Contraceptive acceptability and associated factors among young women (15-24) living with HIV/AIDS: a hospital-based study in Kampala, Uganda

introduction: In Uganda, over 43% of all pregnancies among young women (15-24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics in Kampala. Methods: Between February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross-sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive. Data were analyzed using STATA 13.0. Statistical significance was determined at a P values < 0.05. Results: Contraceptive acceptability was 40.7% (95% CI: 27.6%-53.6%). Older age group (20-24 years) (aPR; 2.42, 95%CI; 1.06-5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13-1.38, P<0.001), having friend on contraceptives (aPR; 1.90, 95%CI; 1.10 - 3.26; P =0.021) and being married (aPR; 1.20, 95%CI; 1.09 - 1.32, P<0.001) were significantly associated with acceptability of contraceptives. Conclusion: There is a low acceptability for contraceptives. Younger age group who are not yet married need to be targeted

Ability and willingness to pay for family planning services in low resource settings: evidence from an operational research

Objective: This paper establishes levels and patterns of ability and willingness to pay (AWTP) for contraceptives, and associated factors. Study design: A three-stage cluster and stratified sampling was applied in selection of enumeration areas, households and individuals in a baseline survey for a 5-year Family planning programme. Multivariable linear and modified Poisson regressions are used to establish factors associated with AWTP. Results: Ability to pay was higher among men (84%) than women (52%). A high proportion of women (96%) and men (82%) were able to pay at least Ug Shs 1000 ($0.27) for FP services while 93% of women and 83% of men who had never used FP services will in future be able to pay for FP services costed at least Shs 2000 ($0.55). The factors independently associated with AWTP were lower age group (<25 years), residence in urban areas, attainment of higher education level, and higher wealth quintiles. Conclusion: AWTP for FP services varied by different measures. Setting the cost of FP services at Shs 1000 ($0.27) will attract almost all women (96%) and most of men (82%). Key determinants of low AWTP include residence in poor regions, being from rural areas and lack of/low education. Implications statement: Private providers should institute price discrimination for FP services by region, gender and socio-economic levels. More economic empowerment for disadvantaged populations is needed if the country is to realise higher contraceptive uptake. More support for total market approach for FP services needed

Reporting of sexual and gender-based violence and associated factors among survivors in Mayuge, Uganda

background: Reporting of Sexual and Gender-Based Violence (SGBV) allows survivors to access support services to minimize the impact of the violence on their lives. However, research shows that most SGBV survivors do not report. Objective: We aimed to determine the proportion of survivors of SGBV in Mayuge District, Uganda, who report SGBV, and the factors associated with reporting. Methods: Using a cross-sectional study design, we analyzed data of SGBV survivors in eight villages in Mayuge district collected in a baseline survey of a larger experimental study. Data were analyzed using Modified Poisson Regression. Results: Of the 723 participants, 65% were female. Only 31.9% had reported the SGBV experienced. Reporting was 43% lower among survivors aged 45 years and older (p-value = 0.003), and 41% lower among survivors with higher than a primary school education (p-value = 0.005). Likewise, reporting was 37% lower among survivors who relied on financial support from their partners (p-value = 0.001). Female survivors were also 63% more likely to report (p-value = 0.001), while survivors who were separated/widowed were 185% more likely to report than those who were never married (p-value = 0.006). Conclusions: Reporting of SGBV by survivors in Mayuge was found to below

A mixed-methods, cross-sectional study of perceived stigma among Ugandans with epilepsy

