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Item Knowledge and Perceptions of men towardsVasectomy among men of reproductive age inOtuke District-a cross-sectional study(Research square, 2024) Auma, Anna Grace; Madira, Emmanuel; Namukwana, Beth; Izaruku, Ronald; Kabunga, Amir; Wmicheal, Tamrat EndaleObjective: This study aimed to assess the knowledge and perceptions of vasectomy as a family planningmethod among men in rural northern Uganda. Methods: A cross-sectional study was conducted involving 624 participants. Sociodemographiccharacteristics, use of vasectomy, number of children, and knowledge of vasectomy were assessed.Perceptions of vasectomy were measured, focusing on cultural, religious, and gender-related aspects. Results: The study revealed a predominantly adult, married, and Catholic population with low educationalattainment. Only 2% of participants had undergone vasectomy, indicating limited utilization. Whileapproximately half demonstrated awareness of vasectomy, negative perceptions prevailed, with 63.5%expressing unfavorable opinions. Cultural and religious beliefs, along with concerns about promiscuity,played a signifi cant role in shaping negative perceptions. The majority believed in male dominance infamily planning decisions, and a considerable portion endorsed sterilization exclusively for women. Conclusion : This study highlights the low utilization and predominantly negative perceptions ofvasectomy among men in rural northern Uganda, emphasizing the need for targeted interventions toaddress cultural and religious misconceptions and enhance education on family planning options. Publichealth campaigns should focus on dispelling misconceptions about vasectomy, particularly addressingcultural and spiritual concerns. Educational programs should target men and their communities,emphasizing the benefi ts of shared family planning decisions. Further research incorporating qualitativemethods could provide a deeper understanding of the cultural aspects infl uencing vasectomyperceptions in this population.Item Barriers to Voluntary Medical Male Circumcision Uptake to Prevent HIV Transmission: A Qualitative Study among Married Men(International Journal of Academic Research in Business and Social Sciences, 2023) Aryek-kwe, Josephine; Nambozi, Grace; Kabunga, AmirBackground: Voluntary medical male circumcision (VMMC) is a relatively new intervention that has been found to reduce sexual transmission of HIV among heterosexual partners by 60% when properly practiced. However, the poor acceptance of VMMC makes it difficult to accomplish the objectives of health policy to boost uptake. The purpose of this study was to explore the barriers to VMMC Uptake among married men in Kitgum municipality. Methods: The qualitative descriptive design was employed in this study. The purposive sampling method was used to recruit 30 married men who lived within any of the three divisions of the municipality and had been married for at least one year. Data collection was done using an in-depth interview method. Inductive content analysis was used to generate the themes and categories. Results: The study findings revealed that fear, financial uncertainty, involvement of female health workers, cultural beliefs, religious belief, sexual dissatisfaction and advanced age were barriers to voluntary medical male circumcision uptake among the married men in Kitgum municipality. Conclusion: In Kitgum municipality, VMMC Uptake is still low, but the majority of the males had sufficient knowledge about it. We found the low uptake was primarily attributed to anxiety, involvement of female health workers, financial instability, sexual unhappiness, and advanced age. There is a need for proper re-packaging of the health education messages during mobilisations to address the anticipated side effects and to clearly state the reasons for the VMMC program. There is a need for proper re-packaging of the health education messages during mobilisations to address the communication gaps and to clearly state the reasons for VMMC program. Adequate psychological preparation of the men to expect any sex of staffs working in these clinics.Item Genomic analysis, immunomodulation and deep phenotyping of patients with nodding syndrome(BRAIN, 2023) Soldatos, Ariane; Nutman, Thomas B.; Johnson, Tory; Dowell, Scott F.; Sejvar, James J.; Wilson, Michael R.; DeRisi, Joseph L.; Inati, Sara K.; Groden, Catherine; Evans, Colleen; O’Connell, Elise M.; Toliva, Bernard Opar; Aceng, Jane R.; Aryek-Kwe, Josephine; Toro, Camilo; Stratakis, Constantine