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    Knowledge of hypertensive disorders of pregnancy among women attending antenatal care in Soroti Regional Referral Hospital
    (Makerere University, 2025) Elyanu, Peter
    ABSTRACT Introduction: Hypertensive disorders of pregnancy (HDP) are among the leading causes of perinatal and maternal morbidity and mortality globally. The knowledge of HDP among pregnant women is vital in the prevention of complications to the mothers, since adequate knowledge of HDP, influences better health-seeking behavior. Globally, HDP affects about 3 – 10 % population of pregnant women and contributes 15 – 22.1 % of maternal mortality and 15% of neonatal mortality. In Sub-Saharan Africa, HDP caused up to 14% maternal mortality, and it’s the second leading cause of maternal deaths after hemorrhage. In Uganda, the prevalence of HDP is at 5.5% and it causes 13% of maternal mortality. Purpose of the study: To determine the level of knowledge on hypertensive disorders of pregnancy and factors associated with low knowledge among pregnant women attending antenatal care at SRRH. Method: This was a cross-sectional descriptive study which involved 347 pregnant ANC women of SRRH. A structured interviewer-administered questionnaire with closed-ended questions was used. A sampling interval of four using the systematic random sampling technique was used. Level of knowledge of HDP was: <60% inadequate knowledge and ≥60 adequate knowledge, respectively, as stated in a Ghanaian study. Data analysis was done using the statistical packed for social sciences (SPSS) version 23, and descriptive statistics were computed for the patient’s dependent and independent variables. Bivariate and logistic regression tests were run to determine the association between the dependent variable (knowledge on HDP) and the independent variables. Results: The study on 347 participants with a response rate of 100% and a mean age of 26.9 SD ±5.7, found that 87.9% of participants had adequate knowledge of HDP, and 65.1% of participants had secondary education and above. No factor was found to be associated with a low level of knowledge. Conclusion: The study found an adequate level of knowledge of HDP, and no factor was associated with a low level of knowledge on HDP among ANC women of SRRH.
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    Acceptability, effect, and cost-effectiveness of mobile-health on antiretroviral therapy adherence among youth : a mixed methods sequential study in Kiryandongo District, Western Uganda
    (Makerere University, 2025) Naggirinya, Agnes Bwanika
    Introduction: Adherence to antiretroviral therapy is the principal determinant for achieving and sustaining viral suppression, which decreases progression to Acquired immunodeficiency syndrome (AIDS) and reduces the risk of mortality. Few studies have evaluated mHealth adherence tools among youth in resource-limited settings. This study aimed to evaluate the barriers, enablers, acceptability, effect, and cost-effectiveness of an mHealth tool (Call for Life) on antiretroviral therapy (ART) adherence outcomes among youth in Kiryandongo, Uganda. Methods: This was a mixed-methods sequential design with four studies: qualitative studies conducted before (paper 1), a randomized clinical trial (paper 2), a cost-effectiveness analysis study (paper 3) and endline qualitative study (paper 4). The second study involved 206 youth initiating ART or on ART for ≤ six months who were randomized to either the Standard of Care or the mHealth tool plus the Standard of Care .The qualitative analyses were guided by socio-ecological model and information motivation behavioral modes with support from Nvivo 14.0 software. The primary end point was viral load suppression at 12 months and secondary endpoint was viral suppression at 6 months and retention in care. Log binomial analysis through STATA software was performed. The cost-effectiveness analysis outcome was the incremental cost-effectiveness ratio of the intervention in comparison to the standard of care per disability-adjusted life-years. Results: The qualitative results showed multiple barriers to ART adherence at individual and social levels, with travels from home, forgetfulness, stigma, noise from pill bottle, unintended disclosure being the common barriers. The enablers included social support, repacking ART into drug envelopes other than pill bottles and disclosure. The Call for Life interactive voice response tool showed 21.7% more effective on adherence leading to higher proportions of youth with virological suppression. The tool is cost-effective in improving retention and viral suppression in this age group and has an incremental cost-effectiveness ratio of $17 per disability adjusted life year (DALY) averted. The Call for life system was highly acceptable, informative and easy to use among the youth. Conclusion: The major barriers were at individual level and enablers at relationship level. The call for life intervention was effective in viral suppression and retention in care, it was cost-effective compared to usual care, easy to use and acceptable in improving ART adherence, viral suppression and retention in care. Discussion: This project is among a few that have assessed barriers and enablers of ART adherence, acceptability, effectiveness, and cost-effectiveness of mHealth on viral suppression. The tool is cost-effective in this setting and should be considered by policymakers for the improvement of health outcomes in youth living with HIV.
