BMC Complementary and Alternative Medicine, Jan 16, 2014
Background: Infertility is a public health problem associated with devastating psychosocial conse... more Background: Infertility is a public health problem associated with devastating psychosocial consequences. In countries where infertility care is difficult to access, women turn to herbal medicines to achieve parenthood. The aim of this study was to determine the prevalence and factors associated with herbal medicine use by women attending the infertility clinic. Methods: This was a cross-sectional study of 260 women attending the infertility clinic at Mulago hospital. The interviewer administered questionnaire comprised socio-demographic characteristics, infertility-related aspects and information on herbal medicine use. The main outcome measure was herbal medicines use for infertility treatment. Determinants of herbal medicine use were assessed using multivariable logistic regression. The majority (76.2%) of respondents had used herbal medicines for infertility treatment. The mean age of the participants was 28.3 years ± 5.5. Over 80% were married, 59.6% had secondary infertility and 2/3 of the married participants were in monogamous unions. In a multivariable model, the variables that were independently associated with increased use of herbal medicine among infertile patients were being married (OR 2.55, CI 1.24-5.24), never conceived (OR 4.08 CI 1.86-8.96) and infertility for less than 3 years (OR 3.52 CI 1.51-8.821). Factors that were associated with less use of herbal medicine among infertile women were being aged 30 years or less (OR 0.18 CI 0.07-0.46), primary and no education (OR 0.12 CI 0.05-0.46) and living with partner for less than three years (OR 0.39 CI 0.16-0.93). Conclusions: The prevalence of herbal medicine use among women attending the infertility clinic was 76.2%. Herbal medicine use was associated with the participants' age, level of education, marital status, infertility duration, nulliparity, and duration of marriage. Medical care was often delayed and the majority of the participants did not disclose use of herbal medicines to the attending physician. Health professionals should enquire about use of herbal medicines. This may help in educating the patients about the health risks of using herbal medicine and may reduce delays in seeking appropriate care. Collaboration of health professionals with herbal medicine practitioners would help identify the common herbal medicines used for infertility treatment, their potential benefits and harm.
Background: Intimate partner violence (IPV) is a global health problem causing ill health among w... more Background: Intimate partner violence (IPV) is a global health problem causing ill health among women especially of reproductive age. Its global prevalence is estimated to be 30-71%. The prevalence is higher among African and Asian populations compared to American and European populations. In Uganda, the prevalence of IPV among women with abortion was 56.4% in 2005. Since then, the Domestic Violence Act was enacted in 2010; sexual and gender based violence desks initiated in hospitals and a number of agencies working to prevent violence against women have sprung up. The objective of this study was to determine the current prevalence and factors associated with IPV among women with abortion at Mulago National Referral Hospital in Kampala city. Methods: A hospital based cross-sectional study was conducted over 4 months on 480 women. Data were collected using an interviewer-administered questionnaire and analyzed using STATA 13.0. Those variables with a p-value ≤0.05 were considered statistically signi cant at multi-variate analysis. Results: The prevalence of IPV among women with abortion was 71.3%. The factors that were signi cantly associated with intimate partner violence were: being divorced/widowed/separated (aOR 8.7, CI 1.1997-38.268, and p-value= 0.004), being never married (aOR 5.5, CI 2.700-11.138, and p-value <0.001), number of children (aOR 1.2, CI 1.053-1.411 and p-value =0.008) and witnessing abuse as an adult (aOR 6.1, CI 2.678-13.727, and p-value <0.001). Conclusion: This study has shown that the prevalence of IPV among women with abortion is still high despite interventions. More concerted effort needs to be directed toward improving contraceptive services, marriage and family support systems and community awareness on the effects of IPV on women and society.
