Browsing by Author "Udho, Samson"
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Item Access to family planning services and associated factors among young people in Lira city northern Uganda(BMC Public Health, 2024) Kigongo, Eustes; Tumwesigye, Raymond; Anyolitho, Maxson Kenneth; Musinguzi, Marvin; Kwizera, Gad; Achan, Everlyne; Nabasirye, Caroline Kambugu; Udho, Samson; Kabunga, Amir; Omech, BernardBackground Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda. Methods and materials A mixed-methods study was conducted in March to April 2022. Quantitative data were collected using a structured questionnaire from 553 participants aged 15–24 years. Qualitative data were obtained through in-depth interviews and focus group discussions. Data analysis included univariate, bivariate, and multivariate analyses for quantitative data, while interpretative phenomenological analysis was used for qualitative data. Results Overall, 31.7% of the respondents had a good perceived access to family planning services, with 64.6% reporting perceived availability of FP methods. Challenges included lack of privacy (57.7%), fear of mistreatment (77.2%), and decision-making difficulties (66.2%). Among females, good perceived access to FP services was less likely among urban residents (AOR: 0.22, 95% CI: 0.09–0.53), Christian respondents (AOR: 0.51, 95% CI: 0.01–0.36), Muslim respondents (AOR: 0.07, 95% CI: 0.01–0.55) and respondents with poor attitude to FP services (AOR: 0.39, 95% CI: 0.24–0.64), but more likely among respondents with a sexual a partner (AOR: 4.48, 95% CI: 2.60–7.75). Among males, good perceived access to FP services was less likely among respondents living with parents (AOR: 0.19, 95% CI: 0.05–0.67) but more likely among respondents with good knowledge of FP services (AOR: 2.28, 95% CI: 1.02–5.32). Qualitative findings showed that three themes emerged; knowledge of family planning methods, beliefs about youth contraception and, friendliness of family planning services. Conclusion The study revealed a substantial gap in perceived access to family planning services among young people in Lira City. Barriers include privacy concerns, fear of mistreatment, and decision-making difficulties. Tailored interventions addressing urban access, religious beliefs for females, and knowledge enhancement for males are essential. Positive aspects like diverse FP methods and physical accessibility provide a foundation for targeted interventions. Youth-friendly services, comprehensive sexual education, and further research are emphasized for a nuanced understanding and effective interventions in Northern Uganda. Keywords Access, Contraception, Family planning, Youths, Young peopleItem An Analysis of Post-Traumatic Stress Disorder and Quality of Life Among Adults Living with HIV in Western Uganda(HIV/AIDS - Research and Palliative, 2024) Kabunga, Amir; Kigongo, Eustes; Udho, Samson; Auma, Anna Grace; Tumwesigye, Raymond; Musinguzi, Marvin; Acup, Walter; Akello, Anne Ruth; Okalo, Ponsiano; Nabaziwa, Jannat; Shikanga, Enos Mwirotsi; Halima, NamataBackground: HIV/AIDS remains a significant global public health issue, profoundly impacting infected individuals. Living with HIV involves complex mental health dynamics, with post-traumatic stress disorder (PTSD) being a prevalent challenge. This study aims to examine the correlation between PTSD and quality of life among HIV-positive individuals in western Uganda. Material and Methods: Conducted between May and July 2023, this facility-based cross-sectional study surveyed 439 participants from four HIV clinics in southwestern Uganda. Data were collected through interviewer-administered questionnaires, analyzed using descriptive statistics, simple linear regression, and multiple linear regression (p<0.05). Results: Respondents had a mean age of 40.6 years, with 68.3% female, 54.9% married, and 55.1% lacking formal education. The reported PTSD prevalence among HIV-positive individuals was 33.7%, significantly correlating with reduced overall quality of life (β = −4.52; p<0.001). The social quality of life had the highest mean score of 14.24 (±3.45) while the environmental quality of life had the lowest mean score 11.89 (±2.68). Conclusion: Our study reveals a concerning prevalence of PTSD, affecting 1 in 3 individuals, emphasizing the pressing need for comprehensive mental health support within HIV care settings. We observed a significant negative impact of PTSD on overall quality of life, particularly in physical and social aspects. Integrating mental health screening into routine HIV care is crucial, using validated tools like the PSTD Checklist Civilian Version, alongside training for healthcare providers to recognize PTSD symptoms in the context of HIV diagnosis and treatment.Item Barriers and Facilitators to Successful Intensive Adherence Counseling in Rural Northern Uganda: An Exploratory Interview with HIV-Positive Clients Using the COM-B Framework(HIV/AIDS-Research and Palliative Care, 2022) Beja, Humphrey; Daisy, Nakayiwa; Edek, Micheal Tonny; Kobusinge, Veronic; Akaki, Oscar; Owachgiu, Innocent Ocitti; Udho, SamsonPurpose: Intensive adherence counseling (IAC) was introduced as a strategy to enhance adherence to antiretroviral therapy (ART) among HIV clients with non-suppressed viral loads. There has been sub-optimal viral load suppression among HIV clients in Uganda