Awareness, experiences and perceptions regarding genetic testing and the return of genetic and genomics results in a hypothetical research context among patients in Uganda: a qualitative study.

BACKGROUND: Genetic testing presents unique ethical challenges for research and clinical practice, particularly in low-resource settings. To address such challenges, context-specific understanding of ethical, legal and social issues is essential. Return of genetics and genomics research (GGR) results remains an unresolved yet topical issue particularly in African settings that lack appropriate regulation and guidelines. Despite the need to understand what is contextually acceptable, there is a paucity of empirical research and literature on what constitutes appropriate practice with respect to GGR.The study assessed patients' awareness, experiences and perceptions regarding genetic testing and the return of GGR results in a hypothetical context. METHODS: This cross-sectional study employed a qualitative exploratory approach. Respondents were patients attending the medical outpatient unit of Mulago National Hospital. Three deliberative focus group discussions involving 18 respondents were conducted. Data were analysed through thematic analysis. RESULTS: Three main themes and several subthemes were identified. Most respondents were aware of genetic testing, supportive of GGR and receiving results. However, only a few had undergone genetic testing due to cost constraints. They articulated the need for adequate information and genetic counselling to inform decision-making. Privacy of results was important to respondents while others were willing to share results. CONCLUSION: There was general awareness and support for GGR and the return of results. Stigmatisation emerged as a barrier to disclosure of results for some. Global health inequity impacts access and affordability of genetic testing and counselling in Africa and should be addressed as a matter of social justice.

"These are just finishing our medicines": older persons' perceptions and experiences of access to healthcare in public and private health facilities in Uganda.

BACKGROUND: There is limited research on the experiences of access to medicines for non-communicable diseases (NCDs) in health facilities among older persons in Uganda. This paper explores the perspectives of older persons and healthcare providers concerning older persons' access to essential medicines in Uganda. METHODS: It is based on qualitative data from three districts of Hoima, Kiboga, and Busia in Uganda. Data collection methods included seven (07) focus group discussions (FGDs) and eighteen (18) in-depth interviews with older persons. Nine (9) key informant interviews with healthcare providers were conducted. Deductive and inductive thematic analysis (using Health Access Livelihood Framework) was used to analyze the barriers and facilitators of access to healthcare using QSR International NVivo software. RESULTS: The key facilitators and barriers to access to healthcare included both health system and individual-level factors. The facilitators of access to essential medicines included family or social support, earning some income or Social Assistance Grants for Empowerment (SAGE) money, and knowing a healthcare provider at a health facility. The health system barriers included the unavailability of specialized personnel, equipment, and essential medicines for non-communicable diseases, frequent stock-outs, financial challenges, long waiting times, high costs for medicines for NCDs, and long distances to health facilities. CONCLUSION: Access to essential medicines for NCDs is a critical challenge for older persons in Uganda. The Ministry of Health should make essential drugs for NCDS to be readily available and train geriatricians to provide specialized healthcare for older persons to reduce health inequities in old age. Social support systems need to be strengthened to enable older persons to access healthcare.

"If your mother does not teach you, the world will ": a qualitative study of parent-adolescent communication on sexual and reproductive health issues in Border districts of eastern Uganda.

