Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study

This article reports the evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda.Background: Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda. Methods: This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool. Results: Of the 391 women, 189 (48.3 %) reported that they had ever utilized motorcycle ambulances. Of these, 94.7 % were currently married or living together with a partner while 50.8 % earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95 % CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95 % CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95 % CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95 % CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances were meant for and appreciated their role in taking pregnant women to health facilities. Conclusion: The use of motorcycle ambulances was associated with older age of the mother, male participation in birth preparedness, and consultations with TBAs. These findings suggest a need for interventions to involve men in reproductive health as well as efforts to reach women younger than 35 years of age

FACTORS ASSOCIATED WITH CURRENT USE OF MODERN CONTRACEPTIVE METHODS AMONG YOUNG MARKET WOMEN WORKING AT ST. BALIKUDDEMBE MARKET IN KAMPALA, UGANDA: A CROSS-SECTIONAL STUDY.

Background:  Despite increased access to modern contraception among young women globally, little is known about modern contraceptive use among women working in the informal sector who are usually missed out on in most national surveys. We assessed the factors associated with modern contraceptive use among young market women in Kampala, Uganda. Methods: This was a cross-sectional study conducted among 343 young women aged 15-24 years, working at St. Balikuddembe Market in Kampala, the Capital City of Uganda. Data were collected on socio-demographic and behavior characteristics including the current use of modern FP methods. We computed the proportion of young women who reported the current use of modern FP methods and determined the factors associated with the current use of modern FP methods using a modified Poisson regression model.   Results:  Of 343 young market women, 56% (192) were food handlers. Nearly half of the women (48.4, n=166) had at least one biological child. Forty-seven percent (160) of the women reported the current use of modern FP methods. Having 1-2 living children (adjusted Prevalence Ratio [aPR] =1.81, 95% Confidence Interval [95%CI]: 1.20, 2.72) or three or more living children (aPR=2.20, 95%CI: 1.33, 3.64), age 20-24 years (aPR=2.15, 95%CI: 1.46, 3.17), having secondary education (aPR=2.75, 95%CI: 1.05, 7.21), and having a positive attitude towards modern FP (aPR=1.35, 95%CI: 1.07, 1.71) were positively associated with current use of modern FP methods. Conclusion:  The use of modern contraception among young market women remains sub-optimal. Having at least one living child, older age, and secondary education were the factors associated with modern contraceptive use in this population.  Recommendation:  Our findings suggest a need for innovative, target-specific FP interventions with a focus on several biological children, level of education, and age, to improve the uptake of modern contraceptive services among young market women in this setting. 

Correlates of previous couples' HIV counseling and testing uptake among married individuals in three HIV prevalence strata in Rakai, Uganda.

BACKGROUND: Studies show that uptake of couples' HIV counseling and testing (couples' HCT) can be affected by individual, relationship, and socioeconomic factors. However, while couples' HCT uptake can also be affected by background HIV prevalence and awareness of the existence of couples' HCT services, this is yet to be documented. We explored the correlates of previous couples' HCT uptake among married individuals in a rural Ugandan district with differing HIV prevalence levels. DESIGN: This was a cross-sectional study conducted among 2,135 married individuals resident in the three HIV prevalence strata (low HIV prevalence: 9.7-11.2%; middle HIV prevalence: 11.4-16.4%; and high HIV prevalence: 20.5-43%) in Rakai district, southwestern Uganda, between November 2013 and February 2014. Data were collected on sociodemographic and behavioral characteristics, including previous receipt of couples' HCT. HIV testing data were obtained from the Rakai Community Cohort Study. We conducted multivariable logistic regression analysis to identify correlates that are independently associated with previous receipt of couples' HCT. Data analysis was conducted using STATA (statistical software, version 11.2). RESULTS: Of the 2,135 married individuals enrolled, the majority (n=1,783, 83.5%) had been married for five or more years while (n=1,460, 66%) were in the first-order of marriage. Ever receipt of HCT was almost universal (n=2,020, 95%); of those ever tested, (n=846, 41.9%) reported that they had ever received couples' HCT. There was no significant difference in previous receipt of couples' HCT between low (n=309, 43.9%), middle (n=295, 41.7%), and high (n=242, 39.7%) HIV prevalence settings (p=0.61). Marital order was not significantly associated with previous receipt of couples' HCT. However, marital duration [five or more years vis-à-vis 1-2 years: adjusted odds ratio (aOR): 1.06; 95% confidence interval (95% CI): 1.04-1.08] and awareness about the existence of couples' HCT services within the Rakai community cohort (aOR: 7.58; 95% CI: 5.63-10.20) were significantly associated with previous receipt of couples' HCT. CONCLUSIONS: Previous couples' HCT uptake did not significantly differ by HIV prevalence setting. Longer marital duration and awareness of the existence of couples' HCT services in the community were significantly correlated with previous receipt of couples' HCT. These findings suggest a need for innovative demand-creation interventions to raise awareness about couples' HCT service availability to improve couples' HCT uptake among married individuals

