 1.172–2.539, p=0.006), willingness to use novel methods (aPR=2.90, 95% CI: 1.337–6.293, p=0.007), both partners being responsible for contraception (aPR: 1.53, 95% CI: 1.113–2.119, p=0.009) were the factors associated with male contraception uptake. Conclusion: We found that nearly half of the men surveyed had used male contraceptive methods in Lira City. Factors associated with the uptake of male contraception included having heard about male contraception, joint couple decision regarding contraception, and the use of novel methods of male contraception. We recommend comprehensive education and awareness campaigns to promote male contraception, with a particular emphasis on encouraging shared decision-making within couples and introducing innovative contraceptive options.
Depression, suicidality, substance-use and associated factors among people living with HIV the COVID-19 pandemic in Uganda
(PLOS ONE, 2023) Rukundo, Godfrey Zari; Wakida, Edith K.; Karungi, Christine K.; Asasira, Jenipher; Kumakech, Edward; Obua, Celestino
Background Mental disorders are common in people living with HIV (PLHIV) but they are often unrecog nized and untreated. Furthermore, the COVID-19 pandemic has disrupted the already lim ited mental health services in low resource countries such as Uganda, and yet the extent to which the COVID-19 mitigation measures have affected the mental health of PLHIV is not fully known. We aimed to determine the burden of depression, suicidality, substance use and associated factors among adult PLHIV who were seeking care at two HIV clinics in northern and southwestern Uganda. Methods We conducted a phenomenological qualitative and quantitative cross-sectional study among 431 PLHIV to determine the burden of depression, suicidality and substance-use disorders at two HIV clinics, at Lira Regional Referral Hospital and Mbarara Regional Refer ral Hospital in northern and southwestern Uganda respectively, during the COVID-19 lock down. We used the Patient Health Questionnaire (PHQ-9) to assess for depression and suicidality, and the Michigan Assessment-Screening Test for Alcohol and drugs (MAST-AD) to assess for substance use disorder. We conducted descriptive statistics analysis to deter mine the burden of the disorders, and logistic regression to determine the associated fac tors. For the qualitative method we conducted in-depth interviews with 30 PLHIV and did thematic analysis. Results Of the 431 PLHIV surveyed, mean age was 40.31 ± 12.20 years; 53.1% (n = 229) had depression; 22.0% (n = 95) had suicidality; and 15.1% (n = 65) had substance-use disorder. Female gender (PR = 1.073, 95%CI 1.004–1.148, P = 0.038), lack of formal education (PR0.859–0.994, P = 0.034) and suicidality (PR = 0.757, 95%CI 0.722–0.794, p = 0.000) were associated with depression after adjusting for confounders. Further analysis showed that being female (PR = 0.843, 95% CI 0.787–0.903, P = 0.000*) and having depression (PR = 0.927, 95% CI 0.876–0.981, P = 0.009) and owning a large business (PR = 0.886, 95% CI 0.834–0.941, p = 0.000*) were significantly associated with having a substance-use disor der. Only depression was independently associated with suicidality after adjusting for con founding factors (PR 0.108, 95%CI 0.054–0.218, p = 0.000*). For the qualitative results, there were three apriori themes: a) Burden of depression, b) substance-use, and c) suicidal ity among the PLHIV during the COVID-19 containment measures. Conclusion There was high prevalence of depression, suicidality and substance-use disorder in adult PLHIV in Uganda during the COVID-19 pandemic and the associated lockdown measures. The three mental health problems seem to have bidirectional relationships and gender has a lot of contribution to the relationships. Interventions aimed at any of the disorders should consider these bidirectional relationships.
