Negative effects of undernutrition on sputum smear conversion and treatment success among retreatment cases in Uganda: A quasi-experimental study.

Rationale: The causal relationship between undernutrition and response to anti-tuberculosis (TB) treatment and TB treatment outcomes among people with retreatment TB is understudied. Objective: To evaluate the effect of undernutrition on treatment success and sputum smear conversion among people with retreatment drug-susceptible TB in Kampala, Uganda. Methods: We conducted a quasi-experimental study utilizing propensity score weighting among people with retreatment drug-susceptible TB aged ≥ 15 years treated between 2012 and 2022 in Kampala. The primary exposure was undernutrition assessed using the mid-upper arm circumference at the time of TB diagnosis. The primary outcome was treatment success defined as cure or treatment completion at month 6. Sputum smear conversion was the secondary outcome and was measured as a change in sputum smear status from positive to negative at months 2, 5, and 6. We estimated the causal effect of undernutrition on the outcomes using a propensity-score weighted modified Poisson regression model with robust error variance. Measurements and main results: Of the 605 participants, 432 (71.4 %) were male, 215 (35.5 %) were aged 25-34 years, 427 (70.6 %) had bacteriologically confirmed pulmonary TB, 133 (22.0 %) were undernourished and 398 (65.8 %) achieved treatment success. Of participants with bacteriologically confirmed pulmonary TB, 232 (59.0 %), 327 (59.3 %), and 360 (97.6 %) achieved sputum smear conversion at months 2, 5, and 6, respectively. Undernutrition reduced treatment success (RR 0.42, 95 % CI 0.32-0.55) as well as sputum smear conversion at months 2 (RR 0.45, 95 % CI 0.42-0.49) and 5 (RR 0.46, 95 % CI 0.43-0.51) but not month 6 (RR 0.99, 95 % CI 0.97-1.02). Conclusion: Undernutrition negatively impacts treatment outcomes. Therefore, nutritional assessment should be an integral component of TB care, with nutritional counseling and support offered to those undernourished to optimize their TB treatment response and outcomes.

Barriers and facilitators to viral load suppression among people living with HIV following intensive adherence counseling in Kampala, Uganda: A qualitative study.

We explored the barriers and facilitators to viral load (VL) suppression after three or more intensive adherence counseling (IAC) sessions among adolescents and adults living with human immunodeficiency virus (HIV) on a first-line anti-retroviral therapy (ART) with initially unsuppressed VL in Kampala, Uganda. Using a qualitative study, data were collected through in-depth interviews with people living with HIV (PLHIV) with unsuppressed and suppressed VL and caregivers of younger adolescents living with HIV after three or more IAC sessions. We held key informant interviews with health workers involved in IAC implementation, namely ART/HIV focal persons, IAC Team Leaders, and linkage facilitators. Guided by the socioecological model, we performed content analysis and reported the findings using themes along with the participants' quotes. We studied 24 participants and found the individual-level barriers as forgetting to take HIV medications, high pill burden, medication side effects, a lack of food, and HIV-related psychological distress. Undisclosed HIV status and broken families were the barriers at the interpersonal level. Institutional-level barriers included insufficient HIV and ART counseling. Stigma was considered a community-level barrier while nonadherence to HIV treatment guidelines was a policy-level barrier. Facilitators included personal reminders, knowing the importance of taking treatment, and the ability to deal with side effects of HIV medications at the personal level; treatment support, peer support clubs, and incentivized treatment at the interpersonal level; and mental health support club and explaining during counseling that HIV is a chronic disease at the institutional level. We found an unsuppressed VL after completing IAC was due to several barriers at the personal, interpersonal, health systems, community, and policy levels. Achieving ≥95% VL suppression necessitates tackling the barriers to VL suppression and scaling up the facilitators by HIV control programs.

Magnitude and trends in cervical cancer at Mbarara Regional Referral Hospital in South Western Uganda: Retrospective analysis of data from 2017-2022.