enrolled in IAC. However, there is a scarcity of literature on the barriers and facilitators of successful IAC. We aim to explore the barriers and facilitators to successful IAC among HIV-positive clients seeking care in public health facilities in rural northern Uganda. Patients and Methods: This was an exploratory qualitative study conducted among 15 purposively sampled HIV-positive clients enrolled in IAC in public health facilities offering ART services in northern Uganda. We conducted in-depth interviews using semistructured interview guides based on the capability, opportunity, motivation, and behavior (COM-B) framework for behaviour change. Data were analyzed using the deductive thematic approach of Braun and Clarke following the COM-B framework. Results: The majority of the participants were females (60%), married (53%), and attained primary education (47%). Barriers to successful IAC were Capability – alcoholism and promiscuity, Opportunity – stigma and discrimination, delayed viral load result, shortage of food, and heavy workload; and Motivation – deteriorating health and lack of incentives. Facilitators to successful IAC were Capability – good knowledge of ART, good memory, and reminder alerts; Opportunity – availability of ART, social support, availability of ART, prolonged ART refill, and good counseling; and Motivation – desire to live longer and healthy and the desire to fulfill dreams and goals. Conclusion: Successful implementation of IAC needs to consider the context of the person in care thus the need to strengthen individualized IAC sessions. HIV care providers can adopt the COM-B framework to perform individualized IACs and use the information to strengthen the counseling sessionsItem Burnout and Associated Factors among Hospital-Based Nurses in Northern Uganda: A Cross-Sectional Survey(BioMed Research International, 2022) Udho, Samson; Kabunga, AmirBackground. Burnout is a public health problem that disproportionately affects nurses in sub-Saharan Africa because of the weak health systems that create an unconducive workplace environment. In Uganda, there is limited evidence on the burden of burnout among nurses in a manner that undermine advocacy and policy formulation. We aimed to assess the level of burnout and associated factors among nurses in northern Uganda. Methods. This was a cross-sectional survey conducted among 375 randomly selected nurses from health facilities in northern Uganda. Data were collected using a self-administered questionnaire. Data analysis consisted of descriptive statistics and logistic regression at a 95% level of significance in SPSS version 25. Results. Majority of the respondents were female 56.5% (n = 223). Nearly half, 49.1% (n = 194) of respondents had high levels of burnout, 36.2% (n = 143) reported average levels of burnout, and 14.7% (n = 58) reported low levels of burnout. Factors associated with burnout were age (AOR: 2.90; 95% CI: 1.28-6.58; p = 0:011), social support (AOR: 0.45; 95% CI: 0.22- 0.94; p = 0:033), healthy eating (AOR: 0.06; 95% CI: 0.02-0.22; p < 0:001), workload (AOR: 0.31; 95% CI: 0.14-0.68; p = 0:004), and management responsibilities (AOR: 3.07; 95% CI: 1.54-6.12; p = 0:001). Conclusion. Half of the nurses in northern Uganda experienced high levels of burnout. The Ministry of Health should consider recruiting more nurses to reduce workload and adjust working hours to prevent workplace-related burnout among nurses in the country.Item Burnout and coping mechanisms among healthcare professionals in central Uganda(Psychiatry, 2024) Kabunga, Amir; Kigongo, Eustes; Okalo, Ponsiano; Udho, Samson; Auma, Anna Grace; Tumwesigye, Raymond; Akello, Anne Ruth; Musinguzi, Marvin; Acup, Walter; Nabaziwa, Jannat; Shikanga, Enos Mwirotsi; Namata, HaliamaBackground: The escalating global prevalence of burnout among healthcare professionals poses a serious health concern. Recent studies focus on prevalence and predictors of burnout among healthcare providers, emphasizing the need for well-being interventions. This study investigates burnout and coping mechanisms among healthcare professionals in central Uganda, addressing the dearth of knowledge about coping strategies specific to the region. Methods: An analytical facility cross-sectional study was conducted in five healthcare facilities in central Uganda between June to July 2023. Participants included physicians, nurses, and technicians actively engaged in direct patient care. Data were collected using socio-demographic surveys, the Professional Quality of Life (ProQOL-5), and the Brief-COPE tools. Results: The study revealed a high prevalence of burnout, with 39.8% of participants experiencing significant levels. Active coping, positive reframing, and denial were negatively correlated with low burnout levels. Dysfunctional coping, specifically self-distraction and denial, showed positive correlations with average and high burnout levels. Emotion-focused coping mechanisms were not employed across burnout levels. Conclusions: The results emphasize the demanding nature of healthcare roles in the region and highlight the need for comprehensive, context-specific interventions to address burnout globally. While some healthcare professionals utilized adaptive strategies such as seeking social support, engaging in self-care activities, and utilizing problem-solving skills, others resorted to maladaptive