Anette Agardh

Associations between mass media exposure and birth preparedness among women in southwestern Uganda: a community-based survey

Background Exposure to mass media provides increased awareness and knowledge, as well as changes in attitudes, social norms and behaviors that may lead to positive public health outcomes. Birth preparedness (i.e. the preparations for childbirth made by pregnant women, their families, and communities) increases the use of skilled birth attendants (SBAs) and hence reduces maternal morbidity and mortality. Objective The aim of this study was to explore the association between media exposure and birth preparedness in rural Uganda. Method A total of 765 recently delivered women from 120 villages in the Mbarara District of southwest Uganda were selected for a community-based survey using two-stage cluster sampling. Univariate and multivariate logistic regression was performed with generalized linear mixed models using SPSS 21. Results We found that 88.6% of the women surveyed listened to the radio and 33.9% read newspapers. Birth preparedness actions included were money saved (87.8%), identified SBA (64.3%), identified transport (60.1%), and purchased childbirth materials (20.7%). Women who had taken three or more actions were coded as well birth prepared (53.9%). Women who read newspapers were more likely to be birth prepared (adjusted OR 2.2, 95% CI 1.5–3.2). High media exposure, i.e. regular exposure to radio, newspaper, or television, showed no significant association with birth preparedness (adjusted OR 1.3, 95% CI 0.9–2.0). Conclusion Our results indicate that increased reading of newspapers can enhance birth preparedness and skilled birth attendance. Apart from general literacy skills, this requires newspapers to be accessible in terms of language, dissemination, and cost.Background Exposure to mass media provides increased awareness and knowledge, as well as changes in attitudes, social norms and behaviors that may lead to positive public health outcomes. Birth preparedness (i.e. the preparations for childbirth made by pregnant women, their families, and communities) increases the use of skilled birth attendants (SBAs) and hence reduces maternal morbidity and mortality. Objective The aim of this study was to explore the association between media exposure and birth preparedness in rural Uganda. Method A total of 765 recently delivered women from 120 villages in the Mbarara District of southwest Uganda were selected for a community-based survey using two-stage cluster sampling. Univariate and multivariate logistic regression was performed with generalized linear mixed models using SPSS 21. Results We found that 88.6% of the women surveyed listened to the radio and 33.9% read newspapers. Birth preparedness actions included were money saved (87.8%), identified SBA (64.3%), identified transport (60.1%), and purchased childbirth materials (20.7%). Women who had taken three or more actions were coded as well birth prepared (53.9%). Women who read newspapers were more likely to be birth prepared (adjusted OR 2.2, 95% CI 1.5-3.2). High media exposure, i.e. regular exposure to radio, newspaper, or television, showed no significant association with birth preparedness (adjusted OR 1.3, 95% CI 0.9-2.0). Conclusion Our results indicate that increased reading of newspapers can enhance birth preparedness and skilled birth attendance. Apart from general literacy skills, this requires newspapers to be accessible in terms of language, dissemination, and cost.

Youth, Sexual Risk-Taking Behavior, and Mental Health: a Study of University Students in Uganda.

BackgroundLittle focus has been paid to the role of mental health among young people with regard to risky sexual behavior and HIV prevention in sub-Saharan Africa. The aim of this study was to investigate the relationship between poor mental health and risky sexual behavior (HIV/AIDS) among a population of university students in Uganda.MethodsIn 2005, 980 Ugandan university students completed a self-administered questionnaire (response rate 80%) assessing sociodemographic and religious background factors, mental health, alcohol use, and sexual behavior. Mental health was assessed using items from the Hopkins Symptoms Checklist-25 and the Symptom Checklist-90.ResultsHigh scores on depression and high numbers of sexual partners among both males (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.2–3.3) and females (OR 3.3, 95% CI 1.3–8.6) were significantly associated. Elevated anxiety scores among men were associated with high numbers of sexual partners (OR 1.9, 95% CI 1.1–3.3) and inconsistent condom use (OR 1.9, 95% CI 1.1–3.6). Psychoticism was also significantly associated with high numbers of sexual partners among men. The associations remained statistically significant after controlling for sociodemographic factors and level of alcohol consumption.ConclusionThese findings indicate that previous conclusions on the association between sexual behavior and mental health from high- and middle-income countries also are valid in a low-income setting, such as in Uganda. This knowledge has implications for policy formation and HIV/AIDS preventive strategies. Coordinated youth-friendly mental health and sexual and reproductive health services to meet the needs of young people would be desirable.