BACKGROUND: Adolescents experience a host of sexual and reproductive health (SRH) challenges, with detrimental SRH and socio-economic consequences. These include early sexual debut, sexually transmitted infections including HIV/AIDS, teenage pregnancy, and early childbearing. Parent-adolescent communication about SRH has significant potential to reduce adolescents' risky sexual behaviors. However, communication between parents and adolescents is limited. This study explored the facilitators and barriers to parent-adolescent communication about sexual and reproductive health. METHODS: We conducted a qualitative study in the border districts of Busia and Tororo in Eastern Uganda. Data collection entailed 8 Focus Group Discussions comprising of parents, adolescents (10-17 years), and 25 key informants. Interviews were audio-recorded, transcribed, and translated into English. Thematic analysis was conducted with the aid of NVIVO 12 software. RESULTS: Participants acknowledged the key role parents play in communicating SRH matters; however, only a few parents engage in such discussions. Facilitators of parent-adolescent communication were: having a good parent-child relationship which makes parents approachable and motivates children to discuss issues openly, a closer bond between mothers and children which is partly attributed to gender roles and expectations eases communication, and having parents with high education making them more knowledgeable and confident when discussing SRH issues with children. However, the discussions are limited by cultural norms that treat parent-child conversations on SRH as a taboo, parents' lack of knowledge, and parents busy work schedules made them unavailable to address pertinent SRH issues. CONCLUSION: Parents' ability to communicate with their children is hindered by cultural barriers, busy work schedules, and a lack of knowledge. Engaging all stakeholders including parents to deconstruct sociocultural norms around adolescent SRH, developing the capacity of parents to confidently initiate and convey accurate SRH information, initiation of SRH discussions at early ages, and integrating parent-adolescent communication into parenting interventions, are potential strategies to improve SRH communication between parents and adolescents in high-risk settings such as borders.

Disability status, partner behavior, and the risk of sexual intimate partner violence in Uganda: An analysis of the demographic and health survey data.

BACKGROUND: Women with disabilities in developing countries experience significant marginalization, which negatively affects their reproductive health. This study examined the association between disability status and sexual intimate partner violence; the determinants of sexual intimate partner violence by disability status; and the variations in the determinants by disability status. METHODS: The study, which was based on a merged dataset of 2006, 2011 and 2016 Uganda Demographic Surveys, used a weighted sample of 9689 cases of married women selected for the domestic violence modules. Data were analyzed using frequency distributions and chi-squared tests and multivariable logistic regressions. Other key explanatory variables included partner's alcohol consumption and witnessing parental violence. A model with disability status as an interaction term helped to establish variations in the determinants of sexual intimate partner violence by disability status. RESULTS: Sexual IPV was higher among women with disabilities (25% compared to 18%). Disability status predicted sexual intimate partner violence with higher odds among women with disabilities (aOR = 1.51; 95% CI 1.10-2.07). The determinants of sexual intimate partner violence for women with disabilities were: partner's frequency of getting drunk, having witnessed parental violence, occupation, and wealth index. The odds of sexual intimate partner violence were higher among women whose partners often or sometimes got drunk, that had witnessed parental violence, were involved in agriculture and manual work; and those that belonged to the poorer and middle wealth quintiles. Results for these variables revealed similar patterns irrespective of disability status. However, women with disabilities in the agriculture and manual occupations and in the poorer and rich wealth quintiles had increased odds of sexual intimate partner violence compared to nondisabled women in the same categories. CONCLUSION: Determinants of sexual intimate partner violence mainly relate to partners' behaviors and the socialization process. Addressing sexual intimate partner violence requires prioritizing partners' behaviors, and gender norms and proper childhood modelling, targeting men, women, families and communities. Interventions targeting women with disabilities should prioritize women in agriculture and manual occupations, and those above the poverty line.

Collection and use of human materials during TB clinical research; a review of practices.

BACKGROUND: Human biological materials are usually stored for possible future use in research because they preserve valuable biological information, save time and resources, which would have been spent on collection of fresh samples. However, use of these materials may pose ethical challenges such as unauthorized disclosure of genetic information, which can result in dire consequences for individuals or communities including discrimination, stigma, and psychological harm; has biosecurity implications; and loss of control or ownership of samples or data. To understand these problems better, we evaluated the extent to which tuberculosis (TB) clinical research protocols that were used to collect and store biological materials for future use conform to the requirements stated in the Uganda national guidelines for research involving humans as participants. METHODS: This was a retrospective review of TB clinical research projects approved by the Uganda National Council for Science and Technology (UNCST) from 2011 to 2015, to examine whether they fulfilled the requirements for ethical collection and use of human materials. Data were abstracted through review of the project protocols using a template developed based on the informed consent and the Materials Transfer Agreement (MTA) requirements in the national guidelines. RESULTS: Out of 55 research protocols reviewed, most of the protocols 83.6% had been used to collect the stored samples (sputum, blood and sometimes urine), 28% had a section on specimen collection and 24% mentioned ownership of the biological materials. With respect to review of the consent forms used in the studies that stored materials for future use, only 9% of the protocols had a separate consent form for storage of materials, 4.5% of the consent forms explained the risks, 11.4% explained the purpose of the study while 6.8% mentioned the place of storage for the collected materials. CONCLUSION: Many of the studies reviewed did not meet the requirements for collection and storage of biological materials contained in the national guidelines, which indicates a need to additional training on this topic.

