Aggrey David Mukose

Background: Epilepsy is a common neurological disease especially in Sub-Saharan Africa. Medication adherence is essential in seizure control; however, majority of patients living with epilepsy have poor adherence to anti- seizure medications. The purpose of this study was to determine the prevalence, the factors associated with, and the experiences with adherence to anti-seizure medications among people living with epilepsy attending a community- based epilepsy clinic in Buikwe District and Mukono General Hospital in Mukono District, central-Uganda. Methods and material: In this cross-sectional mixed methods study, 277 participants were enrolled and 20 in-depth interviews were conducted from April to July 2024. Socio-demographics and treatment related information were collected using structured questionnaires. Medication adherence was measured using the standardized 8- item Morisky Medication Adherence Scale. Modified Poisson regression was done to determine factors associated with adherence to anti-seizure medications. Thematic analysis was conducted to explore participant’s experiences with adherence to anti-seizure medications. Results: The overall prevalence of adherence to anti-seizure medications was 66.5%. Factors significantly associated with adherence to Anti-seizure medications were earning a modest monthly income, adjusted prevalence ratios [aPR], (aPR 1.29; CI 1.13-1.53), receiving an inadequate treatment dosage (aPR 0.80; 95% CI 0.64-0.92), waiting for three or more hours at the facility (aPR 0.79: 95% CI 0.61-0.91), and being aged 30 to 34 years (aPR 0.71: CI 0.53-0.95). Key themes describing experiences with adherence to anti-seizure medications included fear of stigmatization, fear of injury and loss of life, social support, financial burden, individual motivation, misconceptions about anti-seizure medications, and limited awareness about their effectiveness. Conclusion: This study revealed that about two- thirds of people living with epilepsy were adherent to anti-seizure medications. There is a need to implement strategies such as incorporating a medication adherence tool into routine patient care to improve adherence in our settings.

Food insecurity is a significant public health problem affecting almost a third of the global population [1]. By 2020, it was estimated that 11.7% of the global population faced severe food insecur...

Background: Uganda faces high HIV/AIDS rates among adolescent girls and young women (AGYW). This study sought to determine the prevalence of satisfaction with HIV counseling and testing services among AGYW. It aimed to identify factors associated with their satisfaction and explored drivers and barriers to their satisfaction with HCT provided at the adolescent and pediatric clinic in Mildmay Hospital. Methodology: A mixed methods cross-sectional study was conducted, 385 AGYW aged 15-24 were obtained through systematic random sampling. Quantitative data on patient satisfaction was collected through exit interviews using a patient satisfaction questionnaire. Modified position regression was conducted to determine factors associated with satisfaction with HCT using STATA version 15 software. Qualitative data was obtained through ten in-depth interviews. Data analysis for this was done by transcribing, coding, and extracting themes manually. Results: The prevalence of satisfaction with HCT services was 86%. AGYW with the following characteristics had higher odds of being satisfied: primary as the highest level of education APR: 1.17, 95 CI(0.70-1.97), age (23-25), APR: 1.18, 95 CI (0.82-1.70), single APR: 0.93 95 CI (0.69-1.26) and students APR: 1.17, 95 CI(0.80-1.70). Drivers of satisfaction included a friendly and supportive environment, positive interactions with healthcare professionals, and efficient service delivery. Barriers on the other hand included long waiting times and accessibility challenges. Conclusion: High satisfaction with HCT services was found among AGYW. Paying attention to the barriers to satisfaction as mentioned by respondents can significantly enhance satisfaction as well as the quality of HCT services. Recommendation: The hospital should work towards reducing waiting times, staff communication skills, and providing transportation assistance to AGYW to ensure that they can access the facility whenever they need to. This will help maintain and enhance satisfaction.

Infants born to HIV-infected mothers are at a high risk of acquiring the infection. The World Health Organization recommends early diagnosis of HIV-exposed infants (HEIs) through deoxyribonucleic acid polymerase chain reaction (DNA PCR) and rapid HIV testing. Early detection of paediatric HIV is critical for access to antiretroviral therapy (ART) and child survival. However, there is limited evidence of the factors associated with receiving early infant diagnosis (EID) tests of the HIV testing protocol among HEIs in fishing communities in Uganda. This study established the factors associated with receiving EID tests of the HIV testing protocol among HEIs in a hard-to-reach fishing community in Uganda. A cross-sectional study was conducted among HEIs in selected healthcare facilities in Buvuma islands, Buvuma district. We obtained secondary data from mother-infant pair files enrolled in the EID program using a data extraction tool. Data were analysed using STATA Version 14. A modified Poisson regression analysis was used to determine the factors associated with not receiving the 1^st DNA PCR test among HEIs enrolled in care. None of the HEIs had received all the EID tests prescribed by the HIV testing protocol within the recommended time frame for the period of January 2014-December 2016. The proportion of infants that had received the 1^st and 2^nd DNA PCR, and rapid HIV tests was 39.5%, 6.1%, and 81.0% respectively. Being under the care of a single mother (PR = 1.11, 95% CI: 1.01–1.23, p = 0.023) and cessation of breastfeeding (PR = 0.90, 95% CI: 0.83–0.98, p = 0.025) were significantly associated with not receiving the 1^st DNA PCR. Our study revealed that none of the HEIs had received all the EID tests of the HIV diagnosis testing protocol. Receiving the 1st DNA PCR was positively associated with being an infant born to a single mother, and exclusive breastfeeding. Our findings highlight the need for the creation of an enabling environment for mothers and caregivers in order to increase the uptake of early diagnosis services for HEIs. Awareness-raising on the importance of EID should be scaled up in fishing communities. Demographic characteristics such as marital and breastfeeding status should be used as an entry point to increase the proportion of HEIs who receive EID tests.

