Factors associated with retention of mother-baby pairs in the elimination of mother-to-child transmission of HIV program in Kaberamaido district: A longitudinal analysis.

BACKGROUND: Retention along the elimination of Mother to Child Transmission (eMTCT) cascade in Uganda remains poor as only 62.7%-69.5% are followed up to 18months. The objective of this study was to determine the rates of retention of mother-baby pairs at two levels of the eMTCT cascade (12 and 18 months) and associated factors. METHODS: This was a longitudinal analysis of 368 mother-baby pairs who were enrolled into the eMTCT program in Kaberamaido district from January 2013 to December 2018. Data was extracted from early infant diagnosis (EID) and mothers' ART registers, entered into Microsoft Excel and then exported to Stata statistical software package version 14.0 for management and analysis. Descriptive statistics such as mean and frequencies were computed at univariate level. At the bivariate level, Cox proportional hazard regression was performed to assess the level of association between the primary outcome and each independent variable, while Cox proportional hazard regression model was built at multivariate level to determine the factors independently associated with retention of mother-baby pairs in the eMTCT program. RESULTS: Of the 368 mothers enrolled into the study, their average age was 29.7years (SD = 6.6). Nearly two-thirds of the mothers were married/cohabiting, (n = 232, 63.0%). The 368 mother baby pairs were observed for a total time of 6340 person months, with majority, 349 (94.8%, 95%CI = 92.0-96.7) still active in eMTCT care, while 19(5.2%, 95%CI = 3.3-8.0) were lost to follow up at 12months. At 18 months, 323 (87.8%, 95%CI = 84.0-90.8) were active in eMTCT program while 45(12.2%, 95 CI = 9.2-16.0) were lost to follow up. At bivariate level, marital status, health facility level of enrolment, mothers' ART treatment supporter, and mothers' ART enrolment time were significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs along the eMTCT cascade. At multivariable level, the mothers' time of ART initiation was significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs at along the eMTCT cascade, with mothers-baby pairs who were initiated during the antenatal/post-natal periods having higher hazards of LTFU compared to those who initiated ART before Antenatal period (before pregnancy), aHR = 4.37(95%CI, 1.62-11.76, P = 0.003). Mother-baby pairs who were enrolled into the eMTCT program after the implementation of HIV test and treat policy (year 2017 and 2018) had higher hazards of LTFU as compared to those enrolled before the implementation of test and treat policy in Uganda (year 2013-2016), aHR = 2.22(95% CI, 1.15-4.30, P = 0.017). All the other factors had no significant association with lost to follow up and cascade completion at multivariate level. CONCLUSION: There was high level of retention of mother-baby pairs in the eMTCT program in Kaberamaido at 12 months, but it was suboptimal at 18months. ART initiation during the antenatal and/or post-natal period was significantly associated with suboptimal retention of mother-baby pairs along the eMTCT cascade.

Perceptions of adolescent mothers towards adolescent repeat childbirth in Soroti district, Teso sub-region, Uganda: A phenomenological study.

The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1%) is higher than the global estimate (18.5%). Soroti district tops Teso (a region with highest adolescent childbearing rate nationally) in adolescent childbearing. Adolescent repeat childbearing (ARC) is associated with poor health outcomes, increased risk of stillbirth, maternal and child mortality, thus a public health concern. The explanations to the high prevalence of repeat childbirth in Soroti district remain unknown. We conducted a phenomenological study where theoretical saturation was achieved with 3 focus group discussions; each comprised of 8 respondents. The questions posed focused on modified socio-ecological model regarding the factors associated with repeat childbirth. These included; perceived individual factors of repeat childbirth, factors related to the sexual partner of the adolescent mother, adolescent mother's family related factors and factors related to the peers and community of the adolescent mothers. Transcripts were organized and analyzed by QSR Nvivo following deductive approach. Results: Adolescent marriage was viewed as a privilege, family planning methods were viewed as non-functional, man's demand for sex was unchallengeable and non-supportive families including mistreatment of the participants by their families were perceived as risk factors for ARC. This therefore suggests that in order to prevent repeat adolescent childbearing in Soroti district, and contribute towards the achievement of the SDG numbered three (ensure healthy lives and promote well-being for all at all ages) there is need to awaken and strengthen the implementation of the anti-teen marriage programs and policies; strengthen sexual/reproductive education including family planning programs, and addressing identified myths regarding ARC.

