Barriers and opportunities for improving management of snakebites: Perspectives of healthcare workers in Northern Uganda.

BACKGROUND: Snakebites are a neglected public health problem that pose a significant burden on affected individuals and communities in many sub-Saharan African countries, including Uganda. However, the barriers and facilitators to snakebite management within healthcare settings are not as well understood and well-documented. The aim of this study was to explore the experiences and perspectives of healthcare workers involved in handling snakebite incidents at individual and health system levels in Arua and Gulu districts in Northern Uganda. We sought to understand how healthcare workers manage snakebite cases, what challenges they encounter, and what opportunities they perceive for improvement. METHODS: We conducted a qualitative study using in-depth interviews with 18 healthcare workers from different cadres, seniority levels, and facility types. We used iterative thematic analysis to explore the management procedures, challenges, and opportunities for snakebite management. Using thematic analysis, we identified the overarching themes and subthemes related to snakebite management and associated barriers and opportunities. RESULTS: The main barriers to snakebite management identified by healthcare workers were inadequate knowledge and skills; limited availability of antivenom; lack of protocols for snakebite management; delayed treatment-seeking for patients; and poor referral systems. The main opportunities for improvement were regular in-service training; increasing public education and awareness about snakebite prevention and management; and increased funding and research. CONCLUSION: This study highlights the need for interventions to address the identified barriers while leveraging the existing opportunities to enhance snakebite management in Uganda. Specifically, we recommend the provision of regular training and support to healthcare workers, developing clinical guidelines, and improving the availability of antivenoms.

Capacity of enforcers and level of enforcement of the Tobacco Control Act 2015 in Kampala, Uganda.

Tobacco use is a leading cause of preventable deaths worldwide. Uganda enacted the Tobacco Control Act (TCA) 2015 to domesticate implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) regulations. This study assessed the capacity to enforce the TCA and associated factors, as well as the level and barriers to its enforcement in Kampala, Uganda. A cross-sectional study using both quantitative and qualitative methods was employed. A structured questionnaire was used for quantitative data collection, and a WHO adapted capacity assessment open-ended guide was used for key informant interviews. Multivariable logistic regression was used to obtain odds ratios and 95% confidence intervals for the independent predictors for capacity to enforce the TCA. A total of 162 respondents from 5 institutions and six key informants were involved in the study. Findings established that only 23% (37/162) of the enforcers had the capacity to enforce the TCA. Male enforcers [OR = 0.16, 95% CI (0.05-0.55)], those who did not know when the law was enacted [OR = 0.19, 95% CI (0.07-0.52)], those with no plans to enforce the law [OR = 0.22, 95% CI (0.05-0.93)], and older enforcers (aged 31-40 years) [OR = 0.27, 95% CI (0.09-0.81)] were less likely to have the capacity to enforce the TCA. The level of enforcement of the TCA was mainly low to moderate for most of the institutions mandated to enforce it. Lack of knowledge about the law amongst the enforcers and general public, and inadequate funds were reported as major barriers to enforcement of the TCA. The capacity to enforce the TCA in Kampala was low. There is potential to enhance the capacity of enforcers through further dissemination of the Act, as well as sensitization of enforcers, institutional managers, and the general public about the legislation.

Indoor air pollutants and respiratory symptoms among residents of an informal urban settlement in Uganda: A cross-sectional study.

BACKGROUND: Indoor air pollutants (IAP) and household conditions such as dampness, crowding and chemical exposures have been associated with acute and chronic respiratory infections. In Uganda, literature on the effects of IAP on respiratory outcomes in informal settlements is limited. METHODS: We describe the baseline household characteristics of 284 adults and their children in an informal settlement in Uganda from April to May 2022. We monitored same-day indoor concentrations of particulate matter PM2.5, PM10, Carbon monoxide (CO), relative humidity %, and temperature from 9 am to 2 pm and interviewed caregivers/mothers about their respiratory symptoms and those of their children in the previous 30 days. We employed robust Poisson regressions to evaluate the associations between indoor air indicators and respiratory health symptoms. RESULTS: Approximately 94.7% of households primarily used biomass fuels and 32.7% cooked from inside their dwelling rooms. The median PM2.5, PM10 and CO levels were 49.5 (Interquartile range (IQR) = 31.1,86.2) µg/m3, 73.6 (IQR = 47.3,130.5) µg/m3 and 7.70 (IQR = 4.1,12.5) ppm respectively. Among adults, a 10 unit increase in PM2.5 was associated with cough (Prevalence Ratio (PR) = 3.75, 95%CI 1.15-1.55). Dwelling unit dampness was associated with phlegm (PR = 2.53, 95%CI = 1.39-4.61) and shortness of breath (PR = 1.78, 95% CI 1.23-2.54) while cooking from outside the house was protective against shortness of breath (PR = 0.62, 95% CI = 0.44-0.87). In children, dampness was associated with phlegm (PR = 13.87, 95% CI 3.16-60.91) and cough (PR = 1.62, 95% CI 1.12-2.34) while indoor residual spraying was associated with phlegm (PR = 3.36, 95%CI 1.71-6.61). CONCLUSION: Poor indoor air conditions were associated with respiratory symptoms in adults and children. Efforts to address indoor air pollution should be made to protect adults and children from adverse health effects.

