Department of Community Health

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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, Bernard
Background 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 people
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.
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.
Association Factors with Nutrient Intake and Nutritional Status of HIV Positive Breastfeeding Mothers in Apac District
(Lira University, 2023) Victoria, Atim Sharon; Bonny, Aloka
Introduction: Malnutrition among HIV/AIDS patients is a major challenge to the attainment of the sustainable development goals. This is important since severe malnutrition creates increased strain on the already overstained healthcare system once these patients are admitted. HIV infection causes excess nutrient loss and malabsorption, further increasing the nutritional requirements of HIV-infected lactating women. As a result, A HIV-infected lactating woman is a greater nutritional risk than a non-HIV-infected counterpart. While other students establish maternal under nutrition and associated factors in different parts of the world, few studies in Uganda highlighted the issue on predictors of nutrient intake and nutritional status among HIV positive breastfeeding women. Therefore, this study aimed at determining the associated factors with nutrient intake and nutrition status of HIV positive breastfeeding mothers in Apac district. Method: A cross-sectional study involving 224 HIV positive breastfeeding mothers was conducted. A pre-tested 24-hour recall questionnaire, using dietary diversity score for women (DDS-W) was used to collect the data. The nutritional status was assessed using body mass index (BMI), while the nutrient intake was assessed by entering the actual intakes into an excel sheet to calculate the total nutrient intake per individual from which mean nutrient intake and mean adequacy ratio (MAR) was finally calculated. The data was analyzed using Stata version 14 at univariate, bivariate and multivariate levels. Results: A total of 10.3% of participants were undernourished, with dietary score of 4.3 food groups while 21% had dietary diversity score. The participants were able to meet 61% of their recommended micro nutrition intake, with intake of energy, lipids, zinc, calcium, vitamins A, C, B6, and B12 below recommendations. The factors associated with nutritional status were material age [AOR =1.94, 95% CI (1.05-3.59)], presence of market [AOR =0.42, 95% CI (0.223-0.784)], means of obtaining food (AOR= 0.55, 95% CI (0.234-0.94)) and presence of cultural food taboos [AOR= 0.44, 95% CI (0.136-0.998)]. Factors associated with nutrient intake were presence of market [p=0.018, 95% ci (0.010-0104)], income [p=0.010, 95% CI (0.007-0.048)], DDS [p< 0.001, 95% CI (0.022-0.058)] and household head [p=0.049, 95% CI (-0.095-0.001)]. Conclusion: There prevalence of under nutrition among HIV positive Breastfeeding mothers in Apac district, coupled with poor dietary diversity score and low micronutrient intake. Interventions increasing DDS, nutrition education and income should be promoted. Key Words: Nutrient, Intake, Nutritional status, HIV, Positive, Breastfeeding, mothers
Attempted Suicide: Lived Experiences of Refugees in Rhino Camp, West Nile Uganda
(Lira University, 2023) Robinson, Ojwok; Judith, Abal Akello
Introduction: Suicide is among the leading source of death universally and every year, more people die as a result of suicide than HIV, malaria breast cancer, war and homicide. Sucide rates are high among vulnerable groups who experience discrimination, such as refugees and migrants. Purpose: This study explored the lived experiences of refugees who attempted suicide in Rhino Camp, West Nile, Uganda, using Thomas Joiner’s Interpersonal Theory of Suicide Attempts as a theoretical framework. Methods: This study employed an interpretative phenomenological Research design and purposive sampling techniques to choose participants, the study population consisted of 15 participants (7 Key Informants and 8 Suicide Survivors) to ensure in-depth analysis of qualitative data. Face to face interviews using in depth interview guide and observations were used to gather data. The study data were collected between June - July 2023. Result: Data saturation was reached after 13th interviews. Thirteen themes emerged from the data: 1) Domestic Violence and relationship, 2) mental illness, 3) Financial difficulties, and 4) Inadequate food deliveries 5) Traumatic past, 6) Psychological distress, 7) Social isolation, and 8) Cultural stigma, 9) Community and family support, 10) Role of Religious, Cultural, and Opinion or other leaders, 11) Health facilities support, 12) Coping mechanisms, and 13) Psychosocial Support Providers. Conclusions: The lived experiences of refugee suicide survivors and themes identified enhanced scholarly understanding regarding the experience of refugee suicide survivors. This important information can help us develop strategies to prevent suicide among the refugee population and to provide support for suicide attempt survivors. Mental health professional and counsellors can use the results of this study to effectively support refugee suicide survivors. A rich comprehension of survivor experience can assist and empower mental health professionals to provide, effective psychoeducation and interventions and informed support to suicide survivors. Clinicians and policy makers need to remain open-minded about how attempt survivors might view their experience. Key words: Suicide, Refugees, Lived experiences, Mental Health, Rhino Camp
Bacteriological Quality of Drinking Water and Associated Factors at Community Point Sources, in Arua District, Uganda.