Illicit Drug Use among Commercial 'Boda Boda' Motorcyclists in Uganda.

Background: Illicit drug use is a global public health problem with grave health and socio-economic consequences. Related intoxication has been associated with accidental injuries and fatalities. In Uganda, 67% of road traffic accidents are attributed to motorcyclists. Methods: This study assessed the prevalence and determinants of illicit drug use among commercial motorcyclists in Uganda, using a cross-sectional survey research design. We interviewed 785 commercial motorcyclists in the divisions of Nakawa, Rubaga, Makindye, and Kawempe of Kampala district. We used an on-spot saliva drug test kit to screen and detect the presence of illicit drugs. Data were analyzed using frequency distributions, cross tabulations and multi variable logistic regression. Results: Findings show that 11% of the cyclists used illicit drugs. The use of illicit drugs was associated with division of operation, religiosity, and whether a cyclist resided with a family. The odds of use of illicit drugs were higher among cyclists from Nakawa division compared to cyclists from Kawempe. Cyclists who went to places of worship on a weekly basis compared to those who were less frequent, and cyclists who lived with their families compared to those who did not, had reduced odds of use of illicit drugs. There are variations in the distribution of cyclists that use illicit drugs in Kampala. Religious commitment and residence with families had a mitigating influence on illicit drug use among commercial cyclists. Conclusion: Illicit drug use prevention, treatment, and harm reduction programs among cyclists should collaborate with faith-based organizations and other key stakeholders, and promote stable family relations.

Perspectives and ethical considerations for return of genetics and genomics research results: a qualitative study of genomics researchers in Uganda.

BACKGROUND: The return of genetics and genomics research results has been a subject of ongoing global debate. Such feedback is ethically desirable to update participants on research findings particularly those deemed clinically significant. Although there is limited literature, debate continues in African on what constitutes appropriate practice regarding the return of results for genetics and genomics research. This study explored perspectives and ethical considerations of Ugandan genomics researchers regarding the return of genetics and genomics research results. METHODS: This was a qualitative study that employed in-depth interviews. Thirty participants were purposively selected based on their expertise as genomics researchers in Uganda. Data were analysed through content analysis along the main themes of the study using a comprehensive thematic matrix, to identify common patterns arising from the narratives. NVivo software 12 was used to support data analysis. RESULTS: The return of genetics and genomics research results was generally acceptable to researchers, and some indicated that they had previously returned individual or aggregate results to participants and communities. The main reasons cited for sharing research results with participants included their clinical utility, actionability and overall benefit to society. Ethical considerations for appropriate return of results included a need for effective community engagement, genetic counselling prior to disclosure of the results, adequate informed consent, and proper assessment of the implications of, or consequences of returning of results. However, the approaches to return of results were perceived as unstandardized due to the lack of appropriate regulatory frameworks. CONCLUSIONS: The return of genetic and genomic research results is generally acceptable to researchers despite the lack of appropriate regulatory frameworks. Ethical considerations for return of genetics and genomics research results are highly divergent, hence the need for national ethical guidelines to appropriately regulate the practice.

A scoping review of genetics and genomics research ethics policies and guidelines for Africa.

