Search

Background: Despite the negative impact of chronic school absenteeism on the psychological and physical health of adolescents, data on the burden of adolescent chronic school absenteeism (ACSA) and interventions and programs to address it are lacking. We estimated the global, regional and national level prevalence of ACSA and its correlation with violence and unintentional injury, psychosocial, protective, lifestyle, and food security-related factors among in-school adolescents across low and middle-income, and high-income countries (LMICs-HICs)., Objectives: This study aimed to estimate the prevalence of chronic school absenteeism (CSA) as well as to determine its associated factors among in-school adolescents across 71 low-middle and high-income countries., Methods: We used data from the most recent Global School-based Student Health Survey of 207,107 in-school adolescents aged 11-17 years in 71 LMICs-HICs countries across six WHO regions. We estimated the weighted prevalence of ACSA from national, regional and global perspectives. Multiple binary logistic regression analyses were used to estimate the adjusted effect of independent factors on ACSA., Results: The overall population-weighted prevalence of CSA was 11·43% (95% confidence interval, CI: 11·29-11·57). Higher likelihood of CSA was associated with severe food insecurity, peer victimisation, loneliness, high level of anxiety, physically attack, physical fighting, serious injury, poor peer support, not having close friends, lack of parental support, being obese, and high levels of sedentary behaviours. Lower likelihood of CSA was associated with being female (odds ratio, OR = 0·76, 95% CI: 0·74-0·78)., Conclusion: Our findings indicate that a combination of different socio-economic factors, peer conflict and injury factors, factors exacerbate CSA among adolescents. Interventions should be designed to focus on these risk factors and should consider the diverse cultural and socioeconomic contexts., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Rahman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Low- and middle-income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh., Methods: The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016-2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service-related factors with patients' preferences for healthcare services., Results: The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%) and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio [RRR] = 0.71; 0.56-0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80-9.86) or affordability of healthcare services (RRR = 3.13; 2.25-4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15-1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70-5.04) than the quality of treatment in the health facility, when compared with private service providers., Conclusions: Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management., Patient or Public Contribution: Our research team includes four researchers (co-authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Objectives: The highly transmissible COVID-19 Delta variant (DV) has contributed to a surge in cases and exacerbated the worldwide public health crisis. Several COVID-19 vaccines play a significant role in a high degree of protection against the DV. The primary purpose of this meta-analysis is to estimate the pooled effectiveness of the COVID-19 vaccines against the DV in terms of risk ratio (RR) among fully vaccinated, compared to unvaccinated populations. Methods: We carried out a systematic review, with meta-analysis of original studies focused on COVID-19 vaccines effectiveness against a DV clinical perspective among fully COVID-19 vaccinated populations, compared to placebo (unvaccinated populations), published between 1 May 2021 and 30 September 2021. Eleven studies containing the data of 17.2 million participants were identified and included in our study. Pooled estimates of COVID-19 vaccines effectiveness (i.e., risk ratio, RR) against the DV with 95% confidence intervals were assessed using random-effect models. Publication bias was assessed using Egger's regression test and funnel plot to investigate potential sources of heterogeneity and identify any differences in study design. Results: A total population of 17.2 million (17,200,341 people) were screened for the COVID-19 vaccines' effectiveness against the DV. We found that 61.13% of the study population were fully vaccinated with two doses of COVID-19 vaccines. The weighted pooled incidence of COVID-19 infection was more than double (20.07%) among the unvaccinated population, compared to the fully vaccinated population (8.16%). Overall, the effectiveness of the COVID-19 vaccine against the DV was 85% (RR = 0.15, 95% CI: 0.07-0.31). The effectiveness of COVID-19 vaccines varied slidably by study designs, 87% (RR = 0.13, 95% CI: 0.06-0.30) and 84% (RR = 0.16, 95% CI: 0.02, 1.64) for cohort and case-control studies, respectively. Conclusions: The effectiveness of COVID-19 vaccines were noted to offer higher protection against the DV among populations who received two vaccine doses compared with the unvaccinated population. This finding would help efforts to maximise vaccine coverage (i.e., at least 60% to 70% of the population), with two doses among vulnerable populations, in order to have herd immunity to break the chain of transmission and gain greater overall population protection more rapidly.