Experience of sexual coercion and risky sexual behavior among Ugandan university students

BackgroundGrowing worldwide evidence shows that the experience of sexual coercion is fairly prevalent among young people and is associated with risky sexual behavior thereafter. The causal mechanisms behind this are unclear but may be dependent on specific contextual determinants. Little is known about factors that could buffer the negative effects of coercion. The aim of this study was to assess the association between the experience of sexual coercion and risky sexual behavior among university students of both sexes in Uganda.MethodsIn 2005, 980 (80%) out of a total of 1,220 students enrolled in Mbarara University of Science and Technology in Uganda participated in a self-administered questionnaire covering socio-demographic and religious factors, social capital, mental health, alcohol use, and sexual behavior. A validated scale of six items was used to assess the experience of sexual coercion. Logistic regression analyses were applied to control for confounders. Potential buffering factors were analyzed by testing for effect modification.ResultsFifty-nine percent of those who responded had previously had sexual intercourse. Among the male students 29.0%, and among the female students 33.1% reported having had some experience of sexual coercion. After controlling for age, gender, and educational level of household of origin, role of religion and trust in others sexual coercion was found to be statistically significantly associated with previously had sex (OR 1.6, 95% CI; 1.1-2.3), early sexual debut (OR 2.4, 95% CI; 1.5-3.7), as well as with having had a great number of sexual partners (OR 1.9, 95% CI; 1.2-3.0), but not with inconsistent condom use.Scoring low on an assessment of mental health problems, reporting high trust in others, or stating that religion played a major role in ones family of origin seemed to buffer the negative effect that the experience of sexual coercion had on the likelihood of having many sexual partners.ConclusionThe findings of this study suggest that the experience of sexual coercion is common among youth/young adults in Uganda and is subsequently associated with risky sexual behavior in both sexes. The existence of individual and contextual factors that buffer the effects mentioned was also demonstrated. In the Ugandan context, this has implications for policy formulation and the implementation of preventive strategies for combating HIV/AIDS.

Social capital and sexual behavior among Ugandan university students.

Background: Uganda has reduced its prevalence of HIV/AIDS from 18 to 6.5% within a decade. An important factor behind this might have been the response from faith-based voluntary organizations, which developed social capital for achieving this. Three behaviors have been targeted: Abstinence, Being faithful, and Condom use (the ABC strategy). The aim of this study was to explore the association between social capital and the ABC behaviors, especially with reference to religious factors. Methods: In 2005, 980 Ugandan university students responded to a self-administered questionnaire (response rate 80%). It assessed sociodemographic factors, social capital, importance of religion, sexual debut, number of lifetime sexual partners, and condom use. Logistic regression analysis was applied as the main analytical tool. Results: Thirty-seven percent of the male and 49% of the female students had not had sexual intercourse. Of those with sexual experience, 46% of the males and 23% of the females had had three or more lifetime sexual partners, and 32% of those males and 38% of the females stated they did not always use condoms with a new partner. Low trust in others was associated with a higher risk for not always using condoms with a new partner among male students (OR 1.7, 95% CI 1.1–2.8), and with a lower risk for sexual debut among female students (OR 0.5, 95% CI 0.3–0.9). Non-dominant bridging trust among male students was associated with a higher risk for having had many sexual partners (OR1.8, 95% CI 1.2–2.9). However, low trust in others was associated with a greater likelihood of sexual debut in men, while the opposite was true in women, and a similar pattern was also seen regarding a high number of lifetime sexual partners in individuals who were raised in families where religion played a major role. Conclusions: In general, social capital was associated with less risky sexual behavior in our sample. However, gender and role of religion modified the effect so that we can not assume that risky sexual behavior is automatically reduced by increasing social capital in a highly religious society. The findings indicate the importance of understanding the interplay between social capital, religious influence, and gender issues in HIV/AIDS preventive strategies in Uganda.