coping mechanisms such as substance use and avoidance behaviors. This dichotomy highlights the need for targeted interventions to promote adaptive coping strategies and mitigate the negative impact of maladaptive behaviors on individual well-being and patient careItem Burnout and quality of life among healthcare workers in central Uganda(PLoS ONE, 2024) Kabunga, Amir; Kigongo, Eustes; Okalo, Ponsiano; Udho, Samson; Auma, Anna Grace; Tumwesigye, Raymond; Akello, Anne Ruth; Musinguzi, Marvin; Acup, Walter; Nabaziwa, Jannat; Shikanga, Enos Mwirotsi; Namata, HaliamaBackground The widespread problem of burnout among healthcare workers is not only common but also a significant concern that impacts the entire healthcare system in Uganda. It is essential to understand the connection between burnout and quality of life among healthcare workers in the specific context of central Uganda, where healthcare professionals face high patient volumes, limited resources, exposure to infectious diseases, and socioeconomic challenges. This study examined the relationship between burnout and quality of life among healthcare workers in central Uganda. Methods This research utilized a cross-sectional study conducted across various healthcare settings in central Uganda. The data were analyzed at descriptive, bivariate, and multivariate levels. The relationship between dependent and independent variables was evaluated using an independent t-test for binary variables and a one-way analysis of variance (ANOVA) for categorical variables. Significance was determined with a reported p-value, with relationships deemed significant at p < 0.2. For multivariable analysis, multiple linear regression was employed using a forward selection method, with significance set at 5% (p < 0.05). Results Our findings indicate that nearly 40% of healthcare workers reported experiencing high levels of burnout. The average score for overall quality of life was 10.71 (±4.89), with variations observed across different domains. The study reveals a significant connection between socio-demographic factors, burnout, and overall quality of life, emphasizing the impact of job category, supervisory support, sleep quality, and burnout on the well-being of healthcare workers. Predictive analysis illustrates how these factors influence both overall quality of life scores and scores in specific domains. Particularly noteworthy is that nurses and technicians tend to have a lower quality of life compared to physicians. Conclusion The results underscore the relationship between socio-demographic factors, burnout, and particular aspects of quality of life. Notably, job category, supervisory support, sleep quality, and burnout stand out as significant factors shaping the well-being of healthcare workers. Nurses and technicians encounter distinct challenges, suggesting the need for interventions tailored to their needs. Addressing issues such as inadequate supervisory support, burnout, and sleep-related problems is recognized as a potential approach to improving the overall quality of life among healthcare workers.Item A call for critical midwifery studies: Confronting systemic injustice in sexual, reproductive, maternal, and newborn care(Wiley, 2022) Ashley, Rebecca; Goodarzi, Bahareh; Horn, Anna; de Klerk, Hannah; E. Ku, Susana; Marcus, Jason K.; Mayra, Kaveri; Mohamied, Fatimah; Nayiga, Harriet; Sharma, Priya; Udho, Samson; Vijber, Madyasa Ruby; van der Waal, Rodanteystemic injustice is a threat to sexual, reproductive, ma- ternal, and newborn (SRMN) health. The effects of this injustice are reflected in the high maternal and neonatal morbidity and mortality rates in former colonized coun- tries of the Global South, in marginalized communities of the Global North, and in underprivileged classes around the world. 1 Current research, clinical guidance, and global health politics all point to an inadequate response to in- justice on the part of SRMN care systems. Consider, for instance, four examples of ongoing injustices globally: the lack of workforce to meet SRMN, 2 the lack of access to safe abortion, 3 the “ethnic”, “racial”, and socioeconomic disparities present in maternal and newborn outcomes during the Covid-19 pandemic,4,5 and the severity and persistence of obstetric violence and obstetric racism.Item Chronic stress and coping mechanisms among nurses in Lango sub-region, northern Uganda(Wiley Nursing Open, 2023) Kabunga, Amir; Kigongo, Eustes; Udho, Samson; Auma, Anna Grace; Okalo, Ponsiano; Apili, Brenda; Namata, Halimah; Nalwoga, ViolaAim: This study aimed to assess chronic stress and coping mechanisms among nurses in Lango sub-region, northern Uganda, conducted between May and June 2022. Design: Institutional-based cross-sectional design conducted between May and June 2022. Methods: The study included 498 participants recruited from six health facilities. A 12-Item Short Form Survey tool was used to collect data on chronic stress, while a researcher-developed questionnaire was used to collect data on coping strategies. Descriptive statistics, binary logistic regression and multiple regression were con ducted for data analysis. A p-value of 0.05 was considered statistically significant. Results: Out of 498 participants, 153 (30.7%) were aged between 31 and 40 years, 341 (68.5%) were female, 288 (57.8%) were married, and 266 (53.4%) had less than Diploma. Of the 