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ItemPrevalence of home births assisted by traditional birth attendants and associated factors among mothers 15- 49 years in Lira district, Uganda.(Makerere University., 2026-08-18)Home births, which occur outside formal health facilities and are often attended by traditional birth attendants (TBAs), remain a major public health concern, particularly in rural areas. They are associated with poor maternal and neonatal outcomes and continue to contribute to Uganda’s high maternal mortality. Despite ongoing efforts to promote facility-based deliveries, a considerable proportion of women still give birth at home. This study aimed to determine the prevalence and identify factors associated with home births among mothers in Lira District, northern Uganda. Methods:A cross-sectional study was conducted among women aged 15–49 years who had delivered within the six months preceding the survey. A multistage sampling approach was used to select 267 participants. Quantitative data were collected using semi-structured questionnaires, and qualitative insights were obtained through interviews with nine key informants. Quantitative data were analyzed using STATA software, employing modified Poisson regression to identify factors associated with home births.Results:Of the 267 respondents, the mean age was 28.3 years (SD±7.2), most were married (81.2%), and the majority had attained primary education (70.6%). The prevalence of home births assisted by TBAs was 23.3%. Education level was strongly associated with delivery location: women with primary education had a 30% lower prevalence of home birth compared to those with no education (APR = 0.70; 95% CI: 0.61,0.80), while those with secondary education had a 32% lower prevalence (APR = 0.68; 95% CI: 0.59, 0.79). Single mothers had a 32% higher prevalence of home birth compared to married women (APR = 1.32; 95% CI: 1.19, 1.51), and widowed mothers had a 21% higher prevalence. (APR = 1.21; 95% CI: 1.03, 1.42). Higher parity was associated with a lower prevalence of home birth compared to primiparous women (two births: APR = 0.88; 95% CI: 0.79, 0.99; three births: APR = 0.83; 95% CI: 0.74-0.92; four or more births: APR = 0.85; 95% CI: 0.76, 0.95). Fewer antenatal care visits were associated with a higher prevalence of home birth. Women who attended one ANC visit had a 26% higher prevalence of home births compared to those who attended four or more visits (APR = 1.26; 95% CI: 1.09, 1.46).Conclusion: More than two in ten women in Lira district delivered at home with the assistance of TBAs. Lower education, limited availability of health workers, and inadequate ANC attendance were key drivers of home births, while higher parity appeared protective. Strengthening maternal health education and improving ANC quality and accessibility remain essential to reduce TBA-assisted home births and enhance health facility utilization in similar rural settings.
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ItemImplementation of the World health organization infection prevention and control core components in the provision of care to cancer patients at the Uganda Cancer institute; a mixed methods study.(Makerere University, 2026-06)Background: Effective implementation of infection prevention and control (IPC) is imperative for prevention and reduction of healthcare-associated infections (HAIs) especially in the cancer patient. HAIs are of significant public health concern with a considerable impact on morbidity, mortality, and quality of life especially in cancer patients. Cancer patients are at a greater risk of acquiring HAIs due to their weakened immune system arising from cancerous conditions and medications, as well as prolonged hospital stays. While there has been a study on bacteraemia in febrile cancer patients at UCI, there is scanty literature to describe the level of implementation of the World Health Organization (WHO)Infection Prevention and Control (IPC) core components (CCs) at the Uganda Cancer Institute (UCI). The aim of this study was to assess the level of implementation of WHO IPC CCs at UCI. Methods: The study was a cross sectional three-part mixed methods study, utilising the convergent parallel approach. It consisted of a (1) a hospital-based cross-sectional component (utilizing the WHO infection prevention and control assessment framework (IPCAF) tool, (2) observational checklist, (3) key informant interviews (KIIs). Findings from both the quantitative and qualitative data were collected and triangulated. Based on the overall score obtained from the IPCAF tool, UCI was assigned to one of the 4 levels of IPC promotion and practice. The results from the observational checklist were used to validate the results from the WHO IPCAF too while the findings from the KIIs provided further explanation to level of implementation of the WHO IPC CCs at UCI.Results: The overall IPC compliance score for UCI was 33.2% (265.9/800), interpreted as a basic level of compliance. IPC scores ranged from the lowest, 173/800 in Paediatric OPD to highest 432.5/800 for Lymphoma Tumor Centre (LTC). Adult units had higher IPC scores (mean = 309.3) than paediatric units (mean = 178.8) while outpatient units had higher IPC scores (mean = 276.9) than inpatient units (mean = 260.25). These differences were however not statistically significant, p=0.133 and p=0.800 respectively. Facilitators for IPC implementation included existence of an IPC committee, UCI leadership commitment, availability of PPE, skilled staff, segregation of patients and access controls. Barriers against IPC implementation included insufficient IPC staff, limited space and equipment, delayed PPE replenishment, inadequate training, lack of HAI surveillance, poor monitoring and feedback, and infrastructure limitations. Conclusion: This study revealed a lower level of implementation of WHO IPC CC at UCI 33.2% (265.9/800), which shows that there is still significant room for improvement especially for HAI surveillance (CC4), monitoring/audit and feedback (CC6), and workload, staffing and bed occupancy (CC7).