BACKGROUND: Genetics and genomics research (GGR) is increasingly being conducted around the world; yet, researchers and research oversight entities in many countries have struggled with ethical challenges. A range of ethics and regulatory issues need to be addressed through comprehensive policy frameworks that integrate with local environments. While important efforts have been made to enhance understanding and awareness of ethical dimensions of GGR in Africa, including through the H3Africa initiative, there remains a need for in-depth policy review, at a country-level, to inform and stimulate local policy development and revision on the continent. METHODS: To identify and characterize existing ethics-related guidelines and laws applicable to GGR across much of Africa, we conducted a scoping review of English language policy documents identified through databases, repositories, and web searches. Thirty-six documents were included and coded using a framework that contained a range of themes across five analytical categories: (1) respect, (2) beneficence, (3) justice, (4) independent oversight, and (5) bans and prohibitions. Data analysis software (NVivo 12) was used to organize, code, and tabulate information according to document characteristics and topics. Illustrative examples of policy requirements were selected for inclusion. RESULTS: Documents that met inclusion criteria spanned 20 years; published between 1996 and 2018, with the majority (58%) published after 2009. About two-thirds were denoted as "guidelines," and slightly more than half were non-exclusive to GGR. Very few (six) country-level documents identified were specific to GGR. Requirements related to the principle of "respect" appeared most often across all documents, relative to other principles and processes. The most commonly stated ban was on reproductive cloning. Other prohibitions applied to germline editing, undue inducements in research, sample use for commercial purposes, employee mandatory DNA testing, fetal sex selection, stem cell use, eugenics, and research without public health benefits. CONCLUSIONS: Enforceable policies that are indispensable to the ethical conduct and review of GGR are either deficient or missing in many African countries. Existing international, GGR-specific ethics guidelines can be used to inform GGR policy development at a country-level, in conjunction with insight from country specific ethics committees and other local stakeholders.

Factors associated with HPV vaccination uptake in Uganda: a multi-level analysis.

BACKGROUND: The cervical cancer burden in Uganda is high amidst low uptake of HPV vaccination. Identification of individual and community factors associated with HPV vaccination are imperative for directed interventions. Conversely, in most Low and Middle Income Countries (LMICs) including Uganda this problem has not been sufficiently studied as the influence of individual and contextual determinants remains undetermined in spite of their substantial effect on HPV vaccine uptake. The aim of the study was to identify individual (school attendance status, age of girls, ethnicity, and amount of media exposure) and community (socioeconomic disadvantages) factors associated with HPV vaccination. METHODS: Based on a modified conceptual framework for health care utilization, hierarchical modelling was used to study 6093 girls, aged 10-14 years (level 1), nested within 686 communities (level 2) in Uganda by analyzing data from the 2016 Uganda Demographic and Health Survey. RESULTS: Majority (78%) of the girls had not been vaccinated. A number of both individual and community factors were significantly associated with HPV vaccination. The Odds of HPV vaccination were higher among girls age; 11, 13, and 14 compared to girls age 10 years, attending school compared to girls not attending school, who were; foreigners, Iteso, Karamajong, Banyoro, Basoga, and other tribe compared to Baganda, living in families with 1-8 members compared to those living in families with 9 or more members and middle social economic status compared to poor wealth quintile. CONCLUSIONS: Both individual and community factors show a noticeable effect on HPV vaccination. If higher vaccination rates are to be achieved in Uganda, these factors should be addressed. Strategies aimed at reaching younger girls, street children, out of school girls, and girls with lower SES should be embraced in order to achieve high vaccination uptake.

Prevalence and determinants of recent HIV testing among older persons in rural Uganda: a cross-sectional study.

