Master of Science in Public Health

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Predictors Of Enrollment Into Community Based Health Insurance Schemes Among Patients with Diabetes Mellitus in Wakiso District – Central Uganda
(Clarke International University, 2023-02) Komugisha, Sarah
Background: This study was done to assess predictors of enrollment into community based health insurance schemes and patients with type II diabetes mellitus in Wakiso district – central Uganda. Diabetes is linked with 1.5 million deaths annually, with all deaths related to poorly controlled diabetes that arise, in part due to non-adherence to medication. Such non-adherence in most cases arises from financial limitations and so, diabetic patients need to have health insurance cover. Currently, CBHI schemes are the most common in developing countries and some have been customized for diabetes patients, as is the case in Wakiso district. However, enrollment into those schemes remains a challenge. Method: The study was cross sectional, targeting 291 diabetic patients in Wakiso district, in which all the three facilities with the CBHI scheme were purposively sampled and patients randomly sampled, following which structured interviews were used to collect data. Data was analyzed in SPSS 25 using the log-binomial model. Results: The proportion of patients with diabetes mellitus in Wakiso district that is enrolled into community based health insurance schemes is 81.4% (237). The prevalence of CBHI enrollment was higher among patients who were Catholics (aPR = 3.982 [CI = 1.190 - 13.318], P = 0.025), who had been educated to secondary school (aPR =12.749 [CI = 3.716 - 43.735], P = 0.000), who rated their health status as being somehow okay had 16 times the odds of being enrolled (aPR = 16.526 [CI = 5.001 - 54.611], P = 0.000). It was however less among patients who had lived with diabetes for less than 5 years (aPR = 0.269 [CI= 0.127 - 0.568], P = 0.001), although it was higher among patients who reported that diabetes medication was always available at their respective health facilities (aPR = 1.979 [CI = 1.066 -3.671], P = 0.030). No bivariate analysis could be conducted because of the null integers in the cells of all cross tabulations between the independent variables and the dependent variable. The null integers notwithstanding, it is evident that there could have been significantly higher proportions of enrolled patients who agreed to the institutional assertions than, those who disagreed. Conclusion: Enrollment into the CBHI among diabetic patients in Wakiso district is high, but not universal, contrary to ideal standards. It is mainly predicted by intrapersonal characteristics and to some extent by institutional characteristics, although it was possible that scheme characteristics are also been of conceivable importance. Behavior change communication will go a long way in increasing enrollment among the patients
Assessment Of Self-Medication Among Adults In Ugandan Communities In: A Case Study In Makindye Division-Kampala.
(Clarke International University., 2022-02) Joseph, Zziwa
Introduction:This study assessed self-medication practices and it‟s determinants among communities in Makindye-Kampala capital city. The main objective of the study was to assess self-medication practices among adults living in Makindye Division, Kampala District. The specific objectives were (i)To assess individual factors that influence self-medication practices among communities in Makindye Division, Kampala District, (ii)To assess socioeconomic factors that influence self-medication among communities in Makindye Division, Kampala District and (iii)To determine health system-related factors which influence to self-medication among communities in Makindye Division, Kampala District. Methods:A cross-sectional study was conducted among a sample of 436 residents in selected parishes of Makindye division, Kampala district from November to December 2021. The study employed both quantitative and qualitative collection methods. Self-medication was defined as the use or purchase of drugs without a prescription from a qualified medical professional. Data on individual, socioeconomic and health system factorswere collected using a pretested questionnaireand analyzed using logistic regression at 5% statistical significance level using STATA version 15. Qualitative data were inductively analyzed and themed by the study objective. Results: A total of 436 were enrolled in the study. The participants had a mean age of 33.07(±11.61) years and an age range of 18 - 66 years. The majority were females (53.21%) and most were unmarried (66.74%). Self-medication was more common among participants who rented their household premises (aOR 3.49 95% CI 1.76 - 6.89), didn‟t think a qualified medical provider‟s prescription was needed before taking any medication (aOR 4.11 95% CI 1.88 – 9.00) and those who were managed under community-based DOTS (aOR 1.91, 95% CI 1.25–2.92) and the practice of self-medication to prevent COVID-19 (aOR11.48, 95% (3.36 - 39.25). Individual, socioeconomic and health-system related factors influenced self-medication. Conclusion:The study founda high prevalence of self-medication among adults in Makindye division practised self-medication. To reduce self-medication, local councils, the Ministry of Health and the National Drug Authority should continually enforce standards and increase community awareness towards the importance of prescriptions and the dangers of self- medication.
Malnutrition And Associated Risk Factors Among Children Under Two Years In Mas Hospital Hargeisa,Somaliland
(Clarke International University., 2022) Khadra, Hussein Abdi
Background: Malnutrition rates in children under two continue to be high in south-central Somalia, with rates of over 15% in most areas; in the north of Somalia, where there is more peace, stability, and development, malnutrition rates have been consistently lower, with medium rates of about 10% in Somaliland and 14% in Puntland reported over the past seven years (Sheikh et al., 2020). Methods: A cross sectional study design with quantitative methods of data collection and analysis were used. A sample size of 217 with a response rate of 95% (207/217) respondents who were caretakers to children below 2 years selected by simple random sampling was used. Data was collected using self-administered questionnaire. Results: The results of the study showed that; out of the 207 respondents minority 50 (24%) had malnourished children while majority 157 (76%) had nourished children. Conclusion: In conclusion, malnutrition was associated with age above one year, very LBW, inadequate feeding, history of hospital admission, maternal illiteracy, many child and nonattendance of ANC, having many household members, drinking water from unsafe source and poor hand washing. The study recommends that, children should be well fed on balanced diet, mothers maintain good hygiene and mother’s health educated during pregnancy and after on good child feeding.
Factors Influencing Substance Abuse Amongst Health Care Professionals In Kampala, Uganda.