Factors associated with uptake of human papilloma virus vaccine among school girls aged 9–14 years in Lira City northern Uganda: a cross-sectional study
(BMC Women's Health, 2023) Nakayita, Renniter Mirembe; Benyumiza, Deo; Nekesa, Catherine; Misuk, Ivan; Kyeswa, Julius; Nalubuuka, Aisha; Murungi, Tom; Udho, Samson; Kumakech, Edward
Abstract Background Cervical cancer is the most common Human Papilloma Virus (HPV)-related disease among women. Since 2008, HPV vaccination has been routinely recommended for pre-adolescent and adolescent girls in Uganda as the primary preventive measure for cervical cancer. However, in Uganda, most especially in Lira district, there is limited literature on HPV vaccination uptake and associated factors among girls aged 9-14years. This study assessed the uptake of HPV vaccine and associated factors among in-school girls aged 9–14 years in Lira City, northern Uganda. Methods A cross-sectional study was conducted among 245 primary school girls aged 9–14 years in Lira City, northern Uganda. Multistage sampling technique was used to sample eligible participants and data was collected using interviewer administered questionnaire. Data was analysed using SPSS version 23.0. Descriptive statistics and multivariate logistic regression at 95% level of significance were used to identify the level of HPV vaccine uptake and predictors respectively. Results HPV vaccination uptake was at 19.6% (95% CI,14.8–25.1) among the school girls aged 9–14 years in Lira City, northern Uganda. The mean age of the girls was 12.11 (±1.651) years. Predictors that were independently associated with HPV vaccine uptake included; recommendation from health worker [aOR 9.09, 95% CI (3.19–25.88), P≤0.001], taught about cervical cancer at school [aOR,12.56, 95% CI (4.60–34.28), P≤0.001], and exposure to outreach clinics [aOR, 4.41, 95% CI (1.37–14.19), P=0.013]. Conclusion The study found that one in five of the school girls in Lira City, northern Uganda. received HPV vaccine. Girls who were taught about cervical cancer at school, exposure to outreach clinics and received health worker recommendation had more odds of receiving HPV vaccine than their counter parts. The Ministry of Health should strengthen school based cervical cancer education, awareness raising about HPV vaccination and health worker recommendations to improve HPV vaccine uptake among school girls in Uganda.
Factors Associated with Utilization of Sexual and Reproductive Health Services among the Youth in Lira City West, Northern Uganda: A Cross-Sectional Study
(BioMed Research International, 2023) Murungi, Tom; Benyumiza, Deo; Apio, Juliet; Nekesa, Catherine; Nalubuuka, Aisha; Misuk, Ivan; Kumakech, Edward
Background. The youth in Uganda, as in much of sub-Saharan Africa, face numerous sexual and reproductive health (SRH) challenges, from human immunodeficiency virus HIV infection, and unsafe abortions to unwanted pregnancies. This study, therefore, assessed the utilization of sexual and reproductive health services and associated factors among the youth in Lira city west, northern Uganda. Methods. This was a cross-sectional study conducted in January 2023 among 386 young people (15-24 years) in Lira city west division, Lira city. Multistage cluster sampling technique was used to recruit our study participants. Data were collected using an interviewer-administered questionnaire. Data were analyzed using SPSS version 23, descriptive statistics, cross-tabulation, bivariate, and multivariate logistic regression analyses. All variables were set by p values less than 0.05 and reported adjusted odds ratio with its 95% confidence interval. Results. The utilization of SRH services was 42.0% (162/386) among the study participants. Family planning, voluntary HIV counseling and testing (VCT), and general counseling services were the most utilized SRH services in the past 12 months. Young people who were aware of SRH services (AOR: 0.24; 95% CI: 0.08-0.74), were aware of a reproductive health facility (AOR, 4.24; 95% CI: 1.62-11.09), discussed SRH issues with peers/friends (AOR, 3.98; 95% CI: 1.53-10.33), had a sexual partner (AOR, 10.00; 95% CI: 4.05-24.69), had sexual intercourse (AOR, 4.59; 95% CI: 2.18-9.69), and had access to SRH services (AOR, 2.68; 95% CI: 1.12-6.40) were more likely to utilize SRH services compared to their counterparts. Conclusion. This study showed a low utilization of sexual and reproductive health services among youth in Lira city west, northern Uganda. Being aware of SRH services, awareness of reproductive health facilities, discussing SRH issues with peers, having sexual intercourse, having a sexual partner, and access to SRH services were independently associated with the utilization of SRH services. Therefore, there is a need to strengthen sustainable multisector approaches aimed at improving awareness and access to sexual and reproductive health services among the youth
Depression, suicidality, substance-use and associated factors among people living with HIV the COVID-19 pandemic in Uganda.
