Coverage and Socioeconomic Inequalities in Cervical Cancer Screening in Low- and Middle-Income Countries Between 2010 and 2019.

PURPOSE: Cervical cancer screening is vital in addressing the global burden of cervical cancer. In this study, we describe the coverage and socioeconomic inequalities in the coverage of cervical cancer screening in low- and middle-income countries (LMICs). METHODS: We analyzed data from the women's recode files of the Demographic and Health Surveys conducted in LMICs from 2010 to 2019 with variables on cervical cancer screening. We included women 21 years or older and determined the proportion of women who were screened for cervical cancer by age categories, wealth quintile, type of place of residence, level of education, and marital status. Socioeconomic inequality was measured using the concentration index (CIX) and the slope index of inequality (SII). RESULTS: A total of 269,506 women from 20 surveys in 16 countries were included in the survey. Generally, there was a low coverage of screening, with lower rates among women age 21-24 years, living in rural areas, in the poorest wealth quintile, with no formal education, and who have never been in union with or lived with a man. The CIX and SII values for screening for cervical cancer were positive (pro-rich) for all the countries except Tajikistan in 2012 where they were negative (pro-poor). CONCLUSION: The coverage of cervical cancer screening was low in LMICs with variations by the quintile of wealth (pro-rich) and type of place of residence (pro-urban). To achieve the desired impact of cervical cancer screening services in LMICs, the coverage of cervical cancer screening programs must include women irrespective of the type of place and wealth quintiles.

Prevalence of discontinuation of contraceptives due to failure among women aged 14 to 49 years in Uganda: a nation wide cross-sectional survey.

BACKGROUND: Sustained motivation is essential for effective use of contraceptive methods by women in low- and middle-income countries as many women are likely to abandon contraceptives, especially when they continually experience episodes of failure. We aimed to determine the prevalence of discontinuation of contraceptives due to failure and its associated factors among Ugandan women aged 14-49 years. METHODS: A cross sectional study was conducted using the UDHS 2016 data. Multi stage stratified sampling was used to select participants. All eligible women aged 15 to 49 years at the time of the survey were enrolled. Bivariable and Multivariable logistic regression analysis were used to determine the factors associated with contraceptive failure. All analysis were done using Stata version 13. Contraceptive failure (getting pregnant while on contraceptives) within five years preceding the survey was the dependent variable. RESULTS: A total of 9061 women were included in the study. The overall prevalence of contraceptive failure was 5.6% [n = 506, 95% CI: 5.1-6.1] and was higher (6.2%) among women aged 20-29 years or had completed secondary education (6.1%). Having informed choice on contraceptives [aOR = 0.59, 95% CI: 0.49 - 0.72] and older age [aOR = 0.46, 95% CI: 0.24-0.89] were associated with lower odds of contraceptive failure. CONCLUSION: The burden of contraceptive failure among women of reproductive age in Uganda is substantial and significantly varied by women's age, level of education, exposure to the internet, mass media, and informed choice. These findings highlight the need for improved counseling services and contraceptive quality to help women and couples use methods correctly and consistently.

Negative experiences and coping strategies to stressful situations by undergraduate University students during Covid- 19 lockdown period in Uganda.

Aim: To describe the negative experiences, coping strategies for stressful situations, and factors associated with COVID-19 worry among undergraduate students at Makerere University during the second COVID-19 lockdown in Uganda. Methods: Descriptive cross-sectional study at Makerere University. Negative experiences and coping strategies were measured using a semi-structured questionnaire formulated based on literature and findings from previous studies on mental health and COVID-19. Descriptive statistics and measures of association were done using Stata 13. Results: A total of 301 participants were enrolled. Their median age were 23 years. The majority were male (192, 64.0 %), single (269, 89.7 %,) and on normal academic progress (241, 80.3 %). 48.0 % of the participants were worried about COVID-19. Disruption of students' academics (277, 92.0 %) and financial problems (184, 61.1 %) were the most reported negative experiences. Coping strategies included listening to music (203, 67.4 %), talking to family and friends (191, 63.5 %,) and watching movies (174, 57.8 %). Female students than males (aOR: 2.0, 95% CI: 1.0-45.0, p= 0.118) and students without paid employment than those with paid work (aOR: 2.2, 95% CI: 1.0-5.0, p=0.109) were more worried about COVID-19. Conclusion: Nearly half of the students were worried about COVID-19, which disrupted their social and academic lives. The students utilized a myriad of coping strategies.