498 participants, 351 (70.5%) experienced chronic stress. The protective factors against chronic stress were being married (AOR: 0.132; 95% CI: 0.043–0.408; p< 0.001), optimizing shift length (AOR: 0.056; 95% CI: 0.027–0.115; p< 0.001), religiosity/Spirituality (AOR: 2.750; 95% CI: 1.376–5.497; p= 0.004), and regular exercise and breaks (AOR: 0.405; 95% CI: 0.223–0.737; p= 0.003)Item Chronic stress and its correlates among nurses: A case of Central Uganda(Avicenna J Neuro Psycho Physiology, 2023) Kabunga, Amir; Kigongo, Eustes; Udho, Samson; Musinguzi, Marvin; Tumwesigye, Raymond; Acup, WalterBackground: Despite an overwhelming disease burden, nursing shortages are evident in Sub-Saharan Africa, with the potential for significant healthcare crises. Nurses face increased work demands and chronic stress due to a skilled personnel shortage, which may lead to stress. The present study aimed to examine chronic stress and its correlates among nurses in central Uganda. Methods: The 12-item Short Form Survey (SF-12) for the assessment of chronic stress among nurses, a validated and standardized tool, was used in this cross-sectional study in 2022. For explanatory analysis, the items were combined with dichotomous variables reflecting predictors of chronic stress. These items were used to create dichotomous variables denoting frequent and demanding challenges for exploratory analysis. The relationship between the variables and high levels of chronic stress was investigated using a multivariate logistic regression model. Results: Based on the findings, the majority, 485 (76.0%), had chronic stress. The results indicate that the correlates of chronic stress among participants were widowhood (AOR: 0.040; 95% CI: 0.013-0.127; P= <0.001), being worried about looming deadlines (aOR: 0.003; 95% CI: 0.001-0.023; P = <0.001), long working hours (AOR: 0.283; 95% CI: 0.159-0.504; p=<0.001), insufficient job control (AOR: 0.304; 95% CI: 0.127-0.727; P = 0.007), and inadequate rewards (AOR: 2.554; 95% CI: 1.170-5.574; P = 0.019). Conclusion: According to our findings, three in four nurses in central Uganda suffer from chronic stress. This can exert a negative impact on their overall well-being and caring behaviors. Chronic stress was associated with widowhood, a looming deadline, long working hours, insufficient job control, and inadequate rewards. It is critical to adapt interventions, such as hiring additional nurses, to reduce workload and ensure adequate rest periods.Item Exploring Effective Approaches: Integrating Mental Health Services into HIV Clinics in Northern Uganda(HIV/AIDS - Research and Palliative Care, 2024) Kabunga, Amir; Namata, Halimah; Kigongo, Eustes; Musinguzi, Marvin; Tumwesigye, Raymond; Auma, Anna Grace; Nabaziwa, Jannat; Shikanga, Enos Mwirotsi; Okalo, Ponsiano; Nalwoga, Viola; Udho, SamsonBackground: Integrating mental health services into HIV clinics is recognized as a promising strategy. However, the literature reveals gaps, particularly in the unique context of Northern Uganda, where factors such as historical conflict, stigma, and limited resources pose potential barriers. Material and Methods: This qualitative study, conducted between October and November 2023, employed a phenomenological design. The study involved primary healthcare facilities across diverse urban and rural settings, focusing on healthcare providers, village health teams, and service users. A purposive sampling approach ensured diverse demographics and perspectives. In-depth interviews and focus group discussions were conducted, with healthcare providers and service users participating individually, and village health teams engaged in group discussions. Thematic analysis was employed during data analysis. Results: Findings revealed a predominance of females among healthcare providers (18 of 30) and service users (16 of 25), as well as in VHTs. Average ages were 33.4 (healthcare providers), 38.5 (service users), and 35.1 (VHTs). Most healthcare providers (15) held diplomas, while 12 service users and 4 VHTs had certificates. The majority of healthcare providers (n=20) and 4 VHTs had 6–10 years of experience. Thematic analysis highlighted three key themes: benefits of integrated mental health services, implementation challenges, and the role of community engagement and cultural sensitivity. Conclusion: This study contributes valuable insights into the integration of mental health services into HIV clinics in Northern Uganda. The perceived benefits, challenges, and importance of cultural sensitivity and community engagement should guide future interventions, fostering a holistic approach that enhances the overall well-being of individuals living with HIV/AIDS in the region. Policymakers can use this information to advocate for resource allocation, training programs, and policy changes that support the integration of mental health services into HIV clinics in a way that addresses the identified challengesItem Factors associated with uptake of human papilloma virus vaccine among school girls aged 9–14 years in Lira City northern Uganda: a cross-sectional study(BMC Women's Health, 2023) Nakayita, Renniter Mirembe; Benyumiza, Deo; Nekesa, Catherine; Misuk, Ivan; Kyeswa, Julius; Nalubuuka, Aisha; Murungi, Tom; Udho, Samson; Kumakech, EdwardAbstract Background Cervical cancer is the most common Human Papilloma Virus (HPV)-related disease