What are the pathways between poverty and malaria in sub-Saharan Africa? A systematic review of mediation studies.

BACKGROUND: Malaria remains a major burden in sub-Saharan Africa (SSA). While an association between poverty and malaria has been demonstrated, a clearer understanding of explicit mechanisms through which socioeconomic position (SEP) influences malaria risk is needed to guide the design of more comprehensive interventions for malaria risk mitigation. This systematic review provides an overview of the current evidence on the mediators of socioeconomic disparities in malaria in SSA. METHODS: We searched PubMed and Web of Science for randomised controlled trials, cohort, case-control and cross-sectional studies published in English between January 1, 2000 to May 31, 2022. Further studies were identified following reviews of reference lists of the studies included. We included studies that either (1) conducted a formal mediation analysis of risk factors on the causal pathway between SEP and malaria infections or (2) adjusted for these potential mediators as confounders on the association between SEP and malaria using standard regression models. At least two independent reviewers appraised the studies, conducted data extraction, and assessed risk of bias. A systematic overview is presented for the included studies. RESULTS: We identified 41 articles from 20 countries in SSA for inclusion in the final review. Of these, 30 studies used cross-sectional design, and 26 found socioeconomic inequalities in malaria risk. Three formal mediation analyses showed limited evidence of mediation of food security, housing quality, and previous antimalarial use. Housing, education, insecticide-treated nets, and nutrition were highlighted in the remaining studies as being protective against malaria independent of SEP, suggesting potential for mediation. However, methodological limitations included the use of cross-sectional data, insufficient confounder adjustment, heterogeneity in measuring both SEP and malaria, and generally low or moderate-quality studies. No studies considered exposure mediator interactions or considered identifiability assumptions. CONCLUSIONS: Few studies have conducted formal mediation analyses to elucidate pathways between SEP and malaria. Findings indicate that food security and housing could be more feasible (structural) intervention targets. Further research using well-designed longitudinal studies and improved analysis would illuminate the current sparse evidence into the pathways between SEP and malaria and adduce evidence for more potential targets for effective intervention.

Performance of a Finnish Diabetes Risk Score in detecting undiagnosed diabetes among Kenyans aged 18-69 years.

BACKGROUND: The application of risk scores has often effectively predicted undiagnosed type 2 diabetes in a non-invasive way to guide early clinical management. The capacity for diagnosing diabetes in developing countries including Kenya is limited. Screening tools to identify those at risk and thus target the use of limited resources could be helpful, but these are not validated for use in these settings. We, therefore, aimed to measure the performance of the Finnish diabetes risk score (FINDRISC) as a screening tool to detect undiagnosed diabetes among Kenyan adults. METHODS: A nationwide cross-sectional survey on non-communicable disease risk factors was conducted among Kenyan adults between April and June 2015. Diabetes mellitus was defined as fasting capillary whole blood ≥ 7.0mmol/l. The performance of the original, modified, and simplified FINDRISC tools in predicting undiagnosed diabetes was assessed using the area under the receiver operating curve (AU-ROC). Non-parametric analyses of the AU-ROC, Sensitivity (Se), and Specificity (Sp) of FINDRISC tools were determined. RESULTS: A total of 4,027 data observations of individuals aged 18-69 years were analyzed. The proportion/prevalence of undiagnosed diabetes and prediabetes was 1.8% [1.3-2.6], and 2.6% [1.9-3.4] respectively. The AU-ROC of the modified FINDRISC and simplified FINDRISC in detecting undiagnosed diabetes were 0.7481 and 0.7486 respectively, with no statistically significant difference (p = 0.912). With an optimal cut-off ≥ 7, the simplified FINDRISC had a higher positive predictive value (PPV) (7.9%) and diagnostic odds (OR:6.65, 95%CI: 4.43-9.96) of detecting undiagnosed diabetes than the modified FINDRISC. CONCLUSION: The simple, non-invasive modified, and simplified FINDRISC tools performed well in detecting undiagnosed diabetes and may be useful in the Kenyan population and other similar population settings. For resource-constrained settings like the Kenyan settings, the simplified FINDRISC is preferred.

Prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda.

BACKGROUND: The use of psychoactive substances such as alcohol, heroin and marijuana is associated with negative health outcomes such as sexual violence and unintended pregnancies, and risky sexual behaviours. Although there is evidence linking psychoactive substance use and risky sexual behaviours such as inconsistent condom use and multiple sexual relationships, there is limited data on sex under the influence of psychoactive substances among young people. This study aimed to investigate the prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda. METHODS: A cross-sectional study was conducted among 744 sexually active young psychoactive substance users in informal settlements in Kampala, Uganda. Data were collected through face-to-face interviews using a digitalized structured questionnaire, preloaded on the Kobocollect mobile application. The questionnaire captured data on the socio-demographic characteristics of the respondents, history of psychoactive substance use, and sexual behaviours. Data were analysed using STATA Version 14.0. A modified Poisson regression model was used to determine the predictors of sex under the influence of psychoactive substances.. Adjusted prevalence ratios at a p-value value ≤ 0.05 with a 95% confidence interval were considered. RESULTS: About 61.0% (454/744) of the respondents had had sex under the influence of psychoactive substances in the last 30 days. The predictors of sex under the influence of psychoactive substances were being female (PR 1.18, 95% CI: 1.04-1.34), being 20-24 years of age (PR: 1.22, 95% CI: 1.04-1.44), being married (PR 1.15, 95% CI: 1.01-1.31) or divorced/separated (PR 1.43, 95% CI: 1.26-1.61), not living with biological parents or guardians (PR 1.22, 95% CI: 0.99-1.50), earning 71 USD and below (PR 0.86, 95% CI: 0.79-1.03) and using alcohol (PR 1.43, 95% CI: 1.25-1.69), marijuana (PR 1.16, 95% CI: 1.02-1.31) and khat (PR 1.25, 95% CI: 1.10-1.42) in the last 30 days. CONCLUSION: The study found that a high proportion of sexually active young people in informal settlements in Kampala, Uganda had engaged in sex under the influence of psychoactive substances in the past 30 days. The study also identified several factors associated with sex under the influence of psychoactive substances, including being female, being aged 20-24 years, being married or divorced or separated, not living with biological parents or guardians, and using alcohol, marijuana, or khat in the past 30 days. Our findings suggest the need for targeted sexual and reproductive health programs that incorporate risk-reduction interventions aimed at reducing sex under the influence of psychoactive substances, especially among females and those who do not live with their parents.

Association between recent COVID-19 diagnosis, depression and anxiety symptoms among slum residents in Kampala, Uganda.

BACKGROUND: Despite the known link between poor living conditions and mental health, there has been little research on the mental health of slum dwellers worldwide. Although the Coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health issues, little focus has been given to the impact on slum dwellers. The study aimed to investigate the association between recent COVID-19 diagnosis and the risk of depression and anxiety symptoms among people living in an urban slum in Uganda. METHODS: A cross-sectional study was conducted among 284 adults (at least 18 years of age) in a slum settlement in Kampala, Uganda between April and May 2022. We assessed depression symptoms and anxiety using validated Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder assessment tool (GAD-7) questionnaires respectively. We collected data on sociodemographic characteristics, and self-reported recent COVID-19 diagnosis (in the previous 30 days). Using a modified Poisson regression, adjusted for age, sex, gender and household income, we separately provided prevalence ratios and 95% confidence intervals for the associations between recent COVID-19 diagnosis and depressive and anxiety symptoms. RESULTS: Overall, 33.8% and 13.4% of the participants met the depression and generalized anxiety screening criteria respectively and 11.3% were reportedly diagnosed with COVID-19 in the previous 30 days. People with recent COVID-19 diagnosis were more likely to be depressed (53.1%) than those with no recent diagnosis (31.4%) (p<0.001). Participants who were recently diagnosed with COVID-19 reported higher prevalence of anxiety (34.4%) compared to those with no recent diagnosis of COVID-19 (10.7%) (p = 0.014). After adjusting for confounding, recent diagnosis with COVID-19 was associated with depression (PR = 1.60, 95% CI 1.09-2.34) and anxiety (PR = 2.83, 95% CI 1.50-5.31). CONCLUSION: This study suggests an increased risk of depressive symptoms and GAD in adults following a COVID-19 diagnosis. We recommend additional mental health support for recently diagnosed persons. The long-term of COVID-19 on mental health effects also need to be investigated.

