Assessing sexual practices and contraceptive use among adolescents 15-19 years in a refugee settlement in Uganda
Background: Humanitarian crises and migration make girls and women more vulnerable to poor sexual and reproductive health (SRH) outcomes. Nevertheless, there is still a dearth of information on SRH outcomes an access to SRH services among refugee girls and young women in Africa. We conducted a mixed-methods study to assess SRH experiences, knowledge and access to services of refugee girls in the Nakivale settlement, Uganda.
Methods: A cross-sectional survey among 260 adolescent girls 13–19 years old was conducted between March and May 2018. Concurrently, in-depth interviews were conducted among a subset of 28 adolescents. For both methods, information was collected regarding SRH knowledge, experiences and access to services and commodities. The questionnaire was entered directly on the tablets using the Magpi® app. Descriptive statistical analysis and multinomial logistic regression were performed. Qualitative data was transcribed and analysed using thematic content analysis.
Team
Elizabeth Kemigisha, Olena Ivanova, Catherine Kyakwera, Dorah Nampijja, Stella Kanyesigye, Genevieve Busingye
Knowledge, attitude and behaviour towards the use of insecticide treated mosquito nets among pregnant women and children in rural Southwestern Uganda
Background: The burden of malaria in Uganda remains unacceptably high, especially among children and pregnant women. To prevent malaria related complications, household possession and use of Insecticide Treated mosquito Nets (ITNs) has become a common practice in the country. Despite the availability of ITNs, malaria remains a foremost public health concern in Uganda. We sought to explore knowledge, attitude, and behaviour towards the use of ITNs as a nightly malaria prevention strategy among pregnant women and children under five years of age in Isingiro district, Southwestern Uganda.
Methods: This was a community based, descriptive cross-sectional study, in which households with children under 5 years, and/or pregnant women were enrolled. We used a structured questionnaire to collect data on participants’ understanding of the causes, signs and symptoms of malaria; use of ITNs to prevent malaria; attitudes and behaviours towards the use of ITNs. We also conducted key informant interviews (KIIs) to get in-depth understanding of responses from the participants. We analysed quantitative data using STATA version 12.Qualitative findings from the KIIs were transcribed and translated, and manually analysed using thematic content analysis.
Team
Taremwa Ivan Mugisha, Arimpa Amerias, Carlrona Ayebazibwe , Imelda Kemeza, Ochokoru Harrietadrama, Daniel Omoding, Jane Yatuha, Turuho Thadeus
Determinants of maternal health utilization by adolescents in informal settlements of Nairobi.
Use of antenatal care, delivery in a health facility and use of infant services positively affects the health of both the infant and the mother. Pregnant adolescents are at increased risk of maternal mortality. Despite increased effort to make maternal health care available to adolescents, utilization of these services by this population is still low. In this study we seek to identify the factors that influence maternal health care utilization by pregnant adolescents in informal settlements of Nairobi Kenya. Focus groups will be used to determine the salient factors for adolescents in their decisions to use antenatal health care, or not, and in choosing where they will deliver their babies and the utilization of infant care after delivery. Once these factors have been identified it will be used to inform policy makers .The expected long term impact is the increased utilization of antenatal health care ,increased health facility delivery and infant care utilization which will in turn lead to decreased maternal and infant mortality .
Team
Mose Fred Mochache, Jane Achieng Achola, Lucy Wangari Mwangi, John Kariri Mukui, Peter M. Kirigwi, Jeremiah Munyao, Elijah A. Okall
“I cannot express how relieved I am, and at this point in time, I am one of the happiest people on the face of the earth. I wish to extend my heartfelt gratitude to all of you for all your efforts that have this this proposal reach this far.”
Availability, accessibility and utilization of teenager friendly antenatal services in Mbarara Municipality, South Western Uganda
Globally, about 11 % of all annual births involve adolescents aged 15–19 years. Uganda has one of the highest teenage pregnancy rates in Sub-Saharan Africa. This study assessed stakeholders’ views concerning factors affecting availability, accessibility and utilization of teenager friendly antenatal services in Mbarara Municipality, southwestern Uganda.
Methods: This was a cross-sectional descriptive study utilizing Key Informant Interviews (KIIs). It was conducted in three divisions of Mbarara Municipality. The KIIs were held six Village Health Team (VHT) members, three gynecologists, six midwives, three Community leaders (LC 3 Secretaries for women affairs), one police officer from the Family and Child protection unit at Mbarara Police and three Traditional Birth Attendants (TBAs). Data analysis was done manually by identifying emergent themes which were later coded and organized into concepts which were later developed into explanations.
