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ItemPreparedness of health facilities to respond to effects of flooding on community health in Kasese District, Western Uganda(Makerere University, 2024)Introduction: Climate change presents a profound threat to public health. Uganda is vulnerable to the health effects of climate change. Kasese district has experienced several recurrent floods and landslides during 2013 – 2015, 2020 and 2021 impacting on communities. Objective: To assess the current state of preparedness of health facilities to respond to the effects of flooding on community health in Kasese District, Western Uganda. Methods: We conducted a cross-sectional study during April 2024 in Kasese district. A total of 43 health facilities (96% Response) were purposively selected and surveyed. They comprised all health centre levels – HC II, III, IV, and Hospital – from the eight flood-prone sub-counties in the district. At each health facility, the In-charge and health personnel responsible for disaster/ emergency response were interviewed. A total of 15 key informants including district health workers and stakeholders were interviewed. Quantitative data were analyzed using Stata Version 15. Univariate and bivariate analyses were performed. Qualitative data were exported to ATLAS.ti Version 6.0 and thematic analysis performed. Findings: The study found that more than a third (35%) of the health facilities had experienced flooding during the last five years. None of the health facilities was completely prepared to respond to major flooding events. The majority (86%) of the health facilities neither had emergency plans nor did 81% have disaster management committees. Most (95%) health personnel in charge of emergencies were aware of climate change and its health effects, yet only 14% had been trained on disaster management and climate change. The main barriers to preparedness included shortages of human resources, lack of training and capacity building among health workers, shortage of medical supplies, inadequate infrastructure, and poor coordination. Conclusion: There is a low level of preparedness of health facilities to respond to the effects of flooding characterized by lack of emergency plans, low number of personnel trained on disaster, shortage of personnel and poor coordination. There is a need for a multifaceted approach to improve training of health workers in disaster management, infrastructure, and increase funding for emergency preparedness.
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ItemPrevalance and factors associated with uptake of oral pre-exposure prophylaxis among pregnant women at high risk of HIV in Bugiri District(Makerere University, 2024)Background: The World Health Organization (WHO) and The Ministry of Health Uganda (MOH) recommend Pre-Exposure prophylaxis (PrEP) for pregnant women at increased risk of HIV as a strategy for eliminating mother-to-child transmission of HIV (EMTCT). However, PrEP uptake among pregnant women remains a challenge and there is need to assess PrEP uptake and factors associated with its use among pregnant women at high risk of HIV infection. Objective: The aim of this study was to determine the prevalence and factors associated with uptake of oral pre-exposure prophylaxis among pregnant women at high risk of HIV in Bugiri district. Methods: This was a mixed-methods cross-sectional study to investigate oral PrEP uptake among 352 high-risk pregnant selected using probability proportionate to size and simple random sampling across four healthcare facilities in Bugiri district in May 2024. PrEP uptake was determined as the proportion (95% CI) of women that reported use of PrEP on the day prior to the interview. Bivariate followed by multivariable modified Poisson Regression was used to determine the associations between PrEP uptake and demographic characteristics, awareness levels, sexual behaviour, and health system factors. Key informant and in-depth interviews were conducted with health workers and pregnant women to explore facilitators and barriers to PrEP uptake. Qualitative data was analysed thematically. Results: The median age of the women was 25 years (Inter quartile range (IQR): 21-30). The majority (89.5%) were married. Many (57.4%) were unaware of PrEP and many (53.1%) of the participants did not know their partner’s HIV status. Overall, of the 352 pregnant women, 56 (15.9%) (95% CI 12.25-20.16) reported using PrEP at the time of the study. PrEP uptake was associated with being divorced (aPR 5.36, CI 2.10-13.69), being single (aPR 2.40, CI 1.06-5.41), and being in a sero discordant relationship (aPR 6.53, CI 3.40-12.55). Use of Injectable PrEP was mentioned as a less preferred option as compared to Oral PrEP (aPR 0.32, CI 0.14-0.76). Key informant and in-depth interviews highlighted side effects of PrEP and stigma as barriers to PrEP uptake while availability of PrEP, health education and perceived benefit were identified as facilitating factors. Conclusion: This study highlights a concerning low uptake of oral PrEP among pregnant women at high risk of HIV in Bugiri district, Uganda. Being single or divorced and being in a serodiscordant were associated with PrEP uptake. There is a need for integrated approaches to improve access and utilization in this population.