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    Effectiveness, acceptability and uptake of early versus standard intrauterine contraception following provision of first trimester medical post abortion care in Central Uganda
    (Makerere University, 2025) Kayiga, Herbert
    Background: Unintended pregnancies continue to cause a public health threat in low- and middle- income countries (LMIC) due to restrictive abortion laws and the high unmet need for contraception. Over 40% of these unintended pregnancies end up as abortions, with significant subsequent abortion-related complications. Although accessible and highly effective in LMIC to reduce the burden of unintended pregnancies, the uptake of intrauterine devices (IUDs) is less than five percent. Despite fertility return within two-weeks after abortion treatment, there is paucity of information on the ideal timing of IUD insertion after medical management of first trimester abortions. It’s against this background that we set out to explore the following objectives to streamline patient care in central Uganda. Specific Objectives: 1. To explore the healthcare providers' perceptions on post abortion intrauterine contraception after medical management of first trimester incomplete abortion. 2. To determine the level and factors associated with uptake of intrauterine contraception after medical management of first trimester incomplete abortion. 3. To compare the expulsion and continuation rates at six months between early versus standard intrauterine contraception insertions after medical management of first trimester incomplete abortion. 4. To explore the women’s and their partners' perceptions on post abortion intrauterine contraception after medical management of first trimester incomplete abortion. Methods: This project was conducted at five public health facilities in central Uganda between 1st May, 2022 and 31st May, 2023 using explanatory sequential mixed methods. The first sub-study explored healthcare providers’ perceptions on post abortion intrauterine contraception, to understand the barriers and facilitators towards their recommendation of intrauterine contraception. Forty-five in-depth interviews were conducted among healthcare providers of different cadres in central Uganda. The case study design was used to explore the healthcare providers’ perceptions. Themes were identified using the conventional inductive content analysis. xii The second sub-study evaluated the uptake of intrauterine contraception and the predictors of the uptake using a cross-sectional study. Data from 650 participants were collected using interviewer- administered questionnaires. The primary outcome was uptake of post abortion IUDs, defined as the actual insertion of the post abortion IUDs. The third sub-study was a multicenter non-inferiority randomised controlled trial (RCT) among 1,050 women with first trimester incomplete abortions managed by sublingual misoprostol. After choosing either copper or levonorgestrel IUDs, participants were randomly assigned to early or standard insertion arms in a ratio of 1:1, using block size of 4. The primary outcomes were IUD expulsion and continuation rates at six-months. Participants and clinicians were unblinded to treatment allocation. The non-inferiority margin was set at 5% for the upper limit of the two-sided 95% CI for the absolute risk difference, p-value 0.0001. The trial was registered at ClinicalTrials.gov NCT05343546. The fourth sub-study explored the perceptions of the women and their partners on post abortion intrauterine contraception in fifteen in-depth interviews. Using inductive content analysis, themes and subthemes were generated. Results: From the analysis in the qualitative study among healthcare providers, three themes emerged. Theme one covered health system related barriers in regards to IUD provision such as healthcare providers’ and health facility challenges. The second theme focused on the challenges in post abortion contraceptive counselling focusing on IUDs. The third theme covered the motivating factors and participants’ views on how to scale up IUD uptake and provision within post abortion care in Uganda. We found that lack of appropriate healthcare providers’ knowledge and skills on IUD provision, and heavy workload, negatively impacted IUD provision. Inadequate facilities, IUD stock-outs, and minimal community