Simon P. S. Kibira

Understanding sexual and reproductive health needs of adolescents: evidence from a formative evaluation in Wakiso district, Uganda

IntroductionAdolescents are frequently reluctant to seek sexual and reproductive health services (SRH). In Uganda, adolescent health and development is constrained by translation of the relevant policies to practice. Recent studies done in central Uganda have shown that there is need for a critical assessment of adolescent friendly services (AFS) to gain insights on current practice and inform future interventions. This study aimed to assess the sexual reproductive health needs of the adolescents and explored their attitudes towards current services available.MethodsA qualitative study was conducted in Wakiso district, central Uganda in September 2013.Twenty focus group discussions (FGDs) stratified by gender (10 out-of-school, and 10 in-school), were purposefully sampled. We used trained research assistants (moderator and note taker) who used a pretested FGD guide translated into the local language to collect data. All discussions were audio taped, and were transcribed verbatim before analysis. Thematic areas on; adolescent health problems, adolescent SRH needs, health seeking behaviour and attitudes towards services, and preferred services were explored. Data was analysed using atlas ti version 7 software.ResultsOur results clearly show that adolescents have real SRH issues that need to be addressed. In and out-of-school adolescents had sexuality problems such as unwanted pregnancies, sexually transmitted infections (STIs), defilement, rape, substance abuse. Unique to the females was the issue of sexual advances by older men and adolescents. We further highlight RH needs which would be solved by establishing adolescent friendly clinics with standard recommended characteristics (sexuality information, friendly health providers, a range of good clinical services such as post abortion care etc.). With regard to health seeking behaviour, most adolescents do not take any action at first until disease severity increase.ConclusionsAdolescents in Uganda have multiple sexual and reproductive health needs that require special focus through adolescent friendly services. This calls for resource support in terms of health provider training, information education and communication materials as well as involvement of key stakeholders that include parents, teachers and legislators.

Do Religion and Religiosity Have Anything to Do With Alcohol Consumption Patterns? Evidence From Two Fish Landing Sites on Lake Victoria Uganda

Fish landing sites have high levels of harmful use of alcohol. This paper examines the role of religion and religiosity on alcohol consumption at two fish landing sites on Lake Victoria in Uganda. Questionnaires were administered to randomly selected people at the sites. Dependent variables included alcohol consumption during the previous 30 days, whereas the key independent variables were religion and religiosity. Bivariate and multivariate analysis techniques were applied. People reporting low religiosity were five times more likely to have consumed alcohol (95% confidence interval: 2.45–10.04) compared with those reporting low/average religiosity. Religion and religiosity are potential channels for controlling alcohol use.

Perceptions of HIV and Safe Male Circumcision in High HIV Prevalence Fishing Communities on Lake Victoria, Uganda

Background In 2010, the Uganda Ministry of Health introduced its Safe Male Circumcision (SMC) strategy for HIV prevention with the goal of providing 4.2 million voluntary medical male circumcisions by 2015. Fishing communities, where HIV prevalence is approximately 3–5 times higher than the national average, have been identified as a key population needing targeted HIV prevention services by the National HIV Prevention Strategy. This study aimed to understand perceptions of HIV and identify potential barriers and facilitators to SMC in fishing communities along Lake Victoria. Methods We conducted 8 focus group discussions, stratified by sex and age, with 67 purposefully sampled participants in 4 communities in Kalangala District, Uganda. Results There was universal knowledge of the availability of SMC services, but males reported high uptake in the community while females indicated that it is low. Improved hygiene, disease prevention, and improved sexual performance and desirability were reported facilitators. Barriers included a perceived increase in SMC recipients’ physiological libido, post-surgical abstinence, lost income during convalescence, and lengthier recovery due to occupational hazards. Both males and females reported concerns about spousal fidelity during post-SMC abstinence. Reported misconceptions and community-held cultural beliefs include fear that foreskins are sold after their removal, the belief that a SMC recipient’s first sexual partner after the procedure should not be his spouse, and the belief that vaginal fluids aid circumcision wound healing. Conclusions Previous outreach efforts have effectively reached these remote communities, where availability and health benefits of SMC are widely understood. However, community-specific intervention strategies are needed to address the barriers identified in this study. We recommend the development of targeted counseling, outreach, and communication strategies to address barriers, misconceptions, and community-held beliefs. Interventions should also incorporate female partners into the SMC decision-making process and develop compensation strategies to address lost income during SMC recovery.