among women. Since 2008, HPV vaccination has been routinely recommended for pre-adolescent and adolescent girls in Uganda as the primary preventive measure for cervical cancer. However, in Uganda, most especially in Lira district, there is limited literature on HPV vaccination uptake and associated factors among girls aged 9-14years. This study assessed the uptake of HPV vaccine and associated factors among in-school girls aged 9–14 years in Lira City, northern Uganda. Methods A cross-sectional study was conducted among 245 primary school girls aged 9–14 years in Lira City, northern Uganda. Multistage sampling technique was used to sample eligible participants and data was collected using interviewer administered questionnaire. Data was analysed using SPSS version 23.0. Descriptive statistics and multivariate logistic regression at 95% level of significance were used to identify the level of HPV vaccine uptake and predictors respectively. Results HPV vaccination uptake was at 19.6% (95% CI,14.8–25.1) among the school girls aged 9–14 years in Lira City, northern Uganda. The mean age of the girls was 12.11 (±1.651) years. Predictors that were independently associated with HPV vaccine uptake included; recommendation from health worker [aOR 9.09, 95% CI (3.19–25.88), P≤0.001], taught about cervical cancer at school [aOR,12.56, 95% CI (4.60–34.28), P≤0.001], and exposure to outreach clinics [aOR, 4.41, 95% CI (1.37–14.19), P=0.013]. Conclusion The study found that one in five of the school girls in Lira City, northern Uganda. received HPV vaccine. Girls who were taught about cervical cancer at school, exposure to outreach clinics and received health worker recommendation had more odds of receiving HPV vaccine than their counter parts. The Ministry of Health should strengthen school based cervical cancer education, awareness raising about HPV vaccination and health worker recommendations to improve HPV vaccine uptake among school girls in Uganda.Item Factors Associated with Utilization of HIV Testing Services among Adolescents Aged 10-19 Years in Lira District, Northern Uganda: A Cross-Sectional Study(Hindawi BioMed Research International, 2021-08-12) Benyumiza, Deo; Amongin, Joan Fidelia; Ochaba, Isaac; Adupa, Morish; Abuch, Naume; Banula, Constance Babirye; Udho, SamsonBackground. HIV testing remains a problem among adolescents in low- and middle-income countries, and yet, HIV testing is a cornerstone in the fight against HIV. However, there is scanty literature on the utilization of HIV testing services by adolescents especially in rural settings. This study is aimed at determining the uptake of HIV testing services and associated factors among adolescents aged 10-19 years in Lira District, Northern Uganda. Methods. This was a cross-sectional study done among 277 randomly selected adolescents aged 10-19 years attending outpatient clinics in Pentecostal Assembly of God (PAG) Mission Hospital, Ngetta Health Center III, and Boroboro Health Center III. Data were collected using an interviewer-administered structured questionnaire. Data collected included sociodemographic characteristics, history of test and receipt of HIV results in the last three months, and facility-related factors affecting uptake of HIV testing services. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 25. Results. The uptake of HIV testing services was 43% (119/277) among the study participants. Adolescents who had completed primary education (aOR: 5.47; 95% CI: 1.07-28.15; ), are employed (aOR: 2.77; 95% CI: 1.16-6.60; ), had used a condom in the last sexual intercourse (aOR: 4.46; 95% CI: 1.78-11.15; ), and are involved in HIV testing outreaches (cOR: 10.86; 95% CI: 3.81-30.93; ) were more likely to uptake HIV testing services compared to those who had tertiary education, are unemployed, had never used a condom, and are not involved in HIV testing outreaches. Conclusion. Utilization of HIV testing services by adolescents aged 10-19 in Lira District, Northern Uganda, is generally low. The Ministry of Health should strengthen HIV testing services targeting adolescents to increase uptake of HIV testing services.Item Factors Associated with Utilization of HIV Testing Services among Adolescents Aged 10-19 Years in Lira District, Northern Uganda: A Cross-Sectional Study(BioMed Research International, 2021) Benyumiza, Deo; Amongin, Joan Fidelia; Ochaba, Isaac; Adupa, Morish; Abuch, Naume; Banula, Constance Babirye; Udho, SamsonBackground. HIV testing remains a problem among adolescents in low- and middle-income countries, and yet, HIV testing is a cornerstone in the fight against HIV. However, there is scanty literature on the utilization of HIV testing services by adolescents especially in rural settings. This study is aimed at determining the uptake of HIV testing services and associated factors among adolescents aged 10-19 years in Lira District, Northern Uganda. Methods. This was a cross-sectional study done among 277 randomly selected adolescents aged 10-19 years attending outpatient clinics in Pentecostal Assembly of God (PAG) Mission Hospital, Ngetta Health Center III, and Boroboro Health Center III. Data were collected using an interviewer-administered structured questionnaire. Data collected included sociodemographic characteristics, history of test and receipt of HIV results in the last three months, and facility-related factors affecting uptake of HIV testing services. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 25. Results. The uptake of HIV testing services was 43% (119/277) among the study participants. Adolescents who had completed primary education (aOR: 5.47; 95% CI: 1.07-28.15; p = 0:042), are employed (aOR: 2.77; 95% CI: 1.16-6.60; p = 0:022), had used a condom in the last sexual intercourse (aOR: 4.46; 95% CI: 1.78-11.15; p = 0:001), and are involved in HIV testing outreaches (cOR: 10.86; 95% CI: 3.81-30.93; p ≤ 0:001) were more likely to uptake HIV testing services compared to those who had tertiary education, are unemployed, had never used a condom, and are not involved in HIV testing outreaches. Conclusion. Utilization of HIV testing services by adolescents aged 10-19 in Lira District, Northern Uganda, is generally low. The Ministry of Health should strengthen HIV testing services targeting adolescents to increase uptake of HIV testing services.Item Graduate Midwifery Education in Uganda Aiming to Improve Maternal and Newborn Health Outcomes(Annals of Global Health, 2020) Kumakech, Edward; Anathan, Julie; Udho, Samson; Auma, Anna Grace; Atuhaire, Irene; Nsubuga, Allan G.; Ahaisibwe, BonaventureBackground: Maternal and newborn health outcomes in Uganda have remained poor. The major challenge affecting the implementation of maternal and newborn interventions includes a shortage of skilled midwives. In 2013, Lira University, a Ugandan Public University, in partnership with Seed Global Health, started the first Bachelor of Science in Midwifery (BScM) in Uganda with a vision to develop a Master of Science in Midwifery (MScM) in the future. Objective: Evaluate results of Lira University’s Bachelors in Midwifery program to help inform the development of a Masters in Midwifery program, which would expand midwifery competencies in surgical obstetric and newborn care. Methods: Lira University and Ministry of Health records provided data on curriculum content, student enrollment and internships. The internship reports of the graduate midwives were reviewed to collect data on their employment and scope of practice. Interviews were also conducted with the graduates to confirm the added skills they were able to apply and their outcomes. Findings: The critical competences incorporated into the Bachelor in Midwifery curriculum included competences to care for pre- and post-operative caesarian section patients or assist in a caesarean section, newborn care (e.g. resuscitation from birth asphyxia), anesthesia, and theatre techniques, among others. Overall, 356 students (40.2% male, 59.8% female) enrolled in the BScM program over the period 2013–2018. Annual data shows an increasing trend in enrollment. Of the 32 graduates in January 2019, 87.6% were employed in maternal and newborn healthcare facilities, and 12.4% were employed in midwifery private practice. Follow-up interviews revealed that the graduate midwives reported positive maternal and newborn outcomes and the ability to practice advanced obstetrics and newborn care skills they acquired from the training. Conclusion: There is growing interest in a graduate midwifery education program in Uganda for both male and female students. The retention of the graduate midwives in healthcare facilities gives a renewed hope for mothers and newborns, who benefit from their extra obstetrics and newborn care competences in settings where there are neither medical doctors nor obstetricians and gynecologists. Recommendations: Further, larger tracer studies of the graduate midwives to identify the kinds of obstetric surgeries and newborn care services they ably performed and their corresponding maternal and newborn health outcomes is recommended. Also recommended is advocacy for recognition of extra skills of graduate midwives by health authorities in Uganda and the region.Item HIV Treatment and Care of Adolescents: Perspectives of Adolescents on Community-Based Models in Northern Uganda(HIV/AIDS - Research and Palliative Care, 2023) Miyingo, Charles; Mpayenda, Teddy; Nyole, Ruth; Ayinembabazi, Joan; Ssepuuya, Mujib; Ssebuwufu, Eddie Marvin; Puleh, Sean Steven; Udho, Samson; Kabunga, AmirBackground: Differentiated service delivery models for people living with HIV continue to be scaled up to expand access to HIV services and treatment continuity. However, there is a gap in information on adolescents’ perspectives on community-based models. We aimed to explore the perspectives of adolescents living with HIV on community-based models in northern Uganda. Materials and Methods: Between February and March 2022, we conducted a descriptive qualitative study at two health centres IV in Northern Uganda. Data was collected using an interview guide. The study had 25 purposively selected adolescents enrolled in community-based models for HIV care and treatment. The interviews were audio-recorded, transcribed verbatim, and translated. We analyzed data using a thematic approach. Results: A total of 25 in-depth interviews with HIV-positive adolescents were conducted. More than half (52.0%) of the participants were females, 84.0% were not married, and 44.0% had no formal education. The mean age of the respondents was 15.6 (±1.9) years. The major themes were: community-based models currently accessed by adolescents, benefits, and challenges of the models. Although there are other community-based models (community pharmacies, home ART deliveries) our exploration only discovered two models used by these adolescents to access care, namely, Community Drug Distribution Point (CDDP) and Community Client-Led ART Delivery Groups (CCLADs). The benefits included reduced transportation costs, convenient service access, ART adherence, peer support, a comfortable environment and less stress. However, our results indicate that these models had some challenges, including lack of confidentiality and privacy, perceived stigma, and a lack of face-to-face interaction. Conclusion: Our findings show that CDDP and CCLADs are the two CBMs used by adolescents in Lira District to access treatment and care. Adolescents benefited from these models through reduced transport costs, the convenience of accessing HIV care and treatment, and social support. The challenges associated with these models are lack of confidentiality and privacy, perceived stigma, and a lack of face-to-face interaction. The Ministry of Health should work with other implementing partners to strengthen the implementation of these models to improve HIV/AIDS service delivery for adolescents.Item HIV-Related Stigma Among Pregnant Adolescents: A Qualitative Study of Patient Perspectives in Southwestern Uganda(Taylor and Francis, 2024) Kabunga, Amir; Nabasirye, Caroline Kambugu; Kigingo, Eustes; Namata, Halimah; Shikanga, Enos Mwirotsi; Udho, Samson; Auma, Anna Grace; Nabaziwa, Jannat; Tumwesigye, Raymond; Musinguzi, Marvin; Okalo, Ponsiano; Acup, WalterBackground: The HIV epidemic disproportionately affects adolescents in Sub-Saharan Africa, with adolescent girls facing heightened vulnerability. Despite advancements in antiretroviral therapy, HIV-related stigma remains prevalent, particularly among pregnant adolescents. This qualitative study explores the perspectives of adolescents living with HIV in southwestern Uganda, seeking to understand the nature of HIV-related stigma in this context. Methods: One-on-one narrative interviews were conducted with 28 pregnant adolescents living with HIV aged 14–19 receiving care at Mbarara Regional Referral Hospital. The qualitative approach allowed for in-depth exploration of participants’ experiences. Thematic analysis was employed to identify recurring patterns in the narratives. Results: Five overarching themes emerged from the analysis: Experiences of double stigma, social and cultural influences shaping stigma, healthcare system challenges, psychosocial impacts of stigma, and resilience and coping mechanisms. Double stigma, arising from societal prejudices related to both HIV status and teenage pregnancy, created a complex environment for participants. Despite these challenges, participants exhibited resilience through external support and internal strength. Conclusion: This study reveals the pervasive double stigma experienced by pregnant adolescents living with HIV in southwestern Uganda, driven by societal biases against both HIV status and teenage pregnancy. Urgent targeted interventions are needed to address the intersectionality of stigma, cultural influences, healthcare issues, and psychosocial well-being for the betterment of this vulnerable population.Item HIV-related stigma experiences and coping strategies among pregnant women in rural Uganda: A qualitative descriptive study(PloS one, 2022) Jolle, Judith; Kabunga, Amir; Okello, Tonny Owili; Kadito, Esther Oloi; Aloka, Jimmy; Otiti, Geoffrey; Aluku, Agnes Adong; Kumakech, Edward; Udho, SamsonBackground HIV-related stigma is a global problem among HIV clients with far-reaching effects including increased rates of mother-to-child transmission of HIV. However, HIV-related stigma experiences and coping strategies have received little attention, especially among pregnant women in rural settings. We explored the HIV-related stigma experiences and coping strategies among pregnant women in rural northern Uganda. Methods This was a qualitative descriptive study conducted among HIV-positive pregnant women seeking care at Aboke Health Center IV, Kole district, northern Uganda. We conducted 12 in-depth interviews using a semi-structured interview guide. Data were analyzed using the inductive thematic approach of Braun and Clarke. Results The age range of the 12 participants was 17 to 35 years while the average duration with HIV since diagnosis was five years. The majority of the participants were subsistence farmers who had attained a primary level of education. Social rejection and public ridicule were identified as HIV-related stigma experiences while ignoring, social support, and prayers were identified as HIV-related coping strategies among the study participants. Conclusion Enacted HIV-related stigma is common among pregnant women in rural northern Uganda. Healthcare providers should work closely with HIV-positive women and other stakeholders to identify and strengthen HIV-related stigma coping strategies among pregnant women in rural settings.Item Intimate partner violence among pregnant women in Uganda(African Journal of Midwifery and Women’s Health, 2019) Epuitai, Joshua; Udho, Samson; Auma, Anna Grace; Nabirye, Rose ChaloBackground: Intimate partner violence may be more prevalent during pregnancy as women are more vulnerable. Aims: To determine the prevalence of intimate partner violence and associated factors among pregnant women at Soroti Regional Referral