(Plos one, 2023) Rukundo, Godfrey Zari; Wakida, Edith K.; Karungi, Christine K.; Asasira, Jenipher; Kumakech, Edward; Obua, Celestino
Background Mental disorders are common in people living with HIV (PLHIV) but they are often unrecog nized and untreated. Furthermore, the COVID-19 pandemic has disrupted the already lim ited mental health services in low resource countries such as Uganda, and yet the extent to which the COVID-19 mitigation measures have affected the mental health of PLHIV is not fully known. We aimed to determine the burden of depression, suicidality, substance use and associated factors among adult PLHIV who were seeking care at two HIV clinics in northern and southwestern Uganda. Methods We conducted a phenomenological qualitative and quantitative cross-sectional study among 431 PLHIV to determine the burden of depression, suicidality and substance-use disorders at two HIV clinics, at Lira Regional Referral Hospital and Mbarara Regional Refer ral Hospital in northern and southwestern Uganda respectively, during the COVID-19 lock down. We used the Patient Health Questionnaire (PHQ-9) to assess for depression and suicidality, and the Michigan Assessment-Screening Test for Alcohol and drugs (MAST-AD) to assess for substance use disorder. We conducted descriptive statistics analysis to deter mine the burden of the disorders, and logistic regression to determine the associated fac tors. For the qualitative method we conducted in-depth interviews with 30 PLHIV and did thematic analysis. Results Of the 431 PLHIV surveyed, mean age was 40.31 ± 12.20 years; 53.1% (n = 229) had depression; 22.0% (n = 95) had suicidality; and 15.1% (n = 65) had substance-use disorder. Female gender (PR = 1.073, 95%CI 1.004–1.148, P = 0.038), lack of formal education (PR= 1.197, 95% CI 1.057–1.357, P = 0.005), substance-use disorder (PR = 0.924, 95%CI 0.859–0.994, P = 0.034) and suicidality (PR = 0.757, 95%CI 0.722–0.794, p = 0.000) were associated with depression after adjusting for confounders. Further analysis showed that being female (PR = 0.843, 95% CI 0.787–0.903, P = 0.000*) and having depression (PR = 0.927, 95% CI 0.876–0.981, P = 0.009) and owning a large business (PR = 0.886, 95% CI 0.834–0.941, p = 0.000*) were significantly associated with having a substance-use disor der. Only depression was independently associated with suicidality after adjusting for con founding factors (PR 0.108, 95%CI 0.054–0.218, p = 0.000*). For the qualitative results, there were three apriori themes: a) Burden of depression, b) substance-use, and c) suicidal ity among the PLHIV during the COVID-19 containment measures. Conclusion There was high prevalence of depression, suicidality and substance-use disorder in adult PLHIV in Uganda during the COVID-19 pandemic and the associated lockdown measures. The three mental health problems seem to have bidirectional relationships and gender has a lot of contribution to the relationships. Interventions aimed at any of the disorders should consider these bidirectional relationships.
Factors influencing the use of multiple HIV prevention services among transport workers in a city in southwestern Uganda
(PLOS Glob Public Health, 2023) Betunga, Benjamin; Atuhaire, Phionah; Nakasiita, Catherine; Kanyamuneza, Christa; Namiiro, Proscovia; Tugume, Joseph; Matovu, Hairat; Sark, Ahmed M.; Mugabi, Benedicto; Lilian, Birungi; Mugisha, Richard; Kumakech, Edward; Asiimwe, John Baptist
The use of multiple HIV prevention services has been found to decrease the risk of acquiring HIV when tailored to individuals at risk of HIV exposure, including transport workers. There- fore, we assessed the uptake of multiple HIV prevention services (�2) and associated fac- tors among transport workers in a city in Southwestern Uganda. This cross-sectional study comprised motorcycle taxi riders, motor vehicle and truck drivers, aged 18 to 55 years who were selected and responded to an interviewer-administered questionnaire, between November 2021 and February 2022. Data was analyzed using descriptive statistical and modified Poisson regression analyses. Out of 420 participants, 97.6% were male, with a median age of 28 years and the majority were aged <34 years (84.6%). Overall, less than half (45.3%) of the participants had used multiple (�2) HIV prevention services within a one- year period. Many participants had used condoms (32.2%) followed by voluntary HIV counseling and testing (27.1%), and safe male circumcision (17.3%). Most participants who tested for HIV had ever used condoms (16.2%), followed by those who received safe male circumcision and had ever used condoms (15%), and those who tested for HIV and had started on antiretroviral therapy (ART) (9.1%). In the adjusted model, factors that were sig- nificantly associated with the use of multiple HIV prevention services included religion (aPR = 1.25, 95% CI = 1.05–1.49), the number of concurrent sex partners (aPR = 1.33, 95% CI = 1.10–1.61), prior HIV testing and awareness of HIV serostatus (aPR = 0.55, 95% CI = 0.43– 0.70), awareness of HIV prevention services (aPR = 2.49, 95% CI = 1.16–5.38), and finan- cial payment to access HIV services (aPR = 2.27, 95% CI = 1.47–3.49). In conclusion, the uptake of multiple HIV prevention services among transport workers remains suboptimal. Additionally, individual behavioral factors influence the use of multiple HIV services com- pared with other factors. Therefore, differentiated strategies are needed to increase the utili- zation of HIV prevention services among transport workers