High-income countries have documented a significant decline in the incidence and mortality of cervical cancer over the past decade but such data from low and middle-income countries such as Uganda is limited to ascertain trends. There is also paucity of data on the burden of cervical cancer in comparison to other gynaecologic malignancies and there is a likelihood that the incidence might be on the rise. To describe the current trends and magnitude of cervical cancer in comparison to other gynaecological malignancies histological types, we conducted a retrospective records review of charts of patients admitted with gynaecological malignancies on the gynaecological ward of Mbarara Regional Referral Hospital (MRRH) between January 2017 and December 2022. Of 875 patients with gynaecological malignancies admitted to the MRRH in the 6-year review period, 721 (82.4%) had cervical cancer. Patients with cervical cancer were significantly older than those with other gynaecological malignancies: (50.2±11.5 versus 43.8± 15.0 respectively, p<0.001). Between 2017 and 2022, cervical cancer rates increased by 17% annually compared to other gynaecological cancers (OR:1.17; 95% CI 1.06-1.28, p = 0.0046), with the majority of patients of cervical cancer patients (92.7%, n = 668) having squamous cell carcinoma. Most patients (87.9%, n = 634) had late-stage disease (stage 2 and above) and were referred to the Uganda Cancer Institute for chemoradiation. These results imply that there is a need to scale up screening services and other preventive measures such as vaccination against human papilloma virus.

Food Insecurity and Engagement in Transactional Sex Among Female Secondary Students in Rwanda.

The relationship between food insecurity and transactional sex is well recognized, but less is known about this relationship among adolescents. We analyzed cross-sectional baseline data from 3,130 female secondary students aged 12-19 enrolled in a three-arm, cluster randomized controlled trial to examine the association between food insecurity and transactional sex. The explanatory variable was food security and the outcome was ever engaging in transactional sex. Over one quarter (28.7%) reported any food insecurity and 1.9% of all participants (9.6% of sexually active participants) reported ever engaging in transactional sex. In adjusted models, ever experiencing any food insecurity was associated with a higher prevalence of ever transactional sex (PR: 1.60; 95% CI: 1.02, 2.49) compared to little to no food insecurity. These results provide insight into potential predictors of higher-risk sexual behavior in Rwanda; they also provide policy-makers with populations with whom to intervene on upstream determinants of transactional sex, notably poverty and food insecurity.

Case fatality rate for Ebola disease, 1976-2022: A meta-analysis of global data.

An up-to-date pooled case fatality rate (CFR) for Ebola disease (EBOD) at the global level is lacking. We abstracted EBOD data from 1976 to 2022 for 16 countries and 42 outbreaks to conduct a meta-analysis. The pooled CFR was 60.6% (95% confidence interval (CI) 51.6-69.4; 95% prediction interval 12.9-99.1). Of the four ebolaviruses, Zaire virus was the most lethal (CFR = 66.6%, 95% CI 55.9-76.8), then Sudan virus (CFR=48.5%, 95% CI 38.6-58.4), Bundibugyo virus (CFR=32.8%, 95% CI 25.8-40.2) and Tai Forest virus (CFR= 0%, 95% CI 0.0-97.5). The CFR in sub-Saharan Africa was 61.3% (95% CI 52.8-69.6) and for the rest of the world was 24.5% (95% CI 0.0-67.9%). CFR declined over time but stabilized at 61.0% (95% CI, 52.0-69.0) between 2014 and 2022. Overall, the EBOD CFR is still high and heterogeneous. Accordingly, early diagnosis, early treatment if available, and supportive care are important to prevent significant morbidity and mortality.

Ebola incidence and mortality before and during a lockdown: The 2022 epidemic in Uganda.

