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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]

Introduction: The community score card (CSC) is a participatory monitoring and evaluation tool that has been employed to strengthen the mutual accountability of health system and community actors. In this paper we describe the influence of the CSC on selected maternal and newborn service delivery and utilization indicators. Methods: This was a mixed methods study that used both quantitative and qualitative data collection methods. It was implemented in five sub-counties and one town council in Kibuku district in Uganda. Data was collected through 17 key informant interviews and 10 focus group discussions as well as CSC scoring and stakeholder meeting reports. The repeated measures ANOVA test was used to test for statistical significance. Qualitative data was analyzed manually using content analysis. The analysis about the change pathways was guided by the Wild and Harris dimensions of change framework. Results: There was an overall improvement in the common indicators across sub-counties in the project area between the 1st and 5th round scores. Almost all the red scores had changed to green or yellow by round five except for availability of drugs and mothers attending Antenatal care (ANC) in the first trimester. There were statistically significant differences in mean scores for men escorting their wives for ante natal care (ANC) (F(4,20) = 5.45, P = 0.01), availability of midwives (F(4,16) =5.77, P < 0.01), availability of delivery beds (F(4,12) =9.00, P < 0.01) and mothers delivering from traditional birth attendants (TBAs), F(4,16) = 3.86, p = 0.02). The qualitative findings suggest that strengthening of citizens' demand, availability of resources through collaborative problem solving, increased awareness about targeted maternal health services and increased top down performance pressure contributed to positive changes as perceived by community members and their leaders. Conclusions and recommendations: The community score cards created opportunities for community leaders and communities to work together to identify innovative ways of dealing with the health service delivery and utilization challenges that they face. Local leaders should encourage the availability of safe spaces for dialogue between communities, health workers and leaders where performance and utilization challenges can be identified and solutions proposed and implemented jointly. [ABSTRACT FROM AUTHOR]

Aims: To describe nurses' perceptions of family nursing practice and to explore the influence of their perceptions of the benefits, barriers and activities of family engagement in care on family nursing practice. Design: A cross‐sectional correlational study. Methods: In total, 460 nurses from two tertiary hospitals in the central region of Uganda participated. Quantitative and qualitative data were collected between August 2020 and January 2021 using the Family Nursing Practice Scale. Analyses included descriptive statistics, t‐test, Pearson correlation, analysis of variance and ordinal logistics regression. Quantitative content analysis was carried out on the textual data. Results: Nurses who perceived that family engagement in care improves patient and family outcomes were more likely to rate family nursing practice highly. Perceived barriers to family engagement in care particularly time constraints, work overload and family‐related conflicts have a negative and significant influence on family nursing practice. Nurse characteristics such as education, usual shift pattern and personal experience of having a family member in hospital are significantly associated with family nursing practice; nurses who work morning shifts were likely to report higher family nursing practice. Conclusion: The study reveals that several parameters (perceived barriers, perceived benefits and nurse characteristics) influence nursing practice with families. Thus, bearing in mind the diversity of healthcare contexts, the findings show that multiple interacting factors are important for advancing family nursing interventions and practice. Impact: Probabilistic factor‐specific predictions of nursing practice with families are provided in this study – this addresses a gap in the evidence regarding the elements that should be optimized when designing well‐informed policies and interventions to advance family nursing practice. A comparison of results in the literature with the present study's findings suggests a need to broaden the scope and context perspective in future research and broaden the understanding of how nurses´ perceptions influence family engagement in care. Reporting method: The study adheres to the STROBE reporting guidelines. Patient or public contribution: Family members/caregivers were involved in the design of the study particularly in assessment of validation of the tools used in the study. [ABSTRACT FROM AUTHOR]