Non-use of contraception: determinants among Ugandan university students.

BACKGROUND In Uganda, adolescent pregnancy often results in adverse maternal and neonatal health outcomes. In this context, low use of contraception and high rates of maternal mortality rate make preventing unwanted pregnancies critical. OBJECTIVE The objective was to determine the relationship between non-use of contraception and sociodemographic factors, alcohol consumption, and types of partner(s) among Ugandan university students. DESIGN In 2010, 1,954 students at Mbarara University of Science and Technology in southwestern Uganda participated in a cross-sectional study whereby a self-administered questionnaire was used to assess sociodemographic factors, alcohol consumption, and sexual behaviour including the use of contraceptives. Multivariable logistic regression was used for the analysis and data were stratified by sex. RESULTS 1,179 students (60.3% of the study population) reported that they were sexually active. Of these, 199 (18.6%) did not use contraception in their last sexual encounter. Students currently not in a relationship had higher odds of non-use of contraception (odds ratio 1.8, 95% confidence interval 1.2-2.7). The association remained statistically significant for both males and females after controlling for age, sexual debut, area of growing up, and educational level of the household head. Socio-demographic determinants of age (22 or younger), early sexual debut (at age 16 years or earlier), and a rural background were significant for males but not for females. A synergistic effect between not currently being in a relationship and early sexual debut were also observed to have an effect on the non-use of contraception. CONCLUSION Non-use of contraception among Ugandan university students differs for males and females, possibly due to gendered power relations. Sexual and reproductive health policies and programmes should be designed to take these differences into account.Background : In Uganda, adolescent pregnancy often results in adverse maternal and neonatal health outcomes. In this context, low use of contraception and high rates of maternal mortality rate make preventing unwanted pregnancies critical. Objective : The objective was to determine the relationship between non-use of contraception and sociodemographic factors, alcohol consumption, and types of partner(s) among Ugandan university students. Design : In 2010, 1,954 students at Mbarara University of Science and Technology in southwestern Uganda participated in a cross-sectional study whereby a self-administered questionnaire was used to assess sociodemographic factors, alcohol consumption, and sexual behaviour including the use of contraceptives. Multivariable logistic regression was used for the analysis and data were stratified by sex. Results : 1,179 students (60.3% of the study population) reported that they were sexually active. Of these, 199 (18.6%) did not use contraception in their last sexual encounter. Students currently not in a relationship had higher odds of non-use of contraception (odds ratio 1.8, 95% confidence interval 1.2–2.7). The association remained statistically significant for both males and females after controlling for age, sexual debut, area of growing up, and educational level of the household head. Socio-demographic determinants of age (22 or younger), early sexual debut (at age 16 years or earlier), and a rural background were significant for males but not for females. A synergistic effect between not currently being in a relationship and early sexual debut were also observed to have an effect on the non-use of contraception. Conclusion:Non-use of contraception among Ugandan university students differs for males and females, possibly due to gendered power relations. Sexual and reproductive health policies and programmes should be designed to take these differences into account.

The Impact of Socio-Demographic and Religious Factors upon Sexual Behavior among Ugandan University Students

