Search

Abstract Introduction Exposure to Escherichia coli (E. coli) is a risk factor for diarrhoeal diseases, which pose a significant problem in refugee settlements. Refugee populations are exposed to faecal microorganisms through multiple pathways including sub-optimal sanitary facilities, contaminated drinking water, produce and food, flood water, bathing water, and soil among others. While these pathways are well-documented, specific exposure behaviours remain underexplored. We assessed exposure behaviour to E. coli among households in Imvepi refugee settlement, Uganda, and provided evidence-based recommendations for the design of interventions to reduce excreta-related disease in refugee settlements. Methods Guided by the Sanitation Safety Planning approach, we surveyed 426 households in Imvepi refugee settlement, Uganda, using a digitized questionnaire and an observation checklist. We collected data on the background characteristics and exposure behaviour of women and emancipated girls (minors living on their own, having borne a child, married, or pregnant). The outcome variable, E. coli exposure behaviour, was measured using a five-point Likert scale, assessing behaviours that increase the risk of exposure. Data were cleaned in Microsoft Excel and analyzed in Stata version 17. Descriptive statistics were performed to summarize the data. We used modified Poisson regression to determine the factors associated with the outcome. Results Over 59.4% (253) exhibited high-risk exposure behaviour. Residing in compound homes (Adjusted Prevalence Ratio (APR) = 0.72, 95% Confidence interval (CI): 0.58–0.90), being aged 35–49 years (APR = 0.76, 95% CI: 0.60–0.97), having household heads with post-primary education (APR = 0.54, 95% CI: 0.38–0.77), high knowledge (APR = 0.69, 95% CI: 0.59–0.80), and high-risk perceptions regarding exposure to E. coli (APR = 0.75, 95% CI: 0.64–0.88) were associated with a lower prevalence of high-risk E. coli exposure behaviours. Conversely, having sanitary facilities with excreta overflowing from the squat hole (APR = 1.26, 95% CI: 1.08–1.48) was associated with a higher prevalence of high-risk exposure behaviours. Conclusion The study indicates a substantial prevalence of high-risk E. coli exposure behaviours in the refugee settlement.. There’s a need to implement behaviour change interventions targeted at preventing or minimizing exposure, especially among households whose heads have low education attainment, those with young caretakers and those with limited knowledge and low-risk perceptions regarding exposure to E. coli.

Abstract Background Despite the limited evidence, desludging operators remain at a heightened risk of work-related musculoskeletal disorders (WMSDs). This study established the prevalence and predictors of WMSDs among desludging operators in Uganda. Methods A digitalized structured questionnaire was used to collect cross-sectional data on musculoskeletal disorders and routine workplace activities from 303 desludging operators in 11 cities in Uganda. These cities were purposively selected based on the presence of a fecal sludge treatment plant or wastewater treatment plant. The Nordic Musculoskeletal Questionnaire (NMQ) was used to assess WMSDs. Simple random sampling with replacements was used to select respondents. Data were analyzed using STATA version 15.0. Modified Poisson Regression was used to measure the strength of association between the independent variables and WMSDs. Results A total of 303 study participants were interviewed (97.7% response rate). The average age of the respondents was 34.0 years (SD ± 9.8). The prevalence of WMSDs among desludging operators was 29.7%. The body parts affected by MSDs were; the elbow for 4.6% (14/303), shoulder for 5.0% (15/303), and wrist/hand for 6.3% (19/303) of the respondents. At multivariable analysis, after controlling for age, desludging operators’ ability to influence the availability of equipment needed to do their work (APR = 0.45, 95% CI: 0.20–0.99), and feeling that everything done was an effort (APR = 1.70, 95% CI: 1.01–2.87) were significantly associated with WMSDs. Conclusion The prevalence of WMSDs was high among desludging operators in Uganda. Desludging operators’ ability to influence the availability of equipment needed to do their work and frequency of feeling that everything done was an effort were significantly associated with WMSDs. Interventions should focus on ensuring adequate provision of ergonomic equipment and promoting practices that reduce the physical strain associated with desludging tasks. Additionally, comprehensive training programs addressing proper lifting techniques and posture awareness could significantly mitigate the risk of WMSDs among desludging-operators.