Prevalence and correlates of teenage pregnancy among in-school teenagers during the COVID-19 pandemic in Hoima district western Uganda–A cross sectional community-based study
(PLoS ONE, 2022) Musinguzi, Marvin; Kumakech, Edward; Auma, Anne Grace; Akello, Ruth Anne; Kigongo, Eustes; Tumwesigye, Raymond; Opio, Bosco; Kabunga, Amir; Omech, Bernard
Background The COVID-19 pandemic related restrictions and lockdown measures had compromised the routine delivery and access of sexual and reproductive health and rights services to the population including the teenage girls. However, the teenage pregnancy rates during COVID-19 pandemic period were poorly documented. This study aimed at determining the prevalence and the factors associated with teenage pregnancy among in-school teenage girls during the COVID-19 pandemic period in Hoima District Uganda. Methods This was a descriptive cross-sectional study that employed quantitative research methods. A total of 314 in-school teenage girls aged 13–19 years were selected using a multi-stage sampling techniques. Interviewer-administered questionnaires were used to collect the data from the participant’s homes during the period December 2021-January 2022. Data analysis was done using univariate, bi-variate, and multivariate. Results The prevalence of teenage pregnancy among the in-school teenage girls in Hoima district Uganda was 30.6% [96/314]. Higher teenage pregnancy rates were prevalent among the unmarried teenage girls [aOR: 9.6; 95%CI: 4.64–19.87; p = 0.000], teenage girls studying from boarding schools [aOR 2.83, 95%CI 1.36–5.86, p = 0.005], contraceptive non-users [aOR: 2.54; 95%CI: 1.12–5.4; p = 0.015] and teenage girls involved in sex trade [aOR 3.16, 95%CI 1.5–6.7, p = 0.003]. The factors associated with the reduced likelihood for teenage pregnancy included being an adult teenage girl aged 18–19 years [aOR: 0.15; 95%CI: 0.07–0.32; p = 0.000] and not receiving sex education during the period [aOR 0.36, 95%CI 0.13– 0.62, p = 0.024]. Conclusion The results indicated that 3 out of 10 in-school teenage girls from Hoima district Uganda got pregnant during the COVID-19 pandemic period of 2021. Teenage pregnancy was prevalent among teenage girls who don’t use modern contraceptive methods and those involved in sex trade. Teenage pregnancy was however, less prevalent among adult teenage girls aged 18–19 years. The findings point to the need for health stakeholders to innovate creative policies, contingency plans and programmes aimed at delaying age for sexual activities, increasing contraceptive use and minimizing pregnancy risk from sex trade among in-school teenage girls during COVID-19 pandemics.
Caregiver’s perspectives on the Central Nervous System infection illness trajectory among older persons with dementia in Northern Uganda—a qualitative community‑based study
(BMC Geriatrics, 2022) Benyumiza, Deo; Kumakech, Edward; Gutu, Jastine; Banihani, Jude; Mandap, Joshua; Talib, Zohray M.; Wakida, Edith K.; Maling, Samuel; Obua, Celestino
Background: Few studies have explored the Central Nervous System (CNS) infection illness trajectory among older persons with dementia in sub-Saharan African (SSA) settings. This study explored the Caregiver’s perspectives on the Central Nervous System infection illness trajectory among the older persons with dementia in Northern Uganda. Methods: This was a qualitative study conducted in Lira District northern Uganda in March 2022 amongst purposively selected 20 caregivers of the older persons aged 50 + years with a positive history of CNS infection and later life dementia. Data were collected using an in-depth interview guide. Audio recordings and field notes of the interviews were undertaken. The interviews generated data on the CNS infection illness trajectory from onset to the current demented state of the older persons. The audio-recorded interviews were transcribed verbatim before manual reflective thematic analysis. Results: Older persons with a positive history of CNS infection illness and later life dementia in rural northern Uganda presented with symptoms of early life CNS infection illness ranging from neck pain, back pain, chronic headache, and fatigue. There were also manifestations of comorbidities particularly road traffic accidents involving traumatic injury to the head, neck, and spine, high blood pressure, chronic headache, and or their medications in the older person’s trajectory to later life dementia. A plurality of healthcare which included both formal and informal healthcare medicines was sought and utilized for the treatment and care of the CNS infection illness and dementia by the older persons amidst improper diagnosis and mismanagement. Conclusions and recommendations: Older persons with early-life CNS infections illness and later-life dementia were reported to present with symptoms including neck pain, back pain, chronic headache, high blood pressure, and fatigue. The reported symptoms of CNS infection illness may be intertwined with co-morbidities particularly traumatic injury involving the head, neck, and spine, high blood pressure, and chronic headache. Healthcare professionals should integrate routine screening of older persons for the history of CNS infections, chronic headache, high blood pressure, trauma to the head, neck, and spine, and dementia and early treatment
