Contraceptive Use among Young People in Uganda: Exploration of obstacles, enablers, and quality of services

Background: Unsafe abortions, a life shortening condition leading to untimely deaths of young women in low income countries, are a public health concern. The bio-social gap, which is the period between menarche and marriage has widened, thus the time young women/men need contraception has increased. High rates of teen pregnancy, unintended birth, unsafely induced abortions and associated mortality among young women, is attributed to low contraceptive use. Paradoxically, awareness about contraception is high. It is not understood why young people are not using contraceptives, hence this study. Aim: To explore and analyze obstacles and enablers to contraceptive use and quality of services provided to young people aged 15-24 in two districts in Uganda, in order to increase knowledge about why contraceptives are not used and identify areas for improvement. Methods: The studies were carried out among young people 15-24 years and health care providers at public, private not for profit (PNFP), and private for profit (PFP) contraceptive delivery points. Quantitative and qualitative approaches were used. Focus group discussions (FGDs) were used to explore young peoples’ views about obstacles and enabling factors to contraceptive use (study I). Semi-structured questionnaires were used to guide face-face interviews with health care providers to determine factors influencing contraceptive use and provision (Study II). Simulated client methodology was used to assess the quality of contraceptive services and clients experiences of contraceptive care (Study III and IV). Descriptive statistics (II, IV), inferential statistics (II, IV) and factor analysis (III) were performed. Qualitative data were analyzed using content analysis (I) and thematic analysis (IV). Results: Young men and women described multiple obstacles to contraceptive use, which were categorized as misconceptions and fears related to contraception, gender power relations, socio-cultural expectations and contradictions, short term planning, and health service barriers (I). Additionally, young people recounted several enabling factors that included female strategies to overcome obstacles, changing perceptions and attitude towards contraceptive use and smaller family size (I). Contraceptive use and provision to young people were constrained by sporadic contraceptive stocks, poor service organization, limited number of trained personnel, high costs, and unfriendly service. Most providers were not competent enough to provide long-acting methods. There were significant differences in providers’ self-rated competence by facility type. Private for-profit providers’ competence was limited for most contraceptives. Providers had misconceptions about contraceptives, they had negative attitudes towards the provision of contraceptives to young people, and they imposed non-evidence-based age restrictions and consent requirements. Thus, most providers were not prepared or were hesitant to give young people contraceptives. Short-acting methods were, however, considered acceptable for young married women and those with children (II). Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessments scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. A minority of providers offered young people their preferred method of choice and a minority showed respect for privacy (III, IV). Both qualitative and quantitative results highlighted favorable reception, provider bias, and low client satisfaction. Two thirds of the providers choose a contraceptive method for the client. The clients reported satisfaction with contraceptive services in 29 percent of the consultations. Privacy was reported to be observed in 42 percent and clients felt respectfully treated in 50 percent of the consultations (IV). Conclusion: Our findings suggest changing perceptions and attitudes in favor of contraceptive use and smaller family size although obstacles still exist (I). Provider, client, and health system factors restricted contraceptive provision and use for young people (II). The quality of contraceptive services provided to young people was low (III). Young people were not able to exercise their rights to choose, obtain and use contraceptives when needed. Overall satisfaction with the services was low and client- provider interactions were often unfavorable (IV). Implications: Reducing obstacles and reinforcing enabling factors through education, culturally sensitive behavior change strategies have the potential to enhance contraceptives use. Alternative models of contraceptive service delivery to young people are needed. Contraceptive use prospects are dependent on provider behavior. Concurrent quality improvements and strengthening of health systems are needed

The general population cohort in rural south-western Uganda: a platform for communicable and non-communicable disease studies.

The General Population Cohort (GPC) was set up in 1989 to examine trends in HIV prevalence and incidence, and their determinants in rural south-western Uganda. Recently, the research questions have included the epidemiology and genetics of communicable and non-communicable diseases (NCDs) to address the limited data on the burden and risk factors for NCDs in sub-Saharan Africa. The cohort comprises all residents (52% aged ≥13years, men and women in equal proportions) within one-half of a rural sub-county, residing in scattered houses, and largely farmers of three major ethnic groups. Data collected through annual surveys include; mapping for spatial analysis and participant location; census for individual socio-demographic and household socioeconomic status assessment; and a medical survey for health, lifestyle and biophysical and blood measurements to ascertain disease outcomes and risk factors for selected participants. This cohort offers a rich platform to investigate the interplay between communicable diseases and NCDs. There is robust infrastructure for data management, sample processing and storage, and diverse expertise in epidemiology, social and basic sciences. For any data access enquiries you may contact the director, MRC/UVRI, Uganda Research Unit on AIDS by email to [email protected] or the corresponding author

