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Given the limited attention to young adults as key contributors to the spread of COVID-19 in Uganda, this study examines the effects of the outbreak on the ability of young adults aged 18-29 to access health services and practice preventive measures. A national population-based mobile phone survey was conducted in December 2020. Multivariable regression analyses were used to explore the effect of the COVID-19 pandemic on access to health care services. Control variables included region, education level, parity, and source of health information. The majority (98%) perceived COVID-19 as a serious threat to Ugandans. Although the majority reported handwashing (97%) and masking (92%), fewer respondents avoided shaking hands (39%), ensured physical distancing (57%), avoided groups of more than four people (43%), stayed home most days (30%), avoided touching eyes, nose, and mouth (14%), and practiced sneezing/coughing into their elbow (7%). Participants noted that the COVID-19 pandemic affected their ability to access family planning (40%), HIV (49%), maternal health (55%), child health (56%), and malaria (63%) services. The perceived effect of the COVID-19 pandemic on services was higher for those in the Northern region (OR= 2.00, 95% CI 1.00-4.02), those with higher education OR= 2.26, 95% CI 1.28-3.99), those with five plus children (OR= 2.05, 95% CI 0.92-4.56), and those who trust radio for COVID-19 information (OR= 1.65, 95% CI 1.01-2.67). The findings show the pragmatic importance of understanding the dynamic characteristics and behavioral patterns of young adults in the context of COVID-19 to inform targeted programming.

Despite the benefits of antenatal care, evidence from sub-Saharan Africa suggests that women often initiate these services after the first trimester of pregnancy and do not complete the recommended number of visits. This study examines the impact of mobilising faith-based and lay leaders to address the socio-cultural barriers to antenatal care uptake in northern Ghana in the context of a broader child survival project. A quasi-experimental design was used, and data were analysed using a difference-in-differences approach. The results presented in this article indicate the potential for faith-based and lay leaders to promote uptake of maternal and child health behaviours.

PURPOSE Tanzania recently developed national guidelines for early diagnosis of breast cancer to combat increasing incidence and mortality. The aim of this multiphase, adaptive implementation science study was therefore to assess the local context, couple implementation strategies with identified barriers, and test these strategies to improve breast cancer control, creating an adaptive A.C.T. framework with broad applicability to other low- and middle-income country settings. METHODS The assessment phase was made up of a broad medical chart review of women seeking care for breast concerns (n = 664); a knowledge, attitudes, and practices survey of community women (n = 1,129); and a knowledge, attitudes, and practices survey of health care providers (n = 114), followed by in-depth interviews (n = 15). RESULTS Women presented to the Zonal Hospital with swelling (45%) or a palpable lump (31%), with an average symptom duration of 6 months. Most diagnoses were based on clinical exam only (54%) and included 16% breast cancer. Of these, 43% had no treatment recorded, 50% had surgery at a median of 2.5 months, and 7% had chemotherapy only. Knowledge surveys indicated that 59% of women had heard of breast cancer, but only 14% felt they knew any signs or symptoms. Encouragingly, 56% were fairly to very confident that they would notice breast changes, and 74% said they would be somewhat to very likely to seek care, with 96% noting the severity of symptoms as a motivator. Providers indicated that barriers to care included low community knowledge and repeated misdiagnosis at the primary level. The majority of providers (95%) believe clinical breast examination is feasible to implement for symptomatic patients, yet only 65% feel they have sufficient training. CONCLUSION In all, 8 larger barriers were synthesized and linked to evidence-based interventions as potential solutions. All barriers and solutions were ranked by key stakeholders on the basis of feasibility, importance, and sustainability. These were incorporated into a 3-component intervention to improve breast cancer care at the Zonal Hospital and rollout is underway.