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ItemContraceptive acceptability and associated factors among young women (15-24) living with HIV/AIDS: a hospital-based study in Kampala, Uganda(African Health Sciences, 2022)Introduction: In Uganda, over 43% of all pregnancies among young women (15-24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics in Kampala. Methods: Between February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive. Data were analyzed using STATA 13.0. Statistical significance was determined at a P values < 0.05. Results: Contraceptive acceptability was 40.7% (95% CI: 27.6%-53.6%). Older age group (20-24 years) (aPR; 2.42, 95%CI; 1.06-5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13-1.38, P<0.001), having friend on contraceptives (aPR; 1.90, 95%CI; 1.10 - 3.26; P =0.021) and being married (aPR; 1.20, 95%CI; 1.09 - 1.32, P<0.001) were significantly associated with acceptability of contraceptives. Conclusion: There is a low acceptability for contraceptives. Younger age group who are not yet married need to be targeted.
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ItemHealth-related quality of life among adult patients with cancer in Uganda – A cross-sectional study(Taylor & Francis, 2024)Objectives: The study aimed to investigate the prevalence and factors associated with poor health-related quality of life in adults with cancer in Uganda. Methods: This cross-sectional study surveyed 385 adult patients (95% response rate) with various cancers at a specialised oncology facility in Uganda. Health-related quality of life was measured using the EORTC QLQ-C30 in the Luganda and English languages. Predetermined validated clinical thresholds were applied to the instrument in order to identify patients with poor health-related quality of life, that is, functional impairments or symptoms warranting concern. Multivariable logistic regression was used to identify factors associated with poor health-related quality of life in six subscales: Physical Function, Role Function, Emotional Function, Social Function, Pain and Fatigue. Results: The mean age of the patients was 48 years. The majority self-reported poor functioning ranging between 61% (Emotional Function) to 79% (Physical Function) and symptoms (Fatigue 63%, Pain 80%) at clinically concerning levels. These patients were more likely to be older, without formal education and not currently working. Being an inpatient at the facility and being diagnosed with cervical cancer or leukaemia was a predictor of poor health-related quality of life. Conclusion: Improvement of cancer care in East Africa requires a comprehensive and integrated approach that addresses various challenges specific to the region. Such strategies include investment in healthcare infrastructure, for example, clinical guidelines to improve pain management, and patient education and support services.
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ItemContinuous labor support from a companion of choice in Uganda: Practices, role orientation, experiences and effect on birth outcomes(Makerere University, 2024)Background: With the current pace of progress in meeting the goal to end preventable maternal deaths by 2030, the world will likely fall short of this target by more than 1 million lives. Globally, up to 2.5 million lives can be saved using evidence-based care practices including utilization of the birth companion in the intrapartum care. Uganda grapples with challenges of health human resources especially midwifery care providers. Such shortages jeopardize midwives’ ability, availability, and motivation to offer support to women during childbirth. A birth companion of choice is recommended by WHO to promote non-clinical care for all women for a positive childbirth experience and improved birth outcomes. Birth companions could be leveraged to a great degree to mitigate the current health human resource crisis. Empirical evidence on the effect of labor support, and specific support practices with regards to women's care needs is weak in low-income settings. This study aimed to explore labor support practices and to evaluate the effect of role orientation of birth companions on birth outcomes, maternal satisfaction, and care experiences in Eastern Uganda. Methods Sub-study I: Exploratory descriptive qualitative design was used. Ten non-participant direct observations of normal laboring women admitted in early labor with a full-time birth companion were conducted. In-depth interviews with the women observed were conducted pre-discharge. Latent content analysis was done. Sub-study II: A stepped wedge cluster randomized trial; a pilot study among 475 participants (control n=240), intervention n= 235) from 4 clusters. Midwives in the intervention period provided an orientation session for the birth companions on supportive labor techniques. Women with a birth companion, and expecting a vaginal delivery were included. The primary outcome was the mode of delivery. Secondary outcomes were coping, anxiety, length of labor, Apgar score, need for augmentation, and maternal satisfaction. Analysis was undertaken on an “intention to treat basis”. Statistical tests, including Chi-squared tests, t-tests, and confidence intervals, were two-sided. The statistical significance was set at 5%. Sub-study III. A phenomenological descriptive study design among 12 women supported by birth companions who had received a role orientation session on admission. Follow up home based in-depth interviews were conducted within a week during the postpartum period. Colaizzi method of phenomenological