Introduction Within Africa, contraceptive use is low although about 214 million women who are not... more Introduction Within Africa, contraceptive use is low although about 214 million women who are not using contraception want to avoid pregnancy. In Uganda, modern contraceptive uptake is at 35% resulting in unwanted or unplanned pregnancies which may increase morbidity and mortality among children and mothers. Contraceptive uptake at 6 weeks postpartum is encouraged but it is not very effective since there is low attendance during this visit. Additionally, some women may have become sexually active by the visit at 6 weeks postpartum leading to early conception. Objectives This study sought to determine contraceptive uptake in the immediate postpartum period and the associated factors among women delivering at Kawempe Hospital. Methods This study employed a cross-sectional study design where 397 women aged 18–49 years were recruited using systematic random sampling. The women who were discharged within 72 h after delivery were considered. Data collection was done using an interviewer-a...
Introduction While urban areas are often perceived and reported as better off due to the wide ava... more Introduction While urban areas are often perceived and reported as better off due to the wide availability of and apparent proximity to services, family planning (FP) access among the marginalized communities such as slums might be worse. Although evidence on access to FP in urban space is illusive, just like rural poor, the urban poor residents are characterized by multidimensional challenges that not only limit the population from accessing voluntary FP (VFP) services but also expose them to unplanned sexual intercourse and ultimately unplanned pregnancies and other related consequences. In this study we seek to augment and strengthen existing efforts towards increasing coverage and uptake of VFP in Jinja city and Iganga Municipality, central eastern Uganda. Our primary question is “what interventions can effectively be packaged and delivered to increase uptake of VFP and promote urban thriving. Methods We propose to use the Human-Centered Design (HCD) approach to understand the n...
Contraception and reproductive medicine, Apr 12, 2023
Background High levels of unmet need for contraception and unwanted pregnancies are high in devel... more Background High levels of unmet need for contraception and unwanted pregnancies are high in developing countries despite efforts to reduce them. Long-acting reversible contraceptive (LARC) methods are more than 99% effective in preventing pregnancy. Discontinuation of LARC within the first year of initiation contributes to the high levels of unmet need. This study aimed to determine the prevalence and factors associated with the first-year discontinuation of LARC at Kawempe National Referral hospital. Methods A facility-based cross-sectional study was conducted from February 2020 to June 2021. We consecutively recruited 354 participants who discontinued a LARC (intrauterine device {IUD} and sub-dermal implant) during the study period after informed written consent. Data on duration of use, reasons for discontinuation, and factors associated were collected using a face-to-face interviewer-administered questionnaire and review of client records. Early LARC discontinuation was defined as the termination of the contraception within the first 12 months of use. Data were entered using SPSS version 14/0 and analyzed in STATA version 15. Prevalence was expressed as a proportion while logistic regression was used to assess factors associated with early LARC discontinuation. Variables with a p-value of < 0.05 were considered statistically significant. Results The proportion of first-year discontinuation of LARC was 29%. Women Age less than 25 years (OR = 5.07; 95% CI: 1.1-24.8) and those who desired a family size of fewer than four children (OR = 3.19; 95%CI: 1.2-8.7) were more likely to discontinue the LARC within 12 months of initiation after multivariate analysis. Method-related reasons for removal were painful menstrual cramps for implants, recurrent infections for IUDs, and a non-side effect reason was the desire to get pregnant. Conclusion A high proportion of women discontinue LARC within 12 months following initiation. Young adults and those who desire small families are more likely to have first-year discontinuation of LARC. We recommend age-specific
International journal of gynaecology and obstetrics, Sep 19, 2022
ObjectivesTo understand the relationship between informed choice and long‐acting reversible contr... more ObjectivesTo understand the relationship between informed choice and long‐acting reversible contraceptive (LARC) use among women aged 15–49 years in Uganda after adjusting for potential confounding.MethodsThis cross‐sectional study uses data from the 2016 Uganda Standard Demographic and Health Survey. Thomas‐Rao corrections to a χ2 test were used for the bivariable analysis. A design‐adjusted multivariable logistic regression was used to estimate the association between informed choice and LARC use. Propensity score matching was conducted as a sensitivity analysis.ResultsIn all, 3646 women were included in the analysis and 975 reported using a LARC. In the design‐adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% confidence interval 1.61–2.43) times higher among women who reported informed choice compared with those who did not. The subsequent propensity score analysis reported similar findings.ConclusionProviding informed choice can help to increase the number of women who use LARC in Uganda. As such, the Ugandan Ministry of Health should further expand access to family planning counseling as it could contribute to the reduction of unplanned pregnancies across Uganda with the use of LARC.