On September 20, 2022, an Ebola Disease (EBOD) outbreak was declared in Mubende district, Central Uganda. Following a rapid surge in the number of cases and mortality, the Government of Uganda imposed a lockdown in the two most affected districts, Mubende and Kassanda. We describe the trends in EBOD incidence and mortality nationally and in the two districts before and during the lockdown and the lessons learned during the epidemic response. We retrieved data from the Ministry of Health situation reports from September 20, 2022, when the EBOD outbreak was declared until November 26, 2022, when the lockdown ended. We graphed trends in EBOD morbidity and mortality during a 3-week and 6-week lockdown, computed the EBOD case fatality rate, and summarized the major lessons learned during the epidemic response. We found case fatality rate during the pre-lockdown, 3-week lockdown, and 6-week lockdown period was 37.9% (22/58), 39.3% (53/135), and 38.7% (55/142), respectively. In the early weeks of the lockdown, EBOD incidence and mortality increased nationally and in Kassanda district while Mubende district registered a decline in incidence and stagnation in mortality. With the extension of the lockdown to six weeks, the EBOD incidence and mortality during the 4-6-week lockdown declined compared to the pre-lockdown period. In conclusion, the EBOD incidence and mortality remained higher in the early weeks of the lockdown than during the pre-lockdown period nationally and in one of the two districts. With extended lockdown, incidence and mortality dropped in the 4-6-week period than the pre-lockdown period. Therefore, reliance on known public health measures to control an EBOD outbreak is important.

Risk factors for unsuppressed viral load after intensive adherence counseling among HIV infected persons in Kampala, Uganda: a nested case-control study.

BACKGROUND: Intensive adherence counseling (IAC) is the global standard of care for people living with human immunodeficiency virus (PLHIV) who have unsuppressed VL after ≥ 6 months of first-line anti-retroviral therapy (ART). We investigated whether the number of IAC sessions is associated with suppressed VL among PLHIV in Kampala, Uganda. METHODS: We conducted a nested case-control study among PLHIV with unsuppressed VL after ≥ 3 IAC sessions (cases) and a 2:1 random sample of PLHIV with suppressed VL after ≥ 3 IAC sessions (controls). Unsuppressed VL was defined as VL ≥ 1000 copies/ml. We performed multivariable logistic regression to identify factors that differed significantly between cases and controls. RESULTS: Demographic and clinical characteristics were similar among the 16 cases and 32 controls including mean age, sex, baseline CD4 count, VL before IAC, and WHO clinical stage. Only the number of IAC sessions differed significantly between cases and controls in unadjusted (p = 0.012) and adjusted (p = 0.016) analyses. Each unit increase in IAC session was associated with unsuppressed VL (Adjusted odds ratio 5.09; 95% CI 1.35-19.10). CONCLUSIONS: VL remained unsuppressed despite increasing IAC frequency. The fidelity to standardized IAC protocol besides drug resistance testing among PLHIV with unsuppressed VL before IAC commencement should be examined.

Experiences of mothers and health workers with MomCare and SafeCare bundles in Kenya and Tanzania: A qualitative evaluation.

Between 2019 and 2022, the digital dividend project (DDP), a technology-based intervention that combined care (MomCare) and quality improvement (SafeCare) bundles to empower mothers to access quality care during pregnancy, labor, and delivery, and postnatally, was implemented in Kenya and Tanzania aiming to improve maternal and newborn health outcomes. We describe the experiences of the mothers in accessing and utilizing health services under the bundles, and the experiences of the health workers in providing the services. Between November and December 2022, we conducted a qualitative evaluation across health facilities in Kenya and Tanzania. We held Interviews with mothers (pregnant and postpartum women who had benefited from the care bundles) and health workers (physicians, nurses, and midwives who provided the care bundles, including health facility In-Charges) at the antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) service delivery points. We performed content analysis. Findings are reported using themes and quotes from the participants. We included 127 mothers (Kenya = 76, Tanzania = 51) and 119 health workers. Findings revealed that among mothers, the care bundles eased access to health services, ensured easy access and optimal ANC use, provision of respectful care, removed financial constraints, and led to the receipt of sufficient health education. Health workers reported that the care bundles offered them a new opportunity to provide quality maternal and newborn care and to adhere to the standard of care besides experiencing a positive and fulfilling practice. Health systems improvements included prompt emergency response and continual care, infrastructural developments, medical supplies and logistics, staffing, and increased documentation. Overall, the care bundles led to the strengthening of the healthcare system (staffing, service delivery, financing, supplies/logistics, and information management) in order to deliver quality maternal and child health services. The bundles should be replicated in settings with similar maternal and child health challenges.