(Clarke International University., 2022-01) Rebecca, Suubi
Introduction: Substance Abuse has become a subtle yet growing trend amongst Health Care Professionals and thus the increases the risk of mental illness, suicide attempts through self-poisoning, health care malpractices, and ultimately pre-mature mortality rates among Health Care Professionals. Unfortunately, in developing countries, barely any substantial research targeting the well-being of Health Care Professionals in relation to substance abuse has been carried out, and yet this is a crucial group of individuals in society. This cross-sectional research study addressed the factors associated to substance abuse amongst Health Care Professionals, the prevalence as well as Health Care Professionals’ perceptions toward Substance Abuse in Kampala, Uganda. Methodology: Data was collected from 380 respondents of the study directly using self- administered approaches and a pretested structured questionnaire adapted from World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST Tool) version 3 specifically screening for substance abuse. Other factors such as Socio-Demographic factors, Occupational-related factors, and perception of Health Care Professionals towards Substance Abuse were measured. Amongst the intended 383 respondents in this study, 380 complete references were analysed. The relevant bivariate, binary logistics regression and multivariate analysis was run using the Statistical Package for Social Sciences (SPSS)-Version23. Results: The prevalence for Substance Abuse amongst Health Care Professionals in Kampala, Uganda was 4%. After controlling for Monthly Income, Highest level of Education and Work- related Stress Coping mechanisms, it was evident that there was an association between age and Nationality, in relation to Substance Abuse. Older Adults were 5times more likely to becoming abuse substances compared to Younger Adults (AOR=5.014 95% CI= 1.855 – 13.552). Furthermore, it was found that participants who were Non-Ugandans were less likely to abuse Substances (AOR = 0.159, 95% CI – 0.030- 0.846) compared to Ugandan Health Care Professionals. Conclusion: Based on our findings, 4 out of every 100 Health Care Workers are susceptible to substance abuse; specifically the Ugandan Health Care Professionals who are older adults (above the age of 35years), are at a high risk of substance abuse. Moreover, considering the fact that alcohol was the most abused substance, strict regulations on alcohol consumption, mental health education and incorporating physical activity as a form of stress-management amongst old-aged Ugandan Health Care Professionals is paramount.
Assessment of pregnant women’s satisfaction with the quality of antenatal care services in Ba-nadir Hospital, Mogadishu Somalia
(Clarke International University., 2022) Ibrahim, Abdullahi Dahir
Background: Somalia has a high infant and maternal mortality rate of 732/1000 and 74/100000 respectively due to pregnancy-related complications which would be intervened by regular and timely utilization of ANC services. Methods: Across sectional design with quantitative methods of data collection and analysis were used. A sample size of 384 respondents who were pregnant women selected bysystematic random and purposive sampling was used. Data was collected using a questionnaire. Results: A third 33% (127/384) of the PMs were satisfied with ANC services thus low satisfaction with ANC services. Factors associated with low satisfaction with the ANC services included; being between 20-30 years (AOR: 97.7, P=0.010), being employed by other people (AOR: 97.9, P=0.007) and being married (AOR: 97.5, P=0.018). Tangibility factors were; lack of drugs (AOR: 0.2, P=0.001), uneasiness to obtain drugs (AOR: 0.12,P=0.001), unclean sanitation (AOR: 0.1, P=0.001). About the reliability factors, receiving appointments (AOR: 93.7, P=0.028), poor communication and information from HCWs (AOR: 0.1, P=0.004), and unfulfilled expectations in diagnosis (AOR: 0.2, P=0.001). Responsiveness factors were; delayed retrieval of records (AOR: 0.12, P=0.001), delayed health care service delivery (AOR: 0.1, P=0.002), long waiting time of more than 45 minutes (AOR: 85.9, P=0.002), and staff at the OPD not spending enough time (at least 10 minutes) attending to patients (AOR: 0.4, P=0.013). Assurance and empathy factors included, not receiving laboratory results on time (AOR: 0.4, P=0.008), a belief that health care workers didn’t have enough knowledge to answer the questions (AOR: 0.1, 95% CI: 0.02-0.20, P=0.001), and receiving inadequate help from the auxiliary staff (AOR: 0.02, P=0.001). Conclusion: Low satisfaction with ANC services was due to young age, failure to obtain drugs, unclean sanitary facilities, delayed service delivery by HCWs and auxiliary staff, delayed retrieval and delivery of laboratory results. The researcher recommends that the government recruits more HCWs, gives them on-the-job training, and equips them with adequate utilities.Background: Somalia has a high infant and maternal mortality rate of 732/1000 and 74/100000 respectively due to pregnancy-related complications which would be intervened by regular and timely utilization of ANC services. Methods: Across sectional design with quantitative methods of data collection and analysis were used. A sample size of 384 respondents who were pregnant women selected by systematic random and purposive sampling was used. Data was collected using a questionnaire. Results: A third 33% (127/384) of the PMs were satisfied with ANC services thus low satisfaction with ANC services. Factors associated with low satisfaction with the ANC services included; being between 20-30 years (AOR: 97.7, P=0.010), being employed by other people (AOR: 97.9, P=0.007) and being married (AOR: 97.5, P=0.018). Tangibility factors were; lack of drugs (AOR: 0.2, P=0.001), uneasiness to obtain drugs (AOR: 0.12,P=0.001), unclean sanitation (AOR: 0.1, P=0.001). About the reliability factors, receiving appointments (AOR: 93.7, P=0.028), poor communication and information from HCWs (AOR: 0.1, P=0.004), and unfulfilled expectations in diagnosis (AOR: 0.2, P=0.001). Responsiveness factors were; delayed retrieval of records (AOR: 0.12, P=0.001), delayed health care service delivery (AOR: 0.1, P=0.002), long waiting time of more than 45 minutes (AOR: 85.9, P=0.002), and staff at the OPD not spending enough time (at least 10 minutes) attending to patients (AOR: 0.4, P=0.013). Assurance and empathy factors included, not receiving laboratory results on time (AOR: 0.4, P=0.008), a belief that health care workers didn’t have enough knowledge to answer the questions (AOR: 0.1, 95% CI: 0.02-0.20, P=0.001), and receiving inadequate help from the auxiliary staff (AOR: 0.02, P=0.001). Conclusion: Low satisfaction with ANC services was due to young age, failure to obtain drugs, unclean sanitary facilities, delayed service delivery by HCWs and auxiliary staff, delayed retrieval and delivery of laboratory results. The researcher recommends that the government recruits more HCWs, gives them on-the-job training, and equips them with adequate utilities.
