Joseph Kihika Kamara

Resilience to climate-induced disasters and its overall impact on well-being in Southern Africa: a mixed-methods systematic review protocol

BackgroundSouthern Africa has long been vulnerable to climate-induced disasters, especially droughts and floods. The severity and frequency of disasters increased in the early 1980s, continuously eroding livelihoods, which in turn invoked humanitarian intervention. A systematic review of the relationship between resilience to drought and well-being will be undertaken.MethodsStudies will be included if they were conducted between January 1980 and December 2017; used quantitative and/or qualitative methods; were peer reviewed or comprise grey literature; covered Southern Africa; and measured resilience and its relationship to well-being. Data extraction will be informed by the Cochrane Public Health Group and the Joanna Briggs Institute manuals. The quality of evidence of the studies included will be assessed for risk bias, psychometric properties of tools used, and their suitability. The findings will be summarised into themes and narrated.DiscussionThis protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. The protocol gives insight of the scope and parameters for the systematic review to be carried out. The systematic review will establish how resilience to climate-induced disasters affects well-being. It will also provide recommendations to improve humanitarian coordination in Southern Africa.Systematic review registrationThe protocol was registered by the PROSPERO international prospective register of systematic reviews, reference CRD42017064396.

Child rights and protection in slum settlements of Kampala, Uganda: A qualitative study

ABSTRACT Child abuse and neglect are complex and polarizing issues in many low and middle income countries. We explore them through a situation analysis of child rights and protection in Uganda. A qualitative study, incorporating 10 focus group discussions (FGDs; N = 113) and 20 individual interviews was undertaken in Kampala, Uganda. Emerging themes were grouped into family and community-level factors; legal framework, structure and continuum of services, and human and financial resources. Violation of child rights was characterized by physical, emotional, and sexual abuse and exploitation; child neglect, homelessness, and child labor; dysfunctional families and abject poverty; and poor accommodation conditions; school drop-out due to economic hardship; early pregnancy, and social exclusion. Legal and regulatory factors included traditional harmful practices (including child sacrifice and witchcraft practices); forced marriage; and the perceived lack of the governments commitment to child protection. Without a strong legislation that protects children against abuse, promotes confidential reporting systems, and tackles domestic violence, children will still remain prone to various forms of abuses and exploitation.

Sexual, reproductive health needs, and rights of young people in slum areas of Kampala, Uganda : a cross sectional study

Background Young people in Uganda face various sexual and reproductive health risks, especially those living in urban slums. The aim of this study was to examine factors associated with comprehensive categories of sexual and reproductive health, including sexual behaviours; sexual education and access to contraceptive services; family planning; prevention of STDs; sexual consent as a right; gender based violence; as well as HIV testing, counselling, disclosure and support. Methods The study was cross-sectional in design and was carried out in July 2014 in Makindye and Nakawa Divisions of Kampala City, Uganda. Using systematic random sampling, data were collected on 663 participants aged between 13 and 24 years in Kampala’s urban slums. Results Sixty two percent of participants reported having ever had sex and the mean age of sexual debut was 16 years (95%CI: 15.6, 16.4 years, range: 5–23 years). The odds of reporting ever having had sexual intercourse were higher among respondents living alone (OR: 2.75; 95%CI: 1.35, 5.61; p<0.01) than those living in a nuclear family. However, condom use was only 54%. The number of sexual partners in the last 12 months preceding the survey averaged 1.8 partners (95%CI: 1.7, 1.9; range 1–4) with 18.1% reporting an age gap of 10 years or older. More than three quarters (80.6%) of sexually active participants reported that their first sexual encounter was consensual, suggesting that most young people are choosing when they make their sexual debut. Low prevalence of willing first sexual intercourse was associated with younger age (OR = 0.48, 95%CI: 0.25, 0.90, p<0.05), having a disability (OR = 0.40, 95%CI: 0.16, 0.98, p<0.05), living with non-relatives (OR = 0.44, 95%CI: 0.16, 0.97, p<0.05), and being still at school (OR = 0.29, 95%CI: 0.12, 0.67, p<0.01). These results remained significant after adjusting for covariates, except for disability and the age of participants. The proportion of unwilling first sexual intercourse was significantly higher among women for persuasion (13.2% vs. 2.4%, p<0.001), being tricked (7.1% vs 2.9%, p<0.05) and being forced or raped (9.9% vs 4.4%, p<0.05) than men. A high level of sexual abuse emerged from the data with 34.3% affirming that it was alright for a boy to force a girl to have sex if he had feelings for her; 73.3% affirming that it was common for strangers and relatives to force young females to have sexual intercourse with them without consent; 26.3% indicating that it was sometimes justifiable for a boy to hit his girlfriend, as long as they loved each other. Conclusion This study has explored current sexual practice among young people in a specific part of urban Kampala. Young people’s sexual and reproductive health remains a challenge in Uganda. To address these barriers, a comprehensive and harmonised sexual and reproductive health system that is youth friendly and takes into account local socio-cultural contexts is urgently needed.