sensitization, limited the utilization of IUDs. The prevalence of post abortion IUD uptake among all women assessed was 370/1911 (19.4%; 95%CI 17.7 to 21.2). The prevalence of IUD acceptors among those who accepted any form of contraceptives was 370/650 (56.9%; 95%CI 53.1 to 60.7). The median age of the participants was 27  IQR (30, 23) years. The post abortion IUD uptake was independently associated with religion- being a Pentecostal (Adjusted PR=2.49, 95%CI= (1.19-5.23), p-value=0.015), monthly earning > one million Ugx (270 USD) (Adjusted PR=1.88, 95%CI= (1.44-2.46), p-value<0.001), and staying <5 kilometres from the health facility (Adjusted PR=1.34, 95%CI= (1.04-1.72), p-value=0.035). Women who were not cohabiting with their partners, were less likely to choose IUDs (Adjusted PR=0.59, 95% CI= (0.44-0.79), p-value<0.001). In the non-inferiority RCT, 528 (50.3%) participants were randomized to early and 522 (49.7%) participants to standard insertion arms. A total of 532 (50.6%) participants chose levonorgestrel IUDs, 488 (46.6%) participants chose copper IUDs, while 30 (2.9%) participants opted against IUDs. In an intention-to-treat analysis, expulsion occurred in 23 (4.4%) of 528 participants in the early insertion arm and in 24 (4.6%) of 522 participants in the standard arm; Adjusted Risk Difference (ARD)(standard-early) was -0.01(95% CI: -0.001 to 0.07, p-value = 0.93). The IUD continuation rates at six-months were 91.1% in the early and 90.2% in the standard insertion arms. ARD (early-standard) was 0.009 (95% CI: -0.11 to 0.12, p-value = 0.88). No serious adverse events occurred in both arms. In the qualitative study among women and their partners, three themes emerged: 1) perceived women’s and their partners’ barriers in accessing post abortion IUDs such as myths and misconceptions on IUDs, spouse refusal, IUD-related side effects. 2) Women’s and their partners’ experiences while using post abortion IUDs such as increased lubrication, freedom from prior contraceptive side effects, assurance of early return to fertility after IUD removal, menstrual irregularities and abdominal pain following IUD insertion. 3) Motivators and recommendations to the uptake of IUDs such as peer influence, client-healthcare provider relationship, spousal approval of IUDs and community sensitization on IUDs using social media platforms. Conclusions: Health system barriers including healthcare providers’ skills and knowledge gaps, supply chain challenges, influence the uptake of post abortion intrauterine contraception. With provision of on-job refresher trainings, mentoring and supervision of healthcare providers, the subsequent uptake of IUDs among post abortion women was nearly 60%. Understanding the socio- cultural context of women and their partners, is pivotal in the uptake of post abortion IUDs. Our findings reveal that early IUD insertion after medical treatment of first trimester incomplete abortions, was non-inferior to standard IUD insertion, with respect to IUD expulsion and continuation rates. To enhance the utilization of early IUD insertion, healthcare providers ought to provide evidence-based counselling to demystify individual and community misconceptions on IUD use. Regardless of their sociodemographic status, women seeking post abortion care should be provided with high-quality integrated services by trained providers, offering a range of contraceptive methods. Such efforts may not only prevent unintended pregnancies but also improve health equity across the country. Study utility: Our study demonstrates that early insertion of post abortion IUDs is non-inferior to the standard insertion after first trimester medical management of incomplete abortions. Women can safely utilize early insertion of IUDs after medical management of their abortions. With return to fertility as early as within two-weeks after treatment of first trimester incomplete abortion, women should be encouraged to utilize early insertion of IUDs, to prevent subsequent unintended pregnancies. Measures should be underway to update policies and pre- and in-service training in post abortion counselling and family planning provision after medical management of first trimester abortions. Efforts to address health system barriers and understand the socio-cultural context of women and their partners, are pivotal in improving the uptake of post abortion IUDs.
