Proximity to public green spaces and depressive symptoms among South African residents: a population-based study.

BACKGROUND: Exposure to green spaces has been suggested to improve mental health and may reduce the risk of depression. However, there is generally limited evidence on the association between green spaces and depression originating from low-and middle-income countries and Africa in particular. Here, we investigate the association between proximity to public green spaces and depressive symptoms among residents of Gauteng Province, South Africa. METHODS: We used data from the 2017/2018 Gauteng quality of life survey. We included all individuals aged 18 years or older residing in the nine municipalities of Gauteng Province that completed the survey (n = 24,341). Depressive symptoms were assessed using the Patient Health Questionnaire-2. Proximity to public green spaces was defined as self-reported walking time (either less or greater than 15 min) from individuals' homes to the nearest public green space. To assess the association between access to public green spaces and depressive symptoms, we used mixed-effects models, adjusted for age, sex, population group (African, Indian/Asian, Coloured (mixed race), and White), educational attainment, and municipality. We additionally performed stratified analyses by age, sex, educational attainment, and population group to evaluate whether associations differed within subgroups. Associations are expressed as prevalence ratios (PR) and their 95% confidence intervals (95% CI). RESULTS: We observed a 6% (PR = 0.94, 95%CI = 0.92-0.96) prevalence reduction in depressive symptoms for individuals who reported that the nearest public green space was less than 15 min from their homes as compared to those who reported > 15 min. After stratification, this inverse association was stronger among females, individuals aged 35-59 years,those with higher levels of educational attainment, and Coloured individuals as compared to their counterparts. CONCLUSION: Our findings suggest that public green spaces close to residential homes may be associated with a reduction in the occurrence of depressive symptoms among urban populations in resource-constrained settings like South Africa.

Indoor air pollutants and respiratory symptoms among residents of an informal urban settlement in Uganda: A cross-sectional study.

BACKGROUND: Indoor air pollutants (IAP) and household conditions such as dampness, crowding and chemical exposures have been associated with acute and chronic respiratory infections. In Uganda, literature on the effects of IAP on respiratory outcomes in informal settlements is limited. METHODS: We describe the baseline household characteristics of 284 adults and their children in an informal settlement in Uganda from April to May 2022. We monitored same-day indoor concentrations of particulate matter PM2.5, PM10, Carbon monoxide (CO), relative humidity %, and temperature from 9 am to 2 pm and interviewed caregivers/mothers about their respiratory symptoms and those of their children in the previous 30 days. We employed robust Poisson regressions to evaluate the associations between indoor air indicators and respiratory health symptoms. RESULTS: Approximately 94.7% of households primarily used biomass fuels and 32.7% cooked from inside their dwelling rooms. The median PM2.5, PM10 and CO levels were 49.5 (Interquartile range (IQR) = 31.1,86.2) µg/m3, 73.6 (IQR = 47.3,130.5) µg/m3 and 7.70 (IQR = 4.1,12.5) ppm respectively. Among adults, a 10 unit increase in PM2.5 was associated with cough (Prevalence Ratio (PR) = 3.75, 95%CI 1.15-1.55). Dwelling unit dampness was associated with phlegm (PR = 2.53, 95%CI = 1.39-4.61) and shortness of breath (PR = 1.78, 95% CI 1.23-2.54) while cooking from outside the house was protective against shortness of breath (PR = 0.62, 95% CI = 0.44-0.87). In children, dampness was associated with phlegm (PR = 13.87, 95% CI 3.16-60.91) and cough (PR = 1.62, 95% CI 1.12-2.34) while indoor residual spraying was associated with phlegm (PR = 3.36, 95%CI 1.71-6.61). CONCLUSION: Poor indoor air conditions were associated with respiratory symptoms in adults and children. Efforts to address indoor air pollution should be made to protect adults and children from adverse health effects.

Association between recent COVID-19 diagnosis, depression and anxiety symptoms among slum residents in Kampala, Uganda.

