Prevalence and factors associated with sexual and reproductive health literacy among youth living with HIV in Uganda: a cross-sectional study.

BACKGROUND: Adequate sexual and reproductive health literacy (SRHL) among young people has been linked to informed sexual behaviours. Studies on SRHL have largely been conducted among the general adolescent population. Little is known about youth aged 15-24 years living with human immunodeficiency virus (YLHIV). There is a possible lack of SRHL in this population, considering the high rate of teenage pregnancies and unprotected sex reported by YLHIV. This study aimed to assess the prevalence and associated personal and environmental factors for SRHL among YLHIV at a high-volume urban HIV Clinic in Uganda. METHODS: Through a cross-sectional survey, YLHIV receiving routine HIV care services at Baylor-Uganda HIV Clinic were interviewed using an adapted European Health Literacy Survey (HLS-EU). Using simple random sampling, eligible youth who received HIV care services between August and November 2019 were enrolled in the study. SRHL scores were computed using the HLS-EU index method; and individuals whose scores ranged from 34 to 50 were considered health literate. We used descriptive statistics to determine the prevalence. Potential associated personal and environmental factors (p<0.05) were identified by performing two-step inferential statistics, bivariate analysis and binary logistic regression. Odds ratios were calculated to estimate the likelihood of youth being health literate on sexual and reproductive health (SRH) issues in comparison with the reference categories, and 95% confidence intervals were determined to establish whether the relationships were statistically significant. RESULTS: Of the 267 YLHIV interviewed at Baylor-Uganda HIV Clinic, 167 (62.5%) were female with a mean age of 18.9 years (SD± 2.8), and the majority (242; 90.6%) were vertically infected with HIV. Only 52 (19.5%) were health literate on SRH issues. At the multivariate level, YLHIV who never had difficulty accessing SRH information were 0.391 times less likely to be health literate on SRH issues than their counterparts with challenges in accessing SRH information (Adjusted Odds Ratio [AOR] = 0.391, 95% CI =0.178 to 0.860; p= 0.019). YLHIV who did not find it easy to access SRH care service points were 2.929 times more likely to be literate in SRH than those who found it easy to access such services (Adjusted Odds Ratio [AOR] = 2.929, 95% CI =1.241 to 6.917; p=0.014). Additionally, YLHIV who did not listen to radio health talks were 2.406 times more likely to be health literate on SRH issues than those who did (AOR = 2.406, 95% CI =1.133 to 5.112; p=0.022). CONCLUSIONS: SRHL is an unmet need among YLHIV; only 19.5% were health literate on SRH issues. This could complicate the achievement of the UNAIDS sustainable development goal (SDG) of an HIV/AIDS-free generation by 2030 because low health literacy (HL) skills can affect the efficacy of almost all HIV disease prevention and health promotion efforts. Inaccessible SRH care service points and not listening to radio health talks were positively associated with SRHL, while having access to SRH information was negatively associated with SRHL.

The contribution of social norms and religious practices towards low death registration in 3 HDSS sites of Uganda.

BACKGROUND: Uganda has low levels of death registration, estimated at two per cent by the National Identification and Registration Authority (NIRA). There are 56 tribes and over 5 religious denominations with so many social norms and religious practices that could have contributed to low death registration in Uganda. Previous studies on the factors affecting death registration have not assessed the contribution of social norms and religious practices toward low death registration in developing countries. METHODS: A qualitative study design was adopted to examine the contribution of social norms and religious practices toward low death registration in the 3 Health and Demographic Surveillance systems (HDSS) sites of Uganda. The methods of data collection included: focus group discussions, key informant interviews, and a document review of the death registration booklet. 6 FGDs, 2 from each HDSS site were conducted comprising 1 female FGD of 10 participants and 1 male FGD of 10 participants. In addition, 26 key informant interviews were conducted with the district leaders, local council leaders, health care workers, cultural leaders, elderly, HDSS scouts and religious leaders in the 3 HDSS sites. RESULTS: In the 4 sub-counties and 1 town council where the study was conducted, only 32 deaths were registered with NIRA, the Civil Registration authority in Uganda for the entire year from 1st January to 31st December 2020. The study shows that social norms and religious practices have contributed to the low death registration in the 3 HDSS sites in Uganda. Social norms and religious practices either hinder or discourage death registration initiatives by the government of Uganda. It was found out that burials that take place on the same day of death discourage death registration. Cultural taboo to announcing the death of infants, neonates, twins and suicides in the community hinder death registration. The burying of a woman at her parent's house after bride price payment default by the family of a husband discourages death registration. The religious institutions have their own set of rules, practices, and norms, which in most cases discourage death registration. For example, religious leaders refuse to lead funeral prayers for non-active members in religious activities. Results also showed that mixed religions in families bring about conflicts that undermine death registration. Lastly, results showed that traditionalists do not seek medical treatment in hospitals and this hinders death registration at the health facilities. CONCLUSION: The study shows that death registration is very low in the 3 HDSS sites in Uganda and that social norms and religious practices contribute greatly to the low death registration. To overcome the negative effects of social norms and religious practices, a social behaviour campaign is proposed. In addition, community dialogue should be conducted to identify all negative social norms and religious practices, how they are perpetuated, their effects, and how they can be renegotiated or eliminated to bring about high death registration in the 3 HDSS sites of Uganda. Lastly, there is a need for partnerships with cultural and religious leaders to sensitize community members on the effect of social norms and religious practices on low death registration in the 3 HDSS sites in Uganda.