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ItemPrevalence and factors associated with depression, anxiety and stress among minibus taxi drivers in Kampala City, Uganda(Makerere University, 2025)Introduction: Minibus taxi drivers in Kampala city have increased risk of developing depression, anxiety and stress because of their occupation. The prevalence and factors associated with depression, anxiety and stress among minibus taxi drivers in Kampala are not well documented yet their significance in the transport industry has impacts on individual lives, society and the population health. General objective: To determine the prevalence and factors associated with depression, anxiety and stress among taxi drivers in Kampala city. Methods: This cross-sectional study was conducted among 422 minibus taxi drivers whose taxi stages/ routes were in Old, New, Kisenyi, Usafi, Namirembe, Nakawa and Nateete minibus taxi parks in Kampala. A validated Depression Anxiety Stress Scale (DASS-21) questionnaire was used to assess the levels of depression, anxiety and stress among the minibus taxi drivers. A semi-structured questionnaire was also used to collect data on factors associated with depression, anxiety and stress. STATA software version 15 was used for descriptive and Robust Poisson regression model statistical analyses. Results: The prevalence of depression, anxiety and stress was high at 65.64%, 70.85% and 81.99% respectively. Minibus taxi drivers who were using Internet had 17% (aPR= 0.83, 95% CI: 0.72-0.97) less prevalence of depression. The prevalence of depression was less by 21% (aPR= 0.79, 95% CI: 0.64-0.98) among minibus drivers who worked six days of in a week compared to those who worked ≤5 days. The prevalence of depression was 24% (aPR=1.24, 95% CI: 1.00-1.53) higher among minibus taxi drivers who were involved in a major road accident in the last 1 year compared to those who had not been involved in an accident. Having a chronic medical condition (aPR=1.22, 95% CI: 1.06-1.41) and having Family history of mental disorders (aPR=1.29, 95% CI: 1.10-1.51) were found to be significant risk factors for depression. The prevalence of anxiety was less by 28% and 21% among minibus taxi drivers who owned the taxi (aPR=0.72, 95% CI: 0.55-0.94) and those who worked 6 days in a week (aPR=0.79, 95% CI: 0.66-0.95), respectively. Having an average of 7 or more hours of sleep per day (aPR=1.49, 95% CI: 1.02-2.17), Sometimes (aPR=1.94, 95% CI: 1.27-2.96) and never (aPR=1.70, 95% CI: 1.10-2.61) getting 7 to 9 hours of sleep per day and having a chronic medical condition (aPR=1.20, 95% CI: 1.05-1.36) were found to be risk factors for anxiety. There was 12% and 39% increased prevalence of stress among minibus taxi drivers who had been involved in a major road accident in the last 1year (aPR=1.12, 95% CI: 1.00-1.26) and those who got an average of 7 or more hours of sleep per day (aPR=1.39, 95% CI: 1.02-1.91), respectively. Minibus taxi drivers who sometimes and never got 7 to 9 hours of sleep per day had a 68% (aPR=1.68, 95% CI: 1.19-2.35) and 62% (aPR=1.62, 95% CI: 1.15-2.29) higher prevalence of stress respectively compared to those got 7 to 9 hours of sleep daily. Having a chronic medical condition (aPR=1.13, 95% CI: 1.04-1.23) and having a family history of mental disorders (aPR=1.16, 95% CI: 1.06-1.27) were also found to be significant risk factors for stress. Conclusion and recommendation: Depression, anxiety and stress among minibus taxi drivers in Kampala are public health issues. There is need for routine screening for depression, anxiety and stress. The Ministry of Health in collaboration with the Ministry of Works and Transport should hold campaigns to raise awareness on mental health and coping mechanisms plus enforce good occupational health practices among minibus taxi drivers.
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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.