(Lira University, 2022) Asiku, Norman; Akech, Stella Immaculate; Opio, Bosco
Introduction: This section summarizes the objectives, methodology, results and conclusions of the study. Background: Sufficient quantity and good quality of water is paramount for life. However, majority of the world’s population lack access to adequate and safe water. Every year, more than 3.4 million people die as a result of water-related diseases, and in Uganda, it is estimated that about 89,000 cases and 3,000 deaths occur annually due to cholera. Broad objective: To assess the bacteriological quality of drinking water and associated factors at community water source points in Arua District. Method: A cross-sectional study design was used, with Laboratory based experiment. Sample size of 140 was used. Dependent variable was the presence of the count of coliform forming units of bacteria on the filter membrane meanwhile independent variables were the hazard, pathway and indirect factors obtained through the sanitary inspection checklist. Data was entered into Excel spread sheet and imported for analysis to Stata/SE 15.0. Result: Majority (70.71%) of the water sources had bacteria, the predominant isolated indicator organism was total coliform. The following risk factors showed statistical association with bacteria presence in drinking water source; drainage for wastewater being defective with aOR of 19.7[5.34 72.72], parts of appliances being loose aOR of 10.7[2.52 45.92] and defective/lack of fence aOR of 9.2[2.43 34.96] all with P-value <0.001. Conclusion: Treatment of drinking water sources, regular water quality surveillance, cleaning, repairing spoiled appliance parts, fencing and repairing of spoiled fences among others to mitigate bacteriological contamination of water sources are required.
Cervical Cancer Screening Uptake and associated factors among HIV positive women at Antiretroviral-Clinic of Lira Regional Referral Hospital
(Lira University, 2022) Kagenda, Gabriel Atwoki; Acio, Christine
t 305 participants (women receiving care from an Antiretroviral-Clinic in LRRH), between July 2022 and October 2022 was conducted in Lira Regional Referral Hospital. Data entries from questionnaires were captured in Microsoft excel version 2013 and exported to and analyzed in STATA version 15, at a confidence level of 95%. Logistic regression analysis was used to determine association between cervical cancer screening uptake and risk factors. Risk factors that show significant association with bivariate analysis were further subjected to multivariate analysis. Results: This study found that a significant number of the respondents had ever screened for cervical cancer (69%). Although other factors such as age, education level, religion and parity did not have significant impact, marital status, perceived barrier and chronic disease condition had scientifically significant associations with uptake of cervical cancer screening among respondents (AOR=0.19, 96% CI=0.064-0.560; AOR=9.63, 95% CI=3.81-26.36; AOR=06.34,95% CI=4.23- 13.56) respectively. Besides, compliance to guidelines for yearly screening for cervical cancer for women living with HIV was at 18.36%. Conclusion: The overall uptake of cervical cancer screening among the participants was relatively high (69%). However, compliance to guidelines was poor, with only 18.36% respondents attending to yearly screening as recommended by Ministry of Health. Key words: Cervical Cancer, Cervical Cancer Screening, HIV positive women, and Antiretroviral-Clinic
Cervical Cancer Screening Uptake and associated factors among women of reproductive age (21-49 years) attending Amach Health Centre-IV in Lira District
(Lira University, 2023) Kasongo, Joseph; Kumakech, Edward; Kigongo, Eustes
Background: Cervical cancer is a significant global health concern, ranking as the fourth most common cancer among women worldwide. Fortunately, early screening and effective management can prevent its progression. However, the uptake of cervical cancer screening varies across different regions, remaining suboptimal in developing countries such as Uganda. This study aimed to assess the level of cervical cancer screening uptake and identify associated factors among women aged 21 to 49 years attending Amach Health Centre in Lira district, Uganda. Methodology: A mixed methods approach was employed, combining quantitative and qualitative data collection techniques. The study included 312 randomly selected women who participated in face-to-face interviews using structured questionnaires and key informant interviews with health workers. The data was analyzed using STATA software, including