analysis was used. Results Birth companion practices identified were “support actions aiding a good childbirth experience” and “support actions hindering coping with labor”. Support actions aiding a good experience reported were emotional presence, motivation, providing nourishments, messenger activities, body massage for pain relief, assisting in ambulation, and coaching. Companion fearful behaviors, disrespectful care in the form of unacknowledged needs, and hostility from birth companions were cited to hinder coping. Women’s care needs identified included: thoughtful communication, trust, anticipatory care, and birth companions to recognize non-perceptive phases of labor to allow them focus on themselves. Following orientation of birth companions on labor support techniques, anxiety scores were lower in the intervention group (p = 0.001). The proportion of women able to cope during early active labor was higher during the intervention period (P = 0.031). Women in the intervention period had 80 percent higher odds of coping (P=0.032) compared to the control period. Notable differences were observed in anxiety and coping with labor among first-time mothers, younger women (15-24), and women who received support from siblings. There were no statistically significant differences in the mode of delivery, need to augment labor, length of labor, and Apgar scores. The mean maternal satisfaction score was significantly higher in the intervention period compared to the control period (P>0.001). Maternal satisfaction scores were lowest with pain management and highest with humaneness across the study periods. Qualitative evaluation of orientation showed that women that received support from birth companions who had an orientation had higher self efficacy to give birth even in moments when they had given up on having a normal birth. Women were contented with their experience with birth companions who had received an orientation. They reported feeling loved, esteemed, respected due to birth companions’ profound care. Trust between birth companion and woman was critical and influenced response to instructions to relaxation, mobility, nutrition, and hydration. Kindness was a driver for obedience to instructions. Conclusion: Birth companions provide emotional, physical support, and advocate for women’s needs during labor. Companion fearful behaviors and insensitiveness hinders coping with labor. Midwife-provided orientation of birth companions on labor support lowered maternal anxiety and improves coping with labor and maternal satisfaction with care. Birth companion orientation enhanced women’s self-efficacy, promoted respectful, compassionate intrapartum care and a positive birth experience. Midwife-provided orientation of birth companion is a low-cost intervention pivotal in improving women's care experience, as well as contributing to ending preventable maternal and newborn mortality in Uganda.
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ItemPsychometric properties of the EORTC QLQ‑C30 in Uganda(BMC, 2021-04-23)Background: Self-reported measures play a crucial role in research, clinical practice and health assessment. Instruments used to assess self-reported health-related quality of life (HRQoL) need validation to ensure that they measure what they are intended to, detect true changes over time and differentiate between subjects. A generic instrument measuring HRQoL adapted for use among people living with cancer in Uganda is lacking; therefore, this study aimed to evaluate the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 in patients with cancer in Uganda. Methods: Adult patients with various types of cancer (n = 385) cared for at the Uganda Cancer Institute answered the EORTC QLQ-C30 in Luganda or English language, the two most spoken languages in the country. The two language versions were evaluated with regard to data quality (floor and ceiling effects and missing responses), reliability (internal consistency) and validity (construct, known-group and criterion). Construct validity was examined through confirmatory factor analysis (CFA). Mean scores were compared between groups differing in disease stage to assess known-group validity. Criterion validity was examined according to associations between two QLQ-C30 subscales (Global quality of life and Physical function) and the Karnofsky Performance Scale (KPS). Results: Floor and ceiling effects were observed for several scales in the Luganda and English versions. All EORTC scales with the exception of Cognitive function (Luganda α = 0.66, English α = 0.50) had acceptable Cronbach’s alpha values (0.79–0.96). The CFA yielded good fit indices for both versions (RMSEA = 0.08, SRMR = 0.05 and CFI = 0.93). Known-group validity was demonstrated with statistically significant better HRQoL reported by patients with disease stages I–II compared to those in stages III–IV. Criterion validity was supported by positive correlations between KPS and the subscales Physical function (Luganda r = 0.75, English r = 0.76) and Global quality of life (Luganda r = 0.59, English r = 0.72). Conclusion: The Luganda and English versions of the EORTC QLQ-C30 appear to be valid and reliable measures and can be recommended for use in clinical research to assess HRQoL in adult Ugandans with cancer. However, the cognitive scale did not reach acceptable internal consistency and needs further evaluation. Keywords: Cancer, Cancer care, EORTC , Health-related quality of life, Quality of life, Sub-Saharan © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