Introduction More knowledge is needed about structural factors in society that affect risky sexual behaviors. Educational institutions such as universities provide an opportune arena for interventions among young people. The aim of this study was to investigate the relationship between sociodemographic and religious factors and their impact on sexual behavior among university students in Uganda. Methods In 2005, 980 university students (response rate 80%) were assessed by a self-administered questionnaire. Validated instruments were used to assess socio-demographic and religious factors and sexual behavior. Logistic regression analyses were applied. Results Our findings indicated that 37% of the male and 49% of the female students had not previously had sex. Of those with sexual experience, 46% of the males and 23% of the females had had three or more sexual partners, and 32% of the males and 38% of the females did not consistently use condoms. For those who rated religion as less important in their family, the probability of early sexual activity and having had a high number of lifetime partners increased by a statistically significant amount (OR = 1.7; 95% CI: 1.2–2.4 and OR = 1.6; 95% CI: 1.1–2.3, respectively). However, the role of religion seemed to have no impact on condom use. Being of Protestant faith interacted with gender: among those who had debuted sexually, Protestant female students were more likely to have had three or more lifetime partners; the opposite was true for Protestant male students. Conclusion Religion emerged as an important determinant of sexual behavior among Ugandan university students. Our findings correlate with the increasing number of conservative religious injunctions against premarital sex directed at young people in many countries with a high burden. of HIV/AIDS. Such influence of religion must be taken into account in order to gain a deeper understanding of the forces that shape sexual behavior in Uganda.

Inadequate Knowledge of Neonatal Danger Signs among Recently Delivered Women in Southwestern Rural Uganda: A Community Survey

Background Early detection of neonatal illness is an important step towards improving newborn survival. Every year an estimated 3.07 million children die during their first month of life and about one-third of these deaths occur during the first 24 hours. Ninety-eight percent of all neonatal deaths occur in low- and middle-income countries like Uganda. Inadequate progress has been made globally to reduce the amount of neonatal deaths that would be required to meet Millennium Development Goal 4. Poor knowledge of newborn danger signs delays care seeking. The aim of this study was to explore the knowledge of key newborn danger signs among mothers in southwestern Uganda. Methods Results from a community survey of 765 recently delivered women were analyzed using univariate and multivariate logistic regressions. Six key danger signs were identified, and spontaneous responses were categorized, tabulated, and analyzed. Results Knowledge of at least one key danger sign was significantly associated with being birth prepared (adjusted OR 1.7, 95% CI 1.2–2.3). Birth preparedness consisted of saving money, identifying transportation, identifying a skilled birth attendant and buying a delivery kit or materials. Overall, respondents had a poor knowledge of key newborn danger signs: 58.2% could identify one and 14.8% could identify two. We found no association between women attending the recommended number of antenatal care visits and their knowledge of danger signs (adjusted OR 1.0, 95% CI 0.8–1.4), or between women using a skilled birth attendant at delivery and their knowledge of danger signs (adjusted OR 1.2, 95% CI 0.9–1.7). Conclusions Our findings indicate the need to enhance education of mothers in antenatal care as well as those discharged from health facilities after delivery. Further promotion of birth preparedness is encouraged as part of the continuum of maternal care.

Patterns of alcohol consumption and risky sexual behavior: a cross-sectional study among Ugandan university students.

BackgroundAs reflected in elevated rates of sexually transmitted infections, there is a high prevalence of risky sexual behavior among Ugandan university students. It has been assumed that alcohol contributes to risky sexual behavior. However, perhaps owing to methodological issues, this relationship has found only mixed support in empirical research. The present study analyzes the association between alcohol use and risky sexual behavior at the global, situational, and event level among Uganda university students with sexual experience.MethodsA cross-sectional survey was carried out in 2010 among 1954 students at Mbarara University of Science and Technology, Uganda, using a self-administered questionnaire. Alcohol use was measured as consumption over the previous 12 months, during situations related to sexual activity and on the most recent occasion of sexual intercourse. Risky sexual behavior was defined as having two or more sexual partners in the previous 12 months or inconsistent condom use with new partners. Bivariate and multivariate logistic regression was performed to analyze the association between alcohol use and risky sexual behavior separately for males and females.ResultsEven after adjusting for confounders, the odds ratio (OR) of having two or more sexual partners in the past year indicated a statistically significant association with alcohol use on all levels (global, situational, and event) for both males and females. The ORs of inconsistent condom use with a new partner were significant for males who often consumed alcohol in relation to sexual activity—even after adjusting for potential confounders (OR, 1.75; confidence interval, 1.01–3.08). The risk of inconsistent condom use with a new partner was twice as high for females who often consumed alcohol in relation to sexual activity, although this association was not statistically significant.ConclusionsThe study supports previous research that alcohol consumption is associated with having multiple sexual partners. Inconsistent condom use was associated with the situational use of alcohol in relation to sexual activity and was similar for both genders. Interventions to reduce alcohol-related risky sexual behavior should target both male and female drinkers, particularly subgroups of students, who often consume alcohol in relation to sexual activity.