Factors Associated with viral non-suppression among Adolescents Living with HIV at Lira Regional Referral Hospital (LRRH): A cross sectional analytical studyFactors Associated with viral non-suppression among Adolescents Living with HIV at Lira Regional Referral Hospital (LRRH):
(Clarke International University., 2022) Lyagoba, Anthony
Purpose : WHO defines viral load non-suppression as viral load ≥1000 copies/ml. Within a year of attaining the “90- 90-90” target, current records show that 53% of people living with HIV (PLWH) have viral non-suppression worldwide. Despite a continuing global trend of fewer AIDS-related deaths in children and adults, the opposite has occurred among adolescents aged 10-19 years. However, results on viral non-suppression among adolescents suggest that antiretroviral therapy outcomes for adolescents from both high-income and low-income settings tend to be worse than for adults. In Uganda, the proportion of viral non-suppression among adolescents countrywide is 27%. In Lira Regional Referral Hospital, almost 30% of these adolescent patients developed viral non-suppression within one year after starting antiretroviral therapy. This study aimed to investigate factors associated with viral non-suppression among Adolescents living with HIV at Lira Regional Referral Hospital (LRRH) Methods: A cross sectional analytical study was conducted with a mixed methods approach on asimple random sample of adolescents living with HIV aged between 10-19 years attending the antiretroviral therapy clinic at LRRH. Data was collected using a researcher-administered questionnaire on health-facility, care-giver and behavioral factors associated with viral load non- suppression. 5 key informant interviews were also conducted to further understand viral load non-suppression among adolescents. Results: The level of viral non-suppression was 69% with a mean age of 16.44 and standard deviation of 1.74. Females made up 55.5% of our respondents. Having lived with HIV/AIDS for 3-6 years (AOR: 4.28, 95% CI: 2.94-15.01, p-0.000) and being an alcohol consumer (AOR: 5.88, 95% CI: 2.78-11.85, p-0.009) were positively associated with viral load non-suppression. A positive attitude of health workers (AOR: 0.16, 95% CI: 0.08-0.46, p-0.002) and having received continuous counseling from the counsellor at the facility (AOR: 0.15, 95% CI: 0.09-0.55, p- 0.000) were independently negatively associated with viral non-suppression. Conclusions: Viral load non-suppression was more likely if an individual was an alcohol consumer and less likely if the health workers had a positive attitude or were under continuous counselling from the counselor at the Healthy facility. At the Healthy facility, there is need to set up adolescent friendly clinics and ensure a positive attitude of health workers towards adolescents living with HIV. Key programs that support continuous counselling of adolescents living with HIV should also be set up at the facility to ensure that the Adolescents are supported.
Determinants of breast cancer screening among women above 18 Years in Banaadir region Mogadishu, Somalia.
(Clarke International University., 2022) Nasteho, Abdullahi Mohamud
Background: In Somalia, data on breast cancer screening is sketchy because the Ministry of Health has limited documented cases of BCS. Somali women remain significantly under- screened for breast cancer due to educational, financial, access, and cultural barriers among others. A majority do not even know how to do BSE. This prompted the researcher to carry out a study on the determinants of BCS among women above 18 years in the Banaadir region of Mogadishu, Somalia. Methods: The study used a cross-sectional research design that employed quantitative methods for data collection and analysis. A sample size of 217 women from 18 years of age and above were enrolled from households using systematic and simple random sampling. Data was collected using a questionnaire . Results: Out of the 217 respondents that participated in the study, a minority of 41 (19%) screened for BC while the majority 176 (81%) never screened for BC. After adjusting for confounding, statistically significant factors were; social demographic factors included; having 30-39 years (AOR 10.4, P=0.006), being single (AOR 14.9, P=0.048), having secondar education (AOR 138.4, P=0.005), and having 1-2 children (AOR 44.4, P=0.007) and not believing in cultural beliefs against clinical BCS (AOR 112.9 P=0.001). Knowledge factors included; knowing anybody who suffered from BC (AOR 99.95, P=0.026) and family history of BC (AOR 99.98, P=0.003). Among health-system factors; being frequently given brochures/handouts or videotapes on BCS at the MCHC (AOR 13.7, P=0.001) was statistically significantly associated with uptake of BCS services among women. Conclusion: In conclusion, uptake of BCS services was associated with being of young age, single, having lower levels of education, having fewer children, not believing in cultural beliefs against BC, knowing anybody who suffered from BC, family history of BC, and frequent receiving of brochures/handouts or videotapes on BCS at the MCHC. The study recommends that women be health educated about BCS.
Disclosure OF Positive HIV Status TO Sexual Partner(s) and Associated Factors among Mothers Attending Elimination of Mother to child Treatment clinic in Mbale Regional Referral Hospital.