Slum dwellers across Africa have been targeted in interventions whose impacts remain unclear. We evaluated the impact of a livelihood intervention on the sexual and reproductive health and rights (SRHR) of young people in the slum areas of Kampala, Uganda. We carried out a repeated cross-sectional survey in 2014 and 2017 to examine the impact of community-based livelihood interventions on the SRHR of young people in the slum areas of Kampala, Uganda. Impacts were observed such as reduced sexual activity, reduction in aspects of gender-based violence attitudes and beliefs, increased access to and decision-making about contraceptive and family-planning services, increased availability and affordability of SRHR services, reduced need to seek further knowledge on SRHR, reduced barriers to HIV testing, and increased knowledge of health responsibilities. Unexpected results included: increased proportion of young people who had ever had sex, decreased mean age of sexual debut, unaffordability of contraceptives, and increased culturally shaped attitudes and social norms related to gender-based violence. We observed no impact on condom use, consensual sex and sexual assault, the number of sexual partners, knowledge about HIV/AIDS, stigma and discrimination against people living with HIV/AIDS, affordability of male and female condoms, and uptake of HIV testing services. Rights-based interventions are crucial to how we understand the SRHR of young people in complex sociocultural environments. While the livelihood interventions made significant impacts on the SRHR of young people, there are questions about how such interventions address deeply rooted sociocultural practices to maximise outcomes., (© 2021. The New York Academy of Medicine.)

