Reasons, methods used and decision-making for pregnancy termination among adolescents and older women in Mulago Hospital, Uganda.

OBJECTIVE: To explore the methods, reasons and decision-making process for termination of pregnancy among adolescents and older women, in Mulago hospital, Kampala, Uganda. DESIGN: Comparative study. SUBJECTS: Nine hundred and forty two women seeking postabortion care, of which 333 had induced abortion (of whom 115 were adolescents). SETTING: The emergency gynaecological ward of Mulago Hospital, Kampala, Uganda from September 2003 through June 2004. RESULTS: Women with induced abortion were single, in polygamous marital relationships and of lower parity (p<0.001); had lower education and number of living children (p<0.05), reported more (p<0.001) mistimed, unplanned or unwanted pregnancies, and were 13 times more likely to have recent history of domestic violence. Relationship issues were the most common reason for pregnancy termination for both categories. Decision-making for induced abortion was influenced by socio-economic, educational and personal considerations. Instrumentation and use of local herbs in the genitalia were the most common methods for pregnancy termination. Neither methods used for pregnancy termination nor reasons differed when adolescents were compared with older women. CONCLUSION: Relationship issues influence the decision-making process for pregnancy termination. Neither methods used for pregnancy termination nor reasons for pregnancy termination differ when adolescents are compared with older women.

Validating population surveys for the measurement of HIV/STD prevention indicators.

OBJECTIVE: To validate the World Health Organization/Global Programme on AIDS (GPA) protocol for measuring HIV/sexually transmitted disease prevention indicators pertaining to knowledge and sexual practices of the general population. METHODS: Data were collected in Uganda during 1993. Three different interview strategies were complemented with qualitative methods, including observations at visits and key-informant interviews. Two interview strategies consisted of structured questionnaires which were applied to 460 randomly selected people aged 15-49 years and 60 intentionally selected women who were known prostitutes. The third strategy involved in-depth interviewing and was applied to a random subset of all respondents (n = 75). RESULTS: The three interview strategies generated similar results for demographic characteristics. The strategies using structured questionnaires gave similar results with regards to the number of reported sex partners and the prevalence of condom use, but differed from in-depth interviews on these aspects. The high numbers of casual sex partners of female prostitutes was confirmed by in-depth interviews but not via the questionnaires. CONCLUSION: The GPA questionnaire may not be optimal to capture people at high risk and to assess sexual behaviour, especially of people at high risk. Nevertheless, the questionnaire provides the most realistic option, since in-depth interviews are expensive and not as objective in assessing trends over time. Evaluation studies of HIV interventions in the general population should therefore be complemented with small qualitative studies to detect and iron out biases in interpreting results.

Risk factors, nature and severity of domestic violence among women attending antenatal clinic in Mulago Hospital, Kampala, Uganda.

OBJECTIVES: To determine the prevalence, types, severity and risk factors for domestic violence among women attending antenatal clinic. DESIGN: Cross sectional study. SETTING: The antenatal clinic, Mulago Hospital, the national referral hospital, Kampala, Uganda. SUBJECTS: Pregnant women (n = 379) attending the antenatal clinic, on their index visit. METHODS: Interviewer-administered pre-coded questionnaires about history of domestic violence during the index pregnancy (prevalence, nature, severity, and associated factors from socio-demographic history, reproductive history, childhood history and domicile); during the previous one year prior to the interview, or beyond the previous year. MAIN OUTCOME MEASURES: History of domestic violence and its severity, type, risk factors and associated factors in the index pregnancy or prior to it. RESULTS: Over 57% of the subjects reported moderate-to-severe abuse due to domestic violence. Abuse in childhood and witnessing abuse in childhood were significantly associated with domestic violence in index pregnancy (p = 0.000). Staying with co-wife, adolescent pregnancy and the first pregnancy were significantly associated with domestic violence. CONCLUSIONS: Domestic violence is common in pregnancy at Mulago; is moderate to severe and physical abuse is often associated with both sexual and psychological abuse.