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Background: Up to 1.45 billion people currently suffer from soil transmitted helminth infection, with the largest burden occurring in Africa and Asia. Safe and cost effective deworming treatment exists, but there is a debate about mass distribution of this treatment in high prevalence settings. While the World Health Organization recommends mass administration of anthelmintic drugs for preschool and school-aged children in high (>20%) prevalence settings, and several long run follow up studies of an influential trial have suggested large benefits that persist over time, recent systematic reviews have called this recommendation into question. Methods and findings: This paper analyzes the long-term impact of a cluster-randomized trial in eastern Uganda that provided mass deworming treatment to preschool aged children from 2000 to 2003 on the numeracy and literacy skills of children and young adults living in those villages in 2010-2015. This study uses numeracy and literacy data collected seven to twelve years after the end of the deworming trial in a randomly selected subset of communities from the original trial, by an education-focused survey that had no relationship to the deworming study. Building on an earlier working paper which used data from 2010 and 2011 survey rounds, this paper uses an additional four years of numeracy and literacy data (2012, 2013, 2014, and 2015). Aggregating data from all survey rounds, the difference between numeracy scores in treatment versus control communities is 0.07 standard deviations (SD) (95% CI -0.10, 0.24, p = 0.40), the difference in literacy scores is 0.05 SD (95% CI -0.16, 0.27, p = 0.62), and the difference in total scores is 0.07 SD (95% CI -0.11, 0.25, p = 0.44). There are significant differences in program impact by gender, with numeracy and literacy differentially positively affected for girls, and by age, with treatment effects larger for the primary school aged subsample. There are also significant treatment interactions for those living in households with more treatment-eligible children. There is no evidence of differential treatment effects on age at program eligibility or number of years of program eligibility. Conclusions: Mass deworming of preschool aged children in high prevalence communities in Uganda resulted in no statistically significant gains in numeracy or literacy 7-12 years after program completion. Point estimates were positive but imprecise; the study lacked sufficient power to rule out substantial positive effects or more modest negative effects. However, there is suggestive evidence that deworming was relatively more beneficial for girls, primary school aged children, and children living in households with other treated children. Research approval: As this analysis was conducted on secondary data which is publicly available, no research approval was sought or received. All individual records were anonymized by the data provider prior to public release. [ABSTRACT FROM AUTHOR]

Notions of 'participation' in sexuality education has gained considerable traction in recent years - with participation being regarded as a fundamental right and a critical means to empower young people. However, the notion has increasingly been subject of debate, with critics problematising the manner in which participation is operationalised, and questioning the assumed impact of participation in relation to sexuality education goals. This paper contributes to these debates by examining the under-researched gendered dimensions of participation of young people in sexuality education. It utilises data from a qualitative study conducted in 2015 on young women and men's (10-15 years old) perceptions of their participation in the dance4life programme, an in-school sexuality education programme in Jinja district in eastern Uganda. The paper highlights subtle but important differences between young men and women's participation in the programme, which are arguably reflective of existing gendered hierarchies. We conclude by providing recommendations on how to address gender differences in participation. [ABSTRACT FROM AUTHOR]

An introduction is provided in which the author discusses articles in the issue on topics including counseling in Africa, prediction of academic success in southwestern Nigeria, and the experiences of college students from Ghana who are studying in Great Britain.

Purpose – The purpose of this paper is to explore the ways in which "mental health" difficulties are approached in low-income countries, using a case study of Uganda focus down upon the issues. Design/methodology/approach – The study involved two phases. The first was the collection and analysis of documentary evidence and interviews with policy makers in Uganda. The second involved interviews with health staff, traditional healers and the public in the Buganda Kingdom of Uganda. Interviews were conducted in English or Luganda and translated as necessary. No external sources of funding to declare. Findings – There are differing perceptions of mental health and illness in Uganda and there exists culturally accepted sources of support for distress. This highlights the important role of traditional healers and the paper argues that they should be recognised for their work in mental health care. Research limitations/implications – The paper is a small-scale study of one area of Uganda (Buganda Kingdom), the extent to which it can be generalised is therefore very limited. However, the research is sufficient to indicate the benefits of traditional healers in mental health care and supports an argument towards a public mental health model. Practical implications – The paper argues for a move in priority away from a focus upon a biomedical model of mental health support towards a public health model and the meaningful engagement of traditional healers. This would also necessitate a refocus of spending in the wider society. Originality/value – The paper poses a challenge to the Global Public Health movement and questions the relevance of expanding biomedical psychiatry in low-income countries. The paper also adds weight to emerging literature on the value of a public health approach to mental health and illness, especially in the developing world. [ABSTRACT FROM AUTHOR]

Background: A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest ("the first mile"). In this paper we document how a major Ebola outbreak control effort in central Uganda in 2012 was experienced from the perspective of the community. We ask to what extent the community became a resource for early detection, and identify problems encountered with community health worker and social mobilization strategies.Methods: Analysis is based on first-hand ethnographic data from the center of a small Ebola outbreak in Luwero Country, Uganda, in 2012. Three of this paper's authors were engaged in an 18 month period of fieldwork on community health resources when the outbreak occurred. In total, 13 respondents from the outbreak site were interviewed, along with 21 key informants and 61 focus group respondents from nearby Kaguugo Parish. All informants were chosen through non-probability sampling sampling.Results: Our data illustrate the lack of credibility, from an emic perspective, of biomedical explanations which ignore local understandings. These explanations were undermined by an insensitivity to local culture, a mismatch between information circulated and the local interpretative framework, and the inability of the emergency response team to take the time needed to listen and empathize with community needs. Stigmatization of the local community--in particular its belief in amayembe spirits--fuelled historical distrust of the external health system and engendered community-level resistance to early detection.Conclusions: Given the available anthropological knowledge of a previous outbreak in Northern Uganda, it is surprising that so little serious effort was made this time round to take local sensibilities and culture into account. The "first mile" problem is not only a question of using local resources for early detection, but also of making use of the contextual cultural knowledge that has already been collected and is readily available. Despite remarkable technological innovations, outbreak control remains contingent upon human interaction and openness to cultural difference. [ABSTRACT FROM AUTHOR]