Introduction: Uganda has implemented lifelong antiretroviral therapy for the prevention of mother-to-child HIV transmission since September 2012. Implementation of this strategy has been met with health provider and client challenges which have persisted up to date. This study explored providers’ perspectives on the challenges and countermeasures of the implementation and scale-up of lifelong ART among pregnant and breastfeeding women. Methods: A qualitative descriptive study was conducted whereby 54 purposively selected participants from six facilities in three districts of Central Uganda namely; Masaka, Mityana, and Luwero were recruited. A key informant interview guide was used to collect data from the study participants. The data were thematically analysed using Atlas-ti, Version 7. Results: Study participants reported challenges under the themes of 1) inadequacy of HIV service delivery (lack of relevant training, health provider shortages, inadequate counselling, stock-outs of essential HIV commodities); 2) Non-utilization of HIV services (Non-disclosure of HIV- positive results, denial of HIV positive results, fear to be followed up, unwillingness to be referred, large catchment area, lack of transport); and 3) Suboptimal treatment adherence (fear of ART side effects, preference for traditional medicines, low male partner involvement in care and treatment). Strategies such as on-job training, mentorship, task shifting, redistribution of HIV commodities across facilities, accompanying of women to mother-baby care points, ongoing counseling of women, peers, and family support groups were commonly used countermeasures. Conclusions: This study highlights key challenges that health providers face in implementing lifelong antiretroviral therapy services among pregnant and postpartum women. Context-specific, innovative, and multilevel system interventions are required at national, district, health facility, community and individual levels to scale up and sustain the lifelong antiretroviral therapy strategy among pregnant and breastfeeding women.

Alcohol use during pregnancy is a preventable risk factor for Fetal Alcohol Spectrum disorders. Psycho-social and educational interventions have been reported to enable women reduce alcohol intake levels during pregnancy and help improve some health outcomes of unhealthy alcohol use. We set out to assess the effect of a communication intervention on alcohol use during pregnancy in post conflict northern Uganda. The study employed a quasi - experimental design to assess the effect of a community health worker led communication strategy on pregnant women’s knowledge, attitudes and various patterns of alcohol use using Difference in Difference(DiD). 420 respondents were recruited at baseline as at endline. The communication messages were significantly associated with reduced odds of binge drinking (P = 0.018; OR = 0.09; CI = 0.012–0.66). Also those who received the intervention were less likely to drink frequently (P = 0.80; OR = 0.75; 95%CI = 0.074–7.5) or be harmful alcohol users(P = 0.948). The intervention also positively influenced having fair (β =0.49;P = 0.217;RRR =1.63)or adequate knowledge(β = 0.89;P = 0.25;RRR = 2.44) and having positive(β = 0.37;RRR =1.44;P = 0.46) or fair attitude(β = 0.19;RRR = 1.21; P = 0.693) although not to a significant level. The communication intervention affected some patterns of alcohol use among pregnant women and not others. Our results contribute to existing evidence that communication interventions are a promising approach in reduction of alcohol exposed pregnancies. Interventions aimed at promoting alcohol abstinence during pregnancy should be implemented alongside other strategies that address factors that influence pregnant women to drink to achieve maximum results.

