Men’s Involvement in a Parenting Programme to Reduce Child Maltreatment and Gender-Based Violence: Formative Evaluation in Uganda

AbstractParenting programmes involving fathers can reduce child maltreatment and gender-based violence. However, most parenting programmes find it difficult to recruit fathers. We piloted a 21 session parenting intervention, ‘Parenting for Respectability’, with fathers and mothers near Kampala, Uganda. Sixty-one fathers and 83 mothers were recruited initially and 52 fathers and 76 mothers retained to the end. We interviewed with 24 fathers and 16 mothers. Data were analysed thematically. Success in involving fathers was probably due to (a) the first 10 sessions being father-only, allowing them to share experiences before participating in mixed-sex sessions; (b) exploiting men’s pre-existing motivation to improve their children’s behaviour, thereby enhancing family respectability; and (c) the interactive, participatory delivery. Mixed sessions enabled couples to clarify conflicting perspectives regarding spousal relationships and gendered norms. However, men experienced social pressure to conform to conventional masculinity, suggesting the need to instil intervention values at community level. </jats:p

Poor Parenting:Teenagers' Views on Adolescent Pregnancy in Eastern Uganda

In Uganda teenage pregnancy is considered a problem for moral and social, as well as health, reasons. This qualitative study in Busia District focused on the views of teenagers themselves as expressed in 9 focus group discussions with girls and boys. Their perspectives were contrasted with those of community leaders and mothers of adolescents. The young people blamed teenage pregnancy on failuresof the parental generation. They asserted that parents and guardians were both too lenient and too harsh, that they failed to provide for their daughters’ needs, and that they pressured them into early marriagesinstead of giving priority to education. Although poverty and family breakdown were recognized as underlying structural causes of parental failure, the teenagers experienced these factors in their everydaylives as problems with their parents and guardians. The teenagers expressed the ‘enlightened’ view that adolescent pregnancy was undesireable, even though many girls have few alternatives to marriage and childbearing. (Afr J Reprod Health 2009; 13[4]:113-127

Understanding Unlicensed Drug Vendor Practices Related to Childhood Malaria in One Rural District of Uganda: An Exploratory Study

This study investigated unlicensed drug outlets’ practices for the management of malaria in the rural district of Butaleja, Uganda. A qualitative design using semistructured interviews was used. Interviews were recorded, translated, transcribed, and analyzed using thematic analysis. A total of 75 vendors, representing 85% of the outlets in the study area, were interviewed. Most of the vendors were associated with a drug shop type of outfit. About three-quarters reported having completed some level of postsecondary education, but just one-tenth of the vendors had qualifications that made them eligible to apply for a license to operate a drug shop. While most outlets stocked at least one type of antimalarial, only about one-quarter stocked an artemisinin-based combination therapy (ACT), one-quarter expressed a preference for ACTs, and less than one-tenth attested to firmly adhering to the national malaria treatment guidelines on dispensing ACTs as the first-line option. In contrast, nine out of 10 vendors stocked quinine and well over a third stocked antimalarials no longer recommended, such as chloroquine and sulphadoxine-pyrimethamine. Given the ongoing gap between the national malaria policy and unlicensed drug outlet practices, this study calls for greater engagement of unlicensed vendors to improve the management of childhood malaria

Mauvaise éducation des enfants : Les opinions des adolescents sur la grossesse chez les adolescentes en Ouganda de l’est

