Timing of onset of symptom for COVID-19 from publicly reported confirmed cases in Uganda.

INTRODUCTION: incubation period for COVID-19, 2-14 (average 5-6) days. Timing of onset of COVID-19 signs and symptoms amongst cases in Uganda is however not known. METHODS: we utilized data on real-time reverse transcription polymerase chain reaction (RT-PCR) confirmed cases to investigate symptom onset timing, from 21st March to 4th September 2020. Since timing of COVID-19 symptom onset is highly likely to be an interval rather than a point estimate, we generated 3-tertile categories: 1st, 2nd and 3rd tertile denoting symptom presentation within 3, 4 to 6 and at least 7 days. We considered all signs and symptoms in the database and analysed using Chi-square test and multinomial logistic regression, controlling for age and sex. RESULTS: we analysed a total of 420 symptomatic case-patients; 72.0% were males, median age of 33 years. Common symptoms were cough (47.6%), running nose (46.2%), fever (27.4%), headache (26.4%) and sore throat (20.5%). We utilized 293 cases with clinical symptom onset date recorded. Most of the patients, 37.5%, presented symptom within 3 days, 31.4% had symptoms in the 2nd and 31.4% in 3rd tertile, denoting 4 to 6 days and at least 7 days after exposure. Running nose (RRR=0.45, 95%CI: 0.24-0.84) and chest pain (RRR=0.64, 95%CI: 0.09-0.72) were more likely to occur in 3rd tertile than 1st or 2nd tertile. Cases aged ≥20 years were less likely to have symptoms in the 1st and 2nd tertile compared to ≤20 years (p<0.05). CONCLUSION: our study provides empirical evidence for epidemiological characterization of cases by signs and symptoms which complements current proposals for the length of active monitoring of persons exposed to SARS-CoV-2.

Interrelationships between early antenatal care, health facility delivery and early postnatal care among women in Uganda: a structural equation analysis.

BACKGROUND: Early medical checkups during and after delivery are key strategies to detect, prevent and treat maternal health concerns. Knowledge of interrelationships between early Antenatal Care (ANC), skilled delivery and early postnatal care (EPNC) is essential for focused and well-targeted interventions. This paper investigated the interconnectedness between maternal health services in Uganda. OBJECTIVE: This study examines the predictors of interrelationships between early antenatal care, health facility delivery and early postnatal care. METHODS: We used a sample of 10,152 women of reproductive ages (15-49), who delivered a child five years prior to the 2016 Uganda Demographic and Health Survey. A generalized Structural Equation Model and STATA 13.0 software were used. RESULTS: Early ANC was a mediating factor for health facility delivery (aOR=1.04; 95% CI=1.01-1.14) and EPNC (aOR=1.1; 95% CI=1.05-1.26). Increased odds of early ANC utilization was directly associated with: Adult women aged 35-49 (aOR=1.18; 95% CI=1.10-1.35), having completed primary seven (aOR=1.68; 95% CI=1.56-1.84); distance to a health facility (aOR=1.35; 95% CI=1.23-1.73) and costs (aOR=1.85; 95% CI=1.31-2.12) not being a problem, available community workers (aOR=1.06; 95% CI=1.04-1.17), pregnancy complications (aOR=2.04; 95% CI=1.85-2.26) and desire for pregnancy (aOR=1.15; 95% CI=1.07-1.36). Through early ANC utilization, being married (aOR=1.16; (=1.04*1.10)), no distance issues ((aOR=1.40; (=1.04*1.35)) and complications (aOR=2.12; (=1.04*2.04)) indirectly influenced utilization of health facility delivery. Women aged 20-34 (aOR=1.01; (=0.92*1.1)), completing primary seven (aOR=1.85; (=1.69*1.1)) and no cost problems (aOR=2.04; (=1.85*1.1)) indirectly influenced EPNC. CONCLUSION: Early antenatal care was a mediating factor for health facility delivery and EPNC; and hence, there is need for more focus on factors for increased early antenatal care utilization. Women with higher education and those with no cost problems were more likely to have early ANC utilization, skilled delivery and EPNC; therefore there is need to design and implement policies targeting social and economically disadvantaged women.

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.

A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda.