AWARENESS, PERCEPTIONS AND ACCEPTABILITY OF THE COVID-19 VACCINE IN BUGIRI DISTRICT: A CROSS-SECTIONAL STUDY.

Background: Globally, COVID-19 vaccine uptake has been hampered by misperceptions and conspiracy theories. We investigated people’s awareness, perceptions, and acceptability of the COVID-19 vaccine in Bugiri district.   Methods: This was a cross-sectional study among COVID-19 unvaccinated adults aged 18 and above. Data were collected in October and November 2021. Data were collected on people’s awareness, perceptions, and willingness to accept the vaccine if availed freely. ‘Acceptability of the COVID-19 vaccine’ denoted people’s willingness to accept to take the vaccine if offered to them free of charge. We used an interviewer-administered, pilot-tested, structured questionnaire loaded on a mobile phone to collect data from 465 respondents. Data were analyzed using STATA version 15.0.   Results: Of 465 respondents, 59.05% (n=274) were aged 18-35 years; 52.80% (n=245) were male; 68.97% (n=320) were married; while 68.75% (n=319) attained primary education. Overall, awareness about the COVID-19 vaccine was nearly universal (95.04%, n=441), with no marked difference between males and females. We found favorable perceptions towards the COVID-19 vaccine, with slightly more than three-quarters (76.72%, n=356) agreeing with the statement that people should be willingly vaccinated against COVID-19. When asked about their willingness to accept the COVID-19 vaccine, 60.78% (n=282) reported that they would be willing to accept the vaccine if it was to be given to them free of charge, with a higher of males (75.80%, n=166) indicating that they would be willing to accept the vaccine than their female counterparts (60%, n=147). Conclusion: Awareness was nearly universal and respondents had favorable perceptions towards the COVID-19 vaccine. Only six in ten participants would accept the COVID-19 vaccine if availed to them free of charge. Findings suggest increased access to improve uptake. Recommendation: Our study findings suggest efforts should be geared towards increasing access to vaccines while reducing associated costs in order to improve acceptance

Expanding access to voluntary HIV counselling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001–2007

This article reports The changing face of the HIV ⁄ AIDS epidemic has resulted in new opportunities to increase access to voluntary HIV counselling and testing (VCT), especially during the past 7 years (2001–2007).The changing face of the HIV ⁄ AIDS epidemic has resulted in new opportunities to increase access to voluntary HIV counselling and testing (VCT), especially during the past 7 years (2001–2007). As access to HIV treatment becomes more widely available in sub-Saharan Africa, the need for enhanced access to VCT would become even greater. When given the opportunity, many more adults in sub-Saharan African would accept VCT, and many clearly express the desire to learn their HIV sero-status. However, in most parts of sub-Saharan Africa, fewer than one in 10 people know their HIV status. Stigma, fear of receiving an HIV-positive status, lack of confidentiality, long distances to VCT sites, and long delays in returning HIV test results limit people’s access to traditional VCT systems. Alternative VCT delivery models, such as mobile VCT, routine offer of VCT and home-based VCT increase access to and uptake of VCT. We recommend that these alternative models be implemented in more settings and on a much larger scale in sub-Saharan Africa, where VCT uptake rates remain low

HIV health care providers’ perspectives on smoking behavior among PLHIV and smoking cessation service provision in HIV clinics in Uganda