Hospital, Uganda. Methods: A cross-sectional study was conducted among 180 pregnant women. Data were collected using a pre-tested, semi-structured questionnaire. Intimate partner violence was measured using the revised Conflict Tactile Scale 2. Findings: The overall prevalence of intimate partner violence during pregnancy was 27.8%. Household average monthly income, experiences of intimate partner violence before pregnancy and marital conflicts were independently associated with intimate partner violence during pregnancy. Conclusions: Screening should be done during antenatal care among women with low household income, marital conflicts, and history of intimate partner violence before pregnancy to identify and manage cases of intimate partner violence. More research is needed to identify interventions for reduction of intimate partner violence during pregnancy.Item Partograph Documentation: Barriers and Faciltators Among Skilled Health Personnel in Lamwo District, Northern Uganda(Lira University, 2022) Lokwang, Paul Pax; Udho, Samson; Auma, Anna GraceBackground: Appropriate use of partograph is significantly associated with improved maternal and neonatal outcomes of labour and that is why the World Health Organization recommends its universal use during labour. However, the extent of partograph documentation and the barriers and facilitators to partograph documentation by skilled health personnel in Lamwo district is not well documented. This study aimed to assess the level of partograph documentation and explore the barriers and facilitators to partograph documentation by skilled health personnel in Lamwo district, northern Uganda. Methods: This was a parallel convergent mixed methods study conducted in 10 purposively sampled health facilities in Lamwo district. We retrospectively reviewed 328 randomly sampled partographs and conducted 18 key informant interviews and 8 Focused Group Discussions with purposively sampled skilled health personnel. The partographs were reviewed using a checklist while FGD and KII guides were used for FGDs and KIIs respectively. Quantitative data were analysed descriptively while qualitative data were analyzed thematically. Results: The overall documentation of partograph according to the WHO recommended standard was at 54.3% while maternal and fetal components of the partograph were documented at 58% and 95% respectively. The identified barriers to standard partograph documentation were heavy workload, lack of knowledge and skills, negative attitude, lack of equipment and supplies, and negative perception. The identified facilitators were being knowledgeable and skilled, adequate human resource, availability of equipment, supportive supervision, and a positive attitude. Conclusion: Standard partograph documentation by skilled health personnel in Lamwo district is still suboptimal owed to various factors. The ministry of Health and supporting partners should create an enabling environment and build capacity of skilled health personnel to strengthen Partograph documentation in the district.Item Phenomenology of Induced Abortion in Northern Uganda Among HIV-Positive Women Following an Unintended Pregnancy(Open Access Journal of Contraception, 2023) Kabunga, Amir; Acanga, Alfred; Akello, Judith Abal; Nabasirye, Caroline Kambugu; Namata, Halimah; Mwesigwa, David; Auma, Anna Grace; Kigongo, Eustes; Udho, SamsonBackground: More than half of pregnancies in Uganda are unintended, and nearly a third of these end in abortion. However, little research has focused on women living with HIV’s subjective experiences following induced abortion. We explored how women living with HIV subjectively experience induced abortions in health facilities in Lira District, Uganda. Materials and Methods: This was a descriptive-phenomenological study between October and November 2022. The study was conducted among women of reproductive age (15–49 years) who were HIV positive and had undergone induced abortion following an unintended pregnancy. Purposive sampling was used to sample 30 participants who could speak to the research aims and have experience with the phenomenon under scrutiny. The principle of information power was used to estimate the sample size. We conducted face-to-face, in-depth interviews to collect data. Data were presented as direct quotes while providing a contextual understanding of the lived experiences of the study participants. Results: The results showed that the major causes of induced abortion were financial constraints, concern for the unborn babies, unplanned pregnancy, and complex relationships. Regarding induced abortion-related experiences, three themes emerged: loss of family support, internalized and perceived stigma, and feelings of guilt and regret. Conclusion: This study highlights the lived experiences of women living with HIV following an induced abortion. The study shows that women living with HIV had induced abortions due to numerous reasons, including financial concerns, complicated relationships, and a fear of infecting their unborn babies. However, after induced abortion, the women living with HIV faced several challenges like loss of family support, stigma, and feelings of guilt and regret. Based on HIV-infected women who underwent induced abortion and an unexpected pregnancy, they may need mental health services to reduce the stigma associated with induced abortion.