The Ugandan Youth Quality of Life index: assessing the relevance of incorporating perceived importance into the quality of life measure and factors associated with the quality of life among youth in slum areas of Kampala, Uganda

Background While quality of life (QoL) has long been an explicit policy goal for international development programmes, no instruments have specifically been developed for measuring health-related QoL in resource-limited settings. The aim of this study was to develop and validate a QoL instrument for use in international aid and development programmes and to assess factors associated with QoL among youth participating in a civic engagement project in Kampala. Design Using systematic random sampling, data were collected on 663 participants aged between 13 and 24 years in Kampala. The QoL questionnaire included 36 questions divided into a two-part scale: 18 questions rated for satisfaction (Part 1) and 18 other questions rated on importance (Part 2). The total sample was randomly divided into two split-half samples: one for the exploratory factor analysis (EFA; N=310) and the other for the confirmatorty factor analysis (CFA; N=353). The effect of demographic, socio-economic, and lifestyle factors on QoL was assessed using linear regressions. Results The EFA yielded three factors: living conditions and lifestyle (seven items, α=0.84), social relationships (five items, α=0.86), and personal independence (five items, α=0.76). In the CFA, the initial model demonstrated a poor to marginal fit model. Its re-specification by examining modification indices resulted in a good model fit: Comparative Fit Index=0.95, Root Mean Square Error of Approximation=0.06, and p of Close Fit >0.05. The model incorporating perceived importance had lower Akaike Information Criteria and Bayesian Information Criteria values than the unweighted model, thereby providing very strong support to weight satisfaction scores with importance ratings when measuring QoL in Uganda. Poor QoL was associated with poor educational attainment, drug and substance misuse, and family disruption. Conclusions The findings suggest that there is a relationship between QoL and lifestyle and structural issues among youth in Uganda. The study provides the first validated QoL measure to allow government and non-government organisations in low- and middle-income countries to track progress of international aid and development programmes.Background While quality of life (QoL) has long been an explicit policy goal for international development programmes, no instruments have specifically been developed for measuring health-related QoL in resource-limited settings. The aim of this study was to develop and validate a QoL instrument for use in international aid and development programmes and to assess factors associated with QoL among youth participating in a civic engagement project in Kampala. Design Using systematic random sampling, data were collected on 663 participants aged between 13 and 24 years in Kampala. The QoL questionnaire included 36 questions divided into a two-part scale: 18 questions rated for satisfaction (Part 1) and 18 other questions rated on importance (Part 2). The total sample was randomly divided into two split-half samples: one for the exploratory factor analysis (EFA; N=310) and the other for the confirmatorty factor analysis (CFA; N=353). The effect of demographic, socio-economic, and lifestyle factors on QoL was assessed using linear regressions. Results The EFA yielded three factors: living conditions and lifestyle (seven items, α=0.84), social relationships (five items, α=0.86), and personal independence (five items, α=0.76). In the CFA, the initial model demonstrated a poor to marginal fit model. Its re-specification by examining modification indices resulted in a good model fit: Comparative Fit Index=0.95, Root Mean Square Error of Approximation=0.06, and p of Close Fit >0.05. The model incorporating perceived importance had lower Akaike Information Criteria and Bayesian Information Criteria values than the unweighted model, thereby providing very strong support to weight satisfaction scores with importance ratings when measuring QoL in Uganda. Poor QoL was associated with poor educational attainment, drug and substance misuse, and family disruption. Conclusions The findings suggest that there is a relationship between QoL and lifestyle and structural issues among youth in Uganda. The study provides the first validated QoL measure to allow government and non-government organisations in low- and middle-income countries to track progress of international aid and development programmes.