Abstract Background Cervical cancer is a major public health challenge, accounting for substantial morbidity and mortality. Human Papilloma Virus (HPV) vaccination is the recommended primary public health intervention for HPV infection prevention. However, there’s limited evidence on the level of knowledge, attitude, and practices of adolescent girls regarding HPV vaccination in Kampala city, Uganda. This study assessed the knowledge, perceptions, and practices of adolescent girls aged 10-14 years towards HPV vaccination program in Kampala, Uganda to generate evidence to guide programs targeted at improving uptake of the vaccine. Methods A convergent parallel mixed methods study was conducted in Kampala, Uganda. A structured questionnaire was used to elicit data from 524 adolescent girls. In addition, 6 Focus group discussions, and 24 key informant interviews (teacher and parents) were conducted. Multistage and purposive sampling techniques were used to select quantitative and qualitative participants respectively. Quantitative data were entered using epidata, cleaned and analyzed using Stata v14 while qualitative data were analyzed using thematic content analysis in atlas ti version 8. Results Overall, only 8.6% (45/524) of the girls had completed the HPV vaccine schedule of two dozes, 49.2% (258/524) of the girls had low knowledge about the HPV vaccine and teachers and parents affirmed this lack of knowledge among adolescent girls especially concerning the target age group, dosage, and vaccine interval. About 51.9% (272/524) of girls had negative perceptions towards HPV vaccination. Parents expressed negative perceptions, beliefs, superstitions, and safety concerns of the vaccine.Girls residing in rural areas (adjusted prevalence ratio, aPR = 0.35, C. I = 0.14–0.85) had lower knowledge levels compared to those in urban areas. Girls whose mothers were healthcare providers (aPR = 1.94, C. I = 1.10–3.41), girls with high knowledge levels (aPR = 1.79, C. I = 1.21–2.63) and positive perceptions (aPR = 2.87, C. I = 1.93–4.27) had a higher prevalence of being fully vaccinated. Conclusion Girls generally had low levels of knowledge, negative perceptions, and poor uptake of HPV vaccination. We recommend sensitization campaigns in schools and communities to improve awareness, perceptions, and practices of stakeholders towards HPV vaccination.

BackgroundWhereas digital payments have been identified as a solution to health payment challenges, evidence on their adoptability among Community Health Workers (CHWs) is limited. Understanding their adoptability is crucial for sustainability. This study assessed the adoptability of digital payments for CHWs in Wakiso district, Uganda.MethodsA convergent parallel mixed-methods study was conducted between November and December 2022, in Wakiso district, Uganda. We surveyed a random sample of 150 CHWs using a structured questionnaire and conducted key informant interviews among three purposively selected Digital payment coordinators. The study utilized the Technology Acceptance Model (TAM) framework to assess the adoptability of digital payments among CHWs. Factor analysis was performed to extract composite variables from the original constituting variables. Using the median, the outcome was converted to a binary variable and logistic regression was conducted to assess the association between the TAM constructs and adoptability of digital payments by CHWs. Quantitative data was analyzed using STATA 14, while qualitative data was transcribed verbatim and analyzed using ATLAS.ti 22.ResultsNearly all participants (98.0%; n = 49) had previously received payments through mobile money, a digital payment method. (52%; n = 78) of CHWs said they intend to use digital payment modalities. Perceived risk of digital payments was associated with 83% lower odds of adoptability of digital payment modalities (OR = 0.17;95%CI:0.052, 0.54), while perceived trust had nearly three times higher odds of adoptability of digital payment modalities (OR = 2.82;95%CI:1.41, 5.67). Qualitative interviews showed that most CHWs reported positive experiences with digital health payments, including effectiveness and completeness of payments except for delays associated with mobile money payments across payment providers. Mobile money was reported to be easy to use, in addition to fostering financial responsibility compared to cash.ConclusionCHWs in Wakiso district intend to use digital payment modalities, particularly mobile money/e-cash. Perceived risk of the payment method and trust are key determinants of adoptability. Synergized efforts by both payment providers to manage payment delays and mitigate risks associated with digital payments could attenuate perceived risk and build trust in digital payment modalities.

