AIDS morbidity and the role of the family in patient care in Uganda.

Extended families and clans in African societies have extensive systems of treatment and patient management which can be used with AIDS sufferers. This paper used data from a baseline survey of six districts to study patient care in Uganda. The levels of AIDS illness are high, and highest in the sexually active age groups of 20-49 years. Of the nuclear family, parents, siblings, spouses and children are the dominant AIDS patients' primary carers in that order. Other relatives in the extended family also contribute much primary care. The contribution of neighbours and friends to primary caring and of other relatives as secondary carers is small. This is perhaps because of the financial burden of caring for the patients. However, there are indications that households and families are coping with the effects of the disease.

PIP: Extended families and clans in African societies have extensive systems of treatment and patient management from which people with AIDS can benefit. Findings are presented from the analysis of survey data collected since 1992 on patient care in Iganga, Mbale, Masaka, Mbarara, Kabale, and Hoima districts of Uganda. High levels of AIDS morbidity were observed, highest in the sexually active age groups of 20-49 years. In nuclear families, parents provide the highest level of care to AIDS patients, followed by lower levels of care provided by siblings, spouses, and children in descending order of importance. Other relatives in the extended family also contribute much primary care. However, the contribution of neighbors and friends to primary caring and of other relatives as secondary carers is small. The financial burden of caring for AIDS patients may be one reason why neighbors, friends, and distant relatives provide only very low levels of care. The data suggest that households and families are coping with the effects of AIDS.

Widowhood, remarriage and migration during the HIV/AIDS epidemic in Uganda.

Recently the levels of widowhood have increased in countries of sub-Saharan Africa that are afflicted by the HIV/AIDS epidemic. This paper reviews the cultures of several societies in Uganda in relation to the treatment of widows. Using a data set based on a sample of 1797 households covering east, south and western Uganda, the study finds higher proportions of widows than widowers. Over half of widowers compared to one quarter of widows remarry. Reasons for remarriages of widowers and widows are discussed. While younger widows migrated from their late spouses' homes more than the older ones, the pattern of the widowers shows that those in age 20-34 migrated most. Deeper analysis indicates that widowed people who moved away from their deceased spouses' homes did so for reasons other than the death of their spouses. The widowers were more likely to move than the widows and the unhealthy ones migrated more than the healthy ones.

Socio-economic determinants of HIV serostatus: a study of Rakai District, Uganda.

The objective of the study was to establish the extent to which socio-economic status affects the acquisition of HIV. Data were collected in 1992 from 1784 respondents in Rakai district by the Rakai Project, with results for HIV serology and information on demographic, socio-economic and some behavioural variables. Level of education and urban residence were positively significantly related to HIV status both at bivariate and multivariate levels. Household wealth status was positively associated with HIV status at the bivariate level, but negatively related with HIV status at the multivariate level though not statistically significantly. Occupation was significantly associated with HIV status at the bivariate level and for one model at the multivariate level, but when occupation of the partner, travel destinations of partner and respondent, condom use and number of sexual partners in the previous year were introduced in a second model, occupation was not significantly related to HIV status.

PIP: Secondary 1992 data from the Rakai Project database on the HIV serology, demographic, socioeconomic, and some behavioral variables of 1784 respondents in Rakai district were used in this study to determine the extent to which socioeconomic status affects the acquisition of HIV. Higher level of education and urban residence were positively significantly related to positive HIV serostatus at the bivariate and multivariate levels. Relatively high household wealth status was positively associated with positive HIV serostatus at the bivariate level, but negatively related with HIV status at the multivariate level. The difference, however, was not statistically significant. Occupation was significantly associated with HIV status at the bivariate level and for one model at the multivariate level. However, when occupation of the partner, travel destinations of partner and respondent, condom use, and number of sex partners in the previous year were introduced into a second model, occupation was not significantly related to HIV status.

Fertility levels and trends in the face of the AIDS epidemic in Uganda.

The paper uses data on ever-married women interviewed in 1992 and 1995 surveys in six districts of Uganda. Total fertility rates declined during the inter-survey period from 7.3 to 6.0. Women in households that experienced AIDS-related deaths had lower fertility levels than women in non-AIDS-affected households in both 1992 and 1995. This pattern was true of women at older ages, in polygamous unions, the widowed and separated, and among the highly educated and the uneducated.

PIP: Data on ever-married women in 1797 urban and rural households in the Mbale, Iganga, Masaka, Mbarara, Kabale, and Hoima districts of Uganda were obtained in a 1992 survey. Each household had experienced a death, mainly since 1982. 2352 households including those in the 1992 study were later interviewed in a 1995 survey. The additional households surveyed in 1995 had experienced a death during 1992-95. Total fertility rates declined during the period from 7.3 to 6.0. Women in households which experienced AIDS-related deaths had lower fertility levels than women in non-AIDS-affected households in both 1992 and 1995. That pattern held true for women at older ages, women in polygamous unions, the widowed and separated, and among the highly educated and the uneducated.

HIV/AIDS, change in sexual behaviour and community attitudes in Uganda.

The spread of HIV/AIDS is mostly through sexual intercourse and is largely influenced by behaviour and attitude. Data based on a sample of 1797 households are used to study changes in sexual behaviour and attitudes sickness and death in Ugandan communities, which were due to the realization that too many deaths were occurring in the community. Positive behaviour and attitudes include willingness to use condoms and go for HIV tests. Reasons for willingness and reluctance to test for HIV status are discussed. Changes of behaviour and attitude are significantly related to age, sex, education, ethnic group and number of AIDS patients and deaths known to a respondent.

The AIDS epidemic and infant and child mortality in six districts of Uganda.

Several studies in sub-Saharan Africa have associated infant and child mortality with the AIDS epidemic in the region. The paper uses retrospective survey data of six districts in the east, south and west of Uganda to study infant and child mortality, which increased in the 1980s probably because of the AIDS epidemic and started declining in the early 1990s, a period when the epidemic was reported to be subsiding. Deeper analysis of data indicates that children whose parents are polygamous, educated, formally employed and in business are at a higher risk of death from AIDS and related illness. Although AIDS as a direct cause of death is the fourth leading killer of children, other serious diseases such as diarrhoea, respiratory infection and measles are associated with AIDS.

PIP: Several studies in sub-Saharan Africa have associated infant and child mortality with the AIDS epidemic in the region. In the Mbale, Iganga, Masaka, Mbarara, Kabale, and Hoima districts of Uganda, infant and child mortality increased during the 1980s, most likely because of the AIDS epidemic, and began declining in the early 1990s, a period when the epidemic was reported to be subsiding. Using survey data collected from households in the districts in 1992 and 1995 and vital registration data for 1 year during 1995 and 1996, children whose parents are polygamous, educated, formally employed, and in business were found to be at higher risk of death from AIDS and related illness. AIDS as a direct cause of death is the fourth leading killer of children. However, other serious diseases such as diarrhea, respiratory infection, and measles are also associated with AIDS. 1797 households were surveyed in 1992 and 2352 in 1995.

AIDS mortality in Uganda: circumstances, factors and impact of death.

HIV/AIDS is a serious problem in sub-Saharan Africa. The disease affects the most sexually active adults of the population, who belong to the most productive age groups, and some of whom are breadwinners. The paper uses data from a baseline survey of six districts of Uganda to study the circumstances, factors and impact of death due to AIDS. While high proportions of patients of AIDS or related diseases use health facilities, most deaths occur at home. Deaths due to AIDS or related diseases are associated with sex, age, marital status, type of marriage, education, occupation and ethnicity. The worst effect of AIDS deaths on the household is lack of finance.

