Being an 'adolescent': The consequences of gendered risks for young people in rural Uganda.

The behaviour of adolescents is recognised increasingly as having substantial and long-term consequences for their health. We examined the meaning of 'adolescence' in southern Uganda with HIV-positive young people aged 11-24 years. Adolescent girls and boys are described differently in the local language (Luganda). Adolescence is described as a behavioural rather than a life course category and an inherently dangerous one. The practices, risks and consequences of 'adolescent' behaviour are highly gendered. Local understandings of adolescence are likely to have a significant impact on the efficacy of interventions designed to minimise their 'risky behaviour'

Gender, land and responses to health and environmental shocks in rural South Western Uganda

We examine the gendered responses to shocks – including HIV-related illness and death, and environmental factors such as drought or too much rain – and how women in south western Uganda navigate structural barriers such as the gender constraints in land ownership, to cope with the impact of shocks. The study is based on data drawn from households selected from a General Population Cohort of 20,000 people in Kalungu District. As part of a larger study investigating the impact of HIV on agricultural livelihoods, 22 households were purposively sampled for a qualitative study. These households were stratified by sex of household head and by a death having occurred/not occurred of an HIV-positive individual in the household. Our findings show the gendered dimensions in household responses to crises are shaped by women and men’s position in the social structure in general and within their families and households. Women can make effective use of their social relations to obtain material support and information to improve their family’s livelihood

Dealing with disclosure: Perspectives from HIV-positive children and their older carers living in rural south-western Uganda.

There are limited data on the challenges faced by carers, in particular older carers, in managing the difficult task of status disclosure for HIV-positive children. We report findings from qualitative interviews with 18 care dyads of older people and HIV-positive children living in rural south-western Uganda. Our data provide insights into perceptions and norms influencing communication during and following disclosure among both carers and children, including those shaped by gendered expectations of girls' and boys' sexual behaviour. Young participants reported several advantages of knowing their status and showed considerable resilience in the face of HIV disclosure. Better and more support is needed to help health workers and carers (particularly older carers) manage cross-generational communication around HIV disclosure and other related aspects of sexual and reproductive health as critical aspects of children's psychosocial development and well-being

Stroke Survivors’ Knowledge of Risk Factors for Stroke and their Post-Stroke Care Seeking Experiences: A cross-sectional study in rural southwestern Uganda.

INTRODUCTION: Stroke is a major cause of morbidity and mortality globally. The aim of this study was to examine the stroke survivors’ knowledge of the risk factors for stroke, stroke warning signs and post stroke care seeking behaviour and signs of stroke in rural southwestern Uganda. MATERIALS AND METHODS: A mixed methods cross-sectional study was conducted from October 2018 to February 2019, with 25 stroke survivors in a general population cohort. Questionnaire were administered with 25 people and in-depth interviews conducted with 10 people. Descriptive statistics and thematic content analysis were applied to the quantitative and qualitative data, respectively. RESULTS: Participants described stroke as: a persistent numbness of a particular body part; a condition due to witchcraft; a sexually transmitted infection (‘obulwadde bw’obukaba’); a disease parents get when a daughter engages in pre-marital sex in their home (‘obuko’). The participants reported that their awareness of their own hypertension and diabetes increased post-stroke. Participants also reported that their smoking prevalence decreased in the post-stroke period. Participants reported experiencing persistent headaches and numbness but did not associate them with stroke. Participants responding to the questionnaire described post-stroke care as biomedical (19/25), traditional (13/25) and for rehabilitation (10/25). The participants also described delays in seeking medical care because either they did not know what to do, or they thought the stroke was a self-limiting brief episode or that they required alternative treatment to biomedical care. CONCLUSION: Misconceptions around the causes of stroke, and poor care seeking behaviour suggests a need for health education to improve community knowledge about risk factors and warning signs of stroke to help reduce incidence and improve post stroke treatment outcomes

Adherence to antiretroviral therapy in Jinja, Uganda: a six-year follow-up study.

INTRODUCTION: We report on the adherence experience of a group of people living with HIV on ART over six years in Uganda. METHODS: Between 2005 and 2009, we followed up 41 participants who were also part of a clinical trial comparing home and facility based delivery of ART in Jinja, eastern Uganda. We conducted qualitative in-depth interviews at enrolment, 3, 6, 18 and 30 months to capture experiences with adherence over time. In 2011 we returned to these participants to find out how they were fairing with long term adherence. We managed to retrace 24 participants and interviewed them about their experience. We thematically analysed the data and compared findings over time. RESULTS: Initially there were few barriers to adherence and many followed the adherence guidance closely. By year six, relaxation of these rules was noticeable although self-reported adherence continued to be high. Alcohol consumption was more common than before. Some relatives of the participants who had died claimed that some deaths were a result of alcohol. While participants reported that ART had allowed them to reclaim independence and return to work the changes in work and social routines created new challenges for adherence. Side effects like lipodystrophy were not only causing some stigma but for some tested their faith in the drugs. Many participants reported resumption of sexual lives but apart from those who selected same status partners, disclosure to new partners was minimal. CONCLUSION: Good adherence practice to ART wanes over the long-term, and people who may have disclosed at initiation find it difficult to do so to new partners once they are healthy. Further adherence interventions and support with disclosure over the course of therapy may need to be considered

Stroke Survivors’ Knowledge of Risk Factors for Stroke and their Post-Stroke Care Seeking Experiences: A cross-sectional study in rural southwestern Uganda

Introduction: Stroke is a major cause of morbidity and mortality globally. The aim of this study was to examine the stroke survivors’ knowledge of the risk factors for stroke, stroke warning signs and post stroke care seeking behaviour and signs of stroke in rural southwestern Uganda. Materials and Methods: A mixed methods cross-sectional study was conducted from October 2018 to February 2019, with 25 stroke survivors in a general population cohort. Questionnaire were administered with 25 people and in-depth interviews conducted with 10 people. Descriptive statistics and thematic content analysis were applied to the quantitative and qualitative data, respectively. Results: Participants described stroke as: a persistent numbness of a particular body part; a condition due to witchcraft; a sexually transmitted infection (‘obulwadde bw’obukaba’); a disease parents get when a daughter engages in pre-marital sex in their home (‘obuko’). The participants reported that their awareness of their own hypertension and diabetes increased post-stroke. Participants also reported that their smoking prevalence decreased in the post-stroke period. Participants reported experiencing persistent headaches and numbness but did not associate them with stroke. Participants responding to the questionnaire described post-stroke care as biomedical (19/25), traditional (13/25) and for rehabilitation (10/25). The participants also described delays in seeking medical care because either they did not know what to do, or they thought the stroke was a self-limiting brief episode or that they required alternative treatment to biomedical care. Conclusion: Misconceptions around the causes of stroke, and poor care seeking behaviour suggests a need for health education to improve community knowledge about risk factors and warning signs of stroke to help reduce incidence and improve post stroke treatment outcomes