Background: Food insecurity and early sexual behaviors increase the risk of suicidal behavior, however their combined association on social behaviors receive little attention. Therefore, this study estimated the magnitude of adolescent global suicidal burden, it correlates with food insecurity and sexual behaviors, and assessed the combined association of food insecurity and sexual behaviors on the burden of suicidal behaviors (SBs) among school-going adolescent girls aged between 11 and 17 years., Methods: The study design is multi-county, and pooled cross-sectional in nature. Data for 67 countries from the Global School-based Student Health Survey (GSHS) were used. A random-effects meta-analysis was used to generate national and overall pooled estimates of suicidal behaviors. Multinomial logistic regression analyses were employed to estimate the adjusted effect of independent factors and the combined associations of sexual behaviors and food insecurity on adolescent SBs in the context of global, regional, and country income groups and adjusted by a set of explanatory factors., Results: The study included 121,248 girls aged 11-17 years. The population-weighted prevalence of high-level (SBs) was 40.65% among school-going girls who experienced sexual intercourse and 7.41% among those who reported severe food insecurity. However, the burden of SBs varied according to type of sexual behaviors and the age. The burden of SB among girls who had sexual intercourse with 1-2 sex partners, 3-4 sex partners, or >4 sex partners was 11.49%, 13.28%, or 18.43%, respectively. The high-level SB was double (23.08%) among adolescent girls who had first sexual intercourse aged 11-13 years old compared to adolescent girls aged 14-17 years (11.49%). The burden of SBs (for at least one SB, for two SBs, or for three SBs) were significantly associated with adolescent girls who experienced sexual intercourse (relative risk ratio, RRR = 2.04, 95% confidence interval, CI:1.83-2.28; RRR = 2.24, 1.99-2.52; RRR = 1.86, 1.59-2.18), sexual intercourse with four or more sex partners (RRR = 1.44, 1.15-1.79; RRR = 1.65, 1.33-2.06; RRR = 2.47, 1.94-3.16), first sexual intercourse aged 11-13 years (RRR = 1.22, 1.02-1.46; RRR = 1.51, 1.26-1.82; RRR = 2.26, 1.81-2.83), compared to adolescents who had no experience of SBs. Compared to adolescent girls who did neither experience food insecurity nor sexual intercourse, the overall burden of SBs (for at least one SB, for two SBs or for three SBs) were significantly higher among girls reporting to have experienced both food insecurity and sexual intercourse (RRR = 1.55, 1.29-1.86; RRR = 1.70, 1.42-2.04; RRR = 1.54, 1.26-1.88); and those reporting having experienced food insecurity but have never had sexual intercourse (RRR = 1.66, 1.48-1.87; RRR = 1.45, 1.26-1.67; RRR = 1.62, 1.36-1.92). However, it was significantly lower among girls reporting to have had sexual intercourse but never experienced food insecurity. This association was extended among adolescents in the context of regional and country income groups., Conclusion: The high burden of suicidal behaviors among adolescents calls for an urgent policy interventions to address food insecurity as a means to keep adolescents in school. The interventions should also aim to integrate safeguards that dissuade youngsters from early sex and protect them from sexual victimisation, and the associated adverse outcomes that that hamstring the attainment of SDG 3.4.2., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Various interventions to improve the quality of life (QoL) among slum dwellers across sub Saharan Africa have been implemented. However, the interventions impacts remain less understood. We assessed the impact of the Urban Program on Livelihoods and Income Fortification and Socio-civic Transformation (UPLIFT) project on QoL, psychological wellbeing, self-esteem, and the quality of neighbourhood social environment of young people aged 13-25 years in slum areas of Makindye and Nakawa Divisions in Kampala, Uganda., Methods: The study was designed as a mixed method evaluation using repeated cross-sectional survey and grounded theory in both the intervention and comparison communities. The intervention effect was estimated using the difference-in-differences Kernel propensity-score matching technique, with bootstrapping. The "rcs" option was used given that data were from repeated cross-sectional surveys. A thematic analysis was adopted for the qualitative data to triangulate and complement the quantitative data., Results: The UPLIFT project led to an improvement in QoL, psychological wellbeing, and self-esteem of young people. In terms of QoL, the project led to a six-percentage point increase in quality of living conditions scores (where higher scores reflect better living conditions; lower ones, worse living conditions). However, a negative effect was observed for personal independence whilst the project did not have any impact on social relations. In terms of self-esteem and psychological wellbeing, the project led to a 4.6-point increase in self-esteem scores, a 5.4-point increase in self-acceptance scores, a 5.3- point increase in purpose in life scores, a 5.7 - point increase in personal growth, and a 10.7-point increase in autonomy scores. However, the project had a negative effect on personal independence; and had no impact on environmental mastery and the quality of neighbourhood social environment., Conclusion: Functional community-owned assets accumulation and capacity building initiatives for young people in slum areas improved their psychological wellbeing and quality of life. However, such initiatives do not appear to address social relationships and personal independence of young people in slum areas.

Purpose: The main purpose of this study was to examine the overall distribution of chronic comorbidities in coronavirus disease-19 (COVID-19) infected populations and the risk of the underlying burden of disease in terms of the case fatality ratio (CFR)., Methods: We carried out a systematic review and meta-analysis of studies on COVID-19 patients published before 10 th April 2020. Twenty-three studies containing data for 202,005 COVID-19 patients were identified and included in our study. Pooled effects of chronic comorbid conditions and CFR with 95% confidence intervals were calculated using random-effects models., Results: A median age of COVID-19 patients was 56.4 years and 55% of the patients were male. The most prevalent chronic comorbid conditions were: any type of chronic comorbidity (37%; 95% CI 32-41%), hypertension (22%; 95% CI 17-27%), diabetes (14%; 95% CI 12-17%), respiratory diseases (5%; 95% CI 3-6%), cardiovascular diseases (13%; 95% CI 10-16%) and other chronic diseases (e.g., cancer) (8%; 95% CI 6-10%). Furthermore, 37% of COVID-19 patients had at least one chronic comorbid condition, 28% of patients had two conditions, and 19% of patients had three or more chronic conditions. The overall pooled CFR was 7% (95% CI 6-7%). The crude CFRs increased significantly with increasing number of chronic comorbid conditions, ranging from 6% for at least one chronic comorbid condition to 13% for 2 or 3 chronic comorbid conditions, 12% for 4 chronic comorbid conditions, 14% for 5 chronic comorbid conditions, and 21% for 6 or more chronic comorbid conditions. Furthermore, the overall CFRs also significantly increased with higher levels of reported clinical symptoms, ranging from 14% for at least four symptoms, to 15% for 5 or 6 symptoms, and 21% for 7 or more symptoms., Conclusions: The chronic comorbid conditions were identified as dominating risk factors, which should be considered in an emergency disease management and treatment choices. There is urgent need to further enhance systematic and real-time sharing of epidemiologic data, clinical results, and experience to inform the global response to COVID-19.