BACKGROUND: Despite the known link between poor living conditions and mental health, there has been little research on the mental health of slum dwellers worldwide. Although the Coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health issues, little focus has been given to the impact on slum dwellers. The study aimed to investigate the association between recent COVID-19 diagnosis and the risk of depression and anxiety symptoms among people living in an urban slum in Uganda. METHODS: A cross-sectional study was conducted among 284 adults (at least 18 years of age) in a slum settlement in Kampala, Uganda between April and May 2022. We assessed depression symptoms and anxiety using validated Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder assessment tool (GAD-7) questionnaires respectively. We collected data on sociodemographic characteristics, and self-reported recent COVID-19 diagnosis (in the previous 30 days). Using a modified Poisson regression, adjusted for age, sex, gender and household income, we separately provided prevalence ratios and 95% confidence intervals for the associations between recent COVID-19 diagnosis and depressive and anxiety symptoms. RESULTS: Overall, 33.8% and 13.4% of the participants met the depression and generalized anxiety screening criteria respectively and 11.3% were reportedly diagnosed with COVID-19 in the previous 30 days. People with recent COVID-19 diagnosis were more likely to be depressed (53.1%) than those with no recent diagnosis (31.4%) (p<0.001). Participants who were recently diagnosed with COVID-19 reported higher prevalence of anxiety (34.4%) compared to those with no recent diagnosis of COVID-19 (10.7%) (p = 0.014). After adjusting for confounding, recent diagnosis with COVID-19 was associated with depression (PR = 1.60, 95% CI 1.09-2.34) and anxiety (PR = 2.83, 95% CI 1.50-5.31). CONCLUSION: This study suggests an increased risk of depressive symptoms and GAD in adults following a COVID-19 diagnosis. We recommend additional mental health support for recently diagnosed persons. The long-term of COVID-19 on mental health effects also need to be investigated.

Urban green spaces and suicide mortality in Belgium (2001-2011): A census-based longitudinal study.

BACKGROUND: Exposure to green spaces is associated with improved mental health and may reduce risk of suicide. Here, we investigate the association between long-term exposure to residential surrounding greenness and suicide mortality. METHODS: We used data from the 2001 Belgian census linked to mortality register data (2001-2011). We included all registered individuals aged 18 years or older at baseline (2001) residing in the five largest urban areas in Belgium (n = 3,549,514). Suicide mortality was defined using the tenth revision of the World Health Organisation International Classification of Diseases (ICD-10) codes X60-X84, Y10-Y34, and Y870. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within a 300 m and 1,000 m buffer around the residential address at baseline. To assess the association between residential surrounding greenness and suicide mortality, we applied Cox proportional hazards models with age as the underlying time scale. Models were adjusted for age, sex, living arrangement, migrant background, educational attainment, neighbourhood socio-economic position. We additionally explored potential mediation by residential outdoor nitrogen dioxide (NO2) concentrations. Finally, we assessed potential effect modification by various socio-demographic characteristics of the population (sex, age, educational attainment, migrant background, and neighbourhood socio-economic position). Associations are expressed as hazard ratios and their 95% confidence intervals (CI) for an interquartile range (IQR) increase in residential surrounding greenness. RESULTS: We observed a 7% (95%CI 0.89-0.97) and 6% (95%CI 0.90-0.98) risk reduction of suicide mortality for an IQR increase in residential surrounding greenness for buffers of 300 m and 1,000 m, respectively. Furthermore, this association was independent of exposure to NO2. After stratification, the inverse association was only apparent among women, and residents of Belgian origin, and that it was stronger among residents aged 36 or older, those with high level of education, and residents of most deprived neighbourhoods. CONCLUSION: Our results suggest that urban green spaces may protect against suicide mortality, but this beneficial effect may not be equally distributed across all strata of the population.

The preference of women living with HIV for the HPV self-sampling of urine at a rural HIV clinic in Uganda.

Background: Women living with HIV have a double risk of acquiring cervical cancer (CC) due to repeated human papilloma virus (HPV) infections resulting from reduced immunity, with CC screening being low at 46.7%. Objectives: To determine the factors associated with the preference for HPV self-sampling using urine as well as establish its feasibility among women living with HIV attending a rural HIV clinic in Uganda. Method: A cross-sectional study design using quantitative data collection methods was used at the HIV clinic, Luweero District Hospital, among 426 women aged between 30 and 65 years. Data were analysed using descriptive statistics and modified Poisson regression. Urine samples were analysed using a Liferiver high-risk HPV genotyping real-time polymerase chain reaction (PCR) kit to determine the prevalence of the 15 HPV subtypes. Cervical intraepithelial neoplasia 2 (CIN2) was determined by visual inspection under acetic acid (VIA) using the nurse-led approach. Results: Most women (296/426, 70%) preferred nurse-led screening. Preference for HPV self-sampling using urine was associated with older age (46-65 years) (adjusted prevalence risk ratios [aPRR] 1.59; 95% confidence interval [CI]: 1.13-2.24), history of sexually transmitted infections (aPRR 0.74: 95% CI: 0.55-0.98) and acquisition of CC information from the television (aPRR 1.48: 95% CI: 1.09-2.02). Approximately 97% (68/70) of women living with HIV tested HPV positive with one or more subtypes. The most prevalent subtype of HPV was HPV 58 (87.1%). Only one woman tested positive with VIA. Conclusion: Nurse-led CC screening is preferred among women living with HIV, and HPV self-sampling using urine is feasible at the HIV clinic. Therefore, educational programmes to reassure the masses about urine HPV self-sampling need to be designed. Contribution: This study's findings provide early insights into the merits and demerits of the current HPV sample collection approaches. Hence, HPV testing should be tailored to routine HIV care in rural communities.

