St. Ignatius University Kabale Digital Repository (IGUKADR)
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I am alone and isolated”: a qualitative study of experiences of women living with genital fistula in Uganda
(Springer, 2015) Barageine, Justus Kafunjo; Beyeza-Kashesya, Jolly; Byamugisha, Josaphat K.; Tumwesigye, Nazarius Mbona; Almroth, Lars; Faxelid, Elisabeth
Background: Globally, 2–3 million women are estimated to have a genital fistula, with an annual incidence of
50,000–100,000 women. Affected women remain silent within their communities, and their experiences often go
unnoticed. Our objective was to explore the experiences of Ugandan women living with genital fistulas to
understand how their lives were affected and how they coped with the condition.
Methods: We conducted 8 focus group discussions (FGDs) with 56 purposively selected women with a genital
fistula seeking treatment at Mulago Hospital, Uganda. Data were transcribed and analysed using qualitative content
analysis.
Results: Women with a fistula were living a physically changed and challenging life, living socially deprived and
isolated, living psychologically stigmatised and depressed, and living marital and sexual lives that were no longer
joyful. The women’s experiences were full of life changes and coping strategies, and they used both problem- and
emotion-focused coping strategies to deal with the challenges. They devised ways to reduce the smell of urine to
reduce the stigma, rejection and isolation. While trying to cope, the women found themselves alone and isolated.
Women either isolated themselves or were isolated by society, including by close relatives and their husbands.
Their sex lives were no longer enjoyable, and generally, women felt a loss of their marital and sexual rights.
Conclusion: Women with a fistula make adjustments in their lives to cope with the physical, social, psychological
and sexual challenges. They use both problem- and emotion-focused coping to minimise their sense of isolation, as
well as the rejection and stigma associated with fistula. These findings are essential for counselling patients, families
and community members affected by a fistula. In similar contexts, health programmes should go beyond fistula
closure and target communities and families to reduce the stigma and isolation faced by women with genital
fistula.
The effects of vitamin C supplementation on pre-eclampsia in Mulago Hospital, Kampala, Uganda: a randomized placebo controlled clinical trial
(BMC, 2014) Kiondo, Paul; Wamuyu-Maina, Gakenia; Wandabwa, Julius; Bimenya, Gabriel S; Tumwesigye, Nazarius Mbona; Okong, Pius
Background: Oxidative stress plays a role in the pathogenesis of pre-eclampsia. Supplementing women with
antioxidants during pregnancy may reduce oxidative stress and thereby prevent or delay the onset pre-eclampsia.
The objective of this study was to evaluate the effect of supplementing vitamin C in pregnancy on the incidence of
pre-eclampsia, at Mulago hospital, Kampala, Uganda.
Methods: This was a (parallel, balanced randomization, 1:1) placebo randomized controlled trial conducted at Mulago
hospital, Department of Obstetrics and Gynecology. Participants included in this study were pregnant women aged
15-42 years, who lived 15 km or less from the hospital with gestational ages between 12-22 weeks. The women were
randomized to take 1000mg of vitamin C (as ascorbic acid) or a placebo daily until they delivered. The primary
outcome was pre-eclamsia. Secondary outcomes were: severe pre-eclampsia, gestational hypertension, preterm
delivery, low birth weight and still birth delivery. Participants were 932 pregnant women randomized into one of the
two treatment arms in a ratio of 1:1. The participants, the care providers and those assessing the outcomes were
blinded to the study allocation.
Results: Of the 932 women recruited; 466 were randomized to the vitamin and 466 to the placebo group. Recruitment
of participants was from November 2011 to June 2012 and follow up was up to January 2013. Outcome data was
available 415 women in the vitamin group and 418 women in the placebo group.
There were no differences in vitamin and placebo groups in the incidence of pre-eclampsia (3.1% versus 4.1%; RR 0.77;
95% CI: 0.37-1.56), severe pre-eclampsia (1.2% versus 1.0%; RR 1.25; 95% CI: 0.34-4.65), gestational hypertension
(7.7% versus 11.5%; RR 0.67; 95% CI: 0.43-1.03), preterm delivery (11.3% versus 12.2%; RR 0.92; 95% CI: 0.63-1.34),
low birth weight (11.1% versus 10.3%; RR 1.07; 95% CI: 0.72-1.59) and still birth delivery (4.6% versus 4.5%; RR 1.01;
95% CI: 0.54-1.87).
Conclusions: Supplementation with vitamin C did not reduce the incidence of pre-eclampsia nor did it reduce the
adverse maternal or neonatal outcomes. We do not recommend the use of vitamin C in pregnancy to prevent
pre-eclampsia.
Trial registration: This study was registered at the Pan African Clinical Trial Registry, PACTR201210000418271 on 25th
October 2012.