descriptive statistics, chi-square tests, and logistic regression. Results: The findings revealed that only 44.8% of the 310 interviewed women had ever undergone cervical cancer screening. The predictors of cervical cancer screening include: not being in a marital relationship (Apr: 2.767, 95% CI: 1.463-5.231, p=0.002), poor knowledge about cervical cancer (Apr: 0.561, 95% CI: 0.374-0.843, p=0.005), not being familiar with screening modalities (Apr: 0.653, 95% CI: 0.441-0.966, p=0.33), and women whose decisions were made by their spouses (Apr: 0.510, 95% CI: 0.271-0.961, p=0.05). Conclusion: About 4 in 10 women had undergone cervical cancer screening by the time of the study. This study underscores the importance of addressing barriers to cervical cancer screening in Uganda, particularly among women of reproductive age in rural areas. Recommendations should target improving access to cervical cancer screening through sensitization of the community and making services available. Keywords: Cervical Cancer Screening Uptake, Women, Reproductive Age
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.
Community and Health System Factors Associated with Parental Readiness for Human Papilloma Virus Vaccination Uptake Among Adolescents in Lira District
(Lira University, 2023) James, Ogwal C., K.; Dr. Sam, Opolo Marc
Background: High vaccination rates against Human Papilloma Virus (HPV) is a milestone in primary prevention of cervical cancer. With an increasing number of cases and deaths in the country among women hover, like many other countries around the globe, Uganda has had a high number of district (over 90%) who were underperforming in HPV vaccine uptake among adolescent girls. Despite the safe, effective, and opportunities for free vaccine delivery in health – care settings, Lira district still have very low HPV vaccine uptakes of 17.4% less than national target 80%. Objective: To assess community and health system factors associated with parental PHV vaccine uptake among female adolescent age (9 to 15) years in Lira district. Methods: This study was a crossed-sectional design employing explanatory sequential quantitative and qualitative methods of data collection. The phenomenology design was used for qualitative approach. Additionally, quantitative research generates factual information that can be readily communicated through statistics and figures and from which one can draw factual conclusions. Structured questionnaire was used to parent/guardians of girls age (9 to 15) years and some health workers from some selected health facilities. A total of 577 participants were interviewed and data processed. Results: The study shown that, majority (61.2%) of the 577 interviewed participants were not aware of HPV vaccine and 38.8% reported being ready to vaccinate their adolescent girls age (9 to 15) years. There was statistical significance association with parental readiness to vaccinate adolescent girls age (9 to 15) years: level of formal education (x2=55.4, df=3, p<0.001); and occupation (x2=6.76 df=2, p=0.034). Community factors significantly associated the willingness of parents to immunize their teenage daughters are: family history of cervical cancer (x2=18.5, df=1, p<0.001); get information about HPV vaccination (x2=470.6, df=1, p<0.001) and knowledge about HPV vaccination (x2=184.1, df=2, p<0.001). The study considers variables such as the level of formal education, material status, family history of cervical cancer, knowledge about HPV vaccination, and income level. The adjusted odds ratios (AOR) indicate that parents with tertiary education are 2.25 times likely to be ready (AOR=2.25, p=0.01) while unmarried individuals are 0.47 times likely to be ready (AOR=0.47, p=0.009), those without a family history of cervical cancer are 0.36 times likely (AOR=0.36, p<0.001 and parents with poor knowledge about HPV vaccination are 0.05 likely to be ready (AOR=0.05, p<0.001). Distance, health staffs’ attitude, parents’ level of education, misconception, parents, occupation and vaccine shortage were the common barriers of HPV vaccine uptakes reported. Conclusion: HPV vaccine uptakes readiness was low (38.8%) below the national threshold of (80%) due to association factors and barriers which were program based, beneficiaries and health care provider related. Addressing them such as creation of awareness, outreaches, trainings to health staff, steady vaccine supply and mobile survives revival, staffing and using leaders as an access strategy shall increase uptake of HPV vaccine Key words: Community, Health, System, Parental, Readiness, Human, Papilloma, Virus, Vaccination, Adolescents .