The increased mortality rate among the Acoli people of northern Uganda is anecdotally blamed on excessive consumption of cheap and widely available sachet-packaged alcohol in the region. In this paper, we quantify this perceived association by determining statistically the health risks associated with ingesting 20 heavy metals in 17 popular spirits products consumed in Acoli. Thirteen of these products were industrially packaged in sachets (locally known as ‘sachet,’ waragi, arege or moo lyec) and four were locally produced Lira-Lira spirits from Bolo, Awere and Teso Bar in the region and Nsambya in southern Uganda. A Scottish whisky purchased in San Diego (USA) was our reference. Risk assessment was performed according to standardized protocols developed by the United States Environmental Protection Agency (US EPA). Our results show that a strong correlation indeed exists between health risks and ingestion of spirits in Acoli. At >2.5 sachets/day for 240 day/year over a lifetime for example, the risk of developing cancer due to exposure to As, Pb and Cr alone is 1 in 102,041. This estimate excludes ethanol, a known carcinogen, and 17 heavy metals also studied due to lack of their cancer slope factors. The primary non-cancer related health risk factor in all samples tested is ethanol with unacceptably high health index of four. The Lira-Lira spirits, with 100–6000% copper above the US EPA limit for intake by oral ingestion in water, would be the ‘cleanest’ without copper and at par with the Scottish whisky. Collectively, we find that no amount of alcohol consumed in Acoli is safe. Preventive measures are therefore recommended to reduce mortality in Acoli in particular, and in Uganda in general. These measures should include public education, better public policies, creating productive economic activities other than brewing alcohol, and social activities that engage people away from drinking. [ABSTRACT FROM AUTHOR]

This article explores the theoretical binary that has tended to encompass the majority of scholarship with unaccompanied refugee young people (URYP) affected by armed conflict. In this paper, we argue that URYP scholars often theorise this population via either a trauma/victimisation framework or resiliency lens, which creates a distinct binary. While these opposing theoretical perspectives provide important insight into understanding URYP's experiences, this conceptual binary has tended to neglect the nexus of factors for URYP who are resourceful and determined in particular aspects of their lives, while simultaneously being vulnerable in others. We suggest that a more nuanced exploration of theoretical frameworks is necessary, specific to URYP's experiences. Moreover, we call for greater analysis of theories that emerge from both the Global North and, particularly, the Global South in order to gain a more holistic appreciation of the complex lives and realities of URYP, whether during armed conflict or in its aftermath. By uniting trauma and resilience theories and integrating theories from the Global South, from where a majority of URYP originate, scholars may provide a richer account of URYP that is not only beneficial for global discourse, but may have greater significance for URYP who attempt to make meaning out of their experiences. [ABSTRACT FROM AUTHOR]

There is increasing interest in farmers’ organizations as an effective approach to farmer participatory research (FPR). Using data from an empirical study of farmers’ research groups (FRGs) in Uganda, this paper examines the patterns of participation in groups and answers questions such as: Who participates? What types of participation? How does participation occur? What are the factors determining participation? Results show that there is no single type of participation, but rather that FPR is a dynamic process with types of participation varying at different stages of the process. Farmers’ participation does not follow the normal adoption curve. Rather, it is characterized by high participation at the initial stages, followed by dramatic decrease and dropping-out, and slow increases toward the end. There is usually significantly higher participation among male farmers at the beginning of the process. However, as FRGs evolve, the proportion of men decreases sharply while the relative proportion of women continues to increase until it dominates the group. The findings do not support the common assumption that groups usually exclude women and the poor. On the contrary, we argue that FRGs are an effective mechanism to provide women and the poor with opportunities to participate in research. However, to be effective, this requires moving beyond head counting to promote more proactive gender and equity perspectives for amplifying the benefits of agricultural research to those who tend to be marginalized or excluded by mainstream development initiatives. This will be critical for making agricultural research more client-oriented and demand-driven. [ABSTRACT FROM AUTHOR]

Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients’ journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system. [ABSTRACT FROM PUBLISHER]

Background: Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness. Objectives: Assess the impact of providing reusable sanitary pads and puberty education on girls’ school attendance and psychosocial wellbeing outcomes. Methods: A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing. Results: At follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26–0.77), with those in control schools having a 17.1% (95%CI: 8.7–25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls’ self-reported shame or insecurity during menstruation. Conclusion: Results of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used. Trial Registration: Pan African Clinical Trials Registry [ABSTRACT FROM AUTHOR]

Background: Uganda like many developing countries still experiences high levels of maternal and perinatal deaths despite a decade of maternal and perinatal death review (MPDR) program. Oyam district has been implementing MPDR since 2008 with varying successes among the health facilities. This paper presents the factors that influence the conduct of maternal and perinatal death reviews in Oyam District, Uganda.Methods: This was a cross-sectional study where both qualitative and quantitative data were collected. Semi-structured interviews were administered to 66 health workers and ten key informants (KIs) to assess the factors influencing the conduct of MPDR. Univariate and Bivariate analysis of quantitative data was done using SPSS version 17.0. A Pearson Chi-Square test was done to determine factors associated with conduct of MPDR. Factors with a p-value < 0.05 were considered statistically significant. Qualitative data was analyzed using content analysis.Results: Only 34.8 % of the health workers had ever participated in MPDR. The factors that influenced conduct of MPDR were existence of MPDR committees (p < 0.001), attendance of review meetings (p < 0.001) and knowledge of objectives of MPDR (p < 0.001), implementation of MPDR recommendations (p < 0.001), observed improvement in maternal and newborn care (p < 0.001) and provision of feedback (p < 0.001). Hindrance to conduct of MPDR was obtained from KIs: the health workers were not made aware of the MPDR process, committee formation and training of MPDR committee members was not effectively done, inadequate support supervision, and lack of financial motivation of MPDR committee members. Challenges to MPDR included: heavy workload to health workers, high number of perinatal deaths, and non-implementation of recommendations.Conclusion: The proportion of maternal and perinatal death reviews conducted in Oyam was low. This was due to poor initiation of the review process and a lack of support supervision. The district and Ministry of Health needs to put more emphasis on monitoring the conduct of maternal and perinatal death reviews by: forming and training MPDR committees and ensuring they are financially supported, providing overall coordination, and ensuring effective support supervision. [ABSTRACT FROM AUTHOR]

Later-life loneliness is becoming an area of great concern in Uganda in light of gradual weakening of extended family as a source of old-age human support. Although information about the effects of feeling lonely exists, little is known about the associated risk factors within the country's social and cultural setting. This paper discusses prevalence and correlates of feeling lonely among older persons. An interviewer-administered questionnaire was used to collect data on 605 older persons in a 2012 cross-sectional study. Respondents were asked to evaluate how they felt in terms of loneliness during the administration of the questionnaire. A total of ten focus group discussions and 12 key informant interviews were also conducted to collect qualitative data. Binary logistic regression was used to predict factors affecting loneliness. Findings indicate that approximately seven in ten older persons felt lonely. Elderly people residing in the urban area were more likely to be lonely than their counterparts staying in the rural environment. In comparison with married older persons, elderly people who were widowed were more likely to be lonely. Absence of a television and pension benefits and prevalence of limb joint ill-health predicted loneliness. The findings have several implications, including developing age-friendly urban centres, encouraging old-age social organisations, decentralising the elderly health-care system and establishing a special old-age fund. [ABSTRACT FROM PUBLISHER]

