Department of Community Health

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Induction of HIV-specific functional immune responses by a multiclade HIV-1 DNA vaccine candidate in healthy Ugandans
(Vaccine, 2007) Eller, Michael A.; Eller, Leigh Anne; Opollo, Marc S.; Ouma, Benson J.; Oballah, Peter O.; Galley, Lynee; Karnasuta, Chitraporn; Kim, Silvia Ratto; Robb, Merlin L.; Michael, Nelson L.; Kibuuka, Hannah; Wabwire-Mangen, Fred; Graham, Barney S.; Birx, Deborah L.; de Souza, Mark S.; Cox, Josephine H.
A phase I randomized, double blind, placebo-controlled trial to assess the immunogenicity of a multiclade HIV-1 DNA plasmid vaccine was conducted in 31 HIV-1-negative Ugandans. Following immunization with DNA at 0, 1, and 2 months, the frequency of HIV-specific immune responses was assessed up to 10 months using a standard chromium release assay (CRA), lymphoproliferative assay (LPA), and antibody dependent cell-mediated cytotoxicity assay (ADCC). Seven of 15 (47%) vaccinees demonstrated CTL activity using the CRA to HIV-1 Env B with responses observed 1 month following the second vaccination and as late as 7 months following complete immunization. Additionally, lymphoproliferative reponses were observed in 14/15 vaccinees against p24. No CTL or LPA responses were observed at baseline or in the placebo group. ADCC activity was minimally induced by DNA vaccination. This study demonstrates that immunization with DNA alone induces CTL and lymphoproliferative responses in a population that will participate in a phase IIb study evaluating HIV-1 DNA priming followed by boosting with a replication-defective recombinant adenovirus vector. Keywords: DNA vaccine; HIV-1; CTL; LPA; ADCC
Factors associated with DPT 1-3 vaccine dropout in Kabarole district
(International Journal of Infectious Diseases, 2010) Opollo, M.-S.; Makumbi, F.; Mukanga, D.; Namusisi, O.; Ayebazibwe, N.; Tweheyo, R.
Background: Among the top ten causes of poor health in the district are complications due to vaccine preventable diseases notably diphtheria, pertussis and tetanus (DPT). In 2008, the DPT dropout rate in Kabarole was high (18%). This study assessed the service, community and individual factors associated with DPT1-3 dropout in Kabarole District. Methods: A cross sectional study using cluster sampling was employed. Two clusters at parish level (rural and urban) each from a county in the district were selected by sim ple random sampling and all villages therein were studied. A total of 230 children (115 from either cluster) were recruited and their parent or guardian interviewed. Cross-tabulations and chi-square tests were used to determine the strength of associations between independent variables and the outcome. Binary logistic regression was done to adjust for potential confounders and identify independent predic tors. Key informant interviews were held with in-charges of health units. Qualitative data was analysed manually using thematic approach and results presented in the form of text. Results: Factors found to be associated with DPT1-3 dropout were; lack of caretaker knowledge about DPT dosage, (adj. OR = 8.2; 95% CI: 3.12, 21.53); Child’s Birth Order, 6th and above (adj. OR = 3.0; 95% CI: 0.80, 11.05); Child Birth Order 2-3 (adj. OR = 2.2; 95% CI: 0.70, 6.71); Child age group 31-36 compared to 12-18 (adj. OR = 2.5; 95% CI: 0.81, 7.84). However, Rural residence (OR = 1.2; 95% CI: 0.56, 2.57); and Child without immunisation card (OR = 4.4; 95% CI: 0.35, 39.86) were not significantly associated with DPT dropout. Conclusion: The current DPT1-3 dropout prevalence in Kabarole is still high but dropping (13.7%). DPT 1-3 dropout is associated with caretaker lack of knowledge of number of dosages a child should receive and involvement of religious leaders, long travel distance to point of accessing transport means, and convenient time for immunisation. Findings from this study can be used to improve DPT immunisation services. Specific campaigns on DPT immunisation through home visits, involving community leaders and full day immunisation can help further reduce the dropout rate
Assessing factors associated with CD4 cell absolute count in patients at Gulu Regional Referral Hospital: A case study by Marc Sam Opollo, Uganda
(South American Journal of Public Health, 2014) Opollo, Marc Sam
Background: This study is set to assess individual, environmental and medication factors associated with CD4 cell count in patients attending HIV/AIDS treatment and care clinic in Gulu Regional Referral Hospital. Gulu Regional Referral Hospital is located in the northern district of Gulu. Gulu Regional Referral Hospital performs CD4 cell counts to monitor HIV +ve patients. Methodology: A cross-sectional study, with study population of Gulu and target population being HIV +ve patients attending HIV clinic in Gulu Regional Referral Hospital. Systematic random sampling will be used. Questionnaires will be administered to patients after informed consent. Results: will be presented in Texts, Tables, Graphs.
