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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.
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.
Lack of effect of intermittent preventive treatment for malaria in pregnancy and intense drug resistance in western Uganda
(Malaria Journal, 2015) Braun, Vera; Rempis, Eva; Schnack, Alexandra; Decker, Sarah; Rubaihayo, John; Tumwesigye, Nazarius Mbona; Theuring, Stefanie; Harms, Gundel; Busingye, Priscilla; Mockenhaupt, Frank P.
Background: Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine (SP) is widely implemented in sub-Saharan Africa for the prevention of malaria in pregnancy and adverse birth outcomes. However, in areas of intense SP resistance, the efficacy of IPTp may be compromised. Methods: A cross-sectional study among 915 delivering women (728 analysable live singleton deliveries) was conducted in Fort Portal, western Uganda, to assess associations of reported IPTp use, Plasmodium falciparum infection, maternal anaemia, low birth weight, and preterm delivery, and to estimate the degree of SP resistance as reflected by pfdhfr/pfdhps mutations. Results: Plasmodium falciparum infection was detected by PCR in 8.9 % and by microscopy of placental blood samples in 4.0 %. Infection was significantly associated with stillbirth, early neonatal death, anaemia, low birth weight, and pre-term delivery. Eighty percent of the women had taken at least one dose of IPTp, and more than half had taken two doses. As compared to women without chemoprophylaxis against malaria, IPTp had no significant influence on the presence of P. falciparum infection (13.8 vs. 9.6 %, P = 0.31). Nor was it associated with reductions in anaemia, low birth weight or preterm delivery. P. falciparum with intense SP resistance (pfdhfr/pfdhps quintuple or sextuple mutations) were observed in 93 % (pfdhps 581G, 36 %), and the additional high resistance allele pfhdr 164L in 36 %. Conclusions: In Fort Portal, Uganda, reported use of IPTp with SP does not provide an observable benefit. The molecular markers of P. falciparum indicate high grade SP resistance reaching the threshold set by WHO for the discontinuation of IPTp with SP. Alternative approaches for the prevention of malaria in pregnancy are urgently needed.
Problem drinking and physical intimate partner violence against women: evidence from a national survey in Uganda
(BMC, 2012) Tumwesigye, Nazarius Mbona; Kyomuhendo, Grace Bantebya; Greenfield, Thomas Kennedy; Wanyenze, Rhoda K
Background: Problem drinking has been identified as a major risk factor for physical intimate partner violence (PIPV) in many studies. However, few studies have been carried on the subject in developing countries and even fewer have a nationwide perspective. This paper assesses the patterns and levels of PIPV against women and its association with problem drinking of their sexual partners in a nationwide survey in Uganda. Methods: The data came from the women’s dataset in the Uganda Demographic and Health Survey of 2006. Problem drinking among sexual partners was defined by women’s reports that their partner got drunk sometimes or often and served as the main independent variable while experience of PIPV by the women was the main dependent variable. In another aspect problem drinking was treated an ordinal variable with levels ranging from not drinking to getting drunk often. A woman was classified as experiencing PIPV if her partner pushed or shook her; threw something at her; slapped her; pushed her with a fist or a harmful object; kicked or dragged her, tried to strangle or burn her; threatened/attacked her with a knife/gun or other weapon. General chi-square and chi-square for trend analyses were used to assess the significance of the relationship between PIPV and problem drinking. Multivariate analysis was applied to establish the significance of the relationship of the two after controlling for key independent factors. Results: Results show that 48% of the women had experienced PIPV while 49.5% reported that their partners got drunk at least sometimes. The prevalence of both PIPV and problem drinking significantly varied by age group, education level, wealth status, and region and to a less extent by occupation, type of residence, education level and occupation of the partner. Women whose partners got drunk often were 6 times more likely to report PIPV (95% CI: 4.6-8.3) compared to those whose partners never drank alcohol. The higher the education level of the women the less the likelihood of experiencing PIPV (ptrend<0.001). Similar relationship was found between wealth status and experiencing PIPV. Conclusions: Problem drinking among male partners is a strong determinant of PIPV among women in Uganda. PIPV prevention measures should address reduction of problem drinking among men. Longerterm prevention measures should address empowerment of women including ensuring higher education, employment and increased income.