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    Factors associated with uptake of long acting reversible contraceptives (LARCS) among immediate post-partum mothers at Kawempe National Referral Hospital
    (Makerere University, 2025) Rugumayo, Johnson
    Background: Long-acting reversible contraceptives (LARCs) are essential to women’s empowerment, promotion of economic growth and improvement of child survival. Thus, LARCs use in the post-partum is recommended for improving maternal health and child survival in countries with high rates of unintended pregnancies like Uganda. This study aimed to determine the level of uptake of immediate post-partum LARCs and its associated factors among post-partum mothers. Methods: This was a hospital-based cross-sectional study conducted among post-partum mothers at Kawempe National Referral Hospital. Mothers were enrolled from the postnatal wards, health educated on LARCs and offered an option to have LARCs. For those who agreed to have IUDs or Implants inserted, these were sent to trained midwives who inserted the IUDs or implants and were considered to have taken up LARCs. A structured questionnaire was used to collect participant data and record the uptake of LARCs. Results: The study involved 421 post-partum mothers with an average age of 27.8 (±6.0) years, ranging from 15 to 45 years. Majority were aware of LARCs 329 (78.1%) with health facilities 289 (87.8%) as the main source of information about LARCs. The level of uptake of LARCs was 32.1% [95% CI: 27.6% – 36.5%] for which 48.9% used IUDs while 51.1% used implants. For mothers who had not used any family planning method post-partum, only 76 (27.6%) reported having intentions to use family planning at a later stage. The uptake of LARCs was more likely in women who were salary employed (aOR=2.6 [1.289 - 5.212], p=0.008), who had attended ANC for eight or more times (aOR=6.4 [2.132 - 19.019], p=0.001), women who had ever used LARCs (aOR=2.8 [1.539 - 4.927], p=0.001) and women whose spouses approves use of family planning (aOR=2.0 [1.079 - 3.645], p=0.027). Uptake of LARCs was however less likely in women who desired to have more children in a period of less than 2 years (aOR=0.5 [0.288 - 0.821], p=0.007). Conclusion: Uptake of LARCs is high with patient education and availability of the services. It is recommended that all post-partum women be given clear information about LARCs, encouraged to consider using them, and ensure easy access to these services. Key words: Post-partum period, LARCs, Family planning, Uptake
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    Prevalence and factors associated with asthma among children with sickle cell disease aged 6-17 years attending the Sickle Cell Clinic at Mulago national Referral Hospital
    (Makerere University, 2025) Mawanda, Daniel
    Sub-Saharan Africa harbours more than three quarters of the world Sickle cell disease (SCD) burden, coinciding with a rapidly growing asthma prevalence in the region. Murine studies have demonstrated the classical inflammatory markers of asthma in mice with SCD. The Cooperative study of SCD revealed a 17% occurrence of asthma among children with SCD. Literature on this comorbidity is limited especially in Africa, with precarious diagnostic and treatment approaches to asthma among this special population. Objective: To determine the prevalence and factors associated with asthma among children with SCD aged 6-17 years attending the sickle cell clinic at Mulago national referral hospital also called the Mulago Hospital Sickle cell clinic (MHSCC). Methods: A cross-sectional study was conducted at the MHSCC between November 2024 and February 2025. A total of 305 children were systematically sampled on each of the clinic days and successfully enrolled into the study. Data on key variables was collected using a pre-tested ISAACguided questionnaire that included a review of participants’ clinic records, physical examination, and laboratory workup. Spirometry was performed in participants with characteristic asthma symptoms to confirm asthma diagnosis. STATA v18.0 was used for analysis, participant characteristics were described, and the prevalence of asthma was then established as a proportion of children with SCD found to have the characteristic asthma symptoms with a post-bronchodilator increase in FEV1 of  10% predicted on spirometry. Logistic regression was carried out to establish factors associated with the SCD-asthma comorbidity. Results: The prevalence of asthma among children with SCD in this study was 4.3% (13/305) with a female preponderance (7/13). The mean age of children enrolled was 10.7 years (SD 3.3), with a nearly equal male (51.1%) to female participation. Hospitalization in the past year was reported in 111 (36.4%) children. Having been a preterm at birth was associated with a 30-fold increase in the risk for asthma aOR 30.74 (95% CI; 3.31 – 285.69, p=0.003). The SCD-Asthma comorbidity was associated with a 6 times higher likelihood of having been hospitalized in the past year aOR 5.78 (95% CI; 1.71 – 19.52, p= 0.005). Conclusion: This study highlights the occurrence of asthma in SCD in our clinical setting and the need for meticulous assessments to avoid any missed opportunities for asthma diagnosis