Time to treatment-seeking by caretakers of children under-five with diarrhea and associated factors in Uganda: a multilevel proportional hazards analysis.

BACKGROUND: Diarrhea is considered to be one of the major public health concerns in developing countries. It has a detrimental impact, reflecting one of the highest child mortality rates globally, especially in Sub-Saharan Africa, where 2 out of every 10 children in Uganda under the age of five die. The objective of this study was to investigate the factors associated with time to treatment seeking by caretakers of children under-five with Diarrhea in Uganda. METHOD: DOVE dataset of 745 caretakers in a prospective and retrospective incidence-based study using multi-stage sampling design was used in the assessment. The analysis was done using a time-to-event approach using life tables, Kaplan Meier survival analysis and multilevel proportional hazards model. RESULTS: Kaplan-Meier survival analysis indicated the median time to seeking treatment among 745 caretakers of children under-Five after onset of diarrhea was 2 days. The multi-level proportional hazards model of a Weibull distribution showed that the estimated frailty variance was 0.13, indicating heterogeneity of treatment seeking time by caretakers of under-five children with diarrhea across regions in Uganda. Significant factors found to influence time to treatment-seeking by caretakers of children under-five with diarrhea were, male children (HR = 0.82; 95% CI = 0.71-0.95, p = 0.010), belonging to richest wealth quintile (HR = 1.37; 95% CI = 1.05-1.78, p = 0.022), and residing more than 5 km away from a health facility (HR = 0.68; 95% CI = 0.56-0.84, p = 0.000). CONCLUSIONS: There are delays in seeking diarrhea treatment in Uganda because two days are enough to claim a life after dehydration.The policymakers should pay attention to formulate effective intervention to sensitize caregivers on the importance of early treatment-seeking behavior to avoid severe malnutrition caused by diarrhea. Community awareness program should also be encouraged particularly in areas of more than 5 km from the health facility to make people aware of the necessity to take prompt action to seek care in the early stage.

Deprivation and Its Association with Child Health and Nutrition in the Greater Kampala Metropolitan Area of Uganda.

African cities are experiencing increasing living standard disparities with limited evidence of intra-urban health disparities. Using data from the 2006-2016 Uganda Demographic and Health Surveys, we employed the UN-Habitat definition to examine slum-like household conditions in the Greater Kampala Metropolitan Area (GKMA). Subsequently, we developed a slum-like severity index and assessed its association with under-5 common morbidities and healthcare access. We also assessed the characteristics of people in slum-like household conditions. We identified five slum-like conditions: substandard housing conditions, limited water access, overcrowding, unclean cooking fuel, and limited toilet access. By 2016, 67% of GKMA households were classified as slum-like conditions, including 31% in severe conditions. Limited toilet access, overcrowding, and limited water access were the main forms of deprivation.Living in slum-like household conditions correlated with lower education levels, youth status, unprofessional jobs, and marriage. Compared to neighboring Kampala city urban outskirts, Kampala city households had lower slum-like prevalence. Children in GKMA living in slum-like household conditions were more likely to experience diarrhea (moderate: OR = 1.21[95% CI: 1.05-1.39], severe: OR = 1.47 [95% CI: 1.27-1.7]); fever (moderate: OR = 2.67 [95% CI: 1.23-5.8], severe: OR = 3.09 [95% CI: 1.63-5.85]); anemia (moderate: OR = 1.18 [95% CI: 0.88-1.58], severe: OR = 1.44 [95% CI: 1.11-1.86]); and stunting (moderate: OR = 1.23 [95% CI: 1.23-1.25], severe: OR = 1.40 [95% CI: 1.41-1.47]) compared to those living in less slum-like conditions. However, seeking treatment for fever was less likely in slum-like household conditions, and the association of slum-like household conditions with diarrhea was insignificant. These findings underscore the precarious urban living conditions and the need for targeted health interventions addressing the social determinants of health in urban settings.

Multilevel mixed effects analysis of individual and community factors associated with unmet need for contraception among married women in four East African countries.