Effect of high-risk versus low-risk pregnancy at the first antenatal care visit on the occurrence of complication during pregnancy and labour or delivery in Kenya: a double-robust estimation.

OBJECTIVES: We evaluated the causal effects of high-risk versus low-risk pregnancy at the first antenatal care (ANC) visit on the occurrence of complications during pregnancy and labour or delivery among women in Kenya. METHODS: We designed a quasi-experimental study using observational data from a large mobile health wallet programme, with the exposure as pregnancy risk at the first ANC visit, measured on a binary scale (low vs high). Complications during pregnancy and at labour or delivery were the study outcomes on a binary scale (yes vs no). Causal effects of the exposure were examined using a double-robust estimation, reported as an OR with a 95% CI. RESULTS: We studied 4419 women aged 10-49 years (mean, 25.6±6.27 years), with the majority aged 20-29 years (53.4%) and rural residents (87.4%). Of 3271 women with low-risk pregnancy at the first ANC visit, 833 (25.5%) had complications during pregnancy while 1074 (32.8%) had complications at labour/delivery. Conversely, of 1148 women with high-risk pregnancy at the first ANC visit, 343 (29.9%) had complication during pregnancy while 488 (42.5%) had complications at labour delivery. Multivariable adjusted analysis showed that women with high-risk pregnancy at the time of first ANC attendance had a higher occurrence of pregnancy during pregnancy (adjusted OR (aOR) 1.22, 95% CI 1.02 to 1.46) and labour or delivery (aOR 1.20, 95% CI 1.03 to 1.41). In the double-robust estimation, a high-risk pregnancy at first ANC visit increased the occurrence of complications during pregnancy (OR 1.23, 95% CI 1.04 to 1.46) and labour or delivery (OR 1.24, 95% CI 1.07 to 1.45). CONCLUSION: Women with a high-risk pregnancy at the first ANC visit have an increased occurrence of complications during pregnancy and labour or delivery. These women should be identified early for close and appropriate obstetric and intrapartum monitoring and care to ensure maternal and neonatal survival.

High prevalence of risky sexual behaviour among key populations receiving antiretroviral therapy at a large HIV clinic in northern Uganda.

Background: Risky sexual behaviour (RSB) among key populations pose a significant risk of human immunodeficiency virus (HIV) infection but remains understudied. Objectives: We assessed the prevalence and factors associated with RSB among key populations living with HIV (KPLHIV) in the post-conflict region of northern Uganda. Methods: We designed a cross-sectional study using secondary data, with the outcome as RSB defined as having multiple sexual partners, or condomless sex in the past 3 months, or sexual intercourse with a commercial sex worker in the past 3 months, or sexual intercourse under the influence of substance use in the past 3 months. We used modified Poisson regression to determine factors associated with RSB, reported as adjusted risk ratio (aRR) with 95% confidence interval (CI). Results: We studied 165 participants and 122 (73.9%) reported RSB and this was more likely among heterosexual females (aRR, 2.39; 95% CI, 1.54-3.71), the married (aRR, 1.92; 95% CI, 1.42-2.49) or separated participants (aRR, 1.47; 95% CI, 1.21-1.79), and transgender persons (aRR, 3.71; 95% CI, 2.05-6.71). Conclusions: RSB is highly prevalent among KPLHIV in northern Uganda so they should be targeted with HIV prevention and behavioural interventions to prevent potential HIV transmission to the general population.

Impact of intensive adherence counseling on viral load suppression and mortality among people living with HIV in Kampala, Uganda: A regression discontinuity design.