Team
Godfrey Zari Rukundo, Peace Byamukama Natukunda, Agirie Aligawesa Lubega, Catherine Abaasa, Christine Kakaire, Bob Harold Ashabahebwa, Joshua Musinguzi
The Lived experience of VHT members in the Kinoni Health sub-district South West Uganda.
We shall use random sampling to select 4 villages from the 6 parishes in Kinoni Health sub-district from which purposive sampling of VHTs and local leaders in each of the villages will be done. In-depth interviews will be conducted with the study participants and the interviews will be audio-recorded and transcribed verbatim. Field notes will be taken during the interviews and incorporated into written transcripts. Individual VHT members will be targeted for these interviews and Key informants will be targeted to provide the information on the context in which the VHTs perform their duties. Interviews will be followed by Focus group discussions which will be organized for randomly selected VHTs to provide more information on the commonly arising themes. Four FGDs will be held with a minimum of 8 participants per focus group discussion and we shall have one FGD in each of the selected villages.
Team
Clare Kyokushaba, Ainembabazi Doreen, Christine Acio, Barbra Naggayi, Teddy Kyomuhangi, Kataaha Salome, Agaba Gad
Role of income generating activities in motivation and retention of Village Health Teams in the Kinoni health sub-district.
Village health team mobilization and awareness, Conduct Focus group Discussion with the VHTs and Key informant Interviews, Data analysis, Report writing, Meeting to discuss the findings, Meeting to prepare the dissemination, Dissemination to the VHTs, community leaders, Policy makers, District leaders and other stake holders.
Team
David Tumusiime Katuruba, Ms. Mary Samantha, Ms. Mahooro Christine, Mr. John Baptist Asiimwe, Mr. Apuulison, Ms. Gladys Aliyinza
Maternal mental health and Malnutrition in children admitted in Mbarara Regional Referral Hospital in South Western Uganda.
The aim of the study is to establish if there is an association between the mental health status of the mothers and malnutrition in children below five years in south western Uganda. The study will be a case control study. The mental health status of mothers of children with malnutrition (cases) will be compared with the mental health status of mothers of children with normal nutrition status (controls). Controls will be children admitted in the paediatric ward with other chronic conditions but normal nutritional status. Measurements of weight, height, mid upper arm circumference (MUAC) will be carried out to determine the nutritional status of children below five years admitted in Natasha nutritional ward in Mbarara Regional Referral Hospital. Level of malnutrition will be determined using the WHO growth standards of z-score below minus two standard deviations (-2SD). A sample size of 186 participants is planned for (83 cases and 83 controls. We shall recruit children from Mbarara regional referral paediatric ward. We shall seek ethical approval from Mbarara University of Science and Technology Faculty Research Ethical Committee as well as Mbarara University Institutional Review Board. Informed consent will be sought from the study participants.
Team
Ashaba Scholastic, Dr GodfreyRukundo, Dr Data Santorino, Nataro Moses, Beinempaka Florence, Katushabe Syson
Factors Contributing to Poor Patient Adherence to Ponseti Management of Clubfoot at AIC-CURE International Children’s Hospital Kijabe.
Clubfoot is a deformity of the feet that a child is born with. If not treated early and correctly, it can result in disability. Treatment of this condition is available in Kenya at several government facilities for free. However, some children stop attending treatment before proper correction is reached, ending up with recurrence of the deformity. The study will seek to find out what makes some of the patients stop attending treatment even when this treatment is free. Trained research assistants will interview the parents/guardians of children with clubfoot who are undergoing treatment at AIC-CURE International Children's Hospital Kijabe. Those who stopped attending treatment will be interviewed at their homes.
Team
Hellen Kariuki, Susan Ndinguri, Dr.Inziani Mary, Dr. Kollmann Martinm, Kareri Danson Mwangi, Mwaniki John Njeru
Impact of In-Service training of midwives on partogram use.