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
Cost-Effectiveness Analysis of adding Tuberculosis Household Contact Investigation on Passive Case Finding Strategy in South Western Uganda
(Lira University, 2022) Odongo, Dickens; Omech, Benard; Acanga, Alfred
Background: The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of TB. A household contact investigation is an alternative approach. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HHCI) to the passive case-finding (PCF) strategy in the Tuberculosis Control Program in southwestern Uganda. Methods: The study utilized decision-analytic modelling and bottom-up costing (ingredients) methods. The study obtained cost and probability estimates from national TB program data, activity costs, published literature, and expert opinions. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntugamo, Sheema and Rwampara districts. The primary effectiveness measure was the number of the actual TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients diagnosed over the screen. The Incremental Cost-Effectiveness Ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. Results: The TB screening yields were 0.52% (1496/289140) for HHCI and 5.8% (197/3414) for PCF. HHCI yield among children 0-14Vs. 15+ years (6.2% Vs.5.4%) p=0.04. the yield among PLHIV Vs HIV- negative (15.8% Vs. 5.3%) p=0.03 in HHCI. The PCF yield in men Vs. women (1.12% Vs. 0.28%) p<0.01. this NNS in PCF was 193 (95% CI: 186-294) and 17 (95% CI: 14-22) in HHCI. The unit costs of detecting a TB case were US$ 204.22 for PCF and US$ 315.07 for HHCI. Patient and caregiver costs are five times in PCF than HHCI (US$ 26.37 vs US$ 5.42). Under the study baseline assumption, adding HHCI to PCF strategies was not cost-effective at US$ 3,596.94 per additional case detected. Conclusion: HHCI improves access to TB diagnosis in children 0-14 years and PLHIV; however, PCF improves access to TB diagnosis among men. The unit cost of detecting one TB case in HHCI was higher than in PCF. Adding HHCI to PCF was not cost effective for detecting TB compared to PCF alone. Therefore, PCF remains the ideal and cost-effective strategy for low resource countries like Uganda. Keywords: Cost-Effectiveness, Yield, NNS, Tuberculosis, Household Contact Investigation, Passive Case Finding, Southwestern Uganda.
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.
Empowering communities through citizen science and participatory action research: implementation of a schistosomiasis communication campaign in Uganda
(Humanities and Social Sciences Communications, 2024) Anyolitho, Maxson Kenneth; Huyse, Tine; Masquillier, Caroline; Nyakato, Viola Nilah; Poels, Karolien
Schistosomiasis is a water-related disease strongly linked with high-risk water and sanitation practices perpetuating disease transmission. In Uganda, despite health education and sensitisation efforts through communication campaigns by the Ministry of Health to reduce schistosomiasis prevalence, common risky practices still pose a challenge, especially among endemic communities. Here, we steered away from the conventional top-down approach to communication campaigns and explored alternative methods. We employed citizen science (CS) and other participatory action research (PAR) techniques as a bottom-up approach to co-design and implement a communication campaign among communities of western Uganda, to achieve a more tangible outcome of behaviour change for preventing schistosomiasis. We collected qualitative data using data party, world café, prioritisation and ranking, focus group discussion, and key informant interviews from 378 purposively selected individuals and analysed it using a thematic analysis model. Community volunteers, community radios and local leaders were the most preferred channels for passing schistosomiasis information identified by participants. Lack of access to safe water and healthcare services, open defecation, and inadequate knowledge of schistosomiasis are some of the most pressing problems prioritised. Door-to-door visits by citizen scientists (CSs), community meetings, drama, and tournaments were the channels proposed by CSs and community groups during the co-design workshops. Over 1000 households and about 9000 community members were directly reached using the channels. Endemic communities prefer receiving schistosomiasis information using local channels instead of conventional ones. Combining citizen science with other PAR approaches empowers communities to interpret research findings in their contexts and take charge of the interventions. As such, clear and simple message coverage and a high audience turn-up can be achieved. A follow-up study is needed to evaluate the process and impact of the communication intervention on the citizen scientists and the community’s knowledge, attitudes, and practices regarding preventive measures.