Abstract Background The use of psychoactive substances such as alcohol, heroin and marijuana is associated with negative health outcomes such as sexual violence and unintended pregnancies, and risky sexual behaviours. Although there is evidence linking psychoactive substance use and risky sexual behaviours such as inconsistent condom use and multiple sexual relationships, there is limited data on sex under the influence of psychoactive substances among young people. This study aimed to investigate the prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda. Methods A cross-sectional study was conducted among 744 sexually active young psychoactive substance users in informal settlements in Kampala, Uganda. Data were collected through face-to-face interviews using a digitalized structured questionnaire, preloaded on the Kobocollect mobile application. The questionnaire captured data on the socio-demographic characteristics of the respondents, history of psychoactive substance use, and sexual behaviours. Data were analysed using STATA Version 14.0. A modified Poisson regression model was used to determine the predictors of sex under the influence of psychoactive substances.. Adjusted prevalence ratios at a p-value value ≤ 0.05 with a 95% confidence interval were considered. Results About 61.0% (454/744) of the respondents had had sex under the influence of psychoactive substances in the last 30 days. The predictors of sex under the influence of psychoactive substances were being female (PR 1.18, 95% CI: 1.04–1.34), being 20–24 years of age (PR: 1.22, 95% CI: 1.04–1.44), being married (PR 1.15, 95% CI: 1.01–1.31) or divorced/separated (PR 1.43, 95% CI: 1.26–1.61), not living with biological parents or guardians (PR 1.22, 95% CI: 0.99–1.50), earning 71 USD and below (PR 0.86, 95% CI: 0.79–1.03) and using alcohol (PR 1.43, 95% CI: 1.25–1.69), marijuana (PR 1.16, 95% CI: 1.02–1.31) and khat (PR 1.25, 95% CI: 1.10–1.42) in the last 30 days. Conclusion The study found that a high proportion of sexually active young people in informal settlements in Kampala, Uganda had engaged in sex under the influence of psychoactive substances in the past 30 days. The study also identified several factors associated with sex under the influence of psychoactive substances, including being female, being aged 20–24 years, being married or divorced or separated, not living with biological parents or guardians, and using alcohol, marijuana, or khat in the past 30 days. Our findings suggest the need for targeted sexual and reproductive health programs that incorporate risk-reduction interventions aimed at reducing sex under the influence of psychoactive substances, especially among females and those who do not live with their parents.

Background Despite the risks involved in welding, there is limited evidence of the knowledge, attitude and practices related to the use of personal protective equipment (PPE) among welders in small-scale metal workshops. We assessed the level of knowledge, attitude and practices (KAP) related to PPE use among welders in small-scale workshops in Nansana Municipality, Wakiso district, Uganda.Methods A cross-sectional study was conducted among 329 welders. A structured questionnaire was used to collect data on welder knowledge and attitude while an observation checklist was used to establish utilization of PPE. Ten key informant interviews were conducted to further understand welders’ knowledge, attitude and PPE-related practices. A ‘modified Poisson’ regression analysis was done to establish the independent factors associated with PPE KAP. NVivo 12 was used for the management of qualitative data. A thematic content approach guided qualitative data analysis.Results About 61.4% (202/329) of the respondents had a high level of knowledge, 68.7% (226/329) had a negative attitude, and only 37.1% (122/329) exhibited good PPE-related practices. Knowledge of PPE use was associated with the type of training (aPR = 1.52, CI = 1.29–1.80). Attitude toward PPE use was associated with the level of education (aPR = 2.31, CI = 1.28–4.14), duration of work experience (aPR = 2.37, CI = 1.01–5.55), (aPR = 2.79, CI = 1.13–6.89), and level of knowledge (aPR = 1.73, CI = 1.13–2.65). PPE-related practices were associated with the type of training (aPR = 2.91, CI = 2.14–3.96) and attitude (aPR = 1.45, CI = 1.08–1.93).Conclusion While the welders’ level of knowledge of PPE was found to be high, the majority exhibited a negative attitude and poor PPE-related practices. A high level of knowledge was associated with a positive attitude. In turn, a positive attitude was associated with good PPE practices. Welders need to be sensitized on the health risks that may arise from the non-use of PPE.