The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH’s motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH’s self-management of HIV and their wellbeing are likely to be interrelated. Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH’s self-management processes on ART in resource-limited settings. This paper presents findings from a study of PLWH’s self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. The majority were managing their condition well across three broad domains of self-management. First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. Third, participants were psychologically adjusting to their condition and their new ‘self’: they saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. Our study demonstrates the centrality of social relationships and other non-medical aspects of wellbeing for self-management which ART programmes might explore further and encourage. [ABSTRACT FROM AUTHOR]

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Background: Sexual and gender-based violence (SGBV) remains a silent epidemic in many humanitarian settings with many survivors concealing their experiences. Attitudes towards help-seeking for SGBV is an important determinant of SGBV service use. This paper examined the association between attitudes towards seeking care and knowledge and perceptions about SGBV among men and women in a humanitarian setting in Uganda. Methods: A cross-sectional survey was conducted from May to June 2015 among 601 heads of refugee households (261 females and 340 males) in Rwamwanja Refugees Settlement Scheme, South West Uganda. Analysis entails cross-tabulation with chi-square test and estimation of a multivariate logistic regression model. Results: Results showed increased odds of having a favorable attitude toward seeking help for SGBV among women with progressive attitudes towards SGBV (OR = 2.78, 95% CI: 1.56–4.95); who felt that SBGV was not tolerated in the community (OR = 2.03, 95% CI: 1.03–4.00); those who had not experienced violence (OR = 2.08, 95% CI: 1.06–4.07); and those who were aware of the timing for post-exposure prophylaxis (OR = 3.08, 95% CI: 1.57–6.04). In contrast, results for men sample showed lack of variations in attitude toward seeking help for SGBV for all independent variables except timing for PEP (OR = 2.57, 95% CI: 1.30–5.10). Among individuals who had experienced SGBV, the odds of seeking help was more likely among those with favorable attitude towards seeking help (OR = 4.22, 95% CI: 1.47–12.06) than among those with unfavorable help-seeking attitudes. Conclusion: The findings of the paper suggest that targeted interventions aimed at promoting awareness and progressive attitudes towards SGBV are likely to encourage positive help-seeking attitudes and behaviors in humanitarian contexts. [ABSTRACT FROM AUTHOR]

Background: Studies on the association between partners' controlling behaviors and intimate partner sexual violence (IPSV) in Uganda are limited. The aim of this paper was to investigate the association between IPSV and partners' controlling behaviors among married women in Uganda. Methods: We used the 2011 Uganda Demographic and Health Survey (UDHS) data, and selected a weighted sample of 1,307 women who were in a union, out of those considered for the domestic violence module. We used chi-squared tests and multivariable logistic regressions to investigate the factors associated with IPSV, including partners' controlling behaviors. Results: More than a quarter (27%) of women who were in a union in Uganda reported IPSV. The odds of reporting IPSV were higher among women whose partners were jealous if they talked with other men (OR = 1.81; 95% CI: 1.22-2.68), if their partners accused them of unfaithfulness (OR = 1.50; 95% CI: 1.03-2.19) and if their partners did not permit them to meet with female friends (OR = 1.63; 95% CI: 1.11-2.39). The odds of IPSV were also higher among women whose partners tried to limit contact with their family (OR = 1.73; 95% CI: 1.11-2.67) and often got drunk (OR = 1.80; 95% CI: 1.15-2.81). Finally, women who were sometimes or often afraid of their partners (OR = 1.78; 95% CI: 1.21-2.60 and OR = 1.56; 95% CI: 1.04-2.40 respectively) were more likely to report IPSV. Conclusion: In Uganda, women's socio-economic and demographic background and empowerment had no mitigating effect on IPSV in the face of their partners' dysfunctional behaviors. Interventions addressing IPSV should place more emphasis on reducing partners' controlling behaviors and the prevention of problem drinking. [ABSTRACT FROM AUTHOR]

Objective: "Negotiated standards" describe a level of quality of care that is acceptable and achievable within a specific health system, based on consensus between key stakeholders. This paper presents the development of negotiated standards for effective labor and childbirth care in selected hospitals and communities in Nigeria and Uganda.Methods: A four-step development process involving different methodologies. The process included: (1) review and synthesis of internationally recognized intrapartum clinical principles and practices; (2) primary qualitative research to assess values and preferences of women and healthcare providers, and practices that align with these preferences; (3) draft contextualization of effective and ineffective behaviors to reflect values and preferences; and (4) WHO-mediated negotiations between relevant stakeholders, including community members, providers, and administrators.Results: The primary outcomes of this process were a comprehensive set of effective behaviors and clinical practices covering the main domains of quality of care, which are practical and easy to communicate, implement, and audit across all levels of healthcare delivery.Conclusion: The process demonstrates that health facilities and providers can be motivated to adopt standards of care that uphold the values and preferences of both service users and providers, while adhering to international best practices. [ABSTRACT FROM AUTHOR]

Background: Health partnerships often use health professional training to change practice with the aim of improving quality of care. Interventions to change practice can learn from behavioural science and focus not only on improving the competence and capability of health professionals but also their opportunity and motivation to make changes in practice. We describe a project that used behavioural scientist volunteers to enable health partnerships to understand and use the theories, techniques and assessments of behavioural science.Case Studies: This paper outlines how The Change Exchange, a collective of volunteer behavioural scientists, worked with health partnerships to strengthen their projects by translating behavioural science in situ. We describe three case studies in which behavioural scientists, embedded in health partnerships in Uganda, Sierra Leone and Mozambique, explored the behaviour change techniques used by educators, supported knowledge and skill development in behaviour change, monitored the impact of projects on psychological determinants of behaviour and made recommendations for future project developments.Discussion: Challenges in the work included having time and space for behavioural science in already very busy health partnership schedules and the difficulties in using certain methods in other cultures. Future work could explore other modes of translation and further develop methods to make them more culturally applicable.Conclusion: Behavioural scientists could translate behavioural science which was understood and used by the health partnerships to strengthen their project work. [ABSTRACT FROM AUTHOR]

Investigates the long-term psychological effects of gender-based violence against women following armed conflict in Luwero District, Uganda. Acts of violence that were committed against women between 1989 and 1986; Symptoms of psychological distress that resulted from the traumatic events; Methods of coping developed by the victims of violence.