A.; Buckler, A. Gretchen; Cantilena, Cathy; . Palmore, Tara N; Thurm, Audrey; Baker, Eva H.; Chang, Richard; Fauni, Harper; Adams, David; Macnamara, Ellen F.; Lau, C. Christopher; . Malicdan, May Christine V; Pusey-Swerdzewski, Barbara; Downing, Robert; Bunga, Sudhir; Thomas, Jerry D.; Gahl, William A.; Nath, Avindrahttps://doi.org/10.1093/brain/awac357 BRAIN 2023: 146; 968–976 | 968 Genomic analysis, immunomodulation and deep phenotyping of patients with nodding syndrome Ariane Soldatos,1 Thomas B. Nutman, 1 Tory Johnson,1 Scott F. Dowell,2 James J. Sejvar, 2 Michael R. Wilson,3,4 Joseph L. DeRisi, 3,5 Sara K. Inati, 1 Catherine Groden, 1 Colleen Evans, 1 Elise M. O’Connell, 1 Bernard Opar Toliva, 6 Jane R. Aceng,6 Josephine Aryek-Kwe, 6 Camilo Toro, 1 Constantine A. Stratakis, 1 A. Gretchen Buckler, 1 Cathy Cantilena,1 Tara N. Palmore,1 Audrey Thurm, 1 Eva H. Baker, 1 Richard Chang, 1 Harper Fauni, 1 David Adams, 1 Ellen F. Macnamara, 1 C. Christopher Lau, 1 May Christine V. Malicdan,1 Barbara Pusey-Swerdzewski, 1 Robert Downing,7 Sudhir Bunga,2 Jerry D. Thomas, 8 William A. Gahl1 and Avindra Nath 1 The aetiology of nodding syndrome remains unclear, and comprehensive genotyping and phenotyping data from pa- tients remain sparse. Our objectives were to characterize the phenotype of patients with nodding syndrome, inves- tigate potential contributors to disease aetiology, and evaluate response to immunotherapy. This cohort study investigated members of a single-family unit from Lamwo District, Uganda. The participants for this study were selected by the Ugandan Ministry of Health as representative for nodding syndrome and with a con- ducive family structure for genomic analyses. Of the eight family members who participated in the study at the National Institutes of Health (NIH) Clinical Center, three had nodding syndrome. The three affected patients were extensively evaluated with metagenomic sequencing for infectious pathogens, exome sequencing, spinal fluid immune analyses, neurometabolic and toxicology testing, continuous electroenceph- alography and neuroimaging. Five unaffected family members underwent a subset of testing for comparison. A dis- tinctive interictal pattern of sleep-activated bursts of generalized and multifocal epileptiform discharges and slowing was observed in two patients. Brain imaging showed two patients had mild generalized cerebral atrophy, and both patients and unaffected family members had excessive metal deposition in the basal ganglia. Trace metal biochem- ical evaluation was normal. CSF was non-inflammatory and one patient had CSF-restricted oligoclonal bands. Onchocerca volvulus-specific antibodies were present in all patients and skin snips were negative for active onchocer- ciasis. Metagenomic sequencing of serum and CSF revealed hepatitis B virus in the serum of one patient. Vitamin B6 metabolites were borderline low in all family members and CSF pyridoxine metabolites were normal. Mitochondrial DNA testing was normal. Exome sequencing did not identify potentially causal candidate gene variants. Nodding syndrome is characterized by a distinctive pattern of sleep-activated epileptiform activity. The associated growth stunting may be due to hypothalamic dysfunction. Extensive testing years after disease onset did not clarify a causal aetiology. A trial of immunomodulation (plasmapheresis in two patients and intravenous immunoglobulin in one patient) was given without short-term effect, but longer-term follow-up was not possible to fully assess any benefit of this intervention.Item HIV Treatment and Care of Adolescents: Perspectives of Adolescents on Community-Based Models in Northern Uganda(HIV/AIDS - Research and Palliative Care, 2023) Miyingo, Charles; Mpayenda, Teddy; Nyole, Ruth; Ayinembabazi, Joan; Ssepuuya, Mujib; Ssebuwufu, Eddie Marvin; Puleh, Sean Steven; Udho, Samson; Kabunga, AmirBackground: Differentiated service delivery models for people living with HIV continue to be scaled up to expand access to HIV services and treatment continuity. However, there is a gap in information on adolescents’ perspectives on community-based models. We aimed to explore the perspectives of adolescents living with HIV on community-based models in northern Uganda. Materials and Methods: Between February and March 2022, we conducted a descriptive qualitative study at two health centres IV in Northern Uganda. Data was collected using an interview guide. The study had 25 purposively selected adolescents enrolled in community-based models for HIV care and treatment. The