Factors associated with adherence to community-directed treatment with Ivermectin for Onchocerciasis control among adults in Pader District, Northern Uganda
(Lira University, 2023) Oyet, William Sam; Akello, Anne Ruth; Opollo, Marc Sam
Background: Onchocerciasis is caused by a filarial nematode, Onchocerca volvulus, and transmitted by a female black fly of the genus Simulium. Ivermectin Mass Drug administration (IVM MDA) is the primary strategy for controlling Onchocerciasis in the endemic countries including Uganda. Pader district commenced annual IVM MDA implementation in 2008 and semi-annual in 2012. From 2008 to 2022, no study has been conducted on the factors associated with adherence to Ivermectin treatment. The objective of this study was to determine the factors associated with adherence to Ivermectin treatment for Onchocerciasis control among adults in Pader district. Methodology: A cross-sectional study design that targeted 384 adults who received ivermectin mass drug administration in Pader, between July 2022 and October 2022 was conducted in Pader District. Data was analyzed in STATA version 17. Logistic regression was used to determine the factors associated with adherence to Ivermectin treatment. The factors that show significant association at bivariate analysis were further subjected to multivariate analysis (logistic regression) Results: The study found out that there was a high level of adherence (67.6%) to Ivermectin treatment in Pader district, with waiting time (AOR=44.1, CI:9.42-206.1), community involvement (AOR=7.19, CI: 1.37-37.8), received health education (AOR=0.09; CI: 0.02- 0.35), and CCDs trained (AOR=0.16, CI: 00.02-0.94) showed significant association with ivermectin treatment adherence among respondents. Conclusions: The community involvement, wasting time, health education received and training CCDs showed good adherence to Ivermectin treatment in Pader district. Keywords: Adherence, community-directed treatment, Ivermectin, Onchocerciasis control, adults, Pader District, Northern Uganda
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
Factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City, Northern Uganda: a facility-based cross- sectional study
(BMJ, 2023) Acup, Walter; Opollo, Marc Sam; Akullo, Betty Nancy; Musinguzi, Marvin; Kigongo, Eustes; Opio, Bosco; Kabunga, Amir
Objective This study aimed at assessing factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City. Design A cross-sectional study. Settings The study was conducted in health facilities offering ANC services in Lira City, Northern Uganda. Participants The study was among 368 pregnant mothers attending their first ANC in the three selected facilities (Lira Regional Referral Hospital, Ober Health Center IV and Pentecostal Assembly of God Mission Health Center IV) in Lira City. Primary and secondary outcome measures Level of first ANC attendance within 12 weeks of pregnancy and associated factors. Results Early ANC attendance was 36.1%. Women who were: unmarried (adjusted OR (aOR): 0.40, 95% CI: 0.16 to 0.99), took >2 hours to reach a health facility (aOR: 0.21, 95% CI: 0.07 to 0.62), or not visited by village health teams or healthcare workers at home (aOR: 0.33, 95% CI: 0.12 to 0.92) were less likely to attend their first ANC early. On the other hand, women who were: not knowing first that ANC guides parents on infant care (aOR: 2.22, 95% CI: 1.06 to 4.67); pregnant without consent of spouse (aOR: 4.29, 95% CI: 1.75 to 10.55); attending ANC from a private facility (aOR: 2.89, 95% CI: 1.27 to 6.15); and having two to three healthcare workers present at the ANC clinic (aOR: 1.79, 95% CI: 1.03 to 3.13) were more likely to attend ANC early. Conclusions Despite the fact that the WHO recommends that all women begin ANC within 12 weeks after conception, Lira City in Northern Uganda had a low overall incidence of timely ANC initiation. Being unmarried, distance to reach a health facility, and being visited by village health teams or healthcare workers at home were all linked to timely ANC commencement. As a result, intervention efforts should concentrate on the highlighted determinants in order to promote ANC initiation in Lira City, Northern Uganda. This can be accomplished by providing information and education to the community on the timing and necessity of ANC in Northern Uganda.