HIV Type 1 Disease Progression to AIDS and Death in a Rural Ugandan Cohort Is Primarily Dependent on Viral Load Despite Variable Subtype and T-Cell Immune Activation Levels
(The Journal of infectious diseases, 2015) Eller, Michael A.; Opollo, Marc S.; Liu, Michelle; Redd, Andrew D.; Leigh, Anne Eller; Kityo, Cissy; Kayiwa, Joshua; Laeyendecker, Oliver; Wawer, Maria J.; Milazzo, Mark; Kiwanuka, Noah; Gray, Ronald H.; Serwadda, David; Sewankambo, Nelson K.; Quinn, Thomas C.; Michael, Nelson L.; Wabwire-Mangen, Fred; Sandberg, Johan K.; Robb, Merlin L.
Background. Untreated human immunodeficiency virus type 1 (HIV) infection is associated with persistent im mune activation, which is an independent driver of disease progression in European and United States cohorts. In Uganda, HIV-1 subtypes A and D and recombinant AD viruses predominate and exhibit differential rates of disease progression. Methods. HIV-1 seroconverters (n = 156) from rural Uganda were evaluated to assess the effects of T-cell acti vation, viral load, and viral subtype on disease progression during clinical follow-up. Results. The frequency of activated T cells was increased in HIV-1–infected Ugandans, compared with commu nity matched uninfected individuals, but did not differ significantly between viral subtypes. Higher HIV-1 load, sub type D, older age, and high T-cell activation levels were associated with faster disease progression to AIDS or death. In a multivariate Cox regression analysis, HIV-1 load was the strongest predictor of progression, with subtype also contributing. T-cell activation did not emerge an independent predictor of disease progression from this particular cohort. Conclusions. These findings suggest that the independent contribution of T-cell activation on morbidity and mortality observed in European and North American cohorts may not be directly translated to the HIV epidemic in East Africa. In this setting, HIV-1 load appears to be the primary determinant of disease progression. Keywords. HIV-1; AIDS; subtype D; immune activation; PD-1; viral load.
Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done
(Tropical Medicine and Infectious Disease, 2021) Opollo, Marc Sam; Otim, Tom Charles; Kizito, Walter; Thekkur,Pruthu; Kumar, Ajay M. V. ; Kitutu, Freddy Eric; Kisame, Rogers; Zolfo, Maria
Globally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobialresistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, crosssectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.
The Potential of Citizen- Driven Monitoring of Freshwater Snails in Schistosomiasis Research
(Citizen Science: Theory and Practice, 2021) Brees, Jef; Huyse, Tine; Tumusiime, Julius; Kagoro-Rugunda, Grace; Namirembe, Daisy; Mugabi, Faith; Nyakato, Viola; Anyolitho, Maxson Kenneth; Tolo, Casim Umba; Jacobs, Liesbet
Schistosomiasis is a tropical parasitic disease affecting more than 200 million people worldwide, predominantly in Africa. The World Health Organization recently highlighted the importance of targeted control of the freshwater snails acting as intermediate hosts for the parasites causing schistosomiasis. However, because of a shortage of trained experts and resources, detailed information on spatiotemporal snail distributions, which is needed for targeted control measures, is often missing. We explore the potential of citizen science to build these much-needed datasets through fine-grained, frequent snail sampling. We trained a network of 25 citizen scientists to weekly report on snail host abundances in 77 predefined water contact sites in and around Lake Albert (western Uganda). Snail abundance, together with marked GPS locations, water chemistry parameters, and photographs of the identified snails are recorded and submitted using the freely available mobile phone application KoBoToolbox. Trained researchers then engage in remote, semi-automatic validation of the submissions, after which there is an opportunity to provide targeted feedback to the citizen scientists. Five months after the operationalisation of the network, a total of 570 reports were submitted and personalized feedback was given, resulting in lasting improvements in subsequent reporting and snail genus identification. The preliminary results show the possibility of citizen science to independently obtain reliable data on the presence of schistosome snail hosts. We therefore argue that citizen-driven monitoring on a high spatiotemporal resolution could help to generate the much-needed data to support local targeted snail control measures in remote and/or resource-limited environments.