(Clarke International University., 2022-01) Chelimo, Juliet
Introduction: Disclosure of one’s HIV status to a sexual partner(s) during pregnancy has been shown to result in better clinical outcomes to the mother and baby. In Mbale, 1 in every 3mothers is reported to have disclosed their status. We assessed disclosure of HIV positive status to sexual partner(s) and associated factors among mothers attending the Elimination of Mother-To-Child Transmission (EMTCT) clinic at Mbale Regional Referral Hospital, Mbale City. Methodology: We conducted an analytical cross-sectional study utilizing both quantitative and qualitative methods on a systematic random sample of mothers attending the EMTCT clinic at Mbale Regional Referral Hospital. We used a researcher-administered questionnaire to collect data on individual, social and health facility characteristics. We also conducted key informant interviews to help further understand factors associated with HIV status disclosure. Data was analyzed using SPSS version with p-value of <0.05 used to declare statistical significance.Qualitative data was coded and main themes associated with disclosure established. Results: We interviewed 148 mothers with a mean age of 29.2297 and standard deviation of 6.2757 Disclosure of HIV positive statuses to sexual partner(s) was 51.4%. Disclosure of HIV status to sexual partners was positively associated with having social support from family member and friends (aOR: 7.143, 95% CI: 3.157-13.329, p<0.001) having no formal education (aOR: 4.426, 95% CI: 1.738-8.526, p-0.002), having primary education (aOR: 5.586, 95% CI: 2.705-10.701, p<0.001). Being Catholic (aOR: 0.159, 95% CI: 30.023-0.418, p-0.001), Anglican (aOR: 0.311, 95% CI: 0.103-0.499, p-0.044), ever missing taking ART medication (aOR: 0.631,95% CI: 0.114-0.668, p<0.001) were negatively associated with disclosure. Conclusion and recommendations: Approximately half of all HIV positive mothers didn’t disclose their HIV status to their sexual partner(s). Disclosure was positively associated with having social support from family member and friends and negatively associated with ever missing A. Factors negatively associated with disclosure included being catholic or Anglican, ever missing to take ART medication. We recommend treatment adherence monitors for HIV positive mothers, especially family members and friends, to provide support that will help in eventual disclosure to sexual partner(s). Introduction: Disclosure of one’s HIV status to a sexual partner(s) during pregnancy has beenshown to result in better clinical outcomes to the mother and baby. In Mbale, 1 in every 3 mothers is reported to have disclosed their status. We assessed disclosure of HIV positive status to sexual partner(s) and associated factors among mothers attending the Elimination of Mother-To-Child Transmission (EMTCT) clinic at Mbale Regional Referral Hospital, Mbale City. Methodology: We conducted an analytical cross-sectional study utilizing both quantitative and qualitative methods on a systematic random sample of mothers attending the EMTCT clinic at Mbale Regional Referral Hospital. We used a researcher-administered questionnaire to collect data on individual, social and health facility characteristics. We also conducted key informant interviews to help further understand factors associated with HIV status disclosure. Data was analyzed using SPSS version with p-value of <0.05 used to declare statistical significance. Qualitative data was coded and main themes associated with disclosure established. Results: We interviewed 148 mothers with a mean age of 29.2297 and standard deviation of 6.2757 Disclosure of HIV positive statuses to sexual partner(s) was 51.4%. Disclosure of HIV status to sexual partners was positively associated with having social support from family member and friends (aOR: 7.143, 95% CI: 3.157-13.329, p<0.001) having no formal education (aOR: 4.426, 95% CI: 1.738-8.526, p-0.002), having primary education (aOR: 5.586, 95% CI: 2.705-10.701, p<0.001). Being Catholic (aOR: 0.159, 95% CI: 30.023-0.418, p-0.001), Anglican (aOR: 0.311, 95% CI: 0.103-0.499, p-0.044), ever missing taking ART medication (aOR: 0.631, 95% CI: 0.114-0.668, p<0.001) were negatively associated with disclosure. Conclusion and recommendations: Approximately half of all HIV positive mothers didn’t disclose their HIV status to their sexual partner(s). Disclosure was positively associated with having social support from family member and friends and negatively associated with ever missing A. Factors negatively associated with disclosure included being catholic or Anglican, ever missing to take ART medication. We recommend treatment adherence monitors for HIV positive mothers, especially family members and friends, to provide support that will help in eventual disclosure to sexual partner(s).
Predictors Of Male Involvement Inantenatal Care In Palabek Refugee Settlement, Lamwo District, Northern Uganda:
(Clarke International University, 2022-01) Auma, Irene
Background: Male involvement in Maternal and Child Health (MCH) remains low in developing countries with more involvement being realized in the developed nations. In Uganda, although the government launched the national male involvement strategy in 2014, male involvement in antenatal care (ANC) remains low. Objective of the study: We investigated predictors of male involvement in antenatal care in Palabek refugee settlement. Methodology: We conducted a community based cross sectional study with a mixed methods approach in Palabek refugee settlement among a proportionate sample of mothers. We also conducted focus group discussions and key informant interviews to collect qualitative data on male involvement in ANC. Data analysis was done using SPSS version 21. In order to ascertain the relation between the dependent and independent variables, Pearson Chi-Square test was conducted. Variables whose P-values were <0.05 at 95% confidence interval were considered significant. Alogistic regression model was used to determine the relationship between the dependent and independent variables. Results: High level of male involvement in ANC in Palabek refugee settlement was 38.77% while low level of involvement stood at 61.23%. Male involvement was positively associated with access to information to ANC (AOR=2.836;95%Cl=1.558-5.161; P<0.001) and frequent couple discussion on ANC (AOR =10.780;95%Cl=5.876-19.777; P<0.001) Conclusions: The predictors of male involvement arise from different levels of the socio-ecological model therefore strategies to address gaps of low male involvement should be implemented at all these levels. The government of Uganda and UNHCR should accelerate community sensitization on the importance of male involvement and the role of male partners during pregnancy. The government of Uganda and UNCHR should emphasize the implementation of the modeling approach where men with high involvement index are modeled to become change agents to their peers.
Determinants of uptake of Mass Drug Administration for Schistosomiasis Control in Butiaba, Uganda
(Clarke International University, 2022-02) Ayebazibwe, Gloria Kakoba
Introduction: Schistosomiasis is one of the Neglected Tropical Diseases (NTDs) targeted for elimination in Uganda through Mass drug administration(MDA) using praziquantel with a WHO target coverage and uptake of 75% to eliminate the disease as a public health problem by 2025. Treatment coverages reported have however often been suboptimal for programs to attain the goal of transmission interruption within reasonable time. This study aimed to assess the uptake of praziquantel during MDA and associated factors in Butiaba, Uganda. Methods: A cross sectional study was conducted in five randomly selected villages within Butiaba sub county in September 2021. Both quantitative and qualitative data was collected. Quantitative data was collected through researcher administered semi structured questionnaires. 450 adults (≥18years) were interviewed about swallowing praziquantel/praziquantel uptake during the 2020 MDA exercise, sociodemographic characteristics, knowledge and attitudinal factors for taking/not taking the drug. Qualitative data was collected through 2 Focus Group Discussions and 3 key informant interviews that were purposively selected with representation from the District health office, local leadership and MDA parish supervisors. Results: The overall self-reported uptake of praziquantel was 71.56% (322/450), 95% confidence interval (CI) 67.14%-75.68%. 5.78% of the participants reported having never swallowed praziquantel in their lifetime and 75%(96/128) of participants who didn’t swallow praziquantel in 2020 reported having at least swallowed the drug in the last 10years. Uptake of praziquantel was less likely if the respondent had no knowledge about schistosomiasis signs (adjusted odds ratio [AOR] 0.18, 95% CI 0.08–0.39) and more likely if the respondent was 30-39years (adjusted odds ratio [AOR] 2.31, 95% CI 1.35–3.95) or 40 years and above (adjusted odds ratio [AOR] 2.86, 95%CI 1.45–4.95). Operational challenges such as inadequate supply and financial constraint also influence uptake of praziquantel during MDA in Butiaba. Conclusion: Uptake of praziquantel during MDA in Butiaba was high but still below the target rate of 75% set by WHO. Limited knowledge on schistosomiasis symptoms, being in a young adult age group (18-29) and irregular inadequate drug supply are some of the factors associated with uptake being below target. Rigorous health education, adequate drug supply and a methodical approach to drug distribution targeting the young adults are likely to have considerable potential for increasing praziquantel uptake hence lead to successful schistosomiasis elimination in the sub county. Keywords: Schistosomiasis, mass drug administration, Sub-Saharan Africa, uptake,praziquantel.