Background: Research on contraceptive behaviour changes over time in Uganda is scarce, yet it has among the highest fertility and maternal mortality rates of any country in the East African region. Understanding temporal patterns of contraceptive use for both women and men is vital in evaluating the effectiveness of family planning interventions and strategies, and identifying those with the most unmet need. Using repeated nationally representative cross-sectional samples, this study charts the changes in Uganda’s population-based contraceptive use over recent years. Methods: Five Demographic and Health Survey datasets for Uganda over 21 years, from 1995 to 2016, were sourced and interrogated. Eligible participants included all women aged 15–49 years and men aged 15–54 years. Responses to questions on modern and any (modern or traditional) contraceptive use were analysed. Stratified by gender, weighted regression analyses were employed to detect change over time. The patterns associated with key demographic variables were also investigated. Results: Overall, 50,027 women and 14,092 men were included within the study. In 2016, 30.3% of women and 39.9% of men were using any contraceptive method, a significant non-linear increase from 13.4% of women and 20.3% of men in 1995. Furthermore, 27.3% of women and 35.9% of men were using modern contraceptive methods in 2016, an increase from 7.4% of women and 10.4% of men in 1995. All considered demographic variables were significantly associated with contraceptive use for both women and men (all P<0.001); and for women, all variables differentially changed over time (all P<0.001). Conclusion: This study showed a significant increase and dynamism across key demographic variables in contraceptive uptake by both women and men. Sustained family planning programs and interventions have successfully resulted in behaviour change across the Ugandan population. However, continued efforts are needed to further reduce Uganda’s relatively high fertility and associated maternal mortality rates. [ABSTRACT FROM AUTHOR]

Background: Fisherfolk are a most-at-risk population for HIV being prioritized for the scale up of HIV treatment in Uganda. Heavy alcohol use and potential drug use may be a major barrier to treatment adherence for men in this setting. Objective: This study examines the prevalence of substance use, and its influence on antiretroviral treatment (ART) adherence, among male fisherfolk on ART in Wakiso District, Uganda. Methods: This cross-sectional study included structured questionnaires (N = 300) with men attending HIV clinics near Lake Victoria. Using generalized logistic modeling analyses with a binomial distribution and logit link, we conducted multivariate models to test the association between each alcohol variable (quantity and frequency index, hazardous drinking) and missed pills, adjusting for covariates, and tested for interactions between number of pills prescribed and alcohol variables. Results: Thirty-one percent of men reported sub-optimal adherence. Half (46.7%) reported drinking, of which 64.8% met criteria for hazardous drinking. Illicit drug use was low (6%). In the multivariate model, men with greater scores on the alcohol frequency and quantity index were more likely to report missed pills compared to those reporting no drinking (AOR: 1.60, 95% CI: 1.29–1.97). Hazardous drinking had a greater effect on missed ARV doses among men taking twice daily regimens compared to once daily (AOR: 4.91, 95% CI: 1.68–14.37). Conclusions: Our findings highlight the need for targeted alcohol-reduction interventions for male fisherfolk on ART who drink at high quantities to improve ART adherence and to prevent the known negative health effects of alcohol for HIV-infected individuals. [ABSTRACT FROM AUTHOR]

Background: Although conceptualisation of addiction varies with time and culture, literature on intercultural studies between high and low income countries is scarce. This article uses Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 guidelines on diagnosis of Alcohol Use Disorder (AUD) and the Capability Opportunity Motivation - Behaviour (COM-B) model to explore perspectives on alcohol addiction and its facilitating factors in Uganda and Belgium. Method: Sixty qualitative interviews (40 with service providers and 20 service users) were administered in four alcohol treatment centres, two in Uganda and two in Belgium. Interviews were transcribed and analysed thematically using Nvivo software. Result: While addiction was primarily regarded as a disease enabled by capability factors (affordability and the absence of life and social skills) by Belgian respondents, many Ugandans viewed it as a moral or criminal issue; motivated by the varied roles of informal alcohol use amidst weak restrictions. Opportunity-related factors including; acceptability, availability, media influence, cultural/religious beliefs and practices and peer influence were recognised as facilitating factors in both countries, while stigma was equally prevalent. Conclusion: Interventions in Uganda could explore strengthening legislation and research on utilisation of the well-entrenched religious and cultural institutions to encourage alternatives to alcohol use. In Belgium, promotion of life and social skills, alcohol regulation in educational institutions and other demand reduction strategies seem essential to delay the onset of (mis)use. In both societies; general reduction of opportunities for access, early intervention, programmes for young persons and prevention of stigma through awareness-raising can be explored for mitigation of AUD. [ABSTRACT FROM AUTHOR]

Ugandan fishing communities are dually burdened with high rates of HIV and alcohol use. This qualitative study explores context and motivation of alcohol consumption, and alcohol's effect on antiretroviral treatment (ART) adherence, among male fisherfolk living with HIV in Wakiso District, Uganda. We conducted in-depth semi-structured interviews with 30 men in HIV care and on ART, and used a thematic analysis approach for analysis. Alcohol use was identified as a major barrier to ART adherence through cognitive impairment and the intentional skipping of doses when drinking. Men reportedly reduced their drinking since HIV diagnosis -- motivated by counseling received from providers and a newfound desire to live a healthy lifestyle. However, social, occupational, and stress-related influences that make alcohol reduction difficult were identified. Our findings suggest alcohol use may pose a challenge to ART adherence for fishermen living with HIV -- and has implications for the tailoring of screening and brief intervention for alcohol reduction in HIV care for this population. [ABSTRACT FROM AUTHOR]

This article has been written to call for further attention to the importance of involving males in efforts to reduce maternal mortality. Since the 1995 International Conference on Population and Development [ICPD], institutional and community arrangements have been implemented in developing countries to engage males in maternal and child health promotions. The government of Uganda - in partnership with other health promotion institutions such as the United Nations agencies - has in the past decade formulated and implemented national and local strategies for male involvement in Sexual and Reproductive Health and Rights (SRHR). Nevertheless, strategies are such as Male Action Groups (MAGs) have been short-lived because the strategies within cannot by themselves work without 'genuine' acceptance at community levels where implementation takes place. Even acceptance alone is also not enough. Majority of males have more interest in economic than social endeavors. They have less interest to engage in maternal health promotion initiatives. Cultural based perceptions and behaviors associated with patriarchal tendencies remain the greatest challenge. Therefore, relevancy, functionality, adaptability, and sustainability in relation to the effectiveness of male involvement initiatives must be assessed before these interventions are initiated in such culturally diverse communities with different informal institutional arrangements. The individual, interpersonal and institutional contexts in which interventions operate matters. The article identifies relevant stakeholders and suggests, though not discussed in detail, strategies for improving stakeholders' interests to respond to male involvement as a core issue in maternal health. [ABSTRACT FROM AUTHOR]

