Search

Background: Malaria during pregnancy contributes to significant perinatal morbidity and mortality, accounting for almost 25% of global maternal mortality. However, the epidemiology and risk factors for subclinical malaria among pregnant women living in refugee settlements is poorly understood., Objective: To determine the prevalence and predictors of subclinical malaria among pregnant women in refugee settlements in Northern Uganda., Design: We conducted a multi-center, cross-sectional study., Methods: The study was conducted between April and June 2023 and involved pregnant women aged 18-45 years attending routine antenatal care (ANC) at three health facilities serving refugee communities in Adjumani district, Uganda. We collected sociodemographic, environmental, maternal, and obstetric factors using a structured questionnaire. Both CareStart Malaria HRP-2/pLDH (Pf/Pan) combo rapid diagnostic test (RDT) and blood smear microscopy with 3% Giemsa staining were simultaneously performed on samples from each patient. Logistic regression analysis identified factors independently associated with subclinical malaria, reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs)., Results: We enrolled 304 pregnant women, with a mean age of 25 years. In total, 68.8% ( n  = 209) had lived in the settlement for over 12 months, 25.7% ( n  = 78) were primigravida, and 1.0% ( n  = 3) were living with HIV. Malaria prevalence was 5.3% ( n  = 16) by RDT and 3.2% ( n  = 10; seven Plasmodium falciparum and three P. malariae ) by microscopy. Only 4 (25.0%) of the RDT-positive cases were also positive by microscopy (Cohen's kappa: 0.278-Fair agreement). All participants were asymptomatic. Factors associated with higher odds of subclinical malaria included primiparity (aOR: 2.79, 95% CI: 1.25-6.25, p  = 0.013), ⩾4 ANC visits (aOR: 2.41, 95% CI: 1.34-4.34, p  = 0.003), and residence in the settlement for less than 12 months (aOR: 2.54, 95% CI: 2.0-3.22, p  < 0.001). Living in the settlement for over 3 years, being primigravida, and being married were associated with 68%, 50%, and 68% lower odds of subclinical malaria, respectively (aOR: 0.32, 95% CI: 0.13-0.79, p  = 0.014; aOR: 0.50, 95% CI: 1.22-5.52, p  = 0.016; aOR: 0.32, 95% CI: 0.13-0.78, p  = 0.012)., Conclusion: Our study reveals the high prevalence of subclinical malaria among pregnant women in refugee settlements, particularly among primiparous women and recent arrivals. The poor agreement between RDT and microscopy suggests the need for dual screening in asymptomatic pregnant women., (© The Author(s), 2024.)

Background: Cesarean section poses a fourfold risk for postpartum hemorrhage (PPH), necessitating accurate blood loss estimation to enable timely interventions. However, the conventional visual estimation method often leads to underestimation, resulting in undiagnosed PPH even in our setting, Uganda. Yet, the quantitative standard techniques remain underutilized., Objective: We compared visual and calculated blood loss among women undergoing cesarean delivery at Gulu Regional Referral Hospital in northern Uganda., Design: We employed a cross-sectional study design., Methods: We enrolled pregnant women scheduled for cesarean section and determined both calculated and visually estimated blood loss. Data analysis involved using Pearson's moment correlation coefficient to compare the two methods and logistic regression to determine the factors associated with PPH., Results: We included 105 participants, most were primigravida ( n  = 100, 43%), aged 15-24 years ( n  = 100, 52%), with term gestation ( n  = 100, 75%). The mean visual estimated blood loss (vEBL) was 235.3 ± 123.7 ml (interquartile range (IQR) 50-600 ml), while the calculated estimated blood loss (cEBL) was 435.0 ± 1328.2 ml (IQR -11,182.1-2226.7 ml). Visual estimation underestimated blood loss in 90% of cases ( n  = 100), and 21% ( n  = 21) had undiagnosed PPH (>1000 ml blood loss). None of the respondents had PPH (>1000 ml blood loss) following vEBL. There was a small positive correlation between both methods (vEBL and cEBL; r  = 0.1165; p  = 0.2482). Women aged >35 years were 1.60 times more likely to experience PPH than their counterparts aged 25-34 years (adjusted odds ratio (AOR): 1.60; 95% CI: 1.11-2.30, p  < 0.011). Chorioamnionitis increased the risk of PPH by 2.2 times (AOR: 2.20; 95% CI: 1.20-4.05, p  < 0.012)., Conclusion: The visual estimation technique significantly underestimated blood loss in up to 90% of cases, particularly during emergency cesarean sections. Among the 21% of cases diagnosed with PPH based on calculated blood loss, advanced maternal age and chorioamnionitis were notable contributing factors. Routine hemoglobin and hematocrit testing in obstetric care can be effectively utilized to objectively assess blood loss, aiding in the accurate diagnosis and management of PPH. Implementing these measures, even in resource-constrained settings, can significantly reduce the morbidity and mortality associated with PPH., Trial Registration: Not applicable., (© The Author(s), 2024.)

Introduction: In Uganda, although most women wish to delay or prevent future pregnancies, uptake of postpartum family planning (PPFP) is low. We explored behavioural factors influencing the utilisation of postpartum long-acting reversible contraceptives (LARCs) in Eastern Uganda., Methods: We conducted a qualitative study in two districts of Eastern Uganda. We conducted 20 in-depth interviews and three focus group discussions with postpartum women, male partners, midwives, and village health team members. We analysed transcripts using framework analysis, based on the COM-B framework., Results: The use of immediate postpartum LARC was affected by the capabilities of women in terms of their knowledge and misconceptions. Limited capabilities of health workers to provide counselling and insert IUDs, as well as shortages of implants, reduced the physical opportunites for women to access PPFP. Social opportunities for women were limited because men wanted to be involved in the decision but rarely had time to accompany their partners to health facilities, and health workers often appeared too stressed. Men also feared that PPFP would enable their partners to be unfaithful. Motivation to take up immediate postpartum LARC included the desire to space births, preference for contraceptive implants over intra uterine devices (IUD) at the 6-week postpartum period, resumption of sex and menses, partner support, and perceived effectiveness of postpartum contraception. Participants thought that uptake of immediate postpartum LARC could be improved by health education and outreach visits, male involvement and couples' counselling in antenatal clinic appointments, and enabling switching between family planning methods (in case of side-effects) ., Conclusion: Low uptake of PPFP was caused by inadequate knowledge and misconceptions about LARC by women and their partners, insufficient numbers of midwives trained to provide PPFP, stock-outs of PPFP methods, and few social opportunities for couples to be counselled together. These factors could be addressed by scaling up effective, low cost and innovative ways to provide health education (such as films), involving men in decision-making, as well as training more midwives to provide PPFP services, and ensuring that they have sufficient time and supplies., (© 2024. The Author(s).)