Undergraduate students’ contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda

BackgroundIt has been realised that there is need to have medical training closer to communities where the majority of the population lives in order to orient the trainees’ attitudes towards future practice in such communities. Although community based education (CBE) has increasingly been integrated into health professions curricula since the 1990s, the contribution students make to service delivery during CBE remains largely undocumented. In this study, we examined undergraduate health professions students’ contribution to primary health care during their CBE placements.MethodsThis was a qualitative study involving the Medical Education for Equitable Services to All Ugandans consortium (MESAU). Overall, we conducted 36 Focus Group Discussions (FGDs): one each with youth, men and women at each of 12 CBE sites. Additionally, we interviewed 64 community key-informants. All data were audio-recorded, transcribed and analysed using qualitative data analysis software Atlas.ti Ver7.ResultsTwo themes emerged: students’ contribution at health facility level and students’ contribution at community level. Under theme one, we established that students were not only learning; they also contributed to delivery of health services at the facilities. Their contribution was highly appreciated especially by community members. Students were described as caring and compassionate, available on time and anytime, and as participating in patient care. They were willing to share their knowledge and skills, and stimulated discussion on work ethics. Under the second theme, students were reported to have participated in water, sanitation, and hygiene education in the community. Students contributed to maintenance of safe water sources, educated communities on drinking safe water and on good sanitation practices (hand washing and proper waste disposal). Hygiene promotion was done at household level (food hygiene, hand washing, cleanliness) and to the public. Public health education was extended to institutions. School pupils were sensitised on various health-related issues including sexuality and sexual health.ConclusionHealth professions students at the MESAU institutions contribute meaningfully to primary health care delivery. We recommend CBE to all health training programs in sub-Saharan Africa.

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.

Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda

Introduction About 2.5 million men have voluntarily been circumcised since Uganda started implementing the WHO recommendation to scale up safe male circumcision to reduce HIV transmission. This study sought to understand what influences mens circumcision decisions, their experiences with health education at health facilities and their knowledge of partial HIV risk reduction in Wakiso district. Methods Data were collected in May and June 2015 at five public health facilities in Wakiso District. Twenty-five in-depth interviews were held with adult safe male circumcision clients. Data were analysed using thematic network analysis. Findings Safe male circumcision decisions were mainly influenced by sexual partners, a perceived need to reduce the risk of HIV/STIs, community pressure and other benefits like hygiene. Sexual partners directly requested men to circumcise or indirectly influenced them in varied ways. Health education at facilities mainly focused on the surgical procedure, circumcision benefits especially HIV risk reduction, wound care and time to resumption of sex, with less focus on post-circumcision sexual behaviour. Five men reported no health education. All men reported that circumcision only reduces and does not eliminate HIV risk, and could mention ways it protects, although some extended the benefit to direct protection for women and prevention of other STIs. Five men thought social marketing messages were ‘misleading’ and feared risk compensation within the community. Conclusions Participants reported positive community perception about safe male circumcision campaigns, influencing men to seek services and enabling female partners to impact this decision-making process. However, there seemed to be gaps in safe male circumcision health education, although all participants correctly understood that circumcision offers only partial protection from HIV. Standard health education procedures, if followed at health facilities offering safe male circumcision, would ensure all clients are well informed, especially about post-circumcision sexual behaviour that is key to prevention of risk compensation.

“Now that you are circumcised, you cannot have first sex with your wife”: post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda

Introduction: Safe male circumcision is an important biomedical intervention in the comprehensive HIV prevention programmes implemented in 14 sub‐Saharan African countries with high HIV prevalence. To sustain its partial protective benefit, it is important that perceived reduced HIV risk does not lead to behavioural risk compensation among circumcised men and their sexual partners. This study explored beliefs that may influence post circumcision sexual behaviours among circumcised men in a programme setting.

Correction: Sexual Risk Behaviours and Willingness to Be Circumcised among Uncircumcised Adult Men in Uganda.

The reference cited in the fourth sentence of the “Statistical analyses” section are incorrect. The sentence should read: PRRs were used because the outcome variable had prevalence above 10% (Zocchetti et al., 1997; Traissac et al., 1999; Barros et al., 2003). The correct references are: Zocchetti, C., D. Consonni, and P.A. Bertazzi, Relationship between prevalence rate ratios and odds ratios in cross-sectional studies. Int J Epidemiol, 1997. 26(1): p. 220–3. Traissac, P., Y. Martin-Prevel, F. Delpeuch, and B. Maire, [Logistic regression vs other generalized linear models to estimate prevalence rate ratios]. Rev Epidemiol Sante Publique, 1999. 47(6): p. 593–604. Barros, A.J. and V.N. Hirakata, Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol, 2003. 3: p. 21.