Prevalence and factors associated with use of herbal medicines during pregnancy among women attending postnatal clinics in Gulu district, Northern Uganda
(BMC, 2016) Nyeko, Richard; Tumwesigye, Nazarius Mbona; Halage, Abdullah Ali
Background: According to World Health Organization (WHO) estimates, 80 % of the population living in rural areas in developing countries depends on traditional medicine for their health needs, including use during pregnancy. Despite the fact that knowledge of potential side effects of many herbal medicines in pregnancy is limited and that some herbal products may be teratogenic, data on the extent of use of herbal medicines by women during pregnancy in the study setting is largely unknown. We determined the prevalence and factors associated with herbal medicine use during pregnancy among women attending postnatal clinics in Gulu district, Northern Uganda. Methods: This was a descriptive cross-sectional study which involved 383 women attending postnatal care across four sites in Gulu district using quantitative and qualitative methods of data collection. A structured questionnaire was used to collect quantitative data while qualitative data were obtained using focus group discussions and key informant interviews. The selection of the study participants was by systematic sampling and the main outcome variable was the proportion of mothers who used herbal medicine. Quantitative data was coded and entered into a computerized database using Epidata 3.1. Analysis was done using Statistical Package for Social Scientists version 13, while thematic analysis was used for qualitative data. Results: The prevalence of herbal medicines use during the current pregnancy was 20 % (78/383), and was commonly used in the second 23 % (18/78) and third 21 % (16/78) trimesters. The factors significantly associated with use of herbal medicines during pregnancy were perception (OR 2.18, CI 1.02-4.66), and having ever used herbal medicines during previous pregnancy (OR 2.51, CI 1.21-5.19) and for other reasons (OR 3.87, CI 1.46-10.25). Conclusions: The use of herbal medicines during pregnancy among women in Gulu district is common, which may be an indicator for poor access to conventional western healthcare. Perception that herbal medicines are effective and having ever used herbal medicines during previous pregnancy were associated with use of herbal medicines during current pregnancy. This therefore calls for community sensitization drives on the dangers of indiscriminate use of herbal medicine in pregnancy, as well as integration of trained traditional herbalists and all those community persons who influence the process in addressing the varied health needs of pregnant women.
Socio‑economic and education related inequities in use of modern contraceptive in seven sub‑regions in Uganda
(BMC, 2023) Makumbi, Fredrick E; Nabukeera, Sarah; Tumwesigye, Nazarius Mbona; Namanda, Cissie; Atuyambe, Lynn; Mukose, Aggrey; Ssali, Sarah; Ssenyonga, Ronald; Tweheyo, Ritah; Gidudu, Andrew; Sekimpi, Carole; Hashim, Catherine Verde; Nicholson, Martha; Ddungu, Peter
Background: Advocacy for equity in health service utilization and access, including Family Planning (FP) continues to be a cornerstone in increasing universal health coverage. Inequities in Family planning are highlighted by the differences in reproductive health outcomes or in the distribution of resources among different population groups. In this study we examine inequities in use of modern contraceptives with respect to Socio-economic and Education dimensions in seven sub-regions in Uganda. Methods: The data were obtained from a baseline cross-sectional study in seven statistical regions where a program entitled “Reducing High Fertility Rates and Improving Sexual Reproductive Health Outcomes in Uganda, (RISE)” is implemented in Uganda. There was a total of 3,607 respondents, half of whom were women of reproductive age (15-49 years) and the other half men (18-54 years). Equity in family planning utilization was assessed by geography, wealth/economic and social-demographics. The use of modern family planning was measured as; using or not using modern FP. Concentration indices were used to measure the degree of Inequality in the use of modern contraceptives. Prevalence Ratios to compare use of modern FP were computed using modified Poisson regression run in STATA V15. Results: Three-quarters (75.6%) of the participants in rural areas were married compared to only 63% in the urban. Overall use of modern contraceptives was 34.2% [CI:30.9, 37.6], without significant variation by rural/urban settings. Women in the higher socio-economic status (SES) were more advantaged in use of modern contraceptives compared to lower SES women. The overall Erreygers Concentration Index, as a measure of inequity, was 0.172, p<0.001. Overall, inequity in use of modern contraceptives by education was highest in favor of women with higher education (ECI=0.146, p=0.0001), and the concentration of use of modern contraceptives in women with higher education was significant in the rural but not urban areas Conclusion: Inequities in the use of modern contraceptives still exist in favor of women with more education or higher socio-economic status, mainly in the rural settings. Focused programmatic interventions in rural settings should be delivered if universal Family Planning uptake is to be improved.
