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Introduction: This paper aims to describe and assess social demographic factors associated with childbearing decision-making, fertility and contraceptive intentions among street adolescents and youth in Kampala, Uganda while considering rural-urban migration as an explanatory factor. Materials and Methods: A cross-sectional survey of 513 adolescents and youth aged 12-24 years self-identifying as street adolescents and youth were interviewed with a structured questionnaire in 2019. Street adolescents and youth who migrated from other rural districts to Kampala were compared with those from the city. Logistic regression was performed to assess associations between the independent factors and personal childbearing decision-making, fertility and contraceptive intentions. Results: Overall, 80.31% of the street adolescents and youth had a rural-urban migration experience. Fifty six percent (56.32%) of the street adolescents and youth made personal childbearing decisions, 94.15% expressed intentions to have children in the future and 42.88%expressed intentions to use contraceptives in the future. Intentions to use contraceptives were significantly higher among males (58.75%) than females (20.00%), and higher among migrants (65.91%) compared to non-migrants (34.09%). Contraceptive intentions were positively associated with self-perceived permanent residential status (aOR = 10.26, 2.70-39.08), intra-urban mobility (aOR = 4.99, 95%CI 1.50-6.59) and intentions to migrate to other towns within the country (aOR = 5.33, 95%CI 1.59-17.80). Being married (aOR = 0.13, 95%CI 0.02-0.85), a large shelter population size (aOR = 0.13, 95%CI 0.03-0.63) and having repeat migrations between the city and home district (aOR = 0.23, 95%CI 0.05-0.94), including migration-associated challenges reduced the odds of street youth's personal childbearing decision-making, while belonging to a social support group increased the odds of childbearing decision-making. We found no significant association between social demographic characteristics and fertility intentions. Discussion: Factors that influenced personal childbearing decision-making and contraceptive intentions among street adolescents and youth in Kampala operate mainly at the interpersonal and community levels, with marital status, shelter population size, rural-urban migration and its associated challenges associated with childbearing decision-making. Interventions to promote childbearing decision-making and contraceptive use among street adolescents and youth should take into consideration their migration and intra-urban mobility patterns. [ABSTRACT FROM AUTHOR]

Background: Despite the vulnerabilities associated with the youth migration process, knowledge on the drivers of risky sexual behaviour among migrant street youth is limited. This study sought to explore the pathways driving risky sexual behaviour among rural-urban migrant street youth in Kampala, Uganda.Methods: We conducted 11 focus-group discussions composed of 8-10 participants each, and 15 in-depth interviews with urban street adolescents and youth aged 12-24 years. We purposively recruited street youth who had migrated from other districts to Kampala, Uganda, and who identified themselves as street youth. Data were analysed thematically using an inductive approach facilitated by Dedoose software.Results: The migration journey acted as a catalyst for risky sexual behaviour among the adolescents and youth moving from rural districts to Kampala. Three primary pathways were found to drive risky sexual behaviour of street youth: 1) rural-urban migration itself, through sexual exploitation of and violence toward street youth especially young girls during movement, 2) economic survival through engaging in casual jobs and sex work upon arrival in the city, and 3) personal physical safety through friendships and networks, which consequently lead to having multiple sexual partners and unprotected sex. Engagement in risky sexual behaviour, especially sex work, was found to be an adaptation to the challenging and complex street life within the city.Conclusions: This study highlights the migration process, personal physical safety and economic survival as major pathways driving risky sexual behaviour among rural-urban street youth in Kampala. Interventions to improve sexual health, physical safety and protection of street youth during the migration process and within the city spaces should be prioritised. [ABSTRACT FROM AUTHOR]

Background: Although under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala's informal settlements are still dying despite living in close proximity to nearby health facilities. Methods: This exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework. Results: 20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs' perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as "incentivized delays" to care-seeking. Discussion: This study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support. [ABSTRACT FROM AUTHOR]

While research on the nexus of migration and wellbeing of individuals has gained recognition in recent years, far less attention has been devoted to intra-urban mobility especially among the urban poor young populations. We assess the drivers of intra-urban mobility using a random sample of 412 migrant street children and youth in Kampala city, Uganda. This paper draws from a larger cross-sectional survey of circular migration and sexual and reproductive health choices among street children in Kampala, Uganda. We define 'migrants' as street children and youth with a rural-urban migration experience and 'intra-urban mobility' as the number of places stayed in or moved since migrating to the city, measured on a continuous scale. More than half (54.37%) of the migrant street children and youth had lived in two or more places since migrating to the city. Multivariate negative binomial regression analysis reveals migrant street children and youth's intra-urban mobility to be associated with gender (aIRR = 0.71, 95%CI 0.53–0.96), sex work (aIRR = 1.38, 95%CI 1.01–1.88), a daily income of one USD or more (aIRR = 1.57, 95%CI 1.16–2.13) and duration of stay in the city (aIRR = 1.54, 95%CI 1.17–2.01). Other drivers of intra-urban mobility included availability of causal work, personal safety and affordability of rental costs. Our findings suggest the need for urban housing and health policies to take into account street children and youth's intra-urban mobility and its drivers. Future research on all drivers of street children and youth's intra-urban mobility and its linkage with their health outcomes is recommended. [ABSTRACT FROM AUTHOR]