Objective: Maternal and child health outcomes remain a challenge in Uganda. Antenatal care (ANC) is effective in mitigating pregnancy and childbirth risks. Women's decision-making autonomy and partner support are crucial for adherence to ANC contacts and better pregnancy outcomes. We assessed the impact of women's decision-making autonomy and partner support on adherence to the 8 + ANC contact schedule among post-partum mothers in Eastern Uganda., Methods: A multicenter cross-sectional study was conducted in four tertiary health facilities in Eastern Uganda, utilizing quantitative techniques to collect data from 1077 postnatal mothers. Eligible participants were those who had given birth within the previous 48 h and had documentation of ANC contacts from their pregnancy. Data was collected using structured questionnaires and analyzed using multivariable logistic regression to assess factors associated with adherence to the WHO-recommended 8 + ANC contacts., Results: Most women were aged 20-34 years (792; 73.5 %). Only 253 (23.5 %) women adhered to the 8 + ANC contacts. A significant proportion lacked decision-making autonomy (839; 77.9 %), and over half reported partner support (550; 51.2 %). Decision-making autonomy and partner support were significantly associated with adherence to the 8 + ANC contacts (aOR: 1.6, 95 % CI: 1.2 - 2.2, p = 0.005) and (aOR: 1.9, 95 % CI: 1.4 - 2.7, p < 0.001), respectively. Women with at least five children had lower adherence to the 8 + ANC contacts (aOR=0.4, 95 % CI: 0.2 - 0.7, p = 0.002)., Conclusion: Empowering women and engaging their partners can improve maternal health service utilization and increase ANC contact adherence, leading to better maternal and neonatal health outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Tuberculosis (TB) is a leading cause of death among children living with HIV (CLHIV). Isoniazid preventive therapy (IPT) reduces the incidence of TB by 70% and mortality by 50% among CLHIV. However, in most developing countries including Tanzania, the uptake of IPT is suboptimal, below the 90% WHO-global uptake target. We assessed the factors associated with IPT uptake among CLHIV in Mwanza region, Tanzania., Methods: This was a multicenter facility-based cross-sectional study among CLHIV aged 1 to 10 years in seven districts of Mwanza region, Tanzania from 1st November 2021 to 20th January 2022. Data were collected using a structured interview-administered questionnaire including information on children and caregivers' demographics, caregivers' health related information and children's clinical information. Our outcome variable was uptake of IPT, defined as initiation on IPT either during the time of the study or within past three years before this study We conducted modified Poisson regression to assess the association between IPT uptake and selected exposures in Stata version 15.0., Results: A total of 415 CLHIV were enrolled, the median age of the children was 7 years (Interquartile range: 5-8). The uptake of IPT was 91% (n = 377). The majority of children's caregivers were HIV positive (86%, n = 387) and were aware about IPT (63.6%, n = 264). Factors associated with IPT uptake included; having an employed caregiver [Adjusted Prevalence Ratio (aPR): 1.06 95% Confidence Interval (CI): 1.00-1.13] and attending the ART clinic every month [aPR: 1.00; 95% CI: 0.87-1.00] ., Conclusions: The uptake of IPT uptake among CLHIV in Mwanza, Tanzania exceeds the global WHO-target of ≥ 90%. Monthly ART clinic visits could be essential in promoting IPT uptake among CLHIV., (© 2024. The Author(s).)

Background: Globally, there are an estimated 20.9 million cases of onchocerciasis, with Africa bearing the greatest burden. The World Health Organization (WHO) has targeted the disease for elimination by 2030. As of August 2023, there were 15 foci in 37/48 (76%) districts and one city in Uganda that had reached the elimination phase. However, there is a paucity of data on community involvement in post-elimination surveillance (PES) activities. The communities in the post-elimination phase are expected to maintain surveillance, provide health education, refer cases for treatment, and participate in surveillance. However, it is not clear whether this is being done. In this study, we assessed the feasibility of community involvement in post-elimination surveillance activities in Bududa District, Eastern Uganda, to draw key generalisable lessons for similar settings., Methods: This was a cross-sectional study employing rigorous mixed methods of data collection. We used a semi-structured questionnaire to collect quantitative data on randomly sampled study participants in two sub-countries in the district. Community involvement in post-elimination surveillance (PES) was our dependent variable, measured using Yes or No questions, and our independent variables were measured on different scales. Computations of proportions and associations were done using Stata 15 software. Conversely, qualitative data were collected via focus group discussions (FGDs) for community participants and key informant interviews (KIIs) for local leaders. For the qualitative component, we had 2 FGDs, each consisting of 8 gender-balanced participants per group and 8 KIIs. Qualitative data analyses were done using a robust thematic framework approach, ensuring the reliability and validity of our findings., Results: A total of 422 participants with a mean age of 51.4 years (SD = 15.8) participated in the study. Community involvement in post-elimination surveillance was low (14%). Factors associated with involvements were district support [Adjusted odd ratio AOR 14, 95 CI = (2.5, 81.7)], seeing black flies in the environment in a week preceding the survey [AOR 8, 95% CI = (1.5, 42.5)], in one month [AOR 3.8, 95% CI = (1.1, 13.2)], and being a community volunteer in the Ivermectin treatment program [AOR 4.3, 95% CI = (1.03, 17.9)]. Lack of funding, poor motivation, poor program sustainability planning, and a lack of drugs at health facilities were key challenges affecting community involvement in post-elimination surveillance., Conclusion: Community involvement in onchocerciasis post-elimination surveillance activities in Bududa District in Eastern Uganda was low but could be improved by increased district support, funding, community motivation and sensitisation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Khainza 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.)