Despite increasing numbers of studies investigating grandparent-caregivers of children orphaned by HIV/AIDS in sub-Saharan Africa, research on their mental and physical health remains inadequate. We provide a qualitative account of the nature, extent, and relationships among multiple variations of loss emerging from 32 interviews with Ugandan grandparent-caregivers of grandchildren affected by HIV/AIDS. Regardless the type or nature of the loss, participants expressed physical, emotional, and financial distress as a result. This cumulative loss and subsequent grief could potentially be associated with mental and physical health problems. Research to further explore the concept of loss among this vulnerable population is recommended. [ABSTRACT FROM AUTHOR]

Background and context: The Royal College of Midwives is engaged in a long-term twinning partnership with the Uganda Private Midwives Association. Uganda is one of the poorest countries in the world and only 27% of women and newborns have their needs met (UNFPA, 2014). A well-skilled, competent midwifery workforce is required to meet these needs yet Ugandan student midwives often receive poor-quality clinical education. The Ugandan Nurses and Midwives Council approached the Royal College of Midwives for assistance in designing a system of mentorship for Ugandan midwifery to address this gap. The project was funded by UK-Aid through the Tropical Health and Education Trust. Aims of the project: MOMENTUM was a 20-month action research project that aimed to develop and pilot a model of mentorship for student midwives in Uganda. This article focuses on one workstream relating to practice development, a twinning project that used workbased learning and appreciative inquiry, embedded in an action research approach, to facilitate practice development. Conclusions: This project added to the body of knowledge about midwifery twinning for building capacity in mentorship, research, and cross-cultural competence. MOMENTUM created a powerful community of practice that was enabling, fulfilling and transformative. Replication of this would require funding, management capacity and sufficient lead time for participatory planning and piloting. MOMENTUM's audit tool was a bespoke design for this pilot project and so may not be transferable to other settings without further development, testing and validation. Implications for practice: • Twinning, action research, appreciative enquiry and workbased learning can be effective in enabling practice development • The impact of midwifery twinning on leadership development requires further investigation, together with greater evidence on the reciprocal impact of twinning on the sending country [ABSTRACT FROM AUTHOR]

Therapeutic interventions for bereavement in Northern Ireland and in the Sub-Saharan African country of Uganda are compared. Semi-structured interviews were conducted with Ugandan (n = 18) and Northern Irish (n = 20) therapists. These were thematically analysed. The findings focused on: the counselling context, the characteristics of counsellors, the characteristics of clients and counselling practices. Whilst there were many similarities in practice, core differences arose from the demands of these regions’ predominately collectivist or individualist settings. Findings suggest that counselling interventions require adjustment to reflect cultural practices where there is less emphasis on an individualised ego, and where bereavement responses must concur with social norms. [ABSTRACT FROM PUBLISHER]

Existing literature suggests that acculturation and integration processes for immigrant youth from East Africa are complicated by family values, interaction styles, and social roles that are in conflict with those of the US host culture. The purpose of this study was to explore first-generation female Ugandan immigrant youth perceptions, beliefs and attitudes toward self-development and identify factors among their social contexts that impact their development and adjustment. This study utilized dimensional analysis, an approach to the generation of grounded theory. Data collection included over 100 h of community participatory observation and 28 interviews in total. Participants included 20 English speaking Ugandan females aged 16-25 years who immigrated to the US after age of eight. Participants' adaptations and adjustments led to an altered developmental path, including their beliefs about gender, ethnic and racial identities, and how they balanced and integrated US culture into their existing understandings and cultural awareness. Conditions that impacted the identity development process include timing of their immigration, the contexts of reception, media, the Ugandan Community, the school social setting, the perceived value of Ugandan cultural maintenance vs. the value of adopting certain American traits, and experiences of prejudice and discrimination vs. new future opportunities. The findings represent an in-depth consideration of the cultural, linguistic, religious, racial, and social attributes of the female Ugandan immigrant youth population and can therefore be seen as an important step in the direction of developing an understanding of the developmental assets and risk/protective factors that characterize this young immigrant population. [ABSTRACT FROM AUTHOR]

Previous research has identified strong associations between war experiences and posttraumatic stress disorder (PTSD). Few studies, however, have explored the underlying mechanisms of these associations in an integrated model. This study explored whether feelings of anger, shame, and guilt mediated the effects of war experiences and PTSD and if this association is heightened in former child soldiers from Northern Uganda. Nearly 40% of the sample were former child soldiers ( N = 122), and 189 were civilians. A total of 35.5% met the proposed ICD- 11 criteria for PTSD. Findings indicated previous war experiences were directly associated with PTSD. Anger and guilt were significant mediators of this effect, child soldier status did not moderate the mediated effects. This study provides an alternative framework of assessing the association between trauma and PTSD using a sample of young adults exposed to mass conflict. [ABSTRACT FROM AUTHOR]

In 2015, the World Health Organization reported that more than 60 million people were tested for HIV in 122 low- and middle-income countries between 2010 and 2014. Despite this level of progress, over 40% of people living with HIV remain unaware of their HIV status. This calls for innovative approaches to improve uptake of HIV testing services, including use of HIV self-test (HIVST) kits. We conducted a cross-sectional, qualitative study to assess pregnant women and their male partners' perceptions regarding female partner-delivered HIVST kits. This study was conducted at two health facilities in Central Uganda between November and December 2015. Data were collected on pregnant women's willingness to take HIVST kits to their male partners and other household members using eight focus group discussions and 30 in-depth interviews. Data were analyzed following a thematic framework approach. Overall, pregnant women were willing to take HIVST kits to their partners and other household members, with the exception of their cowives. Male partners were willing to use HIVST kits brought by their female partners. Our findings suggest that secondary distribution of HIVST kits through female partners is acceptable and has the potential to improve male partner and household-member HIV testing. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Low contraceptive uptake and high unmet need for contraception remain significant issues in Uganda compared to neighboring countries such as Kenya, Ethiopia, and Rwanda. Although prior research on contraceptive uptake has indicated that male partners strongly influence women's decisions around contraceptive use, there is limited in-depth qualitative research on knowledge and concerns regarding modern contraceptive methods among Ugandan men.Methods: Using in-depth interviews (N = 41), this qualitative study investigated major sources of knowledge about contraception and perceptions of contraceptive side effects among married Ugandan men.Results: Men primarily reported knowledge of contraceptives based on partner's experience of side effects, partner's knowledge from health providers and mass media campaigns, and partner's knowledge from her peers. Men were less likely to report contraceptive knowledge from health care providers, mass media campaigns, or peers. Men's concerns about various contraceptive methods were broadly associated with failure of the method to work properly, adverse health effects on women, and severe adverse health effects on children. Own or partner's human immunodeficiency virus (HIV) status did not impact on contraceptive knowledge.Conclusions: Overall, we found limited accurate knowledge about contraceptive methods among men in Uganda. Moreover, fears about the side effects of modern contraceptive methods appeared to be common among men. Family planning services in Uganda could be significantly strengthened by renewed efforts to focus on men's knowledge, fears, and misconceptions. [ABSTRACT FROM AUTHOR]