A prolonged, community-wide cholera outbreak associated with drinking water contaminated by sewage in Kasese District, western Uganda
(BMC, 2018) Kwesiga, Benon; Pande, Gerald; Ario, Alex Riolexus; Tumwesigye, Nazarius Mbona; Matovu, Joseph K. B.; Zhu, Bao-Ping
Background: In May 2015, a cholera outbreak that had lasted 3 months and infected over 100 people was reported in Kasese District, Uganda, where multiple cholera outbreaks had occurred previously. We conducted an investigation to identify the mode of transmission to guide control measures. Methods: We defined a suspected case as onset of acute watery diarrhoea from 1 February 2015 onwards in a Kasese resident. A confirmed case was a suspected case with Vibrio cholerae O1 El Tor, serotype Inaba cultured from a stool sample. We reviewed medical records to find cases. We conducted a case-control study to compare exposures among confirmed case-persons and asymptomatic controls, matched by village and age-group. We conducted environmental assessments. We tested water samples from the most affected area for total coliforms using the Most Probable Number (MPN) method. Results: We identified 183 suspected cases including 61 confirmed cases of Vibrio cholerae 01; serotype Inaba, with onset between February and July 2015. 2 case-persons died of cholera. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in the 5–14 year age group (4.1/10,000). The outbreak started in Bwera Sub-County bordering the Democratic Republic of Congo and spread eastward through sustained community transmission. The first case-persons were involved in cross-border trading. The case-control study, which involved 49 confirmed cases and 201 controls, showed that 94% (46/49) of case-persons compared with 79% (160/201) of control-persons drank water without boiling or treatment (ORM-H=4.8, 95% CI: 1.3–18). Water collected from the two main sources, i.e., public pipes (consumed by 39% of case-persons and 38% of control-persons) or streams (consumed by 29% of case-persons and 24% control-persons) had high coliform counts, a marker of faecal contamination. Environmental assessment revealed evidence of open defecation along the streams. No food items were significantly associated with illness. Conclusions: This prolonged, community-wide cholera outbreak was associated with drinking water contaminated by faecal matter and cross-border trading. We recommended rigorous disposal of patients’ faeces, chlorination of piped water, and boiling or treatment of drinking water. The outbreak stopped 6 weeks after these recommendations were implemented.
Efficacy of a Single, Brief Alcohol Reduction Intervention among Men and Women Living with HIV/AIDS and Using Alcohol in Kampala, Uganda: A Randomized Trial
(SAGE, 2017) Wandera, Bonnie; Tumwesigye, Nazarius Mbona; Nankabirwa, Joaniter Immaculate; Mafigiri, David Kaawa; Parkes-Ratanshi, Rosalind M.; Kapiga, Saidi; Hahn, Judith; Sethi, Ajay K.
We evaluated the efficacy of a brief motivational intervention (MI) counseling in reducing alcohol consumption among persons living with HIV/AIDS in Kampala, Uganda. Persons living with HIV/AIDS with Alcohol Use Disorders Identification Tool (AUDIT) score 3 points were randomized to either standardized positive prevention counseling alone or in combination with alcohol brief MI counseling. The mean change in AUDIT-C scores over 6 months was compared by treatment arm. The mean (standard deviation [SD]) AUDIT-C scores were 6.3 (2.3) and 6.8 (2.3) for control and MI arms (P ¼ .1) at baseline, respectively, and change in mean AUDIT-C score was not statistically different between arms over the 6 months (P ¼ .8). However, there was a statistically significant decrease in mean AUDIT-C score ( 1.10; 95% confidence interval: 2.19 to 0.02, P ¼ .046) among women in the MI arm. There was a nondifferential reduction in alcohol consumption overall, but MI appeared effective among women only. Studies with more than 1 counseling session and evaluation of gender differences in treatment response are needed.
Alcohol Consumption among HIV-Infected Persons in a Large Urban HIV Clinic in Kampala Uganda: A Constellation of Harmful Behaviors
(PLoS ONE, 2015) Wandera, Bonnie; Tumwesigye, Nazarius Mbona; Nankabirwa, Joaniter Immaculate; Kambugu, Andrew Ddungu; Parkes-Ratanshi, Rosalind; Mafigiri, David Kaawa; Kapiga, Saidi; Sethi, Ajay K.
