School of Public Health (Public-Health) Collections

Permanent URI for this collection

http://10.29.1.53:4000/handle/10570/184

Browse

Recent Submissions

Now showing 1 - 5 of 1053
  • Item
    Probable depression, its correlates and coping mechanisms among adults exposed to floods in Ntoroko District, Uganda
    (Makerere University, 2026) Mudondo, Donna Kisembo
    Background: Flooding is one of the most frequent natural disasters contributing to both direct and indirect effects on human health globally. Anthropogenic climate change has contributed to intensified hydrological cycle characteristics, in a nature sufficient to alter the strength and geographical distribution of extreme climate-related weather events. At least 90% of these extremes are weather-water-related exacerbated by increasing intensity of heavy rainfall. In East Africa, rural Ugandan populations experienced floods resulting from the heavy rains of the March-April-May (MAM), and September-October-November-December (SOND) 2024 rainfall seasons. The focus of studies on health consequences of these floods in this region of Sub-Saharan Africa (SSA) has often been directed towards other health outcomes, and less frequently on mental health. Study aim: To determine the prevalence of depressive disorders and their correlates among adults who were exposed to the SOND floods in Ntoroko, Uganda, and determine the different coping mechanisms utilized by these adults post-flood. Methods: A cross-sectional study was conducted to collect data from 360 participants following the extreme flood event of SOND 2024 in Ntoroko. The Patient Health Questionnaire-9 (PHQ-9) tool, General Anxiety Disorder-7 (GAD-7) scale, Perceived Stress Scale (PSS) and Oslo Social Support Scale-3 (OSSS3)were incorporated in a semi-structured online questionnaire to screen for probable depression and its correlates. Total scores on each tool/scale were determined for each participant. These scores were used to report on probable depression status, anxiety, perceived stress and social support. Other measures were used to determine and report on exposure and coping mechanisms. Analysis was performed using methods of descriptive statistics and other methods such as Poisson regression, then presented in summaries such as mean, prevalence ratio (PR), and tabular/graphic selections. Results: The study achieved a 93.51% response rate. Male participants accounted for 56.4% (n=203) of the study. The prevalence of probable depression was 64.7% with most participants experiencing moderate severity (106; 29.4%). Male participants recorded a higher occurrence of probable depression (121; 33.6%) compared to females (112; 31.1%). The correlates of probable depression included anxiety status (p<0.001) (PR= 0.550 95% CI [0.457-0.663] ) and social support level (p=0.033) (Low; PR=1.704 95% CI [1.140-2.548], Moderate; PR= 1.567 95% CI [1.043-2.354]). The final predictive model for depressive status included other variables despite them showing non-significant associations with depression status; sex, age, marital status, primary source of income, flood level, flood impact, former location, community leaders support, flooring material and stress severity. Conclusions: The study found a high prevalence of probable depression as compared to Uganda’s pooled prevalence of 30.2% from a systematic review, moderate severity being the most common. The correlates of probable depression included anxiety status and social support level even though the final predictive model for probable depression status included sex, age, marital status, primary source of income, flood level, flood impact, former location, community leaders support, flooring material and stress severity. The participants suggested needing more coping-focused aid from the government. This study gave recommendations including prioritizing early warning systems, mental health screening, psychosocial first aid, and community-led social support.
  • Item
    Evaluating the effectiveness of seasonal malaria chemoprevention in reducing under-five malaria incidence in Karamoja, Uganda using generalised linear mixed models
    (Makerere University, 2026-02-04) Mbabazi, Mercy
    Background: Malaria remains a major public health challenge in Uganda, particularly among children under five years. Seasonal Malaria Chemoprevention (SMC) is a recommended intervention to reduce malaria incidence in high-transmission areas. This study assessed the effectiveness of SMC in reducing malaria incidence among children under five in the Karamoja region using DHIS2 data. Methods: A retrospective analysis was conducted using malaria case data from the District Health Information Software 2 (DHIS2) for children under five. Temporal and spatial trends were analyzed to identify peak transmission periods and high-burden districts. The effectiveness of SMC was evaluated using Generalized Linear Mixed Models (GLMMs), adjusting for relevant covariates. Results: Malaria incidence exhibited clear seasonal peaks during the rainy months, with considerable variation across districts. Some districts consistently reported higher malaria burden than others. GLMM analysis indicated that SMC significantly reduced malaria incidence among children under five. Additionally, female neonates (0–28 days) were found to have higher malaria incidence compared to older children, highlighting a vulnerable subgroup. Conclusion: SMC is effective in reducing malaria incidence among children under five in the Karamoja region. Malaria transmission varies temporally and spatially, emphasizing the need for targeted, location-specific interventions. Early-life preventive measures should be strengthened for neonates, and SMC delivery should be aligned with seasonal transmission peaks to maximize impact.
  • Item
    Assessing monitoring and evaluation practices for disability-inclusive health services in selected health facilities in Kampala city
    (Makerere University, 2026) Tumaeletse, Botho Bridget