interviews were audio-recorded, transcribed verbatim, and translated. We analyzed data using a thematic approach. Results: A total of 25 in-depth interviews with HIV-positive adolescents were conducted. More than half (52.0%) of the participants were females, 84.0% were not married, and 44.0% had no formal education. The mean age of the respondents was 15.6 (±1.9) years. The major themes were: community-based models currently accessed by adolescents, benefits, and challenges of the models. Although there are other community-based models (community pharmacies, home ART deliveries) our exploration only discovered two models used by these adolescents to access care, namely, Community Drug Distribution Point (CDDP) and Community Client-Led ART Delivery Groups (CCLADs). The benefits included reduced transportation costs, convenient service access, ART adherence, peer support, a comfortable environment and less stress. However, our results indicate that these models had some challenges, including lack of confidentiality and privacy, perceived stigma, and a lack of face-to-face interaction. Conclusion: Our findings show that CDDP and CCLADs are the two CBMs used by adolescents in Lira District to access treatment and care. Adolescents benefited from these models through reduced transport costs, the convenience of accessing HIV care and treatment, and social support. The challenges associated with these models are lack of confidentiality and privacy, perceived stigma, and a lack of face-to-face interaction. The Ministry of Health should work with other implementing partners to strengthen the implementation of these models to improve HIV/AIDS service delivery for adolescents.Item Prevalence of anaemia in pregnancy and associated factors in northern Uganda: a crosssectional study(South African Journal of Clinical Nutrition, 2022) Udho, Samson; Nankumbi, Joyce; Namutebi, Mariam; Mukunya, David; Ndeezi, Grace; Tumwine, James KBackground: Anaemia in pregnancy is associated with poor maternal and foetal outcomes. Nonetheless, there is a paucity of recent literature on the predictors of anaemia during pregnancy in the context of northern Uganda, a region emerging out of decades of war. A study was undertaken to determine the prevalence and factors associated with anaemia among pregnant women in northern Uganda. Methods: In this cross-sectional study, 320 pregnant women seeking care at Lira Regional Referral Hospital were consecutively enrolled. Data were collected using a structured interviewer-administered questionnaire. Data collected included: demographic, obstetric, nutritional and dietary characteristics of study participants. Data analysis consisted of descriptive statistics, cross-tabulations and logistic regression with 95% confidence and a p-value of < 0.05 as significant using STATA version 14. Results: The mean age of the women was 25.3 ± 5.6 years while their mean gestational age was 25.4 ± 7.8 weeks. The overall prevalence of anaemia (Hb < 11 g/dl in the first and third trimesters and less than 10.5 g/dl in the second trimester) was 24.7%. Iron deficiency was prevalent in half of the women (50%) with anaemia. Factors independently associated with anaemia included taking antimalarial prophylaxis (AOR 0.44; 95% CI 0.19, 0.99) and consumption of legumes and cereals more than twice in the previous week (AOR 0.46; 95% CI 0.24, 0.89). Conclusion: One-quarter of pregnant women in this study population based in northern Uganda were anaemic. There is a need to strengthen interventions to control anaemia during pregnancy, particularly the intake of antimalarial prophylaxis and consumption of iron-rich locally available foods.Item Barriers and Facilitators to Successful Intensive Adherence Counseling in Rural Northern Uganda: An Exploratory Interview with HIV-Positive Clients Using the COM-B Framework(HIV/AIDS-Research and Palliative Care, 2022) Beja, Humphrey; Daisy, Nakayiwa; Edek, Micheal Tonny; Kobusinge, Veronic; Akaki, Oscar; Owachgiu, Innocent Ocitti; Udho, SamsonPurpose: Intensive adherence counseling (IAC) was introduced as a strategy to enhance adherence to antiretroviral therapy (ART) among HIV clients with non-suppressed viral loads. There has been sub-optimal viral load suppression among HIV clients in Uganda enrolled in IAC. However, there is a scarcity of literature on the barriers and facilitators of successful IAC. We aim to explore the barriers and facilitators to successful IAC among HIV-positive clients seeking care in public health facilities in rural northern Uganda. Patients and Methods: This