Youths' perceptions of community health workers' delivery of family planning services: a cross-sectional, mixed-methods study in Nakaseke District, Uganda.

BACKGROUND: High rates of unintended adolescent pregnancy are a significant health problem in Uganda. To improve access to family planning (FP) services, community-based Village Health Teams (VHTs) are widely employed in Uganda to deliver education and services. However, evaluations of FP programs suggest that mainly older, married women use VHT FP services. METHODS: To better understand youth reluctance to use VHTs, we collected quantitative FP and contraceptive-seeking behavior data from a survey of 250 youths aged 15-25 in randomly selected households in Nakaseke District, which we triangulated with data from 3 focus group discussions (FGDs) (n = 15). RESULTS: Most respondents received FP services from the formal health sector, not VHTs. Only half had talked to a VHT, but 65% knew that VHTs provide free FP services, and most (82%) felt comfortable talking to VHTs about FP. The main reasons for discomfort were fear that VHTs would violate privacy (mentioned by 60% of those not comfortable), that VHTs would talk to parents (33%), shyness (mentioned by 42% of those ≤18), and fear of being judged (14%). Concern about side effects was the most common reason for not using FP methods. Survey respondents said having VHTs of the same sex was important, particularly those in the youngest age group (OR = 4.45; 95%CI: 1.24, 16.00) and those who were unmarried (OR = 5.02; 95%CI: 2.42, 10.39). However, FGD participants (who were older than survey respondents on average) often preferred older VHTs of the opposite sex, whom they viewed as more professional and trustworthy. Respondents said the primary deciding factors for using VHTs were whether privacy would be respected, the proximity of care, and the respectfulness of care. CONCLUSIONS: VHTs are a known source of FP services but not widely used by youth due to privacy and quality of care concerns. VHT messaging and training should increase focus on ensuring privacy, protecting confidentiality, providing respectful care, and addressing concerns about contraceptive side effects. Preferences for VHTs of similar age and sex may be more important for younger adolescents than older youths for whom quality concerns predominate.

Chronic Obstructive Pulmonary Disease Prevalence and Associated Factors in a Setting of Well-Controlled HIV, A Cross-Sectional Study.

In Sub-Saharan Africa, COPD remains prevalent but its association with HIV is not well characterized especially in rural settings. We assessed for COPD prevalence, associated factors and lung function profile among HIV-infected individuals attending ART clinics in rural Nakaseke district of Uganda. We enrolled HIV-positive participants from four HIV treatment centers in rural Uganda. Participants underwent spirometry testing following standard guidelines. We defined COPD as a post-bronchodilator FEV1/FVC ratio less than the fifth percentile of the NHANES III African-American reference. We assessed for factors associated with COPD and lung function profiles using multivariable logistic and linear regression analyses. We analyzed data from 722 HIV-positive participants (mean age 48.0 years, 59.7% women). Over 90% of participants were on ART for a median duration of 4 years (IQR 2-7 years), with a median viral load of 0 copies/mL (IQR 0-0 copies/mL), current and baseline CD4 + T cell count of 478 cells/mm3 (IQR 346-663 cells/mm3) and 335 cells/mm3 (IQR 187-523 cells/mm3) respectively. The prevalence of COPD was 6.22%. COPD was associated with worse respiratory symptoms and health status. History of pulmonary tuberculosis was strongly associated with COPD (adjusted OR = 4.92, 95% CI 1.71 to 14.15, p = 0.003) and reduced lung function. Use of ART, CD4+T cell count and viral load were not associated with COPD or reduced lung function. In conclusion, we report a COPD prevalence of 6.22% in HIV-infected individuals in rural Uganda. Pulmonary tuberculosis remains the strongest predictor of COPD risk and reduced lung function in well-controlled HIV.

Knowledge and use of family planning among men in rural Uganda.

