Tackling the escalating burden of care in Uganda: a qualitative exploration of the challenges experienced by family carers of patients with chronic non-communicable diseases.

BACKGROUND: Family carers face challenges that could significantly affect their health and the health of those they care for. However, these challenges are not well documented in low-income settings, including Uganda. We explored the challenges of caring for someone with chronic non-communicable disease (NCD) in Uganda. METHODS: We conducted a qualitative exploratory study at Hospice Africa, Uganda (an urban setting) and Hampton Health Center (a rural setting) in Uganda in February and March 2021. Family carers (n = 44) were recruited using snowball and purposive sampling techniques. Data were collected using focus group discussions and in-depth interviews, gathering family carer perspectives of (a) their caring role (b) their support needs, and (c) attitudes of the wider community. In total, four focus group discussions and 10 individual interviews were completed. RESULTS: The average age of carers was 46 years old. The majority of family care was provided by female relatives, who also experienced intersectional disadvantages relating to economic opportunities and employment. Family carers carried a huge burden of care, experiencing significant challenges that affected their physical health, and material and emotional well-being. These challenges also affected the quality of care of the patients for whom they cared. Carers struggled to provide for the basic needs of the patient including the provision of medication and transport to health facilities. Carers received no formal training and limited support to carry out the caring role. They reported that they had little understanding of the patient's illness, or how best to provide care. CONCLUSIONS: As NCDs continue to rise globally, the role of family caregivers is becoming more prominent. The need to support carers is an urgent concern. Family carer needs should be prioritised in policy and resource allocation. The need for a carer's toolkit of resources, and the enhancement of community support, have been identified.

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.

Out of school female adolescent employment status and sexually transmitted infections (STIs) risk in Uganda: is it a plausible relationship?

BACKGROUND: High prevalence of Sexually Transmitted Infections (STIs) among adolescents is a serious public health concern. Although many factors are attributed to adolescents' risk of STI infections, the association between out of school adolescents' employment status and STIs has not been thoroughly explored in Uganda, yet many adolescents are known to be employed. Consequently, the extent to which adolescents' employment status may be a risk factor for unprotected sex and STIs among female adolescents is unclear. This study examines the association between female out of school adolescents' employment status and STI status using the Uganda Demographic and Health Survey (UDHS) data for 2016. METHODS: Both descriptive and multilevel binary logistic regressions were used to analyse the data. The descriptive statistics provided an overview of the association between the two main variables while the multilevel binary logistic estimated the relationship between employment status and STI status, while controlling for other fixed factors and community random factors. RESULTS: Compared to female adolescents who were not employed or not working, the odds of reporting positive STIs were significantly higher for female adolescents who were working but received no pay (1.801(95% CI = 1.105-2.936), were self-employed in agriculture (1.502 (95% CI = 1.003-2.250) and who did manual jobs (2.258(95% CI = 1.429-3.568) whether skilled or not. Likewise, female adolescents who had two or more lifetime sexual partners (11.679 (95% CI = 1.254-2.248) had significantly higher odds of reporting STIs than those who had only one lifetime sexual partner. CONCLUSION: Out of school female adolescents who are employed in various types of low wage employments are at greater risk of exposure to STIs than their counterparts who do not work in Uganda. Instead of being a protective factor against the risk of STIs, their employment may expose them to risky sexual behaviour and STIs, given the vulnerabilities female adolescents who have dropped out of school tend to report. Therefore, the provision of decent employment opportunities for these females may provide an avenue for instructional scaffolding to build the life skills and empower these females so that they are better able to reduce their exposure to STIs.

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.