In Uganda teenage pregnancy is considered a problem for moral and social, as well as health, reasons. This qualitative study in Busia District focused on the views of teenagers themselves as expressed in 9 focus group discussions with girls and boys. Their perspectives were contrasted with those of community leaders and mothers of adolescents. The young people blamed teenage pregnancy on failures of the parental generation. They asserted that parents and guardians were both too lenient and too harsh, that they failed to provide for their daughters’ needs, and that they pressured them into early marriages instead of giving priority to education. Although poverty and family breakdown were recognized as underlying structural causes of parental failure, the teenagers experienced these factors in their everyday lives as problems with their parents and guardians. The teenagers expressed the "enlightened" view that adolescent pregnancy was undesireable, even though many girls have few alternatives to marriage and childbearing (Afr J Reprod Health 2009; 13[4]:113-127).En Ouganda, on considère que la grossesse chez les adolescentes est un problème pour des raisons morales, sociales aussi bien que de la santé. Cette étude qualitative menée dans le District de Busia est concentrée sur les opinions des adolescents eux-mêmes comme elles ont été exprimées dans 9 discussions à groupe cible avec les filles et les garçons. Nous avons mis leurs opinions en contraste avec celles des chefs de la communauté et les mères des adolescents. Les jeunes gens ont rejetté la responsabilité de la grossesse chez les adolescentes sur le dos des parents. Ils affirment que les parents et les gardiens étaient à la fois trop indulgents et trop sévères qu’ils ont échoue dans leur responsabilité de fournir ce dont leurs filles ont besoin et qu’ils ont mis la pression sur les filles pour qu’elles se marient tôt au lieu de donner la priorité à l’éducation. Bien que la pauvreté et la rapture dans la vie familiale ont été reconnues comme étant des causes structurales qui sous-tendent l’échec parental, les adolescents vivent ces expériences quotidiennement comme des problèmes avec leurs parents et leurs gardians. Les adolescents ont exprimé cette opinion éclairée que la grossesse chez les adolescentes était indésirable, bien que beaucoup de filles ont peu d’alternatifs au mariage et à la maternité (Afr J Reprod Health 2009; 13[4]:113-127)

Assets and challenges facing caregivers when managing malaria in young children in rural Uganda

Background: Despite efforts to improve malaria management for children, a substantial gap remains between policy and practice in Uganda. The aim of this study was to create quantitative profiles of assets and challenges facing caregivers in Butaleja District when managing malaria in children aged 5 years and under. The objectives were: (1) to estimate caregivers’ assets and challenges during an acute episode; and, (2) to ascertain which caregiver attributes influenced receipt of an appropriate anti-malarial the most. Methods Data from a 2011 cross-sectional, household survey and ten psychometrically justified scales were used to estimate caregivers’ assets and challenges. The scales scores were simple counts across a series of items, for example, the number of times a caregiver answered a knowledge item correctly or the number of times a caregiver relied on a credible source for information. Since high scores on six of the scales reflected attributes that eased the burden of caregiving, these were labelled ‘caregiver assets’. Similarly, high scores on four of the measures signalled that a caregiver was having trouble managing the malaria episode, thereby reflecting deficits, and these were labelled ‘caregiver challenges’. ANOVAs were used to compare scale scores between caregivers of children who received an appropriate anti-malarial versus those who did not. Results On the six asset scales, caregivers averaged highest on knowledge (65 %), followed by correct episode management (48 %), use of trustworthy information sources (40 %), ability to initiate or redirect their child’s treatment (37 %), and lowest on possible encounters with health professionals to assist in treatment decisions (33 %). Similarly, the average caregiver reported problems with 74 % of the issues they might encounter in accessing advice, and 56 % of the problems in obtaining the best anti-malarial. Caregivers whose children received an appropriate anti-malarial demonstrated greater assets and fewer challenges than those whose child did not, with important regional differences existing. Overall, no one region performed particularly well across all ten scales. Conclusions Findings from this study suggest that the low use of artemisinin-based combination therapy (ACT) in Butaleja for children 5 years and under may result from caregivers’ high perceived barrier to accessing ACT and low perceived benefits from ACT.Education, Faculty ofMedicine, Faculty ofNon UBCEducational Studies (EDST), Department ofPopulation and Public Health (SPPH), School ofReviewedFacult

Challenges with accessing health care for young children presumed to have malaria in the rural district of Butaleja, Uganda: a qualitative study