Fertility Desires And Intentions Of HIV Positive Men And Women Aged 15-49 Attending HIV Care At Selected Health Facilities In Aswa Gulu District.
(Clarke International University, 2021-12) Otim, Richard Ajalia
Studies from different contexts worldwide indicate fertility desires of people living with HIV/AIDS have become a public health challenge, this is for both developed / rich countries like USA and non-developed or limited resource setting countries like in Sub Sahara Africa both indicate HIV infected men and women have fertility desires and intentions, yet HIV is known to be the major cause of death in women of reproductive age in the world and there is limited evidence pertaining the fertility desire of HIV positive women receiving HIV care in Uganda. This has shown controversial results with regard to whether childbearing desire and intention are changed after the expansion of ART and PMTCT services, however the intake of EMTCT services in the remote setting like Aswa is seem to be hard. This was justified by studies in 2011 in several HIV clinics across Northern Uganda indicates that only 24% of male respondents and 19% of female respondents said they wanted more Children and some Scanty information indicates that those desires to stop child bearing among PLHIV was 6.25 times greater among HIV infected men and women compared to HIV negative. This calls for a lot of interventions to put in place otherwise HIV positive men and women will die with pain of not being able to produce a child or fear of producing HIV infected children. The Objective was to determine factors affecting fertility desires and intention of HIV positive men and women living in Aswa Gulu District and the implications of HIV transmission in regard to MTCT of HIV and public Health Practices. And to address three research questions: What are the individual factors affecting fertility desires and intentions of HIV positive men and women of Aswa Health sub district? What are the partner factors affecting fertility desires of HIV positive men and women in selected health facilities in Aswa Health sub district? What is the level of integration of family planning services with HIV programs at selected health facilities in Aswa Health sub district? This study contributes to the understanding of the ongoing changes in fertility desire among PLHIV in Uganda and other developing countries that realized significant improvement in the life expectancy of HIV/AIDS patients
Depression And Its Associated Factors Among Students Of Clarke International University, Kampala Uganda.
(Clarke International University, 2022-01) Owachi, Deirdre
Introduction: Over the years, mental health disorders such as depression have increasingly become a major public health concern. University students are at a crucial transitional stage in their lives, where they experience various personal, social, and economic challenges. These challenges predispose them to depression, affecting an individual’s ability to function at school or work or cope with daily life. Objective: This study was aimed at assessing the prevalence of depression and its’ associated factors among students of Clarke International University, Kampala Uganda. Methodology: An analytical cross-sectional study design was used. Self-administered research questionnaires were used for data collection, and the BDI II tool was used to measure the prevalence of depression. A total of 361 students from the four main faculties of the university participated in the study. Results: The overall prevalence of depression was 16.1%. In terms of severity, 10.8% had mild depression, 3.6% had moderate depression and 1.7% had severe depression. Conclusion: The study revealed that depression among the students was significant to the academic performance of the student as a demographic factor, and family history with depression, conflicts within the family, and student nationality status as social factors. There was no association between depression and economic factors. Recommendations: The university should develop new and culturally sensitive innovations aimed at managing depression among the students
Determination of the levels of mental health literacy in Uganda
(IHSU, 2012-11) NANYONJO, HENRIETTA LYDIA
Background: The advancement of mental health literacy is important for the integration of mental health care services into primary health care. Little is known about the knowledge of and attitude to mental illness in sub-Saharan Africa and Uganda in particular. From the evidence perused in the literature, the researcher observed that communities with sound mental health knowledge and a positive attitude towards mental illness are motivated to seek professional help, whilst communities with a lack of mental health knowledge and a negative attitude towards mental illness are less motivated to seek professional help. Aims: The study aimed to determine the knowledge and attitudes of the Oyam community members towards mental illness. Methodology: A descriptive, cross sectional survey, with a quantitative approach. An adjusted, existing questionnaire, with, self-compiled, closed ended questions, was used to collect data on the level of knowledge, awareness and attitudes about mental illness. 400 respondents were randomly selected from 5 villages in Loro sub county Oyam district. Results: Poor knowledge of causation was common. Negative views of mental illness were widespread, with as many as 96.5% (s.d. =0.5) believing that people with mental illness are dangerous because of their violent behavior. Most would not tolerate even basic social contacts with a mentally ill person: 82.7% (s.e. =1.3) Conclusions: There is indeed a significant relationship/ association between awareness, attitudes and mental health seeking behavior. For example 40%-50% of the variance in mental health seeking behavior is explained by the attitudes towards mental ill health and the level of awareness about mental health. This indicates that community knowledge, attitudes and awareness affect mental health seeking behavior.
Assessing Uptake Of Hepatitis B Services Among Female Sex Workers In Masaka Municipality,Masaka District.