BACKGROUND: There is limited research on HIV testing among older persons in Uganda. The aim of this study was to investigate the socio-demographic determinants of recent HIV testing among older persons in selected rural districts in Uganda. METHODS: A cross-sectional survey of 649 older men and women age 50 years and older, from central (Masaka district) and western (Hoima district) Uganda was conducted. Frequency distributions, chi-square tests and multivariable logistic regressions were used to examine the association between recent HIV testing and selected explanatory variables. RESULTS: Nearly six in ten (58%) of older persons had primary education. About 60% of the respondents were in union and 13% of them had two or more spouses. Half of the older people (51%) had sex in the last twelve months. A quarter (25%) of older persons gave or received gifts in exchange for sex in their lifetime. Nearly a third (29%) reported sexually transmitted infections in the last 12 months. Prevalence of lifetime HIV testing was 82% and recent (last 12 months) HIV testing was 53%. HIV testing in the last 12 months was associated with age (OR = 0.50; 95% CI: 0.31-0.79), self-reported sexually transmitted infections (OR = 1.59; 95% CI: 1.00-2.30), male circumcision (OR = 1.71; 95% CI: 1.0-2.93), and sexual activity in the last 12 months (OR = 2.89; 95% CI: 1.83-4.57). CONCLUSION: Recent HIV testing among older persons was associated with younger age, self-reported STIs, male circumcision, and sexual activity among older persons in rural Uganda. HIV testing interventions need to target older persons who are 70 years and older, who were less likely to test.

Evolution of research ethics in a low resource setting: A case for Uganda.

BACKGROUND: The globalization of clinical research in the last two decades has led to a significant increase in the volume of clinical research in developing countries. As of 2016, Uganda was the third largest destination for clinical trials in Africa. This requires adequate capacity and systems to facilitate ethical practice. METHODS: This was a retrospective study involving review of laws, guidelines, policies and records from 1896 to date. RESULTS: Modern medicine evolved from 1896 and by the time of Uganda's independence in 1962, a 1500 bed national referral hospital was in place and a fully-fledged medical school was established at the Makerere University. As the practice of medicine evolved in the country, so did medical research that addressed priority health issues. The growth in modern medicine was not matched with development of research infrastructure and regulatory systems. The first documented regulation of research activities was in 1970 while the first research ethics committee established in 1986 was to facilitate review of research related to the HIV/AIDs pandemic. In 1990 an Act of Parliament was passed to facilitate development and implementation of policies, hence the development of the national guidelines in 1997, training, establishment and accreditation of research ethics committees, conferences and research site monitoring. CONCLUSION: Over the past 120 years, the implementation and structural aspects of research ethics in Uganda have evolved through 70 years of no regulation, followed by 30 years of rudimentary regulation while the last 20 years have shown significant growth in the regulatory system associated with supportive laws, institutionalization of regulatory and training processes.

Differences in HIV testing and receipt of results between adolescent and non-adolescent women in Uganda.

Despite notable increase in HIV testing among Uganda's women from 25% in 2006 to 71% in 2011, HIV testing among adolescent women remains very low at 45.5%. This study assesses differences in HIV testing and receipt of results (HTR) between adolescent and non-adolescent women in Uganda. The differences were decomposed into components attributed to variation in characteristics and variation in effects of characteristics in the two groups. The assessment was based on data sourced from 2011 Uganda Demographic Health Survey. Statistical analysis was done using a Non-linear Oaxaca' Blinder Multivariate Decomposition of the logistic regression. In the results, the difference in HIV testing and receipt of result between adolescent and non-adolescent women was significantly (P < 0.05) attributed to both variation in characteristics (57.2%) and variation in the effects of characteristics/coefficients (42.8%). In particular, the gap in HTR was mainly attributed to variation in characteristics such as ever had sex (34.7%) and ever given birth (31.6%) and variation in effects of characteristics such as education level (- 68.8%) and marital status (- 12.6%). Based on the findings of the study, government and other development partners need to scale up HIV testing programs targeting adolescents through tackling stigma, increasing on community outreach services and expanding adolescent friendly HIV services center.

Facilitators, best practices and barriers to integrating family planning data in Uganda's health management information system.