Introduction: Integration of smoking cessation interventions into HIV care can play a crucial role in reducing the growing burden of disease due to smoking among people living with HIV (PLHIV). However, there is a dearth of information on HIV care providers’ perspectives towards integrating smoking cessation interventions into HIV care programs. We explored HIV health care providers’ perceptions on the smoking behaviour among PLHIV, and the provision of smoking cessation services to PLHIV who smoke within HIV care services in Uganda. Methods: Semi structured face-to-face qualitative interviews were conducted with 12 HIV care providers between October and November 2019. Data were collected on perceptions on smoking among HIV-positive patients enrolled in HIV care, support provided to PLHIV who smoke to quit and integrating smoking cessation services into HIV care programs. Data were analysed deductively following a thematic framework approach. Results: Findings show that: a); HIV care providers in HIV clinics had low knowledge on the prevalence and magnitude of smoking among PLHIV who attended the clinics b) HIV care providers did not routinely screen HIV-positive patients for smoking and offered sub-optimal smoking cessation services; c) HIV care providers had a positive attitude towards integration of tobacco smoking cessation services into HIV care programs but called for support in form of guidelines, capacity building and strengthening of data collection and use as part of the integration process. Conclusion: Our study shows that HIV care providers did not routinely screen for tobacco use among PLHIV and offered suboptimal cessation support to smoking patients but they have a positive attitude towards the integration of tobacco smoking into HIV care programs. These findings suggest a favourable ground for integrating tobacco smoking cessation interventions to into HIV care programmes

HIV counseling and testing practices among clients presenting at a market HIV clinic in Kampala, Uganda: a cross-sectional study.

Background: Uptake of HIV counseling and testing (HCT) among informal sector workers is not well documented. Objective: To assess HCT practices among clients presenting for HIV services at a market HIV clinic in Kampala, Uganda. Methods: Between August 1 and September 15, 2009, clients presenting for HIV services at a market HIV clinic were invited to participate in the study. Socio-demographic and HCT data were collected from consenting adults aged 16+ years. Descriptive statistics were performed using STATA version 14.1. Results: Of 224 individuals who consented to the interview, n=139 62 % were market vendors while n=85 38 % were engaged in other market-related activities. Majority of the respondents, n=165, 73.7 %, had ever tested for HIV; of these, n=148,89.7 % had ever tested for 2+ times. The main reasons for repeat testing were the need to confirm previous HIV test results, n=126, 85.1% and the belief that the previous HIV test results were false, n=35, 23.6 %. Uptake of couples\u2019 HCT was low, n=63, 38.2 %, despite the fact that n=200, 89 % had ever heard of couples\u2019 HCT. Conclusion: These findings indicate high rates of repeat testing but low rates of couples\u2019 HCT uptake in this population

Diagnostic Infectious Diseases Testing Outside Clinics: A Global Systematic Review and Meta-analysis.

BACKGROUND: Most people around the world do not have access to facility-based diagnostic testing, and the gap in availability of diagnostic tests is a major public health challenge. Self-testing, self-sampling, and institutional testing outside conventional clinical settings are transforming infectious disease diagnostic testing in a wide range of low- and middle-income countries (LMICs). We examined the delivery models of infectious disease diagnostic testing outside clinics to assess the impact on test uptake and linkage to care. METHODS: We conducted a systematic review and meta-analysis, searching 6 databases and including original research manuscripts comparing testing outside clinics with conventional testing. The main outcomes were test uptake and linkage to care, delivery models, and adverse outcomes. Data from studies with similar interventions and outcomes within thematic areas of interest were pooled, and the quality of evidence was assessed using GRADE. This study was registered in PROSPERO (CRD42019140828).We identified 10 386 de-duplicated citations, and 76 studies were included. Data from 18 studies were pooled in meta-analyses. Studies focused on HIV (48 studies), chlamydia (8 studies), and multiple diseases (20 studies). HIV self-testing increased test uptake compared with facility-based testing (9 studies: pooled odds ratio [OR], 2.59; 95% CI, 1.06-6.29; moderate quality). Self-sampling for sexually transmitted infections increased test uptake compared with facility-based testing (7 studies: pooled OR, 1.74; 95% CI, 0.97-3.12; moderate quality). Conclusions.  Testing outside of clinics increased test uptake without significant adverse outcomes. These testing approaches provide an opportunity to expand access and empower patients. Further implementation research, scale-up of effective service delivery models, and policies in LMIC settings are needed