The determinants of early childbearing by disability status in Uganda: an analysis of demographic and health survey data

Introduction: females with disabilities experience multiple sexual and reproductive challenges that can result in teenage pregnancy and motherhood. This study assessed the determinants of early childbearing among women by disability status. Methods: the study used the 2016 Uganda demographic and health survey data, analyzing a weighted sample of 18,506 women of reproductive age. We used frequency distributions to describe respondents´ characteristics, chi-squared tests and multivariable logistic regressions to establish the determinants of early childbearing. Results: early childbearing is higher among women with disabilities. The determinants of early childbearing among women with disabilities were marital status, religion, education, and occupation. The odds of early childbearing were higher among ever married compared with never married women (aOR=5.35; 95% CI: 2.42-11.84, p=0.000); women who engaged in sales and services compared with those that did not work (aOR=2.73; 95% CI: 1.36-5.50, p=0.005); and smaller religious faiths compared with protestants (aOR=2.70; 95% CI: 1.04-1.34, p=0.047). The odds reduced with advancement in education. Region, attitude towards violence and knowledge of the ovulatory cycle, though associated with early childbearing for nondisabled women were not significant for women with disabilities. Conclusion: the lack of formal education and early marriages increased the odds of early childbearing for all women. Efforts to address early childbearing especially for women with disabilities should consider advancing women´s education; and preventive measures targeting women of smaller religious faiths, stressing the dangers of early sex and marriages. The measures should target women with disabilities irrespective of attitudes towards violence, knowledge concerning fertility, and region

Spousal sexual violence, sexual behavior and sexually transmitted infections among ever-married women in Uganda

Despite the increasing recognition of the significance of spousal sexual violence in developing countries, evidence on its consequences for reproductive health remains limited. The aim of the paper was to examine the relationship between spousal sexual violence (SSV) and sexually transmitted infections (STIs) using a sample of 1749 ever-married women, from the 2006 Uganda Demographic and Health Survey. Pearson Chi-square tests and binary logistic regressions were used to investigate associations between SSV, STIs and selected reproductive health outcomes. From the analyses, 25% and 15% of ever-married women experienced SSV and reported STIs, respectively in the last 12 months. Women who experienced SSV were twice more likely to have had STIs in the last 12 months compared to those who did not. SSV is an important social and public health problem having implications on women's reproductive health and interventions to improve it should directly address the issue of spousal sexual violence

Contraceptive Uptake Among Married Women in Uganda: Does Empowerment Matter?

Although contraceptive prevalence increased from 24% to 30% between 2006 and 2011, this uptake is still below global level of 62% and low levels of women empowerment could be a factor. Data was extracted from 2011 UDHS to examine associations between women’s empowerment and contraceptive uptake. We developed four empowerment indices symbolising economic and social empowerment, established associations between them and contraceptive use. Most women (83%) were from the rural areas and 61% were married for 10+ years. Most (59%) scored low on power over earnings and domestic violence indices. All indices independently were positively associated with contraceptive use, but only the reproductive health rights index was significant before (OR 2.13, 95% CI; 1.52-2.98) and after adjusting for background characteristics (AOR 1.72, 95% CI; 1.07-2.73). Empowered women were more likely to use contraceptives. More efforts in sensitisation of women about their sexual and reproductive health rights as well as ensuring more control over their earnings.

NGOs water health service delivery

Uganda was one of the most promising developing countries south of the Sahara, particularly in relation to service delivery. The positive trend was reversed with succeeding regimes that were marked with over centralization - creating a dependence syndrome and leading to deterioration in service delivery - (World Bank, 1992). NGOs have been instrumental in filling up the gaps. With the advent of the National Resistance Movement regime, multi-lateral agencies, NGOs both external and indigenous flourished. The regime is devoted to reversing the situation particularly through decentralization and promotion of participatory development. The paper focuses on NGO approaches to health and water services delivery under decentralization with special focus on participation

Gender relations, sexual behaviour, and risk of contracting sexually transmitted infections among women in union in Uganda

Abstract Background Sexually transmitted infections (STIs) are a major reproductive and public health concern, especially in the era of HIV/AIDS. This study examined the relationship between sexual empowerment and STI status of women in union (married or cohabiting) in Uganda, controlling for sexual behaviour, partner factors, and women’s background characteristics. Methods The study, based on data from the 2011 Uganda Demographic and Health Survey (UDHS), analysed 1307 weighted cases of women age 15–49 in union and selected for the domestic violence module. Chi-squared tests and multivariate logistic regressions were used to examine the predicators of STI status. The main explanatory variables included sexual empowerment, involvement in decision making on own health, experience of any sexual violence, condom use during last sex with most recent partner, number of lifetime partners and partner control behaviours. Sexual empowerment was measured with three indicators: a woman’s reported ability to refuse sex, ability to ask her partner to use a condom, and opinion regarding whether a woman is justified to refuse sex with her husband if he is unfaithful. Results Results show that 28 % of women in union reported STIs in the last 12 months. Sexual violence and number of lifetime partners were the strongest predictors of reporting STIs. Women’s sexual empowerment was a significant predictor of their STI status, but, surprisingly, the odds of reporting STIs were greater among women who were sexually empowered. Reporting of STIs was negatively associated with a woman’s participation in decision-making with respect to her own health, and was positively associated with experience of sexual violence, partner’s controlling behaviour, and having more than one life partner. Conclusions Our findings suggest that, with respect to STIs, sexual empowerment as measured in the study does not protect women who have sexually violent and controlling partners. Interventions promoting sexual health must effectively address negative masculine attitudes and roles that perpetuate unhealthy sexual behaviours and gender relations within marriage. It is also important to promote marital fidelity and better communication within union and to encourage women to take charge of their health jointly with their partners

