Socio-cultural inhibitors to use of modern contraceptive techniques in rural Uganda: a qualitative study.

INTRODUCTION: Family planning is one of the cost-effective strategies in reducing maternal and child morbidity and mortality rates. Yet in Uganda, the contraceptive prevalence rate is only 30% among married women in conjunction with a persistently high fertility rate of 6.2 children per woman. These demographic indicators have contributed to a high population growth rate of over 3.2% annually. This study examines the role of socio-cultural inhibitions in the use of modern contraceptives in rural Uganda. METHODS: This was a qualitative study conducted in 2012 among men aged 15-64 and women aged 15-49 in the districts of Mpigi and Bugiri in rural Uganda. Eighteen selected focus group discussions (FGDs), each internally homogeneous, and eight in-depth interviews (IDIs) were conducted among men and women. Data were collected on sociocultural beliefs and practices, barriers to modern contraceptive use and perceptions of and attitudes to contraceptive use. All interviews were tape recoded, translated and transcribed verbatim. All the transcripts were coded, prearranged into categories and later analyzed using a latent content analysis approach, with support of ATLAS.ti qualitative software. Suitable quotations were used to provide in-depth explanations of the findings. RESULTS: Three themes central in hindering the uptake of modern contraceptives emerged: (i) persistence of socio-cultural beliefs and practices promoting births (such as polygamy, extending family lineage, replacement of the dead, gender-based violence, power relations and twin myths). (ii) Continued reliance on traditional family planning practices and (iii) misconceptions and fears about modern contraception. CONCLUSION: Sociocultural expectations and values attached to marriage, women and child bearing remain an impediment to using family planning methods. The study suggests a need to eradicate the cultural beliefs and practices that hinder people from using contraceptives, as well as a need to scale-up family planning services and sensitization at the grassroots

Modern contraceptive use among women in Uganda: An analysis of trend and patterns (1995-2011)

There is an extensive body of literature concerning modern contraceptive use among women in Uganda. A questionable aspect however is whether the impact of factors associated with modern contraceptive use has remained the same in the recent past. Demographic Health Survey (DHS) data of women in the period 1995-2011 was adopted to establish an understanding of this issue. The focus in the investigations was none pregnant sexually active women. Variations in patterns of modern contraceptive use were assessed by socioeconomic and demographic characteristics of women using a logistic regression based on a complex survey design. In the results, an upward trend in modern contraceptive use - from 11.6% in 1995 to 32.1% in 2011 - shows that progress has been made in this regard. Increased odds of modern contraceptive use across the study period were noted among women with primary and post-primary education, those in urban areas, women in the higher wealth quartiles and those with a higher number of surviving children (p < 0.01). Further, reduced odds of modern contraceptive use across the study period were noted among married women and those in cohabiting relationships (p < 0.05). The study however demonstrates variations in the impact of these factors across the study period. All the same, efforts towards enhancing modern contraceptive use in the near future should focus on enhancing: (i) literacy levels of woman particularly, (ii) access to and affordability of the services and (iii) awareness campaigns on family planning use targeting both men and women

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Determinants of change in fertility pattern among women in Uganda during the period 2006–2011

Abstract Background Studies on fertility in Uganda have attributed fertility reduction to a shift in the overall characteristics of women of reproductive age. It is not clear whether the reduction in fertility is due to changing socioeconomic and demographic characteristics over time or stems from the shifts in the reproductive behavior of women. In this paper we examine how fertility rates have changed between 2006 and 2011 and whether these changes have resulted from changing characteristics or from changing reproductive behavior of women. Methods Using the 2006 and 2011 Demographic and Health Survey data for Uganda, Multivariate Poisson Decomposition techniques were applied to evaluate observed changes in fertility. Results Changing characteristics of women aged 15–49 years significantly contributed to the overall change in fertility from 2006 to 2011. The change observed in older age at first marriage was the major contributor to the changes in fertility. The contribution that can be attributed to changes in reproductive behavior was not significant. Conclusions This study finds that the major contribution to the reduction in fertility between 2006 and 2011 was from increased education and delayed marriage among women. Continued improvement in secondary school completion, will lead to older age at first marriage and will continue to be an important factor in Uganda’s declining fertility rates

Age reporting by and for older people in Uganda: relationships with frailty, human capital and population registration

In this article, we investigate the accuracy of age reporting by people aged 60 and older and proxy reporting by their carers in a peri-urban area of Uganda, and analyse the factors that influence reporting by both groups. We find a high level of age heaping on terminal digits 0 and 5, indicating poor knowledge of age. Contrary to other studies, we find that literate people were more likely to exhibit age heaping. We link this to the absence of birth registration for this cohort and the introduction of National Identification (ID) cards in Uganda five years before our survey. We conclude that age heaping is better interpreted as an indicator of registration machinery than of human capital. We also find that the health, functional capabilities and education of older people influenced the age ascribed to them by their carers. Carers who knew the older people less well were more likely to overestimate their age, and carers of healthy and more educated people were more likely to report a younger age than that reported by the older people themselves. Where people don’t know their age, the age they report may also be influenced by their health and capabilities, making it difficult to establish true relationships between chronological age and outcomes such as health. In many disciplines, self-reported age or age reported by proxy respondents is accepted uncritically by researchers, but our study shows that in peri-urban Uganda age reporting remains approximate and biased, and this has strong implications for appropriate targeting and monitoring of interventions to support healthy ageing in such contexts