Adherence to Benzathine Prophylaxis Among Rheumatic Fever and Rheumatic Heart Disease Patients Attending Outpatient Clinic at Lira Regional Referral Hospital
(Lira University, 2022) Atala, Jenifer; Omech, Bernard; Obura, Bonniface
Background:Secondary prevention of Rheumatic fever and Rheumatic Heart Disease with 3-4 weekly Benzathine prophylaxis is the most effective strategy in preventing disease progression and complications. Efficacy of this regimen is dependent on its rational use. However, adherence to Benzathine prophylaxis worldwide is suboptimal. Magnitude and impact of poor adherence is higher in developing countries. Methods: A retrospective cohort study design using mixed methods was done. To acquire information on adherence to monthly BPG injections, the quantitative component involved a retrospective chart review of secondary data extracted from the Lira RHD Registry. The primary information was qualitative, obtained from key informant and in-depth interviews with RHD patients, care givers, and healthcare professionals respectively. Utilizing a logistic regression model, data was evaluated. Predictors that were at alpha=0.2 were considered significant at bivariate analysis and submitted to multivariate analysis. A significant threshold was set at 0.05 and 95% confidence interval. Thematic analysis using both inductive and deductive coding was used to analyze qualitative data. Results: Overall, 57.8% (89/154) of patients adhered to their benzathine prophylactic regimen. Majority of participants had at least primary education (84/153). Those with tertiary education were 2.6 times more likely to adhere to Benzathine penicillin prophylaxis. (AOR 2.69, 95% CI: 1.00-7.3, P value 0.049). Demand side factors associated with adherence included logistics involved, suboptimal communication, patient related factors and condition related factors whereas supply side factors included medicine stockout, human resource related challenges, costs involved and poor provider client relationship. Conclusion: Adherence was sub-optimal. To address some of the issues impacting adherence to BPG prophylaxis among these patients, it is necessary to address the demand side and supply side factors associated with adherence to BPG, such as training of healthcare professionals and strengthening the sensitization and health education of patients and their caregivers on the need for the monthly BPG injections in relation to their condition.
Uptake of Integrated Community Case Management and Associated Factors Among Caregivers of Children Under Five Years in Apac District
(Lira University, 2022) Eluk, Job; Omech, Bernard; Akello, Anne Ruth
Background: Globally, child mortality remains a public health concern with 38 deaths per 1000 live births and accounting for 5.2 million deaths in children under 5 years, with Sub-Saharan Africa region having the highest figure of 76 deaths per 1,000 live births that is equivalent to one child in 13 dying before reaching age five in 2019. In Uganda, the child mortality rate has reduced gradually from 191 deaths per 1000 live births to 45.8 deaths per 1000 live births in 2019. Objective: To determine the Uptake of integrated community case management of childhood illnesses and associated factors among caregivers of children under five years in Apac district. Methods: This was a cross-sectional study using quantitative methods, 403 family caregivers of children under five in Apac District. Data was collected using a semi-structured questionnaire on Uptake, associated factors, and perceptions of caregivers towards ICCM services. Data was analyzed using STATA version 15.1. Results: The majority of the caregivers were female 337 (83.6%), with a mean age of 27.7 years and standard deviation of 6.64 years, attained primary education, 253(62.8%), Christians, 393 (97.5%), and married 346 (85.9%) were married. The level of Uptake of ICCM services was 38.7% (156/403). Results of the study indicate that the child’s illness (p=0.01, AOR=3.5(2.1-7.2), knowledge of ICCM (P<0.01, AOR12.1 (1.7-87), timely services (p<0.001, AOR (12.7(3.4-47), and referral by VHT (P<0.01, AOR 4.0(1.4-11.0). were statistically significant. Conclusion: The Uptake level of ICCM services provided by the VHTs was low, though caregivers had a good perception of ICCM services and child referral to health facilities by VHT. To improve Uptake of ICCM services, there is a need to provide more information regarding ICCM within the community.
