Sexual behaviours among adolescents in a rural setting in eastern Uganda: a cross-sectional study.

OBJECTIVE: Globally as adolescents transition into adulthood, some engage in risky sexual behaviours. Such risky behaviours expose adolescents to unintended pregnancy and sexually transmitted infections (STIs), including HIV infection. Our objective was to examine sexual practices of adolescents (aged 10-19 years) in eastern Uganda and identify factors associated with having ever had sexual intercourse. METHODS: Face-to-face interviews were conducted using a standardised questionnaire among randomly selected adolescents residing within the Iganga-Mayuge Health and Demographic Surveillance Site in eastern Uganda. Crude and adjusted prevalence rate ratios (PRR) were estimated using the Modified Poisson regression model to identify factors associated with adolescents having ever had sex. RESULTS: Of the 598 adolescents studied, 108 (18.1%) reported ever having had sexual intercourse, of whom 20 (18.5%) had ever gotten pregnant. Adolescents who reported to be out of school, 76 (12.7%), were more likely to have ever had sexual intercourse (PRR = 1.82, CI = 1.09-3.01). Females were less likely to ever have had sexual intercourse (PRR 0.69 (0.51-0.93) than males. History of ever having had sexual intercourse was associated with adolescents sexting (PRR = 1.54, CI: 1.14-2.08), watching sexually explicit films (PRR = 2.29 Cl: 1.60 - 3.29) and experiencing verbal jokes about sexual intentions (PRR = 1.76, Cl: 1.27 - 2.44). CONCLUSIONS: A majority of participants reported not being sexually active; however, interventions should be required for both sexually active and not sexually active adolescents. Programmes targeted at adolescents in this and similar communities should include comprehensive sex education, and contraceptive distribution among adolescents. In particular, urgent interventions are needed to guide adolescents as they use social media.

OBJECTIF: Partout dans le monde, lorsque les adolescents passent à l'âge adulte, certains adoptent des comportements sexuels à risque. De tels comportements à risque exposent les adolescents à une grossesse non désirée et aux infections sexuellement transmissibles (IST), y compris l'infection à VIH. Notre objectif était d'examiner les pratiques sexuelles des adolescents (âgés de 10 à 19 ans) dans l'est de l'Ouganda et identifier les facteurs associés au fait d'avoir déjà eu un rapport sexuel. MÉTHODES: Des interviews de face à face ont été menées à l'aide d'un questionnaire standardisé parmi des adolescents sélectionnés au hasard, résidant sur le site de surveillance démographique et de santé d'Iganga-Mayuge, dans l'est de l'Ouganda. Les rapports de taux de prévalence (PRR) bruts et ajustés ont été estimés à l'aide du modèle de régression de Poisson modifié afin d'identifier les facteurs associés aux adolescents ayant déjà eu des rapports sexuels. RÉSULTATS: Sur les 598 adolescentes étudiées, 108 (18,1%) ont déclaré avoir déjà eu des rapports sexuels, dont 20 (18,5%) sont déjà tombées enceintes. Les adolescents qui ont déclarés être non scolarisés, 76 (12,7%) étaient plus susceptibles d'avoir déjà eu des rapports sexuels (PRR = 1,82 ; IC = 1,09-3,01). Les filles étaient moins susceptibles que les garçons d'avoir déjà eu des rapports sexuels (RPP de 0,69 (0,51-0,93)). Des antécédents d'avoir déjà eu des rapports sexuels étaient associés au sexting d'adolescents (PRR = 1,54 ; IC: 1,14-2,08), au visionnement de films sexuellement explicites (PRR = 2,29 Cl: 1,60 - 3,29) et avoir été confronté à des blagues sur les intentions sexuelles (PRR = 1,76 ; Cl: 1,27 - 2,44). CONCLUSIONS: Une majorité de participants ont déclaré ne pas être sexuellement actifs. Cependant, des interventions devraient être nécessaires pour les adolescents sexuellement actifs et non sexuellement actifs. Les programmes ciblés sur les adolescents de cette communauté et de communautés similaires devraient comprendre une éducation sexuelle complète et une distribution de contraceptifs à ces adolescents. Des interventions urgentes sont notamment nécessaires pour guider les adolescents dans leur utilisation des médias sociaux.

Dietary diversity and associated factors among adolescents in eastern Uganda: a cross-sectional study.

