Contraceptive use among young women of pastoral communities of Karamoja sub-region in Uganda.

Sexual and reproductive health is an important part of general health globally recognised in Sustainable Development Goal (SDG) 3. Access to sexual and reproductive health services such as contraception provides young people with the opportunity to make informed choices regarding reproductive health. However, poor sexual and reproductive health is evident in numerous forms including sexually transmitted infections, unwanted pregnancies and unsafe abortion. In this paper, we examine the experiences of contraceptive use among young women living in pastoral communities. Findings derive from a qualitative contextual analysis of adolescent sexual and reproductive health conducted in the Karamoja sub-region of Uganda. Focus group discussions and in-depth interviews were conducted with married young women aged 15-19. Audio recordings and field notes were taken during interviews. Thematic data analysis was conducted aided by Atlas.ti software. Findings reveal that young women living in pastoralist communities experience challenges which deter their use of contraception. Contraceptive use experiences, socio-cultural values and practices, the attitudes of service providers, and livelihood necessities of pastoralism cause low uptake of contraception. Adequate understanding of the experiences and associated values encountered by such vulnerable and marginalised groups in the use of contraception is critical in addressing the challenge to achieving SDG targets.

Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda.

BACKGROUND: The effect of seasons on health outcomes is a reflection on the status of public health and the state of development in a given society. Evidence shows that in Sub-Saharan Africa, most infectious diseases flourish during the wet months of the year; while human activities in a context of constrained choices in life exacerbate the effects of seasons on human health. The paper argues that, the wet season and when human activities are at their peak, sanitation is most dire poor slum populations. METHODS: A shared latrine cleaning observation was undertaken over a period of 6 months in the slums of Kampala city. Data was collected through facility observations, user group meetings, Focus group discussions and, key informant interviews. The photos of the observed sanitation facilities were taken and assessed for facility cleanliness or dirt. Shared latrine pictures, observations, Focus Group Discussion, community meetings and key informant interviews were analysed and subjected to an analysis over the wet, dry and human activity cycles before a facility was categorised as either 'dirty' or 'clean'. RESULTS: Human activity cycles also referred to as socio-economic seasons were, school days, holidays, weekends and market days. These have been called 'impure' seasons, while the 'pure' seasons were the wet and dry months: improved and unimproved facilities were negatively affected by the wet seasons and the peak seasons of human activity. Wet seasons were associated with, mud and stagnant water, flooding pits and a repugnant smell from the latrine cubicle which made cleaning difficult. During the dry season, latrines became relatively cleaner than during the wet season. The presence of many child(ren) users during school days as well as the influx of market goers for the roadside weekly markets compromised the cleaning outcomes for these shared sanitation facilities. CONCLUSION: Shared latrine cleaning in slums is impacted by seasonal variations related to weather conditions and human activity. The wet seasons made the already bad sanitation situation worse. The seasonal fluctuations in the state of shared slum sanitation relate to a wider malaise in the population and an implied capacity deficit among urban authorities. Poor sanitation in slums is part of a broader urban mismanagement conundrum pointing towards the urgent need for multiple interventions aimed at improving the general urban living conditions well beyond sanitation.

Deaf identities in a multicultural setting: The Ugandan context.

Often located far apart from each other, deaf and hearing impaired persons face a multiplicity of challenges that evolve around isolation, neglect and the deprivation of essential social services that affect their welfare and survival. Although it is evident that the number of persons born with or acquire hearing impairments in later stages of their lives is increasing in many developing countries, there is limited research on this population. The main objective of this article is to explore the identities and experiences of living as a person who is deaf in Uganda. Using data from semi-structured interviews with 42 deaf persons (aged 19-41) and three focus group discussions, the study findings show that beneath the more pragmatic identities documented in the United States and European discourses there is a matrix of ambiguous, often competing and manifold forms in Uganda that are not necessarily based on the deaf and deaf constructions. The results further show that the country's cultural, religious and ethnic diversity is more of a restraint than an enabler to the aspirations of the deaf community. The study concludes that researchers and policy makers need to be cognisant of the unique issues underlying deaf epistemologies whilst implementing policy and programme initiatives that directly affect them. The upper case 'D' in the term deaf is a convention that has been used since the early 1970s to connote a 'socially constructed visual culture' or a linguistic, social and cultural minority group who use sign language as primary means of communication and identify with the deaf community, whereas the lower case 'd' in deaf refers to 'the audio logical condition of hearing impairment'. However, in this article the lower case has been used consistently.

Gender variations in access, choice to use and cleaning of shared latrines; experiences from Kampala Slums, Uganda.