BACKGROUND: Health management information systems (HMIS) are instrumental in addressing health delivery problems and strengthening health sectors by generating credible evidence about the health status of clients. There is paucity of studies which have explored possibilities for integrating family planning data from the public and private health sectors in Uganda's national HMIS. This study sought to investigate the facilitators, best practices and barriers of integrating family planning data into the district and national HMIS in Uganda. METHODS: We conducted a qualitative study in Kampala, Jinja, and Hoima Districts of Uganda, based on 16 key informant interviews and a multi-stakeholder dialogue workshop with 11 participants. Deductive and inductive thematic methods were used to analyze the data. RESULTS: The technical facilitators of integrating family planning data from public and private facilities in the national and district HMIS were user-friendly software; web-based and integrated reporting; and availability of resources, including computers. Organizational facilitators included prioritizing family planning data; training staff; supportive supervision; and quarterly performance review meetings. Key behavioral facilitators were motivation and competence of staff. Collaborative networks with implementing partners were also found to be essential for improving performance and sustainability. Significant technical barriers included limited supply of computers in lower level health facilities, complex forms, double and therefore tedious entry of data, and web-reporting challenges. Organizational barriers included limited human resources; high levels of staff attrition in private facilities; inadequate training in data collection and use; poor culture of information use; and frequent stock outs of paper-based forms. Behavioral barriers were low use of family planning data for planning purposes by district and health facility staff. CONCLUSION: Family planning data collection and reporting are integrated in Uganda's district and national HMIS. Best practices included integrated reporting and performance review, among others. Limited priority and attention is given to family planning data collection at the facility and national levels. Data are not used by the health facilities that collect them. We recommend reviewing and tailoring data collection forms and ensuring their availability at health facilities. All staff involved in data reporting should be trained and regularly supervised.

Gender relations, sexual behaviour, and risk of contracting sexually transmitted infections among women in union in Uganda.

BACKGROUND: Sexually transmitted infections (STIs) are a major reproductive and public health concern, especially in the era of HIV/AIDS. This study examined the relationship between sexual empowerment and STI status of women in union (married or cohabiting) in Uganda, controlling for sexual behaviour, partner factors, and women's background characteristics. METHODS: The study, based on data from the 2011 Uganda Demographic and Health Survey (UDHS), analysed 1307 weighted cases of women age 15-49 in union and selected for the domestic violence module. Chi-squared tests and multivariate logistic regressions were used to examine the predicators of STI status. The main explanatory variables included sexual empowerment, involvement in decision making on own health, experience of any sexual violence, condom use during last sex with most recent partner, number of lifetime partners and partner control behaviours. Sexual empowerment was measured with three indicators: a woman's reported ability to refuse sex, ability to ask her partner to use a condom, and opinion regarding whether a woman is justified to refuse sex with her husband if he is unfaithful. RESULTS: Results show that 28 % of women in union reported STIs in the last 12 months. Sexual violence and number of lifetime partners were the strongest predictors of reporting STIs. Women's sexual empowerment was a significant predictor of their STI status, but, surprisingly, the odds of reporting STIs were greater among women who were sexually empowered. Reporting of STIs was negatively associated with a woman's participation in decision-making with respect to her own health, and was positively associated with experience of sexual violence, partner's controlling behaviour, and having more than one life partner. CONCLUSIONS: Our findings suggest that, with respect to STIs, sexual empowerment as measured in the study does not protect women who have sexually violent and controlling partners. Interventions promoting sexual health must effectively address negative masculine attitudes and roles that perpetuate unhealthy sexual behaviours and gender relations within marriage. It is also important to promote marital fidelity and better communication within union and to encourage women to take charge of their health jointly with their partners.

Empowerment, intimate partner violence and skilled birth attendance among women in rural Uganda.

BACKGROUND: There is limited research on how the empowerment of women and intimate partner violence (IPV) are associated with skilled birth attendance (SBA) among rural women in Uganda. Therefore, the aim of this paper was to investigate the association between women's empowerment, their experience of IPV and SBA in rural Uganda. METHODS: Using data from the Uganda Demographic and Health Survey (UDHS), we selected 857 rural women who were in union, had given birth in the last 5 years preceding the survey and were selected for the domestic violence (DV) module. Frequency distributions were used to describe the background characteristics of the women and their partners. Pearson's chi-squared (χ (2)) tests were used to investigate the associations between SBA and women's empowerment; and partners' and women's socio-demographic factors including sexual violence. Multivariable logistic regression analyses were used to examine the association between SBA and explanatory variables. RESULTS: More than half (55 %) of the women delivered under the supervision of skilled birth attendant. Women's empowerment with respect to participation in household decision-making, property (land and house) (co)ownership, IPV, and sexual empowerment did not positively predict SBA among rural women in Uganda. Key predictors of SBA were household wealth status, partners' education, ANC attendance and parity. CONCLUSIONS: For enhancement of SBA in rural areas, there is a need to encourage a more comprehensive ANC attendance irrespective of number of children a woman has; and design interventions to enhance household wealth and promote men's education.