Community mask wearing as a COVID-19 preventive measure, its barriers, and motivators among rural households of Uganda: A mixed methods approach.

Adherence to mask wearing has the potential to reduce coronavirus disease 2019 acquisition risk. However, there is limited information about community mask wearing and its predictors among rural populations. This study aimed to assess the level of adherence to community mask wearing as a COVID-19 prevention measure, its barriers, and motivators among the Ugandan rural population of Wakiso District. This cross-sectional study utilised both quantitative and qualitative data collection methods. The quantitative component employed a semi-structured interviewer-administered questionnaire among 400 participants, to assess the level of adherence and associated predictors towards mask wearing. Modified Poisson regression with robust standard error estimates was used to obtain crude and adjusted prevalence ratios associated with mask wearing. Quantitative data analysis was performed using Stata 15.0 Statistical software. The qualitative component was used to further explore the barriers and motivators of community mask wearing whereseven focus group discussions among 56 community health workers were conducted. Data was analysed using a thematic approach with the help of Nvivo Version 12 software. The quantitative results showed that 70.8% (283/400) of the participants were adherent to mask wearing. Furthermore, reusable (cloth masks) were the most common form of face masks worn by the participants; 71.9% (282/400). Adequate knowledge about mask wearing as a COVID-19 prevention measure was positively associated with mask wearing (adjusted prevalence ratio (95% CI); 3.2 (1.19-8.56)). The qualitative results revealed; sensitization from health workers, provision of free masks, and fear of fines and arrests as motivators to mask wearing. Barriers to mask wearing included: inability to buy masks due to financial constraints, one-time provision of free masks, ill-fitting and worn-out masks, discomfort, and bribery. The practice of community mask wearing was sub-optimal among the study rural communities. Initiatives to scale up the practice need to be feasible for rural communities.

Physical activity levels and sociodemographic factors associated with meeting recommended levels among shop attendants in Mbarara municipality, Uganda.

BACKGROUND: Shop attendants are urban dwellers who may spend significant periods in sedentary lifestyles exposing them to non-communicable diseases. This study assessed the physical activity levels and sociodemographic factors associated with meeting the WHO recommended physical activity levels among shop attendants in Mbarara municipality, Uganda. METHODS: We conducted a cross-sectional study among 301 shop attendants. We used the global physical activity questionnaire to assess participants' physical activity levels. Modified Poisson regression was used to assess the sociodemographic factors associated with meeting recommended physical activity levels. RESULTS: Of the 301 participants, 234 (77.7%) met the WHO physical activity recommendations, especially through work-related physical activity of moderate intensity 194 (64.5%). The median weekly duration of all moderate-intensity physical activity was 180 min (IQR=90 to 360). The median daily sedentary time was 300 min (IQR=300 to 360). Being male (adjusted prevalence ratio=1.33, 95% CI 1.17 to 1.51) was significantly associated with meeting recommended physical activity levels. CONCLUSION: The physical activity levels among shop attendants were high and were mostly achieved through work-related activities of moderate intensity, with males being more likely to meet recommended physical activity levels. Findings suggest a need for gender-sensitive initiatives to increase physical activity levels, especially among female shop attendants.

Impact of the Sachet Alcohol Ban on Alcohol Availability in Uganda.

OBJECTIVE: Alcohol use continues to be a major public health problem in Uganda. This study sought to estimate the availability of sachet alcohol among retail food and beverage establishments in two Ugandan districts (Kampala and Jinja) before and after enactment of the national sachet alcohol ban. METHOD: Independent observations in 100 establishments were conducted by a pair of trained observers during the peak hours of 7 P.M. to 1 A.M. Using a standardized checklist, observers recorded indications of alcohol availability before and after enactment of the sachet alcohol ban. RESULTS: Availability of (a) alcohol and (b) sachet alcohol were significantly affected by the ban. Before the ban, 69% of all establishments sold alcohol; there was a significant reduction in alcohol availability after enactment of the ban to 43% of the establishments (p < .001). This reduction was observed in off-premise establishments (p < .001), but not in on-premise establishments (p = .710). Additionally, before the sachet alcohol ban, 52% of all establishments sold sachet alcohol; however, there was a significant reduction in sachet availability after enactment of the ban (1.4%, p < .001). CONCLUSIONS: Legislation banning the manufacture and sale of sachet alcohol has the potential to reduce sachet availability. Future studies should examine changes in alcohol consumption following the sachet alcohol ban.