Competing Interests: We declare no competing interests.

We examined the self-rated competence of Ugandan healthcare workers (HCWs) in obtaining informed consent for autopsies, considering the challenges of low autopsy acceptance rates globally. In September and October 2023, we conducted a nationwide cross-sectional study of HCWs, who provided informed consent to participate and completed an online, self-administered questionnaire. Participants' self-rated competence in obtaining informed consent for autopsy was assessed through Likert scale questions. Knowledge and practices were also assessed. All scores were converted to percentages, with scores ≥80% indicating higher competence. We enrolled 216 HCWs (including 145 [67.1%] doctors), with a mean age of 31.6 ± 7.2 years. Overall, 55.6% (n = 120) had ever assisted in obtaining consent for autopsy, 43.6% (n = 100) had ever obtained consent for autopsy themselves, and 13.4% (n = 29) had ever attended training on obtaining consent for autopsy. The mean competency score was 59.8 ± 17.0% (perfect score, 100%), with 29 (13.4%) participants demonstrating high competence. Healthcare workers with adequate knowledge had higher competence scores (odds ratio [OR]: 15.0, 95% CI: 6.17-36.58, P <0.001). Compared with nurses/midwives, doctors had 73% lower odds of having a high competence score (adjusted OR: 0.27, 95% CI: 0.08-0.94, P = 0.040). Fewer than one in five Ugandan HCWs demonstrated high self-rated competence or possessed adequate knowledge regarding informed consent for autopsies, and only a few had received specialized training on how to obtain consent for an autopsy. Therefore, there is a pressing need for enhanced training and increased awareness among Ugandan HCWs in obtaining informed consent for autopsies.

Background: HIV+-to-HIV+ organ transplantation has demonstrated promise and is now authorized for research purposes in certain countries. However, organ transplantation is dependent on the availability of organ donors. We assessed the awareness and willingness to donate organs among people with HIV (PWH) in Uganda., Methods: We conducted a multicenter cross-sectional study between October 2023 and January 2024 in four large HIV clinics in Northern Uganda. The study population consisted of PWH. A structured questionnaire was used to collect data regarding awareness, willingness, and beliefs regarding organ donation. Organ donation was defined as the willingness to be a living donor of a solid organ. We conducted multivariable logistic regression to assess for an association between willingness to donate organs and selected exposures. Data were analyzed in Stata version 15.0. Results are expressed as adjusted odds ratio (AOR) with 95% confidence intervals (CI)., Results: A total of 232 participants were recruited. The mean age ± standard deviation of the participants was 42.2±11.8 years. All participants were on antiretroviral therapy. Sixty-two (26.7%) had a CD4 count less than or equal to 200 cells/mm 3 . The majority (80.6%, n = 187) had ever heard of organ donation. Slightly more than a third (34.9%, n = 81) were willing to donate organs. Factors associated with willingness to be a living organ donor included being female (AOR: 1.56; 95% CI: 1.15-2.11), having a tertiary education level (AOR: 1.79; 95% CI: 1.03-3.11), average monthly income >500 000 UGX (135.1USD) (AOR: 5.5; 95% CI: 1.97-15.40), ever heard about organ donation (AOR: 5.4; 95% CI: 1.67-17.8), and attending an organ donation campaign (AOR: 2.0; 95% CI: 1.07-3.74)., Conclusions: Awareness about organ donation was high but the willingness to be a living organ donor was low among PWH in Uganda. There is a need to sensitize the community about the need and benefits of organ donation with the involvement of media and the healthcare workers., (© 2024 Wiley Periodicals LLC.)

Background: The COVID-19 pandemic has dramatically impacted communities worldwide, particularly in developing countries. To successfully control the pandemic, correct information and more than 80% vaccine coverage in a population were required. However, misinformation and disinformation could impact this, thus increasing COVID-19 vaccine hesitancy in communities. Several studies observed the effect of misinformation and disinformation on COVID-19 vaccine acceptance and other responses to the pandemic in the African continent. Thus, the most trusted sources of information on COVID-19 vaccines are critical for the successful management and control of the pandemic. This study aimed to assess the most trusted sources of information on COVID-19 vaccines during the pandemic in Uganda., Methods: We conducted a cross-sectional study on 587 adult population members in northern Uganda. Single-stage stratified and systematic sampling methods were used to select participants from northern Uganda. An interviewer-administered questionnaire with an internal validity of Cronbach's α = 0.72 was used for data collection. An Institution Review Board (IRB) approved this study and Stata version 18 was used for data analysis. A Pearson Chi-square (χ2) analysis was conducted to assess associations between trusted sources of COVID-19 vaccine information and selected independent variables. Fisher's exact test considered associations when the cell value following cross-tabulation was < 5. A P-value < 0.05 was used as evidence for an association between trusted sources of information and independent variables. All results were presented as frequencies, proportions, Chi-square or Fisher's exact tests, and P-values at 95% Confidence Intervals (CI)., Results: In a study of 587 participants, most were males, 335(57.1%), in the age group of 25-34 years, 180(31.4%), and the most trusted source of COVID-19 vaccine information were the traditional media sources for example, Televisions, Radios, and Newspapers, 349(33.6%). There was no significant association between sex and trusted sources of COVID-19 vaccine information. However, by age-group population, COVID-19 vaccine information was significantly associated with internet use (14.7% versus 85.3%; p = 0.02), information from family members (9.4% versus 90.6%; p < 0.01), and the Government/Ministry of Health (37.9% versus 62.1%; p < 0.01). Between healthcare workers and non-health workers, it was significantly associated with internet use (32.2% versus 67.8%; p = 0.03), healthcare providers (32.5% versus 67.5%; p < 0.018), the Government/Ministry of Health (31.1% versus 68.9%; p < 0.01), and scientific articles (44.7% versus 55.3%; p < 0.01)., Conclusion: The most trusted sources of COVID-19 vaccine information in northern Uganda were Televisions, Radios, and Newspapers. The trusted sources of COVID-19 vaccine information were not significantly different between males and females. However, there were significant differences among age groups and occupations of participants with younger age groups (≤ 44 years) and non-healthcare workers having more trust in Televisions, Radios, and Newspapers. Thus, for effective management of an epidemic, there is a need for accurate communication so that misinformation, disinformation, and malinformation in the era of "infodemic" do not disrupt the flow of correct information to communities., (© 2024. The Author(s).)