HIV-related stigma experiences and coping strategies among pregnant women in rural Uganda: A qualitative descriptive study
(PloS one, 2022) Jolle, Judith; Kabunga, Amir; Okello, Tonny Owili; Kadito, Esther Oloi; Aloka, Jimmy; Otiti, Geoffrey; Aluku, Agnes Adong; Kumakech, Edward; Udho, Samson
Background HIV-related stigma is a global problem among HIV clients with far-reaching effects including increased rates of mother-to-child transmission of HIV. However, HIV-related stigma experiences and coping strategies have received little attention, especially among pregnant women in rural settings. We explored the HIV-related stigma experiences and coping strategies among pregnant women in rural northern Uganda. Methods This was a qualitative descriptive study conducted among HIV-positive pregnant women seeking care at Aboke Health Center IV, Kole district, northern Uganda. We conducted 12 in-depth interviews using a semi-structured interview guide. Data were analyzed using the inductive thematic approach of Braun and Clarke. Results The age range of the 12 participants was 17 to 35 years while the average duration with HIV since diagnosis was five years. The majority of the participants were subsistence farmers who had attained a primary level of education. Social rejection and public ridicule were identified as HIV-related stigma experiences while ignoring, social support, and prayers were identified as HIV-related coping strategies among the study participants. Conclusion Enacted HIV-related stigma is common among pregnant women in rural northern Uganda. Healthcare providers should work closely with HIV-positive women and other stakeholders to identify and strengthen HIV-related stigma coping strategies among pregnant women in rural settings.
Perceptions of Undergraduates and Mentors on the Appropriateness, Acceptability, and Feasibility of the HEPI-TUITAH Micro-Research Approach to HIV Training in Uganda
(Advances in Medical Education and Practice, 2022) Wakida, Edith K; Rukundo, Godfrey Z; Atuhaire, Clara; Karungi, Christine K; Kumakech, Edward; Haberer, Jessica E; Talib, Zohray M; Obua, Celestino
Purpose: To evaluate the perceptions of undergraduates and mentors on the appropriateness, acceptability, and feasibility of a mentored seed-grant (micro-research) by Health Professions Education Partnership Initiative - Transforming Ugandan Institutions Training Against HIV/AIDS (HEPI-TUITAH) program on HIV training in Uganda. Methods: We conducted a cross-sectional descriptive qualitative study with focus groups, on HIV micro-research training, with undergraduate health professions students and faculty mentors across three partner institutions in rural Uganda. Results: A total of 24 students and 13 mentors (5–8 per group) took part in the focus group discussions. Most participants stated that the HEPI-TUITAH micro-research program was acceptable, appropriate and feasible for health professions undergraduate students. The interprofessional education approach of bringing together students from different programs and years of study was valuable especially for peer mentorship. There was a need to provide for institution-based training in addition to the centrally organized training for the benefit of all the team members. Participants also noted a need for the program to find a way of providing the students with data collection experience even with the COVID-19 pandemic situation. Conclusion: The HEPI-TUITAH micro-research program was perceived as acceptable, appropriate, and feasible for health professions undergraduate students. It also promoted teamwork and academic collaboration. Provision for institution-based micro-research training activities and data collection experiences for the undergraduate students even during the COVID-19 pandemic would make the program more valuable. The lessons learnt will be applied to future training cohorts to optimize program impact and may be useful for similar programs in other settings.
Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: A community-based crosssectional study
(PLoS ONE, 2020) Arach, Anna Agnes Ojok; Nakasujja, Noeline; Nankabirwa, Victoria; Ndeezi, Grace; Kiguli, Juliet; Mukunya, David; Odongkara, Beatrice; Achora, Vincentina; Tongun, Justin Bruno; Musaba, Milton Wamboko; Napyo, Agnes; Zalwango, Vivian; Tylleskar, Thorkild; Tumwine, James K.