Knowledge, Attitude and Practices on Water, Sanitation and Hygiene among the Community in Lira District
(Lira University, 2022) Akullu, Milly Grace; Akech, Stella Immaculate; Kigongo, Eustes
Background: In Uganda, more than half of the households use unimproved sanitation facilities, with only 19% of the households owning improved facilities, leading to the prevalence of sanitation-related diseases among the general population. The Government of Uganda has implemented community-led total sanitation by engaging the community in sustaining their own sanitation. The study assessed the knowledge, attitudes and practices among the community regarding WASH following the implementation of the CLTS program in Lira District. Methods: The study employed a cross-sectional design. Data was collected from 528 respondents using a close-ended questionnaires and analyzed using STATA version 17 at univariate, bivariate, and multivariate levels. Results: According to the study, the majority of the respondents (181;35.6%) were between the ages of 18 and 30, male (305;57.9%), and had a primary education (371;70.1%). The study also found out that earning between 50,000 and 100,000 Ugandan shillings (AOR=0.39, CI: 0.19-0.83), not knowing ways of preventing water borne diseases (AOR=0.29, CI: 0.14-0.61), not feeling the importance of having hand washing facilities (AOR=0.14, CI: 0.06-0.36) and not having a tippy tap (AOR=0.33, CI: 0.17-0.66) were associated with poor wash practices. Conclusion: Therefore, the researcher concluded that the WASH practices of community members were suboptimal and below the MOH target of the appropriate hygiene practice of WASH. Recommendations: Through this finding, better interventions and policies to reduce the burden of WASH related diseases be intensified, and also there is a need to intensify sensitization on water-related diseases and prevention, as well as enforce the installation, use and sustainability of hand washing facilities among the community in Lira District. Key words: Knowledge, Attitude, Practices on Water, Sanitation and Hygiene
Factors associated with HIV Virological non-suppression among adults receiving Anti-Retroviral Therapy at Lira Regional Referral Hospital, Northern Uganda
(Lira University, 2022) Niyongira, Joseph Nturo; Opollo, Marc Sam
Background: By 2030, all adults with HIV will have been dragonized, will be receiving Antiretroviral Therapy (ART), and will have achieved viral load suppression. These goals form the global effort to stop new HIV infections, increase treatment coverage, and end aids-related deaths. This study investigated the variables that affect HIV RNA viral load suppression among adults living with HIV at Lira Regional Referral Hospital in Uganda. Methods: For this mixed-methods study, data was collected using a data extraction form, a semi structured questionnaire, and a key informant interview guide. STATA 17 was used to analyze the quantitative data, and the thematic method was used to analyze the qualitative data. The results were presented in charts, tables, and themes for quantitative data and qualitative data respectively. Results: Of the 425 respondents, 235 (55.3%) were female and 190 (44.7%) were male. The majority, 208 (48.9%) were between the ages of 31 and 40. Of those, 238 (56%) had at least primary education, and 264 (62.1%) were married. The prevalence of HIV RNA viral non suppression was at 8.5% among adults living with HIV and 91.5% were HIN RNA virologically suppressed. Recent cd4 counts, baseline viral load, and WHO clinical stage were significantly associated with HIV RNA virological suppression. In addition to that, adherence (a OR=1.00, 95% CI: 0.004-0.07, P=0.001) was associated with HIV RNA virological non-suppression. Qualitatively, results revealed that status disclosure is always done by close relatives of the victims, stigma, and discrimination were not common in the community. Conclusion: There is a need for strategies on how to promote drug adherence among adults living with HIV rather than just providing the treatment, as viral load suppression is related to baseline viral load, CD4, marital status, and drug adherence. In this study, monitoring the immunological response through scheduled CD4 and viral load tests is critical for maintaining patients’ immunity and preventing disease progression. Intensive adherence support and counselling should conclusively be provided through the effective implementation of ART programs by providers to enhance viral suppression and ensure the quality of care and treatment. Keywords: Non-Suppression, Adults Living with HIV, and Antiretroviral Therapy
Partograph Documentation: Barriers and Faciltators Among Skilled Health Personnel in Lamwo District, Northern Uganda
(Lira University, 2022) Lokwang, Paul Pax; Udho, Samson; Auma, Anna Grace
Background: 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.