Background: The high rate of avoidable child mortality in disadvantaged communities in Africa is an important health problem. This article examines factors associated with mortality in children <5 y of age in three disadvantaged East African districts., Methods: Pooled cross-sectional data on 9270 live singleton births from rural districts in Rwanda (Gicumbi), Uganda (Kitgum) and Tanzania (Kilindi) were analysed using logistic regression generalized linear latent and mixed models to adjust for clustering and sampling weights. Mortality outcomes were neonatal (0-30 d), post-neonatal (1-11 months), infant (0-11 months), child (1-4 y) and under-5 y (0-4 y)., Results: The odds of post-neonatal and infant mortality were lower among children delivered by a health professional (adjusted odds ratio [AOR] 0.62 [95% confidence interval {CI} 0.47-0.81] for post-neonatal; AOR 0.60 [95% CI 0.46-0.79] for infant), mothers who had four or more antenatal care (ANC) visits during pregnancy (AOR 0.66 [95% CI 0.51-0.85]) and mothers who initiated breastfeeding within 1 h after birth (AOR 0.60 [95% CI 0.47-0.78]). Neonates not exclusively breastfed had higher mortality (AOR 3.88 [95% CI 1.58-9.52]). Children who lived >6 h away from the nearest health centre (6-23 h: AOR 1.66 [95% CI 1.4-2.0] and ≥24 h: AOR 1.43 [95% CI 1.26-1.72]) reported higher mortality rates in children <5 y of age., Conclusions: Interventions for reducing deaths in children ≤5 y of age in disadvantaged East African communities should be strengthened to target communities >6 h away from health centres and mothers who received inadequate ANC visits during pregnancy., (© The Author(s) 2020. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Slum dweller youth in Kampala, Uganda, face social economic exclusion and a plethora of health risks, and their needs are poorly understood. The aim of the current study was to analyze their needs and to suggest contextual evidence-based solutions to improve their well-being sustainably. We conducted a qualitative study involving 10 focus group discussions (FGDs; N = 113) and 20 key informant (KII) interviews. Emerging themes and sub-themes were identified, defined, reviewed, and organized and narrated following the structuration theoretical framework, which enabled the examination of the inherent capacity of slum dweller youth to make choices independently and the recurrent rules and resources that influence or limit the choices and opportunities available to them. The findings suggest that the slum dweller youth's ability to reach and fulfil their potential remains constrained by a confluence of individual and societal-level factors. The individual factors were poor quality of and dissatisfaction with life, and poor sexual and reproductive health practices. The societal-level factors were poor sexual and reproductive health services, and an extremely weak labor market. The needs of slum dweller youth in Kampala, Uganda, remain unaddressed, and leaving such a large population economically unproductive and dissatisfied with life is a recipe for political instability and insecurity. Interventions to address their needs need to adopt a whole-community approach in order to engage and empower all parts of the slum community and strengthen community structures that improve livelihoods and harness the opportunities that engender income fortification and socio-civic transformation for the youth.