COVID-19 vaccine hesitancy among health workers in rural Uganda: A mixed methods study.

Background: COVID-19 vaccination is the latest preventive intervention strategy in an attempt to control the global pandemic. Its efficacy has come under scrutiny because of break through infections among the vaccinated and need for booster doses. Besides, although health workers were prioritized for COVID-19 vaccine in most countries, anecdotal evidence points to high levels of reluctance to take the vaccine among health workers. We assessed COVID-19 vaccine hesitancy among health workers in Dokolo district, northern Uganda. Methods: This was a mixed-method, cross-sectional descriptive study. A customised self-administered data collection tool was used to collect quantitative data on characteristics, vaccination status and factors for or rejection of vaccine uptake. We conducted multivariable logistic regression to assess the association between selected exposures and vaccine hesitancy using Stata version 15. Conversely, qualitative data were collected using key informant interviews (KIIs) among 15 participants that were purposively selected. Data were analysed using thematic content analysis with the help of NVivo 12.0. Results: Of the 346 health workers enrolled, (13.3% [46/346]) were vaccine hesitant. Factors associated with vaccine hesitancy included fear of side effects (Adjusted Odds Ratio [AOR]: 2.55; 95% Confidence Interval [95%CI]: 1.00, 6.49) and health workers' lack of trust in the information provided by health authorities (AOR: 6.74; 95% CI: 2.43, 18.72). Similar factors were associated with vaccine hesitancy when we used the vaccine hesitancy score. Fear of side effects, distrust in vaccine stakeholders, and lack of trust in the vaccine were barriers to COVID-19 vaccination among health workers. Conclusion: A small proportion of health workers were found to be hesitant to take the COVID-19 vaccine in this study. The paucity of COVID-19 vaccine safety information, which eroded the health workers' trust in the information they received on the vaccine, was responsible for health workers hesitancy to take up the vaccine in Uganda.

Characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care in Kapelebyong district in Uganda: a mixed-methods study.

BACKGROUND: A rapid increase in community transmission of COVID-19 across the country overwhelmed Uganda's health care system. In response, the Ministry of Health adopted the home-based care strategy for COVID-19 patients with mild-to-moderate disease. We determined the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care during the second wave in Kapelebyong district, in eastern Uganda. METHODS: We conducted a sequential explanatory mixed-methods study. We first collected quantitative data using an interviewer-administered questionnaire to determine characteristics and treatment outcomes of COVID-19 patients under home-based care. Cured at home was coded as 1 (considered a good outcome) while being admitted to a health facility and/or dying were coded as 0 (considered poor outcomes). Thereafter, we conducted 11 in-depth interviews to explore the experiences of COVID-19 patients under home-based care. Multivariable logistic regression was used to assess factors associated with poor treatment outcomes using Stata v.15.0. Thematic content analysis was used to explore lived experiences of COVID-19 patients under home-based care using NVivo 12.0.0 RESULTS: A total of 303 study participants were included. The mean age ± standard deviation of participants was 32.2 years ± 19.9. Majority of the participants [96.0% (289/303)] cured at home, 3.3% (10/303) were admitted to a health facility and 0.7% (2/303) died. Patients above 60 years of age had 17.4 times the odds of having poor treatment outcomes compared to those below 60 years of age (adjusted odds ratio (AOR): 17.4; 95% CI: 2.2-137.6). Patients who spent more than one month under home-based care had 15.3 times the odds of having poor treatment outcomes compared to those that spent less than one month (AOR: 15.3; 95% CI: 1.6-145.7). From the qualitative interviews, participants identified stigma, fear, anxiety, rejection, not being followed up by health workers and economic loss as negative experiences encountered during home-based care. Positive lived experiences included closeness to friends and family, more freedom, and easy access to food. CONCLUSION: Home-based care of COVID-19 was operational in eastern Uganda. Older age (> 60 years) and prolonged illness (> 1 months) were associated with poor treatment outcomes. Social support was an impetus for home-based care.