In Africa mothers all too often die during delivery due to prolonged labour. These deaths could be prevented by more careful monitoring of labour using a form that requires midwives to record the progress of labour such as fetal heart rate and frequency of contractions. This form is known as the partogram. If used consistently, the partogram can reduce the deaths during delivery. Unfortunately many midwives do not fill the partogram. We propose to train selected midwives in two institutions in Nairobi on coaching skills. These skills will be used by the trained midwives to promote partogram use by their peers. This project aims to measure the effects of the coach training intervention on partogram use by colleague midwives. If this study demonstrates that the coaching intervention is effective in improving the use of the partogram, the Ministries of Health will be approached to consider scaling up the intervention. The expected long term impact is reduced Maternal Mortality in Africa.
Team
Jennifer Oyieke, Alice Yugi, Jane Ong'ang'o, Elizabeth Dimba, Regina Mutave, Maria Ndunge Kiio, Faith Apolot Okalebo
Knowledge, Attitudes and Practices about blood donation in rural communities of Kiruhura District, South Western Uganda.
Blood transfusion is a vital element of health care system in Uganda. Much (75%) of donated blood is used by children with different conditions and pregnant women with complications of pregnancy and/or child birth. Children with different conditions requiring transfusion use more than a half (50%) of donated blood. Therefore, to reduce maternal and child mortality in Uganda and meet MDGS related to child health and maternal health by 2015, there is an urgent need to ensure a sustained supply of adequate units of safe blood throughout the year. In Uganda, 100% of blood is donated by voluntary non-remunerated blood donors and majority of whom 90% are secondary school students. This indicates that during school holidays, communities become a major source of blood.
Team
Natukunda Peace, Agaba Ellon, Wabuyi Patrick
Availability, accessibility and utilization of teenager friendly antenatal services in Mbarara Municipality, South Western Uganda.
The study will be cross-sectional descriptive study utilizing qualitative data collection and analysis methods. Focus group discussions and key informant interviews will be used to collect data. Three Focus group discussions will be held in each of the three divisions; with the teenagers, care-takers of teenagers and community leaders. Key informant interviews will be conducted with reproductive health workers and some community leaders. Teenagers aged between 14-17 years residing in Mbarara municipality and are pregnant or have given birth within six months and will consent, will be included in the study.
Team
Godfrey Zari Rukundo, Bob Harold Ashabahebwa, Catherine Abaasa, Agirie Aligawesa Lubega, Christine Kakaire, Joshua Musinguzi
Knowledge and Current Practices of Village Health Teams in Early Detection and Care oChristine Kakairef Young Children with Malnutrition in Healthy Child Uganda Supported Communities in Mwizi Sub County, Uganda
Malnutrition remains a big problem in Uganda affecting 38% of children in South Western Uganda. The Ministry of Health interventions to address this problem together with organisations such as UNICEF, Health Child Uganda is to roll out the Village Health Team (VHT) strategy to manage malnutrition at a community level. This project intends to carry out a survey to determine the knowledge and current practices of VHTs members in early detection and care for young children (under 5years) with malnutrition in Mwizi Sub County, in South Western Uganda.
Team
Elizabeth Kemigisha, Celestine Atwebembeire, Gad Agaba, Rosemary Namayanja, Silvano Twinomujuni, Umar Masereka
Couples HIV Counselling and Testing : Factors Influencing Uptake
The purpose of this research is to identify understand and document the factors that are influencing the uptake of couple HIV counselling and testing in Mukono district in Uganda. This study will enable HIV couseling and testing programs and the district to implement a culturally sensitive program. The information obtained will be shared with the different stakeholders with the intention of developing clear action plans for implementation.
Team
Nannozi Victoria, Dr. Nansera Denis, Hakim Kalungi, Matsiko Nicholas, Kibirige Leonard
Knowledge and Practices of Women Regarding PMTCT in Mwizi Sub-country
Of the 2.5 million children younger than 15 years living with HIV, 90% were infected by their mothers during pregnancy, labour and breastfeeding. 95% of the children live in the Sub-Saharan Africa. It’s therefore important that women of child-bearing age (15-49 years) know and practise the methods of preventing transmitting the infection to their children. Our research is aimed at finding out what the women in a rural Ugandan sub-county know about the prevention of HIV from infected mothers to their babies.
Team
Atwiine Barnabas, Rukundo Aloysius, Lillian Birungi, Mutibwa David, Robert Turyamureeba
The impact of Community Owned Resource Persons on reducing malnutrition among children less than two years in three health Sub Districts in Mbarara and Bushenyi.