BACKGROUND: Sanitation is one of the most intimate issues that affect women, especially in slums of developing countries. There are few studies that have paid attention to the gender variations in access, choice to use and cleaning of shared latrines in slums. METHODS: This paper draws on qualitative data from a cross sectional study conducted between 2012 and 2013 in six slums of Kampala City, Uganda. The study involved both women and men. Data were collected from 12 Focus Group Discussions (FGDs), 15 Key informant interviews; community transects and photographs of shared latrines. RESULTS: Location of a shared latrine facility, distance, filthy, narrow and irregular paths; the time when a facility is visited (day or night), privacy and steep inclines were gender 'filters' to accessing shared latrines. A full latrine pit was more likely to inhibit access to and choice of a facility for women than men. Results indicate that the available coping mechanisms turned out to be gendered, with fewer options available for women than men. On the whole, women sought for privacy, easy reach, self-respect and esteem, cleanliness and privacy than men. While men like women also wanted clean facilities for use; they (men) were not keen on cleaning these facilities. The cleaning of shared latrines was seen by both women and men as a role for women. CONCLUSION: The presence of sanitation facilities as the first step in the access, choice, use, and cleaning by both women and men has distinct motivations and limitations along gender lines. The study confirms that the use and cleaning of latrines is regulated by gender in daily living. Using a latrine for women was much more than relieving oneself: it involved security, intimacy and health concerns.

Descending the sanitation ladder in urban Uganda: evidence from Kampala Slums.

BACKGROUND: While the sanitation ladder is useful in analysing progressive improvements in sanitation, studies in Uganda have not indicated the sanitation barriers faced by the urban poor. There are various challenges in shared latrine use, cleaning and maintenance. Results from Kampala city indicate that, failure to clean and maintain sanitation infrastructure can lead to a reversal of the potential benefits that come with various sanitation facilities. METHODS: A cross sectional qualitative study was conducted between March and May 2013. Data were collected through 18 focus group discussions (FGDs) held separately; one with women, men and youth respectively. We also used pictorial methods; in addition, 16 key informant interviews were conducted. Data were analysed using content thematic approach. Relevant quotations per thematic area were identified and have been used in the presentation of the results. RESULTS: Whether a shared sanitation facility was improved or not, it was abandoned once it was not properly used and cleaned. The problem of using shared latrines began with the lack of proper latrine training when people do not know how to squat on the latrine hole. The constrained access and security concerns, obscure paths that were filthy especially at night, lack of light in the latrine cubicle, raised latrines sometimes up to two metres above the ground, coupled with lack of cleaning and emptying the shared facilities only made a bad situation worse. In this way, open defecation gradually substituted use of the available sanitation facilities. This paper argues that, filthy latrines have the same net effect as crude open defection. CONCLUSION: Whereas most sanitation campaigns are geared towards provision of improved sanitation infrastructure, these findings show that mere provision of infrastructure (improved or not) without adequate emphasis on proper use, cleaning and maintenance triggers an involuntary descent off the sanitation ladder. Understanding this reversal movement is critical in sustainable sanitation services and should be a concern for all actors.

Influence of pregnancy perceptions on patterns of seeking antenatal care among women in reproductive age of Masaka District, Uganda.

Maternal mortality remains a challenge in Sub-Saharan Africa including Uganda. Antenatal Care (ANC) is one of the recommended measures to improve maternal and child health. However, the influence of pregnancy definition and perception on patterns of seeking regular and timely antenatal care among women in the reproductive age group (15-49 years) is not known. The objectives of this study were to: (i) understand the women's social definitions and perceptions on their pregnancy; (ii) understand the socio-cultural beliefs related to pregnancy among women of the reproductive age group; and, (iii) examine the influence of social definitions, perceptions and beliefs about pregnancy on women's antenatal care seeking behaviour patterns to inform the decentralised health care delivery system in Uganda. A total of 45 women, mothers and expectant women who were purposively selected from Kimanya sub county of Masaka district in Uganda participated in the study. Ten key informant interviews and four Focus Group Discussions (FGDs) were also conducted. Key findings indicate that the women's socio-definitions and perceptions of pregnancy influence their seeking behaviour on antenatal health care. To the women with a positive orientation towards antenatal care, pregnancy provides joy, happiness, pride, promotes their social status and safe-guards their marriage. Pregnancy is rewarding with care, love, support and gifts. Women who shun antenatal care perceive pregnancy to be a source of misery, sadness, pain and suffering. It is an uncomfortable and regrettable experience. Women also hold socio-cultural beliefs on pregnancy, which are culturally constructed and rooted in taboos, rituals and practices of their communities. It is therefore important to sensitise women and those who attend to them when they are pregnant to understand these perceptions and definitions to motivate them to seek antenatal and postnatal care for better maternal and child health.