Background: Epilepsy is associated with stigma and negatively impacts the lives of people living with epilepsy (PLWE) and their immediate families. More understanding of the stigma and discrimination experienced by PLWE in sub-Saharan Africa is needed. Methods: In a cross-sectional, mixed methods study, forty- eight PLWE who met the study inclusion criteria were enrolled. In depth interviews and focus group discussions were conducted and were audiotaped and transcribed verbatim. Analysis was conducted using a thematic, constant comparative approach with an emphasis on dominant themes. Perceived stigma was measured using the Kilifi epilepsy stigma score. Associations between socio-demographic factors and Kilifi epilepsy stigma score were assessed. Results: The median age of the study participants was 25 years, with median age (IQR) of epilepsy onset of 12 (6-18) years. The prevalence of high-perceived stigma was 31.9% (15/48). Seizure frequency was associated with high levels of perceived stigma (p-value of 0.038). Psychological abuse, rejections at home, places of employment and schools, poor relationships and intimacy and unmet engagements in social activities were cited as the perceived stigmatizing aspects among PLWE. Conclusion: In this Ugandan sample perceived stigma remains unacceptably high and interventions to address it are urgently needed in our settings.

Application of a modified Poisson model in identifying factors associated with prevalence of pregnancy termination among women aged 15 ­ 49 years in Uganda

Background: Abortion in Uganda is illegal, only permitted when it places the pregnant mother at risk. This study aimed to apply the modified Poisson model in identifying factors associated with the prevalence of pregnancy termination among women of reproductive age in Uganda. Methods: The 2016 Uganda Demographic Health Survey (UDHS) data were used in this study. More than 18,000 women of the age of 15 ­ 49 years participated in this study. A modified Poisson model that incorporated sampling weights was used to establish the factors associated with pregnancy termination. Results: In Uganda, 18,506 (18.1%) had ever had a pregnancy terminated. The results revealed that, the woman's age [APR = 3.15, 95% CI: 2.72-3.63], being married [APR = 1.55, 95% CI: 1.40-1.71], mass media exposure [APR = 1.18, 95% CI: 1.08-1.29], working status [APR = 1.21, 95% CI: 1.09-1.35], and having visited a health facility [APR = 1.20, 95% CI: 1.10-1.31] were positively significantly associated with likelihood of pregnancy termination. Conclusion: There exists a significant proportion of women who have had their pregnancies terminated in Uganda. It is observed that woman's age, marital status, mass media exposure, having visited a health facility in the last 12 months and working status were main predictors. Based on these results, researchers concluded that the emphasis should be put on improving access to post-abortion care, contraceptive use and media exposure

Indirect serum biomarkers perform sub optimally in screening for significant liver fibrosis among HIV-infected and uninfected adults in Uganda

ntroduction: Indirect serum biomarkers present an acceptable noninvasive and cheap alternative for screening of significant liver fibrosis (SLF). Evaluation of their use in resource limited settings is important to determine their utility. Methods: We conducted a cross sectional study among 520 HIV infected and HIV uninfected adults attending care clinics in Kampala Uganda. Presence of SLF was determined using Fibroscan® liver stiffness measurement of ≥7.2KPa. The diagnostic value of indirect serum biomarkers for diagnosis of SLF was evaluated using the area under the receiver operating characteristics curve (AUROC) using Fibroscan® as gold standard. Results: Overall AUROC values for Age Platelet Index (API), Aspartate to Alanine Ratio (AAR), AST-to-Platelet Ratio Index (APRI), Fibrosis Index based on 4 Factors (FIB-4) and Gamma glutamyl transferase to Platelet Ratio Index (GPR) were 0.52, 0.49, 0.55, 0.55 and 0.54 respectively. Among HIV-infected participants AUROC values were slightly improved at predicting presence of SLF but still under 70%. Conclusion: Despite APRI and FIB-4 being more likely to identify participants with SLF, the overall diagnostic value of all serum biomarkers was poor with and without stratification by HIV status. We recommend the use of Fibroscan® technology as more accurate non-invasive diagnostic method for screening of SLF

Factors influencing utilization of modern family planning services by persons living with Human Immunodeficiency Virus at Luwero Hospital, Uganda

Introduction: The use of modern family planning methods is key for achieving the prevention of unintended pregnancies among women living with HIV, in the prevention of Mother-to-child transmission (PMTCT) package. The purpose of this study was to examine the factors influencing the utilization of modern family planning services by persons living with HIV at Luwero Hospital, Uganda. Methods: The study was conducted among 210 persons living with HIV attending the ART clinic and was based on cross-sectional descriptive and analytical design. Sampling was by simple random techniques. Data was collected using researcher-administered questionnaires. Results: The uptake of Modern FP services is low (36.7%) among persons living with HIV. It was attributed to client-related factors such as being married [AOR: 2.2, 95% CI [1.123-4.140], p = 0.038]) and other factors. These are; religious views discouraging use of modern FP (p= 0.034), negative side effects (AOR: 1.8, 95% CI [0.043-1.968], p = 0.044) and services being unfriendly for persons living with HIV (p=0.000]). Conclusions: Despite the presence of modern family planning services, uptake among persons living with HIV is low. Poor utilization is a recipe for unintended pregnancy and thus jeopardizes efforts in the elimination of mother-to-child transmission of HIV

Prevalence of violence towards men living with HIVAIDS in rural communities of Southwestern Uganda

Background: Violence towards HIV positive men is one of the silent barriers to utilization of HIV care services. HIV positive men are potential victims of violence from other people including women, and violence may interfere with treatment outcomes. This study determined the prevalence of violence towards HIV positive men in rural communities of southwestern Uganda. Methods: A cross-sectional study was conducted among 307 HIV positive men at selected health centers using an interviewer administered questionnaire. Data were analyzed in SPSS version 23 using chi-square and multivariate regression at 95% level of significance and a precision of 0.05. Results: Of the 307 participants, 45.3% had experienced violence. Of these, 23.8% (n=73) had experienced kicking or slapping while 12.7% (39) reported sexual violence. Factors associated with violence were; using alcohol and drugs (aOR 0.26, 95% CI 0.09-0.76, p=0.014), knowledge of support structures (OR 2.25, 95% CI 1.33-3.78, p=0.002) and owning land for farming (aOR 0.26, 95% CI 0.10-0.70, p=0.011). Conclusion: The prevalence of violence at 45.3% is quite high especially since violence against men is rarely talked about. This should not be ignored there should be strategies to support this vulnerable group

Aspergillus-specific IgM/IgG antibody serostatus of patients hospitalized with moderate-critical COVID-19 in Uganda

Invasive pulmonary aspergillosis is known to complicate the coronavirus diseases-2019 (COVID-19), especially those with critical illness. We investigated the baseline anti Aspergillus antibody serostatus of patients with moderate-critical COVID-19 hospitalized at 3 COVID-19 Treatment Units in Uganda. All 46 tested patients, mean age 30, and 11% with underlying respiratory disease had a negative serum anti-Aspergillus IgM/IgG antibody immunochromatographic test on day 3 (mean) of symptom onset (range 1-26), but follow up specimens to assess seroconversion were not available

The profile and causes of death among medical doctors and dental surgeons in Uganda: 1986 to 2016

Background: The loss of health workers through death is of great importance and interest to the public, media and the medical profession as it has very profound social and professional consequences on the delivery of health services. Objective: To describe the profile, causes and patterns of death among medical doctors and dental surgeons in Uganda between 1986 and 2016. Methods: We conducted a retrospective descriptive study of mortality among registered medical doctors and dental surgeons. Information on each case was collected using a standard questionnaire and analyzed. Cause of death was determined using pathology reports, and if unavailable, verbal autopsies. We summarized our findings across decades using means and standard deviations, proportions and line graphs as appropriate. Cuzick's test for trend was used to assess crude change in characteristics across the three decades. To estimate the change in deaths across decades adjusted for age and sex, we fit a logistic regression model, and used the margins command with a dy/dx option. All analyses were done in Stata version 14.0 (Stata Corp, College Station, TX). Results: There were 489 deaths registered between 1986 and 2016. Of these, 59 (12.1%) were female. The mean age at death was 48.8 years (Standard Deviation (SD) 15.1) among male and 40.1 years (SD 12.8) among females. We ascertained the cause of death for 468/489 (95.7%). The most common causes of death were HIV/AIDS (218/468, 46.6%), cancer (68/468, 14.5%), non-communicable diseases (62/48, 13.3%), alcohol related deaths (36, 7.7%), road traffic accidents (34, 7.3%), gunshots (11, 2.4%), among others. After adjusting for age and sex, HIV/AIDs attributable deaths decreased by 33 percentage points between the decade of 1986 to1995 and that of 2006 to 2016 ­0.33 (­0.44, ­0.21. During the same period, cancer attributable deaths increased by 13 percentage periods 0.13 (0.05,0.20). Conclusion: The main causes of death were HIV/AIDS, cancer, non-communicable diseases, alcohol-related diseases and road traffic accidents. There was a general downward trend in the HIV/AIDS related deaths and a general upward trend in cancer related deaths. Doctors should be targeted for preventive and support services especially for both communicable and non-communicable diseases

Implementation of UN Convention on the Rights of Persons with Disabilities in public and private schools in three districts of Uganda

The study was grounded in the recent developments of implementing the United Nations Convention on the Right of Persons with Disabilities (UNCRPD) in schools in Uganda, leading to a renewed interest in the questionings about inclusive education. Objectives: The inclusive approach was evaluated in terms of: (1) how public or private schools in Uganda understand inclusive education; (2) how schools implement inclusive education under the influence of the UN Convention; and (3) what determines the course of action and school routine of private and state schools. Methods: This exploratory qualitative research included interviews with six schools purposively selected in Mukono, Wakiso and Kampala districts of Central Uganda. The selected schools comprised three private and three state schools (i.e. representing primary and secondary schools and a vocational training institute). Results: The research demonstrated that 'inclusive education practice' that was upheld by all the schools, was ironically stained with exclusion, for example, by non-admission of students with visual and hearing impairment, inaccessible physical environment, inadequate funding and separation of students according to abilities. However, whilst all schools followed the regular curriculum, some schools developed their own ways of teaching learners with diverse learning needs. Conclusion: Some schools in Uganda have developed meaningful approaches of including students with disabilities but there are still many challenges for many. Enforcing Uganda's disability policies adapted from the CRPDs could enable learners with disabilities to enjoy their legal rights. Contribution: Since the intention of inclusion of students with disabilities stands in contrast to the reality of practice found in many schools, there seems to be a need to carry out regular assessments and measures of support for a sustainable inclusive school development

Antimicrobial-resistant enterobacteria in surface waters with fecal contamination from urban and rural communities

Abstract INTRODUCTION: Inadequate wastewater treatment and fecal contamination have a strong environmental impact on antimicrobial resistance (AMR). This study evaluated the profile of AMR enterobacteria and fecal contamination from four surface waters: Jiquiriça-Brejões River and Cabrito, Tororó, and Abaeté Lagoons. METHODS: We analyzed AMR β-lactamase genes using the polymerase chain reaction method and fecal contamination using Coliscan®. RESULTS: We found high levels of fecal contamination, β-lactamase producers, and AMR genes (blaOXA-48, blaSPM, and blaVIM) in all waterbodies. CONCLUSIONS: Poor sanitation evidenced by fecal contamination and human activities around these surface waters contributed to the distribution and increase in AMR enterobacteria.

The role of Escherichia coli in the etiology of piglet diarrhea in selected pig producing districts of central Uganda

Background: Pig production in Uganda is highly constrained by rampant piglet mortalities with diarrhea being a key feature. The present study was conducted to determine possible involvement of Escherichia coli (E. coli) as agents of diarrhea in piglets and elucidate the factors for their spread and virulence, towards development of mitigation strategies in the smallholder pig value chains in Uganda. Methodology: This was a cross-sectional study carried out from January to August 2020 on pre- and post-weaned piglets from households in Kayunga and Mityana districts of Central Uganda, selected by snowballing method to redundancy. Data about herd management and risk factors for colibacillosis were collected from selected farmers in the two districts. A total of 179 faecal samples were collected from randomly selected neonatal and pre-weaning piglets for bacteriological isolation of Escherichia coli. Virulence (enterotoxin and fimbrial) genes from the isolates were detected by multiplex polymerase chain reaction (PCR) assay. Results: From the 179 faecal samples, a total of 158 (88.3%) E. coli isolates were obtained. Virulence gene markers were detected in 18.4% (29/158) of the isolates. Among the investigated genes encoding for enterotoxin production, STb was the most prevalent (16/158, 10.13%), followed by STa (12/158, 7.59%), while gene for LT was not detected. The gene coding for F4 adhesin was the only one detected while F18 adhesin was not detected from the isolates. On multiple logistic regression analysis, only tertiary educational level (OR=0.141; 95% CI=0.30-0.666; p=0.013) and infrequent use of antibiotics (OR=0.231, 95% CI=0.062-0.859; p=0.029) among the farmers, were the two factors significantly protective of the piglets from diarrhoea. Conclusion: This study reports a high prevalence of enterotoxin gene markers among E. coli isolates in piglets and revealed the potential role of these bacteria in the aetiology of piglet diarrhoea and mortalities in Uganda. Additionally, this study identified risk factors that can be useful in formulating treatment and control strategies of infection caused by these bacteria. Further studies are needed to identify more adhesins these E. coli isolates employ for intestinal colonization, a step that will help inform vaccine development.

Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study

Introduction: Systematic screening for TB among patients presenting to care and among high risk populations is recom- mended to improve TB case finding. We aimed to describe the comparative yield of three TB screening approaches imple- mented by a large urban TB project in central Uganda. Methods: We abstracted data on the screening cascade from 65 health facilities and their surrounding communities (num- bers screened, with presumptive TB, receiving a diagnostic test and diagnosed with TB) from the different clinic and com- munity TB registers. Results: From January 2018 to December 2019, 93,378 (24%) of all patients screened at health facilities had presumptive TB; 77,381 (82.9%) received a diagnostic test and 14,305 (18.5%) were diagnosed with TB. The screening yield (the number of patients diagnosed with TB out of all patients screened) was 0.3% and was three times higher among men than women (0.6% vs 0.2% p<0.01). During targeted community screening interventions, 9874 (21.1%) of all patients screened had presumptive TB; 7034 (71.2%) of these received a diagnostic test and 1699 (24.2%) were diagnosed with TB. The screening yield was higher among men, (3.7% vs 3.3% p<0.01) and highest among children 0-14 (4.8% vs 3.2% p<0.01). Conclusion: Targeted community TB screening interventions improve access to TB diagnosis for men and children 0-14 years

Prevalence, severity and factors associated with dental caries among school adolescents in Uganda: a cross-sectional study

Abstract Dental caries is one of the most prevalent diseases in developing countries. However, there is limited data on the prevalence and factors associated with dental caries in Ugandan adolescents. The purpose of the present study was to describe the prevalence, severity of dental caries and to determine the factors associated with the disease among school adolescents in Uganda. A cross sectional study was conducted at two secondary schools from Kampala (n=197) and Mukono (n=209) districts, Uganda. At both schools, random sampling was used to select the participating classes and the 406 adolescents (11-19 years) eligible to participate in the research. Dental caries was examined using the Decayed, Missing and Filled Teeth (DMFT) index, and a questionnaire was used to collect other relevant data in form of an oral interview. The data were analyzed using STATA version 12. The data was declared as survey data and all analyses were done with svy command. The prevalence of caries was determined as a percentage of individuals with DMFT score ≥1. Modified Poisson regression models were utilized to assess the association between prevalence, severity of dental caries and independent variables. The overall prevalence of dental caries was 66.0% and mean DMFT score of 2.18±2.67. Dental caries prevalence and severity were significantly (p<0.05) associated with tooth cleaning device, age and history of previous dental visit. There was a high prevalence and severity of dental caries among adolescents, which emphasizes the urgent need to develop and design appropriate interventions to reduce the disease burden.

