Master of Public Health in Population and Reproductive Health (Dissertations)

Factors associated with untimely uptake of early infant diagnosis (EID) testing among HIV exposed infants (HEI)

2020-03-01T00:00:00Z

Factors associated with untimely uptake of early infant diagnosis (EID) testing among HIV exposed infants (HEI) Nsubuga, Fredrick Background: Highly Exposed Infants (HEI) to HIV through their HIV positive mothers, require to receive timely Early Infant Diagnosis (EID) to enable identification of HIV positive infants, as to facilitate early treatment and follow up, and for negative infants, to reduce risk of infection by planning, counselling on appropriate feeding whilst maintaining adequate nutrition. Objective: To assess the factors associated untimely uptake of Early Infant Diagnosis (EID) among HEIs attending Kiryandongo General Hospital. Methodology: A cross-sectional study design was undertaken among 112 mothers in Kiryandongo Hospital, Kiryandongo District. All HIV positive mothers with HEIs aged 4 weeks to 18 months, enrolled and active in the Mother Baby Care Point (MBCP) in Kiryandongo Hospital were included in this study. Logistic regression was used to assess the factors associated with untimely EID among HEIs’. The data was analyzed by STATA 12 statistical software. Results: Most (70%) of HEIs obtained untimely EID. With all variables accounted for, the statistically independent predictor of untimely EID among HEIs where families where the household head had primary Education were more likely to have untimely EID compared to those where the household head had no formal education (AOR = 4.5986 [95% CI: 1.01-20.95], PV 0.049) Conclusion: Timely EID among HEI remains low in Uganda, Ugandan HEIs continue to be at risk of acquiring HIV infection due to untimely EID. The study recommends reducing untimely EID through proactively identifying and following mothers with identified predisposing factors to untimely EID among HEIs families, as opposed to follow up of HEIs mothers who have already missed timely EID. In addition, this study noted that a number of HEIs receive EID before the recommended timeline which may lead to poor diagnosis especially if the infant contracted HIV at birth. Mothers to HEIs should be given enough information during antenatal and at birth to ensure that they follow the proper recommendations. Most of factors that have been identified in most studies to influence the timeliness of EID did not show any significant association with untimely EID in this study. This calls for an in-depth qualitative study to understand the dynamics in rural settings and how they may influence the timeliness of EID Andinda Maureen

Correlates of intimate partner sexual violence among pregnant women in Napak district Northern Uganda