Household food insecurity (HFI) plays an important role in child malnutrition in many low-income countries. We determined the association between HFI and stunting and severe stunting among Rwandan children from the Gicumbi district, aged 6-59 months using a cross-sectional study of 2,222 children. HFI factor was calculated by summing all seven HFI (access) frequency questions and was categorised into food security, mildly food insecurity, moderately food insecurity, and severe food insecurity. The association between stunting, severe stunting, and HFI was determined using the multiple logistic regression analyses that adjust for clustering and sampling weights. The odds of moderate and severe HFI were significantly higher among stunted children aged 6-59 months than those who were not stunted (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI] [1.11, 1.84] and AOR = 1.35; 95% CI [1.08, 1.69], respectively). Children from households with moderate food insecurity were 2.47 times more likely to be severely stunted (AOR = 2.47; 95% CI [1.77, 3.46]), and those from households with severe food insecurity were more likely to be severely stunted (AOR = 1.82; 95% CI [1.34, 2.48]), compared with children aged 6-59 months from households with food security. Other factors included male children and children who did not attend monthly growth monitoring sessions. This study showed that moderate and severe HFI correlated with stunting and severe stunting. Interventions to improve stunting in Gicumbi children should also focus on male children, children who did not attend monthly growth monitoring sessions, and households with moderate and severe food insecurity., (© 2018 John Wiley & Sons Ltd.)

Background: Undernutrition is an important public health indicator for monitoring nutritional status and survival. In spite of its importance, undernutrition is a significant problem health problem in many East African communities. The aim of this study was to identify factors associated with childhood undernutrition in three disadvantaged East African Districts., Methods: We examined data for 9270 children aged 0-59 months using cross-sectional survey from Gicumbi District in Rwanda, Kitgum District in Uganda and Kilindi District in Tanzania. We considered the level of undernutrition (stunting, wasting and underweight) as the outcome variables with four ordinal categories (severely undernourished, moderately undernourished, mildly undernourished, and nourished). Generalized linear latent and mixed models (GLLAMM) with the mlogit link and binomial family that adjusted for clustering and sampling weights were used to identify factors associated with undernutrition among children aged 0-59 months in three disadvantaged East African Districts., Results: After adjusting for potential confounding factors, the odds of a child being stunted were higher in Gicumbi District in Rwanda while the odds of a child being wasted and underweight were higher in Kitgum District in Uganda. Having diarrhoea two weeks prior to the survey was significantly associated with severe undernutrition. Wealth index (least poor household), increasing child's age, sex of the child (male) and unavailability of water all year were reported to be associated with moderate or severe stunting/wasting. Children of women who did not attend monthly child growth monitoring sessions and children who had Acute Respiratory Infection (ARI) symptoms were significantly associated with moderate or severe underweight., Conclusions: Findings from our study indicated that having diarrhoea, having ARI, not having water availability all year and not attending monthly child growth monitoring sessions were associated with undernutrition among children aged 0-59 months. Interventions aimed at improving undernutrition in these disadvantaged communities should target all children especially those children from households with poor sanitation practices.

Background: Lesotho and Swaziland experience intense, recurring drought resulting in disaster situations. Despite the recurrence of drought, both its influence on rural subsistence communities' support systems and the actions that enable structures of resilience remain poorly understood. Each incidence of drought stimulates a disaster resilience discussion that stalls without achievement of positive results until the next disaster. This study has examined the influence of recurring drought on communities' inherent resilience and proposes an evidence-based framework to enhance community resilience., Methods: Data were collected from 16 focus group discussions (N = 197) in the Highveld, Midveld and Lowveld agro-ecological regions of Swaziland and Lesotho. Themes and subthemes have been identified, defined, categorised and narrated using structuration theory as a guide., Results: Resilience activities were found to be characterised by knowledgeability and changes in behaviour in adapting and applying appropriate actions, all of which were enhanced by institutional support. The effectiveness of institutional support hinged on harnessing communities' knowledge, social groups, value systems, connectedness, participation, decision-making and collectivism., Conclusion: Large-scale interventions to build and strengthen resilience are urgently needed in order to maintain cohesiveness and development gains, especially because rural subsistence farmers make up the majority of these two countries' populations. Policies that integrate resilience with national development planning must be urgently developed and executed., Competing Interests: The authors have declared that no competing interests exist.