Introduction Alcohol use by persons living with HIV/AIDS (PLWHA) negatively impacts the public health benefits of antiretroviral therapy (ART). Using a standardized alcohol assessment tool, we estimate the prevalence of alcohol use, identify associated factors, and test the association of alcohol misuse with sexual risk behaviors among PLWHA in Uganda. Methods A cross-section of PLWHA in Kampala were interviewed regarding their sexual behavior and self-reported alcohol consumption in the previous 6 months. Alcohol use was assessed using the alcohol use disorders identification test (AUDIT). Gender-stratified log binomial regression analyses were used to identify independent factors associated with alcohol misuse and to test whether alcohol misuse was associated with risky sexual behaviors. Results Of the 725 subjects enrolled, 235 (33%) reported any alcohol use and 135 (18.6%) reported alcohol misuse, while 38 (5.2%) drank hazardous levels of alcohol. Alcohol misuse was more likely among subjects not yet on ART (adjusted prevalence ratio [aPR] was 1.65 p=0.043 for males and 1.79, p=0.019 for females) and those with self-reported poor adherence (aPR for males=1.56, p=0.052, and for females=1.93, p=0.0189). Belonging to Pentecostal or Muslim religious denominations was protective against alcohol misuse compared to belonging to Anglican and Catholic denominations in both sexes (aPR=0.11 for men, p<0.001, and aPR=0.32 for women, p=0.003). Alcohol misuse was independently associated with reporting risky sexual behaviors (aPR=1.67; 95% CI: 1.07–2.60, p=0.023) among males, but not significant among females (aPR=1.29; 95% CI: 0.95–1.74, p=0.098). Nondisclosure of HIV positive status to sexual partner was significantly associated with risky sex in both males (aPR=1.69; p=0.014) and females (aPR 2.45; p<0.001). Conclusion Alcohol use among PLWHA was high, and was associated with self-reported medication non-adherence, non-disclosure of HIV positive status to sexual partner(s), and risky sexual behaviors among male subjects. Interventions targeting alcohol use and the associated negative behaviors should be tested in this setting.
Risk Factors for Obstetric Fistula in Western Uganda: A Case Control Study
(PLoS ONE, 2014) Barageine, Justus Kafunjo; Tumwesigye, Nazarius Mbona; Byamugisha, Josaphat K.; Almroth, Lars; Faxelid, Elisabeth
Introduction: Two million women worldwide are living with genital fistula with an annual incidence of 50,000–100,000 women. Risk factors for obstetric fistula are context bound. Studies from other countries show variation in the risk factors for obstetric fistula. This study was conducted to identify risk factors for obstetric fistula in western Ugandan context. Methods: A case control study comparing background factors of women with obstetric fistula (cases) and women without fistula (controls) was conducted in western Uganda. Data was collected using face-to-face interviews. Univariate, bivariate and multivariate analysis was conducted using Stata 12. Results: Altogether, 420 respondents (140 cases and 280 controls) participated in the study. Duration of labour was used to form the product terms when assessing for interaction and confounding since it was one the most significant factors at bivariate level with a narrow confidence interval and was hence considered the main predictor. After adjusting for interaction and confounding, significant risk factors associated with development of obstetric fistula in western Uganda were: Caesarean section (adjusted odds ratio [AOR] = 13.30, 95% CI = 6.74–26.39), respondent height of 150 cm or less (AOR = 2.63, 95% CI = 1.35–5.26), baby weight of 3.5 kg or more (AOR = 1.52, 95% CI = 1.15–1.99), prolonged labour (AOR = 1.06, 95% CI = 1.04–1.08. A quarter of the fistulas had resulted from iatrogenic complication during caesarean section. Compared to no education, post primary level of education was protective against obstetric fistula (AOR = 0.31, 95% CI = 0.13–0.72) and there was no difference between respondents without education and those with primary level education. Conclusions: Surgeons contribute to a big proportion (25%) of fistula cases hence caesarean section being a risk factor in this region. Other risk factors include; prolonged labour, weight of the baby of 3.5 kg or more, respondent height of 150 cm or less (short stature), and low or no education are risk factors for obstetric fistula in western Ugandan.