Intensive adherence counseling (IAC) is recommended for people living with HIV (PLHIV) with viral load (VL) ≥1,000 copies/ml after ≥6 months of anti-retroviral therapy (ART). We evaluated the effect of IAC on VL suppression and all-cause mortality among PLHIV on first-line ART with VL ≥1,000 copies/ml after ≥6 months of ART in Kampala, Uganda using regression discontinuity design, a quasi-experimental method for effect estimation when interventions depend on a cut-off. PLHIV just above VL ≥1,000 copies/ml cut-off who received ≥3 IAC sessions formed the intervention group while those just below the cut-off who received routine psychosocial support constituted the control group. Primary outcome was repeat VL suppression defined as VL <1,000 copies/ml approximately 9-12 months following initial VL assessment. Secondary outcome was all-cause mortality. We used logistic regression for causal-effect analysis, reported as odds ratio (OR) with a 95% confidence interval (CI). We performed sensitivity analyses to assess the robustness of findings to varying bandwidths at the cut-off. We found 3,735 PLHIV were started on ART between Nov 2020 and Nov 2021 of whom 3,199 were included in the analysis (3,085 control, 114 intervention). Within an optimal bandwidth, there were 236 participants (222 control, 14 intervention) with similar demographic and clinical characteristics. Repeat VL suppression was lower in the intervention than in the control group (85.7% versus 98.6%, p = 0.021) while all-cause mortality was similar (0% versus 0.5%, p = 1.000). In multivariable analysis, the odds of repeat VL suppression were 91% lower in the intervention than control group (OR = 0.09; 95% CI, 0.01-0.66). Findings are robust to varying bandwidths around the cut-off. We concluded IAC is ineffective in suppressing VL among PLHIV on first-line ART in Kampala, Uganda. Findings suggest a need to investigate the IAC implementation fidelity for successful translation in practice and the reasons for VL persistence beyond the suppression threshold.

Use of a context-specific package to increase sputum smear monitoring among people with pulmonary tuberculosis in Uganda: a quality improvement study.

BACKGROUND: People with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) require sputum smear monitoring (SSM) to ascertain response to anti-TB treatment and cure from TB disease. We aimed to increase SSM at 2, 5 and 6 months among people with BC-PTB from the baseline (March to July 2021) of 68%, 37% and 39%, respectively, to 90% in February 2022 by implementing a context-specific improvement package at a rural health facility in northeastern Uganda. METHODS: We designed a continuous quality improvement (CQI) study for people with BC-PTB, developed and tested an improvement package that consisted of the following context-specific measures: (1) line listing of all eligible persons for SSM; (2) use of reminder stickers to identify eligible persons for SSM; (3) use of community health workers to conduct home visits for people with missed clinic visits; and (4) integration of SSM into community-based ART points for distant persons. We implemented the measures using the plan-do-study-act cycle and tracked the progress in SSM through monthly data reviews and analyses. RESULTS: SSM at 2 months improved from 68% (17/25) at the baseline to 74% (32/43) during phase I (p=0.818) and then to 94% (17/18) during phase II (p=0.562). SSM at 5 months improved from 37% (11/29) at the baseline to 82% (41/50) during phase I (p=0.094) and then to 100% (10/10) during phase II (p=0.688). SSM at 6 months improved from 39% (9/23) at the baseline to 59% (28/39) during phase I (p=0.189) and then to 100% (12/12) during phase II (p=0.487). CONCLUSION: The use of a context-relevant CQI package was accompanied by improved SSM at 2, 5 and 6 months among people with BC-PTB. Trends are encouraging but this should be considered as preliminary report because of limited numbers. These data can inform the design of a fully powered randomised controlled trial.

Behaviors and practices of incarcerated women towards menstrual hygiene in a large urban prison in Uganda: a phenomenological qualitative study.