Quality of Life and the Prevalence of Depression in Cohabitants and Marrieds

Cohabitation has become part of romantic relationships in the United States; cohabitation has become a normal experience for both men and women. With the rapid increase in cohabitation this raises important concerns about its consequences for the institution of marriage and the lives of individuals involved in this family form, as research indicates that cohabiters hold lower levels of commitment, and cohabiters are more likely to be depressed than marrieds( Brown, S.L 2003). Some studies have been done to find out whether marriages are beneficial to one’s mental health, Pro marriage initiatives and policies like tax breaks for married people have taken a part in this (Perelli-Harris 2017). Although the prevalence and patterns of cohabitation have generally been well documented, we know very little about the outcomes of cohabitation and marriage. This is especially true for middle age adults; despite the increasing significance of cohabitation at younger ages, the cohabitation literature continues to focus on older adults who tend to settle or move in with a partner after a divorce from a previous marriage. The experiences of cohabitation and marriage are not the same at all ages. Some people may view marriage as a union of comfort, something that’s more solid than cohabitation though the meaning and significance of both these relationship is different for each individual (Haas, S. M., & Whitton, S. W. 2015). Cohabitation has become a big part of an everyday American life (Pollard and Harris 2013). There has been an increase in the number of cohabiting households.https://scholar.dominican.edu/ug-student-posters/1079/thumbnail.jp

Quality of life and the prevalence of Depression

Cohabitation is the state of living together and having a sexual relationship without being married. Although there has been evidence that suggests cohabitation can be positive there is also evidence that suggests it may be negative. With a rapid increase in cohabitation, this raises important concerns about its consequences for the institution of marriage and the lives of individuals involved in this family form, as research indicates that cohabiters hold lower levels of commitment thus why cohabiters are more likely to be depressed than marrieds. Although the patterns of cohabitation have generally been well documented, we know very little about the outcomes of cohabitation and marriage, especially in younger and middle-aged adults. The goal of this study is to compare the quality of life and the prevalence of depression between marrieds and cohabiters because experiences of cohabitation and marriage are not the same

Prospects for Genomic Selection in Cassava Breeding

Article purchased; Published online: 28 Sept 2017Cassava (Manihot esculenta Crantz) is a clonally propagated staple food crop in the tropics. Genomic selection (GS) has been implemented at three breeding institutions in Africa to reduce cycle times. Initial studies provided promising estimates of predictive abilities. Here, we expand on previous analyses by assessing the accuracy of seven prediction models for seven traits in three prediction scenarios: cross-validation within populations, cross-population prediction and cross-generation prediction. We also evaluated the impact of increasing the training population (TP) size by phenotyping progenies selected either at random or with a genetic algorithm. Cross-validation results were mostly consistent across programs, with nonadditive models predicting of 10% better on average. Cross-population accuracy was generally low (mean = 0.18) but prediction of cassava mosaic disease increased up to 57% in one Nigerian population when data from another related population were combined. Accuracy across generations was poorer than within-generation accuracy, as expected, but accuracy for dry matter content and mosaic disease severity should be sufficient for rapid-cycling GS. Selection of a prediction model made some difference across generations, but increasing TP size was more important. With a genetic algorithm, selection of one-third of progeny could achieve an accuracy equivalent to phenotyping all progeny. We are in the early stages of GS for this crop but the results are promising for some traits. General guidelines that are emerging are that TPs need to continue to grow but phenotyping can be done on a cleverly selected subset of individuals, reducing the overall phenotyping burden.Bill & Melinda Gates FoundationUKaidCGIAR Research Program on Roots, Tubers and BananasPeer Revie

Intrapatient Evolutionary Dynamics of Human Immunodeficiency Virus Type 1 in Individuals Undergoing Alternative Treatment Strategies with Reverse Transcriptase Inhibitors.

Structured treatment interruption (STI) has been trialed as an alternative to lifelong antiretroviral therapy (ART). We retrospectively performed single genome sequencing of the HIV-1 pol region from three patients representing different scenarios. They were either failing on continuous therapy (CT-F), failing STI (STI-F), or suppressing on STI (STI-S). Over 460 genomes were generated from three to five different time points over a 2-year period. We found multiple-linked-resistant mutations in both treatment failures. However, the CT-F patient showed a stepwise accumulation of diverse, linked mutations whereas the STI-F patient had lineage turnover between treatment periods with recirculation of wild-type and resistant variants from reservoirs. The STI-F patient showed a 7-fold increase in the third codon position substitution rate relative to the first and second positions compared to a 2-fold increase for CT-F and increased purifying selection in the pol gene (62 vs. 22 sites, respectively). An understanding of intrapatient viral dynamics could guide the future direction of treatment interruption strategies

Spatially explicit modelling of extreme weather and climate events hot spots for cumulative climate change in Uganda