Background: Early contraceptive implant removal without intentions to conceive predisposes women to unintended pregnancies.. Some of the unintended pregnancies end in unsafe abortions which further increases the risk of maternal mortality and morbidity. Therefore, we assessed the proportion of women who had early contraceptive implant removal. We also explored the reasons for early contraceptive implant removalamong women at Mbale Regional Referral Hospital in eastern Uganda., Methods: We conducted a sequential explanatory mixed methods study at Mbale Regional Referral Hospital between November 2022 to December 2022. For quantitative data, we performed a secondary analysis on data extracted from the integrated family planning registers. We used systematic random sampling to select 600 clients' serial numbers from the registers. The outcome variable was early contraceptive implant removal defined as removal of the implant by the woman before 18 months from the time of insertion. For qualitative data, we conducted 11 in-depth interviews among women who had come for contraceptive implant removal at the family planning clinic. We also conducted two key informant interviews with midwives working at the family planning unit. Quantitative data were analysed using Stata version 14.0 (Stata Corp LLC, College Station, Texas, USA) while qualitative data were analysed by thematic content analysis., Results: In this study, 15% (91/600) of the women discontinued contraceptive implants within 12 months, 29% (175/600) within 18 months, 38% (230/600) within 24 months and 40% (240/600) within 36 months of insertion. Among the women who discontinued contraceptive implant use, only 6.7% (40/600) switched to another family planning method. Out of the 175 women who removed contraceptive implants early, side effects 61.1% (107/175) desire to conceive 53.1% ( 93/175),, and gender-based violence 8.6% (15/175) were the major reasons for removal. From the qualitative interviews, the major reasons for early contraceptive implant removal were side effects such as heavy menstrualbleeding., Conclusion: A third of women discontinued contraceptive implant use within 18 months. Addressing concerns regarding side effects and male partner disapproval of modern contraceptives may improve continued use of implants., (© 2024. The Author(s).)

Background: Over two million children and adolescents suffer from chronic kidney disease globally. Early childhood insults such as birth asphyxia could be risk factors for chronic kidney disease in later life. Our study aimed to assess renal function among children aged two to four years, born to women with obstructed labour., Methods: We followed up 144 children aged two to four years, born to women with obstructed labor at Mbale regional referral hospital in Eastern Uganda. We used serum creatinine to calculate estimated glomerular filtration rate (eGFR) using the Schwartz formula. We defined decreased renal function as eGFR less than 90 ml/min/1.73m 2 ., Results: The mean age of the children was 2.8 years, standard deviation (SD) of 0.4 years. Majority of the children were male (96/144: 66.7%). The mean umbilical lactate level at birth among the study participants was 8.9 mmol/L with a standard deviation (SD) of 5.0. eGFR of the children ranged from 55 to 163 ml/min/1.73m 2 , mean 85.8 ± SD 15.9. Nearly one third of the children (45/144) had normal eGFR (> 90 ml/Min/1.73m 2 ), two thirds (97/144) had a mild decrease of eGFR (60-89 ml/Min/1.73m 2 ), and only two children had a moderate decrease of eGFR (< 60 ml/Min/1.73m 2 ). Overall incidence of reduced eGFR was 68.8% [(99/144): 95% CI (60.6 to 75.9)]., Conclusion: We observed a high incidence of reduced renal function among children born to women with obstructed labour. We recommend routine follow up of children born to women with obstructed labour and add our voices to those calling for improved intra-partum and peripartum care., (© 2024. The Author(s).)

Background: Globally, high systolic blood pressure accounts for 10.8 million deaths annually. The deaths are disproportionately higher among black people. The reasons for this disparity are poorly understood, but could include a high burden of perinatal insults such as birth asphyxia. Therefore, we aimed to assess the incidence of elevated blood pressure and to explore associated factors among children born to women with obstructed labour., Methods: We followed up children born to women with obstructed labour aged 25 to 44 months at Mbale regional referral hospital that had participated in the sodium bicarbonate trial ( Trial registration number PACTR201805003364421) between October 2021 and April 2022. Our primary outcome was elevated blood pressure defined as blood pressure (either systolic or diastolic or both) ≥ the 90th percentile for age, height, and sex in the reference population based on the clinical practice guideline for screening and management of high blood pressure in children and adolescents. We used logistic regression to estimate odds ratios between selected exposures and elevated blood pressure., Results: The incidence of elevated blood pressure was (39/140, 27.9%: 95% (CI: 20.6-36.1)). Participants aged three years and above had twice the odds of elevated blood pressure as those aged less than three years (Adjusted odds ratio (AOR) 2.46: 95% CI (1.01-5.97). Female participants had 2.81 times the odds of elevated blood pressure as their male counterparts (AOR 2.81 95% CI (1.16-6.82). Participants with reduced estimated glomerular filtration rate had 2.85 times the odds of having elevated blood pressure as those with normal estimated glomerular filtration rate (AOR 2.85 95% CI (1.00-8.13). We found no association between arterial cord lactate, stunting, wealth index, exclusive breastfeeding, food diversity and elevated blood pressure., Conclusion: Our findings show a high incidence of elevated blood pressure among children. We encourage routine checking for elevated blood pressure in the pediatric population particularly those with known risk factors., (© 2024. The Author(s).)