BACKGROUND: Deplorable and unconducive conditions in prisons present serious challenges to menstrual hygiene management. However, little is known about menstrual hygiene among incarcerated women in Uganda. Our study explored the behaviors and practices of incarcerated women regarding menstrual hygiene management in a large government prison in Uganda. In addition, we explored the barriers to menstrual hygiene management in this population. METHODS: In this phenomenological qualitative study, we conducted in-depth interviews with incarcerated women aged 20-49 years and key informant interviews with female prison officers (wardresses) at Luzira Prison in Kampala, Uganda. The data were analyzed using content analysis and the findings were presented using themes/sub-themes along with participant quotes. RESULTS: We interviewed 15 incarcerated women aged 20-49 years (mean age, 29.5 ± 8.7 years) and five key informants aged 30-50 years (mean, 42.6 ± 4.9) about menstrual hygiene behaviors and practices, including barriers to menstrual hygiene. Five sub-themes emerged concerning behaviors and practices of menstrual hygiene among incarcerated women. Findings reveal the behaviors and practices of menstrual hygiene management were characterized by infrequent change of menstrual pads, lack of privacy during menstrual hygiene practices, use of poor-quality menstrual hygiene materials, and improper disposal of used sanitary products. However, bathing with soap and water during menstruation was frequent and non-restricted. Three sub-themes emerged as barriers to menstrual hygiene practices, largely at the institutional level, and they included unhygienic sanitary facilities, unreliable access to clean water, and insufficient sanitary products. CONCLUSIONS: Behaviors and practices of incarcerated women fall short of desired standards and they face several barriers to practicing menstrual hygiene. The prison authorities should provide sufficient sanitary products like pads, and knickers including soap, construct more sanitary facilities, educate about the safe disposal of used sanitary products, and provide sufficient clean water to promote good menstrual hygiene management among incarcerated women.

Low treatment success rate among previously treated persons with drug-susceptible pulmonary tuberculosis in Kampala, Uganda.

Rationale: In 2017, the treatment regimen for previously treated persons with tuberculosis (TB) changed to a shorter regimen that lasts six months and consists of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol. Few studies have examined treatment success rate (TSR) among previously treated persons with TB including the associated factors. Objective: To determine TSR and the associated factors among previously treated persons with bacteriologically confirmed pulmonary TB on a six-month treatment regimen in Kampala, Uganda. Methods: We retrieved data (January 2012 and December 2021) across six TB clinics in the Kampala Metropolitan area for all previously treated persons with bacteriologically confirmed pulmonary TB. TSR was defined as cure or treatment completion. Frequencies and percentages for categorical data, and the mean and standard deviation for numerical data were computed. Multivariable modified Poisson regression analysis was performed to identify factors associated with TSR, reported as adjusted risk ratio (aRR) with a 95% confidence interval (CI). Measurements and main results: We enrolled 230 participants with a mean age of 34.8±10.6 years. TSR was 52.2% and was associated with Mycobacterium tuberculosis (MTB) sputum smear load of ≥2+ (1-10 or >10 Acid Fast Bacilli (AFB)/Field) (aRR = 0.51; 95% CI, 0.38-0.68), TB/human immunodeficiency virus (HIV) (aRR = 0.67; 95% CI, 0.51-0.88) or unknown HIV serostatus (aRR = 0.42; 95% CI, 0.26-0.68), and digital community-based directly observed therapy short-course (DOTS) (aRR = 0.42; 95% CI, 0.20-0.88). Conclusions: The TSR among previously treated persons with bacteriologically confirmed pulmonary TB on a six-month treatment regimen is suboptimal. TSR is less likely for people with TB/HIV co-infection or unknown HIV serostatus, high MTB sputum smear load, and on digital community-based DOTs. We recommend strengthening of TB/HIV collaborative activities and people with TB with high MTB sputum smear load should receive targeted treatment support, and the contextual barriers to digital community DOTS should be addressed.

High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study.

BACKGROUND: Malaria in pregnancy contributes to substantial morbidity and mortality among women in Uganda. However, there is limited information on the prevalence and factors associated with malaria in pregnancy among women in Arua district, northwestern Uganda. We, therefore, assessed the prevalence and factors associated with malaria in pregnancy among women attending routine antenatal care (ANC) clinics at Arua regional referral hospital in north-western Uganda. METHODS: We conducted an analytic cross-sectional study between October and December 2021. We used a paper-based structured questionnaire to collect data on maternal socio-demographic and obstetric factors and malaria preventive measures. Malaria in pregnancy was defined as a positive rapid malarial antigen test during ANC visits. We performed a modified Poisson regression analysis with robust standard errors to determine factors independently associated with malaria in pregnancy, reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). RESULTS: We studied 238 pregnant women with a mean age of 25.32±5.79 years that attended the ANC clinic, all without symptomatic malaria. Of the participants, 173 (72.7%) were in their second or third trimester, 117 (49.2%) were first or second-time pregnant women, and 212 (89.1%) reported sleeping under insecticide-treated bednets (ITNs) every day. The prevalence of malaria in pregnancy was 26.1% (62/238) by rapid diagnostic testing (RDT), with the independently associated factors being daily use of insecticide-treated bednets (aPR 0.41, 95% CI 0.28, 0.62), first ANC visit after 12 weeks of gestation (aPR1.78, 95% CI 1.05, 3.03), and being in the second or third trimester (aPR 0.45, 95% CI 0.26, 0.76). CONCLUSION: The prevalence of malaria in pregnancy among women attending ANC in this setting is high. We recommend the provision of insecticide-treated bednets to all pregnant women and early ANC attendance to enable access to malaria preventive therapy and related interventions.