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ItemProduction and use of post–graduate students’ research: a multiple methods study of universities in Uganda and other low- and middle-income countries(Makerere University, 2023-01-15)Background: Sir Ian Chalmers, a leading health scientist noted, “…For ethical, economic and scientific reasons, health-relevant degree theses must be made publicly accessible, […] otherwise it is a waste…”. Post–graduate students’ research in institutions of higher learning involves considerable investment in time, effort, and money. However, the developments from these post–graduate students’ research projects, for example, the volume of publications and whether or not they are used to inform decisions of practice or policy in the field of health was unclear. The thesis attempted to address this gap in four papers or sub-studies focusing on Uganda and other low- and middle-income countries. Specific objectives: 1. Sub-study 1: To review and summarize existing evidence on the effectiveness of approaches that increase research productivity (proportion published) or the use (proportion cited) of post– graduate students’ research; and assess the determinants of post–graduate students’ research productivity and use. 2. Sub-study 2: To quantify and characterize Masters students’ research and their outputs over a 15-year period (from 1996 to 2010) at Makerere University College of Health Sciences, Uganda. 3. Sub-study 3: To determine the extent to which research generated by Masters students at Makerere University contributes to decision–making or policy formulation in health in Uganda and internationally. 4. Sub-study 4: To identify and evaluate current support mechanisms for research generation and application for Masters students in four universities in Uganda. Page 22 of 164 Methods: A multiple methods approach was used. Sub–study 1 was a systematic review of studies about how post–graduate students furthered their research project work or theses in low– and middle– income countries. These studies investigated whether the post–graduate students published their work or presented in conferences or were used to inform technical reports or policy related documents. This review was guided by a protocol registered in PROSPERO (CRD42016042819). Briefly, published articles in PubMed/MEDLINE and the ERIC databases were searched for through to July 2017. Duplicate assessments for included primary studies was performed and discrepancies resolved by consensus. Outcomes of interest were research productivity (proportion published) or the use (proportion cited). A meta-analysis of the findings was done using both fixed and random effects approaches. Sub–study 2 was a retrospective review of post–graduate students’ research records enrolled for masters’ degree courses from 1996 to 2010 at Makerere University College of Health Sciences, and followed to 2016. The outcome measures were publications (primary) and citations, electronic dissertations found online or conference abstracts (secondary). Descriptive and multivariable logistic regression analyses were performed to identify determinants of the primary outcome. Sub–study 3 was a multiple case study of ‘research use’ from masters’ students’ dissertations at Makerere University College of Health Sciences completed between 1996 and 2010. A case of ‘research use’ was defined as citation of research products from post–graduate students’ dissertations in publicly available health policy–related documents. Sub–study 4 was a self–assessment cross–sectional survey by masters students in four schools of public health and medicine in Uganda, namely: Makerere, Mbarara, Mukono and Nkozi Universities. The four domains assessed for were: research question identification (priority Page 23 of 164 setting), proposal development for the post-graduate research project, knowledge transfer of postgraduate research products and promoting use of post-graduate research products Results: In sub–study 1, the proportion of manuscripts published from post–graduate research projects in the 12 studies included from 8 low and middle income countries was 7% (95% CI: 7% – 8%; Higgins I–squared and Cochran’s Q, p value of < 0.01) and 23% (95% CI: 17% – 29%; Higgins I–squared of 98.4% and Cochran’s Q, p value of < 0.01) using fixed effects and random effects models respectively. Hardly any studies reported on the citation of post-graduate students’ studies, or the determinants of productivity or use of post-graduate students’ research. No study was found that reported effectiveness of interventions to increase publication or use of post–graduate students research. In sub–study 2, there were 1,172 dissertations were found with Masters of Public Health being the single most popular course, enrolling 363 students (31%). Manuscripts from 209 masters’ dissertations at Makerere University were published (18%, 95% CI: 16%–20%) and 196 were cited (17%, 95% CI: 15%–19%). Few (4%), policy–related documents (technical reports and guidelines) cited these dissertations. In terms of research priorities, the bulk of the research was about MDG 6, predominantly on infectious diseases (42%), and the health services delivery pillar (66%) was the most common World Health Organization health system pillar researched. Three quarters (75%) of the post-graduate research projects were cross-sectional studies whilst a fifth (21%) used qualitative case-study methodology. Variables that significantly affected publication proportion in the multivariable model were students’ age at enrolment into the masters programme, with adjusted coefficient -0.12 (95% CI: -0.18 – -0.06),