Abstract Background The One Health (OH) approach integrates multiple competencies in the prevention and control of disease outbreaks. Through a range of OH competence-based activities, the Africa One Health University Network (AFROHUN) built the capacity of selected students at Makerere University and Mbarara University of Science and Technology. This study applied the Systems Theoretical Framework (STF) of career development to establish the employment status of AFROHUN-Uganda alumni, and the facilitators and barriers to application of the OH approach in their organisations. Methods We conducted an embedded mixed-methods study among a random sample of 182 AFROHUN-Uganda alumni of the 2013–2018 cohorts. For quantitative data, descriptive statistics were computed using Stata 14.0 statistical software. A total of 12 in-depth interviews were conducted, and NVivo 12 Pro was used to organise data during thematic analysis. Results While the majority, 87.4% were or got employed after participating in the AFROHUN Uganda capacity building programme, 68.1% were employed at the time of the survey, 57.7% had worked with their current employer for at least a year, and 39% held managerial positions. The facilitators of applying the OH approach into employing organisations included being knowledgeable about OH, the presence of a multidisciplinary workforce, the nature of activities implemented, and existing partnerships and collaborations between organisations. The barriers to the application of the OH approach included limited funding, a negative attitude towards working with people from other disciplines, and limited knowledge of the One Health approach. Conclusion Notably, more than two-thirds of the OH alumni were employed, and more than a third held managerial position. While these findings portray a fairly good absorption rate of the OH alumni into the workforce, they also highlight the facilitators of application of the OH approach that need to be promoted as well as the barriers that need to be addressed if the application of the OH approach is to be improved within the workforce.

Abstract Background The Africa One Health University Network (AFROHUN) with support from the United States Agency for International Development (USAID), has since 2012 conducted pre and in-service One health (OH) trainings with the objective of improving global health security. These trainings aim to build competencies that, enhance a multidisciplinary approach to solving global health challenges. Despite the investment in OH trainings, there is limited documentation of the extent of acquisition and application of the OH competencies at workplaces. This tracer study explored the extent of acquisition and application of the OH competencies by the AFROHUN-Uganda alumni. Methods A cross-sectional study was conducted among a random sample of 182 AFROHUN-Uganda alumni of 2013–2018 cohorts. A blended approach of interviewer-administered and self-administered questionnaires was used. Virtual platforms such as Zoom, Microsoft teams, and Skype, and phone interviews were used to collect data when face-to-face interactions with alumni were not possible. Data were collected electronically, either through a link or with the aid of the KoboCollect mobile application, pre-installed on android enabled devices, and analysed using STATA14.0. Results The majority of respondents, 78.6% (143/182) had jobs that required application of OH knowledge and skills, 95.6% (174/182) had learned employable skills from OH activities and 89.6% (163/182) had applied such skills when searching for employment. About 21.7% (34/180) to a very high extent required OH field-specific theoretical knowledge at their workplaces, 27.4% (43/80) to a very high extent required OH field-specific practical knowledge/skills, 42.7% (67/180) to a high extent required a change in attitude and perceptions towards working with people from different disciplines, 49.0% (77/180) required collaboration and networking skills, and more than half, 51.0% (80/180) required team building skills. Conclusions The majority of OH alumni to a very high extent acquired and applied OH competences such as teamwork, effective communication, community entry and engagement, report writing and problem-solving skills. This study revealed the significant contribution of the AFROHUN Uganda OH activities towards supportive work environments, and highlights areas of improvement such as supporting the trainees to acquire people-management skills, innovation, and an entrepreneurial mind set.

Introduction: The use of psychoactive substances increases the likelihood of unprotected sexual intercourse with individuals whose health status is not known, and consequently sexually transmitted infections, especially among young people. Despite this risk, there is limited evidence of the predictors of consistent condom use among young psychoactive substance users (YPSUs) in informal settings. This study examined the predictors of condom use among YPSUs in Kampala's informal settlements, Uganda. Methods: A cross-sectional study was conducted among 768 YPSUs. Respondent-driven sampling was used to recruit respondents. A structured questionnaire was used to collect respondent data on condom use. Data were analysed using Stata version 15.0. Prevalence ratios (PR) were used to determine the predictors of consistent condom use. Results: Out of the 744 YPSUs, only 37.4% of the respondents reported consistent condom use in the last 30 days. The prevalence of condom use was statistically lower among young people aged 20–24 years (35.4%) compared to those aged 18–19 years (43.7%), and among the married (17.3%) compared to respondents with a “single” marital status (43.0%). Being married (PR 0.42, 95% CI: 0.30–0.59), longer duration between meeting the most recent partner and having initial sexual contact with them (7 months to 1 year: PR 0.56, 95% CI: 0.36–0.88; more than a year: PR 0.36, 95% CI: 0.17–0.75) was negatively associated with consistent condom use. Spending less than 24 h between meeting the most recent partner and having initial sexual contact was positively associated with consistent condom use (PR 1.60, 95% CI: 1.24–2.08). Conclusion: The prevalence of consistent condom use in the last 30 days among YPSUs was low. Marital status and the duration between meeting the most recent partner and initial sexual contact predicted consistent condom use. There is a need to intensify awareness on the importance of consistent condom use among young people.