Proximity to Alcohol Sellers and Dose Response Relationship Between Alcohol Consumption With Intimate Partner Violence in Rural Southwestern Uganda

Introduction: Intimate partner violence (IPV) is associated with several adverse public health outcomes and alcohol use is one of its risk factors. Proximity to alcohol selling points could be linked with problem drinking and IPV. We aimed to determine whether proximal location to alcohol and intensity of alcohol consumption are associated with IPV in rural southwest Uganda.Methods: We conducted a cross-sectional study in rural southwest Uganda with structured interviews at household level. We used the alcohol use disorders identification test (AUDIT) and the Conflict Tactics Scale to measure past year alcohol consumption and IPV (perpetration and victimization). We estimated Euclidean distances between participants' households and nearest alcohol outlets using geographic information systems. We used generalized estimating equation models to calculate adjusted odds ratios (aOR) for the factors associated with IPV.Results: We enrolled 742 participants and median age was 41 years (inter-quartile range or IQR 32-53) and 52.2% of respondents were male. The overall prevalence of IPV in the past year was 52.2%. In a multivariable regression model, women (aOR = 2.24, 95%CI 1.28, 3.91) compared to men, those living proximal to an alcohol selling point (OR = 1.77, 95% CI 1.38, 2.27) were more likely to experience IPV. There was a dose-response relationship between alcohol consumption and IPV. With non-drinkers as the reference category, the aORs were 4.54 (95% CI 2.04, 10.08) for casual drinkers, 10.53 (95% CI 4.15, 26.77) for hazardous drinkers and 15.31 (95% CI 4.73, 49.54) for alcohol dependent drinkers.Conclusion: IPV is very common and has a dose-response relationship with alcohol consumption and drinking outlet proximity. There is an urgent need for IPV and alcohol interventions programs in these rural communities. Policy to restrict proximity of alcohol outlets to residential locations should be examined as an intervention for alcohol consumption and IPV perpetration.

EdTech for Ugandan girls: Affordances of different technologies for girls' secondary education during the Covid-19 pandemic

MOTIVATION

This article discusses the use of educational technology (EdTech) in girls' education at PEAS (Promoting Education in African Schools) schools in rural Uganda during the Covid-19-related school closures.

PURPOSE

This article addresses a research gap surrounding the potential use of EdTech to support girls' education, focusing on the barriers to girls' EdTech use and how technology might be used to enhance girls' education in disadvantaged rural areas-specifically their academic learning and their social and emotional learning.

METHODS AND APPROACH

A sequential, explanatory mixed-methods case-study approach was used. Quantitative exploration of a dataset of 483 Ugandan students, from 28 PEAS schools, was first conducted, followed by interviews with PEAS staff to elucidate the reasons and context behind the findings.

FINDINGS

Findings show that female students are less likely than male students to have access to their caregivers' phones for learning. The form of EdTech that appeared to be most beneficial for girls' academic learning was radio; girls also had significantly more interest in tuning into radio broadcasts than boys did. Also, poorer boys were more likely to be influenced by SMS messages than wealthier boys. Apart from gender-based differences, students with more highly educated parents found SMS messages more helpful, and phone calls from teachers appeared to help boost younger students' self-confidence.

POLICY IMPLICATIONS

The findings suggest that policy-makers need to: carefully consider provision of education through multiple modes of EdTech in order to ensure that it reaches all students; ensure that caregivers are involved in the strategies developed for girls' education; make EdTech interventions interactive; and consider language in EdTech interventions. Given the gender differences which emerged, the findings are of relevance both to supporting the continuation of educational provision during periods of school closure, and also in terms of finding additional ways to support girls' education alongside formal schooling.

Depression in Ugandan Rural Women Involved in a Money Saving Group: The Role of Spouse's Unemployment, Extramarital Relationship, and Substance Use

Background

Rural women are highly prevalent to depression, where spouse-related factors, including extramarital affairs and poverty, intensify its likelihood of occurrence. However, women engaged with a Money-Saving Group (MSG) are financially self-dependent, which can reduce the risk of depression suffering. Despite this, there is less study among this cohort, which led us to investigate the prevalence and associated factors of depression among the Ugandan women involved in MSG.

Methods

This was a cross-sectional study in Uganda among rural married or cohabiting women aged 18 to 45 years engaged in MSG. The survey was carried out within a total of 153 participants (33.3 ± 6.7 years) in April 2021. Information related to socio-demographic of the participants, their spouse characteristics, and depression were collected.

Results

About 65.4% of the participants had depressive symptoms (based on the cutoff 10/27 at the PHQ-9). But, 8.15 times (CI: 2.83–23.44, p<0.001) and 16.69 times (CI: 4.85–57.39, p<0.001), higher risk of depression were observed, if the participants’ spouses were using an addictive substance and had been involved in an extramarital relationship, respectively. Similarly, there was an increased likelihood of depression when the participant or spouse was unemployed.