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ItemSafety climate and occupational injuries among construction workers at Kabuyanda Irrigation Dam, Isingiro District, Western Uganda(Makerere University, 2024)Background: Globally construction workplaces are usually unsafe leading to high injury and fatality rates among workers. This study determined safety climate and prevalence of occupational injuries (OIs) among construction workers at Kabuyanda Irrigation Dam (KID) in Isingiro District, Western Uganda. Methods: A cross-sectional study was conducted among 200 workers using an adapted Nordic Occupational Safety Questionnaire (NOSACQ-50). Socio-demographic and health related variables (e.g. age, daily income, experiencing injuries and sleep disorder) and climate dimensions data were collected. Exploratory data analysis (EDA) was used to generate descriptive statistics (frequencies, percentages, means and graphs). The primary outcome was experiencing occupational injury measured on Yes/No basis (binary categorical) for 6 months prior to the study. A modified Poisson regression model was used to determine associations between independent variables and prevalence of OIs while prevalence ratio (PR) was used as a measure of association. Results: Majority of the workers were males (86%, 172/200) and close to a third (29.5%) were -25-29 years old. The overall average safety climate score was fairly low (2.73). Workers had a fairly good perceived value of dimension 6 (peer safety communication, learning, and trust in safety ability) with a mean score of 3.18 while dimension 7 (workers’ safety priority and risk non-acceptance) had the lowest mean score of 2.03 (very low) on a scale of 1-4. The prevalence of OIs within a six-months period was relatively high (23%, 46/200). More than a third (82.6%, 38/46) suffered injuries on their hands and fingers, while nearly a quarter (23.9%, 11/46) of the injured workers were hospitalized and could not resume work immediately, leading to lost time injury (LTI) cases. Of the 11 LTIs, 63.6% (7/11), 27.3% (3/11) and 9.11% (1/11) lost 1-7 working days, 8-14 working days and 15-30 working days, respectively. Factors associated with higher prevalence of OIs were; a fairly good management safety justice (adj.PR:2.34, 95% CI: 1.30-5.34, p=0.042) compared to good management safety justice. However, prevalence of OIs was lower among workers who received rewards for excellent performance (adj.PR:0.57, 95% CI: 0.32-0.95, p=0.022) compared to those who were not rewarded for excellent work and those who experienced good peer safety communication, learning and trust in safety ability (adj.PR:0.18, CI: 0.07-0.45, p=0.001) in relation to those who experienced very low peer safety communication, learning and trust in safety ability. Conclusions: The overall mean safety climate at KID was fairly low (2.73) while the 6-months’ prevalence of occupational injuries was relatively higher (23%) than the set target of 2 minor injuries in 6 months. Prevalence of OIs was higher among workers who were not rewarded for excellent performance and those who felt fairly good safety justice but it was lower among workers with good peer safety communication, learning and trust in safety ability. Health and safety control measures should be reviewed and enhanced to reduce the prevalence of OIs and construction time losses at KID.
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ItemUptake of a single dose human papillomavirus vaccine among adolescent girls aged 13-19 years in Wakiso Dstrict, Uganda(Makerere University, 2026)Introduction: Cervical cancer remains a major public health challenge in Uganda, and Human Papillomavirus (HPV) vaccination is a key preventive measure. Despite national vaccination programs, coverage among adolescents remains suboptimal. This study assessed the uptake and factors associated with uptake of single-dose HPV vaccination among adolescent girls aged 13-19 years in Wakiso District. Methods: A mixed-methods cross-sectional study was conducted with 597 adolescent records extracted from African Medical and Behavioral Sciences Organization (AMBSO) Population Health Surveillance (APHS) and 58 participants through focus group discussions and key informant interviews, including adolescents, parents, health workers, Head teachers, and Village Health Teams (VHTs). Quantitative analysis included descriptive statistics and regression model using STATA 14.0 and qualitative data were thematically analyzed using NVivo version 15; QSR International, 2021. Results: The overall uptake of at least one dose of the HPV vaccine was 33.3%. Uptake was higher among Protestants (44.8%) than Catholics (33.3%), and among rural residents (47.3%) compared to urban residents (27.2%). Younger adolescents aged 13–15 years (42.9%) were more likely to have been vaccinated than those aged 16–19 years (27.8%). In multivariable modified Poisson regression, significant predictors of HPV vaccine uptake were Protestant religion (Adjusted PR = 1.36, 95% CI: 1.04–1.77, p=0.022), rural residence (Adjusted PR = 1.81, 95% CI: 1.46–2.24, p=0.001), and younger age (Adjusted PR = 0.63, 95% CI: 0.50–0.81, p=0.001). Facilitators included community outreach programs, peer encouragement, school-based vaccination program, and trust in health workers. Key barriers, were limited awareness (90.5%) and misinformation. Conclusion: Single-dose HPV vaccine uptake among adolescent girls aged 13-19years in Wakiso District remains low, largely due to inadequate awareness and sociocultural misconceptions. Strengthening community education, parental engagement, school-health facility programs, and continuous outreach is critical for improving coverage and advancing Uganda’s cervical cancer prevention goals. Keywords: HPV vaccine, adolescent girls, uptake, cervical cancer prevention.
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ItemDeveloping a social media middleware application to improve data accessibility for targeted DHIS2 users in Uganda(Makerere University, 2026)Access to data is very important in ensuring data utilization for service delivery improvement, proper resource allocation, and informing policies. This research resulted in the development of a middleware application integrated into the DHIS2’s application store that enabled reports generated in DHIS2 to be shared on preconfigured social media platforms like Telegram Messenger. The main objective of this research was to develop, test, and validate the feasibility and acceptability of a middleware application that extends access to DHIS2 data beyond the native system by leveraging social media platforms, particularly Telegram Messenger, to support timely data access and use within the routine communication and decision-making environments of health workers. The choice to use social media was informed by the reality that health workers already rely on platforms such as Telegram, WhatsApp, and others for routine coordination, supervision, and decision-making. Embedding DHIS2 data access within these existing communication ecosystems enhances timeliness, and aligns data use with users’ natural workflows. Methodology: The study applied the user-centered design approach by gathering requirements from purposively sampled users of DHIS2 for the development of the middleware application. Participants in the study included DHOs, Software developers from HISP- Uganda and participants from The Ministry of Health Division of Health information Data Center. Users were then asked to give their experience on whether the application improved data access and hence utilization during the study duration. Results The study revealed that there is positive reception of using social media platforms such as Telegram and WhatsApp and that it can actually improve data access in DHIS2 since it blends in well with the naturalistic settings of the DHIS2 users. It was also revealed in the study that uptake of the new technology was easier because it was simple and easy to use in the daily workflow of users. The study showed that improving data access can positively impact data utilization. However, there were concerns about privacy and security of data that called for more stringent measures to secure the information in future iterations of the middleware application.