The available literature suggests that natural disasters, especially droughts and floods, were occurring in southern Africa in the early 1900s. However, their frequency and intensity increased during the 1980s. The aim of this systematic review was to assess the relationship between resilience to droughts and people's well-being in southern Africa. A combination of keywords was used to search the following 13 electronic bibliographic databases: Africa Journal Online (AJOL), MEDLINE, Academic Search Complete, Environment Complete, Humanities International Complete, Psychology and Behavioral Sciences Collection, PsycINFO, Embase, Scopus, Web of Science, Applied Social Science Index and Abstracts, ProQuest Central, and CINAHL. Relevant websites were also searched and potential studies for inclusion were downloaded in an EndNote database and screened for eligibility using pre-determined criteria. Quality assessment of the studies was undertaken using the Joana Briggs Qualitative Assessment and Review Instrument, the National Institutes of Health (NIH) checklist, and the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist. Resilience and well-being scales used in the studies for inclusion were also assessed using pre-defined criteria. Nineteen studies met the inclusion criteria. Poverty alleviation policies were important in strengthening resilience and well-being outcomes. Resilience and well-being were connected by old age, gender, race, adaptive farming and livelihoods diversification, security, and knowledgeability. Resilience and well-being outcomes were advanced by the synergistic effect of household, community and governance level capacities encapsulated in knowledgeability. This systematic review is critical to improving southern Africa context-specific resilience, and well-being policies and interventions.

Background: Southern Africa has long been vulnerable to climate-induced disasters, especially droughts and floods. The severity and frequency of disasters increased in the early 1980s, continuously eroding livelihoods, which in turn invoked humanitarian intervention. A systematic review of the relationship between resilience to drought and well-being will be undertaken., Methods: Studies will be included if they were conducted between January 1980 and December 2017; used quantitative and/or qualitative methods; were peer reviewed or comprise grey literature; covered Southern Africa; and measured resilience and its relationship to well-being. Data extraction will be informed by the Cochrane Public Health Group and the Joanna Briggs Institute manuals. The quality of evidence of the studies included will be assessed for risk bias, psychometric properties of tools used, and their suitability. The findings will be summarised into themes and narrated., Discussion: This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. The protocol gives insight of the scope and parameters for the systematic review to be carried out. The systematic review will establish how resilience to climate-induced disasters affects well-being. It will also provide recommendations to improve humanitarian coordination in Southern Africa., Systematic Review Registration: The protocol was registered by the PROSPERO international prospective register of systematic reviews, reference CRD42017064396 .

Good sanitation and clean water are basic human rights yet they remain elusive to many rural communities in Sub-Saharan Africa (SSA). We carried out a cross sectional study to examine the impact of a four-year intervention aimed at improving access to water and sanitation and reducing waterborne disease, especially diarrhea in children under five years old. The study was carried out in April and May 2015 in Busangi, Chela and Ntobo wards of Kahama District of Tanzania. The interventions included education campaigns and improved water supply, and sanitation. The percentage of households (HHs) with access to water within 30 min increased from 19.2 to 48.9 and 17.6 to 27.3 in the wet and dry seasons, respectively. The percentage of HHs with hand washing facilities at the latrine increased from 0% to 13.2%. However, the incidence of diarrhea among children under five years increased over the intervention period, RR 2.91 95% CI 2.71-3.11, p < 0.0001. Availability of water alone may not influence the incidence of waterborne diseases. Factors such as water storage and usage, safe excreta disposal and other hygiene practices are critical for interventions negating the spread of water borne diseases. A model that articulates the extent to which these factors are helpful for such interventions should be explored.