Healthcare practitioners' knowledge of snakebite management and associated factors in high-burden, low-resource settings in Uganda.

BACKGROUND: Snakebites cause significant morbidity and mortality in Uganda. Effective management of snakebites requires knowledge of the appropriate first aid measures, as well as knowledge of the appropriate antivenom to use, but little is known about familiarity with effective snakebite management techniques and associated factors among healthcare practitioners (HCPs) in Uganda. METHODS: In May 2022, we collected data on sociodemographic characteristics, knowledge of snakebite first aid, envenomation signs, diagnosis and antivenom administration among 311 HCPs from two snakebite high-incidence districts in Uganda using a semi-structured questionnaire. RESULTS: Of the 311 HCPs, 64.3% had ever treated snakebite cases, 87.1% were confident to provide supportive treatment, but only 9.6% had ever been trained on snakebite management. Overall, 22.8% of HCPs had high knowledge of snakebite management. Higher education (at least degree vs certificate; PR=2.21 95% CI 1.508 to 4.56), older age (30-45 vs <30 y; PR=1.97, 95% CI 1.22 to 3.21) and previous training (PR=1.82, 95% CI 1.08 to 3.05) were associated with high knowledge of snakebite diagnosis and management. CONCLUSIONS: Overall, knowledge of snakebite management was limited. Training, level of education and age of the HCP all had an impact on knowledge. Deliberate efforts are required to increase HCPs' knowledge of snakebite case care in high-burden regions to manage incident cases.

Socioeconomic determinants of malaria prevalence among under five children in Uganda: Evidence from 2018-19 Uganda Malaria Indicator Survey.

BACKGROUND & OBJECTIVES: Malaria remains a significant public health problem in sub-Saharan Africa, affecting mainly children and pregnant women. In Uganda, little is known about the underlying socioeconomic correlates of malaria prevalence in children under five years of age. This study investigated the link between malaria infection among children under five and the socio-economic factors in Uganda. METHODS: We estimated the prevalence of malaria among under-five children using secondary data from the 2019 Uganda Malaria Indicator Survey. Malaria infection status was ascertained using rapid diagnostic tests (RDTs). Multivariable logistic regression was employed to explore the socioeconomic correlates of malaria prevalence. Svyset command in STATA 16.0 was used to control for survey design. RESULTS: Overall, 6503 children were enrolled in the study. Of these, 1516 children tested positive for malaria, leading to an observed malaria prevalence of 23.3%. Older children (OR 1.01, 95%CI 1.01-1.01), and those from rural areas (OR 1.8, 95%CI 1.09-2.84) had higher odds of malaria infection. Children belonging to the highest wealth quintile had lower odds of malaria (OR 0.2, 95%CI 0.08-0.44). Indoor residual spray (OR 0.2, 95%CI 0.10-0.51) and use of treated bed nets (OR 0.8, 95%CI 0.69-0.99) were associated with reduced odds of malaria in children Interpretation & conclusion: Despite the significant increase in malaria preventive interventions in the last two decades, malaria remains highly prevalent in Ugandan under-five children. Indoor residual spraying and treated bed nets need to be promoted countrywide to reach malaria control targets. It is also imperative that appropriate education on proper and consistent use of mosquito bed-nets should be emphasized alongside embracing living habits that reduce the chances of mosquito bites like staying indoors.

Effect of community-level intervention on antenatal care attendance: a quasi-experimental study among postpartum women in Eastern Uganda.