The Invisible Suffering: Sexual Coercion, Interpersonal Violence, and Mental Health - A Cross-Sectional Study among University Students in South-Western Uganda

Background Despite a history of conflicts and widespread human rights violation in sub-Saharan Africa, little is known about the prevalence of interpersonal violence among the population in this region. Evidence from high-income countries suggests that exposure to violence has mental health consequences and violence also has associations with experiences of sexual coercion. Aims This study sought to investigate the prevalence of physical and perceived threats of violence among university students in Uganda and to assess the possible relationship between such violence, sexual coercion, and symptoms of anxiety, depression, and psychoticism, respectively. Method In 2005, 980 Ugandan university students responded to a self-administered questionnaire (response rate 80%) that assessed socio-demographic factors, social capital, importance of religion, mental health, experience of violence and sexual coercion, and sexual behaviour factors. Logistic regression analysis was applied as the main analytical tool. Results Of those who responded, 28% reported perceived threats/threats of violence and 10% exposure to actual physical violence over the previous 12 months, with no significant gender differences in exposure history. Exposure to violence was significantly associated with the experience of sexual coercion among both males and females. Sexual coercion and threats/threats of violence were both significantly associated with poor mental health in males and females, but only males showed a strong association between exposure to physical violence and poor mental health. Conclusion The current study suggests that in terms of general exposure, both males and females in the study population are equally exposed to sexual coercion and interpersonal violence, and both male and female students show generally similar mental health effects of exposure to such violence. The prevalence of interpersonal violence found in our study population may have long-term negative health implications. Our findings may serve as a baseline for interventions and continuing research aimed at preventing interpersonal violence.

Transactional sex and HIV risks - evidence from a cross-sectional national survey among young people in Uganda.

Background Transactional sex is associated with the HIV epidemic among young people in Uganda. Few quantitative studies based on nationally representative survey data explored the relationship between sexual behaviors, HIV infection, and transactional sex. Objective This study aimed to determine the associations between risky sexual behaviors, participation in transactional sex, and HIV sero-status among men and women aged 15–24 in Uganda. Design The study uses data from the Uganda AIDS Indicator Survey, a cross-sectional national HIV serological study conducted in 2011. We analyzed data on 1,516 men and 2,824 women aged 15–24 who had been sexually active in the 12 months preceding the survey. Private, face-to-face interviews were also conducted to record the sociodemographics, sexual history, and experiences of sexual coercion. Logistic regression analysis was performed to measure associations between sexual behaviors and transactional sex, and associations between HIV sero-status and transactional sex. Results Among young people who had been sexually active in the 12 months prior to the survey, 5.2% of young men reported paying for sex while 3.7% of young women reported receiving gifts, favors, or money for sex. Lower educational attainment (ORadjusted 3.25, CI 1.10–9.60) and experience of sexual coercion (ORadjusted 2.83, CI 1.07–7.47) were significantly associated with paying for sex among men. Multiple concurrent sexual relationships were significantly associated with paying for sex among young men (ORadjusted 5.60, CI 2.08–14.95) and receiving something for sex among young women (ORadjusted 8.04, CI 2.55–25.37). Paying for sex among young men and having three to five lifetime sexual partners among young women were associated with increased odds of testing positive for HIV. Conclusions Transactional sex is associated with sexual coercion and HIV risk behaviors such as multiple concurrent sexual partnerships among young people in Uganda. In addition, transactional sex appears to place young men at increased risk for HIV in Uganda. Both sexes appear equally vulnerable to risks associated with transactional sex, and therefore should be targeted in intervention programs. In addition, strengthening universal education policy and improving school retention programs may be beneficial in reducing risky sexual behaviors and transactional sex.