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ItemDetermining the willingness to enroll into the proposed contributory National Health Insurance Scheme among public servants working in Gulu City, Northern Uganda(Makerere University, 2024)Introduction: Uganda is committed to achieving Universal Health Coverage (SDG 3.8) by 2030. While health insurance is key to achieving universal health coverage, it is not yet well developed in Uganda contributing less than 2% of the healthcare financing. Uganda's spending on health is only USD 43 (Ugx 158833.44), and this is far below (WHO) recommended minimum of USD 84 (Ugx 310,279.28) per capita thus creating a USD 41 gap. Out-of-pocket health expenditures remained the major source of health financing at 28% thus limiting access to healthcare.However, only private commercial and community health insurance schemes operate in Uganda with a very minimal population enrolled. Uganda has proposed the establishment of a National Health Insurance Scheme where individuals are expected to contribute premiums to be covered by the scheme. As of 2024, the proposed scheme is yet to be fully approved into law. Objective: The objective of this research was to determine the willingness to enroll into the proposed contributory National Health Insurance Scheme among public servants working in Gulu City, Northern Uganda. Methodology: A cross-sectional study design was conducted among the public servants working in Gulu City. Data was collected on factors influencing willingness to enroll, level of knowledge, perception, and institutional factors. A probability simple random sampling method was used to select 396 public servants and were interviewed using semi-structured questionnaires. Quantitative data was analysed using SPSS statistical software, version 26.0 (IBM). Descriptive statistics and multivariable logistic regression was used to determine the willingness to enroll into the proposed contributory National Health Insurance Scheme and its associated factors among public servants working in Gulu City, Northern Uganda. Additionally, 12 heads of department were purposively selected and interviewed using key informant guide; qualitative data was analysed using thematic content analysis to generate themes. Results: The proportion of the public servants who were willing to enroll for the proposed contributory NHIS was 47.2%. Out of 187/396(47.2%) who expressed WTE, 351/396(88.7%) were willing to pay a maximum of Ugx 29,000 (equivalent to USD 7.90) as the monthly premium. The Willingness to Enroll (WTE) was associated with having chronic illness (AOR 7.114, 95% CI: 2.575-19.656, p-0.001), preferring a monthly premium deductible payment model (AOR, 0.059, 95% CI: 0.010-0.330, p-0.001), quality of diagnostic facilities (AOR 0.399, 95% CI: 0.169-0.945, p-0.037), staff friendliness (AOR 2.690, 95% CI: 0.967-7.487, p-0.058), level of awareness of NHIS (AOR 0.218, 95% CI: 0.108-0.439, p-0.001), and the necessity for stakeholder consultation (AOR 5.437, 95% CI: 1.024-28.876, p-0.047). Conclusion and Recommendations: The predictors that influenced WTE were; having a chronic illness, owning a refrigerator, preferring a monthly premium-deductible payment model, the quality of diagnostic facilities, staff friendliness, awareness of the NHIS, and the necessity for stakeholder consultation. Consequently, the research recommends raising awareness about the proposed contributory NHIS and organizing broader stakeholder consultation meetings to gather their opinions and approval of the NHIS before its legislative enactment.
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ItemCost-effectiveness analysis of self-injectable versus health worker-administered injectable contraceptive modalities among women of reproductive age (15-49 years) at Kajjansi Health Center IV Wakiso District(Makerere University, 2025)Background: Globally, injectable contraceptives are valued for their safety and convenience, with self-injection further enhancing accessibility. However, the cost-effectiveness of self-injectables compared to intramuscular methods remains unclear. This study assessed the cost-effectiveness of self-injectable versus health worker-administered DMPA to evaluate its economic and practical benefits. Objectives: To assess the incremental costs, effectiveness, and cost-effectiveness of self-injectable versus health worker-administered injectable contraceptive modalities among women aged 15-49 at Kajjansi Health Center IV. Methods: The study compared self-injectable and health worker-administered contraceptive modalities over a one-and-a-half-year period using a Decision Tree model from a societal perspective. Costs were estimated by identifying and valuing resources for each modality, while effectiveness was measured in terms of unintended pregnancies averted. Incremental cost-effectiveness ratio (ICER) calculations and sensitivity analyses were conducted to assess robustness under different scenarios and willingness-to-pay (WTP) thresholds. Results: The self-injectable contraceptive method had a total cost of $557 and prevented 145 pregnancies, while the health worker-administered method cost $527 and prevented 140 pregnancies. The incremental cost-effectiveness ratio (ICER) of 750 indicates that self-injection provides greater effectiveness for a modest cost increase. Sensitivity analysis confirmed the stability of the results across various scenarios, supporting the cost-effectiveness of the self-injectable method. Conclusions and Recommendations: Self-injection was a more cost-effective contraceptive modality, preventing more unintended pregnancies at a slightly higher cost compared to health worker-administered injections. These findings provide evidence to support resource allocation decisions and improvements in contraceptive modalities at Kajjansi Health Center IV and similar settings.