Background Increasing interest is concentrating in the investigation of whether socioeconomic interventions yield results for children in the area of protection. AVSI Foundation, in Uganda, leads a consortium implementing the “Sustainable, Comprehensive Responses for Vulnerable Children and their Families” (SCORE) Project. The project targets 25,000 moderately and critically vulnerable households in Uganda and addresses them through a multisectoral intervention package encompassing socio-economic, food security, protection and family strengthening. Data from SCORE's monitoring and evaluation system and the mid-term assessment has become available and is used to investigate the topic. Objective This paper contributes original data and analysis to the discussion of socioeconomic strategies for vulnerability reduction and protection of children. Methods Statistical analysis of Village Savings and Loan Association Management Information System (VSLA MIS) data from 741 VSLAs was supported by the SCORE Project between 2012 and 2013. Statistical analysis of SCORE Vulnerability Assessment Tool (VAT) data covering 13,327 beneficiary households enrolled by SCORE in its first phase (last quarter 2011–first quarter 2012) and corresponding second assessment (second quarter 2013). Data analysis was carried out using Statistical Package for Social Sciences (SPSS). Results Between 2011 and 2012, SCORE supported the establishment of 743 Village Savings and Loan Associations (VSLAs), with a total membership of 20,818. Total saving stands at 1,113,185,960 Uganda Shillings. Saving and loans per capita are at 53,754 and 50,093 Uganda Shillings respectively, with regional variation (ranging 33,008–83,073 for savings, and 24,005–93,280 for lending). The overall loan to saving ratio is at 84.45%, with regional variation and range 60.83%–97.97%. Vulnerability data concerning the protection for 13,326 households supported by SCORE shows a reduction by 52%, with regional variation (range 42%–71%). Conclusion Results show that the VSLA approach can be used, besides community development, for direct vulnerability reduction strategies. VSLA approach can be made more inclusive of the most disenfranchised members of the community without losing in efficiency or effectiveness. SCORE Project data is highly suggestive of a positive linkage between socioeconomic interventions and protection outcomes, thereby reinforcing the current literature. More detailed analysis of SCORE databases may allow further understanding of the pathways linking the two result dimensions. [ABSTRACT FROM AUTHOR]

Background.: Annona muricata and Khaya grandifoliola are ethnomedicinally used for the treatment of malaria and have been experimentally shown to have an anti-plasmodial effect, but the mechanisms involved are not fully understood. This study investigated the effect of the ethanol extracts of their leaves on parasitemia, radical scavenging and cytokines in Plasmodium berghei ANKA-infected BALB/c mice. Methods.: BALB/c mice were infected with P. berghei and treated with chloroquine, A. muricata or K. grandifoliola extract for 4 days. The percentage of parasitemia and the level of cytokine expression were determined after treatment. Trace element, phytochemical and nitric oxide (NO) scavenging activity, 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging properties assays were done to study the antioxidant effects of AN and KG in vitro. Results.: P. berghei consistently increased parasitemia in BALB/c mice. The tested doses (100-, 200-, and 400 mg/kg) of A. muricata and K. grandifoliola attenuated the P. berghei -induced elevation of parasitemia and cytokines (TNF-α, IL-5, and IL-6) in vivo during the experimental period, though not as much as chloroquine. Moreover, both extracts scavenged the DPPH and NO radicals, though A. muricata had more anti-oxidant effect than K. grandifoliola in-vitro. Conclusion.: The ethanol extracts of A. muricata and K. grandifoliola reduce parasitemia in P. berghei -treated mice BALB/c by scavenging free radicals and reducing cytokines, though the extracts were not as effective as chloroquine. [ABSTRACT FROM AUTHOR]

As global mental health research and programming proliferate, research that prioritizes women's voices and examines marginalized women's mental health outcomes in relation to exposure to violence at community and relational levels of the socioecological model is needed. In a mixed methods, transnational study, we examined armed conflict exposure, intimate partner violence (IPV), and depressive symptoms among 605 women in Northeastern Uganda. We used analysis of variance to test between groups of women who had experienced no IPV or armed conflict, IPV only, armed conflict only, and both; and linear regression to predict depressive symptoms. We used rapid ethnographic methods with a subsample (n = 21) to identify problem prioritization; and, to characterize women's mental health experiences, we conducted follow up in-depth interviews (n = 15), which we analyzed with grounded theory methods. Thirty percent of the sample met the cut-off for probable major depressive disorder; women exposed to both IPV and armed conflict had significantly higher rates of depression than all other groups. While women attributed psychological symptoms primarily to IPV exposure, both past-year IPV and exposure to armed conflict were significantly associated with depressive symptoms. Women identified socioeconomic neglect as having the most impact and described three interrelated mental health experiences that contribute to thoughts of escape, including escape through suicide. Policy efforts should be interprofessional, and specialists should collaborate to advance multi-pronged interventions and gender-informed implementation strategies for women's wellbeing. Additional online materials for this article are available on PWQ's website at http://journals.sagepub.com/doi/suppl/10.1177/0361684319864366 [ABSTRACT FROM AUTHOR]