was an exploratory qualitative study conducted among 15 purposively sampled HIV-positive clients enrolled in IAC in public health facilities offering ART services in northern Uganda. We conducted in-depth interviews using semistructured interview guides based on the capability, opportunity, motivation, and behavior (COM-B) framework for behaviour change. Data were analyzed using the deductive thematic approach of Braun and Clarke following the COM-B framework. Results: The majority of the participants were females (60%), married (53%), and attained primary education (47%). Barriers to successful IAC were Capability – alcoholism and promiscuity, Opportunity – stigma and discrimination, delayed viral load result, shortage of food, and heavy workload; and Motivation – deteriorating health and lack of incentives. Facilitators to successful IAC were Capability – good knowledge of ART, good memory, and reminder alerts; Opportunity – availability of ART, social support, availability of ART, prolonged ART refill, and good counseling; and Motivation – desire to live longer and healthy and the desire to fulfill dreams and goals. Conclusion: Successful implementation of IAC needs to consider the context of the person in care thus the need to strengthen individualized IAC sessions. HIV care providers can adopt the COM-B framework to perform individualized IACs and use the information to strengthen the counseling sessionsItem A call for critical midwifery studies: Confronting systemic injustice in sexual, reproductive, maternal, and newborn care(Wiley, 2022) Ashley, Rebecca; Goodarzi, Bahareh; Horn, Anna; de Klerk, Hannah; E. Ku, Susana; Marcus, Jason K.; Mayra, Kaveri; Mohamied, Fatimah; Nayiga, Harriet; Sharma, Priya; Udho, Samson; Vijber, Madyasa Ruby; van der Waal, Rodanteystemic injustice is a threat to sexual, reproductive, ma- ternal, and newborn (SRMN) health. The effects of this injustice are reflected in the high maternal and neonatal morbidity and mortality rates in former colonized coun- tries of the Global South, in marginalized communities of the Global North, and in underprivileged classes around the world. 1 Current research, clinical guidance, and global health politics all point to an inadequate response to in- justice on the part of SRMN care systems. Consider, for instance, four examples of ongoing injustices globally: the lack of workforce to meet SRMN, 2 the lack of access to safe abortion, 3 the “ethnic”, “racial”, and socioeconomic disparities present in maternal and newborn outcomes during the Covid-19 pandemic,4,5 and the severity and persistence of obstetric violence and obstetric racism.Item Intimate partner violence among pregnant women in Uganda(African Journal of Midwifery and Women’s Health, 2019) Epuitai, Joshua; Udho, Samson; Auma, Anna Grace; Nabirye, Rose ChaloBackground: Intimate partner violence may be more prevalent during pregnancy as women are more vulnerable. Aims: To determine the prevalence of intimate partner violence and associated factors among pregnant women at Soroti Regional Referral Hospital, Uganda. Methods: A cross-sectional study was conducted among 180 pregnant women. Data were collected using a pre-tested, semi-structured questionnaire. Intimate partner violence was measured using the revised Conflict Tactile Scale 2. Findings: The overall prevalence of intimate partner violence during pregnancy was 27.8%. Household average monthly income, experiences of intimate partner violence before pregnancy and marital conflicts were independently associated with intimate partner violence during pregnancy. Conclusions: Screening should be done during antenatal care among women with low household income, marital conflicts, and history of intimate partner violence before pregnancy to identify and manage cases of intimate partner violence. More research is needed to identify interventions for reduction of intimate partner violence during pregnancy.Item Burnout and Associated Factors among Hospital-Based Nurses in Northern Uganda: A Cross-Sectional Survey(BioMed Research International, 2022) Udho, Samson; Kabunga, AmirBackground. Burnout is a public health problem that disproportionately affects nurses in sub-Saharan Africa because of the weak health systems that create an unconducive workplace environment. In Uganda, there is limited evidence on the burden of burnout among nurses in a manner that undermine advocacy and policy formulation. We aimed to assess the level of burnout and associated factors among nurses in northern Uganda. Methods. This was a cross-sectional