Objective: A qualitative study was conducted to gain insight into challenges reported by Butaleja households during a previous household survey. Specifically, this paper discusses heads of households’ and caregivers’ perceptions of challenges they face when seeking care for their very young children with fever presumed to be malaria. Methods: Eleven focus groups (FGs) were carried out with household members (five with heads of households and six with household caregivers) residing in five sub-counties located across the district. Purposive sampling was used to ensure the sample represented the religious diversity and geographical distance from the peri-urban center of the district. Each FG consisted of five to six participants. The FGs were conducted at a community centre by two pairs of researchers residing in the district and who were fluent in both English and the local dialect of Lunyole. The discussions were recorded, translated, and transcribed. Transcripts were reviewed and coded with the assistance of QDA Miner (version 4.0) qualitative data management software, and analyzed using thematic content analysis. Results: The FG discussions identified four major areas of challenges when managing acute febrile illness in their child under the age of five with presumed malaria: (1) difficulties with getting to public health facilities due to long geographical distances and lack of affordable transportation; (2) poor service once at a public health facility, including denial of care, delay in treatment, and negative experiences with the staff; (3) difficulties with managing the child’s illness at home, including challenges with keeping home-stock medicines and administering medicines as prescribed; and (4) constrained to use private outlets despite their shortcomings. Conclusions: Future interventions may need to look beyond the public health system to improve case management of childhood malaria at the community level in rural districts such as Butaleja. Given the difficulties with accessing quality private health outlets, there is a need to partner with the private sector to explore feasible models of community-based health insurance programs and expand the role of informal private providers

A Ugandan parenting programme to prevent gender-based violence: description and formative evaluation

Purpose: To develop a culturally-sensitive intervention for the early prevention of gender-based violence (GBV) in Uganda. Methods: Programme design followed the 6SQuID model of intervention development and multi-sectorial advice. A formative evaluation was conducted in two communities with six groups and 138 participants. Findings: Four familial predictors of GBV were identified as potentially malleable: poor parent–child attachment, harsh parenting, inequitable gendered socialization and parental conflict. A community-based parenting programme was developed to address them. Its programme theory incorporates Attachment Theory, the concept that positive behavioural control develops emotional control, and Social Learning Theory. Its rationale, structure and content are presented using the TIDieR checklist. A formative evaluation showed the programme to be widely acceptable, culturally appropriate, and perceived to be effective, but also identified challenges. Conclusion: The careful development of this community-based parenting programme shows promise for the early prevention of GBV

Patterns of treatment-seeking behaviors among caregivers of febrile young children: a Ugandan multiple case study

Background: The vast majority of malaria deaths in Uganda occur in children five and under and in rural areas. This study’s exploratory case study approach captured unique situations to illustrate special attributes and aspects of treatment-seeking during a malaria episode. Methods During August 2010, a qualitative exploratory study was conducted in seven of Butaleja District’s 12 sub-counties. Multiple case study methodology consisting of loosely-structured interviews were carried out with eight caregivers of children five and under in the local dialect. Caregivers were geographically distant and not known to each other. Interviews were translated into English and transcribed the same day. Data were analyzed using content analysis. Results Of the eight cases, children recovered fully in three instances, survived but with deficits in three, and died in two. Common to all outcomes were (1) triggers to illness recognition, (2) similar treatment sequences and practices, (3) factors which influenced caregivers’ treatment-seeking decisions, (4) challenges encountered while seeking care at public health facilities, (5) cost burdens associated with managing malaria, (6) life burdens resulting from negative outcomes from malaria, (7) variations in caregiver knowledge about artemisinin combination therapy, and (8) varying perspectives how malaria management could be improved. Conclusions Despite the reality that caregivers in Butaleja District generally share similar practices, experiences and challenges, very few children ever receive treatment in accordance with the Uganda’s national guidelines. To bring national practice into conformance with policy, three advances must occur: (1) All key stakeholders (those affiliated with the formal health system - public facilities and licensed private outlets, unlicensed drug vendors, and caregivers of young children) must concur on the need and the means to improve malaria management, (2) all health providers (formal and unlicensed) need to be engaged in training and certification to improve timely access to affordable treatment irrespective of a region’s remoteness or low population density, and (3) future public health interventions need to improve caregivers’ capacity to take the necessary actions to best manage malaria in young children.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult