"If your mother does not teach you, the world will ": a qualitative study of parent-adolescent communication on sexual and reproductive health issues in Border districts of eastern Uganda.

BACKGROUND: Adolescents experience a host of sexual and reproductive health (SRH) challenges, with detrimental SRH and socio-economic consequences. These include early sexual debut, sexually transmitted infections including HIV/AIDS, teenage pregnancy, and early childbearing. Parent-adolescent communication about SRH has significant potential to reduce adolescents' risky sexual behaviors. However, communication between parents and adolescents is limited. This study explored the facilitators and barriers to parent-adolescent communication about sexual and reproductive health. METHODS: We conducted a qualitative study in the border districts of Busia and Tororo in Eastern Uganda. Data collection entailed 8 Focus Group Discussions comprising of parents, adolescents (10-17 years), and 25 key informants. Interviews were audio-recorded, transcribed, and translated into English. Thematic analysis was conducted with the aid of NVIVO 12 software. RESULTS: Participants acknowledged the key role parents play in communicating SRH matters; however, only a few parents engage in such discussions. Facilitators of parent-adolescent communication were: having a good parent-child relationship which makes parents approachable and motivates children to discuss issues openly, a closer bond between mothers and children which is partly attributed to gender roles and expectations eases communication, and having parents with high education making them more knowledgeable and confident when discussing SRH issues with children. However, the discussions are limited by cultural norms that treat parent-child conversations on SRH as a taboo, parents' lack of knowledge, and parents busy work schedules made them unavailable to address pertinent SRH issues. CONCLUSION: Parents' ability to communicate with their children is hindered by cultural barriers, busy work schedules, and a lack of knowledge. Engaging all stakeholders including parents to deconstruct sociocultural norms around adolescent SRH, developing the capacity of parents to confidently initiate and convey accurate SRH information, initiation of SRH discussions at early ages, and integrating parent-adolescent communication into parenting interventions, are potential strategies to improve SRH communication between parents and adolescents in high-risk settings such as borders.

Perceptions about COVID-19 preventive measures among Ghanaian women.

Though the advent of COVID-19 vaccines has significantly reduced severe morbidity and mortality, infection rates continue to rise. Therefore, adhering to COVID-19 preventive measures remains essential in the fight against the pandemic, particularly in Africa, where vaccination rates remain low. However, the perceived risk associated with COVID-19 and public education and awareness campaigns has waned over time. COVID-19 vaccine hesitancy is consistently high among women globally. This study, therefore, assessed the facilitators, and barriers to adherence to COVID-19 preventive measures. A qualitative descriptive study was conducted among Ghanaian women. Twenty-seven in-depth interviews were conducted with women in the Greater Accra and Ashanti regions. All interviews were audio-recorded and transcribed verbatim into English. The data were analysed using NVivo 10 software. While some participants found the use of face masks as the easiest, others found it as the most difficult. In addition, institutional and policy decisions such as access to water and the use of public transport impacted individual level adherence to preventive measures. In conclusion, the fight against COVID-19 is not over; hence public education and the provision of facilities that would enhance compliance with preventive measures should continue to be prioritised.

Access to information on gender-based violence prevention during COVID-19 lockdown in Uganda: a cross-sectional study.

Background: During the lockdowns to contain the COVID-19 pandemic in Uganda, women and girls, disproportionately, had increased exposure to gender-based violence (GBV). Access to high-quality and empowering information or knowledge to minimise the incidences of GBV for women, girls, men and boys, was, therefore, crucial. The purpose of this study was to understand the characteristics of the individuals who were unable to access such information, and if received information, was associated with more awareness in the populace. Methods: The data analysed were from a cross-sectional nationally representative phone survey of individuals aged 18 years and above from all four regions of Uganda. The survey was carried out by Uganda Bureau of Statistics using a purely quantitative approach, and all questions were closed-ended. The sample was stratified by sex, age, and geographical region, and executed in November 2020, six months after COVID-19 lockdown restrictions. Binary logistic regression analysis was used for data analysis in STATA software. Findings: Female respondents with tertiary education (OR = 0.47; 95% CI = 0.26, 0.85) and male respondents with tertiary education (OR = 0.70; 95% CI: 0.49, 1.00) were more likely to receive information on GBV prevention. Both female (aOR = 0.68; 95% CI: 0.52, 0.88) and male (aOR = 0.66; 95% CI: 0.50, 0.87) respondents who were working had about a third the odds of being unable to access information about GBV prevention. Female respondents living in urban areas were associated with less odds of being unable to access the information (aOR = 0.77; 95% CI: 0.59, 1.00), while unmarried male respondents had higher odds of being unable to access the information (aOR = 1.37; 95% CI: 1.00, 1.89). Respondents who reported being vulnerable to GBV were also more likely to know someone who experienced GBV. This was similar for female respondents (PR = 3.00; 95% CI: 2.26, 3.98) and male respondents (PR = 3.01, 95% CI: 2.3, 3.95) (PR = 5.49; 95% CI = 4.12-7.30). Results also indicated that both male (PR = 1.28; 95% CI: 1.14, 1.43) and female respondents (PR = 1.24; 95% CI: 1.11, 1.37) who did not perceive themselves at risk of GBV were less likely to know a GBV survivor. Interpretation: The individuals who were unable to access information had characteristics associated with GBV perpetration or victimization. Monitoring the dissemination and quality of information empowers individuals and communities to develop local solutions to GBV prevention and protection. The design of GBV prevention messages and delivery channels needs to take into consideration the risk factors at the different levels of the socio-ecological model (individual, community, institutional, and society). Interventions aimed at increasing access to information on GBV prevention should consider the different socio-demographic as well as context-specific factors. Funding: There was no funding source for this study.

Vulnerability to violence against women or girls during COVID-19 in Uganda.

At the height of the COVID-19 pandemic, gender-based violence (GBV) was reported to have increased worldwide. We build on existing literature to examine the factors that increased vulnerability to GBV during the COVID-19 pandemic in Uganda. We use data from the Rapid Gender Assessment (RGA) survey that was conducted during COVID-19, which was designed to provide information to guide policymaking and offer appropriate interventions that address the needs of people in Uganda during the pandemic. The results show that the following respondents are more likely to experience increased risk and vulnerability to gender-based violence: those with primary level of education (OR = 1.49; 95% CI = 1.10-2.01), those who received information about GBV (OR = 1.30; 95% CI = 1.08-1.57), and those who needed help or medical support as a prevention measure against GBV (OR = 1.29; 95% CI = 1.04-1.61). However, respondents who would need financial support to prevent GBV were less likely to experience increased GBV (OR = 0.83; 95% CI = 0.70-0.98). Our results align with evidence from other studies that risk and vulnerability to GBV in Uganda increased since the onset of COVID-19. The findings provide an understanding of the interrelationship between GBV and COVID-19,which can help with designing GBV preventive measures, particularly during pandemics among those most at-risk.

Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda.

Background: The spread of COVID-19 exposed the inadequacies inherent in the health care systems of many countries. COVID-19 and the attendant demands for emergency treatment and management put a significant strain on countries' health care systems, including hitherto strong health systems. In Uganda, as the government strived to contain COVID-19, other essential health care services were either disrupted or completely crowded out. Balancing the provision of COVID-19 treatment and management services and at the same time offering sexual and reproductive health and rights services (SRHR) proved to be a considerable challenge in these circumstances. COVID-19 prevention-related travel restrictions and border closures had far-reaching negative consequences on the mobility of individuals to access essential health services in Uganda. The situation may have been worse for cross-border communities that sometimes access services across the borders. Methods: Using quantitative data from 1521 respondents and qualitative data (20 key informant interviews and 12 focus group discussions), we investigate the disruption in accessing SRHR services for border communities in Uganda during COVID-19. Results: Results indicate that females (adjusted odds ratio (aOR) = 1.3; 95% confidence interval CI = 1.08-1.79), those with primary education (aOR = 1.47; 95% CI = 1.61-2.57), currently employed (aOR = 2.03; 95% CI = 1.61-2.57) and those with the intention to leave current residence (aOR = 2.09; 95% CI = 1.23-3.55) were more likely to have experienced a disruption in accessing SRHR services. However, respondents aged 35 years, or more were less likely to have experienced a disruption compared to their younger counterparts. Conclusions: Results shed light on the disruption of access toSRHR services during pandemics such as COVID-19 among a highly mobile population. There is a need to invest in building strong and resilient health care systems that can guarantee continuous access to essential health services including SRHR provisions among mobile populations during pandemics.

Access to HIV/AIDS or TB care among refugees in Kampala, Uganda: exploring the enablers and barriers during the COVID-19 pandemic.

The rapid spread of COVID-19 has overwhelmed the existing health care systems, finding it challenging to provide essential health services besides the COVID-19 response interventions. Refugees are disproportionately affected by the COVID-19 pandemic because of the barriers they face to access health care. However, there is limited research that investigates how access to HIV/AIDS or TB care services by urban refugees is affected during pandemics such as the COVID-19. This study adopted a cross-sectional survey utilizing quantitative (N=229) and qualitative data (26 in-depth interviews and 8 key informant interviews) held among urban refugees living in Kampala, Uganda. Results revealed that more females (75%) than males (25%) were able to access TB or HIV/AIDS services during COVID-19 related lockdowns. A decrease in queues, delivery of drugs through Village Health Teams (VHTs), proximity to health facilities, supply of necessities like food and the reception at the health facilities facilitated access to TB or HIV/AIDS services. On the other hand, restrictions on public transport, high transport costs, unemployment and subsequent poverty were barriers to access to TB or HIV/AIDS services. Results offer major insights into the effect of COVID-19 control measures on disruption of access to services particularly in relation to being able to access service points. The findings suggest that recognizing structural barriers to uninterrupted or continued access to HIV/AIDS or TB services during pandemics such as COVID-19 can go a long way in helping stakeholders to design measures that make it possible for more urban refugees to access HIV/AIDS or TB services.

Assessing willingness to pay for water during the COVID-19 crisis in Ugandan households.

With the emergence of COVID-19, improving hygiene through handwashing with water and detergent is a priority. This behavioural practice requires that households have access to reliable improved water. One measure that can provide an invaluable source of information to measure access to improved water supply is willingness to pay (WTP). However, little is known about WTP for water during a pandemic such as COVID-19. Data from a cross-sectional survey was used to assess potential household determinants of WTP for water during March-June 2020 in 1639 Ugandan households. The focus is on the period March-June 2020 when the government of Uganda implemented a countrywide total lockdown in a bid to curb the spread of the deadly virus. Results indicate that most households were not willing to pay for water during March-June 2020. Sex of the household head, region of residence, water source, number of times hands are washed and whether a household buys or pays for water were significant explanatory household determinants for WTP for water. The results provide a rich understanding of the household factors that determine WTP for water during a pandemic. This evidence is important in guiding government and water utilities in developing sustainable regulations and policy interventions particularly during emergencies. The findings suggest that increasing or maintaining water revenues will be a challenge in emergencies if no attention is placed to addressing the disparity in socio-economic attributes associated with households' WTP.

The Decision to Wear a Face Mask as a Protective Behavioral Measure Against COVID-19: Survey Results From Greater Kampala Metropolitan Area, Uganda.

The use of face masks is one of the behavioral measures used to prevent COVID-19 infection. Despite the positive contribution of face masks, there is uncertainty surrounding face mask wearing in low-income countries. Using data from 1,054 respondents in Greater Kampala Metropolitan area, we investigate the variation in face mask wearing inside and outside public spaces. Results indicate that more than three quarters of the respondents wore a face mask always outside public spaces and slightly more than half wore a face mask sometimes inside public spaces. Irrespective of location (inside or outside public spaces), respondents were more likely to wear facemasks sometimes or always to prevent COVID-19 infection. There is need to raise awareness about face mask wearing and its efficacy to prevent COVID-19 infection.

Suicidal Ideations and Attempts Among Adolescents in Kampala Urban Settlements in Uganda: A Case Study of Adolescents Receiving Care From the Uganda Youth Development Link.

There is an increasing recognition that suicidal ideation is a major public health concern in sub-Saharan Africa. We employed a case study design, taking a case study of adolescents currently under the care of Uganda Youth Development Link (UYDEL). The data analyzed were collected from 219 female and male adolescents (13-19 years) recruited through UYDEL in Kampala, Uganda. A Poisson regression model with robust variance was used to assess the risk factors associated with suicidality. The prevalence of suicidal ideation in the past 4 weeks and attempt within the past 6 months among adolescents was 30.6% (95% CI: 24.8, 38.0%) and 24.2% (95% CI: 18.7, 30.4%), respectively. The most stressful precursors of suicidal ideation or attempt included financial difficulties (59.5%), family breakdown or conflicts (37.4%), and trauma (23.1%). Suicidal ideation in the past 1 week preceding the survey was as high as 13.3% (95% CI: 9.0, 18.6%), of which 75.0% (95% CI: 55.1%, 89.3%) had a suicide plan. Prevalence of suicidal ideation in the past 4 weeks was significantly higher among respondents with moderate psychological distress [Prevalence Ratio (PRR) = 2.74; 95% CI: 0.96, 7.84] and severe psychological distress (PRR = 4.75; 95% CI: 1.72, 13.08) but lower among adolescents who knew where to obtain professional psychological care (PRR = 0.51; 95% CI: 0.30, 0.87). Similarly, suicidal attempt was significantly higher among respondents with moderate psychological distress (PRR = 4.72; 95% CI: 1.01, 12.03) and severe psychological distress (PRR = 11.8; 95% CI: 4.66, 32.37), and who abuse drugs or substances (PRR = 2.13; 95% CI: 1.13, 4.01). Therefore, suicidal ideation is a major public health issue among adolescents living in poor urban settlements in Kampala, Uganda. Psychological distress due to financial difficulties, unemployment, and family breakdown are major facilitators of suicidality among adolescents in urban poor settlements in Kampala. Interventions aimed at preventing suicide among vulnerable adolescents in urban settlements in Kampala, Uganda should incorporate this unique risk factor profile.

Tolerance of Violence against Women and the Risk of Psychosocial Distress in Humanitarian Settings in Northern Uganda.

BACKGROUND: Violence against women (VAW) remains a public health concern, which can sometimes lead to mental or psychological stress among other negative consequences. DATA AND METHODS: we fitted a binary logistic regression model on 657 respondents from host and refugee settings in three humanitarian districts (Adjumani, Obongi, and Lamwo) to examine the determinants of psychosocial stress. RESULTS: experience of psychosocial distress is higher among refugees than host populations. Results indicate a higher proportion of respondents who ever experienced psychosocial stress in the 6 months preceding the survey among those who believed that a woman should tolerate violence (59% vs. 53%). Respondents who believed that a woman should tolerate violence had higher odds of experiencing psychosocial stress than their counterparts who believed a woman should not tolerate violence (OR = 6.86; 95%CI = 1.23-38.22). The likelihood to experience psychosocial stress was higher among females (OR = 6.94; 95%CI = 1.76-27.32), those with primary education (OR = 4.73; 95%CI = 1.24-18.00), and respondents with less than USD 2.7 as personal income one month before the survey (OR = 3.37; 95%CI = 1.32-8.62). Respondents who said that women should engage in income generation activities had higher odds to experience psychosocial stress (OR = 0.39; 95%CI = 0.17-0.89). CONCLUSION: results suggest that income and positive attitudes toward female-led income generating activities act as protective measures against psychosocial distress. Given the associations between VAW and psychosocial distress, efforts aimed at prevention and response to VAW in humanitarian settings should integrate mental health and psychosocial support interventions.

An assessment of availability of handwashing facilities in households from four East African countries

The World Health Organization provides guidelines on handwashing as part of the global campaign towards achieving proper hygiene. In East Africa, cholera and diarrhoea outbreaks and, most recently, COVID-19 remain a threat to public health – calling for the promotion of handwashing to prevent infection. Using data from demographic and health surveys in four East African countries (Kenya, Rwanda, Tanzania and Uganda), we estimate the prevalence and identify the predictors of the availability of handwashing facilities in households. Findings indicate that the presence of a handwashing facility is not universal in the four countries: Kenya (66.4%), Rwanda (76.4%), Tanzania (80.7%) and Uganda (59.2%). Results from the pooled binary logistic regression model indicate that age, sex and education of the household head, type of place of residence, number of children, and household wealth are strong predictors of having handwashing facilities in all countries. However, the likelihood of having a handwashing facility in Uganda is lower than other countries. This study provides a rich understanding of the factors that explain the availability of handwashing facilities. Findings indicate how prepared the four countries are in the face of the COVID-19 pandemic – and can guide the policy direction in the prevention of infection.