Conclusion

This study observed a higher prevalence of depression, which suggests paying attention to this cohort. Thus, there should be routine screening for depression among married women involved in MSG at lower-level health facilities in rural settings, especially those with spouses engaged in substance use, having an extramarital relationship, and being unemployed.

Social Support, Food Insecurity, and HIV Stigma Among Men Living with HIV in Rural Southwestern Uganda: A Cross-Sectional Analysis

BACKGROUND

HIV stigma is one of the major barriers to HIV care due to the fear of disclosure and social discrimination. HIV stigma among men in sub-Saharan countries, including Uganda, has been linked to the fear about how HIV status might affect their status in society. HIV among men in sub-Saharan settings has been associated with feelings of shame, reduced self-worth, and self-blame for their HIV positive status. Information about HIV stigma and its associated factors among men living with HIV in rural Uganda is limited. This study assessed the burden of HIV stigma and its association with social support and food insecurity among men accessing HIV care at a rural health facility in southwestern Uganda.

METHODS

We conducted a clinic-based cross-sectional study and consecutively enrolled 252 adult men accessing HIV care at a rural health centre in southwestern Uganda. We collected information on sociodemographic information, HIV stigma, social support, and food insecurity. We fitted modified Poisson regression models to determine the associations between social support, food insecurity, and HIV stigma.

RESULTS

The mean HIV stigma score of the study participants was 70.08 (SD 19.34) and 75% reported food insecurity 5% of whom were severely food insecure. The risk of HIV stigma was lower among those aged 35 years and above (adjusted risk ratio [ARR]=0.89; 95% CI 0.83-0.96; P=0.003, those who had been on ART for more than 5 years (ARR=0.92; 95% CI=0.84-0.99; P=0.04), and those who had social support (ARR=0.99; 95% CI=0.98-0.99; P=<0.001). Food insecurity was associated with an increased risk of HIV stigma (ARR=1.07; 95% CI 1.00-1.15; P=0.03). Social support moderated the effect of food insecurity on HIV stigma (P=0.45).

CONCLUSION

Stigma is common among men living with HIV in rural Uganda and is significantly associated with food insecurity. Social support moderated the effect of severe food insecurity on HIV stigma among men living with HIV. Interventions to build social support systems and to economically empower men living with HIV should be incorporated into the mainstream HIV care clinics.

Addressing Family Planning Access Barriers Using an Integrated Population Health Environment Approach in Rural Uganda

Recent studies recommend FP initiatives in rural sub-Saharan Africa operate in more context-specific ways to reduce inequities. In 2011 such a project, HoPE-LVB, was implemented by Pathfinder International and local partners among Ugandan Lake Victoria fishing communities using a Population, Health and Environment approach. Among other objectives, the project aimed to increase support for FP and women's involvement in decision-making by linking FP benefits to community needs including income generation from nature-based livelihoods. Improved FP access was measured by the project using qualitative methods and the project's indicator database in terms of five barriers: service quality, community knowledge, physical access, finances, and social acceptability. Through coordinated interventions representing multiple sectors, the project helped communities move more towards a -tipping point‖ whereby FP use has now become more an acceptable and accepted social norm. Central to this has been improving service quality and physical access as well as facilitating women's involvement in income-generation, thereby increasing their agency and contribution to decision-making including pregnancy timing.

Internalized HIV stigma, bullying, major depressive disorder, and high-risk suicidality among HIV-positive adolescents in rural Uganda

BACKGROUND

Studies conducted in sub-Saharan Africa suggest a high prevalence of depression and suicidality among adolescents living with HIV (ALWH). This is an important public health issue because depression is known to compromise HIV treatment adherence. However, the drivers of depression and suicidality in this population are unclear. We conducted a cross-sectional study to estimate the associations between internalized stigma, bullying, major depressive disorder, and suicidality.

METHODS

We conducted a cross-sectional survey between November 2016 and March 2017, enrolling a consecutive sample of 224 ALWH aged 13-17 years. We collected information on demographic characteristics, internalized HIV-related stigma (using the six-item Internalized AIDS-Related Stigma Scale), bullying victimization (using the nine-item Social and Health Assessment Peer Victimization Scale), major depressive disorder [using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)], and suicidality (also using the MINI-KID). We fitted multivariable logistic regression models to estimate the associations between stigma, bullying, major depressive disorder, and suicidality.