Double Face Mask Use for COVID-19 Infection Prevention and Control Among Medical Students at Makerere University: A Cross-Section Survey.

INTRODUCTION: The second wave of COVID-19 greatly affected the health care and education systems in Uganda, due to the infection itself and the lockdowns instituted. Double masking has been suggested as a safe alternative to double-layered masks, where the quality of the latter may not be guaranteed. This study aimed to determine patterns of double mask use among undergraduate medical students at Makerere University, Uganda. METHODS: We conducted a descriptive cross-sectional study using an online questionnaire. All students enrolled at the College of Health Sciences; Makerere University received the link to this questionnaire to participate. Logistic regression analysis was used to assess factors associated with double mask use. RESULTS: A total of 348 participants were enrolled. The majority (61.8%) were male; the median age was 23 (range: 32) years. Up to 10.3%, 42%, and 4.3% reported past COVID-19 positive test, history of COVID-19 symptoms, and having comorbidities, respectively. Up to 40.8% had been vaccinated against COVID-19. More than half (68.7%) believed double masking was superior to single masking for COVID-19 IPC, but only 20.5% reported double masking. Participants with a past COVID-19 positive test [aOR: 2.5; 95% CI: 1.1-5.8, p = 0.026] and participants who believed double masks had a superior protective advantage [aOR: 20; 95% CI: 4.9-86.2, p < 0.001] were more likely to double mask. Lack of trust in the quality of masks (46.5%) was the most frequent motivation for double masking, while excessive sweating (68.4%), high cost of masks (66.4%), and difficulty in breathing (66.1%) were the major barriers. CONCLUSION: Very few medical students practice double masking to prevent COVID-19. Coupled with inconsistencies in the availability of the recommended four-layered masks in Uganda and increased exposure in lecture rooms and clinical rotations, medical students may be at risk of contracting COVID-19.

Socioeconomic inequalities in prostate cancer screening in low- and middle-income countries: An analysis of the demographic and health surveys between 2010 and 2019.

INTRODUCTION: Prostate cancer screening is a valuable public health tool in the early detection of prostate cancer. In this study, we aimed to determine the socioeconomic inequalities in the coverage of prostate cancer screening in Low and Middle-Income Countries (LMICs). METHODS: This was a retrospective analysis of men's recode data files that were collected by the Demographic and Health Surveys (DHS) in LMICs (Armenia, Colombia, Honduras, Kenya, Namibia, Dominican Republic, and the Philippines). We included surveys that were conducted from 2010 to 2020 and measured the coverage of prostate cancer screening and the study population was men aged 40 years or older. Socioeconomic inequality was measured using the Concertation Index (CIX) and the Slope Index of Inequality (SII). RESULTS: Eight surveys from seven countries were included in the study with a total of 47,863 men. The coverage of prostate cancer screening was below 50% in all the countries with lower rates in the rural areas compared to the urban areas. The pooled estimate for the coverage of screening was 10.4% [95% CI, 7.9-12.9%). Inequalities in the coverage of prostate cancer screening between the wealth quintiles were observed in the Democratic Republic, Honduras, and Namibia. Great variation in inequalities in the coverage of prostate cancer screening between rural and urban residents was observed in Colombia and Namibia. CONCLUSION: The coverage of prostate cancer screening was low in LMICs with variations in the coverage by the quintile of wealth (pro-rich) and type of place of residence (pro-urban). POLICY SUMMARY: To achieve the desired impact of prostate cancer screening services in LMICs, it is important that the coverage of screening programs targets men living in rural areas and those in low wealth quintiles.