BACKGROUND: Early Initiation of antenatal care (ANC) and at least four visits during pregnancy allow screening and support for a healthy lifestyle and self-care during pregnancy however, community-directed interventions to improve access to these services are rarely explored. OBJECTIVE: To assess the effect of community health worker (CHW) involvement on utilisation of antenatal services during pregnancy in resource-constrained rural settings in Uganda. METHODS: We conducted a quasi-experimental evaluation study among mothers from Eastern Uganda. We used Difference in Differences (DiD) analysis to assess the effect of CHW intervention on ANC attendance. Components of the intervention included community dialogues and empowering CHWs to educate pregnant women about using maternal health services. The primary endpoints were early initiation of ANC and completion of at least 4 ANC visits. RESULTS: Overall, the intervention significantly improved attendance of ≥ 4 ANC visits (DiD = 5.5%). The increase was significant in both intervention and comparison areas (46.2-64.4% vs. 54.1-66.8%, respectively), with slightly greater gains in the intervention area. Other elements that predicted ≥4 ANC attendance besides the intervention were post-primary education (PR1.14, 95%CI 1.02-1.30), higher wealth quintile (PR1.17, 95%CI 1.06-1.30), and early initiation of ANC (PR1.58, 95%CI 1.49-1.68). The intervention did not significantly improve early initiation of ANC (DiD =-1.3%). Instead, early initiation of ANC was associated with higher husband education (PR1.19,95%CI 1.02-1.39), larger household size (PR = 0.81, 95%CI 0.70-0.95), and higher wealth index (PR1.19,95%CI 1.03-1.37). CONCLUSIONS: The CHW intervention improved attendance of at least 4 ANC visits but not early initiation of ANC. There is need to promote CHW-led health education to increase attendance at 4+ ANC visits, but other approaches to promote early initiation are urgently required.

Drivers of Solid Waste Segregation and Recycling in Kampala Slums, Uganda: A Qualitative Exploration Using the Behavior Centered Design Model.

Solid-waste management is a challenge in many cities, especially in low-income countries, including Uganda. Simple and inexpensive strategies such as solid-waste segregation and recycling have the potential to reduce risks associated with indiscriminate waste management. Unfortunately, these strategies have not been studied and adopted in slums in low-income countries. This cross-sectional qualitative study, therefore, used the behavioral-centered design model to understand the drivers of recycling in Kampala slums. Data were coded using ATLAS ti version 7.0, and content analysis was used for interpreting the findings. Our findings revealed that the study practices were not yet habitual and were driven by the presence of physical space for segregation containers, and functional social networks in the communities. Additionally, financial rewards and awareness related to the recycling benefits, and available community support were found to be critical drivers. The availability of infrastructure and objects for segregation and recycling and the influence of politics and policies were identified. There is, therefore, need for both the public and private sector to engage in developing and implementing the relevant laws and policies on solid waste recycling, increase community awareness of the critical behavior, and create sustainable markets for waste segregated and recycled products.

Use of biomass fuels predicts indoor particulate matter and carbon monoxide concentrations; evidence from an informal urban settlement in Fort Portal city, Uganda.

BACKGROUND: Poor indoor air quality (IAQ) is a leading cause of respiratory and cardiopulmonary illnesses. Particulate matter (PM2.5) and carbon monoxide (CO) are critical indicators of IAQ, yet there is limited evidence of their concentrations in informal urban settlements in low-income countries. OBJECTIVE: This study assessed household characteristics that predict the concentrations of PM2.5 and CO within households in an informal settlement in Fort Portal City, Uganda. METHODOLOGY: A cross-sectional study was conducted in 374 households. Concentrations of PM2.5 and CO were measured using a multi-purpose laser particle detector and a carbon monoxide IAQ meter, respectively. Data on household characteristics were collected using a structured questionnaire and an observational checklist. Data were analysed using STATA version 14.0. Linear regression was used to establish the relationship between PM2.5, CO concentrations and household cooking characteristics. RESULTS: The majority (89%, 332/374) of the households used charcoal for cooking. More than half (52%, 194/374) cooked outdoors. Cooking areas had significantly higher PM2.5 and CO concentrations (t = 18.14, p ≤ 0.05) and (t = 5.77 p ≤ 0.05), respectively. Cooking outdoors was associated with a 0.112 increase in the PM2.5 concentrations in the cooking area (0.112 [95% CI: -0.069, 1.614; p = 0.033]). Cooking with moderately polluting fuel was associated with a 0.718 increase in CO concentrations (0.718 [95% CI: 0.084, 1.352; p = 0.027]) in the living area. CONCLUSIONS: The cooking and the living areas had high concentrations of PM2.5 and CO during the cooking time. Cooking with charcoal resulted in higher CO in the living area. Furthermore, cooking outdoors did not have a protective effect against PM2.5, and ambient PM2.5 exceeded the WHO Air quality limits. Interventions to improve the indoor air quality in informal settlements should promote a switch to cleaner cooking energy and improvement in the ambient air quality.