The research will explore secondary data that was collected on children during the baseline in 2006 and the endline survey in 2009. On addition some data for validation will be collected. The primary purpose of the study is to determine whether the Community Health Volunteer (CHVs) program reduced malnutrition. To achieve this, the researcher will focus on the main activities that were normally conducted by the CHVs and test if there is any statistical relationship. The study will further explore if social demographic factors contributed significantly to the reducation in malnutrition. The data will be further cleaned and new variables created so that various statistical associations can be analysed.
Team
Moses Ntaro
Assessing the relationship between social support system and nutrition status among children under 5 years.
The study will be carried out in Kyera parish in South Western Uganda; it will involve a baseline survey to fully achieve all the specified objectives. Data analysis and report writing as well results dissemination. Descriptive studies on the other hand give a representation of a social phenomenon (Neuman, 2006). The two designs are expected to be appropriate for this study due to their ability to generate new insights and to describe in-depth the little-studied relationship between social support system and nutritional status among children under 5 years. A combination of qualitative and quantitative approaches will be adopted during the study. A qualitative approach enjoys a number of merits such as flexibility and ability to generate in-depth information The method will provide an opportunity for participants to directly and interactively ‘tell their story’ concerning the relationship between social support system and nutritional status of children.
Team
Natukwatsa Amon, Martin Ouna, Lydia Rukundo, Francis Oriokot, Bariyo Rogers, Godfrey Kwizera
Efficacy of Glutamine Supplementation on the outcome of children admitted with persistent diarrhea to Mulago hospital (Completed 2012)
Since persistent diarrhea is a major cause of death in infants in sub Sahara Africa, 138 infants with persistent diarrhea were randomized to receive either standard treatment or standard treatment with Glutamine supplement. Although glutamine was reported to be beneficial in other studie, no benefit was shown in this prospective study.
PRIMARY RESEARCHER
Justine M. Kamuchaki supervised by Kiguli Sara, Robert Bortolussi, Eric Wobudeya
REPORTS
Impact of the VHT Newborn Strategy in Reducing Perinatal Deaths in a Rural District of Uganda
Mwondha, Moses Katagawa Peri-natal audit is a tool used by health workers to assess the mortality rates during the neonatal period. Our project aims to establish the impact of the Village Health Team newborn strategy which has been launched in Uganda in 2010. The project will conduct community verbal autopsy as baseline in Bamunanika County, Luweero District in Uganda. Thereafter, utilize the Village Health Team members who were trained on essential newborn care to conduct community training of the newborn care package. Evaluation will be done 12 months later to assess the value of this project in reducing neonatal mortality at community level.
PRIMARY RESEARCHER
Isha Grant, Deogratias Munube, Angelina Kakooza, Timothy
Link to article
Knowledge and Practices of Women Regarding Prevention of Mother-to-Child Transmission of HIV in Rural South West Uganda (Completed 2012)
Over 95% of all paediatric HIV infections in Sub Saharan Africa result from mother-to-child transmission (MTCT) which occurs during pregnancy, labour or breastfeeding. HIV mother-to-child prevention measures (PMTCT) can significantly reduce the risk of MTCT. This descriptive study sought to explore the knowledge and practices of women in rural south west Uganda regarding MTCT and PMTCT to determine if the current strategy to help women gain this knowledge is working. The majority of women of child bearing age in Mwizi sub-county of Uganda lacked adequate knowledge to prevent MTCT despite high awareness of MTCT and need for PMTCT. For PMTCT knowledge to trickle down to the women at the village level MTCT and PMTCT messaging from local health care workers needs to be reinforced since they are currently the major source of MTCT and PMTCT information locally. More training on how to better reinforce PMTCT messages by local health workers is needed. Other forms of messaging such as radio and cell phone messages, village meeting discussions and social gatherings might be considered to reinforce prevention awareness.