Risk Factors for Maternal Anemia Among Women Attending Antenatal Care in Moroto Regional Referral Hospital. Case-Control Study
(Lira University, 2022) Emina, Godfrey; Omech, Bernard; Puleh, Sean Steven
Background: Maternal Anemia remains a significant public health problem mainly because of its association with poor maternal and fetal outcomes. The study aimed o to assess the association between risk factors and maternal anemia among women attending antenatal care at Moroto Regional Referral Hospital. Methods: A case-control study was conducted among 100 (50 cases and 50 controls) Pregnant women between November 2021 to march 2022. Cases were pregnant women whose hemoglobin level was less than 11 g/dl at their first antenatal care visits and Controls were pregnant women whose hemoglobin level was 11 g/dl and above. Data was collected using a semi-structured interviewer-administered questionnaire and analyzed using Stata version 15.0. A bivariate and multivariate logistic regression model was used to identify the risk factors for anemia among pregnant women. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value were used to identify the significant association. Results: The independent risk/protective factors were; residential area, Wealth category, education level (AOR=0.16, 95% CI: 0.03, -0.89), Dietary diversity score (DDS) (AOR=0.51, 95% CI: 0.14 -1.82) and gestational age (AOR=3.78, 95%CI: 1.36,10.55). Conclusion: In this study, the protective factors were; residing in an urban residential area, high education levels, high wealth category, and high dietary diversity. Increasing gestational age was a risk factor. Prevention strategies should include improving livelihood and household income for women of reproductive age, advocating for and encouraging girl child education, community-based health education and counseling on nutrition, and improved household DDS
Factors influencing uptake of childhood Immunization Services among Caretakers of Children Aged 10-18 Months in Lira City
(Lira University, 2022) Abor, Jasper; Kabunga, Amir; Nabasirye, Carol
Background: The routine immunization services in Uganda ensures that that by the time a child is celebrating the first birth day, complete vaccination is vaccination is achieved. The factors influencing uptake to the services has been rarely explored. This study investigated the factors influencing uptake of childhood immunization services in Lira city. Participants and methods: This was a descriptive cross-sectional study which used quantitative method where data was obtained using a questionnaire from 420 caretakers of children aged 10—18 months who consented and had a child health card. Univariate analysis provided description of the variables while bivariate analysis compared the dependent variable with specific predictor variables to predict associations. Logistic regression model was used to identify significant factors influencing uptake of childhood vaccination (P-values less than 0.05). Results: The study result indicated that majority, 365(87.0%) of caretakers had their children fully immunized. The findings showed that caretakers who knew that vaccination starts immediately after birth were associated with increased odds of full childhood immunization (AOR: 5.65;95% CI: 1.82-17.55; p < 0.003). The study result also revealed information on next immunization appointments (AOR: 3.45;95% CI: 1.16-10.29; p < 0.03) and those given mosquito nets (AOR: 2.15;95% CI: 1.18-3.90; p < 0.01) were associated with increased odds of full childhood immunization Conclusion: These study findings indicated that high vaccination coverage was strongly associated with provision of health education on childhood vaccination and incentives to the caregivers. The health education provided adequate information for the caretakers about the importance of completing child’s vaccination. It is vital that local programmatic interventions should be put in place to strengthen these areas in order to improve uptake of routine immunization services by caretakers of children.