Awareness of pubertal body changes among primary school children aged 10– 14 years in Eastern Uganda; challenges and opportunities
(BMC, 2022) Bunoti, Sarah Nantono; Tumwesigye, Nazarius Mbona; Atuyambe, Lynn
Background: Globally, programs that educate young people about pubertal body changes are vital. In some communities, teaching sexual education in schools has been the subject of debate. This is probably why access to sexual and reproductive health information and resources is still a challenge to children aged 10–14 years. Methods: We conducted a qualitative study design among school children aged 10–14 years. Data were collected from 19 focus group discussions (FGDs) in 16 primary schools purposively selected from Eastern Uganda. Data were transcribed, coded and thematically analysed. Results: We established that girls in rural schools were aware of their body changes than those from urban schools. Boys in urban schools were knowledgeable of pubertal body changes than those from rural schools. We further found that girls experienced pubertal-related challenges amongst themselves and boys including lack of shavers, pain while shaving, rape, bad boy–girl relationships, unwanted early pregnancies, limited funds to buy pads, menstrual pain, etc. Boys too indicated that they experienced similar challenges and these included lack of shavers, pain during and after shaving, changes in height, raping of girls, bad boy–girl relationships, peer pressure, HIV and other STIs, limited infrastructure, voice changes, bad body odour etc. Girls and boys endeavoured to overcome pubertal-related challenges by utilising advise from teachers, parents and friends. Conclusion: Boys and girls who were knowledgeable about puberty body changes possessed opportunities that enable them to cope with pubertal-related challenges.
The Prevalence and Context of Alcohol Use, Problem Drinking and Alcohol-Related Harm among Youth Living in the Slums of Kampala, Uganda
(International Journal of Environmental Research and Public Health, 2020-04-03) Swahn, Monica H.; Culbreth, Rachel; Salazar, Laura F.; Tumwesigye, Nazarius Mbona; Jernigan, David H.; Kasirye, Rogers; Obot, Isidore S.
Background. The purpose of this paper is to investigate the prevalence and context of alcohol use, problem drinking and alcohol-related harm among boys and girls in the slums of Kampala, Uganda. Methods. The Kampala Youth Survey is a cross-sectional study conducted in 2014 among youth (ages 12–18 years) living in the slums of Kampala (n = 1133) who were participating in Uganda Youth Development Link (UYDEL) centers. Chi-square tests were used to determine differences in alcohol use behaviors between 1) gender (boys vs. girls), and 2) alcohol use behaviors between problem drinkers and non-problem drinkers, stratified by gender. Results. Among all participants(n = 1133), the prevalence of any alcohol use in the past 12 months was 31% (n = 346). A higher percentage of girl drinkers reported having sex in the past month, without a condom (57.9%) due to alcohol consumption, compared to boy drinkers (41.9%) ( 2 = 8.09, df = 1, p = 0.005). For girl and boy drinkers, nearly half (49.5% and 44.1%, respectively) met the criteria for problem drinkers, measured using the Cut-Annoyed-Guilty-Eye-Opener (CAGE) questionnaire. Conclusions. The high prevalence of alcohol use and problem drinking among youth, as well as alcohol-related harm, warrant urgent alcohol prevention and intervention strategies, particularly among these underserved girls.
Genital infections and risk of premature rupture of membranes in Mulago Hospital, Uganda: a case control study
(BMC, 2015) Nakubulwa , Sarah; Kaye, Dan K.; Bwanga, Freddie; Tumwesigye, Nazarius Mbona; Mirembe, Florence M.
Background: Inflammatory mediators that weaken and cause membrane rupture are released during the course of genital infections among pregnant women. We set out to determine the association of common genital infections (Trichomonas vaginalis, syphilis, Neisseria gonorrhea, Chlamydia trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 and candidiasis) and premature rupture of membranes in Mulago hospital, Uganda. Methods: We conducted an unmatched case–control study among women who were in the third trimester of pregnancy at New Mulago hospital, Uganda. The cases had PROM and the controls had intact membranes during latent phase of labour in the labour ward. We used interviewer-administered questionnaires to collect data on sociodemographic characteristics, obstetric and medical history. Laboratory tests were conducted to identify T. vaginalis, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 (HSV-2) and candidiasis. Logistic regression models were used to estimate the odds ratios (OR) and 95 % CI of the association between genital infections and PROM. Results: There was an association between PROM and abnormal vaginal discharge (OR = 2.02, 95 % CI 1.10–3.70 and AOR = 2.30, 95 % CI 1.18–4.47), presence of candidiasis (OR = 0.27, 95 % CI 0.14–0.52 and AOR = 0.22, 95 % CI 0.10–0.46) and T. vaginalis (OR = 2.98, 95 % CI 1.18–7.56 and AOR = 4.22, 95 % CI 1.51–11.80). However, there was no association between PROM and presence of C. trachomatis (OR = 2.05, 95 % CI 0.37–11.49) and HSV-2 serostatus (OR = 1.15, 95 % CI 0.63–2.09). Few or no patients with Bacterial vaginosis, Neisseria gonorrhoea, Group B streptococcus or syphilis were identified among the cases and controls. Co-infection of Trichomoniasis and candidiasis was not associated with PROM (AOR = 1.34, 95 % CI 0.16–11.10). Co infection with T. vaginalis and C. trachomatis was associated with PROM (OR = 3.09, 95 % CI 1.21–7.84 and AOR = 4.22, 95 % CI 1.51–11.83). Conclusion: Trichomonas vaginalis alone, T. vaginalis with C. trachomatis co-infection and abnormal per vaginal discharge were found as risk factors for PROM. There was no association of HSV-2 serostatus, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus and Bacterial vaginosis with PROM. Candidiasis seemed to have a protective effect on PROM.