(CIU, 2017-11) Nalutaya, Sophie
ABSTRACT Background: Hepatitis B is an important public health problem; although it is often asymptomatic initially, the long-term complications include cirrhosis and hepatic cancer, diseases that kill about a million people worldwide each year. Sexually Transmitted Infections (STIs) like hepatitis B are usually concentrated in core groups, such as female sex workers (FSWs). who have a high number of partners and receive poor health care. Hepatitis B is a common infection that is often asymptomatic and can have chronic and serious outcomes, including chronic hepatitis, fulminant liver failure and hepatocellular carcinoma (NICE, 2016. This study is about assessing the uptake of Hepatitis B services among female sex workers in Masaka Overall Objective: To assess the uptake of hepatitis b services among female sex workers in Masaka Municipality. Specific Objectives were: To determine the proportion of female sex workers accessing Hepatitis B services; To establish the individual attributes of the female sex workers seeking Hepatitis B services; To determine the level of susceptibility on Hepatitis B virus among female sex workers and to determine the health services factors influencing uptake of Hepatitis B services in Masaka Municipality Methodology :A quantitative, descriptive cross sectional study design was used to investigate uptake of the Hepatitis B services among female sex workers in Masaka Municipality. The design sought to describe the current status of an identified variable or phenomenon. The sampling procedure that was used consisted of mapping of the hot spots for female sex workers and This was followed by Snow balling where the first participant interviewed was asked to identify other potential respondents. The total sample size was 138 Participants was recruited using the respondent- driven sampling technique, which has been shown to be reliable for conducting studies in hard to reach groups and samples (Wejnert, 2009). Mapping was done to identify FSW sites and the hangouts were clearly marked out. Data was collected using structured researcher-administered questionnaire was used to obtain information on respondent’s socio-demographic characteristics, knowledge of HVB infection, risk perception and Hepatitis B vaccination status. It was analysed using univariate, bivariate and multivariate levels. Results :The results in this study showed that uptake of Hepatitis B services was low at only a paltry 27% (29.7) among the respondents in in the study area had ever been screened and received a test result (negative or positive). Amongst these, 23.6% (25.9) had tested negative while 3.6% (3.9) had tested positive whereas only one did not know here results. All individual attributes of the female sex workers did not have a significant relationship with the uptake of Hepatitis B services. The Bivariate analysis for the relationships between baseline characteristics and uptake of hepatitis screening services showed that age (p = 0.118), education status (p = 0.184), marital status (p = 0.699), religious affiliation (p = 0.738), and income level (p = 0.438) did not have a xsignificant relationship with the uptake of Hepatitis B services uptake among female sex workers. This study found significant relationships between level of susceptibility on Hepatitis B virus among female sex workers in Masaka Municipality. These were: HCW having ever heard about Hepatitis B infection (χ2 = 10.905, P value = 0.001*) at 0.05 confidence level. There was also a significant association with the modes of transmission noted such as shaking hands (χ2 = 4.551, P value = 0.033*); sexual contact with infected person (χ2 = 19.606; P value = 0.000) and other factors (χ2 = 8.142 and P value = 0.004*) at 0.05 confidence level. Conclusions: the uptake of Hepatitis B services among female sex workers is low at 27%. All individual attributes of the female sex workers did not have a significant relationship with the uptake of Hepatitis B services. This study established a significant relationship between level of susceptibility on Hepatitis B virus among female sex workers. Finally, there was a significant association between uptake of Hepatitis B among the female sex workers and location of these services, privacy and confidentiality, transport costs and presence of outreach clinics
Compliance To Occupational Health And Safety Guidelines Among Workers In Kakira Sugar Factory
(CIU, 2017-11) Belinda, Tumushabe
ABSTRACT Introduction: The Sugar industry is one of the important agro-based industries not only in Uganda but also in the world which directly contributes to creating employment, income and social developments in the rural areas of the country. (Rossi-Rocha, 2007). Employees in this industry are exposed to health and safety hazards in their workplaces arising from various activities involved in sugar production. failure to comply with OHS guidelines exposes workers to accidents, ill health, morbidity and in severe forms mortality. Objectives: The objectives of the study were to assess the level of compliance to the OHS guidelines. (study PPE use), To also determine the Individual and environmental factors of compliance to OHS guidelines among factory workers in Kakira sugar factory. Methodology: A cross sectional survey design was employed, the target population were workers of Kakira sugar factory. A sample of 266 workers was established using probability sampling, these were interviewed and quantitative data obtained, 2 key informants were interviewed for an in depth understanding of OHS practices at the factory. Analysis was done using SPSS, findings presented as frequencies for descriptive data, Bi-variant analysis done using Chi square at 0.05 level of significance, Multi-variant analysis done using Regression on all the significant factors. Results were illustrated in form of Tables and figures. Results; The key findings were that (119(44.7%) of the respondents complied with the guidelines while 147(55.3%) did not comply. Finding of the individual factors were that; Workers who were trained were 6.6 times more likely to comply than those not trained, men were 0.1 times less likely to comply to guidelines compared to females, those that acknowledged susceptibility to injury were 4.6 times more likely to comply than those who did not feel susceptible, those that worked less hours were 4.2 times more likely to comply compared to those who work longer hours and those who were satisfied with their job were 4.3 times more likely to comply to comply to the guidelines compared the dissatisfied. Findings of the environmental factors were that; the respondents who agreed to PPE availability were6.5 times more likely to comply to the guidelines compared to those that disagreed. Those who agreed that OHS supervision was done were 2.3 times more likely to comply than those that disagreed. those that were in agreement that equipment maintenance was done as required were 1.7 times more likely to comply than those that disagreed, the workers that agreed to training being conducted for staff were1.5 times more likely to comply compared to those that disagreed and the workers that agree to PPE being adequate were1.4 times more likely to comply compared to those that disagreed. Conclusion and recommendations: With more than 50% of the respondents reporting non- compliance. The administration should put up strategies like supervision to ensure workers comply with stipulated OHS guidelines, avail adequate amounts of PPE, train the staff on OHS, do maintenance of equipment as required, motivate staff and employ a shift method of working. The employees also have a role to play by using the available PPE and following the stipulated guidelines.
Assessment Of Satisfaction With Life Among Elderly Patients Receiving Hiv Care And Treatment In Mulago Hiv Clinic
(CIU, 2018-11) Kalule; Kizito
Abstract Background: This study aimed at assessing satisfaction with life among elderly HIV patients attending Mulago HIV Clinic. Method: A cross-sectional study design carried out among elderly people (> 50 years old) attending Mulago HIV clinic, as stated by the WHO standard age cut-off of > 50 years. A random selection of 353 elderly HIV patients was made. The study collected quantitative data to assess patient satisfaction with life, Illness related discrimination, Barriers to healthcare and social services, and Physical well being, social support and coping using quantitative data collection techniques. Interview discussions were harnessed to obtain patients‟ opinions and perceptions and then results grouped into themes. EPIDATA and STATA 14.2 statistical software were used for statistical analysis Results: Results from the study showed that only variables that were significantly associated at multivariate level are; disagreeing that other patients are seen before you when you are first to arrive, which had an odds ratio of 2.87, disagreeing that your employer can never promote you which had an odds ratio of 6.87 compared to agreeing, Not being sure whether friend or family member cannot share room/utensil/clothes with you reduced the odds of being satisfied by 95% when compared to agreeing and disagreeing that friend or family member blames you for not getting better with an odds ratio of 5.65 compared to agreeing. Recommendations: This study unearthed existing gaps in levels of satisfaction. These shortfalls in the service delivery can be addressed according to the following recommendations below: Create a quick way for elderly patients to see a clinician and give them priority, provide more work-related support awareness programs; Put more efforts counseling care takers or family members who help them to adhere or socialize with them.