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28–35], a median of 3 living children [IQR: 2–5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy makers, funders and program implementers to work together for the common cause. These consolidated efforts may not only lower the risk of psychological distress but has potential to create long lasting solutions to benefit the wider community. [ABSTRACT FROM AUTHOR]

Background: In 2012, Uganda started implementing lifelong antiretroviral therapy (ART) for prevention of mother to child transmission (PMTCT) in line with the WHO 2012 guidelines. This study explored experiences of HIV infected pregnant and breastfeeding women regarding barriers and facilitators to uptake and adherence to lifelong ART.Methods: This was a cross-sectional qualitative study conducted in three districts (Masaka, Mityana and Luwero) in Uganda, between February and May 2014. We conducted in-depth interviews with 57 pregnant and breastfeeding women receiving care in six health facilities, who had been on lifelong ART for at least 6 months. Data analysis was done using a content thematic approach with Atlas-ti software.Results: Initiation of lifelong ART was done the same day the mother tested HIV positive. Several women felt the counselling was inadequate and had reservations about taking ART for life. The main motivation to initiate and adhere to ART was the desire to have an HIV-free baby. Adherence was a challenge, ranging from not taking the drugs at the right time, to completely missing doses and clinic appointments. Support from their male partners and peer family support groups enhanced good adherence. Fear to disclose HIV status to partners, drug related factors (side effects and the big size of the tablet), and HIV stigma were major barriers to ART initiation and adherence. Transition from antenatal care to HIV chronic care clinics was a challenge due to fear of stigma and discrimination.Conclusions: In order to maximize the benefits of lifelong ART, adequate preparation of women before ART initiation and on-going support through family support groups and male partner engagement are critical, particularly after birth and cessation of breastfeeding. [ABSTRACT FROM AUTHOR]

In this article, I examine whether a critical approach to risk is relevant to pregnancy and maternity care in global South settings and I illustrate my review of current literature with examples from fieldwork I conducted in northern Uganda in 2012. Coxon, in aHealth, Risk & Societyeditorial entitled ‘Risk in pregnancy and birth: are we talking to ourselves?’ (2014,Health, Risk & Society, 16(6), 481–493), noted that the analysis of risk in pregnancy has tended to focus on ‘relatively privileged women in high-income countries’ (p. 490), a narrow lens that in her view not only led to an account that was ‘highly partial’ but also contributed to theory in this area being overly focused on individual accounts, rather than structural inequalities. In this article, I draw on my experiences researching and writing about maternity care in Uganda, to consider whether and how a critical approach to sociocultural risk is relevant in low-income global South countries, as well as how a shift in lens to include less privileged women in low-income countries also shifts the theoretical contribution of a critical risk approach. I examine screening and surveillance as well as risk subjectivity, areas central to the discussion of risk and pregnancy, and find that a critical approach to risk offers insight into new forms of control and new discourses of responsibility. At the same time, I note that the social, political and medical contexts shaping both clinical and critical sociocultural approaches to risk have not occurred universally, and the critiques developed by scholars in and of the global North are not directly transferable to global South settings. Overall, I find that a critical approach to risk is indeed relevant and points to specific cases and discourses where such a lens is particularly valuable. [ABSTRACT FROM AUTHOR]

To feed a growing population, agricultural productivity needs to increase dramatically. Agricultural extension information, with its public, non-rival nature, is generally undersupplied, and public provision remains challenging. In this study, simple agricultural extension video messages, delivered through Android tablets, were tested in the field to determine if they increased farmers’ knowledge of recommended practices on (i) potato seed selection and (ii) seed storage and handling among a sample of potato farmers in southwestern Uganda. Using a field experiment with ex ante matching in a factorial design, it was established that showing agricultural extension videos significantly increased farmers’ knowledge. However, results suggested impact pathways that went beyond simply replicating what was shown in the video. Video messages may have triggered a process of abstraction, whereby farmers applied insights gained in one context to a different context. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV), alcohol use, and depression are key vulnerabilities for HIV in Uganda, and taken together may have a synergistic effect on risk. Our objective was to investigate the associations between depression, IPV, and alcohol use and HIV-risk indicators among a sample of outpatients in rural Uganda, and the effect of co-occurrence of these factors on HIV-risk indicators.Methods: In a structured interview we collected data on high-risk sexual behavior, depression symptoms, emotional and physical IPV, and alcohol use, as well as a blood sample for HIV and syphilis tests and a urine sample for chlamydia and gonorrhea tests from 325 male and female outpatients receiving provider-initiated HIV testing and counseling (PITC) at a public hospital outpatient clinic in rural Uganda. We used logistic regression and generalized linear modeling to test independent associations between depression, IPV, and alcohol use and HIV-risk indicators, as well as the effect of co-occurrence on HIV-risk indicators.Results: Twelve percent of men and 15% of women had two or more of the following conditions: depression, IPV, and alcohol use; another 29% of men and 33% of women had 1 condition. Each condition was independently associated with HIV risk behavior for men and women, and for women, depression was associated with testing positive for HIV or a sexually transmitted infection (STI). Men with one condition (AOR 2.32, 95% CI 1.95-2.77) and two or more conditions (AOR 12.77, 95% CI 7.97-20.47) reported more high risk sex acts compared to those with no potential co-occurring conditions. For men, experiencing two or more conditions increased risky sex more than one alone (χ 2 24.68, p < 0.001). Women experiencing one condition (AOR 3.33, 95% CI 137-8.08) and two co-occurring conditions (AOR 5.87, 95% CI 1.99-17.35) were more likely to test positive for HIV or an STI and women with two co-occurring conditions were also at increased risk for risky sex (AOR 2.18, 95% CI 1.64-2.91). We also found preliminary evidence suggesting synergistic effects between depression and emotional IPV and between alcohol use and depression.Conclusions: This study demonstrates the co-occurrence of depression, IPV, and alcohol use in men and women in an outpatient setting in rural Uganda. The co-occurrence of these factors was associated with greater HIV risk, highlighting the need for a more holistic approach to HIV prevention and care research and programming. [ABSTRACT FROM AUTHOR]