Background: Despite the use of contraceptives being an expression of a woman's reproductive control, the prevalence of unmet need remains high and a public concern among married women in East Africa. However, limited literature has explored the associated factors in the region. We live in age of leaving no one behind unfortunately many women still have unmet for family planning todate. This study therefore intends to examine the individual and community level factors associated with unmet need for contraception among married women in Burundi, Rwanda, Tanzania and Uganda. Methods: The study utilizes data from the four recent demographic and health surveys for Burundi, Rwanda, Tanzania and Uganda. Analyses were conducted using multilevel mixed effects logistic regressions with random community and country level effects. Results are reported using predictive probabilities and margins. Results: This study revealed that: 20%, 22%, 28% and 33% of the married women in Tanzania, Uganda, Rwanda and Burundi respectively had unmet need for contraception. Younger women, and those: without formal education, from the poorest households, had ever experienced child loss, whose husbands desire more children than them, and have no access to family planning messages faced a higher probability of unmet need for contraception. This was also true for women living in communities with low usage of modern contraception and those in communities where there is an increasing number of children per woman. Conclusions: The findings reiterate the need for family planning efforts to focus on younger women. Additionally, improved education, economic empowerment, calls for spousal involvement in family planning matters, support for those with child loss, and comprehensive awareness initiatives remain vital to tackling unmet need for contraception.

Spatial variation and attributable risk factors of anaemia among young children in Uganda: Evidence from a nationally representative survey.

Anaemia continues to be a burden especially in developing countries that not only affects the physical growth and cognitive development of children but also increases their risk to death. Over the past decade, the prevalence of anaemia among Ugandan children has been unacceptably high. Despite this, spatial variation and attributable risk factors of anaemia are not well explored at national level. The study utilized the 2016 Uganda Demographic and Health Survey (UDHS) data with a weighted sample of 3805 children aged 6-59 months. Spatial analysis was performed using ArcGIS version 10.7 and SaTScan version 9.6. This was followed by a multilevel mixed-effects generalized linear model for the analysis of the risk factors. Estimates for population attributable risks (PAR) and fractions (PAF) were also provided using STATA version 17. In the results, intra-cluster correlation coefficient (ICC) indicates that 18% of the total variability of anaemia was due to communities within the different regions. Moran's index further confirmed this clustering (Global Moran's index = 0.17; p-value<0.001). The main hot spot areas of anaemia were Acholi, Teso, Busoga, West Nile, Lango and Karamoja sub-regions. Anaemia prevalence was highest among boy-child, the poor, mothers with no education as well as children who had fever. Results also showed that if all children were born to mothers with higher education or were staying in rich household, the prevalence would be reduced by 14% and 8% respectively. Also having no fever reduces anaemia by 8%. In conclusion, anaemia among young children is significantly clustered in the country with disparities noted across communities within different sub-regions. Policies targeting poverty alleviation, climate change or environment adaptation, food security as well interventions on malaria prevention will help to bridge a gap in the sub regional inequalities of anaemia prevalence.

Timing and Quality of Antenatal Care Among Adolescent Mothers in a Rural Community, Uganda.

Background: Most adolescent mothers attend their first antenatal care (ANC) visit later than the recommended time while others do not receive good quality antenatal care (all the required components of ANC such as iron tablets). This study sought to examine the factors associated with timing of the first ANC visit and quality of ANC among adolescent mothers in Uganda. Methods: This study was based on quantitative data from 248 adolescent mothers aged 10-19 years in Luuka district, Eastern Uganda. We selected adolescent mothers who were either pregnant or had infants aged 0-3 months. We used logistic regression to identify factors associated with timing and receipt of good quality ANC. Results: The majority of the adolescents (82%) attended ANC for their most recent pregnancy. Of these, 47% made the first visit in the first trimester while 36% received good quality ANC. Having knowledge of danger signs in pregnancy was a determinant of both timing of first ANC visit (aOR = 2.89, 95% CI: 1.04-8.06) and receipt of good quality ANC (aOR = 6.57, 95% CI: 1.75-24.65). Other determinants for timing of first ANC visit were mother's age, partner's age, having ever given birth, decision maker on health care and daily earnings. Other determinants for quality of ANC included distance to health facility and knowledge of family planning methods. Conclusion: This study recommends expanding the network of public health facilities further into the rural communities in the district as a means of bringing health services closer to adolescent mothers, deliberate efforts to equip adolescent girls with reproductive health information on pregnancy danger signs, and family planning and empowering adolescent girls to start income-generating activities.

Factors Associated with COVID-19 Vaccine Hesitancy in Uganda: A Population-Based Cross-Sectional Survey.