Assessment Of Determinants Influencing Utilisation Of Sexually Reproductive Health Services Among Adolescent Mothers In Adolescent Mothers In Adekokwok Sub County,Lira District.
(CIU, 2017-11) Bua, Jane
ABSTRACT Background: Adolescent sexual and reproductive health is a global health concern, many adolescent are vulnerable to sexual health challenges and the most vulnerable are the adolescent mothers. The government of Uganda has put in place various efforts to address this gap both in policy and planning however, indicators still reveal that Uganda has a teen age pregnancy rate of 25%, an unmet contraceptive need among married adolescents of 32%, a HIV prevalence rate of 3.7% among adolescents (UBOS and ICF, 2017, MoH Uganda, 2012). Objective: The study aimed at establishing the determinants influencing utilization of adolescent sexual and reproductive health services among adolescent mothers in Adekokwok Sub County, Lira district. Method: The study used an analytical cross sectional study design, employing purpose sampling method to identify the study respondents. A total of 288 adolescent mothers were reached using researcher administered semi-structured questionnaires and a questionnaire guide was used to collect information from the key informants. Data were entered and analyzed using SPSS version 20. Results: The proportion of adolescent mothers utilizing adolescent sexual and reproductive health services was established at 87.5%. Marital status (p=0.001), perceived skill of health worker to provide care (p=0.036), Health worker being friendly and providing a listening ear to the adolescents (0.030), culture prohibiting use of ASRH services (p=0.025), affordability of associated costs of acquiring adolescent sexual and reproductive health services (p=0.003) were found to be statistically significant to utilization of sexual and reproductive health services by adolescent mothers in Adekokwok Sub county, Lira district. Conclusion and recommendation: The study findings indicated utilization of adolescent sexual and reproductive health services was at 87.5% and determinants of utilization by adolescent mothers included; marital status. Perceived skills of health workers, cultural influence, and affordability of associated cost. In order for utilization of sexual and reproductive health services by adolescent mothers to be improved and sustained, it is recommended that Awareness raising must be made on available services at the health facilities, capacity of health workers should be built to offer adolescent friendly services, design mechanisms within the health facilities to create adolescent friendly spaces and drug stock levels should be improved at the health facilities
The Prevalence And Associated Risk Factors Of Needlestick And Sharps Injuries Among Nursing Students In Mayanja Memorial And Rakai Community Nursing Schools
(CIU, 2017-11) Akwang; Alura, Christine
ABSTRACT Background: Needle stick and other sharps injuries have been recognized as one of the most common occupational hazards among health care workers. They increase the spread of blood borne pathogens like HIV, Hepatitis B and Hepatitis C. Most research studies focus on Doctors, Nurses and other Health Care Workers (HCW), but at the same time, student nurses in clinical placements are at equally high risk. Despite the advent of safety measures to protect the health care workforce from contracting blood borne diseases, nurses still sustain percutaneous injuries. This study aimed at investigating the prevalence, associated risk factors and measures used to manage needle stick and sharps injuries among student nurses. Objective: To determine the prevalence, individual and institutional factors predisposing to needle stick and other sharps injuries among nursing students. Methodology: A comparative cross sectional study was conducted of student nurses in Rakai community and Mayanja memorial schools of nursing, using a structured, pre-tested/validated self-administered questionnaire. The respondents consisted of 378 student nurses. Data was analysed using SPSS version 20. Findings: A total number of 378 nursing students from Rakai community and Mayanja memorial training institutes were interviewed. The results show that 70.1% were females and 29.9% were male nursing students. The predisposing factors for needle stick injuries include: year of study (χ2=5.823, p= 0.054), medical instruments (χ2=15.738, p= 0.03), reasons why nursing students did not receive PEP (χ2=20.368, p= 0.001), the presence of written protocol/procedures on disposal of needles/sharps (χ2=13.197, p= 0.001), the number of hepatitis B doses received (χ2=8.018, p= 0.046), availability of PEP protocols in the practice setting (χ2=5.886, p= 0.053) and training of students in the management of PEP (χ2=5.040, p= 0.025). Conclusion: The occurrence of needle stick and sharps injuries among student nurses was found to be quite common. Keywords: needle stick and sharps injuries, nursing students
Awareness,Perception And Implementation Of Comprehensive Sexuality Education:
(CIU, 2017-11) Ogolla, Mercelline
ABSTRACT Background: Few young people receive adequate preparation for their sexual lives leaving them potentially vulnerable to coercion, abuse and exploitation, unintended pregnancy and sexually transmitted infections, including HIV. A school set up provides an environment where many young people can be reached with education related to their sexuality. The critical role of teachers in sexual health promotion can therefore not be over emphasized. Research has shown that comprehensive sexuality education can help young people abstain from or delay the onset of sexual relations; reduce the frequency of unprotected sexual activity; reduce the number of sexual partners; and increase the use of protection against unintended pregnancy and HIV/STIs during sexual intercourse. This study sought to establish the awareness, perception and implementation of comprehensive sexuality education by teachers in secondary schools in Kisumu central subcounty, Kenya. Methods: This was a cross sectional study, with a descriptive exploratory design. The study population comprised of teachers in the secondary schools in Kisumu Central SubCounty. A total of 170 teachers from 11 schools participated in the study. Both purposive and simple random sampling techniques were applied in obtaining respondents in each school. The first stage involved purposive sampling of the teachers with designated responsibilities to counsel students. Subsequently, simple random sampling was used to select an additional 15 teachers. Quantitative data was collected through the use of a self administered questionnaire and an observation checklist, while qualitative data was collected through key informant interviews using a semi structured interview guide. Quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 21. Descriptive statistics such as proportions were used to summarize categorical variables. Qualitative data obtained from responses in the key informant interviews, was analyzed using a thematic approach. The transcripts were annotated and emerging themes were identified. Findings were then presented using frequency tables, pie charts, narratives, and triangulated with qualitative data in verbatim form. Results: The study