Contribution of Community Support Group to Home-Based Care of Persons Living with HIV and AIDS in Lira District: A Case of Amach Town Council and Amach Sub County
(Lira University, 2022) Auma, Zamaradi; Obici, Gilbert
Background: This study examined the contribution of community support groups on home based care to persons living with HIV (PLHIV) in Lira District. Specifically, the study examined the contribution of community support group on adherence to Anti-Retroviral Therapy (ART) for PLHIV, analyzed the contribution of community support groups on nutrition support to PLHIV, and examined the contribution of community support groups on palliative care to PLHIV. Methods: The study adopted a cross-sectional study design, which employed a mixed methods approach of both quantitative and qualitative methods. The study population consisted of 577 participants. Both simple random sampling technique and purposive sampling, were used to select a sample size of 226 respondents. The researcher used self-administered questionnaires to collect quantitative data and an interview guide to collect qualitative data. Descriptive statistics (mean, and standard deviation), and inferential statistics (correlation and regression) were used to analyze numerical data. Content analysis was used to analyse qualitative data from interviews to supplement quantitative data. Results: The findings suggested that community support group (mean=4.959, SD=0.5393) helps in enhancing home based care for PLHIV in Lira District. The study further revealed that community support group had a significant effect on adherence to ART (β=0.641, p<0.05), nutrition support (β=0.581, p<0.05) and palliative care (β=0.638, p<0.05). Conclusion: The study concludes that community support group significantly affects home based care for PLHIV in Lira District, Northern Uganda. This study contributes an original and empirical evidence of the association between community support group and home based care to PLHIV in Lira District. Recommendation: Therefore, for improved home based care to PLHIV, Lira District Local Government is encouraged to mobilize the local community to form community support groups so that they can be in position to give support to PLHIV in Lira District. Keywords: Community Support Group, Home-Based Care, and Persons Living with HIV and AIDS
Effects of Covid-19 On Utilization of Adolescent and Youth Friendly Health Services in Lira District.
(Lira University, 2022) Oyella, Linda Mary; Omech, Bernard; Ojuka, Edward
Purpose: This study assessed the effects of covid-19 on utilization of adolescent and youth friendly services in Lira district. Objectives: To assess the effects of covid-19 and factors affecting the extent of utilization of adolescent and youth friendly services in Lira district. Methods: This was a quantitative cross-sectional study utilizing both primary and secondary data from two H/C IVs (Amac and Ogur) in Lira district. Primary data was collected using a semi-structured questionnaire and review of secondary data on utilization of adolescent and youth friendly services from facility records before and during the covid-19 period was used. Simple random sampling technique was used and data was analyzed using STATA version 15. Results: A total of 296 female participants were recruited of which the median age was 15 years (IQR 12-18). Majority of the participants were; Students (62.7%), from rural areas (94.5%), never married (70.6%), had attained primary education as the highest level (91.6%), and belong to catholic or Anglican religion (80%). Utilization of AFHS was 40% lower during the lockdown period (IRR=0.60, CI: 38%-95%) in comparison to the pre-covid-19 period. Being an adolescent girl of older age (AOR: 3.82, C.I: 2.31, 6.32) and being unmarried (AOR: 0.69, C.I:0.53, 0.88) were highly associated with use of adolescent friendly services. Conclusion: COVID 19 lockdown caused significant decline in utilization of AFHS in Lira. Preparedness plans and strategies for adolescent girls are required to sustain services during pandemics to mitigate adverse health outcomes.