Introduction Deaths during the perinatal period remain a big challenge in Africa, with 38 deaths per 1000 pregnancies in Uganda. The consequences of these deaths can be detrimental to the women; some ending up with postpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda. Methods We conducted a community-based cross-sectional study of 1,789 women. Trained research assistants screened women for postpartum depressive symptoms on day 50 postpartum using the Edinburgh postpartum depression scale (EPDS). Socio-demographic, economic, birth and survival status of the neonate were collected during pregnancy and within one week postpartum. We used generalized estimating equation for the Poisson family with a log link using Stata to estimate the prevalence ratio of the association between postpartum depressive symptoms (EPDS scores �14) and perinatal death. Mothers who lost their babies between 7–49 days postpartum were excluded. Results Of the 1,789 participants symptomatically screened for postpartum depression, 377 (21.1%) [95% confidence interval (95%CI): 17.2%, 23.0%] had probable depressive symptoms. The prevalence of postpartum depressive symptoms among the 77 women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (�7 days of life)) was 62.3% [95% CI: 50.8%, 72.6%] compared to 19.2% [95% CI: 17.4%, 21.2%], among 1,712 with live infants at day 50 postpartum. Women who had experienced a perinatal death were three times as likely to have postpartum depressive symptoms as those who had a live birth [adjusted prevalence ratio 3.45 (95% CI: 2.67, 4.48)]. Conclusions The prevalence of postpartum depressive symptoms, assessed by EPDS, was high among women who had had a perinatal death in Northern Uganda. Women experiencing a perinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.
Prevalence and predictors for unintended pregnancy among HIV‑infected pregnant women in Lira, Northern Uganda: a cross‑sectional study
(Scientific Reports, 2020) Napyo, Agnes; Nankabirwa, Victoria; Mukunya, David; Tumuhamye, Josephine; Ndeezi, Grace; Arach, Anna Agnes Ojok; Odongkara, Beatrice; Waako, Paul; Tylleskär, Thorkild; Tumwine, James K.
Prevention of unintended pregnancies is a global strategy to eliminate mother-to-child transmission of HIV. Factors surrounding unintended pregnancy among women living with HIV are not well understood. We aimed to determine the prevalence and predictors for unintended pregnancy among these women in Northern Uganda. We conducted a cross-sectional survey among 518 women using a structured questionnaire. We asked questions on socio-demographic, reproductive-related and HIVrelated characteristics. We conducted multivariable logistic regression and reported adjusted odds ratios. The prevalence of unintended pregnancy was 41.1%. The predictors for unintended pregnancy were: being single (not living with a partner or being in a marital union), having five or more children and taking antiretroviral drugs for long periods of time. HIV counselling services should target women living with HIV who are not in a marital union, those having a higher parity and those who have taken ART for longer periods.
Perinatal death in Northern Uganda: incidence and risk factors in a community-based prospective cohort study
(Global Health Action, 2021) Arach, Anna Agnes Ojok; Tumwine, James K.; Nakasujja, Noeline; Ndeezi, Grace; Kiguli, Juliet; Mukunya, David; Odongkara, Beatrice; Achora, Vincentina; Tongun, Justin B.; Musaba, Milton W.; Napyo, Agnes; Tylleskar, Thorkild; Nankabirwa, Victoria
Background: Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030. To improve perinatal survival, there is a need to understand the persisting risk factors for death. Objective: We determined the incidence, risk factors, and causes of perinatal death in Lira district, Northern Uganda. Methods: This was a community-based prospective cohort study among pregnant women in Lira district, Northern Uganda. Female community volunteers identified pregnant women in each household who were recruited at ≥28 weeks of gestation and followed until 50 days postpartum. Information on perinatal survival was gathered from participants within 24 hours after childbirth and at 7 days postpartum. The cause of death was ascertained using verbal autopsies. We used generalized estimating equations of the Poisson family to determine the risk factors for perinatal death. Results: Of the 1,877 women enrolled, the majority were ≤30 years old (79.8%), married or cohabiting (91.3%), and had attained only a primary education (77.7%). There were 81 perinatal deaths among them, giving a perinatal mortality rate of 43/1,000 births [95% confidence interval (95% CI: 35, 53)], of these 37 were stillbirths (20 deaths/1,000 total births) and 44 were early neonatal deaths (23 deaths/1,000 live births). Birth asphyxia, respiratory failure, infections and intra-partum events were the major probable contributors to perinatal death. The risk factors for perinatal death were nulliparity at enrolment (adjusted IRR 2.7, [95% CI: 1.3, 5.6]) and maternal age >30 years (adjusted IRR 2.5, [95% CI: 1.1, 5.8]). Conclusion: The incidence of perinatal death in this region was higher than had previously been reported in Uganda. Risk factors for perinatal mortality were nulliparity and maternal age >30 years. Pregnant women in this region need improved access to care during pregnancy and childbirth.