BACKGROUND: Globally adolescents constitute over 16% but in SSA, they make up 23% of the population. While little is known about diets of these adolescents, rapid changes in physiological and social processes undergone require adequate diets. This study aimed to determine dietary diversity and associated factors among adolescents residing in the Iganga -Mayuge HDSS. METHODS: As part of the African Research, Implementation Science, and Education (ARISE) Network, we analysed collected data among 598 adolescents to assess the health status and adolescents' behaviour. Dietary diversity was scored using the 9 food group categories as per the Food and Agriculture Organization -WDDS. Crude and adjusted prevalence rate ratios were estimated using the modified Poisson regression model to identify associated factors. RESULTS: Among the participants, 45.3% had a low dietary diversity score. Proportions of adolescents who consumed from the different food categories over a 24-h period were; cereals/roots/tubers (99.7%), fats & oils (87.0%), spices & beverages (84.1%), sweets (77.1%), legumes (66.2%), other non-vitamin A-rich vegetables (53.8%), dark green leafy vegetables (42.3%), meat/poultry/fish (33.1%), dairy products (32.9%), eggs (11.2%), vitamin A-rich fruits and vegetables (33.4%) and other fruits (8.2%). Staying with a single parent or guardian, low socio-economic class, and dependency on home meals was associated with low dietary diversity. CONCLUSIONS: Adolescents diets were low in diversity and characterised with low micronutrients source foods, but plenty of fats and oils. Interventions to address contributing factors to the burden ought to target the parenting contexts of the adolescents residing in rural eastern Uganda.

Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers' implementation experience.

In settings where antenatal ultrasound is not offered routinely, ultrasound use when a woman first presents to the maternity ward for labour (i.e., triage) may be beneficial. This study investigated patients' perceptions of care and providers' experience with ultrasound implementation during labour triage at a district referral hospital (DH) and three primary health centers (HC) in eastern Uganda. This was a mixed methods study comprising questionnaires administered to women and key informant interviews among midwives pre- and post-ultrasound introduction. Bivariate analyses were conducted using chi-square tests. Qualitative themes were categorized as (1) workflow integration; (2) impact on clinical processes; (3) patient response to ultrasound; and (4) implementation barriers. A total of 731 and 815 women completed questionnaires from the HCs and DH, respectively. At the HC-level, triage quality of care, satisfaction and recommendation ratings increased with implementation of ultrasound. In contrast, satisfaction and recommendation ratings did not differ upon ultrasound introduction at the DH, whereas perceived triage quality of care increased. Most participants noted a perceived improvement in midwives' experience and knowledge upon introduction of ultrasound. Women who underwent a scan also reported diverse feelings, such as fear or worry about their delivery, fear of harm due to the ultrasound, or relief after knowing the baby's condition. For the midwives' perspective (n = 14), respondents noted that ultrasound led to more accurate diagnoses (e.g., fetal position, heart rate, multiple gestation) and improved decision-making. However, they noted health system barriers to ultrasound implementation, such as increased workload, not enough ultrasound-trained providers, and irregular electricity. While triage ultrasound in this context was seen as beneficial to mothers and useful in providers' clinical assessments, further investigation around provider-patient communication, system-level challenges, and fears or misconceptions among women are needed.

Effect of a labor triage checklist and ultrasound on obstetric referral at three primary health centers in Eastern Uganda.

OBJECTIVE: To test whether introduction of a midwife-performed triage checklist and focused ultrasound improves diagnosis and referral for obstetric conditions, including multiple gestation, placenta previa, oligohydramnios, preterm birth, malpresentation, and abnormal fetal heart rate. METHODS: We implemented an intake log (Phase 1), a checklist (Phase 2), and a checklist plus ultrasound scan (Phase 3) at three primary health centers in Eastern Uganda for women presenting in labor. Intake diagnoses, referral status, and delivery outcomes were assessed, as well as sensitivity and positive predictive value (PPV). RESULTS: Between February 2018 and July 2019, 1155, 961, and 603 women were enrolled across the three phases (n=2719); 2339 had outcome data. Incidence of any outcome-confirmed condition was 8.8%, 7.9%, and 7.1% (P=0.526) for each phase, respectively. The proportion of referred women with a condition did not change between Phases 1 and 2 (7.8% versus 8.6%, P=0.855), but increased in Phase 3 (48.4%, P<0.001). Sensitivity improved with each intervention; PPV decreased with ultrasound. CONCLUSION: Use of ultrasound plus checklist increased referrals and sensitivity for high-risk conditions, with decreased PPV. The checklist alone improved correct diagnosis, but not referral. Further evaluation of these triage interventions to maximize diagnostic accuracy, referral decisions, and outcomes are warranted.

Midwife-performed checklist and ultrasound to identify obstetric conditions at labour triage in Uganda: A quasi-experimental study.