Determinants of Male Circumcision for HIV/AIDS Prevention in East Central Uganda.

Safe Male Circumcision (SMC) is one the effective strategies for reducing HIV transmission. The paper examines factors associated with SMC for HIV prevention, based on 4,979 males from East Central Uganda. Data were analysed using chi-squared tests and multinomial logistic regression. Older males aged 31 years and above (p < 0.001), from predominantly non-circumcising districts (Buyende - p < 0.001, Kaliro p < 0.01, and Kamuli - p < 0.01); who had neither used condoms (p = 0.03) nor tested for HIV (p < 0.001) were less likely to circumcise for HIV prevention. Males who were assessed in 2012 (p < 0.001) three years after program implementation were more likely to circumcise for HIV for HIV prevention. Males that did not take measures to prevent HIV infection were less likely to undertake SMC and are therefore highly vulnerable to infection. These (together with older males, and males from non-circumcising districts) should be targeted for promotion of SMC alongside other HIV preventive measures. For better results, the benefits SMC for children as well as adults require emphasis. Wider coverage of SMC services should entail adequate equipping of public and where feasible, private facilities and appropriate training of health personnel countrywide.

Determinants of access to healthcare by older persons in Uganda: a cross-sectional study.

BACKGROUND: Older persons report poor health status and greater need for healthcare. However, there is limited research on older persons' healthcare disparities in Uganda. Therefore, this paper aimed at investigating factors associated with older persons' healthcare access in Uganda, using a nationally representative sample. METHODS: We conducted secondary analysis of data from a sample of 1602 older persons who reported being sick in the last 30 days preceding the Uganda National Household Survey. We used frequency distributions for descriptive data analysis and chi-square tests to identify initial associations. We fit generalized linear models (GLM) with the poisson family and the log link function, to obtain incidence risk ratios (RR) of accessing healthcare in the last 30 days, by older persons in Uganda. RESULTS: More than three quarters (76%) of the older persons accessed healthcare in the last 30 days. Access to healthcare in the last 30 days was reduced for older persons from poor households (RR = 0.91, 95% CI: 0.83-0.99); with some walking difficulty (RR = 0.90, 95% CI: 0.83-0.97); or with a lot of walking difficulty (RR = 0.84, 95% CI: 0.75-0.95). Conversely, accessing healthcare in the last 30 days for older persons increased for those who earned wages (RR = 1.08, 95% CI: 1.00-1.15) and missed work due to illness for 1-7 days (RR = 1.19, 95% CI: 1.10-1.30); and 8-14 days (RR = 1.19, 95% CI: 1.07-1.31). In addition, those who reported non-communicable diseases (NCDs) such as heart disease, hypertension or diabetes (RR = 1.09, 95% CI: 1.01-1.16); were more likely to access healthcare during the last 30 days. CONCLUSION: In the Ugandan context, health need factors (self-reported NCDs, severity of illness and mobility limitations) and enabling factors (household wealth status and earning wages in particular) were the most important determinants of accessing healthcare in the last 30 days among older persons.

Partners' controlling behaviors and intimate partner sexual violence among married women in Uganda.