Background: In Uganda, approximately 170,000 confirmed COVID-19 cases and 3,630 deaths have been reported as of January 2023. At the start of the second COVID-19 wave, the Ugandan health system was overwhelmed with a sudden increase in the number of COVID-19 patients who needed care, and the Ministry of Health resorted to home-based isolation and care for patients with mild to moderate disease. Before its rollout, the COVID-19 home-based care strategy had neither been piloted nor tested in Uganda., Objective: To explore the experiences of COVID-19 patients managed at home in Uganda., Methods: This was a qualitative study that was conducted to explore the lived experiences of COVID-19 patients managed at home. The study was carried out among patients who presented to three hospitals that were designated for treating COVID-19 patients in Uganda. COVID-19 patients diagnosed at these hospitals and managed at home were followed up and contacted for in-depth telephone interviews. The data were analysed using thematic content analysis with the aid of NVIVO 12.0.0 (QRS International, Cambridge, MA)., Results: Participants experienced feelings of fear and anxiety: fear of death, fear of losing jobs, fear of infecting loved ones and fear of adverse events such as loss of libido. Participants also reported feelings of loneliness, hopelessness and depression on top of the debilitating and sometimes worsening symptoms. In addition to conventional medicines, participants took various kinds of home remedies and herbal concoctions to alleviate their symptoms. Furthermore, COVID-19 care resulted in a high economic burden, which persisted after the COVID-19 illness. Stigma was a major theme reported by participants. Participants recommended that COVID-19 care should include counselling before testing and during and after the illness to combat the fear and stigma associated with the diagnosis. Another recommendation was that health workers should carry out home visits to patients undergoing home-based care and that COVID-19 treatment should be free of charge., Conclusion: COVID-19 home-based care was associated with fear, anxiety, loneliness, depression, economic loss and stigma. Policymakers should consider various home-based follow-up strategies and strengthen counselling of COVID-19 patients at all stages of care., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Nakireka 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: Male involvement plays a critical role in the utilization of various sexual and reproductive health services. We explored enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda., Methods: This was a qualitative study in Mbale, Eastern Uganda done between November and December 2022. We conducted three group discussions comprising of four participants each, with male partners and eight key informant interviews with midwives. We followed a group discussion guide during the group discussions and an interview guide during the key informant interviews to explore enablers and barriers of male involvement in the use of modern family planning methods. All the interviews and group discussions were audio-recorded with permission from the participants, transcribed verbatim, and analyzed following thematic content analysis approach., Results: Two sub-themes emerged from the analysis; perceived enablers and barriers. The perceived enablers included positive attitude, subjective norms, need to support the woman, mutual consent, limited resources and expected benefits of reducing gender-based violence and sexually transmitted infections. Lack of male partner consent, busy work engagement, social stigma, religious prohibition, desire for many children and gender roles incompatibility hindered male partner involvement in family planning. Fear of side effects and misconceptions, unconducive hospital environment in form of mistreatment, family planning considered a female's issue, and lack of consideration of male partner needs in family planning clinic were additional barriers to male involvement., Conclusion: Male involvement in family planning was related to positive attitude and subjective norms towards family planning, mutual consent, and recognition for limited resources to support a large family size. Lack of male partner approval, fear of side effects and misconceptions, unconducive hospital environment and social, cultural and religious prohibitions discouraged male partner involvement in family planning. Community based approaches to family planning sensitization, such as community education campaigns, may be an important step toward reducing barriers to male involvement in the use of modern family planning methods., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: The decision to delivery interval is a key indicator of the quality of obstetric care. This study assessed the decision to delivery interval for emergency cesarean sections and factors associated with delay., Methods: We conducted a cross-sectional study between October 2022 and December 2022 in the labor ward at Mbale regional referral hospital. Our primary outcome variable was the decision to delivery interval defined as the time interval in minutes from the decision to perform the emergency caesarean section to delivery of the baby. We used an observer checklist and interviewer administered questionnaire to collect data. Stata version 14.0 (StataCorp; College Station, TX, USA) was used to analyze the data., Results: We enrolled 352 participants; the mean age was 25.9 years and standard deviation (SD) ±5.9 years. The median (interquartile range) decision to delivery interval was 110 minutes (80 to 145). Only 7/352 (2.0%) participants had a decision to delivery time interval of ≤30 minutes. More than three quarters 281 /352 (79.8%) had a decision to delivery interval of greater than 75 minutes. Emergency cesarean section done by intern doctors compared to specialists [Adjusted Prevalence Ratio (aPR): 1.26; 95% CI: (1.09-1.45)] was associated with a prolonged decision to delivery interval., Conclusion: The average decision to delivery interval was almost 2 hours. Delays were mostly due to health system challenges. We recommend routine monitoring of decision to delivery interval as an indicator of the quality of obstetric care., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Apako 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: Donated breast milk is considered beneficial to vulnerable infants. Thus, Uganda launched its first human milk bank in November 2021 to provide breast milk to preterm, low birthweight and sick babies. However, there is a scarcity of information on the acceptability of donated breast milk in Uganda. The study sought to assess the acceptability of using donated breast milk and associated factors among pregnant women at a private and a public hospital in central Uganda., Methods: This cross-sectional study enrolled pregnant women attending antenatal care at the selected hospitals between July and October 2020. All pregnant women recruited had already given birth to at least one child. Data were collected using a semi-structured questionnaire, and we recruited participants through systematic sampling. Used frequencies, percentages and means with standard deviations to summarize variables. Assessed the association between the acceptability of donated milk and selected factors by comparing their arithmetic means using a generalized linear model to allow for clustering at the health facility level. Used a normal distribution and an identity link and calculated the adjusted mean differences together with 95% CIs [generated using robust variance estimators to correct for model misspecification]., Results: A total of 244 pregnant women with a mean age of 30 (± 5.25) years were enrolled. Sixty-one-point 5% (150/244) of the women reported that they would accept donated breast milk. Higher education (adjusted mean difference, technical versus primary level: 1.33; 95% CI 0.64, 2.02), being Muslim (adjusted mean difference, Muslim versus Christian: 1.24; 95% CI 0.77, 1.70), having heard of donated breast milk banking (adjusted mean difference, ever versus never: 0.62; 95% CI 0.18, 1.06) and presence of a serious medical condition (adjusted mean difference, preference of donated milk versus other feeds in a serious medical condition: 3.96; 95% CI, 3.28, 4.64) were associated with acceptability of donated breast milk., Conclusions: The acceptability of using donated breast milk for infant feeding was high among pregnant women. Public sensitization and education campaigns are indispensable for the acceptability of donated milk. These programs should be designed to include women with lower education levels., (© 2023. The Author(s).)