Factors Associated with First Antenatal Care Attendance Within Twelve Weeks of Pregnancy Among Women in Lira City
(Lira University, 2022) Acup, Walter; Marc, Sam Opollo; Akullo, Betty Nancy
Introduction: The World Health Organization (WHO) recommends all pregnant women attend first Antenatal care (ANC) within 12 weeks of pregnancy. However, most pregnant women (71%) in Uganda started first ANC after 12 weeks of pregnancy. This predisposes them to pregnancy complications and outcomes which makes it hard to reduce the current high maternal mortality ratio (MMR) of 336 deaths per 100,000 live births. This study aimed to assess factors associated with first ANC attendance within 12 weeks of pregnancy among women in Lira City. Methods: A cross-sectional study design was conducted among 368 pregnant mothers attending first ANC at Lira Regional Referral Hospital (LRRH), Pentecostal Assembly of God-Mission HC-IV, and Ober HC-IV. Data was collected using interviewer-administered structured questionnaires. In-depth interviews were used to collect qualitative data. A binary logistic regression analysis was computed to determine the association using crude and adjusted odds ratios at 95% confidence intervals. Independent variables with a p-value of less than 0.05 in the multivariable logistic regression model were considered significant Results: Of the 368 respondents interviewed, 36.1% reported first ANC within 12 weeks of pregnancy. Risk factors associated with first ANC attendance within 12 weeks of pregnancy were not being in a marital relationship (aOR:0.40, 95% CI:0.16-0.99), taking >2hours to reach health facility (aOR:0.21, 95% CI:0.07-0.62), not being visited by VHT/HW at home (aOR:0.33, 95% CI:0.12-0.92). Protective factors associated with first ANC attendance within 12 weeks of pregnancy were not knowing that first ANC guides parents on infant and child care (aOR:2.22, 95% CI:1.06-4.67), pregnancy not consented to by spouse (aOR:4.29, 95% CI:1.75-10.55), attending ANC from private health facility (aOR:2.89, 95% CI:1.27-6.15), and having 2-3 HWs present at ANC clinic (aOR:1.79, 95% CI:1.03-3.13). Conclusion: Majority of pregnant women initiate their first ANC visits late. Comparing this to the UDHS 2016, we can conclude that late ANC initiation is a major problem in countrywide. Therefore, Ministry of Health should improve on the staffing of midwives and nurses at all facilities, raising awareness through continues community mobilization and sensitization of the women, their husbands and the community at large about the importance of first and timely ANC attendance should be a priority through HW/VHTs.
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
Factors Associated with Intrauterine Device use among Women of Reproductive age attending Family Planning Clinics at Mbale District
(Lira University, 2022) Ayeko, Jackson; Kumakech, Edward; Acen, Joy
Background: Intrauterine Contraceptive Device (IUCD) is among the most effective contraceptive methods in the market with increasing use globally. The use is predominant in few parts of the world, with sub-Saharan Africa relying on other methods. In Uganda, IUCD utilization remains very low at 1.5% compared to other methods despite several interventions by the government. The objective of this study was to determine the factors associated with IUCD use among women of reproductive age attending family planning clinics in selected public health facilities within Mbale District. Methodology: A facility based cross-sectional study was used among randomly selected women who came to obtain different contraceptive methods in the selected public health facilities. Information was obtained face-to-face by trained research assistants using a pre-coded structured questionnaire. Factors associated with IUCD use were identified by multi-variable binary logistic regression models using the backward stepwise method. Results: After running multi-variable binary logistic regression, IUCD use was associated with women who were employed (Adjusted OR=14.00, 95% CI;2.80-70.07), those who wanted to wait for 6-10 years before having the next pregnancy (Adjusted OR=12.19, 95% CI;1.35-110.08), and those who thought IUCD was associated with cancer (Adjusted OR=0.15, 95% CI;0.03-0.68). Conclusion: In conclusion, the study re-enforced the need to reach out with contraceptive methods especially IUCD to women who have a busy schedule and also points out the need for proper counselling to ensure that women who plan to stay for long should be counselled to also consider IUCD use which has a longer duration of action. Further, proper health education is needed through different channels to address the issues of myths and misconceptions which hinders utilization of IUCD. Keywords: Intrauterine Device, Women of Reproductive age, Family Planning Clinics, and Family Planning

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