Due to the ubiquity of mobile phones around the globe, studies are beginning to analyze their influence on health. Prior work from developed countries highlights negative mental health outcomes related to overuse of mobile phones. However, there is little work on mental health impacts of mobile phone use or ownership in developing countries. This is an important gap to address because there are likely variations in mental health impacts of mobile phones between developing and developed countries, due to cultural nuances to phone use and distinct variations in financial models for obtaining mobile phone access in developing countries. To address this gap, this study analyzes survey data from 92 households in sparse, rural villages in Uganda to test two hypotheses about mobile phone ownership and mental health in a developing country context: (i) Mobile phone ownership is higher among more privileged groups, compared to less privileged groups (ie, wealth and ethnicity); and (ii) mobile phone ownership is positively associated with a culturally-relevant indicator of mental health, ‘feelings of peace’. Results indicate that households with mobile phones had higher levels of wealth on average, yet no significant differences were detected by ethnicity. As hypothesized, mobile phone ownership was associated with increased mental well-being for persons without family nearby (in the District) (p = 0.038) after adjusting for wealth, ethnicity and amount of land for crops and land for grazing. Mobile phone ownership was not significantly associated with increased mental well-being for persons with family nearby. These findings are consistent with studies of mobile phone use in other sub-Saharan African countries which find that phones are important tools for social connection and are thus beneficial for maintaining family ties. One might infer then that this increased feeling of mental well-being for persons located farther from family stems from the ability to maintain family connections. These findings are quite different from work in developed countries where mobile phone use is a source of technology-related stress or technostress. [ABSTRACT FROM AUTHOR]

Objectives: The first objective of this study is to examine the association between caretakers’ caries experience and caries experience of their children. Second, to investigate whether children’s and caretaker’s caries experience is associated with oral health-related quality of life (OHRQoL) of children and their families. Methods:This study is based on the prenatal recruitment interviews and the 5-year follow-up of 417 caretaker–children pairs from the Ugandan site of the PROMISE-EBF trial conducted in Mbale, Eastern Uganda. Face-to-face interviews were conducted with caretakers at the household level. Caries experience of caretakers (DMFT >0) and children (dmft >0) were assessed in accordance with the criteria of the World Health Organization. OHRQoL was assessed using an abbreviated version of the Early Childhood Oral Health Impact Scale (ECOHIS). Results:Adjusted negative binomial regression analysis revealed that caretaker’s caries experience was positively associated with early childhood caries of their offspring (IRR 2.0, 95% confidence interval (CI) 1.3–3.0). Children’s caries experience (IRR 1.8, 95% CI 1.2–3.0), but not caries experience of caretakers, was associated with worse OHRQoL of children and their families. Caretakers who perceived good child oral health were less likely to report OHRQoL impacts (IRR 0.20, 95% CI 0.12–0.35). Conclusion:Improving caretaker’s caries experience and her perception of child’s oral health status could improve children’s caries experience and the OHRQoL of children and family. Such knowledge is important and should inform public oral health programs for young children. [ABSTRACT FROM PUBLISHER]

Among Ugandan fisherfolk, HIV prevalence (with estimates ranging from 15 to 40 %) is higher than in the general population (about 7 %), potentially due to high-risk behaviors and low access to HIV testing and healthcare. We conducted semi-structured interviews on barriers to linkage to care with 10 key stakeholders and 25 fisherfolk within 1-2 months of their testing HIV-positive at clinic outreach events in Ugandan Lake Victoria communities. Interviews were recorded, transcribed, translated, and coded using grounded theory methods. Participants cited low healthcare access and quality of care, mobility, competing needs for work during clinic hours, stigma, and low social support as barriers. Over 10 % of clients screened positive for HIV at outreach events, and only half accessed care. Linkage to care issues may begin with the failure to attract high-risk fisherfolk to testing. New models of HIV testing and treatment delivery are needed to reach fisherfolk. [ABSTRACT FROM AUTHOR]

Background: Postpartum haemorrhage (PPH) remains the leading cause of maternal morbidity and mortality worldwide. The main strategy for preventing PPH is the use of uterotonic drugs given prophylactically by skilled health workers. However, in settings where many women still deliver at home without skilled attendants, uterotonics are often inaccessible. In such cases, women and their caregivers need to recognize PPH promptly so, as to seek expert care. For this reason, it is important to understand how women and their caregivers recognize PPH, as well as the actions they undertake to prevent and treat PPH in home births. Such knowledge can also inform programs aiming to make uterotonics accessible at the community level.Methods: Between April and June 2012, a phenomenological study was carried out in a rural Ugandan district involving 15 in-depth interviews. Respondents were purposively sampled and included six women who had delivered at home in the past year and nine traditional birth attendants (TBAs). The interviews explored how PPH was recognized, its perceived causes, and the practices that respondents used in order to prevent or treat it. Phenomenological descriptive methodology was used to analyse the data.Results: Bleeding after childbirth was considered to be a normal cleansing process, which if stopped or inhibited would lead to negative health consequences to the mother. Respondents used a range of criteria to recognize PPH: rate of blood flow, amount of blood (equivalent to two clenched fists), fainting, feeling thirsty, collapsing or losing consciousness immediately after birth. As a group, respondents seemed to correctly identify women at risk of PPH (those with twin pregnancies, high parity or prolonged labour), but many individuals did not know all the reasons. Respondents used cold drink, uterine massage and traditional medicine to treat PPH.Conclusion: The community viewed bleeding after childbirth as a normal process and their methods of determining excessive bleeding are imprecise and varied. This opens the door for intervention for reducing delays in the home diagnosis of PPH. This includes increasing awareness among TBAs, women and their families about the risk of death due to excessive bleeding in the immediate postpartum period. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Contraception & Reproductive Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Beneficial newborn care practices can improve newborn survival. However, little is known about the factors that affect adoption of these practices.Methods: Cross-sectional study conducted among 1,616 mothers who had delivered in the past year in two health sub-districts (Luuka and Buyende) in Eastern Uganda. Data collection took place between November and December 2011. Data were collected on socio-demographic and economic characteristics, antenatal care visits, skilled delivery attendance, parity, distance to health facility and early newborn care knowledge and practices. Descriptive statistics were computed to determine the proportion of mothers who adopted beneficial newborn care practices (optimal thermal care; good feeding practices; weighing and immunizing the baby immediately after birth; and good cord care) during the neonatal period. We conducted multivariable logistic regression to assess the covariates of adoption of all beneficial newborn care practices. Analysis was done using STATA statistical software, version 12.1.Results: Of the 1,616 mothers enrolled, 622 (38.5%) were aged 25-34; 1,472 (91.1%) were married; 1,096 (67.8%) had primary education; while 1,357 (84%) were laborers or peasants. Utilization of all beneficial newborn care practices was 11.7%; lower in Luuka (9.4%, n = 797) than in Buyende health sub-district (13.9%, n = 819; p = 0.005). Good cord care (83.6% in Luuka; 95% in Buyende) and immunization of newborn (80.7% in Luuka; 82.5% in Buyende) were the most prevalent newborn care practices reported by mothers. At the multivariable analysis, number of ANC visits (3-4 vs. 1-2: Adjusted (Adj.) Odds Ratio (OR) = 1.69, 95% CI = 1.13, 2.52), skilled delivery (Adj. OR = 2.66, 95% CI = 1.92, 3.69), socio-economic status (middle vs. low: Adj. OR = 1.57, 95% CI = 1.09, 2.26) were positively associated with adoption of all beneficial newborn care practices among mothers.Conclusion: Adoption of all beneficial newborn care practices was low, although associated with higher ANC visits; middle-level socio-economic status and skilled delivery attendance. These findings suggest a need for interventions to improve quality ANC and skilled delivery attendance as well as targeting of women with low and high socio-economic status with newborn care health educational messages, improved work conditions for breastfeeding, and supportive policies at national level for uptake of newborn care practices. [ABSTRACT FROM AUTHOR]