Introduction Long-acting reversible contraceptive (LARC) methods are superior to other modern bir... more Introduction Long-acting reversible contraceptive (LARC) methods are superior to other modern birth control methods in preventing pregnancy as they are highly effective and have a low failure rate. The Ugandan Ministry of Health has prioritized providing long-acting reversible contraception (LARC) and ensuring informed choice within the context of family planning. This study aims to understand the relationship between informed choice and LARC use among women aged 15-49 in Uganda after adjusting for potential confounding. Methods This cross-sectional study utilizes data from the 2016 Uganda Standard Demographic and Health Survey. Thomas-Rao corrections to a chi-square test were used for the bivariable analysis. A design-adjusted multivariable logistic regression was used to estimate the association between informed choice and LARC use. Propensity score matching was conducted as a sensitivity analysis. Results In all, 3,646 women were included in the analysis and 975 reported using a LARC. In the design-adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% CI 1.61-2.43) times higher among women who reported informed choice compared to those who did not. The subsequent propensity score analysis reported similar ndings. Discussion Providing informed choices can help increase the number of women who utilize LARCs in Uganda. As such, the Ugandan Ministry of Health should further expand access to family planning counselling as it could contribute to the reduction of unplanned pregnancies across Uganda through the use of LARCs. Signi cance: There is currently no research on the association between informed choice and long-term reversible contraception (LARC) use in Uganda. More broadly, research in relation to informed choice and LARC use in sub-Saharan Africa is largely descriptive. This association is important to understand because Uganda has one of the highest unplanned pregnancy and fertility rates in the world. The study will contribute to a better understanding of family planning counselling in Uganda, which may be useful in developing future family planning programs and interventions. As such, this will help reduce the overall unplanned pregnancy rate in Uganda.
Introduction: Pelvic organ prolapse (POP) is associated with negative physical, social, psycholog... more Introduction: Pelvic organ prolapse (POP) is associated with negative physical, social, psychological, and sexual experiences. There is paucity of data in low and middle income countries like Uganda. The purpose of this study was to describe clinical characteristics and outcomes of patients undergoing surgery for POP from 2007 to 2016. Methods: The study was conducted at Mulago National Referral Hospital from 2014 to 2016. We conducted a retrospective review of the urogynecology surgical records using a standardized medical record abstraction form. Data of 222 POP patients were abstracted and managed using REDCap. Analysis was performed using Stata statistical software, v14. Results: The mean participant age and parity was 57 years and 7 respectively. Ninety four percent of participants presented with a mass protruding from the vagina, 38% with uterine prolapse and 32% with cystocoele. Anaemia and hypertension were common comorbidities. Women underwent a variety of surgery types, and 35% experienced persistent pain post-operatively. At hospital discharge, 83% had achieved either complete resolution or improvement in their condition. Conclusions: Measures encouraging presentation for care as soon as symptoms are experienced and reduction of total fertility rate will be beneficial. Patients with POP should be routinely screened for anaemia and hypertension.
International Journal of Gynecology & Obstetrics
ObjectivesTo understand the relationship between informed choice and long‐acting reversible contr... more ObjectivesTo understand the relationship between informed choice and long‐acting reversible contraceptive (LARC) use among women aged 15–49 years in Uganda after adjusting for potential confounding.MethodsThis cross‐sectional study uses data from the 2016 Uganda Standard Demographic and Health Survey. Thomas‐Rao corrections to a χ2 test were used for the bivariable analysis. A design‐adjusted multivariable logistic regression was used to estimate the association between informed choice and LARC use. Propensity score matching was conducted as a sensitivity analysis.ResultsIn all, 3646 women were included in the analysis and 975 reported using a LARC. In the design‐adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% confidence interval 1.61–2.43) times higher among women who reported informed choice compared with those who did not. The subsequent propensity score analysis reported similar findings.ConclusionProviding informed choice can help to increase th...