Side-Effects following Oxford/AstraZeneca COVID-19 Vaccine in Tororo District, Eastern Uganda: A Cross-Sectional Study.

Effective, safe and proven vaccines would be the most effective strategy against the COVID-19 pandemic but have faced rollout challenges partly due to fear of potential side-effects. We assessed the prevalence, profiles, and predictors of Oxford/AstraZeneca vaccine side-effects in Tororo district of Eastern Uganda. We conducted telephone interviews with 2204 participants between October 2021 and January 2022. Multivariable logistic regression was conducted to assess factors associated with Oxford/AstraZeneca vaccine side-effects using Stata version 15.0. A total of 603/2204 (27.4%) of the participants experienced one or more side-effects (local, systemic, allergic, and other side-effects). Of these, 253/603 (42.0%) experienced local side-effects, 449/603 (74.5%) experienced systemic side-effects, 11/603 (1.8%) experienced allergic reactions, and 166/603 (27.5%) experienced other side-effects. Ten participants declined to receive the second dose because of side-effects they had experienced after the first dose. Previous infection with COVID-19 (adjusted odds ratio (AOR): 4.3, 95% confidence interval (95% CI): 2.7-7.0), being female (AOR: 1.3, 95% CI: 1.1-1.6) and being a security officer (AOR: 0.4, 95% CI: 0.2-0.6) were associated with side-effects to the Oxford/AstraZeneca vaccine. We recommend campaigns to disseminate correct information about potential side-effects of the Oxford/AstraZeneca vaccine and strengthen surveillance for adverse events following vaccination.

Alcohol-based hand rub and incidence of healthcare associated infections in a rural regional referral and teaching hospital in Uganda ('WardGel' study).

Background: Good hand hygiene (HH) practice is crucial to reducing healthcare associated infections (HAIs). Use of alcohol-based hand rub (ABHR) at health facilities is strongly recommended but it is limited in Uganda. Data on the practice of HH and the incidence of HAIs is sparse in resource-limited settings. We conducted a quasi-experimental study to evaluate HH practices of health care providers (HCPs) utilizing locally made ABHR and the incidence of HAIs. Methods: HH compliance among HCPs and the incidence of HAIs were assessed at Mbale Regional Referral Hospital, a teaching hospital in rural Uganda. Inpatients from the obstetrics/gynecology (OBGYN), pediatric and surgical departments were enrolled on their day of admission and followed up during their hospital stay. The baseline (pre-intervention) phase of 12-weeks was followed by a 12-week intervention phase where training for HH practice was provided to all HCPs present on the target wards and ABHR was supplied on the wards. Incidence of HAIs and or Systemic Inflammatory Response Syndrome (SIRS) was measured and compared between the baseline and intervention phases. Multivariate survival analysis was performed to identify associated variables with HAIs/SIRS. Results: A total of 3335 patients (26.3%) were enrolled into the study from a total of 12,665 admissions on the study wards over a 24-week period. HH compliance rate significantly improved from 9.2% at baseline to 56.4% during the intervention phase (p < 0.001). The incidence of HAIs/SIRS was not significantly changed between the baseline and intervention phases (incidence rate ratio (IRR) 1.07, 95% CI: 0.79 - 1.44). However, subgroup analyses showed significant reduction in HAIs/SIRS on the pediatric and surgical departments (IRR 0.21 (95% CI: 0.10 - 0.47) and IRR 0.39 (95% CI: 0.16 - 0.92), respectively) while a significant increase in HAIs/SIRS was found on the OBGYN department (IRR 2.99 (95% CI: 1.92 - 4.66)). Multivariate survival analysis showed a significant reduction in HAIs/SIRS with ABHR use on pediatric and surgical departments (adjusted hazard ratio 0.26 (95% CI: 0.15 - 0.45)). Conclusions: To our knowledge, this study is one of the largest studies that address HAIs in Africa. During the 24-week study period, significant improvement in HH compliance was observed by providing training and ABHR. The intervention was associated with a significant reduction in HAIs/SIRS on the pediatric and surgical departments. Further research is warranted to integrate HAIs surveillance into routine practice and to identify measures to further prevent HAIs in resource limited settings. Trial registration: ClinicalTrials.gov NCT02435719, registered on 20 April, 2015 (retrospectively registered).