Effect of justification of wife-beating on experiences of intimate partner violence among men and women in Uganda: A propensity-score matched analysis of the 2016 Demographic Health Survey data.

INTRODUCTION: In some communities, rationalization of men's controlling attitudes is associated with the justification of gender norms such as wife-beating as a method of correcting spouse behaviour. In this quasi-experimental study, we investigate the causal effects of the acceptability of gender norms justifying wife-beating on experiences of sexual, emotional, and physical intimate partner violence (IPV) among Ugandan men and women. METHODS AND MATERIALS: We analysed the 2016 Uganda Demographic and Health Survey data using propensity-score matching. The exposure variable is the acceptability of gender norms justifying wife-beating measured on a binary scale and the outcomes are the respondent's lifetime experiences of sexual, physical, and emotional IPV. We matched respondents who accepted gender norms justifying wife-beating with those that never through a 1:1 nearest-neighbour matching with a caliper to achieve comparability on selected covariates. We then estimated the causal effects of acceptability of gender norms justifying wife-beating on the study outcomes using a logistic regression model. RESULTS: Results showed that a total of 4,821 (46.5%) out of 10,394 respondents reported that a husband is justified in beating his wife for specific reasons. Among these, the majority (3,774; 78.3%) were women compared to men (1,047; 21.7%). Overall, we found that men and women who accept gender norms justifying wife-beating are more likely to experience all three forms of IPV. In the sub-group analysis, men who justify wife-beating were more likely to experience emotional and physical IPV but not sexual IPV. However, women who justify wife-beating were more likely to experience all three forms of IPV. CONCLUSIONS: In conclusion, the acceptability of gender norms justifying wife-beating has a positive effect on experiences of different forms of IPV by men and women in Uganda. There is, therefore, a need for more research to study drivers for acceptance of gender norms justifying wife-beating to enable appropriate government agencies to put in place mechanisms to address the acceptability of gender norms justifying wife-beating at the societal level.

Determinants of a high prevalence of cesarean section among women in eastern Uganda.

Introduction: increasing proportion of Uganda women deliver by cesarean section (C-section) but limited studies have examined the determinants of C-section. We investigated the prevalence and determinants of C-section among women aged 15-49 years in eastern Uganda. Methods: we retrieved data for women who attended postnatal care across four large healthcare facilities in Kamuli district. C-section (surgical operation to deliver a baby through the abdomen, whether planned or not) was the outcome. Binary logistic regression was done to determine factors independently associated with C-section, reported as adjusted odds ratio (aOR) and 95% confidence interval (Cl). Results: of 727 participants, 126 (17.3%) had delivered by C-section, with the associated factors as self (aOR=1.92, 95% CI 1.04-3.52) and unemployment (aOR=1.81; 95% CI 1.01-3.21), birth order namely second (aOR=3.13, 95% CI 1.77- 5.65), third (aOR=3.60, 95% CI 1.97-6.78), fourth (aOR=2.88, 95% CI 1.46-5.93) and fifth or beyond birth (aOR=2.16, 95% CI, 1.17-4.09), and a rural health facility (aOR=2.04, 95% CI 1.31-3.22). Conclusion: the C-section prevalence is slightly higher than recommended by the World Health Organization. There is a need to promote contraceptive use to limit fertility, increase access to contraceptives among rural women, raise awareness among women about the importance of early and regular antenatal visits through education campaigns, equip healthcare facilities with well-trained staff and infrastructure to ensure quality antenatal care to prevent complications that could lead to C-sections, and conduct ongoing research to identify barriers and challenges faced by women in seeking quality healthcare and knowledge about obstetric risk factors.