Employment status of AFROHUN-Uganda one health alumni, and facilitators and barriers to application of the one health approach: a tracer study.

BACKGROUND: The One Health (OH) approach integrates multiple competencies in the prevention and control of disease outbreaks. Through a range of OH competence-based activities, the Africa One Health University Network (AFROHUN) built the capacity of selected students at Makerere University and Mbarara University of Science and Technology. This study applied the Systems Theoretical Framework (STF) of career development to establish the employment status of AFROHUN-Uganda alumni, and the facilitators and barriers to application of the OH approach in their organisations. METHODS: We conducted an embedded mixed-methods study among a random sample of 182 AFROHUN-Uganda alumni of the 2013-2018 cohorts. For quantitative data, descriptive statistics were computed using Stata 14.0 statistical software. A total of 12 in-depth interviews were conducted, and NVivo 12 Pro was used to organise data during thematic analysis. RESULTS: While the majority, 87.4% were or got employed after participating in the AFROHUN Uganda capacity building programme, 68.1% were employed at the time of the survey, 57.7% had worked with their current employer for at least a year, and 39% held managerial positions. The facilitators of applying the OH approach into employing organisations included being knowledgeable about OH, the presence of a multidisciplinary workforce, the nature of activities implemented, and existing partnerships and collaborations between organisations. The barriers to the application of the OH approach included limited funding, a negative attitude towards working with people from other disciplines, and limited knowledge of the One Health approach. CONCLUSION: Notably, more than two-thirds of the OH alumni were employed, and more than a third held managerial position. While these findings portray a fairly good absorption rate of the OH alumni into the workforce, they also highlight the facilitators of application of the OH approach that need to be promoted as well as the barriers that need to be addressed if the application of the OH approach is to be improved within the workforce.

Knowledge, attitude and practices related to the use of personal protective equipment among welders in small-scale metal workshops in Nansana Municipality, Wakiso District, Uganda.

Background: Despite the risks involved in welding, there is limited evidence of the knowledge, attitude and practices related to the use of personal protective equipment (PPE) among welders in small-scale metal workshops. We assessed the level of knowledge, attitude and practices (KAP) related to PPE use among welders in small-scale workshops in Nansana Municipality, Wakiso district, Uganda. Methods: A cross-sectional study was conducted among 329 welders. A structured questionnaire was used to collect data on welder knowledge and attitude while an observation checklist was used to establish utilization of PPE. Ten key informant interviews were conducted to further understand welders' knowledge, attitude and PPE-related practices. A 'modified Poisson' regression analysis was done to establish the independent factors associated with PPE KAP. NVivo 12 was used for the management of qualitative data. A thematic content approach guided qualitative data analysis. Results: About 61.4% (202/329) of the respondents had a high level of knowledge, 68.7% (226/329) had a negative attitude, and only 37.1% (122/329) exhibited good PPE-related practices. Knowledge of PPE use was associated with the type of training (aPR = 1.52, CI = 1.29-1.80). Attitude toward PPE use was associated with the level of education (aPR = 2.31, CI = 1.28-4.14), duration of work experience (aPR = 2.37, CI = 1.01-5.55), (aPR = 2.79, CI = 1.13-6.89), and level of knowledge (aPR = 1.73, CI = 1.13-2.65). PPE-related practices were associated with the type of training (aPR = 2.91, CI = 2.14-3.96) and attitude (aPR = 1.45, CI = 1.08-1.93). Conclusion: While the welders' level of knowledge of PPE was found to be high, the majority exhibited a negative attitude and poor PPE-related practices. A high level of knowledge was associated with a positive attitude. In turn, a positive attitude was associated with good PPE practices. Welders need to be sensitized on the health risks that may arise from the non-use of PPE.