Early alcohol use and problem drinking among students in Zambia and Uganda
(Journal of Public Health in Africa 2011, 2011-04) Swahn, Monica H.; Ali, Bina; Palmier, Jane; Tumwesigye, Nazarius Mbona; Sikazwe, George; Twa-Twa, Jeremiahs; Kasirye Rogers
Excessive alcohol use is a serious public health concern worldwide, but less attention has been given to the prevalence, risk and protective factors, and consequences of early alcohol use in low-income, developing countries. The purpose of this study was to determine the associations between early alcohol use, before age 13, and problem drinking among adolescents in Uganda and Zambia. Data from students in Zambia (n=2257; 2004) and Uganda (n=3215; 2003) were obtained from the crosssectional Global School-Based Student Health Survey (GSHS). The self-administered questionnaires were completed by students primarily 13 to 16 years of age. Multiple statistical models were computed using logistic regression analyses to test the associations between early alcohol initiation and problem drinking, while controlling for possible confounding factors (e.g., current alcohol use, bullying victimization, sadness, lack of friends, missing school, lack of parental monitoring, and drug use). Results show that early alcohol initiation was associated with problem drinking in both Zambia (AOR=1.28; 95% CI:1.02-1.61) and Uganda (AOR=1.48; 95% CI: 1.11-1.98) among youth after controlling for demographic characteristics, risky behaviors, and other possible confounders. The study shows that there is a significant association between alcohol initiation before 13 years of age and problem drinking among youth in these two countries. These findings underscore the need for interventions and strict alcohol controls as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth.
Risk factors for pre-eclampsia in Mulago Hospital, Kampala, Uganda
(Tropical Medicine and International Health, 2012-04) Kiondo, Paul; Wamuyu-Maina, Gakenia; Bimenya, Gabriel S.; Tumwesigye, Nazarius Mbona; Wandabwa, Julius; Okong, Pius
Objective: Pre-eclampsia contributes significantly to maternal, foetal and neonatal morbidity and mortality. The risk factors for pre-eclampsia have not been well documented in Uganda. In this paper, we describe the risk factors for pre-eclampsia in women attending antenatal clinics at Mulago Hospital, Kampala. Methods: This casecontrol study was conducted from 1st May 2008 to 1st May 2009. 207 women with pre-eclampsia were the cases, and 352 women with normal pregnancy were the controls. The women were 15–39 years old, and their gestational ages were 20 weeks or more. They were interviewed about their socio-demographic characteristics, past medical history and, their past and present obstetric performances. Results The risk factors were low plasma vitamin C (OR 3.19, 95% CI: 1.54–6.61), low education level (OR 1.67, 95% CI: 1.12–2.48), chronic hypertension (OR 2.29, 95% CI 1.12–4.66), family history of hypertension (OR 2.25, 95% CI: 1.53–3.31) and primiparity (OR 2.76, 95% CI: 1.84–4.15) and para‡5 (3.71, 95% CI:1.84–7.45). Conclusion: The risk factors identified are similar to what has been found elsewhere. Health workers need to identify women at risk of pre-eclampsia and manage them appropriately so as to prevent the maternal and neonatal morbidity and mortality associated with this condition.