PIP: HIV/AIDS affects the most sexually active adults of the population in sub-Saharan Africa. Those individuals also belong to the most productive age groups and some support partners, families, and households. Data collected from 1797 urban and rural households in the Mbale, Iganga, Masaka, Mbarara, Kabale, and Hoima districts of Uganda in a 1992 survey were examined to study the circumstances, factors, and impact of death due to AIDS. Each household had experienced a death, mainly since 1982. While high proportions of patients of AIDS or related diseases use health facilities, most deaths occur at home. Deaths due to AIDS or related diseases were found to be associated with sex, age, marital status, type of marriage, education, occupation, and ethnicity, while the worst effect of AIDS deaths upon households is lack of finance.

Effect of AIDS on children: the problem of orphans in Uganda.

The problem of orphans is serious in sub-Saharan Africa and has been increasing with the deaths of both parents from AIDS. A study of six districts of Uganda conducted in 1992 investigated the problem. Almost all the orphans are cared for by their extended family members who made the decisions to do so. It is recommended that more assistance be given to the family to enhance its capacity to cope with increased orphans expected in the future.

PIP: Excess mortality due to AIDS is causing the number of orphans and proportion of orphaned children in sub-Saharan Africa to grow daily. Uganda's 1991 population and housing census identified 1,037,228 children under age 18 years who had lost at least one parent, comprising 11.6% of all children in the same age group. 48,962 boys and 47,886 girls had lost both parents. Findings are presented from the analysis of survey data collected during 1992-93 in Iganga, Mbale, Masaka, Mbarara, Kabale, and Hoima districts. There were 4502 orphans under age 18 years in the districts, for an overall orphanhood prevalence rate of 42.7%. Masaka had the highest rate at 64.0%, while Mbarara had the lowest at 21.9%. The average number of orphans per household in the sample was 2.8. Almost all of the orphans are being cared for by their extended family members. More help should be given to families to enable them to better cope with the increased number of orphans expected in the future.

Impact of AIDS on the family and mortality in Uganda.

PIP: A study is being conducted to examine household composition and family structure in the context of high AIDS-related mortality in Hoima, Iganga, Kabale, Masaka, Mbale, and Mbarara districts. The first phase of the study involved the review of ethnographic materials on the populations in the six districts, collecting information from elders and youths through focus group discussions, and the administration of an individual elders' questionnaire. The second phase was a large-scale household survey in the districts to document recent changes in household composition and family structure, while phase three will be carried out three years after the second phase. That final phase will involve re-surveying areas covered in phase two to determine any subsequent changes which have occurred in the communities. This paper presents the results from the elder's survey conducted during phase one. A total of 143 elders, 109 men and 34 women, were interviewed. The respondents were at least 45 years old and all were heads of households. The survey posed questions on household composition, mortality, morbidity, the impact of AIDS upon the family, general health status of the community, and migration. Findings are presented on family composition and structure, AIDS mortality, feelings of loss by elders, and changes in funeral rites and inheritance.^ieng

Impact of AIDS on marriage patterns, customs and practices in Uganda.

PIP: A study is being conducted to examine household composition and family structure in the context of high AIDS-related mortality in Hoima, Iganga, Kabale, Masaka, Mbale, and Mbarara districts. The first phase of the study involved the review of ethnographic materials on the populations in the six districts, collecting information from elders and youths through focus group discussions, and the administration of an individual elders' questionnaire. The second phase was a large-scale household survey in the districts to document recent changes in household composition and family structure, while phase three will be carried out three years after the second phase. That final phase will involve re-surveying areas covered in phase two to determine any subsequent changes which have occurred in the communities. This paper presents the focus group discussion results from phase one. The participating 231 men and 218 women were aged 19-92 years and 14-92 years, respectively. It appears on the basis of the focus group discussions that marriage customs and practices have changed over time due to factors related to socioeconomic development, modernization, and Western culture. Recent changes in marriage have been closely connected with the AIDS epidemic in the country. The fear of potential partners being HIV-seropositive makes boys and girls reluctant to marry, while mutual monogamy among spouses, especially the young, seems to be gaining popularity. Many customs, however, still persist, such as parental participation in the introduction and negotiation for children's marriages, bride price, dowry, circumcision of boys before marriage, fining boys who elope with girls, and rewarding virginity at marriage.^ieng

Care for AIDS orphans in Uganda: findings from focus group discussions.