BACKGROUND: Unmet need for family planning exceeds 33% in Uganda. One approach to decreasing unmet need is promoting male involvement in family planning. Male disapproval of use of family planning by their female partners and misconceptions about side effects are barriers to family planning globally and in Uganda in particular. Researchers have conducted a number of qualitative studies in recent years to examine different aspects of family planning among Ugandan men. The present study aimed to quantify men's knowledge of family planning in rural Uganda to understand how better to involve men in couples' contraceptive decision-making, particularly in low-resource settings. METHODS: Data were derived from in-person, researcher-administered surveys of men in a rural agrarian district in Uganda (N = 178). Participant demographics and knowledge of family planning methods, side effects, and use were queried. Descriptive statistics were used for analysis. RESULTS: Men were 34 years of age on average (range 18-71) and about half (56%) had a primary school education or less. Ninety-eight percent reported any knowledge of family planning, with 73% of men reporting obtaining information via radio and only 43% from health workers. The most common method known by men was the male condom (72%), but more than half also knew of injections (54%) and pills (52%). Relatively few men reported knowing about the most effective reversible contraceptive methods, intrauterine devices and implants (both 16%). Men identified many common contraceptive side-effects, such as vaginal bleeding (31%), and misconceptions about side effects, such as increased risk of infertility and birth defects, were relatively uncommon (both < 10%). About half of all men reported ever using a family planning method (53%), and 40% reported current use. CONCLUSIONS: This study's quantitative results build on those of recent qualitative studies and provide information about the types of family planning information men are lacking and avenues for getting this information to them.

Implementation of Patient-Centered Education for Chronic-Disease Management in Uganda: An Effectiveness Study.

BACKGROUND: The majority of non-communicable disease related deaths occur in low- and middle-income countries. Patient-centered care is an essential component of chronic disease management in high income settings. OBJECTIVE: To examine feasibility of implementation of a validated patient-centered education tool among patients with heart failure in Uganda. DESIGN: Mixed-methods, prospective cohort. SETTINGS: A private and public cardiology clinic in Mulago National Referral and Teaching Hospital, Kampala, Uganda. PARTICIPANTS: Adults with a primary diagnosis of heart failure. INTERVENTIONS: PocketDoktor Educational Booklets with patient-centered health education. MAIN MEASURES: The primary outcomes were the change in Patient Activation Measure (PAM-13), as well as the acceptability of the PocketDoktor intervention, and feasibility of implementing patient-centered education in outpatient clinical settings. Secondary outcomes included the change in satisfaction with overall clinical care and doctor-patient communication. KEY RESULTS: A total of 105 participants were enrolled at two different clinics: the Mulago Outpatient Department (public) and the Uganda Heart Institute (private). 93 participants completed follow up at 3 months and were included in analysis. The primary analysis showed improved patient activation measure scores regarding disease-specific knowledge, treatment options and prevention of exacerbations among both groups (mean change 0.94 [SD = 1.01], 1.02 [SD = 1.15], and 0.92 [SD = 0.89] among private paying patients and 1.98 [SD = 0.98], 1.93 [SD = 1.02], and 1.45 [SD = 1.02] among public paying patients, p<0.001 for all values) after exposure to the intervention; this effect was significantly larger among indigent patients. Participants reported that materials were easy to read, that they had improved knowledge of disease, and stated improved communication with physicians. CONCLUSIONS: Patient-centered medical education can improve confidence in self-management as well as satisfaction with doctor-patient communication and overall care in Uganda. Our results show that printed booklets are locally appropriate, highly acceptable and feasible to implement in an LMIC outpatient setting across socioeconomic groups.

SegWeigh: a mixed-method approach to segmenting potential contraceptive user groups and meeting Family Planning 2020 goals.

OBJECTIVE: To evaluate a low-cost mixed-method research tool (SegWeigh) that informs awareness raising and family planning interventions for potential contraceptive users. METHODS: A pilot study of SegWeigh was conducted in Uganda and Vietnam between September 3, 2012, and February 21, 2013. User archetypes were produced in four steps by triangulating Demographic and Health Survey (DHS) data; a secondary literature review; family planning service provision data; and primary qualitative investigation. RESULTS: Triangulation of DHS analysis, secondary literature and service data revealed three potential user profiles: Ugandan women wanting to space pregnancies; Ugandan men wanting to limit pregnancies; and unmarried Vietnamese women having infrequent sex. Archetypes were subsequently created of "Kibuuka," a 52-year-old semi-literate subsistence farmer in rural Uganda, and "Anh," a 20-year-old student in Hanoi, Vietnam. CONCLUSION: SegWeigh rapidly produced data-rich "real life" user profiles that might help to tailor family planning interventions.