Determinants of Male Circumcision for HIV/AIDS Prevention in East Central Uganda

Safe Male Circumcision (SMC) is one the effective strategies for reducing HIV transmission. The paper examines factors associated with SMC for HIV prevention, based on 4,979 males from East Central Uganda. Data were analysed using chi-squared tests and multinomial logistic regression. Older males aged 31 years and above (p < 0.001), from predominantly non-circumcising districts (Buyende - p < 0.001, Kaliro p < 0.01, and Kamuli - p < 0.01); who had neither used condoms (p = 0.03) nor tested for HIV (p < 0.001) were less likely to circumcise for HIV prevention. Males who were assessed in 2012 (p < 0.001) three years after program implementation were more likely to circumcise for HIV for HIV prevention. Males that did not take measures to prevent HIV infection were less likely to undertake SMC and are therefore highly vulnerable to infection. These (together with older males, and males from non-circumcising districts) should be targeted for promotion of SMC alongside other HIV preventive measures. For better results, the benefits SMC for children as well as adults require emphasis. Wider coverage of SMC services should entail adequate equipping of public and where feasible, private facilities and appropriate training of health personnel countrywide. Keywords: Male circumcision, HIV/AIDS prevention, Uganda

Maternal employment and child nutritional status in Uganda.

Nearly half of all deaths among children under five (U5) years in low- and middle-income countries are a result of under nutrition. This study examined the relationship between maternal employment and nutrition status of U5 children in Uganda using the 2016 Uganda Demographic and Health Survey (UDHS) data. We used a weighted sample of 3531 children U5 years born to working women age 15-49. Chi-squared tests and multivariate logistic regressions were used to examine the relationship between maternal employment and nutritional outcomes while adjusting for other explanatory factors. Results show that children whose mothers had secondary education had lower odds of stunting and underweight compared with children whose mothers had no formal education. Children who had normal birth weight had lower odds of stunting, wasting and being underweight compared with children with low birth weight. Children whose mothers engaged in agriculture and manual work had higher odds of stunting compared with those whose mothers engaged in professional work. Additionally, children whose mothers were employed by nonfamily members had higher odds of wasting and being underweight compared with children whose mothers were employed by family members. Other determinants of child nutritional status included region, age of the mother, and age and sex of the child. Interventions aimed at improving the nutritional status of children of employed women should promote breastfeeding and flexible conditions in workplaces, target those of low socio-economic status and promote feeding programs and mosquito net use for both mothers and children

Predictors of cervical cancer screening uptake in two districts of Central Uganda.

Uganda's cervical cancer age standardized incidence rate is four times the global estimate. Although Uganda's ministry of health recommends screening for women aged 25-49 years, the screening remains low even in the most developed region (Central Uganda) of the country. This study examined the demographic, social, and economic predictors of cervical cancer screening in Central Uganda with the aim of informing targeted interventions to improve screening. The cross-sectional survey was conducted in Wakiso and Nakasongola districts in Central Uganda. A total of 845 women age 25-49 years participated in the study. Data were analyzed at bivariate and multivariate levels to examine the predictors of CC (cervical cancer) screening. Only 1 in 5 women (20.6%) had ever screened for cervical cancer. Our multivariate logistic regression model indicated that wealth index, source of information, and knowledge about CC and CC screening were significantly associated with cervical cancer screening. The odds of cervical cancer screening were higher among rich women compared with poor women [AOR = 1.93 (95%CI: 1.06-3.42), p = 0.031)], receiving information from health providers compared with radios [AOR = 4.14 (95%CI: 2.65-6.48), p<0.001, and being more knowledgeable compared with being less knowledgeable about CC and CC screening [AOR = 2.46 (95%CI: 1.49-3.37), p<0.001)]. Overall cervical cancer screening uptake in central Uganda was found to be low. The findings of the study indicate that women from a wealthy background, who had been sensitized by health workers and with high knowledge about CC and CC screening had higher odds of having ever screened compared with their counterparts. Efforts to increase uptake of screening must address disparities in access to resources and knowledge