2021-03-01T00:00:00Z

Correlates of intimate partner sexual violence among pregnant women in Napak district Northern Uganda Amodoi, Godfrey Patrick Although historically portrayed as a gender issue, intimate partner sexual violence is of immense reproductive health importance, particularly during pregnancy. It is associated with gynecological complications not limited to vaginal trauma, dyspareunia, Vaginismus, Pelvic Floor Dysfunction and Bacterial Vaginosis. Most of these have been found to be significant causes of infertility, and high risk pregnancies. That is in addition to Most of these have been found to be significant causes of high-risk pregnancies in addition to being significant antecedents of intrapartum complications, some of which are indications for cesarean births. Objective: The purpose of the study was to assess the correlates of intimate partner sexual violence (IPSV) among pregnant women in Napak district – northern Uganda. An analytical cross-sectional survey design was used to study 284 pregnant women in Napak district, who were sampled at both hospital and health centre III facilities. The hospital was purposively. The health center IIIs were randomly sampled. Pregnant women were randomly sampled at the hospital and center IIIs respectively. They were engaged in structured interviews, and the data captured using structured questionnaires, following which it was analyzed in SPSS version 25 using descriptive and inferential methods. A total of 284 women participated in the study. Slightly more than half 158/284(56%) of the pregnant women had experienced IPSV during their current pregnancies, with the most prevalent form being unwanted sexual advances 100 (63. 3%).The prevalence of IPSV was lower among women of gravidity of two (aPR = 0.785, CI = 0.684 - 0.901, P < 0.001), with a history of IPV in any earlier pregnancy (aPR = 0.742, CI = 0.681 - 0.808, P <0.001), with a history of emotional type violence (aPR = 0.823, CI = 0.705 - 0.961, P = 0.014). The prevalence is higher among multipara pregnant women (aPR = 1.907, CI =1.512 - 1.199, P <0.001), with a high rating of communication with spouses (aPR = 1.255, CI = 1.074 - 1.467, P = 0.004). IPSV is negatively correlated with ages of 29 and 39 years old (aPR = 0.762, CI = 0.704 - 0.825, P< 0.001), duration in marital relationship (aPR = 0.805, CI = 0.736 - 0.881, P <0.001), being catholic (aPR = 0.671, CI = 0.612 - 0.735, P<0.001). The prevalence of IPSV is lower among women with spouse‘s aged between the ages of 18 and 28 years (aPR = 0.667, CI = 0.588 - 0.756,P <0.001), higher among women with formally educated spouses (aPR = 1.117, CI = 1.024 - 1.220, P= 0.013), lower among women whose spouse were educated to primary (aPR = 0.762, CI = 0.652 - 0.891, P = 0.001), but higher among women whose spouses use non-illicit substances (aPR = 1.744, CI = 1.521 - 1.999, P <0.001). Being undecided about the belief that marital rape is not considered a grave crime traditionally, even during pregnancy (aPR = 0.671, CI = 0.598 - 0.753, P <0.001), reception of emotional support from anyone in society (aPR = 1.279, CI = 1.084 - 1.509, P = 0.004) and the perception that a pregnant woman who is sexually violated is not allowed to report to the elders (aPR = 1.225, CI = 1.010 - 1.486, P = 0.039) were the societal correlates of IPSV. Intimate partner sexual violence during pregnancy is highly prevalent among pregnant women in Napak district; about 6 in 10 of them experience it during pregnancy. Unwanted sexual advances are the commonest form of IPSV, followed by marital rape. Intimate partner sexual violence among pregnant women in Napak district is correlated with individual, relationship and societal characteristics, with individual characteristics being relatively more important. Nanyingi Miisa

Prevalence and factors associated with virological non suppression among HIV positive adolescents treated with antiretroviral therapy in Apac district