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ItemFactors influencing COVID-19 vaccine uptake among pregnant women aged 18 - 45 attending antenatal care in Nakivale Refugee Settlement, Isingiro District – Uganda(Makerere University, 2024)Background: The COVID-19 pandemic has necessitated global vaccination efforts, with particular attention to vulnerable populations, including pregnant women (Amimo, Lambert, Magit, & Hashizume, 2021). Despite these efforts, vaccine uptake remains inconsistent, especially in low-resource settings like refugee settlements (Rosen, Waitzberg, Israeli, Hartal, & Davidovitch, 2021). This study aimed to assess the factors influencing COVID-19 vaccine uptake among pregnant women aged 18 to 45 years attending antenatal care in Nakivale Refugee Settlement. Methods: We conducted a cross-sectional study that utilized both quantitative and qualitative data collection methods. Quantitative: structured questionnaires were administered to 444 pregnant women, aged 18–45 years to obtain data which was then analyzed using STATA v 15.0. Qualitative: for the qualitative component, we employed Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). 10 FGDs were held, 5 with vaccinated pregnant women and 5 with unvaccinated ones, divided into younger women < 24 years, and older women > 25 years. Additionally, 10 KIIs were conducted with healthcare providers, including EPI/nurse in-charges, and community health workers (VHTs), to explore vaccine hesitancy and acceptance in greater depth. Collected data was then transcribed verbatim and analyzed using Atlas. ti 8.0 software. Results: Out of the 444 pregnant women surveyed, 56% (248/444) had received at least one dose of a COVID-19 vaccine, with Johnson & Johnson being the most commonly administered, accounting for 33.1% (82/248) of those vaccinated. The primary motivation for vaccination was the belief that it would protect both pregnant women and their unborn babies. The most commonly reported side effects were muscle pain and fever, with 19.4% (86/444) of respondents reporting muscle soreness after the first dose. 81% (201/248) of the vaccinated women were knowledgeable about COVID-19 vaccines, compared to 55% (108/196) among the unvaccinated group. Healthcare workers were the primary source of their vaccine awareness. 34% (84/248) of the vaccinated women had a positive perception of the vaccine, compared to only 12% (24/196) of unvaccinated women. The primary reason for their positive views was the perceived protection for themselves and their unborn babies. Health workers were the main source of information on COVID-19 vaccination for 67.3% (298/444) of respondents. Qualitative data highlighted significant barriers to vaccination, including fears of harm to the baby, the belief that COVID-19 was no longer a threat, and the unavailability of vaccines. Conclusions: COVID-19 vaccine uptake among pregnant women in Nakivale Refugee Settlement stands at a moderate 56%, with key factors significantly influencing uptake being household vaccination status, testing positive for COVID-19, educational attainment, knowledge of community vaccination, and vaccine preferences. However, major barriers, such as vaccine unavailability, and safety concerns continue to hinder vaccine uptake. To improve vaccine uptake, public health initiatives should prioritize increasing vaccine access, addressing safety concerns, and utilizing health workers as vital influencers within the community.