Knowledge and use of lactational amenorrhoea as a family planning method among adolescent mothers in Uganda: a secondary analysis of Demographic and Health Surveys between 2006 and 2016.

OBJECTIVE: To assess the level of knowledge and use of the lactational amenorrhoea method (LAM) among adolescents in Uganda between 2006 and 2016 using nationally representative data from Demographic and Health Surveys (DHS). DESIGN: Cross-sectional design involving analysis of three DHS (2006, 2011, and 2016) in Uganda. SETTING: The data collection took place in Uganda. The DHS are nationally representative surveys on a wide range of indicators including contraception knowledge and use. PARTICIPANTS: A total of 1948 (2006), 2026 (2011) and 4276 (2016) adolescents (15-19 years) and 1662 (2006), 1666 (2011) and 3782 (2016) young women (20-24 years) were included. PRIMARY OUTCOME MEASURE: Use of LAM among adolescents and young women with a live birth within 6 months before each survey. RESULTS: In 2016, less than 1.0% (95% CI: 0.2% to 3.5%) of eligible adolescents correctly used LAM, and 56.3% (95% CI: 48.8% to 63.6%) were passively benefitting from LAM. The median duration of postpartum amenorrhoea (PPA) among adolescents in 2016 was 6.9 months, declining from 8.3 months in 2006. Compared with adolescents (56.7%), eligible young women had higher knowledge of LAM (64.1%) and higher median PPA duration (8.0 months) in 2016. The percentage of eligible adolescents who met the LAM criteria irrespective of whether they reported LAM use (were protected by LAM) decreased from 76.4% (95% CI: 66.5% to 84.0%) in 2006 to 57.2% (95% CI: 49.5% to 64.6%) in 2016. More than 50.0% (95% CI: 49.2% to 63.8%) of eligible adolescents were aware of LAM in 2016, increasing from 6.0% (95% CI: 2.5% to 13.8) in 2006. CONCLUSION: Despite increasing awareness of LAM, reported and correct use of LAM was low among adolescents who could benefit from this method in Uganda, and declining over time. Support for adolescents to harness the benefits of correct LAM use should be increased. Additional research is needed to better understand the dynamics of LAM use in adolescents, including the transition to use of other modern contraceptive methods.

Physical activity levels and sociodemographic factors associated with meeting recommended levels among shop attendants in Mbarara municipality, Uganda.

BACKGROUND: Shop attendants are urban dwellers who may spend significant periods in sedentary lifestyles exposing them to non-communicable diseases. This study assessed the physical activity levels and sociodemographic factors associated with meeting the WHO recommended physical activity levels among shop attendants in Mbarara municipality, Uganda. METHODS: We conducted a cross-sectional study among 301 shop attendants. We used the global physical activity questionnaire to assess participants' physical activity levels. Modified Poisson regression was used to assess the sociodemographic factors associated with meeting recommended physical activity levels. RESULTS: Of the 301 participants, 234 (77.7%) met the WHO physical activity recommendations, especially through work-related physical activity of moderate intensity 194 (64.5%). The median weekly duration of all moderate-intensity physical activity was 180 min (IQR=90 to 360). The median daily sedentary time was 300 min (IQR=300 to 360). Being male (adjusted prevalence ratio=1.33, 95% CI 1.17 to 1.51) was significantly associated with meeting recommended physical activity levels. CONCLUSION: The physical activity levels among shop attendants were high and were mostly achieved through work-related activities of moderate intensity, with males being more likely to meet recommended physical activity levels. Findings suggest a need for gender-sensitive initiatives to increase physical activity levels, especially among female shop attendants.

Extent of compliance with COVID-19 prevention and control guidelines among supermarkets in Kampala Capital City and Mukono Municipality, Uganda.