Many obstetric fistula patients remain untreated or present late to treatment despite increasing ... more Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uga nda. We explored women's perceptions of the cause of their obstetric fistula and their treatment seeking behaviours, including barriers and facilitators to timely care access. In-depth interviews and focus group discussions were conducted from June-August 2014 among 33 women treated for obstetric fistula at Mulago Hospital, Kampala. Data were analysed to describe dimensions and commonalities of themes identified under perceived causes and treatment seeking experiences, and their intersection. Perceived obstetric fistula causes included delays in deciding on hospital delivery, lengthy labour, injury caused by the baby, health worker incompetence, and traditional beliefs. Treatment seeking timing varied. Early treatment seeking was facilitated by awareness of treatment availability through referral, the media, community members, and support by partners and ...
Fistula-related stigma is common. The absence of a unifying conceptual framework prevents a nuanc... more Fistula-related stigma is common. The absence of a unifying conceptual framework prevents a nuanced understanding of the nature of fistula-related stigma, comparison across contexts and the ability to contrast with other stigmas. It also hinders intervention development. We conducted in-depth interviews or focus groups with 60 women who had undergone fistula surgery 6-24 months prior at Mulago Hospital in Kampala, Uganda in 2014. Transcripts were analysed for experiences and consequences of enacted, anticipated and internalised stigma. Narratives revealed experiences with enacted stigma, including gossip, verbal abuse and social exclusion. Women also anticipated and feared stigma in the future. Internalised stigma reports revealed shame and low self-esteem: self-worth reduction, feeling disgraced and envisioning no future. Consequences included social isolation, changes to normal activities, non-disclosure and poor mental health. Refining stigma theory to specific conditions has resulted in a more nuanced understanding of stigma dimensions, manifestations, mechanisms and consequences, permitting comparison across contexts and populations and the development of stigma-reduction interventions. These lessons should be applied to fistula, acknowledging unique features: concealability, the potential for treatment, lack of community awareness and the social consequences of stillbirth. Reducing fistula-related stigma requires timely surgery and supportive care, stigma-reduction interventions and addressing the complex societal structures that perpetuate fistula.
STUDY QUESTION Is a mechanical hand-held device for removing a single-rod subdermal contraceptive... more STUDY QUESTION Is a mechanical hand-held device for removing a single-rod subdermal contraceptive implant safe for implant users? SUMMARY ANSWER In terms of safety, the device is non-inferior to the standard technique for implant removal. WHAT IS KNOWN ALREADY An easy-to-use device for removing a subdermal contraceptive implant may be helpful in settings where skilled providers are in short supply. Prior to this study, the only report on the world’s first hand-held, mechanical device with build-in incisor was a Swedish study using earlier versions of the product. STUDY DESIGN, SIZE, DURATION From December 2019 to November 2020, we conducted a three-arm, open-label non-inferiority randomized trial involving 225 Ugandan women to assess safety (primary outcome) and measure implant removal efficacy (secondary outcomes) of a newly developed, hand-held device, compared to the standard removal technique. PARTICIPANTS/MATERIALS, SETTING, METHODS We randomized participants desiring removal o...
Background: Female genital fistula, largely caused by prolonged obstructed labour, is treated by ... more Background: Female genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Avoiding pregnancy for a minimum period post-repair is generally recommended to ensure adequate healing, so contraceptive preferences and use are important for optimizing post-repair outcomes. Methods: We examined contraceptive preferences and use in the year following genital fistula surgery using mixed-methods. 60 Ugandan women were enrolled starting in December 2014 with data collection completed in August 2016. Sociodemographic characteristics, fistula-related incontinence, sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n=30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use. Results: Median participant age was 28 years (interquartile range [IQR]: 21–36 years), and almost half (48%) were married o...
Background: The shortage and mal-distribution of surgical specialists in sub-Saharan African coun... more Background: The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level. Methods: 37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations. Results: Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting. Conclusion: Whereas surgical task shifting was viewed as a short-term measure alongside efforts to train and retain adequate numbers of surgical specialists, efforts to upscale its use were widely encouraged.