Problem Drinking, Alcohol-Related Violence, and Homelessness among Youth Living in the Slums of Kampala, Uganda
(MDPI, 2018) Swahn, Monica H.; Culbreth, Rachel; Tumwesigye, Nazarius Mbona; Topalli, Volkan; Wright, Eric; Rogers Kasirye
This paper examines problem drinking, alcohol-related violence, and homelessness among
youth living in the slums of Kampala—an understudied population at high-risk for both alcohol
use and violence. This study is based on a cross-sectional survey conducted in 2014 with youth
living in the slums and streets of Kampala, Uganda (n = 1134), who were attending Uganda Youth
Development Link drop-in centers. The analyses for this paper were restricted to youth who reported
current alcohol consumption (n = 346). Problem drinking patterns were assessed among youth
involved in alcohol-related violence. Mediation analyses were conducted to examine the impact of
homelessness on alcohol-related violence through different measures of problem drinking. Nearly
46% of youth who consumed alcohol were involved in alcohol-related violence. Problem drinkers
were more likely to report getting in an accident ( 2 = 6.8, df = 1, p = 0.009), having serious problems
with parents ( 2 = 21.1, df = 1, p < 0.0001) and friends ( 2 = 18.2, df = 1, p < 0.0001), being a victim
of robbery ( 2 = 8.8, df = 1, p = 0.003), and going to a hospital ( 2 = 15.6, df = 1, p < 0.0001). For the
mediation analyses, statistically significant models were observed for frequent drinking, heavy
drinking, and drunkenness. Interventions should focus on delaying and reducing alcohol use in this
high-risk population.
Cultures at Crossroads: Culturally Induced Body Marks in the Regime of Universal Human Rights in Eastern Uganda
(International Journal of Research in Sociology and Anthropology (IJRSA), 2026) Barigye, Godfrey; Ngabirano, Maximiano; Tino, Jennifer Opio
This study, "Cultures at Crossroads: Culturally Induced Body Marks in the Regime of Universal
Human Rights in Eastern Uganda," explores the role of traditional body markings in the social and cultural
identities of the Bamasaba, Sabiny, and Pokot communities in Eastern Uganda. These groups, each with distinct
body marking practices such as male and female circumcision, use these rites to signal important cultural
transitions and maintain communal cohesion. Drawing on two studies conducted in 2019 and 2024, the
research examines how these practices are perceived in light of global human rights discourses, which often
challenge traditional cultural practices in favor of universal rights standards. The study highlights the tension
between traditional cultural practices and the universal human rights framework, especially in relation to
gender and bodily integrity. In particular, female circumcision practices among the Sabiny and Pokot face
significant opposition from human rights advocates, while male circumcision, often viewed through a medical
lens as a means to prevent HIV, continues to be practiced as a rite of passage among the Bamasaba. This
research further considers how body markings are intertwined with gender roles, social status, and the
negotiation of identity within both local and global contexts. By examining the intersection of body, society,
and cultural traditions, the study argues that these practices serve not only as cultural markers but also as sites
for resistance and negotiation, where traditional communities strive to balance cultural preservation with the
demands of modernity and human rights. The research concludes by calling for a more nuanced understanding
of cultural practices within the human rights discourse, emphasizing the need for cultural sensitivity and the
recognition of the meanings that these practices hold within the communities that continue to uphold them.
Treatment outcomes for substance use disorders across the African continent: a systematic review
(BMC, 2025) Biribawa, Claire; Tumwesigye, Nazarius Mbona; Sinclair, Deborah Louise; Matovu, Duncan Kabiito; Swensen, Greg; Meyer, Florian De; Mukasa, Moses; Kalema, David; Mutamba, Byamah Brian; Vanderplasschen, Wouter
Background: Substance use disorders (SUDs) are increasingly recognized as a significant public health concern in
Africa, placing considerable strain on the economy, healthcare system, and society at large. Given the dual disease
burden of both infectious and non-communicable diseases, African countries may not prioritize addressing the
emerging epidemic of SUDs. There is a paucity of scientific literature on SUD treatment outcomes following their
management across the African continent. Therefore, this systematic review aimed to address this gap.
Methods: We conducted an electronic search of Web of Science, CINAHL, Embase, Medline (PubMed interface),
Scopus, and PsycArticles. We included studies with participants who were diagnosed and treated for SUDs following
internationally recognized diagnostic criteria in the African region as defined by geographical boundaries and had at
least one treatment outcome measured and reported. Studies were assessed for risk of bias using the Joanna Briggs
Institute critical appraisal tool. This systematic review was registered in the PROSPERO database (CRD42022362926).
Results: Thirteen research studies were included across four African countries (South Africa − 8, Uganda − 2, Zambia
− 2, and the Democratic Republic of Congo − 1). The treatment completion rates across all treatment modalities
averaged 71.4%. A reduction in substance use was reported in nine of the 13 studies, with significant decreases
observed in measures such as heavy drinking days and substance use severity scores. However, relapse rates ranged
from 23 to 92%, with predictors including low recovery capital and poor social support. Substitution behaviours, such
as increased alcohol or crystal methamphetamine use, were noted in some studies following abstinence from primary
substances.
Conclusions: The findings suggest varying levels of efficacy for SUD treatment modalities in Africa, including
reductions in substance use in some studies and moderate treatment completion rates. However, the high relapse
rates underscore the need for comprehensive, resource-adapted interventions. The limited geographical scope of
the literature, with studies predominantly from South Africa, points to a critical gap in research from other African
countries and emphasizes the need for expanded research across the continent to inform scalable, evidence-based
solutions for SUD management.