Determinants of uptake of malaria preventive interventions among pregnant women in eastern Uganda.

BACKGROUND: Consistent use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) have been recommended as cost-effective interventions for malaria prevention during pregnancy in endemic areas. However, the coverage and utilization of these interventions during pregnancy in sub-Saharan Africa is still suboptimal. This study aimed to determine the uptake of IPTp and ITNs and associated factors among women during their recent pregnancy in Eastern Uganda. METHODS: This was a cross-sectional study conducted among 2062 women who had delivered within the last 12 months prior to the start of the study in three districts of Eastern Uganda. The primary outcomes were consistent ITN use and optimal uptake (at least 3 doses) of IPTp. A modified Poisson regression was used to examine the association between consistent ITN use and the uptake of optimal doses of IPTp with independent variables. Data were analysed using Stata 14 software. RESULTS: The level of uptake of IPTp3 (at least three doses) was 14.7%, while IPTp2 (at least two doses) was 60.0%. The majority (86.4%) of mothers reported regularly sleeping under mosquito nets for the full duration of pregnancy. Uptake of IPTp3 was associated with engaging in farming (adjusted PR = 1.71, 95% CI [1.28-2.28]) or business (adjusted PR = 1.60, 95% CI [1.05-2.44]), and attending at least 4 antenatal care (ANC) visits (adjusted PR = 1.72, 95% CI [1.34-2.22]). On the other hand, consistent ITN use was associated with belonging to the fourth wealth quintile (adjusted PR = 1.08, 95% CI [1.02-1.14]) or fifth wealth quintile (adjusted PR = 1.08, 95% CI [1.02-1.15]), and attending at least 4 ANC visits (adjusted PR = 1.07, 95% CI [1.03-1.11]). CONCLUSION: Uptake of IPTp3 and consistent ITN use during pregnancy were lower and higher than the current Ugandan national targets, respectively. Study findings highlight the need for more efforts to enhance utilization of ANC services, which is likely to increase the uptake of these two key malaria preventive measures during pregnancy.

Access to Functional Handwashing Facilities and Associated Factors among South Sudanese Refugees in Rhino Camp Settlement, Northwestern Uganda.

Background: Hand hygiene in refugee camp settlements remains an important measure against diarrhoeal infections. Refugee settings are characterised by overcrowding and inadequate access to water and hygiene facilities which favour proliferation of faecal-oral diseases. Handwashing with soap and water is therefore an effective way of preventing such diseases. Despite this knowledge, there is limited information about access to functional handwashing facilities in these settings and associated factors in Uganda. Methods: Quantitative data were collected from 312 refugee households in Rhino Camp Settlement, Northwestern Uganda, using a semistructured interviewer-administered questionnaire. A modified Poisson regression was used to obtain prevalence ratios (PRs) and 95% confidence intervals (CIs) for the determinants of access to a functional handwashing facility among refugee households. All analyses were performed using STATA 14.0 statistical software. Results: Of the 312 households, 123 (39.4%) had access to a handwashing facility, but only 72 (23.1%) of households had handwashing facilities that were functional. Duration of stay in the camp exceeding 3 years (adjusted PR = 2.63; 95% CI (1.73-4.00)) and history of receiving home-based education on hand hygiene (adjusted PR = 9.44; 95% CI (1.40-63.86)) were independent predictors of access to a functional handwashing facility. Conclusion: Access to functional handwashing facilities among the refugee households was low. Our findings highlight the need for more and continued handwashing promotional programs, most especially among newly arrived refugees in the camp.

Factors Associated with Composting of Solid Waste at Household Level in Masaka Municipality, Central Uganda.

The domestic solid waste stream composition of urban settings in many developing countries including Uganda is largely biodegradable in nature, and thus, composting provides the most suitable solid waste management option for these wastes. However, there is limited information about waste composting at the household level and associated determinants in Uganda. A cross-sectional study was employed to collect quantitative data from 368 residents of Masaka municipality, Central Uganda. A semistructured interviewer administered questionnaire was used which assessed knowledge, perceptions, and practices of composting. Data were analysed using STATA 13.0, and binary logistic regression was used to determine the factors that influence composting at the household level. Of the 368 participants, 11.4% were engaged in composting. Factors associated with household level composting were age of 46 years and above (aOR = 2.69, 95% CI = (1.06-6.80)), possession of a garden (aOR = 28.88, 95% CI = (3.85-216.72)), engagement in waste segregation (aOR = 5.56, 95% CI = (2.25-13.86)), and periurban residence (aOR = 3.81, 95% CI = (1.78-8.16)). The practice of composting at the household level was low. This therefore highlights the need for urban authorities to develop initiatives for promoting composting at the household level while considering the identified predictors associated with composting.