Purpose: Vaccination toward coronavirus disease (COVID-19) has been recommended and adopted as one of the measures of reducing the spread of this novel disease worldwide. Despite this, vaccine uptake among the Ugandan population has been low with reasons surrounding this being unknown. This study aimed to investigate the factors associated with COVID-19 vaccine hesitancy in Uganda. Methods: A cross-sectional study was conducted on a total of 1042 adults in the districts of Mukono, Kiboga, Kumi, Soroti, Gulu, Amuru, Mbarara and Sheema from June to November 2021. Data were analyzed using STATA v.15. Barriers to vaccination were analyzed descriptively, while a binary logistic regression model was used to establish the factors associated with COVID-19 vaccine hesitancy. Results: Overall, COVID-19 vaccine hesitancy was 58.6% (611). Respondents from urban areas and those in the eastern or northern region had increased odds of vaccine hesitancy. Further, higher education level and having knowledge on how COVID-19 is transmitted significantly reduced the odds of vaccine hesitancy. The study also noted individual perception such as COVID-19 kills only people with underlying medical conditions, as well as limited awareness on vaccine types or vaccination areas as the main reasons to vaccine hesitancy. Relatedly, other misconceptions like the ability of the vaccine to cause infertility, or spreading the virus into the body, and acknowledgment of alcohol as a possible cure were other reasons for vaccine hesitancy. Conclusion: The proportion of COVID-19 vaccine hesitancy is still high among the population with this varying across regions. This is driven by low education level and limited awareness on the vaccination as well as perceived myths and misconceptions. The study recommends mass sensitization of the population on the benefits of vaccination using various channels as well as rolling out community-based outreach vaccination campaigns across the country.

Disruption in Essential Health Service Delivery: A Qualitative Study on Access to Family Planning Information and Service Utilization During the First Wave of COVID-19 Pandemic in Uganda.

Background: Coronavirus disease 2019 (COVID-19) remains a challenge to public health with profound impact on people's lives. With several mitigation measures implemented to curb the spread of COVID-19, these impacted on access and utilization of general health services including family planning (FP) services. The objective of the study was to understand the extent to which COVID-19 interrupted access and utilization of FP services as well as highlight the challenges faced during the lockdown in Uganda. Methods: A qualitative study was carried out in August and September 2020 across the country. A total of 21 key informant interviews among researchers, policy makers, funding agencies, district family planning focal persons, district health officers and service providers with implementing partners were conducted. These were conducted using face to face (7), phone calls (11) and zoom (3) meetings. All interviews were audio recorded and transcribed verbatim. Transcripts were used to identify and generate codes, sub themes and themes. Analysis was done using the thematic framework analysis and results presented in themes. Results: Five themes were identified in this study which included; (i) financial and psychosocial needs, (ii) mobility hindrances, (iii) disrupted service delivery, (iv) responsive reproductive health services. The financial and psychosocial needs themes included: household and individual financial constraints, unpredictable future and community acceptance, loss of employment and unemployment, misconceptions and unintended pregnancies; while mobility hindrances included; restricted movement, high transport costs, and difficulty in finding transport. Conclusion: Results showed that the pandemic had immediate and significant long-term effects on family planning service accessibility, utilization and delivery. The study recommends implementation of telehealth services, country-wide sensitization on use of long-term contraceptive methods, empowering village health teams and making family planning services mandatory and free to all private facilities in order to lower any disruptions during pandemics.

Determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006-2016: analysis of the Uganda Demographic and Health Surveys.

OBJECTIVE: Teenage pregnancy has become a public health concern in Uganda because of its negative consequences to both the mother and child. The objective of this study was to examine the determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006-2016. STUDY DESIGN: A retrospective national cross-sectional study. SETTING: Uganda. PARTICIPANTS: Uganda Demographic and Health Survey secondary data of only female teenagers aged 15-19 years. The samples selected for analyses were 1936 in 2006; 2048 in 2011 and 4264 in 2016. OUTCOME MEASURE: The primary outcome was teenage pregnancy. Analysis was performed using the logistic regression, equiplots, concentration curve, normalised concentration index, decomposition of the concentration index and Oaxaca-type decomposition. RESULTS: The prevalence of teenage pregnancy has seemingly remained high and almost constant from 2006 to 2016 with the risk worsening to the disadvantage of the poor. Household wealth-index, teenagers' years of education, early sexual debut and child marriage were the main key predictors and contributors of the large inequality in teenage pregnancy from 2006 to 2016. CONCLUSION: Teenage pregnancy is disproportionately prevalent among different subpopulations of adolescent girls in Uganda. We therefore recommend policy actions to sensitise communities and enforcement of child rights and child protection laws to stop child marriages. There is also need to promote girl child education, improving household incomes, and intensifying mass media awareness on the risks of early pregnancies. Further, ensuring that villages have operational adolescent and youth friendly services as well as incorporating sex education and other different adolescent reproductive health programmes in school curriculum will be key measures in reducing the large inequality in teenage pregnancy.

Multilevel mixed effects analysis of individual and community level factors associated with modern contraceptive use among married women in Uganda.

BACKGROUND: In spite of the universal right for women to decide freely for themselves when, and how many children they want to have in life, married women in Uganda are less likely to use modern contraceptives as compared to other marital categories. This study examines the individual and community factors associated with modern contraceptive use among married women in Uganda. METHODS: The study used data from the 2016 Uganda Demographic and Health Survey which comprised of 8671 married women aged 15-49 years who were fecund and non-pregnant at the time of the survey. Analysis was done using a multilevel mixed-effects logistic regression model. RESULTS: Findings showed that married women who were; Muslims (AOR = 0.78, CI = 0.66-0.91), had more than five children (AOR = 0.76, CI = 0.61-0.98), staying in communities with high poverty (AOR = 0.78, CI = 0.65-0.93), with older age at first birth (AOR = 0.94, CI = 0.92-0.96) as well as having spousal age difference of more than 9 years (AOR = 0.86, CI = 0.76-0.98) were associated with low modern contraceptive use. Women living in communities with higher age at first marriage (AOR = 0.93, CI = 0.88-0.98) or higher sexual debut (AOR = 0.91, CI = 0.85-0.98) were also associated with reduced odds of modern contraception. In addition, older women (AOR = 1.03, CI = 1.01-1.04), having secondary/higher education (AOR = 1.93, CI = 1.58-2.37), living in a rich household (AOR = 1.32, CI = 1.14-1.53), short distance to health facility (AOR = 1.18, CI = 1.06-1.31), high community education (AOR = 1.38, CI = 1.17-1.62), high community exposure to family planning messages (AOR = 1.24, CI = 1.08-1.42), and communities with high proportion of women working (AOR = 1.22, CI = 1.06-1.39) were more likely to use modern contraceptives. CONCLUSION: The study revealed that both individual and community factors were important in explaining the factors associated with modern contraceptive use among married women in Uganda. Therefore, there is need to invest in community based programs like: family planning outreach services, mass media campaigns and community mobilization activities to help in dissemination of family planning information, increase awareness and promotion in use of modern contraceptives. Also, expansion of higher education and the need to make family planning services available and accessible to areas with limited physical access to health facilities will lead to sustained increase in uptake of modern contraceptives.

Circulating levels of angiogenic factors and their association with preeclampsia among pregnant women at Mulago National Referral Hospital in Uganda.

Preeclampsia (PE) is a major cause of maternal and new-born morbidity and mortality. Angiogenic factors contribute a major role in the vascular dysfunction associated with PE. We investigated the circulating levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF) and soluble Feline McDonough Sarcoma (fms)-like tyrosine kinase-1 (sFlt1), their association with PE and diagnostic performance of disease among pregnant women in Uganda. Using a case-control study design, 106 women with PE and 106 with normal pregnancy were enrolled. Demographic and clinical characteristics, and anticoagulated blood samples were collected from participants. Plasma VEGF, PlGF and sFlt1 levels were measured using Luminex and enzyme linked immunosorbent assays (ELISA). Conditional logistic regression was used to explore association of angiogenic factors with PE and receiver operating characteristic analysis was performed to investigate PE diagnostic performance. Levels of VEGF and PIGF were significantly lower in cases compared to controls (VEGF: median = 0.71 pg/ml (IQR = 0.38-1.11) Vs 1.20 pg/ml (0.64-1.91), p-value<0.001 and PlGF: 2.20 pg/ml (1.08-5.86) Vs 84.62 pg/ml (34.00-154.45), p-value<0.001). Plasma levels of sFlt1 were significantly higher in cases than controls (median = 141.13 (71.76-227.10) x103 pg/ml Vs 19.86 (14.20-29.37) x103 pg/ml). Increasing sFlt1 levels were associated with increased likelihood of PE (aOR = 4.73; 95% CI, 1.18-19.01; p-value = 0.0287). The sFlt1/PlGF ratio and sFlt1 had a better performance for diagnosis of PE, with AUC = 0.95 (95% CI, 0.93-0.98) followed by PlGF with AUC = 0.94 (95% CI, 0.91-0.97). Therefore, sFlt1, sFlt1/PlGF ratio and PlGF are potential candidates for incorporation into algorithms for PE diagnosis in the Ugandan population.

Determinants of unintended pregnancies among currently married women in Uganda.

BACKGROUND: Unintended pregnancies are no longer bound to teenagers or school-going children, married women in Uganda, as well do experience such pregnancies though little has been investigated on them. This study examines the determinants of unintended pregnancies among currently married women in Uganda. METHODS: In this study, we used data from the 2016 Uganda Demographic and Health Survey (UDHS) which comprised of 10,958 married women aged 15-49 years who have ever been pregnant. The analysis was done using descriptive analysis, logistic regression, and the generalized structural equation model. RESULTS: The study showed that 37% of pregnancies among married women were unintended. Young women, living in poor households, staying in rural areas, women in the Eastern and Northern region, Muslim women, lack of knowledge on ovulation period, discontinuation of contraceptives, non-use of and intention for contraceptives, high age at sexual debut, high age at first birth, and high parity were directly associated with a higher risk of unintended pregnancies. Relatedly, discontinuation of contraceptives regardless of the place of residence, region, woman's age, education, household wealth, access to family planning messages were associated with higher odds of unintended pregnancies. Older women and those in rural areas who had more children were also at a higher risk of similar pregnancies. However, having more children while using contraceptives, being educated, living in a wealthier household, and having access to family planning messages significantly lowered the risk of unintended pregnancies. CONCLUSION: Increased access to family planning messages, empowering women as well as having improved household incomes are key preventive measures of unintended pregnancies. There is a need to provide quality contraceptive counseling through outreaches so that women are informed about the different contraceptive methods and the possible side effects. Having a variety of contraceptive methods to choose from and making them accessible and affordable will also encourage women to make informed choices and reduce contraceptive discontinuation. All these coupled together will help women have their desired family sizes, increase the uptake of contraceptives and significantly reduce unintended pregnancies.

Severe Anemia Is Associated with Systemic Inflammation in Young Children Presenting to a Tertiary Hospital in Uganda.

The role of inflammation in severe anemia (SA) in African children has not been well characterized. We conducted a study to evaluate risk factors for SA in young children admitted at a tertiary unit in Uganda. Clinical, infectious, and micronutrient risk factors for anemia, along with markers of inflammation, were evaluated in children aged < 5 years in Jinja Hospital, Uganda. Participants included 284 children with SA (Hemoglobin [Hb] < 5.0 g/dL), and two control groups: 63 children admitted with acute illness without SA (Hb > 9.3 g/dL) and 53 asymptomatic community control children. Appropriate logistic analysis was performed to determine factors associated with SA. Of the 284 children with SA, 36.5% had Plasmodium falciparum parasitemia, 32.7% had blackwater fever (one of the types of severe malaria), and 15.5% had vitamin B12 deficiency. HIV infection, bacteremia, hookworm infection, severe acute malnutrition, and folate deficiency were relatively uncommon (each accounting for < 8%). Factors independently associated with SA compared with the combined control groups included (adjusted odds ratio [OR]; 95% CI) the following: P. falciparum parasitemia (OR: 4.3; 95% CI: 1.4-13.8), total white blood count (OR: 1.3; 95% CI: 1.1-1.4), C-reactive protein (OR: 1.8; 95% CI: 1.3-2.4), and ferritin (OR: 2.7; 95% CI: 1.9-4.0). In this area of Uganda, malaria and markers of inflammation were independently associated with SA in children. Additional studies are required to determine the role of inflammation in children with SA in this population.

Comparison of non-magnetic and magnetic beads multiplex assay for assessment of Plasmodium falciparum antibodies.

BACKGROUND: New reagents have emerged allowing researchers to assess a growing number of vaccine-associated immune parameters. Multiplex immunoassay(s) are emerging as efficient high-throughput assays in malaria serology. Currently, commercial vendors market several bead reagents for cytometric bead assays (CBA) but relative performances are not well published. We have compared two types of bead-based multiplex assays to measure relative antibody levels to malarial antigens. METHODS: Assays for the measurement of antibodies to five Plasmodium falciparum vaccine candidates using non-magnetic and magnetic fluorescent microspheres were compared for their performances with a Bio-Plex200 instrument. Mean fluorescence intensity (MFI) was determined from individuals from western Kenya and compared to known positive and negative control plasma samples. RESULTS: P. falciparum recombinant antigens were successfully coupled to both non-magnetic and magnetic beads in multiplex assays. MFIs between the two bead types were comparable for all antigens tested. Bead recovery was superior with magnetic beads for all antigens. MFI values of stored non-magnetic coupled beads did not differ from freshly coupled beads, though they showed higher levels of bead aggregation. DISCUSSION: Magnetic and non-magnetic beads performed similarly in P. falciparum antibody assays. Magnetic beads were more expensive, but had higher bead recovery, were more convenient to use, and provided rapid and easy protocol manipulation. Magnetic beads are a suitable alternative to non-magnetic beads in malarial antibody serology.