WHO technical specifications Cryosurgical equipment for the treatment of precancerous cervical lesions and prevention of cervical cancer
(WHO, 2012) Chidanyika, Agnes; de Vuyst, Hugo; Blumenthal, Paul; Lu Jhpiego, Ricky; Santos, Carlos; Jeronimo, Jose; Hedman, Lisa; Nordin, Ingegerd; Adnew, Shumet; Zaw, Min; Boxshall, Matts; Kumakech, Edward; Baravilala, Wame
Cervical cancer is a serious and growing global health issue. In 2008, there were approximately 274 000 deaths from the disease, about 88% of which occurred in developing countries. Although it affects women worldwide, cervical cancer mortality is highest in low-resource settings. Cryotherapy, also known as cryosurgery, has been widely accepted as a practical and effective method of treating precancerous cervical lesions. It is appropriate for use in lowresource settings because it is effective, has limited side-effects, does not require electricity, is inexpensive compared to other treatment options, and is technically simple to implement. This document seeks to assist programme managers, purchasing managers, and other interested parties with the procurement, management and effective use of cryosurgical equipment to treat precancerous cervical lesions as part of a comprehensive cervical cancer prevention programme. It provides an overview of the procurement and performance issues associated with some cryosurgical devices, gas supplies and gas cylinders, and necessary connectors. The document offers technical specifications for purchasers, including the design and performance recommendations necessary to ensure the safety and efficacy of cryosurgical equipment, issues related to the gases used by the equipment, and guidance on how to procure both the equipment and the gases. Annexes provide additional useful information.
Using Formative Research to Design a Behavior Change Strategy to Increase the Use of Improved Cookstoves in Peri-Urban Kampala, Uganda
(International journal of environmental research and public health, 2013) Martin, Stephanie L.; Arney, Jennifer K.; Mueller, Lisa M.; Kumakech, Edward; Walugembe, Fiona; Mugisha, Emmanuel
Household air pollution from cooking with biomass fuels negatively impacts maternal and child health and the environment, and contributes to the global burden of disease. In Uganda, nearly 20,000 young children die of household air pollution-related pneumonia every year. Qualitative research was used to identify behavioral determinants related to the acquisition and use of improved cookstoves in peri-urban Uganda. Results were used to design a behavior change strategy for the introduction of a locally-fabricated top-lit updraft gasifier (TLUD) stove in Wakiso district. A theoretical framework—opportunity, ability, and motivation—was used to guide the research and behavior change strategy development. Participants consistently cited financial considerations as the most influential factor related to improved cookstove acquisition and use. In contrast, participants did not prioritize the potential health benefits of improved cookstoves. The theoretical framework, research methodology, and behavior change strategy design process can be useful for program planners and 6921 researchers interested in identifying behavioral determinants and designing and evaluating improved cookstove interventions.
Significantly Reduced Genoprevalence of Vaccine-Type HPV-16/18 Infections among Vaccinated Compared to Non-Vaccinated Young Women 5.5 Years after a Bivalent HPV-16/18 Vaccine (Cervarix1) Pilot Project in Uganda
(2016) Kumakech, Edward; Berggren, Vanja; Wabinga, Henry; Lillsunde- Larsson, Gabriella; Helenius, Gisela; Kaliff, Malin; Karlsson, Mats; Kirimunda, Samuel; Musubika, Caroline
The objective of this study was to determine the prevalence and some predictors for vaccine and non-vaccine types of HPV infections among bivalent HPV vaccinated and non-vaccinated young women in Uganda. This was a comparative cross sectional study 5.5 years after a bivalent HPV 16/18 vaccination (Cervarix1, GlaxoSmithKline, Belgium) pilot project in western Uganda. Cervical swabs were collected between July 2014-August 2014 and analyzed with a HPV genotyping test, CLART1 HPV2 assay (Genomica, Madrid Spain) which is based on PCR followed by microarray for determination of genotype. Blood samples were also tested for HIV and syphilis infections as well as CD4 and CD8 lymphocyte levels. The age range of the participants was 15–24 years and mean age was 18.6(SD 1.4). Vaccine-type HPV-16/18 strains were significantly less prevalent among vaccinated women compared to non-vaccinated women (0.5% vs 5.6%, p 0.006, OR 95% CI 0.08 (0.01–0.64). At type-specific level, significant difference was observed for HPV16 only. Other STIs (HIV/syphilis) were important risk factors for HPV infections including both vaccine types and non-vaccine types. In addition, for non-vaccine HPV types, living in an urban area, having a low BMI, low CD4 count and having had a high number of life time sexual partners were also significant risk factors. Our data concurs with the existing literature from other parts of the world regarding the effectiveness of bivalent HPV-16/18 vaccine in reducing the prevalence of HPV infections particularly vaccine HPV- 16/18 strains among vaccinated women. This study reinforces the recommendation to vaccinate young girls before