Background: Young people in Uganda face various sexual and reproductive health risks, especially those living in urban slums. The aim of this study was to examine factors associated with comprehensive categories of sexual and reproductive health, including sexual behaviours; sexual education and access to contraceptive services; family planning; prevention of STDs; sexual consent as a right; gender based violence; as well as HIV testing, counselling, disclosure and support., Methods: The study was cross-sectional in design and was carried out in July 2014 in Makindye and Nakawa Divisions of Kampala City, Uganda. Using systematic random sampling, data were collected on 663 participants aged between 13 and 24 years in Kampala's urban slums., Results: Sixty two percent of participants reported having ever had sex and the mean age of sexual debut was 16 years (95%CI: 15.6, 16.4 years, range: 5-23 years). The odds of reporting ever having had sexual intercourse were higher among respondents living alone (OR: 2.75; 95%CI: 1.35, 5.61; p<0.01) than those living in a nuclear family. However, condom use was only 54%. The number of sexual partners in the last 12 months preceding the survey averaged 1.8 partners (95%CI: 1.7, 1.9; range 1-4) with 18.1% reporting an age gap of 10 years or older. More than three quarters (80.6%) of sexually active participants reported that their first sexual encounter was consensual, suggesting that most young people are choosing when they make their sexual debut. Low prevalence of willing first sexual intercourse was associated with younger age (OR = 0.48, 95%CI: 0.25, 0.90, p<0.05), having a disability (OR = 0.40, 95%CI: 0.16, 0.98, p<0.05), living with non-relatives (OR = 0.44, 95%CI: 0.16, 0.97, p<0.05), and being still at school (OR = 0.29, 95%CI: 0.12, 0.67, p<0.01). These results remained significant after adjusting for covariates, except for disability and the age of participants. The proportion of unwilling first sexual intercourse was significantly higher among women for persuasion (13.2% vs. 2.4%, p<0.001), being tricked (7.1% vs 2.9%, p<0.05) and being forced or raped (9.9% vs 4.4%, p<0.05) than men. A high level of sexual abuse emerged from the data with 34.3% affirming that it was alright for a boy to force a girl to have sex if he had feelings for her; 73.3% affirming that it was common for strangers and relatives to force young females to have sexual intercourse with them without consent; 26.3% indicating that it was sometimes justifiable for a boy to hit his girlfriend, as long as they loved each other., Conclusion: This study has explored current sexual practice among young people in a specific part of urban Kampala. Young people's sexual and reproductive health remains a challenge in Uganda. To address these barriers, a comprehensive and harmonised sexual and reproductive health system that is youth friendly and takes into account local socio-cultural contexts is urgently needed., Competing Interests: The authors have declared that no competing interests exist.

Background: While quality of life (QoL) has long been an explicit policy goal for international development programmes, no instruments have specifically been developed for measuring health-related QoL in resource-limited settings. The aim of this study was to develop and validate a QoL instrument for use in international aid and development programmes and to assess factors associated with QoL among youth participating in a civic engagement project in Kampala., Design: Using systematic random sampling, data were collected on 663 participants aged between 13 and 24 years in Kampala. The QoL questionnaire included 36 questions divided into a two-part scale: 18 questions rated for satisfaction (Part 1) and 18 other questions rated on importance (Part 2). The total sample was randomly divided into two split-half samples: one for the exploratory factor analysis (EFA; N=310) and the other for the confirmatorty factor analysis (CFA; N=353). The effect of demographic, socio-economic, and lifestyle factors on QoL was assessed using linear regressions., Results: The EFA yielded three factors: living conditions and lifestyle (seven items, α=0.84), social relationships (five items, α=0.86), and personal independence (five items, α=0.76). In the CFA, the initial model demonstrated a poor to marginal fit model. Its re-specification by examining modification indices resulted in a good model fit: Comparative Fit Index=0.95, Root Mean Square Error of Approximation=0.06, and p of Close Fit >0.05. The model incorporating perceived importance had lower Akaike Information Criteria and Bayesian Information Criteria values than the unweighted model, thereby providing very strong support to weight satisfaction scores with importance ratings when measuring QoL in Uganda. Poor QoL was associated with poor educational attainment, drug and substance misuse, and family disruption., Conclusions: The findings suggest that there is a relationship between QoL and lifestyle and structural issues among youth in Uganda. The study provides the first validated QoL measure to allow government and non-government organisations in low- and middle-income countries to track progress of international aid and development programmes.