Faculty of Public 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
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    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.
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    Adherence to Tuberculosis Treatment and Its Associated Factors among Drug-susceptible Tuberculosis Patients in Lira District, Northern Uganda
    (International Journal of Academic Research in Business and Social Sciences, 2023) Nabaziwa, Jannat; Kigongo, Eustes; Kabunga, Amir; Acup, Walter; Puleh, Sean Steven
    Uganda has a high incidence of tuberculosis infection at 200 cases per 100,000 people. With effective therapy and adherence to medications is essential for reducing the spread of tuberculosis in the community. However, many of the initiated patients do not get to finish the entire course of treatment. The purpose of this study was to investigate the level of and factors associated with tuberculosis treatment adherence among drug-susceptible tuberculosis patients in the Lira district. A facility-based cross-sectional survey was conducted among 234 randomly selected tuberculosis patients between October and December 2022. The Morisky medication adherence scale was used to measure adherence. Using a structured questionnaire to collect data on socio-demographic characteristics, community factors, and health service delivery factors associated with adherence. Binary logistic regression analysis was used to determine the correlates of adherence to tuberculosis drugs at a p value of 0.05. Most of the respondents (135, 57.7%) were males, (93, 39.7%) aged above 45 years, and (135, 57.7%) in a marital relationship. The prevalence of adherence to tuberculosis drugs was 84.6% (198/234) and was associated with marital status (AOR: 0.307; 95% CI: 0.13-0.0724, p=0.007) and the experience of stigma (AOR: 4.39; 95% CI: 1.612-11.958, p=0.004). The study reported that 2 in 10 drug-susceptible tuberculosis patients are non-adherent, which is lower than the targeted 90%. Marital status and stigma experience are predictors of non-adherence. Interventions by the ministry of health should target how to improve tuberculosis treatment and reduce stigma.
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    Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana
    (South African Medical Journal, 2018) Mwita, Julius Chacha; Magafu, Mgaywa Gilbert Mjungu Damas; Omech, Bernard; Dewhurst, Matthew J; Mashalla, Yohana
    Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients. Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF. Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality. Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality. Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub- Saharan Africa, and call for more studies to be done in this region.
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    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.
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    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
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    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
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    Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review
    (International journal of dermatology, 2019) Madu, Pamela N.; Williams, Victoria L.; Noe, Megan H.; Omech, Bernard; Kovarik, Carrie L.; Wanat, Karolyn A.
    Background There is a paucity of data describing autoimmune skin diseases in sub- Saharan Africa and in HIV positive cohorts. We describe the incidence of autoimmune skin diseases in public dermatology clinics in Botswana. Methods New patient records from public dermatology clinics were reviewed retrospectively for the period of September 2008 to December 2015. New diagnoses of cutaneous lupus erythematosus, systemic lupus erythematosus (SLE) with cutaneous involvement, dermatomyositis, systemic sclerosis, lichen sclerosus, bullous pemphigoid, pemphigus foliaceus, pemphigus vulgaris, and pemphigus vegetans were identified. Demographic data were recorded, and incidence was determined. Results A total of 262 patients were diagnosed with autoimmune skin disease (4% of all new patients) with an incidence rate of 28.8 (per 1,000,000). Cutaneous lupus was the most common diagnosis with discoid lupus occurring most frequently (12.6). The incidence of systemic sclerosis (2.2), morphea (1.6), lichen sclerosus (1.5), SLE with cutaneous involvement (1.3) and dermatomyositis (1.2) was relatively lower. Bullous pemphigoid was the most common bullous disease (3.8). Pemphigus foliaceus (0.9), pemphigus vulgaris (0.6), and pemphigus vegetans (0.2) were observed at a lower rate. At least 19.8% of these patients were also HIV positive. Conclusions The incidence of autoimmune skin diseases in Botswana is lower compared to other published studies in other geographic areas, which may be reflective of a younger population, barriers to access, genetic differences, and a lack of comparative studies in sub-Saharan Africa. The hygiene hypothesis and helminth infections may also contribute to these differences. Further studies are needed to understand these disorders in this region
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    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.