OBJECTIVE: The aim of this study was to evaluate the effect of a midwife-performed checklist and limited obstetric ultrasound on sensitivity and positive predictive value for a composite outcome comprising multiple gestation, placenta praevia, oligohydramnios, preterm birth, malpresentation, abnormal foetal heart rate. DESIGN: Quasi-experimental pre-post intervention study. SETTING: Maternity unit at a district hospital in Eastern Uganda. INTERVENTIONS: Interventions were implemented in a phased approach: standardised labour triage documentation (Phase 1), a triage checklist (Phase 2), and checklist plus limited obstetric ultrasound (Phase 3). PARTICIPANTS: Consenting women presenting to labour triage for admission after 28 weeks of gestation between February 2018 and June 2019 were eligible. Women not in labour or those requiring immediate care were excluded. 3,865 women and 3,937 newborns with similar sample sizes per phase were included in the analysis. MEASUREMENT AND FINDINGS: Outcome data after birth were used to determine true presence of a complication, while intake and checklist data were used to inform diagnosis before birth. Compared to Phase 1, Phase 2 and 3 interventions improved sensitivity (Phase 1: 47%, Phase 2: 68.8%, Phase 3: 73.5%; p ≤ 0.001) and reduced positive predictive value (65.9%, 55%, 48.7%, p ≤ 0.001) for the composite outcome. No phase differences in adverse maternal or foetal outcomes were observed. CONCLUSION: Both a triage checklist and a checklist plus limited obstetric ultrasound improved accurate identification of cases with some increase in false positive diagnosis. These interventions may be beneficial in a resource-limited maternity triage setting to improve midwives' diagnoses and clinical decision-making.

Effects of Implementing the Timed and Targeted Counselling Model on Pregnancy Outcomes and Newborn Survival in Rural Uganda: Protocol for a Quasi-Experimental Study.

BACKGROUND: Although mortality rates have declined in Uganda over the last decade, maternal mortality is still high at 336 deaths per 100,000 live births, as is infant mortality at 43 deaths per 1000 live births. One in every 19 babies born in Uganda does not live to celebrate their first birthday. Many of these deaths occur within the first 28 days of life, forming the single largest category of death. Promising effects for preventing death are expected from timed and targeted counselling (ttC), an intervention package of key messages and actions that address integrated health and nutrition needs of the mothers and children, barriers and negotiation agreement, to cause sustainable behavioural change at specific timelines in the first 1000 days. METHODS: The study has a quasi-experimental design in order to evaluate the implementation and effectiveness of the ttC intervention. Participants are pregnant women who have been registered by village health team (VHT) members and who live in Hoima (intervention region) or Masindi (control region) districts, who will be monitored throughout their pregnancy up to at least six weeks after delivery. A multi-stage sampling technique will be employed to select participants, the study sites being purposively chosen. Sample size is determined using the pregnancy rate from the population estimates, resulting in a total required sample of 1218 (609 each in the intervention and control group). Study instruments that will be used include the Ugandan VHT household register (in which all mothers to be studied will be registered), the ttC register (an additional tool for the study area), and a study questionnaire, to collect data at outcome level. Univariate, bivariate and multivariate analyses will be performed using SPSS to evaluate intervention effects on outcomes (e.g., relationship between pregnancy outcomes and antenatal attendance). In addition, quantitative findings will be triangulated with qualitative data, and collected through interviews and focus group discussions with participants and implementers. DISCUSSION: The proposed study will examine the effectiveness of implementing ttC to improve maternal and child outcomes in Uganda. If ttC is effective, broader implementation of appropriate antenatal services can be advised as essential newborn care improvements. TRIAL REGISTRATION: PACTR, PACTR202002812123868. Registered on 25 February 2020.

Dietary Micronutrients and Gender, Body Mass Index and Viral Suppression Among HIV-Infected Patients in Kampala, Uganda.

BACKGROUND: HIV/AIDS is a hallmark of immune suppression. Micronutrient deficiencies in diet and recurrent opportunistic infections play major roles in the lives of people living with HIV. Although benefits of providing adequate diet to HIV positive persons are well documented, the demand for key elements still remain unclear in particular settings, especially in low and middle-income countries. METHODS: This was a cross sectional analysis of baseline data collected from HIV-infected adults initiating antiretroviral therapy, and who were enrolled in a multivitamin supplementation trial. A food frequency questionnaire was used and intake were obtained as a product of quantities consumed. Adequacy was calculated as the proportion of Recommended Dietary Allowances (RDA). A chi square test and logistic regression analysis were used at p-value 0.05 to show significant associations. RESULTS: Mean intakes were above minimum requirements for analyzed micronutrients with the exception of Calcium and Iron. Participants who met RDA intakes were as follows: highest (≥ 80%) for Magnesium, Selenium, Zinc and Vitamins B2, B6, B9, C and E; moderate (50% to <80%) for Vitamins B3, and A; and lowest (≤50%) for Iron (30%), Calcium (14.9%), Vitamins B12 and B1. Gender differences in met RDA were observed for Iron, Selenium, Zinc, Vitamins A, B1, B3 and E. In multivariable analyses, nutritional status and CD4 count had no influence on meeting RDA for majority of micronutrients such as magnesium, Selenium, B class vitamins (B1, B2, B3, B6, B9, B12), vitamin (A, C, and E), Zinc and Calcium, but not including iron. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Diets consumed by the study participants were low in most protective nutrients (Iron, Calcium, Zinc, Vitamin A, B1, B3, and B12). This deficiency was more common among females than males, and irrespective of BMI or CD 4 count. Findings warrant further investigation on the impact and cost implications for suplementation interventions that target the elements lacking in the diets of people living with HIV in similar low-resourced settings.