Low Contraceptive Use among Young Females in Uganda: Does Birth History and Age at Birth have an Influence? Analysis of 2011 Demographic and Health Survey.

BACKGROUND: Globally adolescent fertility has been associated with increased risk to maternal and child health morbidity and mortality. The low use of contraception has been associated with high fertility levels, which is remains a public health concern that efforts have been raised to avert this. We examine the influence history of a previous birth and age at first birth would have on young women's use of contraception. METHODS: Using the 2011 Uganda Demographic and Health Survey data, we examine the predictors of contraceptive use on a sample of 3692 young females in Uganda. While controlling for education and age of respondents, logistic regression analyses were run to provide the net effect of the examined predictors on contraceptive use. The study variables included age of respondents, marital status, age at first birth, births in past five years, socioeconomic status, residence, region, education level, religion, occupation and whether the last child was wanted. RESULTS: The findings show that only 12% of the adolescents were using contraception at the time of the survey. The key predictors of contraceptive use among young women in Uganda were age at first birth, history of previous birth, current age, and place of residence, education and socioeconomic status. Respondents who had a birth in the 5 years prior to the survey had five times (OR = 5.0, 95% CI = 3.7-6.5) the odds of contraceptive use compared to those who had never had a birth. Further, adolescent females with at least a secondary education were more likely to use contraceptives (OR = 1.55, 95% CI = 1.2-2.0) than those with primary education. The odds of contraceptive use were least among adolescents from Northern region (OR = 0.39, 95% CI = 0.2-0.6) compared to those from central region of Uganda. Muslim adolescent females were more likely to use contraceptives compared to Catholics (OR = 1.59, 95% CI = 1.1-2.3). CONCLUSION: There is great need to address issues that hinder young people from using contraception. Use of contraception and improving access to the services is highly recommended to avert some of the unplanned births among these females.

An investigation on factors associated with malnutrition among underfive children in Nakaseke and Nakasongola districts, Uganda.

BACKGROUND: Malnutrition is one of the major causes of mortality and morbidity among under-five children in Sub Saharan Africa. To understand the factors associated with malnutrition among under-five children, a study was conducted in Nakaseke and Nakasongola districts of Uganda. METHOD: Cross sectional secondary data of 104 underfive children in Nakaseke and Nakasongola districts was used. Epi Info programme-Nutrition module and Stata statistical softwares were used in analyses. Descriptive statistics, cross tabulations and binary logistic regression results were generated. RESULT: Stunting was found to be the most malnutrition condition with the highest prevalence (38.5%) in the two districts followed by wasting (16.5%) and underweight (13.5%) respectively. Results also showed that children aged 39-59 months were less likely to be underweight than those aged below twelve months. Children of peasant farmers were more likely to be stunted than their counterparts with mothers in pastoralist's family. No significant factors were found to be associated with wasting among the underfive children in the two districts although the prevalence was slightly higher than that of child underweight. CONCLUSION: The study is essential in pointing out the particular age-groups among underfive children as well as the maternal occupations that may be factors associated with malnutrition in the districts of Nakaseke and Nakasongola. The author recommends exclusive breast feeding and proper complementary feeding especially among children under three years. Furthermore, special arrangement could be put in place to have children of mothers engaged in cultivation brought to them regularly for breastfeeding.