BACKGROUND: Despite the development and enforcement of preventive guidelines by governments, COVID-19 continues to spread across nations, causing unprecedented economic losses and mortality. Public places remain hotspots for COVID-19 transmission due to large numbers of people present; however preventive measures are poorly enforced. Supermarkets are among the high-risk establishments due to the high interactions involved, which makes compliance with the COVID-19 preventive guidelines of paramount importance. However, until now, there has been limited evidence on compliance with the set COVID-19 prevention guidelines. Therefore, this study aimed to measure compliance with the COVID-19 prevention guidelines among supermarkets in Kampala Capital City and Mukono Municipality Uganda. METHODS: A cross-sectional study was conducted among selected supermarkets in Kampala Capital City and Mukono Municipality in September 2020. A total of 229 supermarkets (195 in Kampala City and 34 in Mukono Municipality) were randomly selected for the study. Data were collected through structured observations on the status of compliance with COVID-19 prevention guidelines, and entered using the KoboCollect software, which was preinstalled on mobile devices (smart phones and tablets). Descriptive statistics were generated to measure compliance to the set COVID-19 Ministry of Health prevention guidelines using Stata 14 software. RESULTS: Only 16.6% (38/229) of the supermarkets complied with the COVID-19 prevention and control guidelines. In line with the specific measures, almost all supermarkets 95.2% (218/229) had hand washing facilities placed at strategic points such as the entrance, and 59.8% (137/229) of the supermarkets surveyed regularly disinfected commonly touched surfaces. Only 40.6% and 30.6% of the supermarkets enforced mandatory hand washing and use of face masks respectively for all customers accessing the premises. Slightly more than half, 52.4% (120/229) of the supermarkets had someone or a team in charge of enforcing compliance to COVID-19 measures and more than half, 55.5% (127/229) of the supermarkets had not provided their staff with job-specific training/mentorship on infection prevention and control for COVID-19. Less than a third, 26.2% (60/229) of the supermarkets had an infrared temperature gun for screening every customer, and only 5.7% (13/229) of the supermarkets captured details of clients accessing the supermarket as a measure to ease follow-up. CONCLUSION: This study revealed low compliance with COVID-19 guidelines, which required mandatory preventive measures such as face masking, regular disinfection, social distancing, and hand hygiene. This study suggests the need for health authorities to strengthen enforcement of these guidelines, and to sensitise the supermarket managers on COVID-19 in order to increase the uptake of the different measures.

Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda.

BACKGROUND: Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. METHODS: Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers' sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. RESULTS: The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01-1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02-1.17)] favoured facility delivery while a higher parity of 3-4 [APR = 0.93, 95% CI (0.88-0.99)] was inversely associated with health facility delivery as compared to parity of 1-2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05-1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04-1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78-0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08-1.19)]. CONCLUSION: Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

Impact of mhealth messages and environmental cues on hand hygiene practice among healthcare workers in the greater Kampala metropolitan area, Uganda: study protocol for a cluster randomized trial.

BACKGROUND: Hand hygiene (HH) among healthcare workers (HCWs) is critical for infection prevention and control (IPC) in healthcare facilities (HCFs). Nonetheless, it remains a challenge in HCFs, largely due to lack of high-impact and efficacious interventions. Environmental cues and mobile phone health messaging (mhealth) have the potential to improve HH compliance among HCWs, however, these remain under-studied. Our study will determine the impact of mhealth hygiene messages and environmental cues on HH practice among HCWs in the Greater Kampala Metropolitan Area (GKMA). METHODS: The study is a cluster-randomized trial, which will be guided by the behaviour centred design model and theory for behaviour change. During the formative phase, we shall conduct 30 key informants' interviews and 30 semi-structured interviews to explore the barriers and facilitators to HCWs' HH practice. Besides, observations of HH facilities in 100 HCFs will be conducted. Findings from the formative phase will guide the intervention design during a stakeholders' insight workshop. The intervention will be implemented for a period of 4 months in 30 HCFs, with a sample of 450 HCWs who work in maternity and children's wards. HCFs in the control arm will receive innovatively designed HH facilities and supplies. HCWs in the intervention arm, in addition to the HH facilities and supplies, will receive environmental cues and mhealth messages. The main outcome will be the proportion of utilized HH opportunities out of the 9000 HH opportunities to be observed. The secondary outcome will be E. coli concentration levels in 100mls of hand rinsates from HCWs, an indicator of recent fecal contamination and HH failure. We shall run multivariable logistic regression under the generalized estimating equations (GEE) framework to account for the dependence of HH on the intervention. DISCUSSION: The study will provide critical findings on barriers and facilitators to HH practice among HCWs, and the impact of environmental cues and mhealth messages on HCWs' HH practice. TRIAL REGISTRATION: ISRCTN Registry with number ISRCTN98148144 . The trial was registered on 23/11/2020.