Resumo A cárie dentária é uma das doenças mais prevalentes nos países em desenvolvimento. No entanto, existem dados limitados sobre a prevalência e os fatores associados à cárie dentária em adolescentes de Uganda. O objetivo do presente estudo foi descrever a prevalência e severidade da cárie dentária e determinar os fatores associados à doença em adolescentes escolares de Uganda. Um estudo transversal foi realizado em duas escolas secundárias dos distritos de Kampala (n = 197) e Mukono (n = 209), Uganda. Nas duas escolas, foi utilizada amostragem aleatória para selecionar as turmas participantes e os 406 adolescentes (11 a 19 anos) elegíveis para participar da pesquisa. A cárie dentária foi examinada usando o índice de dentes cariados, perdidos e obturados (CPOD), e um questionário foi usado para coletar outros dados relevantes na forma de uma entrevista oral. Os dados foram analisados no STATA versão 12. Os dados foram declarados como dados da pesquisa e todas as análises foram realizadas com o comando svy. A prevalência de cárie foi determinada como porcentagem de indivíduos com escore de CPOD ≥1. Modelos de regressão de Poisson modificados foram utilizados para avaliar a associação entre prevalência, gravidade da cárie dentária e variáveis independentes. A prevalência geral de cárie dentária foi de 66,0% e o escore médio do CPOD de 2,18 ± 2,67. A prevalência e severidade de cárie dentária foram significativamente (p<0,05) associadas ao dispositivo de limpeza dentária, idade e histórico de visita odontológica prévia. Houve alta prevalência e gravidade de cárie dentária entre os adolescentes, o que enfatiza a necessidade urgente de desenvolver e projetar intervenções apropriadas para reduzir a carga da doença.

Injury patterns of patients presenting to a non-governmental hospital in Western Uganda

Introduction: Injury is a leading cause of morbidity and mortality globally and disproportionately affects low-income countries. While most injury data comes from tertiary care centers in urban settings, the purpose of this study was to describe the characteristics and severity of injury in rural Uganda and the associated treatment patterns and delays in care. Methods: This is a retrospective cohort study of a trauma registry that was implemented at Masindi-Kitara Medical Center (MKMC), a rural hospital in Western Uganda. Demographic information, injury characteristics, modified Kampala Trauma Scores (M-KTS), and treatment modalities over a 12 month period were retrospectively collected from paper-based registry forms completed for all injury patients presenting to MKMC. Results: A total of 350 patients were entered into the trauma registry. Most patients were male (71.2%) with a median age of 26.5 years. Motorcycle crashes were the most prevalent mechanism of injury (42.3%) with the majority being unhelmeted (83.3%). Soft tissue injury was the most common diagnosis (44.9%). Patients were frequently treated in the outpatient department and then discharged (54.8%). Patients requiring admission or transfer (M-KTS = 11.57 or 11.67) tended to have a lower M-KTS than discharged patients (M-KTS = 12.75). Analgesics (74.6%) and antibiotics (52.9%) were the most common treatments administered. For those patients requiring admission (29.4%), only one in-hospital death was documented. Thirty-nine percent of patients reported a delay in seeking care, most frequently due to lack of transportation (31.5%) with a median time of delay of 11 h. Conclusion: Road traffic injuries were the leading cause of injury in Masindi, with a high proportion of injuries associated with unhelmeted motorcycle crashes. Future opportunities to prevent injury and improve care may be seen through improved prehospital care, enforcement of helmet laws, increased access to neurosurgical services, and enactment of hospital quality improvement measures