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ItemModern contraceptive use among teenage mothers aged 13-19 years in Kamuli District Uganda(Makerere University, 2024)Background: In Uganda, almost a quarter (24%) of women have given birth by the age of 19, making it the highest teenage pregnancy rate in East Africa. Teenage mothers often face adverse outcomes such as school dropout, social stigmatization, forced marriage, pregnancy complications, and even death. Contraceptive use among teenage mothers is essential to prevent repeat unintended pregnancies for those who are unmarried and to enable appropriate child spacing for those who are married. This study aimed to determine the prevalence and factors associated with modern contraceptive use among teenage mothers in Kamuli district so as to suggest recommendations aimed at preventing teenage pregnancy in the district. Methods: This was a cross-sectional study that utilized quantitative and qualitative data collection techniques. Quantitative data was collected among 286 teenage mothers in three randomly selected sub-counties using a semi-structured questionnaire uploaded to the Kobo Collect. Qualitative data was collected among 20 purposively selected key informants, including community health workers, health facility in charges, local and religious leaders. Quantitative data was cleaned in Microsoft Excel and transferred to STATA version 15 for analysis. Univariate analysis was carried out to describe the data, while the bivariable and multivariable analyses were conducted using modified poison regression. Qualitative data was transcribed verbatim, coded and analysed using manual thematic analysis. Quantitative findings were presented using tables, while qualitative findings were presented using themes and quotes. Results: This study found that out of 286 teenage mothers included in this study, 45% (129/286) were using modern contraceptive. The factors that were associated with modern contraceptive use included: being separated (APR=1.68; 95% CI: 1.22-2.30), being a Muslim (APR= 0.69; 95% CI: 0.48-0.99), finding it difficult to access family planning (APR=0.61; 95% CI: 0.38 0.98), contraceptive services being affordable (APR=1.90; 95% CI: 1.24-2.89), and the culture accepting use of contraceptives (APR=1.83; 95% CI: 1.11-3.01). From the qualitative findings, strategies to scale up modern contraceptive use among teenage mothers included enhancing service accessibility and affordability, community education, improving healthcare worker attitudes, supporting village health teams, and encouraging parental involvement. Conclusion: The prevalence of modern contraceptive use among teenage mothers in Kamuli district was 45%. Factors associated with modern contraceptive use included marital status, religion, accessibility, affordability, and cultural acceptance. To increase contraceptive use, targeted strategies are needed to improve service accessibility and affordability, enhance community education, and foster supportive attitudes among healthcare workers.
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ItemPredictors of a positive prostate biopsy following PSA testing: a retrospective study of Ugandan men aged 40 or more years presenting to the Uganda Cancer Institute for prostate-related care between 2014 - 2021.(Makerere University, 2025-06-20)Introduction: The incidence and mortality due to prostate cancer (PCa) have been rising globally, making it the second most commonly diagnosed malignancy among men and the fourth most common cancer overall. In Uganda, PCa has been increasing at an alarming rate of 5.2% annually, making it the most rapidly growing cancer in the country and across sub-Saharan Africa. Despite the widespread use of prostate-specific antigen (PSA) testing and digital rectal examination (DRE) in PCa screening and biopsy referral, these methods remain inconclusive, and data on additional predictors of a positive biopsy are scarce. Objective: This study aimed at identifying the predictors of a positive prostate biopsy following a PSA test among men aged 40 or more years who presented to the Uganda Cancer Institute (UCI) for prostate related care between 2014 and 2021. Methods: This retrospective study analyzed the medical records of 860 Ugandan men aged 40 or more years, who sought prostate related care at UCI from 2014 to 2021. Only records with baseline PSA results and histological reports were included, excluding those with prior surgery, hormone therapy, or duplicates. Variables included PSA levels, family history of PCa, Age, smoking status, Alcohol use, prostate volume (PV), comorbidities, and imaging results. Binary and Bayesian logistic regression (LR and BLR) models were compared using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and are under the curve (AUC), with statistical significance set at p<0.05 and 95% Confidence Intervals. Results: Among the patients, 99.5% of those with a positive PSA result also had a positive biopsy. Although the BLR model slightly outperformed the LR model in terms of AUC (0.91 vs. 0.90), the LR model demonstrated superior sensitivity and specificity (98.71% vs. 65% and 29.76% vs. 5%, respectively). The multivariable LR model identified age (OR: 0.95, 95% CI: 0.90-0.99, p=0.02) and MRI results (OR: 0.53, 95% CI: 0.29-0.93, p=0.03) as significant predictors of a positive prostate biopsy. Conclusion:This study found a 99.5% positive biopsy rate following a positive PSA test. While both models demonstrated predictive value, LR’s superior sensitivity and specificity made it more suitable for clinical use. However, BLR’s slightly higher AUC suggests potential for improved accuracy with refinement. Age and MRI findings emerged as key predictors, emphasizing their role in biopsy decisions. These findings support LR in practice while encouraging further exploration of Bayesian approaches for PCa detection in Uganda.