Willingness to pay for health insurance in the informal sector of Sierra Leone

Purpose The objective of this project is to study the willingness to pay (WTP) for health insurance (HI) of individuals working in the informal sector in Sierra Leone, using a purposely-designed survey of a representative sample of this sector. Methods We elicit the WTP using the Double-Bounded Dichotomous Choice with Follow Up method. We also examine the factors that are positively and negatively associated with the likelihood of the respondents to answer affirmatively to joining a HI scheme and to paying three different possible premiums, to join the HI scheme. We additionally analyze the individual and household characteristics associated with the maximum amount the household is willing to pay to join the HI scheme. Results The results indicate that the average WTP for the HI is 20,237.16 SLL (3.6 USD) per adult but it ranges from about 14,000 SLL (2.5 USD) to about 35,000 SLL (6.2 USD) depending on region, occupation, household and respondent characteristics. The analysis of the maximum WTP indicates that living outside the Western region and working in farming instead of petty trade are associated with a decrease in the maximum premium respondents are WTP for the HI scheme. Instead, the maximum WTP is positively associated to being a driver or a biker; having secondary or tertiary education (as opposed to not having any); the number of pregnant women in the household; having a TV; and, having paid for the last medical requirement. Conclusions In summary, the various analyses show that a premium for the HI package could be set at approximately 20,000 SLL (3.54 USD) but also that establishing a single premium for all individuals in the informal sector could be risky. The efficient functioning of a HI scheme relies on covering as much of the population as possible, in order to spread risks and make the scheme viable. The impact of the various population characteristics raises the issue of how to rate premiums. In other words, setting a premium that may be too high for a big proportion of the population could mean losing many potential enrollees and might have viability consequences for the operation of the scheme.

Resilience to Climate-Induced Disasters and Its Overall Relationship to Well-Being in Southern Africa: A Mixed-Methods Systematic Review

The available literature suggests that natural disasters, especially droughts and floods, were occurring in southern Africa in the early 1900s. However, their frequency and intensity increased during the 1980s. The aim of this systematic review was to assess the relationship between resilience to droughts and people’s well-being in southern Africa. A combination of keywords was used to search the following 13 electronic bibliographic databases: Africa Journal Online (AJOL), MEDLINE, Academic Search Complete, Environment Complete, Humanities International Complete, Psychology and Behavioral Sciences Collection, PsycINFO, Embase, Scopus, Web of Science, Applied Social Science Index and Abstracts, ProQuest Central, and CINAHL. Relevant websites were also searched and potential studies for inclusion were downloaded in an EndNote database and screened for eligibility using pre-determined criteria. Quality assessment of the studies was undertaken using the Joana Briggs Qualitative Assessment and Review Instrument, the National Institutes of Health (NIH) checklist, and the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist. Resilience and well-being scales used in the studies for inclusion were also assessed using pre-defined criteria. Nineteen studies met the inclusion criteria. Poverty alleviation policies were important in strengthening resilience and well-being outcomes. Resilience and well-being were connected by old age, gender, race, adaptive farming and livelihoods diversification, security, and knowledgeability. Resilience and well-being outcomes were advanced by the synergistic effect of household, community and governance level capacities encapsulated in knowledgeability. This systematic review is critical to improving southern Africa context-specific resilience, and well-being policies and interventions.

Understanding the Challenges of Improving Sanitation and Hygiene Outcomes in a Community Based Intervention: A Cross-Sectional Study in Rural Tanzania

Good sanitation and clean water are basic human rights yet they remain elusive to many rural communities in Sub-Saharan Africa (SSA). We carried out a cross sectional study to examine the impact of a four-year intervention aimed at improving access to water and sanitation and reducing waterborne disease, especially diarrhea in children under five years old. The study was carried out in April and May 2015 in Busangi, Chela and Ntobo wards of Kahama District of Tanzania. The interventions included education campaigns and improved water supply, and sanitation. The percentage of households (HHs) with access to water within 30 min increased from 19.2 to 48.9 and 17.6 to 27.3 in the wet and dry seasons, respectively. The percentage of HHs with hand washing facilities at the latrine increased from 0% to 13.2%. However, the incidence of diarrhea among children under five years increased over the intervention period, RR 2.91 95% CI 2.71–3.11, p < 0.0001. Availability of water alone may not influence the incidence of waterborne diseases. Factors such as water storage and usage, safe excreta disposal and other hygiene practices are critical for interventions negating the spread of water borne diseases. A model that articulates the extent to which these factors are helpful for such interventions should be explored.

The social and political dimensions of internal displacement in Uganda: challenges and opportunities - a systematic review

ABSTRACT Internal displacement has been a common occurrence in Uganda since the late 1800s. However, studies that examine the entire spectrum of the social and political dimensions of internal displacement in Uganda are scarce. The aim of this systematic review was to (1) examine the social and political dimensions of internal displacement to inform policy and practice to better meet the needs of internally displaced persons (IDPs) in Uganda; and (2) evaluate the advances made in addressing IDPs’ needs and their protection. Both quantitative and qualitative studies on internally displaced persons in Uganda, published between 1962 and 31 July 2014, were included in this systematic review. A total of 2,529 relevant studies were identified of which 25 met our inclusion criteria. The findings suggest that living conditions, physical and mental health, vulnerability and adaptive capacity, livelihood, and settlement are key factors in internal displacement. These social dimensions were governed by political factors, including foreign policy, human rights abuses, and land dispossession. The findings suggest that the government did not comply with its IDP protection policy and the international standards that it advocated for. Contextual solutions addressing political and social aspects are needed to prevent and mitigate the impact of internal displacement.