BACKGROUND: Studies on the association between partners' controlling behaviors and intimate partner sexual violence (IPSV) in Uganda are limited. The aim of this paper was to investigate the association between IPSV and partners' controlling behaviors among married women in Uganda. METHODS: We used the 2011 Uganda Demographic and Health Survey (UDHS) data, and selected a weighted sample of 1,307 women who were in a union, out of those considered for the domestic violence module. We used chi-squared tests and multivariable logistic regressions to investigate the factors associated with IPSV, including partners' controlling behaviors. RESULTS: More than a quarter (27%) of women who were in a union in Uganda reported IPSV. The odds of reporting IPSV were higher among women whose partners were jealous if they talked with other men (OR = 1.81; 95% CI: 1.22-2.68), if their partners accused them of unfaithfulness (OR = 1.50; 95% CI: 1.03-2.19) and if their partners did not permit them to meet with female friends (OR = 1.63; 95% CI: 1.11-2.39). The odds of IPSV were also higher among women whose partners tried to limit contact with their family (OR = 1.73; 95% CI: 1.11-2.67) and often got drunk (OR = 1.80; 95% CI: 1.15-2.81). Finally, women who were sometimes or often afraid of their partners (OR = 1.78; 95% CI: 1.21-2.60 and OR = 1.56; 95% CI: 1.04-2.40 respectively) were more likely to report IPSV. CONCLUSION: In Uganda, women's socio-economic and demographic background and empowerment had no mitigating effect on IPSV in the face of their partners' dysfunctional behaviors. Interventions addressing IPSV should place more emphasis on reducing partners' controlling behaviors and the prevention of problem drinking.

Modern contraceptive use among sexually active men in Uganda: does discussion with a health worker matter?

BACKGROUND: Family planning programs have recently undergone a fundamental shift from being focused on women only to focusing on men individually, or on both partners. However, contraceptive use among married men has remained low in most high-fertility countries including Uganda. Men's role in reproductive decision-making remains an important and neglected part of understanding fertility control both in high-income and low-income countries. This study examines whether discussion of family planning with a health worker is a critical determinant of modern contraceptive use by sexually active men, and men's reporting of partner contraceptive use. METHODS: The study used data from the 2011 Uganda Demographic and Health Survey comprising 2,295 men aged 15-54 years. Specifically, analyses are based on 1755 men who were sexually active 12 months prior to the study. Descriptive statistics, Pearson's chi-square test, and logistic regression were used to identify factors that influenced modern contraceptive use among sexually active men in Uganda. RESULTS: Findings indicated that discussion of family planning with a health worker (OR=1.85; 95% CI: 1.29-2.66), region (OR=0.41; 95% CI: 0.21-0.77), education (OR=2.13; 95% CI: 1.01-4.47), wealth index: richer (OR=2.52; 95% CI: 1.58-4.01), richest (OR=2.47; 95% CI: 1.44-4.22), surviving children (OR=2.04; 95% CI:1.16-3.59) and fertility preference (OR=3.50; 95% CI: 1.28-9.61) were most significantly associated with modern contraceptive use among men. CONCLUSIONS: The centrality of the role of discussion with health workers in predicting men's participation in family planning matters may necessitate creation of opportunities for their further engagement at health facilities as well as community levels. Men's discussion of family planning with health workers was significantly associated with modern contraceptive use. Thus, creating opportunities through which men interact with health workers, for instance during consultations, may improve contraceptive use among couples.

Determinants of preference of source of injectable contraceptives among rural women in Uganda: a case study of Depo-Provera.

Understanding preference of source of contraceptive commodities is essential in enhancing the delivery of family planning services. This paper identifies the determinants of preferred source of Depo-Provera among rural women in Uganda. The analysis is based on data sourced from a Save the Children and Family Health International study involving 642 women who were introduced to the contraceptive three years prior to the evaluation. Data were analyzed at univariate, bivariate and multivariate levels. Private sources were the most preferred of Depo-Provera as compared to public sources. Preference for private sources was more likely among older women (p < 0.05), those who had never experienced stock-outs of Depo-Provera (p < 0.01), and those who had obtained their last injectable from private sources (p < 0.01). These findings support the strategy of community-based distribution of contraceptives in enhancing access and utilization of family planning services in Uganda.