found low level of awareness on issues of CSE. Most teachers have not undergone comprehensive sexuality education training and there is low knowledge in key topics such as HIV/STIs, condom use, benefits of abstinence and contraception. The study established that teachers understand the need and importance of CSE, and are ready and willing to provide CSE, but personal biases, opinions and valuesrelated to sexuality education threaten the delivery of CSE as most teachers opt to handle only topics they are comfortable with. CSE is not included in the secondary school curriculum and therefore there is no structured way of teaching it. In addition, teachers use more of nonparticipatory approaches to deliver CSE as compared to participatory approaches. Resource materials for teaching CSE ( teachers guides and students manuals) are not available and therefore there is no uniformity in the information being delivered to students, which further implies that secondary school students are not receiving CSE in its entirety. Conclusion: The study concluded that teachers despite teachers acknowledging the need for and importance of comprehensive sexuality education, but its delivery is limited by lack of training, inadequate time allocation for CSE lessons, and lack of teaching resources amongst other challenges. Recommendations: It was recommended that all teachers be trained in comprehensive sexuality education. This will ensure that all teachers are able to support the delivery of CSE. Key topics in CSE such as HIV/STIs, condom use, benefits of abstinence and contraception should be included in the preservice teachers’ course and CSE as a whole incorporated into the inservice teacher trainings. This will help the teachers acquire accurate and scientific knowledge related to the topics and be better able to handle the topics while teaching students. The Ministry of Education should support teachers to implement CSE by incorporating it in the secondary school curriculum. This will ensure a structured way of teaching and time allocated for CSE, standard information on CSE being taught and will enhance its delivery. More research should be conducted to determine the most effective approaches and methodologies that can be used to deliver CSE. The MOE should ensure that resource materials (teaching guides and student’s manuals) are available in all schools. This can be done by enhancing partnerships with nongovernmental organizations with interest in the field of reproductive health. This will ensure that standardized information is communicated to the students across the country.
Determinants Of Hepatitis B Vaccine Uptake Among Adults In Soroti Municipality, Soroti District.
(CIU, 2017-11) Odele, Stephen
ABSTRACT Background: Globally, an estimated 2 billion persons are exposed to HBV infection and another 400 million of these individuals exposed are living with Chronic Hepatitis B infection, with 248 million chronic carriers particularly in the developing countries. The WHO estimates indicate that 90% of HBV related deaths are associated with chronic HBV infection while less than 10% are associated with acute infection. In Uganda 3.5 million (10%) of the exposed population are infected with HBV,30% of those infected are chronically ill and requires treatment and 16 million are eligible for vaccination of which 9.24% have been a screen to be positive across the country. Presently, by region HBV prevalence in Uganda is a range as follows; northeast 23.9%, North-Central 20.7%, West Nile 18.5%, Western 10%, Kampala 5.3%, Central 6.2% while South-West with 3.8% (MOH, 2013; Ocama, 2014). HBV infection is real and exists in Soroti Municipality, Soroti District though there is limited scientific evidence to support the claim. The government initiative to vaccinate eligible adults in the municipality against HBV is on-going but this has not significantly altered the trend of HBV infection rates. Methods: This study set out to assess determinants of uptake of HBV Vaccine among adults in Soroti Municipality, Soroti district. A descriptive cross-sectional study to assess uptake of HBV vaccine among adults in Soroti Municipality was adopted, only quantitative data was collected. Primary data was collected alongside a review of the literature. The study population were adults of age 18 years and above who had received at least one dose of the HBV vaccine during the HBV vaccination campaign in Soroti Municipality. A sample size of 382. Probability sampling was used to establish a sample size. The dependent variable was “Uptake of HBV vaccination, while the Independent Variables in the study were Individual Attributes, Community Systems and Health Services Factors. Structured questionnaires were used; data analysis was done at Univariate, Bivariate and Multivariate levels. Research committee clearance was sought. Results: Only 57.43% of 249respondents had vaccinated. Respondents who received four doses of the vaccine were 10 times most likely to go for HBV vaccination OR=10.181; 95% CI (1.78-58.218) (p-0.009). Respondents who got their next vaccine dose for more than six months were 44 times most likely to go for another vaccination compared to those whose got after some months OR=44.774;95%CI(1.030-1947)(p-0.048). Respondents who revealed that they don‟t know when they got their next dose was 5 times more likely to get another compared to those who received their next dose after one month OR=5.187;95%CI(1.254-21.448)(0.0235) and OR=4.727;95%CI(1.063-21.023)(p-0.041). Respondents who spent more than five hours to be screened were 28 times most likely to quit HBV vaccination compared to those who take less than that time OR=28.981;95%CI(2.327-360.897)(p-0.009). Respondents who reported unavailability of vaccine at the health facility were 0.011 times less likely to be vaccinated compared to those who faced other barriers OR=0.011; 95%CI (0.000-0639) while respondents who reported syringes out of stock had 0.046 times fewer odds of being vaccinated unlike those who were not hindered by factors OR=0.046; 95%CI (0.011-0.198) (p-0.000). Support from local leaders on HBV vaccination X2=11.697(0.001), the kind of support offered by local leaders X2=15.817(p-0.007), community members awareness about HBV X2=8.44(0.004). Vaccination awareness conducted was also found influential X2=6.905(p-0.009), and community perception in regards to HBV vaccination uptake X2=10.921(p-0.012). Respondents who completed their doses to HBV vaccination uptake X2=19.238(0.000); respondents who revealed it’s important to vaccinate against HBV with X2=14.071(p-0.007); HBV vaccination uptake among adults was influenced by a number of doses the respondent had received X2=15.798(p-0.003) and the period taken to get the next dose X2=49.756(p-0.000). Conclusion: Only 57.43% of 249respondents had vaccinated. Number of doses a respondent had received, support from local leaders on HBV vaccination and the kind of support, vaccination awareness, number of doses received, not knowing where to get the next dose, individuals who spent more than five hours to be screened, existing barriers to vaccination, unavailability of vaccine at the health and syringes out of stock out were some associated with uptake of the HBV vaccine.

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