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.

Nucleic Acid Amplification Tests for Diagnosis of Smear-Negative TB in a High HIV-Prevalence Setting: A Prospective Cohort Study

Nucleic acid amplification tests are sensitive for identifying Mycobacterium tuberculosis in populations with positive sputum smears for acid-fast bacilli, but less sensitive in sputum-smear-negative populations. Few studies have evaluated the clinical impact of these tests in low-income countries with high burdens of TB and HIV.We prospectively enrolled 211 consecutive adults with cough ≥2 weeks and negative sputum smears at Mulago Hospital in Kampala, Uganda. We tested a single early-morning sputum specimen for Mycobacterium tuberculosis DNA using two nucleic acid amplification tests: a novel in-house polymerase chain reaction targeting the mycobacterial secA1 gene, and the commercial Amplified® Mycobacterium tuberculosis Direct (MTD) test (Gen-Probe Inc, San Diego, CA). We calculated the diagnostic accuracy of these index tests in reference to a primary microbiologic gold standard (positive mycobacterial culture of sputum or bronchoalveolar lavage fluid), and measured their likely clinical impact on additional tuberculosis cases detected among those not prescribed initial TB treatment.Of 211 patients enrolled, 170 (81%) were HIV-seropositive, with median CD4+ T-cell count 78 cells/µL (interquartile range 29-203). Among HIV-seropositive patients, 94 (55%) reported taking co-trimoxazole prophylaxis and 29 (17%) reported taking antiretroviral therapy. Seventy-five patients (36%) had culture-confirmed TB. Sensitivity of MTD was 39% (95% CI 28-51) and that of secA1 was 24% (95% CI 15-35). Both tests had specificities of 95% (95% CI 90-98). The MTD test correctly identified 18 (24%) TB patients not treated at discharge and led to a 72% relative increase in the smear-negative case detection rate.The secA1 and MTD nucleic acid amplification tests had moderate sensitivity and high specificity for TB in a predominantly HIV-seropositive population with negative sputum smears. Although newer, more sensitive nucleic acid assays may enhance detection of Mycobacterium tuberculosis in sputum, even currently available tests can provide substantial clinical impact in smear-negative populations

Examining the mismatch between fertility desire and contraceptive behaviour in the extended postpartum period in Uganda

In the two years following delivery, women often have an unmet need for family planning, with unplanned and not-optimally spaced pregnancies. Drawing on quantitative and qualitative data, this thesis explores women’s expressed fertility desire, decisions about further childbearing, and contraceptive use among Ugandan women in the extended postpartum period. Data from the 2016 Uganda Demographic and Health Survey (n=5,088 women) were analysed in bivariate and multivariate logistic regression. Qualitative data from 43 interviews with women and men, and 13 family planning providersliving in Mayuge district, Uganda, were transcribed, coded and analysed using thematic analysis. Overall, most women reported desire for further children; having children of the same sex, was associated with increased fertility desire, as was being Muslim. Practising postpartum abstinence, reporting the last child was unwanted, having at least, or more than the desired number of children, being unmarried, no formal education, and being unemployed were negatively associated with fertility desire. In interviews, Muslim men reported to desire large family sizes; women said to continue childbearing to maintain marital stability—implying a need for family planning programmes to actively engage male partners. Contraceptive use was low (33%) and inconsistent with the 92% of women who said not to want a child soon. In interviews, the mismatch was attributed to poor access to contraceptives, side effects, being amenorrhoeic, and provider and partner attitudes. Women recognised they were not at risk of pregnancy while amenorrhoeic, but did not appreciate they could conceive before return of menstruation; educational efforts are needed to encourage the uptake of contraception during postpartum amenorrhoea. In conclusion, programme implementers need to take social norms that favour child sex preference into consideration when providing support to women in their fertility-decision making. This could be done through opinion leaders, such as religious leaders and community leaders, to increase understanding of the importance of birth spacing for women and childrens’ health