There is a dearth of information on the patterns of electrolyte derangements among perioperative women with obstructed labour. We measured the levels and patterns of electrolyte derangements among women with obstructed labour in eastern Uganda. This was a secondary analysis of data for 389 patients with obstructed labour, diagnosed by either an obstetrician or medical officer on duty between July 2018 and June 2019. Five milliliters of venous blood was drawn from the antecubital fossa under an aseptic procedure for electrolytes and complete blood analyses. The primary outcome was the prevalence of electrolyte derangements, defined as values outside the normal ranges: Potassium 3.3-5.1 mmol/L, Sodium 130-148 mmol/L, Chloride 97-109 mmol/L, Magnesium 0.55-1.10 mmol/L, Calcium (Total) 2.05-2.42 mmol/L, and Bicarbonate 20-24 mmol/L. The most prevalent electrolyte derangement was hypobicarbonatemia [85.8% (334/389)], followed by hypocalcaemia [29.1% (113/389)], then hyponatremia [18% (70/389)]. Hyperchloraemia [4.1% (16/389)], hyperbicarbonatemia [3.1% (12/389)], hypercalcaemia [2.8% (11/389)] and hypermagnesemia [2.8% (11/389)] were seen in a minority of the study participants. A total of 209/389 (53.7%) of the participants had multiple electrolyte derangements. Women who used herbal medicines had 1.6 times the odds of having multiple electrolyte derangements as those who did not use herbal medicines [Adjusted Odds Ratio (AOR): 1.6; 95% Confidence Interval (CI): (1.0-2.5)]. Having multiple electrolyte derangements was associated with perinatal death although this estimate was not precise [AOR 2.1; 95% CI: (0.9-4.7)]. Women with obstructed labour in the perioperative period have multiple electrolyte derangements. Use of herbal medicines in labour was associated with having multiple electrolyte derangements. We recommend routine assessment of electrolytes prior to surgery in patients with obstructed labour., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Nantale 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: Breast milk is crucial for the nutritional and developmental milestones in the first two years of life. Uganda has recognized the need for a human milk bank as an opportunity that offers reliable and healthy milk to babies who lack access to their mothers. However, there is little information on the perceptions towards donated breast milk in Uganda. This study aimed to explore the perceptions of mothers, fathers, and health workers on the use of donated breast milk at Nsambya and Naguru hospitals in Kampala district, central Uganda., Methods: A qualitative descriptive study was conducted at Nsambya and Naguru hospitals in central Uganda. The study consisted of 8 focus group discussions (FGDs) of 6 participants each and 19 key informant interviews (KIIs) among mothers, fathers, and health workers. Participants were purposively selected. Data collected were transcribed, translated from Luganda to English, and analyzed using thematic analysis. All data were organized and managed in Nvivo version 12.0., Results: A total of 67 participants were involved in the study. Two main themes were identified: positive perceptions and negative perceptions. Participants linked donated breast milk to blood transfusion, believed it had nutrients comparable to the biological mother's milk, and thought it was an opportunity to avoid formula or cow milk and help babies that cannot access breast milk. However, the notable negative perceptions were; the feeling that donated breast milk is disgusting, could result in acquiring non-parental genes and traits, and that it was unsafe. Participants also feared that donated breast milk could be expensive and affect the bond between mother and child., Conclusion: In summary, participants had positive perceptions about donated breast milk but were concerned about the potential side effects. Health workers should take extra precautions to ensure that donated breast milk is safe. The development of appropriate information and communication programs to sensitize the public about the benefits of donated breast milk will improve the uptake. Further research should focus on understanding the social-cultural beliefs regarding donated breast milk., (© 2023. The Author(s).)

Background: The skin is a major route of infection in the neonatal period, especially in low birthweight (LBW) infants. Appropriate and safe neonatal skin care practices are required to reduce this risk. The perceptions and beliefs of mothers and other caregivers towards various neonatal skin care practices in our setting have been documented. Data from Asia suggests that the application of emollient to the skin of LBW infants can promote growth, reduce serious neonatal infections, and potentially reduce mortality. This is the first study to explore the acceptability of emollients and massage as part of neonatal skin care in a low-resource setting in sub-Saharan Africa (SSA) that is representative of the majority of government health facilities in Uganda and many in SSA., Objective: To explore perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda., Methods: We conducted a qualitative study consisting of three focus group discussions (30 participants), eight in-depth interviews with mothers/caregivers of preterm and term neonates and 12 key informant interviews with midwives, doctors and community health workers involved in neonatal care, to explore the perceptions and practices surrounding neonatal skin care and emollient use. Data collected were transcribed and analyzed using thematic content analysis., Results: Mothers perceived that skin care began in utero. Skincare practices depended on the place of delivery; for deliveries in a health facility the skincare practices were mainly based on the health worker's advice. Vernix caseosa was often washed off due to its perceived undesirability and was attributed to sexual intercourse in the last trimester. Despite their deleterious attributes found in previous studies, petrolatum-based oils, petrolatum-based jellies and talcum baby powders were the most commonly reported items used in neonatal skin care. In our population, there was high acceptability of emollient therapy use; however, neonatal massage was treated with scepticism as mothers feared damaging the vulnerable neonate. Mothers suggested massage and emollient application be undertaken by health workers, if it becomes an intervention., Conclusions: In eastern Uganda, the perceptions and beliefs of mothers/caregivers toward neonatal skincare influenced their practices of which some could potentially be beneficial, and others harmful. Emollient use would be easily accepted if adequate sensitisation is conducted and using the gatekeepers such as health workers., (© 2023. The Author(s).)