Age reporting by and for older people in Uganda: relationships with frailty, human capital and population registration

This paper investigates the accuracy of age reporting among people age 60 and older in a peri-urban area of Uganda and the influences on the ages reported by those people and their carers. We find a high level of age-heaping on terminal digits 0 and 5, indicating poor knowledge of age. Contrary to other studies, literate people were more likely to exhibit age-heaping and we link this to the absence of birth registration for this cohort and the introduction of National ID cards five years before our survey. We conclude that age-heaping is better interpreted as an indicator of registration machinery than of human capital. We also find that the health, functional capabilities, and education of an older person influenced the age ascribed to them by their carer. Carers who knew the older person less well were more likely to over-estimate their age, and the carers of healthy and more educated people were likely to report a younger age than that reported by the older person. Where people don’t know their age, the age they report may also be influenced by their health and capabilities, making it difficult to establish true relationships between chronological age and outcomes such as health. In many disciplines self-reported age or age as reported by proxy respondents is accepted uncritically by researchers, but our study shows that in peri-urban Uganda age reporting remains approximate and biased, with strong implications for appropriate targeting and monitoring of interventions to support healthy ageing in such contexts.This research was funded the UKRI Arts and Humanities Research Council (AHRC) as part of a joint Arts and Humanities (AHRC) and Medical Research Council (MRC) Global Challenges Research Fund (GCRF) (grant reference AH/R005990/1)

Determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006-2016: analysis of the Uganda demographic and health surveys

Objective Teenage pregnancy has become a public health concern in Uganda because of its negative consequences to both the mother and child. The objective of this study was to examine the determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006-2016. Study design A retrospective national cross-sectional study. Setting Uganda. Participants Uganda Demographic and Health Survey secondary data of only female teenagers aged 15-19 years. The samples selected for analyses were 1936 in 2006; 2048 in 2011 and 4264 in 2016. Outcome measure The primary outcome was teenage pregnancy. Analysis was performed using the logistic regression, equiplots, concentration curve, normalised concentration index, decomposition of the concentration index and Oaxaca-type decomposition. Results The prevalence of teenage pregnancy has seemingly remained high and almost constant from 2006 to 2016 with the risk worsening to the disadvantage of the poor. Household wealth-index, teenagers' years of education, early sexual debut and child marriage were the main key predictors and contributors of the large inequality in teenage pregnancy from 2006 to 2016. Conclusion Teenage pregnancy is disproportionately prevalent among different subpopulations of adolescent girls in Uganda. We therefore recommend policy actions to sensitise communities and enforcement of child rights and child protection laws to stop child marriages. There is also need to promote girl child education, improving household incomes, and intensifying mass media awareness on the risks of early pregnancies. Further, ensuring that villages have operational adolescent and youth friendly services as well as incorporating sex education and other different adolescent reproductive health programmes in school curriculum will be key measures in reducing the large inequality in teenage pregnancy

Adherence to COVID-19 preventive measures and its association with intimate partner violence among women in informal settings of Kampala, Uganda.

Cases of coronavirus disease 2019 (COVID-19) detected, and COVID-19 associated mortality increased since the first case was confirmed in Uganda. While adherence to WHO-recommended measures to disrupt COVID-19 transmission has since been implemented, it has been reported to be sub-optimal. An increase in intimate partner violence (IPV) cases was linked to enforcement of COVID-19 lockdowns and other preventive measures especially in informal settings of Kampala. We determined the association between adherence to COVID-19 preventive measures and intimate partner violence among women dwelling in informal settings in Kampala, Uganda. Between July and October 2020, we conducted a three-month prospective cohort study of 148 women living in informal settlements of Kampala during the COVID-19 lockdown and easing of restrictive measures. Participants were surveyed at baseline, at 3-weeks and 6-weeks (endline). The dependent variable was adherence to COVID-19 preventive measures (remained adherent vs poorly adherent) between baseline and endline surveys. This composite outcome variable was computed from implementing all four variables: social distancing, wearing face masks, frequent hand washing and use of hand sanitizers at baseline and endline surveys. The key independent variable was IPV measured as experiencing at least one form of physical, emotional, or sexual IPV. Covariates were age, education, marital status, household size, occupation, and having problems getting food. Adjusted logistic regression analyses tested the independent association between adherence to COVID-19 preventive measures and intimate partner violence. Among 148 respondents, the mean age (SD) was 32.9 (9.3) years, 58.1% were exposed to at least one form of IPV, and 78.2% had problems getting food. Overall, 10.1% were poorly adherent to COVID-19 preventive measures during the first COVID-19 wave. After controlling for potential confounders, remaining adherent to COVID-19 preventive measures were more likely to experience intimate partner violence when compared to women who were poorly adherent to COVID-19 preventive measures during the first COVID-19 wave in Uganda [OR 3.87 95%CI (1.09, 13.79)]. Proportions of women in informal settlements of Kampala experiencing at least one form of IPV during the first COVID-19 wave is substantial. Remaining adherent to preventive measures for COVID-19 transmission may increase IPV exposure risk among women living in informal settlements in Kampala. Contextualizing COVID-19 interventions to the needs of marginalized and vulnerable women and girls in informal settings of Kampala is warranted. Processes to integrated violence prevention and response strategies into the Uganda COVID-19 prevention strategy are underscored