The reality of climate change continues to influence the intensity and frequency of extreme weather events such as heat waves, droughts, floods, and landslides. The impacts of the cumulative interplay of these extreme weather and climate events variation continue to perturb governments causing a scramble into formation of mitigation policies. However, national scale composites of climate hotspots remain a bottle neck to this policy formation. This paper therefore, modelled the spatially explicit extreme weather and climate events indicators into a Uganda-national extreme weather and climate events composite hotspot indicator model. The hotspot model was mapped into decomposable sub-indicators based on the Geon concept. A spatial indicator framework was developed through literature review and expert knowledge. The resulting indicators were weighted using Principal Component Analysis (PCA) /factor analysis and then normalized. They were aggregated using Multi Criteria Decision Analysis (MCDA) tools in an Object Based Image Analysis (OBIA) environment. Sensitivity analysis was carried out to ascertain the influence and significance of the indicators in the resultant model. A cumulative climate change index model was hence analysed and mapped. The mapping provides spatially explicit information regarding climate extremes at national scale, consequently addressing its growing demand among public and private institutions. Further research, into the complex interactions of cumulative climatic factors and external components like ecological systems and anthropogenic biomes will go a long way in boosting climate information. This coupled with easy access to open web availability; if adopted, will readily inform national climate change policy at national level and greatly improve decision making within development sectors, hence mitigating the advance effects of climate change

Geostatistical Assessment of Forest-Based, Exponential Smoothing and Curve Fitting Algorithms in Forecasting Wet and Dry Conditions of The Short Rain Season at a Local Scale in Uganda.

Context and objectives:Climate extremes associated with wet and dry conditions are one of the main causal elements of the disasters that adversely impact Uganda`s agriculturally based economy. However, the lack of reliable forecast records for wet and dry conditions remains a challenge at a local scale. Given the proliferation of geostatistical forecast algorithms, this study assessed the suitability of three forecast algorithms: forest-based, exponential smoothing and curve fitting in forecasting wet and dry conditions at a local scale in Uganda.Methodology:The CHIRPS satellite gridded datasets for the variable short rains season of September, October, and November (SON) for the 1981-2020 historical period were used to develop the forecasts and the 2021-2022 period was used to validate the forecasts. The Standardized Precipitation Index (SPI) derived from the CHIRPS dataset was used as the proxy for wet and dry conditions.  The three algorithms were assessed by subjecting them to the SPI space-time cube structure in the ArcGIS environment.  Using the resultant Forecast and Validation Root Mean Square Error (FRMSE and VRSME respectively), forecast models were then generated for each of the algorithms. A comparison of the least VRSME at every locality from any of the three algorithms was then used to build a joint forecast model.Results:Results from the three algorithms show that irrespective of the neighborhood influence, each locality experiences an independent forecast and by 2025, the majority of the localities will experience moderately wet conditions in the SON season. The forest-based forecast, exponential smoothing, curve fitting and the combined least VRMSE forecast produced a best value of R2=0.33, 0.48, 0.4 and 0.62 respectively upon validation of the exact value. However, for values within the 95% confidence interval band, an R2 =0.89, 0.83 was realized for the forest-based and exponential smoothing. Based on the behavioral performance of the algorithms, results further reveal that most of the localities in the study area exhibit complex patterns and can best be predicted by Forest based algorithms. The results from this study support the motive of the Sustainable Development Goal (SDG) 13 by enabling the communication of empirical studies on locally determined climate contributions. The knowledge gained regarding localized wet and dry conditions prediction will help to increase the capacity of local governance and decision-making organizations that adopt and put into practice local disaster risk reduction initiatives. Further research is needed to assess the driving factors behind the pattern behaviours at the different localitie

Situation analysis of healthcare service delivery using geographically weighted regression: (A case study of Sironko District, Eastern Uganda)

Geography plays an important role in planning and allocation of healthcare resources for an effective and efficient health system. Lack of statistical information analyzed using geostatistical tools then becomes a major bottleneck to proper planning and policy formulation in healthcare delivery. This study sought to compare existing health staffing, funding and medical supplies data given minimal national healthcare package, spatially explore the relationship between health service utilization and gaps in resource allocation, and to develop propositions to support the health policy. Facility survey and secondary data collection from the District Health Office and the Ministry of Health were utilized. Geographically Weighted Regression was used to spatially explore the relationships between Out-patient department attendance and gaps in health funding, staffing and stock-out days for essential drugs in health facilities. Global Moran’s I test was performed on the standard residuals to statistically test for their randomness. The analysis yielded local parameter estimates which were mapped to reveal the spatial variation of the relationships. There was strong influence of facility allocation gap in the North West diminishing towards South East, Strong negative influence of the staffing gap in the South West diminishing eastwards, and High influence of Stock-Out days in the South compared to the South West. Basing on the observations, the study proposed increased health vote while revising allocation based more on need other than solely on budgetary allocation of funds, increased staffing and providence of incentives for disadvantaged areas, and monitoring of drug supply and dispensing at health centres

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

During the past year, a group has argued that unsafe injections are a major if not the main mode of HIV-1 transmission\ud in sub-Saharan Africa. We review the main arguments used to question the epidemiological interpretations on the lead\ud role of unsafe sex in HIV-1 transmission, and conclude there is no compelling evidence that unsafe injections are a\ud predominant mode of HIV-1 transmission in sub-Saharan Africa. Conversely, though there is a clear need to eliminate\ud all unsafe injections, epidemiological evidence indicates that sexual transmission continues to be by far the major\ud mode of spread of HIV-1 in the region. Increased efforts are needed to reduce sexual transmission of HIV-1