PIP: The care of AIDS orphans in several regions of Uganda has recently been studied. The study also investigated how the various societies in Uganda have coped with the orphan problem since the onset of the AIDS epidemic. Changes in past and present coping mechanisms are discussed, with recommendations made for the future. Data were collected during 1992 from 241 men and 218 women in focus groups in Uganda's Hoima, Kabale, Mbarara, Masaka, Iganga, and Mbale districts. The participating men and women were aged 19-92 years and 14-92 years, respectively. Orphan care by a surviving parent, care by relatives, and other assistance to orphans are discussed. Orphan care in Uganda has changed since the onset of the AIDS epidemic. The changes are due mainly to the large number of orphans which have overwhelmed the extended family structure. Nonetheless, relatives still care for orphans despite their own problems, albeit at great financial hardship to the caregivers. It is recommended that governmental and nongovernmental organizations increase their levels of assistance to households caring for orphans. The authors further note the higher mortality of orphans, how many people who care for orphans are either too old or too young to fulfill the responsibility which they have assumed, and stigmatization.^ieng

Family planning in rural Uganda: knowledge and use of modern and traditional methods in Ankole.

Ankole has recorded the highest fertility in Uganda over the past several decades. One of the main proximate determinants of fertility in the area is the low level of contraception. A study of knowledge and use of modern and traditional contraceptive methods is reported in this paper. It is shown that higher proportions of women known and practice traditional methods compared with modern ones. Several factors contributing to past low use of modern contraceptives in the area are examined and current contraceptive use is also examined.

PIP: The Ankole have demonstrated the highest fertility in Uganda over the past several decades. The low level of contraceptive prevalence constituting a main proximate determinant of fertility in the region, a study of the knowledge and use of modern and traditional methods was conducted. 2-stage sample survey data from 1984 were employed, and revealed that more women know and practice traditional methods compared with modern ones. Use of any form of contraception, however, remains low. Low use of modern methods was due to lack of knowledge of supply sources, low education, low levels of employment outside of the home, unavailability of supplies, and pronatalist cultures. The author, therefore, recommends several courses of action to reduce fertility in the Ankole. Better-educated women have shown a higher degree of modern contraceptive method use suggesting that government encourage young women to attain higher education levels. Improved employment opportunities for women will also hopefully serve as incentives to limit fertility. The Family Planning Association of Kenya should take advantage of unmet demand for family planning services and supplies, and make supplies more readily available. Additionally, more efficient follow-up services should be developed. Prolonged breast feeding should be encouraged, child health improved, and research conducted on the traditions, norms, customs, and taboos of target populations. As such cultural conflicts serving as obstacles to program success may be more easily overcome. Finally, the author comments that adopting and improving upon some traditional methods will be better accepted than relying wholly upon modern, foreign contraceptive methods.

Family planning in rural Uganda: knowledge and use of modern and traditional methods in Ankole

Ankole has recorded the highest fertility in Uganda over the past several decades. One of the main proximate determinants of fertility in the area is the low level of contraception. A study of knowledge and use of modern and traditional contraceptive methods is reported in this paper. It is shown that higher proportions of women known and practice traditional methods compared with modern ones. Several factors contributing to past low use of modern contraceptives in the area are examined and current contraceptive use is also examined

The desire for children in tropical Africa: the influence of relatives on fertility decisions in Ankole, Uganda.

In a survey in Ankole (Uganda) in 1985, 1664 women in samples of the three socioeconomic groups (pastoralists, cultivators and mixed farmers) were asked questions on their reproductive history, and 1029 men questions on educational and wedding costs and their expectations of help from relatives and obligations to help relatives. It is shown that the extended family system allows a great deal of mutual support, while the power of the elders allows them to influence younger married relatives to follow the pronatalist traditions of the society.