Background: COVID-19 vaccination is the latest preventive intervention strategy in an attempt to control the global pandemic. Its efficacy has come under scrutiny because of break through infections among the vaccinated and need for booster doses. Besides, although health workers were prioritized for COVID-19 vaccine in most countries, anecdotal evidence points to high levels of reluctance to take the vaccine among health workers. We assessed COVID-19 vaccine hesitancy among health workers in Dokolo district, northern Uganda., Methods: This was a mixed-method, cross-sectional descriptive study. A customised self-administered data collection tool was used to collect quantitative data on characteristics, vaccination status and factors for or rejection of vaccine uptake. We conducted multivariable logistic regression to assess the association between selected exposures and vaccine hesitancy using Stata version 15. Conversely, qualitative data were collected using key informant interviews (KIIs) among 15 participants that were purposively selected. Data were analysed using thematic content analysis with the help of NVivo 12.0., Results: Of the 346 health workers enrolled, (13.3% [46/346]) were vaccine hesitant. Factors associated with vaccine hesitancy included fear of side effects (Adjusted Odds Ratio [AOR]: 2.55; 95% Confidence Interval [95%CI]: 1.00, 6.49) and health workers' lack of trust in the information provided by health authorities (AOR: 6.74; 95% CI: 2.43, 18.72). Similar factors were associated with vaccine hesitancy when we used the vaccine hesitancy score. Fear of side effects, distrust in vaccine stakeholders, and lack of trust in the vaccine were barriers to COVID-19 vaccination among health workers., Conclusion: A small proportion of health workers were found to be hesitant to take the COVID-19 vaccine in this study. The paucity of COVID-19 vaccine safety information, which eroded the health workers' trust in the information they received on the vaccine, was responsible for health workers hesitancy to take up the vaccine in Uganda., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Prostate cancer is the most common cancer among men globally, with over 1.2 million cases reported in 2018. About 90% of men with prostate cancer are diagnosed when the disease is in an advanced stage. We assessed the factors associated with the uptake of prostate cancer screening among men aged ≥ 50 years in Lira city., Methods: This was a cross-sectional study involving 400 men aged ≥ 50 years in Lira city who were sampled using multistage cluster sampling method. Uptake of prostate cancer screening was defined as the proportion of men who received prostate cancer screening in the past one year prior to the interview. Multivariable logistic regression analyses were performed to assess the factors associated with the uptake of prostate cancer screening. Data were analyzed using Stata version 14.0 statistical software., Results: Of the 400 participants, only 18.5% (74/400) had ever been screened for prostate cancer. However, 70.7% (283/400) were willing to screen/rescreen if provided with the opportunity. Majority of the study participants, 70.5% (282/400) had ever heard about prostate cancer, mostly from a health worker (40.8% (115/282)). Less than half of the participants had high knowledge of prostate cancer. The factors that were significantly associated with prostate cancer screening were age ≥ 70 years, Adjusted Odds Ratio (AOR) 3.29: 95% Confidence Interval (CI): 1.20-9.00) and having a family history of prostate cancer, AOR 2.48 (95%CI: 1.32-4.65)., Conclusion: There was low uptake of prostate cancer screening among men in Lira City, but majority of men were willing to screen. We encourage policymakers in Uganda to ensure prostate cancer screening services are readily available and accessible by men so as to improve on early identification and treatment of the disease., (© 2023. The Author(s).)

Over 250 million infants in low and middle-income countries do not fulfill their neurodevelopment potential. In this study, we assessed the incidence and risk factors for neurodevelopmental delay (NDD) among children born following obstructed labor in Eastern Uganda. Between October 2021 and April 2022, we conducted a cohort study of 155 children (aged 25 to 44 months), born at term and assessed their neurodevelopment using the Malawi Developmental Assessment Tool. We assessed the gross motor, fine motor, language and social domains of neurodevelopment. The incidence of neurodevelopmental delay by 25 to 44 months was 67.7% (105/155) (95% CI: 59.8-75.0). Children belonging to the poorest wealth quintile had 83% higher risk of NDD compared to children belonging to the richest quintile (ARR (Adjusted Risk Ratio): 1.83; 95% CI (Confidence Interval): [1.13, 2.94]). Children fed the recommended meal diversity had 25% lower risk of neurodevelopmental delay compared to children who did not (ARR: 0.75; 95% CI: [0.60, 0.94]). Children who were exclusively breastfed for the first 6 months had 27% lower risk of neurodevelopmental delay compared to children who were not (ARR: 0.73; 95% CI: [0.56, 0.96]). We recommend that infants born following obstructed labor undergo neurodevelopmental delay screening.

Introduction: Identification of factors predicting prolonged hospitalization of patients with coronavirus disease (COVID-19) guides the planning, care and flow of patients in the COVID-19 Treatment Units (CTUs). We determined the length of hospital stay and factors associated with prolonged hospitalization among patients with COVID-19 at six CTUs in Uganda., Methods: We conducted a retrospective cohort study of patients admitted with COVID-19 between January and December 2021 in six CTUs in Uganda. We conducted generalized linear regression models of the binomial family with a log link and robust variance estimation to estimate risk ratios of selected exposure variables and prolonged hospitalization (defined as a hospital stay for 14 days or more). We also conducted negative binomial regression models with robust variance to estimate the rate ratios between selected exposures and hospitalization duration., Results: Data from 968 participants were analyzed. The median length of hospitalization was 5 (range: 1-89) days. A total of 136/968 (14.1%: 95% confidence interval (CI): 11.9-16.4%) patients had prolonged hospitalization. Hospitalization in a public facility (adjusted risk ratio (ARR) = 2.49, 95% CI: 1.65-3.76), critical COVID-19 severity scores (ARR = 3.24: 95% CI: 1.01-10.42), and malaria co-infection (adjusted incident rate ratio (AIRR) = 0.67: 95% CI: 0.55-0.83) were associated with prolonged hospitalization., Conclusion: One out of seven COVID-19 patients had prolonged hospitalization. Healthcare providers in public health facilities should watch out for unnecessary hospitalization. We encourage screening for possible co-morbidities such as malaria among patients admitted for COVID-19., (© 2022. The Author(s).)