Screen-and-Treat Approach to Cervical Cancer Prevention Using Visual Inspection With Acetic Acid and Cryotherapy: Experiences, Perceptions, and Beliefs From Demonstration Projects in Peru, Uganda, and Vietnam
(The oncologist, 2013) Proma, Paul; Winkler, Jennifer L.; Bartolini, Rosario M.; Penny, Mary E.; Huong, Trinh Thu; Nga, Le Thi; Kumakech, Edward; Mugisha, Emmanuel; Jeronimo, Jose
Cervical cancer is preventable but continues to cause the deaths of more than 270,000 women worldwide each year, most of them in developing countries where programs to detect and treat precancerous lesions are not affordable or available. Studies have demonstrated that screening by visual inspection of the cervix using acetic acid (VIA) is a simple, affordable, and sensitive test that can identify precancerous changes of the cervix so that treatment such as cryotherapy can be provided. Government partners implemented screening and treatment using VIA and cryotherapy at demonstration sites in Peru, Uganda, and Vietnam. Evaluations were conducted in the three countries to explore the barriers and facilitating factors for the use of services and for incorporation of screen-and-treat programs using VIA andcryotherapyintoroutineservices.Resultsshowedthatuseof VIA and cryotherapy in these settings is a feasible approach to providing cervical cancer prevention services. Activities that can help ensure successful programs include mobilizing and educating communities, organizing services to meet women’s schedules and needs, and strengthening systems to track clients for follow-up. Sustainability also depends on having an adequate number of trained providers and reducing staff turnover. Althoughsomechallengeswerefoundacrossallsites, othersvaried fromcountryto country, suggesting that carefulassessmentsbefore beginning new secondary prevention programs will optimize the probability of success. The Oncologist 2013;18: 1278–1284
Performance of Cervical Cancer Screening Techniques in HIV-Infected Women in Uganda
(Journal of Lower Genital Tract Disease, 2015) Bansil, Pooja; Lim, Jeanette; Kumakech, Edward; Nakisige, Carol; Jeronimo, Jose A
Women infected with human immunodeficiency virus (HIV) have a higher risk of HPV infections and developing cervical cancer, thus screening them is imperative. This study was aimed to evaluate and compare the performance of 3 cervical cancer screening options among HIV-infected women in Uganda. Materials and Methods Data from 2,337 Ugandan women who reported their HIV status were obtained from a population-based cervical cancer screening study. Women were offered 3 screening tests: vaginal and cervical careHPV and visual inspection with acetic acid (VIA), and the results were evaluated by HIV status. Results The prevalence of HIV infection was 16.5%. Women infected with HIV had a higher prevalence of cervical intraepithelial neoplasia grade 2+ (CIN2+) than uninfected women (12.9% vs 1.7%; p < .001). The sensitivity for cervical careHPV among the HIV-infected women was 94.3% compared to 81.3% among the uninfected women. Whereas the sensitivity for vaginal careHPV was also higher among the HIV-infected women, the sensitivity of VIA was higher among the uninfected women. The mean vaginal and cervical careHPV signal strength was higher in the HIV-infected women than in the uninfected women (p < .001). Conclusions CareHPV is very sensitive for detecting CIN2+ in HIV-infected women, even using a vaginal sample. The sensitivity of careHPV in HIV-infected women is higher than in HIV-uninfected women. However, additional research is needed to determine the best option for screening and triage of HPV-positive women that can be implemented in low-resource settings, especially among HIV- and HPV-positive women. CareHPV, a new human papillomavirus DNA screening test, is a very sensitive cervical screening method for detecting cervical intraepithelial neoplasia grade 2+ in human immunodeficiency virus–infected women.
Prevalence, genotypes and risk factors for vaccine and non-vaccine types of Human Papillomavirus (HPV) infections among Bivalent HPV-16/18 vaccinated and non-vaccinated young women in Ibanda district Uganda: 5 year follow up study
(2015) Kumakech, Edward; Berggren, Vanja; Lillsunde-Larsson, Gabriella; Helenius, Gisela; Kaliff, Malin; Karlsson, Mats; Musubika, Carol; Kirimunda, Samuel; Wabinga, Henry; Andersson, Sören

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