survey conducted among 375 randomly selected nurses from health facilities in northern Uganda. Data were collected using a self-administered questionnaire. Data analysis consisted of descriptive statistics and logistic regression at a 95% level of significance in SPSS version 25. Results. Majority of the respondents were female 56.5% (n = 223). Nearly half, 49.1% (n = 194) of respondents had high levels of burnout, 36.2% (n = 143) reported average levels of burnout, and 14.7% (n = 58) reported low levels of burnout. Factors associated with burnout were age (AOR: 2.90; 95% CI: 1.28-6.58; p = 0:011), social support (AOR: 0.45; 95% CI: 0.22- 0.94; p = 0:033), healthy eating (AOR: 0.06; 95% CI: 0.02-0.22; p < 0:001), workload (AOR: 0.31; 95% CI: 0.14-0.68; p = 0:004), and management responsibilities (AOR: 3.07; 95% CI: 1.54-6.12; p = 0:001). Conclusion. Half of the nurses in northern Uganda experienced high levels of burnout. The Ministry of Health should consider recruiting more nurses to reduce workload and adjust working hours to prevent workplace-related burnout among nurses in the country.Item Healthcare providers’ practice and attitude towards abortion service provision in Gulu city, Northern Uganda(Research Square, 2020) Pebalo, Francis Pebolo; Auma, Anna Grace; Obol, James HenryBackground: Unsafe abortion is a growing public health problem concern globally despite being preventable. The World Health Organization estimates that about 20 million pregnancies results into unsafe abortion globally. The proportion of unsafe abortion has been increasing with developing countries contributing about 97% of unsafe abortions cases including Uganda. Unsafe abortion is among the four leading causes of pregnancy related mortality, injuries, and disability globally. The restrictive abortion laws and religious situation make abortion a highly controversial social issue in Uganda leading to high stigma in the society, and a majority of the healthcare providers are reluctant to perform an abortion even if indicated for fear of possible legal consequences. Methods: We conducted survey among health worker about knowledge of complications, practice, and attitudes of induced abortion between September and November 2019 among 252 healthcare providers in Gulu Municipality, Northern Uganda. Multivariate analysis showed associations between healthcare providers' characteristics and adequate knowledge about abortion complications. Ordinary least square regression analysis found associations between providers' characteristics and their intention for general support, generally not in support, conditional support for abortion provision, as well as their personal attitudes and beliefs against or towards abortion provision. Results: The mean attitudinal score for generally in support, generally not in support, conditional in support, personal attitude, and beliefs against and toward abortion provision were 2.80, 2.71, 2.86, 3.239, and 3.35 respectively. Participants who were married and practice Anglican religion were more likely to have good knowledge of abortion complications, p-values 0.035, and 0.042 respectively, meanwhile participants who were employed in faith-based facilities were more likely to have poor knowledge of abortion complications p-value 0.002. Conclusion: Ministry of Health and stakeholders need to provide training of health workers to improve quality of abortion services. Medical training institutions should ensure that students understand the laws and responsibilities that govern their professional actions with respect to abortion care regardless of their personal views, beliefs, and attitudes.Item Factors Associated with Utilization of HIV Testing Services among Adolescents Aged 10-19 Years in Lira District, Northern Uganda: A Cross-Sectional Study(BioMed Research International, 2021) Benyumiza, Deo; Amongin, Joan Fidelia; Ochaba, Isaac; Adupa, Morish; Abuch, Naume; Banula, Constance Babirye; Udho, SamsonBackground. HIV testing remains a problem among adolescents in low- and middle-income countries, and yet, HIV testing is a cornerstone in the fight against HIV. However, there is scanty literature on the utilization of HIV testing services by adolescents especially in rural settings. This study is aimed at determining the uptake of HIV testing services and associated factors among adolescents aged 10-19 years in Lira District, Northern Uganda. Methods. This was a cross-sectional study done among 277 randomly selected adolescents aged 10-19 years attending outpatient clinics in Pentecostal Assembly of God (PAG) Mission Hospital, Ngetta Health Center III, and Boroboro Health Center III. Data were collected using an interviewer-administered structured questionnaire. Data collected included sociodemographic characteristics, history of test and receipt of HIV results in the last three months, and facility-related factors affecting uptake of HIV testing services. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 25. Results. The uptake of HIV testing services was 43% (119/277) among the study participants. Adolescents who had completed primary education (aOR: 5.47; 95% CI: 1.07-28.15; p = 0:042), are employed (aOR: 2.77; 95% CI: 1.16-6.60; p = 0:022), had used a condom in the last sexual intercourse (aOR: 4.46; 95% CI: 1.78-11.15; p = 0:001), and are involved in HIV testing outreaches (cOR: 10.86; 95% CI: 3.81-30.93; p ≤ 0:001) were more likely to uptake HIV testing services compared to those who had tertiary education, are unemployed, had never used a condom, and are not involved in HIV testing outreaches. Conclusion. Utilization of HIV testing services by adolescents aged 10-19 in Lira District, Northern Uganda, is generally low. The Ministry of Health should strengthen HIV testing services targeting adolescents to increase uptake of HIV testing services.Item Factors Associated with Utilization of HIV Testing Services among Adolescents Aged 10-19 Years in Lira District, Northern Uganda: A Cross-Sectional Study(Hindawi BioMed Research International, 2021-08-12) Benyumiza, Deo; Amongin, Joan Fidelia; Ochaba, Isaac; Adupa, Morish; Abuch, Naume; Banula, Constance Babirye; Udho, SamsonBackground. HIV testing remains a problem among adolescents in low- and middle-income countries, and yet, HIV testing is a cornerstone in the fight against HIV. However, there is scanty literature on the utilization of HIV testing services by adolescents especially in rural settings. This study is aimed at determining the uptake of HIV testing services and associated factors among adolescents aged 10-19 years in Lira District, Northern Uganda. Methods. This was a cross-sectional study done among 277 randomly selected adolescents aged 10-19 years attending outpatient clinics in Pentecostal Assembly of God (PAG) Mission Hospital, Ngetta Health Center III, and Boroboro Health Center III. Data were collected using an interviewer-administered structured questionnaire. Data collected included sociodemographic characteristics, history of test and receipt of HIV results in the last three months, and facility-related factors affecting uptake of HIV testing services. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 25. Results. The uptake of HIV testing services was 43% (119/277) among the study participants. Adolescents who had completed primary education (aOR: 5.47; 95% CI: 1.07-28.15; ), are employed (aOR: 2.77; 95% CI: 1.16-6.60; ), had used a condom in the last sexual intercourse (aOR: 4.46; 95% CI: 1.78-11.15; ), and are involved in HIV testing outreaches (cOR: 10.86; 95% CI: 3.81-30.93; ) were more likely to uptake HIV testing services compared to those who had tertiary education, are unemployed, had never used a condom, and are not involved in HIV testing outreaches. Conclusion. Utilization of HIV testing services by adolescents aged 10-19 in Lira District, Northern Uganda, is generally low. The Ministry of Health should strengthen HIV testing services targeting adolescents to increase uptake of HIV testing services.Item Polycystic ovarian syndrome: diagnostic challenges in resource-poor settings (Ugandan perspectives)(PAMJ Clinical Medicine, 2021) Pebolo, Pebalo Francis; Auma, Anna Grace; Alobo, GasthonyPolycystic ovarian syndrome is the most common cause of anovulatory infertility accounting for up to 40% of the reasons for visiting a doctor. The Ugandan government has recognized infertility as a major problem affecting over five million people, yet polycystic ovarian syndrome is not included in the Ugandan Clinical Guidelines, hence it´s not part of the Uganda minimum healthcare package. Lack of guidelines means diagnosis is a challenge and many cases have delayed or no diagnosis. Early diagnosis is good for awareness of associated risks such as infertility, dysfunctional uterine bleeding, endometrial cancer, obesity, diabetes, dyslipidemia, hypertension, and cardiovascular diseases. Clinical laboratories are handy in the diagnosis as well as follow-up of PCOS cases and in most rural settings, these are lacking, confounded by the lack of skilled frontline workers such as gynecologists and reproductive endocrinologists.