Background: A rapid increase in community transmission of COVID-19 across the country overwhelmed Uganda's health care system. In response, the Ministry of Health adopted the home-based care strategy for COVID-19 patients with mild-to-moderate disease. We determined the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care during the second wave in Kapelebyong district, in eastern Uganda., Methods: We conducted a sequential explanatory mixed-methods study. We first collected quantitative data using an interviewer-administered questionnaire to determine characteristics and treatment outcomes of COVID-19 patients under home-based care. Cured at home was coded as 1 (considered a good outcome) while being admitted to a health facility and/or dying were coded as 0 (considered poor outcomes). Thereafter, we conducted 11 in-depth interviews to explore the experiences of COVID-19 patients under home-based care. Multivariable logistic regression was used to assess factors associated with poor treatment outcomes using Stata v.15.0. Thematic content analysis was used to explore lived experiences of COVID-19 patients under home-based care using NVivo 12.0.0 RESULTS: A total of 303 study participants were included. The mean age ± standard deviation of participants was 32.2 years ± 19.9. Majority of the participants [96.0% (289/303)] cured at home, 3.3% (10/303) were admitted to a health facility and 0.7% (2/303) died. Patients above 60 years of age had 17.4 times the odds of having poor treatment outcomes compared to those below 60 years of age (adjusted odds ratio (AOR): 17.4; 95% CI: 2.2-137.6). Patients who spent more than one month under home-based care had 15.3 times the odds of having poor treatment outcomes compared to those that spent less than one month (AOR: 15.3; 95% CI: 1.6-145.7). From the qualitative interviews, participants identified stigma, fear, anxiety, rejection, not being followed up by health workers and economic loss as negative experiences encountered during home-based care. Positive lived experiences included closeness to friends and family, more freedom, and easy access to food., Conclusion: Home-based care of COVID-19 was operational in eastern Uganda. Older age (> 60 years) and prolonged illness (> 1 months) were associated with poor treatment outcomes. Social support was an impetus for home-based care., (© 2022. The Author(s).)

Effective, safe and proven vaccines would be the most effective strategy against the COVID-19 pandemic but have faced rollout challenges partly due to fear of potential side-effects. We assessed the prevalence, profiles, and predictors of Oxford/AstraZeneca vaccine side-effects in Tororo district of Eastern Uganda. We conducted telephone interviews with 2204 participants between October 2021 and January 2022. Multivariable logistic regression was conducted to assess factors associated with Oxford/AstraZeneca vaccine side-effects using Stata version 15.0. A total of 603/2204 (27.4%) of the participants experienced one or more side-effects (local, systemic, allergic, and other side-effects). Of these, 253/603 (42.0%) experienced local side-effects, 449/603 (74.5%) experienced systemic side-effects, 11/603 (1.8%) experienced allergic reactions, and 166/603 (27.5%) experienced other side-effects. Ten participants declined to receive the second dose because of side-effects they had experienced after the first dose. Previous infection with COVID-19 (adjusted odds ratio (AOR): 4.3, 95% confidence interval (95% CI): 2.7-7.0), being female (AOR: 1.3, 95% CI: 1.1-1.6) and being a security officer (AOR: 0.4, 95% CI: 0.2-0.6) were associated with side-effects to the Oxford/AstraZeneca vaccine. We recommend campaigns to disseminate correct information about potential side-effects of the Oxford/AstraZeneca vaccine and strengthen surveillance for adverse events following vaccination.

Background: Assessing factors associated with mortality among COVID-19 patients could guide in developing context relevant interventions to mitigate the risk. The study aimed to describe mortality and associated factors among COVID-19 patients admitted at six health facilities in Uganda., Methods: We reviewed medical records of patients admitted with COVID-19 between January 1st 2021 and December 31st 2021 in six hospitals in Uganda. Using Stata version 17.0, Kaplan Meier and Cox regression analyses were performed to describe the time to death and estimate associations between various exposures and time to death. Finally, accelerated failure time (AFT) models with a lognormal distribution were used to estimate corresponding survival time ratios., Results: Out of the 1040 study participants, 234 (22.5%: 95%CI 12.9 to 36.2%) died. The mortality rate was 30.7 deaths per 1000 person days, 95% CI (26.9 to 35.0). The median survival time was 33 days, IQR (9-82). Factors associated with time to COVID-19 death included; age ≥ 60 years [adjusted hazard ratio (aHR) = 2.4, 95% CI: [1.7, 3.4]], having malaria test at admission [aHR = 2.0, 95% CI:[1.0, 3.9]], a COVID-19 severity score of severe/critical [aHR = 6.7, 95% CI:[1.5, 29.1]] and admission to a public hospital [aHR = 0.4, 95% CI:[0.3, 0.6]]. The survival time of patients aged 60 years or more is estimated to be 63% shorter than that of patients aged less than 60 years [adjusted time ratio (aTR) 0.37, 95% CI 0.24, 0.56]. The survival time of patients admitted in public hospitals was 2.5 times that of patients admitted in private hospitals [aTR 2.5 to 95%CI 1.6, 3.9]. Finally, patients with a severe or critical COVID-19 severity score had 87% shorter survival time than those with a mild score [aTR 0.13, 95% CI 0.03, 0.56]., Conclusion: In-hospital mortality among COVID-19 patients was high. Factors associated with shorter survival; age ≥ 60 years, a COVID-19 severity score of severe or critical, and having malaria at admission. We therefore recommend close monitoring of COVID-19 patients that are elderly and also screening for malaria in COVID-19 admitted patients., (© 2022. The Author(s).)