Cholera epidemic amidst the COVID-19 pandemic in Moroto district, Uganda: Hurdles and opportunities for control
(PLOS Glob Public Health, 2022) Orishaba, Philip; Opollo, Marc Sam; Nalwadda, Christine; Muruta, Allan; Makumbi, Issa; Kabali, Kenneth; Nakinsige, Anne; Lotee, Phillip; Okware, Samuel I.; Bwire, Godfrey
Introduction On 21st March 2020, the first COVID-19 case was detected in Uganda and a COVID-19 pan demic declared. On the same date, a nationwide lockdown was instituted in response to the pandemic. Subsequently, more cases were detected amongst the returning international travelers as the disease continued to spread across the country. On May 14th, 2020, a chol era epidemic was confirmed in Moroto district at a time when the district had registered sev eral COVID-19 cases and was in lockdown. This study aimed to describe the cholera epidemic and response activities during the COVID-19 pandemic as well as the hurdles and opportunities for cholera control encountered during the response. Materials and methods In a cross-sectional study design, we reviewed Moroto district’s weekly epidemiological rec ords on cholera and COVID-19 from April to July 2020. We obtained additional information through a review of the outbreak investigation and control reports. Data were analyzed and presented in frequencies, proportions, attack rates, case fatality rates, graphs, and maps. Results As of June 28th, 2020, 458 cases presenting with severe diarrhea and/or vomiting were line listed in Moroto district. The most affected age group was 15–30 years, 30.1% (138/458). The females, 59.0% [270/458], were the majority. The Case Fatality Rate (CFR) was 0.4% (2/458). Whereas home use of contaminated water following the vandalization of the only clean water source in Natapar Kocuc village, Moroto district, could have elicited the epi demic, implementing COVID-19 preventive and control measures presented some hurdles and opportunities for cholera control. The significant hurdles were observing the COVID-19 control measures such as social distancing, wearing of masks, and limited time in the com munity due to the need to observe curfew rules starting at 6.00 pm. The opportunities from COVID-19 measures complementary to cholera control measures included frequent hand washing, travel restrictions within the district & surrounding areas, and closure of markets. Conclusion COVID-19 preventive and control measures such as social distancing, wearing of masks, and curfew rules may be a hurdle to cholera control whereas frequent hand washing, travel restrictions within the district & surrounding areas, and closure of markets may present opportunities for cholera control. Other settings experiencing concurrent cholera and COVID-19 outbreaks can borrow lessons from this study.
Household’s Willingness to Pay for Improved Solid Waste Collection Services in Lira City, Northern Uganda
(Lira University, 2022) Apio, Everline; Akello, Anne Ruth; Acanga, Alfred
Background: Waste management still remains a big challenge in most urban cities in Uganda including Lira City. This poses a great threat to human kind and the environment. Accordingly, household willingness to pay for solid waste services is paramount for better improvement of SWM at the community. Therefore, this study assessed factors influencing household’s willingness to pay for solid waste collection for disposal in Lira City. Methods: To achieve the study objectives, a survey was conducted utilizing a structured questionnaire to collect quantitative data from 585 randomly selected household heads. Key informant interview was conducted with City Environmental Officers, City Clerk, City Division Health Inspectors, Managers of Private Garbage Collecting Companies, Division Drivers and Staff Engaged in Solid Waste Collection and Market Vendors to supplement quantitative data. Descriptive analysis was used to ascertain the solid waste management practices used by the households and to determine the level of willingness to pay for improved waste collection in Lira City by the residents. The factors influencing household’s willingness to pay were analyzed using a binary logistic model. Results: The findings revealed that, 48.12% of the 585 household heads were willing to pay for improved solid waste collection services and the average amount household heads were to pay for improved solid waste collection services was UGX 3012≠ (0.84$) per month, according to the study, education level, occupation, distance to waste collection sites, and awareness of solid waste environmental concerns were all factors that influenced the amount that households were prepared to pay. Recommendations: As a result of the study findings, it was recommended that residents in Lira City be educated about the importance of effective solid waste management. Secondly, a thriving solid waste collection system should be built in the city, lest the environment’s and human population’s health will be jeopardized. Keywords: Household, Willingness to Pay, and Improved Solid Waste Collection Services
Retention and associated factors among HIV patients enrolled on ART through Assisted Partner Notification Services at Lira Regional Referral Hospital
(Lira University, 2022) Ayoo, Christine; Omech, Benard; Opio, Bosco