BACKGROUND: Neonatal and maternal health services have a bearing on neonatal mortality. Direct and indirect factors affecting neonatal health outcomes therefore require understanding to enable well-targeted interventions. This study, therefore, assessed the interrelationship between newborn health outcomes and maternal service utilization factors. METHODS: We investigated maternal health utilization factors using health facility delivery and at least four Antenatal Care (ANC) visits; and newborn health outcomes using newborn death and low birth weight (LBW). We used data from a household cross-sectional survey that was conducted in 2015 in Kamuli, Pallisa and Kibuku districts. We interviewed 1946 women who had delivered in the last 12 months. The four interrelated (Endogenous) outcomes were ANC attendance, health facility delivery, newborn death, and LBW. We performed analysis using a structural equation modeling technique. RESULTS: A history of newborn death (aOR = 12.64, 95% CI 5.31-30.10) and birth of a LBW baby (aOR = 3.51, 95% CI 1.48-8.37) were directly related to increased odds of newborn death. Factors that reduced the odds of LBW as a mediating factor for newborn death were ANC fourth time attendance (aOR = 0.62, 95% CI 0.45-0.85), having post-primary level education (aOR = 0.68, 95% CI 0.46-0.98) compared to none and being gravida three (aOR = 0.49, 95% CI 0.26-0.94) compared to being gravida one. Mother's age group, 20-24 (aOR = 0.24, 95% CI 0.08-0.75) and 25-29 years (aOR = 0.20, 95% CI 0.05-0.86) compared to 15-19 years was also associated with reduced odds of LBW. Additionally, ANC visits during the first trimester (aOR = 2.04, 95% CI 1.79-2.34), and village health teams (VHTs) visits while pregnant (aOR = 1.14, 95% CI 1.01-1.30) were associated with increased odds of at least four ANC visits, which is a mediating factor for health facility delivery, LBW and newborn death. Surprisingly, newborn death was not significantly different between health facility and community deliveries. CONCLUSIONS: Attending ANC at least four times was a mediating factor for reduced newborn death and low birth weight. Interventions in maternal health and newborn health should focus on factors that increase ANC fourth time attendance and those that reduce LBW especially in resource-limited settings. Targeting women with high-risk pregnancies is also crucial for reducing newborn deaths.

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 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.

Modern contraceptive use among women in Uganda: An analysis of trend and patterns (1995-2011).

There is an extensive body of literature concerning modern contraceptive use among women in Uganda. A questionable aspect however is whether the impact of factors associated with modern contraceptive use has remained the same in the recent past. Demographic Health Survey (DHS) data of women in the period 1995-2011 was adopted to establish an understanding of this issue. The focus in the investigations was none pregnant sexually active women. Variations in patterns of modern contraceptive use were assessed by socio-economic and demographic characteristics of women using a logistic regression based on a complex survey design. In the results, an upward trend in modern contraceptive use - from 11.6% in 1995 to 32.1% in 2011 - shows that progress has been made in this regard. Increased odds of modern contraceptive use across the study period were noted among women with primary and post-primary education, those in urban areas, women in the higher wealth quartiles and those with a higher number of surviving children (p < 0.01). Further, reduced odds of modern contraceptive use across the study period were noted among married women and those in cohabiting relationships (p < 0.05). The study however demonstrates variations in the impact of these factors across the study period. All the same, efforts towards enhancing modern contraceptive use in the near future should focus on enhancing: (i) literacy levels of woman particularly, (ii) access to and affordability of the services, and (iii) awareness campaigns on family planning use targeting both men and women.

Diabetes and quality of life: a Ugandan perspective.

Quality of life of diabetic patients is not a new concept in literature. The contentious issue however is whether factors associated in literature with quality of life apply to diabetic patients in Uganda. A sample of 219 outpatients attending Mulago diabetic clinic--a national referral hospital in Uganda--is used to provide an understanding of this issue. Quality of life is assessed in the dimensions of role limitation due to physical health, emotional health, treatment satisfaction, physical endurance, and diet satisfaction based on a five-point Likert scale. The analysis is made by patients' characteristics, medical conditions, lifestyle factors, and type of medication using frequency distributions, summary statistics, and a Poisson regression. In the results, we confirm a consensus regarding the influence of age and education level on the quality of life in the dimensions of role limitation and physical endurance (P < 0.05). A similar conclusion is reached with regards to impact of diabetic foot ulcers in the dimension of physical endurance. Thus, the factors associated with quality of life are not entirely unique to diabetic patients in the country.