Background: While pelvic floor ultrasound is commonly utilised in high‐resource locations, our understanding of pelvic floor characteristics in women suffering with obstetric fistula and unrepaired fourth degree obstetric tears in low‐resource areas is limited. Aims: This study aimed to assess the pelvic floor ultrasound characteristics of Ugandan women suffering with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse, and determine whether obstructed labour resulting in obstetric fistula causes more levator muscle defects compared to parous women without a history of obstructed labour. Materials and Methods: This was a prospective study in western Uganda assessing 82 women with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse with a pelvic floor ultrasound scan. Results: Demographic characteristics were significantly different, with women suffering pelvic organ prolapse being older and more parous. Hiatal area on Valsalva was significantly smaller in the obstetric fistula group (mean 21.45 cm2) compared to non‐obstetric fistula group (unrepaired fourth degree obstetric tears and pelvic organ prolapse; mean 30.44 cm2); a mean difference of 9.0 cm2 (95% CI: 5.4–12.6 cm2, P < 0.001). Overall, levator muscle defects were significantly more common in women with obstetric fistula (66.7%) compared to the non‐obstetric fistula group (44.7%) with P = 0.048; however, there were no significant differences in complete levator muscle defects between obstetric fistula (28.6%) and non‐obstetric fistula (23.7%). Conclusions: Increased hiatal area on Valsalva was noted in the non‐obstetric fistula group compared to women with obstetric fistula; however, there were no differences in proportions of complete levator muscle defects. [ABSTRACT FROM AUTHOR]

Background: Despite the conventional approaches to HIV prevention being the bedrock for early reductions in HIV infections in Uganda, innovations that demonstrate reduction in risk to infection in vulnerable populations need to be embraced urgently. In the past 2 years, a USAID-funded project tested a quality improvement for behavior change model (QBC) to address barriers to behavioral change among adolescent girls and young women (AGYW) at high risk of HIV infection. The model comprised skills building to improve ability of AGYW to stop risky behavior; setting up and empowering community quality improvement (QI) teams to mobilize community resources to support AGYW to stop risky behavior; and service delivery camps to provide HIV prevention services and commodities to AGYW and other community members. Methods: We recruited and followed a cohort of 409 AGYW at high risk of HIV infection over a 2-year period to examine the effect of the QBC model on risky behaviors. High-risk behavior was defined to include transactional sex, having multiple sexual partners, and non-use of condoms in high-risk sex. We documented unique experiences over the period to assess the effect of QBC model in reducing risky behavior. We analyzed for variances in risk factors over time using repeated measures ANOVA. Results: There were statistically significant declines in high-risk behavior among AGYW over the QBC roll-out period (p < 0.05). Univariate analysis indicated reduction in AGYW reporting multiple sexual partners from 16.6% at baseline to 3.2% at follow up and transactional sex from 13.2 to 3.6%. The proportion of AGYW experiencing sexual and other forms of gender based violence reduced from 49% a baseline to 19.5% at follow up due to the complementary targeting of parents and partners by QI teams. Conclusion: The QBC model is appropriate for the context of northern Uganda because it provides a framework for the community to successfully drive HIV prevention efforts and therefore is recommended as a model for HIV prevention in high-risk groups. [ABSTRACT FROM AUTHOR]

HIV disclosure is a gateway to HIV prevention – particularly among couples living in regions severely affected by the HIV epidemic. This cross-sectional study utilizes data collected from 862 people living with HIV across three countries (Ethiopia, Mozambique, and Uganda) in 2011 to determine the role of partner disclosure on self-reported health perceptions and changes in sexual risk behavior. The study's secondary aims are to understand whether or not internalized stigma mediates this relationship and if there is a different pattern of results by gender. The multivariate analysis reveals that the three key HIV-related independent variables, belonging to a support group, doing volunteer work, and disclosing to one's spouse or partner, were significantly associated with lower levels of internalized stigma. Internalized stigma was associated with self-perceptions of poorer health for both women and men, with women reporting higher levels of internalized stigma than men. Disclosure to spouse was positively associated with perceptions of better health for women but not for men. For men, doing HIV-related volunteer work and disclosing their status to their spouse were positively associated with self-reported changes in sexual risk behavior, although stigma was not found to mediate this relationship. Findings from this study suggest that disclosure and stigma have gender-specific effects on individual well-being and changes in sexual risk behaviors. As such, programs must address gender inequity in disclosure patterns and stigma to enhance prevention efforts. [ABSTRACT FROM AUTHOR]