RESULTS

Thirty-seven participants (16%) had major depressive disorder, 30 (13%) had suicidality, and nine (4%) had high-risk suicidality. Ninety-one participants (41%) had high levels of internalized stigma, while 97 (43%) reported two or more bullying events in the past year. In multivariable logistic regression models, major depressive disorder had a statistically significant association with bullying (AOR = 1.09; 95% CI 1.00-1.20; p = 0.04); while suicidality (low, moderate, high risk) had statistically significant associations with both bullying (AOR = 1.09; 95% CI 1.01-1.17; p = 0.02) and stigma (AOR = 1.30; 95% CI 1.03-1.30; p = 0.02).

CONCLUSIONS

Among ALWH in rural Uganda, stigma and bullying are strongly associated with major depressive disorder and suicidality. There is a need to incorporate psychological interventions in the mainstream HIV care to address these challenges for optimal management of HIV among ALWH.

Community-made mobile videos as a mechanism for maternal, newborn and child health education in rural Uganda; a qualitative evaluation

INTRODUCTION

In Uganda, the maternal, newborn and child mortality is highest in rural areas, which are least served by health services and are also least reached by effective behavior change communication for health. Though maternal and child health related messages are available, they are still not culture and context specific for effective behaviour change.

AIM

This study aimed at evaluating the feasibility of using locally made videos by local community groups in local languages as a channel for increasing knowledge, practices, demand and use of maternal and child health messages among women living in rural communities in Eastern Uganda.

METHODS

This paper describes the qualitative findings from a quasi experimental study targeting the rural semi-illiterate populations in hard to reach areas. Videos were developed and implemented based on Ministry of Health. Focus group discussions and KIs targeted pregnant and post natal mothers. Data transcription and content analysis was done.

RESULTS

Local mobile community videos were effective in communicating knowledge about key maternal and child health messages to both women and their male partners.

CONCLUSION

Locally made mobile community videos are effective in improving knowledge, attitudes, practices and use of maternal and child health messages among rural semi-illiterate communities.

Socioeconomic and Demographic Factors Influencing Feeding Practices, Morbidity Status, and Dietary Intakes of Children Aged 7-24 Months in Rural Uganda

The objective of this study was to analyze the nutritional and morbidity patterns of children aged 7-24 months in relationship to household socioeconomic and demographic characteristics. Structured questionnaires and repeated 24-hour recalls were used to collect data. Maternal education and age influenced timing of complementary foods, dietary diversity score, meal frequency, and diarrhea incidences (p < .05). This resulted in 53%, 59%, 48%, 43%, and 22% of the study children having inadequate intake of energy, protein, vitamin A, iron, and zinc, respectively. Households need to be empowered to utilize available resources for improving nutrient intake and health among their children.

Mortality and its predictors among antiretroviral therapy naïve HIV-infected individuals with CD4 cell count ≥350 cells/mm(3) compared to the general population: data from a population-based prospective HIV cohort in Uganda

Background

Evidence exists that even at high CD4 counts, mortality among HIV-infected antiretroviral therapy (ART) naïve individuals is higher than that in the general population. However, many developing countries still initiate ART at CD4 ≤350 cells/mm³.

Objective

To compare mortality among HIV-infected ART naïve individuals with CD4 counts ≥350 cells/mm³ with mortality in the general Ugandan population and to investigate risk factors for death.

Design

Population-based prospective HIV cohort.

Methods

The study population consisted of HIV-infected people in rural southwest Uganda. Patients were reviewed at the study clinic every 3 months. CD4 cell count was measured every 6 months. Rate ratios were estimated using Poisson regression. Indirect methods were used to calculate standardised mortality ratios (SMRs).

Results

A total of 374 participants with CD4 ≥350 cells/mm³ were followed for 1,328 person-years (PY) over which 27 deaths occurred. Mortality rates (MRs) (per 1,000 PY) were 20.34 (95% CI: 13.95–29.66) among all participants and 16.43 (10.48–25.75) among participants aged 15–49 years. Mortality was higher in periods during which participants had CD4 350–499 cells/mm³ than during periods of CD4 ≥500 cells/mm³ although the difference was not statistically significant [adjusted rate ratio (aRR)=1.52; 95% CI: 0.71–3.25]. Compared to the general Ugandan population aged 15–49 years, MRs were 123% higher among participants with CD4 ≥500 cells/mm³ (SMR: 223%, 95% CI: 127–393%) and 146% higher among participants with CD4 350–499 cells/mm³ (246%, 117%–516). After adjusting for current age, mortality was associated with increasing WHO clinical stage (aRR comparing stage 3 or 4 and stage 1: 10.18, 95% CI: 3.82–27.15) and decreasing body mass index (BMI) (aRR comparing categories ≤17.4 Kg/m² and ≥18.5 Kg/m²: 6.11, 2.30–16.20).

Conclusion

HIV-infected ART naïve individuals with CD4 count ≥350 cells/mm³ had a higher mortality than the general population. After adjusting for age, the main predictors of mortality were WHO clinical stage and BMI.