Background: Infants born to HIV-infected mothers are at a high risk of acquiring the infection. The World Health Organization (WHO) recommends early diagnosis of HIV-exposed infants (HEIs) through deoxyribonucleic acid polymerase chain reaction (DNA PCR) and rapid HIV testing. Early detection of paediatric HIV is critical for access to antiretroviral therapy treatment (ART) and child survival. There’s, however, limited evidence of the adherence to early infant diagnosis (EID) of HIV testing protocol among HEIs in fishing communities in Uganda. This study assessed adherence to EID of HIV testing protocol among HIV-exposed infants in a hard-to-reach fishing community in Uganda. Methods: We conducted a cross-sectional study employing quantitative data collection methods among HEIs in selected healthcare facilities in Buvuma islands, Buvuma district. We obtained secondary data from mother-infant pair files enrolled on the EID program using a data extraction tool. Data were analysed using STATA Version 14. Modified poisson regression analysis was used to determine the factors associated with non-adherence to the 1 ^st DNA PCR test among HIV-exposed infants enrolled into care. Results: None of the HIV-exposed infants had done all the EID tests prescribed by the HIV testing protocol within the recommended time frame for the period of January 2014-December 2016. Adherence to the 1 ^st and 2 ^nd DNA PCR, and rapid HIV tests was 39.5%, 6.1% and 81.0% respectively. Being under the care of single mothers (PR=1.11, 95% CI: 1.01-1.23, p=0.023) and cessation of breast feeding (PR=0.90, 95% CI: 0.83-0.98, p=0.025) were significantly associated with non-adherence to the 1 ^st DNA PCR. Conclusion: None of the HIV-exposed infants adhered to all the EID tests of HIV testing protocol. Adherence to the 1st DNA PCR was positively associated with being a single mother and exclusive breast feeding. Therefore, single mothers and those who stop breastfeeding should be supported to ensure timely EID.

The postnatal period is critical to the delivery of interventions aimed at improving maternal health outcomes. This study examined the timing to resumption of sexual intercourse and associated factors among postnatal women living with HIV (WLWH) in Uganda. A sample of 385 women was drawn from a larger prospective cohort study conducted between 2013 and 2015. We used survival analysis to estimate the postpartum time periods during which women had a higher risk of sexual intercourse resumption within 6 months after childbirth. Cox proportional hazards regression was used to examine associated factors with sexual intercourse resumption. The cumulative probability of sexual intercourse resumption was lowest (6.2%) in the sub-acute postpartum period (1–45 days since delivery) and highest (88.2%) in the delayed postpartum period (151–183 days since delivery). Having a live-term baby (adjusted HR 0.52, 95% CI 0.31–0.85, p = 0.01) and an advanced education (adjusted HR 0.63, 95% CI 0.40–0.98, p = 0.04) were associated with a lower risk of sexual intercourse resumption. Desire for another child (adjusted HR 1.36, 95% CI 1.08–1.73, p = 0.01), having a sexual partner (adjusted HR 5.97, 95% CI 3.10–11.47, p < 0.001) and contraceptive use (adjusted HR 2.21, 95% CI 1.65–2.95, p < 0.001) were associated with a greater risk of sexual intercourse resumption. However, only 1 in 4 women who resumed sexual intercourse by the 90th day after childbirth, reported currently using contraception. HIV programs should focus on supporting postnatal women to align the timing of sexual intercourse resumption with their return to contraceptive use. Interventions aimed at improving contraceptive uptake among postnatal WLWH should target the delayed postpartum period.

Background: High uptake and optimal adherence to Option B+ antiretroviral therapy (ART) increase effectiveness in averting mother-to-child transmission of HIV. Option B+ ART uptake, early adherence, and associated factors need to be evaluated in Central Uganda. Methods: A mixed approaches study was carried out in six health facilities in Masaka, Mityana, and Luwero districts from October 2013 to February 2016. Questionnaires were administered to 507 HIV positive pregnant females seeking antenatal care services. Key informant interviews were conducted with 54 health providers, and in-depth interviews (IDIs) with 57 HIV positive women on Option B+ ART. Quantitative data were analyzed using log-binomial regression model to determine factors associated with optimal adherence (taking at least 95% of the prescribed ART), while thematic analysis was used on qualitative data. Results: Ninety one percent of women (463/507) received a prescription of life long ART. Of these, 93.3% (432/463) started swallowing their medicines. Overall, 83% of women who received ART prescriptions (310/374) felt they were ready to initiate ART immediately. Main motivating factors to swallow ART among those who received a prescription were women’s personal desire to be healthy (92.3%) and desire to protect their babies (90.6%). Optimal adherence to ART was achieved by 76.8% (315/410). Adherence was higher among females who were ready to start ART (adj. PR = 3.20; 95% CI: 1.15–8.79) and those who had revealed their HIV positive result to someone (adj. PR = 1.23; 95% CI: 1.04–1.46). Facilitators of ART uptake from qualitative findings included adequate counseling, willingness to start, and knowing the benefits of ART. Reasons for refusal to start ART included being unready to start ART, fear to take ART for life, doubt of HIV positive results, and preference for local herbs. Reasons for non-adherence were travelling far away from health facilities, fear of side effects, non-disclosure of HIV results to anyone, and perception that the baby is safe from HIV infection post-delivery. Conclusions: Uptake of Option B+ ART was very high. However, failure to start swallowing ART and sub-optimal adherence are a major public health concern. Enhancing women’s readiness to start ART and encouraging HIV result revelation could improve ART uptake and adherence.