PRIMARY RESEARCHER
Barnabas R. Atwiine with Aloysius Rukundo, Julius Mugisha Sebikali, David Mutibwa, Dickson Tumusiime, Robert Turyamureeba, Lillian Birungi, Basil Tibanyendera with coaches Wally Schelech and Noni MacDonald
REPORTS
Report PMTCT
International Journal of Infectious Diseases Barnabas
Healthy Child Uganda (HCU) Survey on Knowledge, Attitude and Behaviour of Village Health Team(VHT) members towards their Responsibilities in South Western Uganda (Completed 2012)
The village health team (VHT) program was started in 2001 by the Ministry of Health in Uganda and was later supported by Healthy Child Uganda (HCU) with a goal of improving maternal child health in South West (SW) Uganda. HCU (www.healthychilduganda.org), is a collaboration between Mbarara University of Science and Technology and several Canadian Universities and the Canadian Paediatric Society. The aim of this study was to determine the knowledge, attitudes and behaviours of VHT members towards their village healthcare responsibilities comparing HCU-supported versus Ugandan Government (UG) supported VHTs. This was a cross sectional study carried out in two health sub-districts in SW Uganda; one supported by HCU, the other by UG. Knowledge gap on danger signs in sick children and in pregnant women were found less in HCU supported VHT members and they had greater insight into where gaps hindered performance. This suggests that more work is needed on VHT training in the HCU and especially in the UG supported programs.
PRIMARY RESEARCHER
Ashaba Scholastic with Teddy Kyomuhangi, Data Santorino with coaches Noni MacDonald and John Leblanc
REPORTS
Frequency of Malaria Resulting in Hospital Admission Among Pregnant Women and its Association with IPT use
Malaria is responsible for more illness and deaths than any other disease in Uganda. It affects mainly people with low immunity, like pregnant women, causing poor health outcomes such as maternal anemia and spontaneous abortions, as well as low birth weight and increased risk of anemia in infants - risk factors for poor infant outcomes such as mental retardation and infant mortality. Pregnant women are given at least two doses of sulfadoxine/pyrimethamine (SP) as intermittent preventive treatment (IPT). IPT prevents development of malaria and eliminates the parasite from the placenta. However, SP has been withdrawn for routine treatment because of high levels of failure to eradicate the malaria parasite from the patient's blood stream. This study will determine the relationship between the number of hospitalizations due to malaria and the use of IPT in pregnancy.
PRIMARY RESEARCHER
Eric Kitutu, Justus Mwesigire, Rajab Kalidi, Haruna Muwonge, Lydia Manuyimbwa, Raymond Mayanja
The practice of traditional rituals and customs in newborns by mothers in selected villages in Southwest Uganda
Many Akole traditional birth customs are contrary to World Health Organization recommended newborn health care practices. Health care practitioners need a deeper understanding of these rituals in order to modernize them for better maternal neonatal care. Ignoring them will not eliminate them. Prevention and intervention steps might include providing VHTs with context based education to help them address these practices with pregnant women and with the community combined with protocol development to enhance VHTs recognition of newborns at risk needing close follow up and early referral for formal health care.
PRIMARY RESEARCHER
Florence Beinempaka
Relationship Between Socioeconomic Status and Neonatal Sepsis in Mbarara, Uganda
Anecdotal evidence suggests that socioeconomic status of households may be linked to the likelihood of a baby getting infection in its first 28 days of life. The general objective of our research is to measure socioeconomic status in households where neonates develop sepsis and compare it with that of households where neonates do not develop sepsis to understand the relationship between socioeconomic status and neonatal sepsis in Mbarara, Uganda. We will interview mothers of babies admitted with sepsis and of those who do not have sepsis. The interview will help us to classify households into different socioeconomic status strata using a modified standard scale, and gather perinatal factors that could predispose babies to sepsis.
PRIMARY RESEARCHER
Jonans Tusiimire, Noel Kansiime, Doreen Nakku, Rebecca Tibenderana, Anthony Nimukama, Juliet Ankunda, Solomon James
Impediments to Immunization in Rural Uganda (Completed 2009)
The infant and under-five mortality rates in Uganda are still high. In the 2006 Demographic Health Survey Report, the infant mortality rate was 76 per 1000 live births, while the under-five mortality rate was 137 per 1000, compared to the 2001 UDHS IMR figures of 88 per 1000 and U5MR figures of 147 per 1000. TheHealthy Child Uganda project set out to address this problem in Southwestern Uganda through volunteer Village Health Teams. This particular study undertaken in Bwizibwera Healthy Child Uganda Project Area was to assess the activities and impact of the Village Health Teams on families and communities with regard to the immunization component of HCU core activity to reduce mortality and morbidity among the children from vaccine preventable life threatening diseases. The study revealed some gaps in knowledge about immunization that has lead to changes in the training program for VHTs.
PRIMARY RESEARCHER
Basil Tibanyendera with Fortunate Atwiine, Esther Beebwa, Francis Mugabi, Milton A Wesuta, Stephens Twesigye with coaches Bob Bortolussi and Noni MacDonald.