    Background Monitoring and evaluation (M&E) systems are crucial for ensuring accountability and informing evidence-based decision-making in health programs. In Uganda, however, routine health information systems seldom collect disability-disaggregated data or assess the accessibility and preparedness of services for persons with disabilities. This shortfall weakens the country’s commitments to inclusive health as outlined in the Sustainable Development Goals (SDGs), the Convention on the Rights of Persons with Disabilities (CRPD), and national policy frameworks. Objective: To assess monitoring and evaluation (M&E) practices for disability-inclusive health services at selected health facilities in Kampala City. Methods: A qualitative case study design was employed, guided by the Performance of Routine Information System Management (PRISM) framework. Data collection involved 25 key informant interviews (KIIs), three focus group discussions (FGDs), and a targeted review of relevant documents. Thematic analysis was utilized to identify patterns across the technical, organizational, and behavioral dimensions of Monitoring and Evaluation (M&E) practices. Findings: This study concludes that although some disability-related data, primarily informal notes concerning physical impairments, observable function limitations, and service utilization by individuals with disabilities, are collected at the facility level, such data are neither systematically analyzed nor utilized to inform planning or service enhancement. Routine Health Management Information System (HMIS) tools lack standardized indicators that are sensitive to disability, and mechanisms for feedback between health facilities and district and national levels remain inadequate. Furthermore, Organizations of Persons with Disabilities (OPDs) are often excluded from monitoring and evaluation (M&E) processes, thereby restricting opportunities for participatory accountability and responsiveness. Conclusion: Enhancing disability-inclusive M&E involves adding disability indicators to HMIS tools, increasing staff capacity for inclusive data collection and utilization, and creating mechanisms for OPD involvement. These actions are essential for advancing equity, accountability, and inclusive health services in urban Uganda.
  • Item
    Timing of the first Antenatal Care Visit (ANC) and its associated factors among adolescent mothers aged 10-19 years in Wakiso District, Uganda
    (Makerere University, 2025) Ajak, William Bhariem
    Background: Timely antenatal care (ANC) is critical for maternal and neonatal health, yet late ANC is common among adolescent mothers in Wakiso District, Uganda, where only 26.6% start in the first trimester. Understanding factors influencing early ANC can guide targeted interventions. Objective: This study examined the timing of the first ANC visit and its associated factors among adolescent mothers aged 10–19 in Wakiso District, Uganda. Methods: A mixed-methods design was used, combining a cross-sectional survey of 384 adolescent mothers aged 10–19 years with 12 in-depth interviews with the mothers and 8 key informant interviews with health workers. Quantitative data from structured questionnaires were analyzed using descriptive statistics and logistic regression; qualitative data from interviews were thematically analyzed. Results: Among 389 adolescent mothers aged 10–19 years in Wakiso District, 233 (59.9%) initiated their first ANC visit late, mostly in the second (weeks 13-26; 214, 55.0%) or third trimester (weeks 27 and above; 19, 4.9%), while only 156 (40.1%) attended within the first trimester (weeks 1-12). Adolescents who were single or separated were 24% more likely to initiate ANC late compared to those cohabiting or married (aPR = 1.24, 95% CI: 1.01–1.53, p = 0.036), receiving community-based peer education about ANC reduced late initiation by 20% (aPR = 0.80, 95% CI: 0.68–0.95, p = 0.010), and fear of being judged or stigmatized increased the likelihood of late initiation by 86% (aPR = 1.86, 95% CI: 1.01–3.43, p = 0.045). Qualitative findings highlighted stigma, financial constraints, limited awareness, health system challenges, and lack of family support as barriers, while adolescent-friendly services, perceived health risks, and health education facilitated timely initiation. Adolescents and healthcare workers recommended financial support and community sensitization to reduce stigma and promote early ANC attendance. Conclusion: Many adolescents delayed their first ANC visit beyond the first trimester due to stigma, limited knowledge, financial constraints, lack of decision-making power, and delayed recognition of pregnancy. The adolescent and healthcare workers recommended strengthening adolescent-friendly services, raising community awareness on first-trimester ANC, and addressing financial and sociocultural barriers as key strategies to improve early 1st ANC initiation among adolescent mothers.
  • Item
    Factors associated with HIV rapid Proficiency Testing performance in Mid-Eastern Uganda
    ( 2026-02-09) Odieka, Reuben.
    Background: HIV Proficiency Testing (HIV-PT) is a critical quality assurance mechanism designed to ensure the accuracy, reliability, and consistency of HIV diagnostic services. Despite Uganda's national External Quality Assessment (EQA) framework, suboptimal HIV-PT performance persists in the Mid-Eastern region, undermining progress toward the UNAIDS 95-95-95 goals. Objective: This study assessed the factors associated with HIV-PT performance among healthcare workers in Mid-Eastern Uganda, with a focus on individual, facility-level, and systemic influences. Methods: A convergent parallel mixed-methods study design was employed. Quantitative data were collected from 345 HIV testers across various facility types using a structured questionnaire and proficiency testing results from the Uganda Virus Research Institute (UVRI). Modified Poisson regression was used to identify factors associated with satisfactory HIV PT performance. Qualitative data from key informant interviews were thematically analysed to contextualize operational barriers. Results: Among 3120 HIV PT enrolled testers in the Mid-Eastern Region of Uganda, the overall HIV-PT response rate was 93%, with 76.8 % of testers achieving satisfactory scores. Laboratory personnel were significantly more likely to pass proficiency testing than lay and medical non-laboratory testers (aPR = 2.99 and 2.52, respectively). Lack of formal training and mentorship were strongly associated with unsatisfactory outcomes, with untrained and non-mentored testers at significantly higher risk of failing. Qualitative findings highlighted persistent barriers, including inconsistent refresher training, limited mentorship, irregular supervision, and frequent stockouts of testing kits and supplies, particularly in private and lower-tier facilities. Conclusion: HIV rapid proficiency testing performance in Mid-Eastern Uganda was shaped by both individual and institutional factors. Tester cadre, training, and mentorship were key factors, with laboratory and medical non-laboratory staff performing better than lay testers. Gaps in refresher training, mentorship, staffing, and resources, alongside systemic challenges such as outdated SOPs, supply stockouts, and limited feedback, negatively affected HIV-PT outcomes.