The desire for children in tropical Africa: the influence of relatives on fertility decisions in Ankole; Uganda

In a survey in Ankole (Uganda) in 1985; 1664 women in samples of the three socioeconomic groups (pastoralists; cultivators and mixed farmers) were asked questions on their reproductive history; and 1029 men questions on educational and wedding costs and their expectations of help from relatives and obligations to help relatives. It is shown that the extended family system allows a great deal of mutual support; while the power of the elders allows them to influence younger married relatives to follow the pronatalist traditions of the society

The value of children as a major influence on fertility in Uganda: a case study of Ankole.

PIP: In the high fertility area of Bankole, a 1985 study of the value of children to the Banyankole was conducted. Information on marriage patterns, perceptions of the pros and cons of children, and the costs and benefits of extended families was obtained through a random sampling of 900 household and surveys of more than 1000 ever-married man and 1000 ever-married women. A total fertility rate of 8.7 exists for the area, with rate differences observed between socioeconomic groups. Of pastoralists, peasants, and cultivators, the pastoralists reported the lowest fertility rate of 7.1, compared to the highest rate from the cultivators of 10.3. Despite the effect of education, employment, and religion in increasing the age of first marriage from 18 years in 1969 to 21.5 by 1985, cultural practices persist in encouraging high fertility levels. Pastoralist male migration for work during dry season, and the female return to her parents' home following delivery may be 2 practices contributing to a comparative lower fertility rate among this group. Absence of taboos regarding postpartum sexual abstinence among the Banyankole is a determinant of high fertility for the Ankole as a whole. With recorded 4% annual growth in the area, and governmental budgetary constraints to shifting funds into the social service sector, politically, culturally, and socially acceptable population policies are needed to combat pronatalist customs of the Ankole.^ieng

The Demeny-Shorter and three-census methods for correcting age data.

This paper presents, tests, applies, and compares methods that utilize age data collected at consecutive censuses to examine and adjust for age and coverage errors. The Demeny-Shorter method, for example, was devised for this purpose, and its flexibility in regard to census coverage errors is examined. The Demeny-Shorter method is found difficult to apply directly, so a method based on the same idea as the Demeny-Shorter method but utilizing age data from three, instead of two, successive censuses is presented and discussed as a possible alternative. This three-census method is applied to data from Turkey's censuses and, in some cases, found to be better than the Demeny-Shorter method, because the former allows for and estimates the likely changes in census coverage and different patterns of age errors in successive censuses. Unfortunately, the three-census method cannot be applied to data from most developing countries on account of a lack of the requisite series of censuses.

Patterns of age and coverage errors in Tropical African surveys.

PIP: The concept of calculating averages of African age distributions is developed in an attempt to distinguish the effect of age and coverage errors in demographic surveys in Tropical Africa from real fluctuations in the age structure. The concept is also used to discern different patterns of age errors and omissions and to indicate the extent of these errors in African age data. The method described is applied to data from 50 surveys undertaken in Tropical Africa between 1950 and 1973.^ieng

Has AIDS awareness changed sexual behaviour in Uganda?

This chapter reports on a study of sexual behavior in three districts of Uganda. The fondings reveal almost universal knowledge about AIDS and its causes. More than two-thirds of the respondents considered themselves to be at risk of HIV infection and a substantial percentage of respondents were aware of measures to prevent infection. Some behavioural changes among respondents were noted as a result of AIDS. The majority of the respondents preferred confining sexual relations to one partner and expressed a willngness to udnertake HIV tests. Most respondents said they would live responsibly with the disease and would not have sex if sexual partners refused to use condoms. Condom use was low (36.7) with the majority of users wanting to avoid Acquired Immunodeficiency Syndromes and AIDS. A positive relationship between awareness and sexual behavior was observed