2020-12-01T00:00:00Z

Prevalence and factors associated with virological non suppression among HIV positive adolescents treated with antiretroviral therapy in Apac district Amegovu, Timothy Globally, there is an increasing population of adolescents and young people among people living with HIV which require more concentrated focus on adolescents and young people (UNICEF, 2018). High virological non-suppression rates among HIV+ adolescents on ART affect their health status, increase chances of HIV transmission, and ultimately diminish the effort to end the HIV/AIDS epidemic. The main study objective was to determine the prevalence and factors associated with virological non-suppression among HIV positive adolescents treated with antiretroviral therapy in the rural setting of Apac district. This is because there is limited information about virological non suppression and its associated factors among HIV positive adolescents enrolled in HIV care in many resource-limited settings. Retrospective cross-sectional design was used. Data for adolescents aged 10-19 years on ART from July 2016 to June 2017 were reviewed from Apac general hospital, Aduku HC IV and Akokoro HC III. In total, 701 of the adolescents were at least six months on ART. Data was collected using retrospective audit form, entered into Microsoft Excel, cleaned and exported into SPSS version 20 for statistical analysis at 95% Confidence Interval. Univariate (central tendencies, frequencies and percentages), Bivariate (Chi-square, Fisher’s exact test and binary logistic regression) and Multivariate analysis were used to analyse the data. Results: There were 532 valid records of adolescents (10-19 years) on ART. The mean age was 13(±2.67) years, 385 (72.4%) were aged 10-14 years. More than half 320 (60.2%) were females. The prevalence of virological non-suppression was 38.9% (n=207 95%CI: 34.74-43.20). Bivariate analysis showed statistically significant difference between age category (p=0.043), social support (p<0.001), levels of support (p<0.001), peer related influence (p<0.001), clients’ adherence to ART (p<0.001), treatment line (p=0.006), BMI (p=0.009) and HIV clinical stage status (p=0.017) with virological non-suppression. Multivariable logistic regression analysis using stepwise backward elimination modeling showed that adolescents aged 15-19 years (aOR=1.14, 95%CI: 0.63-2.08 p=0.662) contrarily that patients with most support contributed in increasing virological non-suppression (aOR=5.94, 95%CI: 3.82-9.25, p<001). On the other hand, adolescents provided with social support (aOR=0.34 95%CI: .16-.73 p=0.006.), had peer related encouragement (aOR=0.18, 95%CI: .13- .27 p<.001), adherence level of 85-94% (aOR=.36, 95%CI: .13-.99, p<.047*) and <85% (aOR=.29, 95%CI: .15-.59, p=.001) indicating level of reduction increases with increase in level of adherence and HIV clinical stage 3 (aOR=0.33, 95%CI: .19-.59, p<.001) were significantly associated with reduction in non-virological non-suppression. Virological non-suppression was at 38.9%. Adolescents aged 15-19 years and those provided with much support increases virological non-suppression. Adolescents with social support, had peer related encouragement during ART, had adherence of 85-94% and were in HIV clinical stage 3 were significantly associated with reduced virological non-suppression. Health care providers should develop strategies for ensuring all adolescents of all age groups achieve the recommended adherence level to ART, BMI, encourage parents or guardians and peers to provide positive social support and encouragement to adolescents on ART. Ndibazza Juliet

Quality of postnatal care on neonatal outcomes among newborns: case study Gulu regional referral hospital

2018-06-01T00:00:00Z

Quality of postnatal care on neonatal outcomes among newborns: case study Gulu regional referral hospital Amono, Florence Omwony The 24 hours during postnatal period remains a significant public health challenge due to its associated morbidities and mortalities. This study assessed the quality of postnatal care provided to postpartum mothers and their newborns at 24 hours after birth at Gulu Regional Referral Hospital. The major objective of this study was to assess quality of postnatal care on neonatal outcomes experienced within the first twenty four hours after birth at Gulu Regional Referral Hospital. This study employed a cross sectional study design that involved studying the postpartum mothers and newborn from delivery up to 24 hours. The women prepared for delivery were sampled randomly on daily basis and studied post-delivery to discharge. Data were collected using semi-structured questionnaire, observation checklist and Key Informants Interview Guide. Data was entered in Microsoft Excel Sheet, cleaned and exported to SPSS, for analysis at univariate where mean, frequencies and percentages were presented. Bivariate analysis was performed to test for significant association and significant variables were considered for analysis at multivariate level to control for confounders. Qualitative data was organized and analyzed according to themes to triangulate the quantitative results. This study found that seven variables were significantly associated with good or normal neonate outcome and these were; essential vaccines (p=0.022), emergency equipment and drugs (P=0.012), adequate healthcare providers (P=0.045), monitoring of the postpartum mother and neonate (P=0.015), counseling and education of postpartum mother on self-care and neonate (p=0.013), physical examination (0.028) and cleanliness of the hospital (0.028). Via multivariable logistic regression, neonates well monitored by healthcare provider was significantly associated with 12% increase in good neonatal outcome (AOR=0.120 95%CI=0.026-0.565, P=0.007*). Counseling and education of the postpartum mothers was significantly association with 8.9% increase in good neonate outcome (AOR=0.089 95%CI=0.015-0.511, P=0.007). Monitoring of the neonates and counseling and education of the postpartum mothers immediately after birth within 24 hours is very important. Therefore, there is need to ensure improvement on close monitoring of the neonates during birth and after birth as well as counseling and education of the postpartum mothers by healthcare provider, avail materials and ensure procedures are followed. Nanyingi Miisa