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    Barriers to treatment and care for depression among the youth in Uganda: The role of mental health literacy
    (Frontiers in Public Health, 2023) Amone-P’Olak, Kennedy; Kakinda, Adrian Ivan; Kibedi, Henry; Omech, Bernard
    Background: Depression represents a significant mental health problem (MHP) in low- and middle-income countries (LMICs), especially among early adults. Nevertheless, most early adults with depression do not seek treatment. Failure to recognize depression and knowledge about mental health literacy (MHL) may contribute to poor help-seeking behavior. This study assessed MHL, access and barriers to mental health care for depression among early adults in Uganda. Methods: Data were collected from students in two of the largest universities in Uganda. Participants completed questionnaires on depression, MHL, sources of barriers and opportunities for MH service. Regression analyses and parametric tests were used to assess depression, access, barriers and opportunities to promote MH. Results: About 12 per cent (n = 56) of the respondents were at the level of moderately severe to severe depression. Mental health literacy (MHL) scores were generally low ranging from “Ability to recognize mental disorders” (mean = 19.32, SD 3.22, range 18–32), and “Knowledge of risk factors” (mean = 4.39, SD 1.17, range 2–8), and “Knowledge of available information” (mean = 9.59, SD 2.53, range 5–20). Respondents reported barriers such as “stigma/discrimination” (65.53%), “lack of knowledge of where to receive help” (65.15%), “lack of trust in health workers” (62.56%), and “distant health facilities” (19.70%) that impede access to treatment and care. MHL significantly predicted depression (based on a continuous scale) (β = 0.63, 95% confidence interval [CI]: [0.56, 0.70]) with the regression model yielding a significant fit [R 2 = 0.40, F (2, 460) = 189.84, p < 0.001]. Conclusions: MHL is low among university students amidst several barriers such as stigma, fear, and lack of trust. To attenuate the negative e
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    A case of Shapiro’s Syndrome in an African young man
    (Case Reports in Internal Medicine, 2015) Chacha, Mwita Julius; Omech, Bernard; Keatlaretse, Siamisang; Humphrey, Bose
    Shapiro’s syndrome is a rare congenital neurological disease characterized by episodes of excessive sweating and hypothermia, and by complete/partial agenesis of the corpus callosum. We report an 18 year-old male who was referred to Princess Marina Hopsital with a longstanding history of episodic shaking chills, excessive sweating, fatigue, and unsteady gait. During the episodes, he was bradycardic (pulse rate of less than 36 beats/minute), with blood pressure of less than 80/45 mmHg, and his axillary body temperatures were unrecordably low. Neurologic examination showed cerebellar signs. The MRI of the brain revealed agenesis of the corpus callosum with no other abnormalities. The patient responded to clonidine therapy. Shapiro’s syndrome is an important consideration when evaluating a patient with episodic hyperhidrosis and hypothermia. The syndrome is rare worldwide and to the best of our knowledge, this report constitutes the first documentation of a case from Africa.
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    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
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    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
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    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.
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    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 .
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    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
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    Coping with post-war mental health problems among survivors of violence in Northern Uganda: Findings from the WAYS study
    (J Health Psychol, 2018-05-01) Amone-P'Olak, Kennedy; Omech, Bernard
    Cognitive emotion regulation strategies and mental health problems were assessed in a sample of war-affected youth in Northern Uganda. Univariable and multivariable regression models were fitted to assess the influence of CERS on mental health problems. Maladaptive cognitive emotion regulation strategies (e.g., rumination) were significantly associated with more mental health problems while adaptive cognitive emotion regulation strategies (e.g., putting into perspective) were associated with reporting fewer symptoms of mental health problems. The youth with significant scores on mental health problems (scores ≥ 85th percentile) reported more frequent use of maladaptive than adaptive strategies. Interventions to reduce mental health problems should focus on enhancing the use of adaptive strategies.
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    Cost effectiveness Analysis of adding Tuberculosis Household Contact Investigation on Passive Case Finding Strategy in Southwestern Uganda.
    (Lira University, 2022) Odongo, Dickens; Omech, Bernard; 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 passive case-findings (PCF)strategy in the Tuberculosis control program in south western Uganda. Methods: The study utilized decision-analytic modelling and bottom-up costing (ingredients) methods. The study obtained cost and ability and probability estimates on from national TB program data, activity costs, publicized literature, and expert opinions. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntuganu, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of 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 0-14 Vs. 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. The 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 cost 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 effectives 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 PCP. 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 Findings, South western Uganda.
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    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.
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    Cost-Effectiveness Analysis of Adding Tuberculosis Household Contact Investigation On Passive Case Finding Strategy in Southwestern Uganda
    (Lira University, 2022) Odongo, Dickens; Omech, Bernard; 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 modeling 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 Ntungamo, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of 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 0-14 Vs. 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. The 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.