Effect of comprehensive knowledge of HIV on risky sexual behaviours associated with HIV transmission among adult Ugandans: a propensity score-matched analysis.

OBJECTIVE: To evaluate the effect of comprehensive knowledge of HIV on extramarital sexual relationships and consistent condom use. DESIGN: Quasi-experimental study. SETTING: 20 880 households, Uganda. PARTICIPANTS: Married/cohabiting men and women, aged 15-54 years. METHODS: We applied propensity score-matched analysis and defined comprehensive knowledge of HIV as knowing that consistent use of condoms during sexual intercourse and having just one faithful partner without HIV reduces the chance of getting HIV, knowing that a healthy-looking person can have HIV and rejecting two local misconceptions (HIV can be transmitted by mosquito bites and by sharing food with a person who has HIV). The primary outcome was extramarital sexual relationship defined as involvement in a sexual relationship with a partner other than a spouse or cohabiting partner, within 12 months preceding the survey. The secondary outcome was consistent condom use, defined as using a condom at every sexual intercourse with any non-spouse/non-cohabiting partner over the past 12 months. RESULTS: Among 18 504 participants matched in a 1:1 ratio, comprehensive knowledge of HIV showed no effect on extramarital sexual relationships (OR 1.03, 95% CI 0.96 to 1.11) but improved consistent condom use among married/cohabiting couples in extramarital sexual relationships (OR 1.18, 95% CI 1.02 to 1.37). Among married/cohabiting men, comprehensive knowledge of HIV had no effect on extramarital sexual relationships (OR 0.95, 95% CI 0.83 to 1.08) but improved consistent use of condoms in extramarital sexual relationships (OR 1.31, 95% CI 1.04 to 1.66). However, among married/cohabiting females, there was no effect on both outcomes. CONCLUSIONS: Comprehensive knowledge of HIV has no effect on extramarital sexual relationships but increases consistent condom use among those in extramarital sexual relationships. There is a need to consistently provide correct HIV prevention messages among sexually active married/cohabiting couples in Uganda.

Patterns and levels of serum electrolyte imbalance among women with obstructed labor in Uganda: A cross-sectional study.

OBJECTIVE: To determine the patterns and levels of imbalance in sodium, potassium, and chloride electrolytes, and the factors associated with each electrolyte imbalance among women with obstructed labor. DESIGN: In this cross-sectional study, we collected data on personal and obstetric factors using a structured questionnaire. We drew 3 mls of blood from the antecubital vein and analyzed for sodium, potassium, and chloride ions using Cobas Integra 400. Multivariable logistic regression was employed to analyze factors independently associated with each electrolyte imbalance. SETTING: Obstetrics and Gynaecology Unit, Mulago National Referral Hospital, Kampala, Uganda. PARTICIPANTS: Women with obstructed labor. MEASUREMENTS: Imbalance in sodium, potassium, and chloride electrolytes, measured on a binary scale using the normal third-trimester pregnancy electrolyte values: 130-148 mmol/Litre for sodium, 3.3-5.1 mmol/Litre for potassium, and 97-109 mmol/Litre for chloride. Women with electrolyte values outside the respective normal ranges were regarded as having an imbalance. FINDINGS: We studied 299 women and found 22/299 (7.4%) had sodium imbalance, 254/299 (84.9%) had potassium imbalance, and 284/299 (95.0%) had chloride imbalance. In multivariable logistic regression analysis, herbal medicine use was associated with sodium imbalance (adjusted odds ratio (aOR), 2.72; 95% confidence interval (CI), 1.11-6.95). KEY CONCLUSIONS: Potassium and chloride imbalances were more prevalent among women with obstructed labor relative to sodium imbalance. Herbal medicine use during pregnancy is associated with a higher likelihood of sodium electrolyte imbalance. IMPLICATIONS FOR PRACTICE: There is a need to routinely monitor women with obstructed labor for electrolyte imbalance.