Background: Assisted Partner Notification is a public health strategy used to curb the spread of STIs and HIV/AIDS through testing and treating sexual partners of infected index cases and ensuring their retention in care. Retention of PLHIVs in LRRH still remains a challenge attributed to patients relocating to other places, forgetfulness, long distance, denial of treatment among others. Objective: to assess the level of retention and associated factors among HIV patients enrolled on ART through assisted partner notification services at LRRH. Methods: This was a cross-sectional study using a quantitative method. Data was collected using semi-structured questionnaire for a sample size of 424. Quantitative data was entered, cleaned and analyzed using SPSS version 16.0 at Univariate, Bivariate and Multivariate Level. Results: Retention level among HIV patients enrolled on ART through APNs was at 77% (327/424) … factors that were associated with this retention level included; gender (AOR 0.37 CI=0.21-0.64), marital status (AOR 2.31 CI=1.37-4.00), linkage to care (AOR 7.40 CI=2.77- 19.67), stigma (AOR 1.74 CI=1.00-3.00), and pill burden (AOR 2.37 CI=1.151-4.867). Conclusion: Retention level of HIV patients enrolled on ART through APNs at LRRH was fair at 77% according to ministry of health. The factors associated with retention level in this study includes; gender, marital status, stigma, linkage to care and pill burden. Recommendation: MoH and policy makers should strengthen their social behavioral change strategies targeting sexual partners and male engagement in HIV care. Keywords: Retention, HIV patients, ART, and Assisted Partner Notification Services
Knowledge, attitudes, and practices regarding schistosomiasis infection and prevention: A mixed-methods study among endemic communities of western Uganda
(PLOS NEGLECTED TROPICAL DISEASES, 2022) Anyolitho, Maxson Kenneth; Poels, Karolien; Huyse, Tine; Tumusiime, Julius; Mugabi, Faith; Tolo, Casim Umba; Masquillier, Caroline; Nyakato, Viola Nilah
Schistosomiasis is one of the leading neglected tropical diseases, second to malaria in prevalence. In Uganda, more than 10 million people (25.6%) are currently infected, with prevalence in some areas as high as 90%, and more than 55% of the population is at risk. The most at-risk populations are the fishing communities and school-aged children. Despite the government’s prevention and control programs such as mass drug administration (MDA) and sensitization, infections and re-infections have continued to occur, even in areas where MDA has been implemented. Previous studies have linked this with risky behavior. However, information from western Uganda is inadequate. We conducted a mixed-methods study to assess community knowledge, attitudes, and practices, and to understand their opinions and perspectives regarding the disease. The study found that, whereas there is adequate knowledge of schistosomiasis and although there is a positive attitude toward avoiding water contact and the use of latrines, it is difficult to do so, something that could explain the persistent risky practices. The risky practices could also be compounded by myths and misconceptions surrounding the disease. These findings shall form the basis for the design and implementation of contextualized, community-based, participatory communication tools for behavior change. Community involvement in schistosomiasis prevention programs could lead to increased awareness about disease prevention and could debunk existing myths and misconceptions, thereby improving behaviors, practices, and habits, ultimately lowering infection.
Water, Sanitation and Hygiene Risk Factors associated with Diarrhoeal Diseases among Children under Five years in Lira City
(Lira University, 2022) Auma, Brenda; Opio, Bosco
Introduction: In developing countries like Uganda; diarrhea in children under five is one of the leading causes of illness and mortality. The country has the highest prevalence of diarrheal diseases among children under five of 22% in East Africa. This study assessed the water, sanitation and hygiene factors associated with diarrheal disease among children under five years in Lira City. Methodology: This was a quantitative community-based cross-sectional survey conducted between August and September 2022. Information on socio-demographic characteristics, water, sanitation, hand washing practices and diarrhea history was obtained from 492 mothers/caregivers of children under the age of five years using a semi-structured interviewer administered questionnaire. Data was analyzed at three levels using STATA (Stata Corp LLC, TX and USA) version 17 software. Descriptive statistics, univariate logistic and multivariate logistic regression analyses were used. Results: Among 492 children under-five, the prevalence of diarrhea was 142 (29.3%). Being a child under four years of age (AOR=0.14, CI: 0.04-0.58), eating food not stored in refrigerators (AOR=0.15, CI:0.03-0.76), living in households practicing open dumping of wastage (OR=6.57, CI:1.63-26.4), and living in a household with a rubbish pit not filled fully (OR=2.84, CI:1.36-5.94) were significantly associated with diarrhea among children under five in Lira City. Conclusion: The prevalence of diarrhea among under-five is high in Lira City. The socio demographic, sanitation, hygiene and environmental factors were found to be associated with diarrhea. Community sensitization on water, sanitation and hygiene risk factors is needed. Keywords: Water, Hygiene, Sanitation, Lira City and Diarrhea

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