Gender variations in access, choice to use and cleaning of shared latrines; experiences from Kampala Slums, Uganda
(BMC, 2014) Kwiringira, Japheth; Atekyereza, Peter; Niwagaba, Charles; Günther, Isabel
Background: Sanitation is one of the most intimate issues that affect women, especially in slums of developing countries. There are few studies that have paid attention to the gender variations in access, choice to use and cleaning of shared latrines in slums. Methods: This paper draws on qualitative data from a cross sectional study conducted between 2012 and 2013 in six slums of Kampala City, Uganda. The study involved both women and men. Data were collected from 12 Focus Group Discussions (FGDs), 15 Key informant interviews; community transects and photographs of shared latrines. Results: Location of a shared latrine facility, distance, filthy, narrow and irregular paths; the time when a facility is visited (day or night), privacy and steep inclines were gender ‘filters’ to accessing shared latrines. A full latrine pit was more likely to inhibit access to and choice of a facility for women than men. Results indicate that the available coping mechanisms turned out to be gendered, with fewer options available for women than men. On the whole, women sought for privacy, easy reach, self-respect and esteem, cleanliness and privacy than men. While men like women also wanted clean facilities for use; they (men) were not keen on cleaning these facilities. The cleaning of shared latrines was seen by both women and men as a role for women. Conclusion: The presence of sanitation facilities as the first step in the access, choice, use, and cleaning by both women and men has distinct motivations and limitations along gender lines. The study confirms that the use and cleaning of latrines is regulated by gender in daily living. Using a latrine for women was much more than relieving oneself: it involved security, intimacy and health concerns.
Influence of pregnancy perceptions on patterns of seeking antenatal care among women in reproductive age of Masaka District, Uganda
(Tanzania Journal of Health Research, 2014-10) ATEKYEREZA, PETER R.; MUBIRU, KENNETH
Maternal mortality remains a challenge in Sub-Saharan Africa including Uganda. Antenatal Care (ANC) is one of the recommended measures to improve maternal and child health. However, the influence of pregnancy definition and perception on patterns of seeking regular and timely antenatal care among women in the reproductive age group (15-49 years) is not known. The objectives of this study were to: (i) understand the women’s social definitions and perceptions on their pregnancy; (ii) understand the sociocultural beliefs related to pregnancy among women of the reproductive age group; and, (iii) examine the influence of social definitions, perceptions and beliefs about pregnancy on women’s antenatal care seeking behaviour patterns to inform the decentralised health care delivery system in Uganda. A total of 45 women, mothers and expectant women who were purposively selected from Kimanya sub county of Masaka district in Uganda participated in the study. Ten key informant interviews and four Focus Group Discussions (FGDs) were also conducted. Key findings indicate that the women’s socio-definitions and perceptions of pregnancy influence their seeking behaviour on antenatal health care. To the women with a positive orientation towards antenatal care, pregnancy provides joy, happiness, pride, promotes their social status and safe-guards their marriage. Pregnancy is rewarding with care, love, support and gifts. Women who shun antenatal care perceive pregnancy to be a source of misery, sadness, pain and suffering. It is an uncomfortable and regrettable experience. Women also hold socio-cultural beliefs on pregnancy, which are culturally constructed and rooted in taboos, rituals and practices of their communities. It is therefore important to sensitise women and those who attend to them when they are pregnant to understand these perceptions and definitions to motivate them to seek antenatal and postnatal care for better maternal and child health.
Descending the sanitation ladder in urban Uganda: evidence from Kampala Slums
(BMC, 2014) Kwiringira, Japheth ; Atekyereza, Peter ; Niwagaba, Charles ; Günther, Isabel
Background: While the sanitation ladder is useful in analysing progressive improvements in sanitation, studies in Uganda have not indicated the sanitation barriers faced by the urban poor. There are various challenges in shared latrine use, cleaning and maintenance. Results from Kampala city indicate that, failure to clean and maintain sanitation infrastructure can lead to a reversal of the potential benefits that come with various sanitation facilities. Methods: A cross sectional qualitative study was conducted between March and May 2013. Data were collected through 18 focus group discussions (FGDs) held separately; one with women, men and youth respectively. We also used pictorial methods; in addition, 16 key informant interviews were conducted. Data were analysed using content thematic approach. Relevant quotations per thematic area were identified and have been used in the presentation of the results. Results: Whether a shared sanitation facility was improved or not, it was abandoned once it was not properly used and cleaned. The problem of using shared latrines began with the lack of proper latrine training when people do not know how to squat on the latrine hole. The constrained access and security concerns, obscure paths that were filthy especially at night, lack of light in the latrine cubicle, raised latrines sometimes up to two metres above the ground, coupled with lack of cleaning and emptying the shared facilities only made a bad situation worse. In this way, open defecation gradually substituted use of the available sanitation facilities. This paper argues that, filthy latrines have the same net effect as crude open defection. Conclusion: Whereas most sanitation campaigns are geared towards provision of improved sanitation infrastructure, these findings show that mere provision of infrastructure (improved or not) without adequate emphasis on proper use, cleaning and maintenance triggers an involuntary descent off the sanitation ladder. Understanding this reversal movement is critical in sustainable sanitation services and should be a concern for all actors.
Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda
(BMC, 2016) Kwiringira, Japheth ; Atekyereza, Peter ; Niwagaba, Charles ; Kabumbuli, Robert ; Rwabukwali, Charles ; Kulabako, Robinah ; Günther, Isabel
Background: The effect of seasons on health outcomes is a reflection on the status of public health and the state of development in a given society. Evidence shows that in Sub-Saharan Africa, most infectious diseases flourish during the wet months of the year; while human activities in a context of constrained choices in life exacerbate the effects of seasons on human health. The paper argues that, the wet season and when human activities are at their peak, sanitation is most dire poor slum populations. Methods: A shared latrine cleaning observation was undertaken over a period of 6 months in the slums of Kampala city. Data was collected through facility observations, user group meetings, Focus group discussions and, key informant interviews. The photos of the observed sanitation facilities were taken and assessed for facility cleanliness or dirt. Shared latrine pictures, observations, Focus Group Discussion, community meetings and key informant interviews were analysed and subjected to an analysis over the wet, dry and human activity cycles before a facility was categorised as either ‘dirty’ or ‘clean’. Results: Human activity cycles also referred to as socio-economic seasons were, school days, holidays, weekends and market days. These have been called ‘impure’ seasons, while the ‘pure’ seasons were the wet and dry months: improved and unimproved facilities were negatively affected by the wet seasons and the peak seasons of human activity. Wet seasons were associated with, mud and stagnant water, flooding pits and a repugnant smell from the latrine cubicle which made cleaning difficult. During the dry season, latrines became relatively cleaner than during the wet season. The presence of many child(ren) users during school days as well as the influx of market goers for the roadside weekly markets compromised the cleaning outcomes for these shared sanitation facilities. Conclusion: Shared latrine cleaning in slums is impacted by seasonal variations related to weather conditions and human activity. The wet seasons made the already bad sanitation situation worse. The seasonal fluctuations in the state of shared slum sanitation relate to a wider malaise in the population and an implied capacity deficit among urban authorities. Poor sanitation in slums is part of a broader urban mismanagement conundrum pointing towards the urgent need for multiple interventions aimed at improving the general urban living conditions well beyond sanitation.
The role of culture in influencing sexual and reproductive health of pastoral adolescent girls in Karamoja sub-region in Uganda
(Springer, 2021) Achen, Stella; Atekyereza, Peter; Rwabukwali, Charles B.
Sexual and reproductive health (SRH) is vital for general health. However, problems of SRH such as unwanted pregnancies, sexually transmitted infections (STIs), and complications during pregnancy and childbirth among adolescents frequently arise due to risky sexual behaviour. Often, this challenge is linked to socio-cultural issues associated with sexuality which result in disparities in the SRH of adolescent girls. Culture provides rules of sexual conduct between sexes which shape knowledge, beliefs, and practices regarding the sexuality of adolescent girls and influence SRH. However, empirical evidence remains scarce on the role of culture in shaping sexuality which affects the SRH of adolescent girls of pastoral communities. This paper explores the role of culture in shaping the SRH of adolescent girls in the pastoral communities of Karamoja sub-region in Uganda. Using the ethnographic method, qualitative data from interviews, key informants, and focus groups was obtained from adolescent girls, key informants, and old women in Moroto District to understand the perceptions of sexuality. The authors made audio recordings and took field notes. Atlas.ti 8.4.15 was used to organize the data which was analysed using thematic analysis. The findings showed that the perception of wealth defines sexuality and influences SRH, social support for sexual assault victims promotes SRH, and beliefs and practices of sexuality shape the SRH of adolescent girls. Promoting a continuous awareness of the harmful cultural practices is vital in attaining SRH among pastoral adolescent girls. Understanding the role of culture in the influence of SRH is important for the effective provision of SRH services.

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