We investigated condom and lubricant use, rectal cleansing and rectal gel use for penile-anal intercourse (PAI), during in-depth interviews with women from South Africa, Uganda and Zimbabwe who formerly participated in VOICE, a five-arm HIV prevention trial of two antiretroviral tablets and a vaginal gel. Few studies have addressed practices related to PAI among women; existing data from Africa on condom and lubricant use for PAI, as well as preparatory practices of PAI such as rectal cleansing, are limited to men who have sex with men. Women demonstrated a lack of awareness of HIV transmission risks of PAI and none of the participants reported using condom-compatible lubricants for PAI. Participants described a variety of preparatory rectal cleansing practices. Some participants disclosed rectal use of the vaginal study gel. Understanding practices related to PAI in Africa is critical to microbicide development, as these practices are likely to influence the acceptability, feasibility, and use of both vaginal and rectal microbicide products. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda.Methods: This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool.Results: Of the 391 women, 189 (48.3%) reported that they had ever utilized motorcycle ambulances. Of these, 94.7% were currently married or living together with a partner while 50.8% earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95% CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95% CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95% CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95% CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances were meant for and appreciated their role in taking pregnant women to health facilities.Conclusion: The use of motorcycle ambulances was associated with older age of the mother, male participation in birth preparedness, and consultations with TBAs. These findings suggest a need for interventions to involve men in reproductive health as well as efforts to reach women younger than 35 years of age. [ABSTRACT FROM AUTHOR]

Sexual behavior among older adults with HIV in Sub-Saharan Africa has been understudied despite the burgeoning of this population. We examined sexual behavior among older adults living with HIV in Uganda. Participants were eligible for the study if they were 50 years of age or older and living with HIV. Quantitative data were collected through face-to-face interviews, including demographic characteristics, health, sexual behavior and function, and mental health. Of respondents, 42 were men and 59 women. More than one-quarter of these HIV-positive older adults were sexually active. A greater proportion of older HIV-positive men reported being sexually active compared to women (54 vs. 15%). Among those who are sexually active, a majority never use condoms. Sixty-one percent of men regarded sex as at least somewhat important (42%), while few women shared this opinion (20%). Multivariate logistic regression analyses revealed that odds of sexual activity in the past year were significantly increased by the availability of a partner (married/cohabitating), better physical functioning, and male gender. As more adults live longer with HIV, it is critical to understand their sexual behavior and related psychosocial variables in order to improve prevention efforts. [ABSTRACT FROM AUTHOR]

Background: In Uganda, the risk of unintended pregnancies and unsafe abortions remains high due to relatively low contraceptive use. There is paucity of data on knowledge, attitudes, perceptions and practices towards modern contraceptives and, sexual and reproductive health especially among the young female university students.Methods: A survey was conducted at Makerere University main campus in Kampala, Uganda during April 2014. A team of well-trained and experienced research assistants interviewed female undergraduate students who provided data on socio-demographic characteristics, knowledge, perceptions and attitudes and use of contraceptives, as well as other sexual and reproductive health practices. Users of any contraceptive method in the past 12 months were coded as '1' and none users as '0'. The prevalence of contraceptive use was determined as the number of users divided by all female participants. Prevalence ratios (PRs) with their corresponding 95 % confidence intervals were used as measures of association between contraceptive use and associated factors. The PRs were obtained via a modified Poisson regression model using a generalized linear model with Poisson as family and a log link without an offset but including robust standard errors. All analyses were conducted with Stata version 13.Results: A total of 1,008 females responded to the survey; median (IQR) age was 21(20, 21) years, 38.6% in year 2 of study, and nearly three quarters (72.3%) were of Christian faith. Knowledge of any contraceptives was almost universal (99.6%) but only 22.1% knew about female condoms. Perceived acceptability of contraceptive use at the university (93%) or being beneficial to male partners too (97.8%) were high. Nearly 70% had ever engaged in sexual intercourse and 62.1% reported sexual intercourse in the past 12 months. Overall, 46.6% reported current contraceptive use, with male condoms (34.5%) being the commonest methods. Factors associated with higher contraceptive use were being in year 2, consensual union or perception that contraceptives are for females only. However, being evangelical/SDA or perception that contraceptive use is wrong was associated with lower contraceptive use. Overall, 9% reported ever being pregnant, 2% were pregnant at the time of the survey and a third (33.8%) knew of a pregnant friend. About 40% of ever pregnant respondents reported ever trying to terminate the pregnancy.Conclusions: Knowledge, perceived acceptability and benefits of contraceptive use were nearly universal, but contraceptive use was suboptimal in this setting. Ever trying to terminate a pregnancy was common and a clear indicator of unintended pregnancies. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. Methods: This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. Discussion: This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population. [ABSTRACT FROM AUTHOR]

When trusted, Community Health Workers (CHWs) can contribute to improving maternal and newborn health outcomes in low- and middle-income countries through education. Issues of acceptability of CHWs by communities were explored through experiences gained in a qualitative study that is part of a cluster randomized trial in East Uganda. Initially, focus group discussions with key community members and leaders were undertaken regarding preventative health and 40 CHWs were observed making home visits by supervisors during the initial 6 months of fieldwork of the trial in eight villages in the Jinja District in Uganda. The results were analyzed using the 5-SPICE framework. Observation of CHWs in the field identified a number of unanticipated issues including a general mistrust of the public health system by community members in areas that had an impact on maternal and newborn health. At the outset, CHWs often did not trust their own abilities and faced community expectations that they would provide curative rather than preventative care. Early community engagement, non- threatening home visits that enhanced friendship and supportive supervision improved the confidence of the CHWs and improved the trust and acceptance of the CHWs and the willingness of the community members to act on what was discussed. [ABSTRACT FROM AUTHOR]