BMC Complementary and Alternative Medicine, Jan 16, 2014
Background: Infertility is a public health problem associated with devastating psychosocial conse... more Background: Infertility is a public health problem associated with devastating psychosocial consequences. In countries where infertility care is difficult to access, women turn to herbal medicines to achieve parenthood. The aim of this study was to determine the prevalence and factors associated with herbal medicine use by women attending the infertility clinic. Methods: This was a cross-sectional study of 260 women attending the infertility clinic at Mulago hospital. The interviewer administered questionnaire comprised socio-demographic characteristics, infertility-related aspects and information on herbal medicine use. The main outcome measure was herbal medicines use for infertility treatment. Determinants of herbal medicine use were assessed using multivariable logistic regression. The majority (76.2%) of respondents had used herbal medicines for infertility treatment. The mean age of the participants was 28.3 years ± 5.5. Over 80% were married, 59.6% had secondary infertility and 2/3 of the married participants were in monogamous unions. In a multivariable model, the variables that were independently associated with increased use of herbal medicine among infertile patients were being married (OR 2.55, CI 1.24-5.24), never conceived (OR 4.08 CI 1.86-8.96) and infertility for less than 3 years (OR 3.52 CI 1.51-8.821). Factors that were associated with less use of herbal medicine among infertile women were being aged 30 years or less (OR 0.18 CI 0.07-0.46), primary and no education (OR 0.12 CI 0.05-0.46) and living with partner for less than three years (OR 0.39 CI 0.16-0.93). Conclusions: The prevalence of herbal medicine use among women attending the infertility clinic was 76.2%. Herbal medicine use was associated with the participants' age, level of education, marital status, infertility duration, nulliparity, and duration of marriage. Medical care was often delayed and the majority of the participants did not disclose use of herbal medicines to the attending physician. Health professionals should enquire about use of herbal medicines. This may help in educating the patients about the health risks of using herbal medicine and may reduce delays in seeking appropriate care. Collaboration of health professionals with herbal medicine practitioners would help identify the common herbal medicines used for infertility treatment, their potential benefits and harm.
Background: Intimate partner violence (IPV) is a global health problem causing ill health among w... more Background: Intimate partner violence (IPV) is a global health problem causing ill health among women especially of reproductive age. Its global prevalence is estimated to be 30-71%. The prevalence is higher among African and Asian populations compared to American and European populations. In Uganda, the prevalence of IPV among women with abortion was 56.4% in 2005. Since then, the Domestic Violence Act was enacted in 2010; sexual and gender based violence desks initiated in hospitals and a number of agencies working to prevent violence against women have sprung up. The objective of this study was to determine the current prevalence and factors associated with IPV among women with abortion at Mulago National Referral Hospital in Kampala city. Methods: A hospital based cross-sectional study was conducted over 4 months on 480 women. Data were collected using an interviewer-administered questionnaire and analyzed using STATA 13.0. Those variables with a p-value ≤0.05 were considered statistically signi cant at multi-variate analysis. Results: The prevalence of IPV among women with abortion was 71.3%. The factors that were signi cantly associated with intimate partner violence were: being divorced/widowed/separated (aOR 8.7, CI 1.1997-38.268, and p-value= 0.004), being never married (aOR 5.5, CI 2.700-11.138, and p-value <0.001), number of children (aOR 1.2, CI 1.053-1.411 and p-value =0.008) and witnessing abuse as an adult (aOR 6.1, CI 2.678-13.727, and p-value <0.001). Conclusion: This study has shown that the prevalence of IPV among women with abortion is still high despite interventions. More concerted effort needs to be directed toward improving contraceptive services, marriage and family support systems and community awareness on the effects of IPV on women and society.
Introduction Within Africa, contraceptive use is low although about 214 million women who are not... more Introduction Within Africa, contraceptive use is low although about 214 million women who are not using contraception want to avoid pregnancy. In Uganda, modern contraceptive uptake is at 35% resulting in unwanted or unplanned pregnancies which may increase morbidity and mortality among children and mothers. Contraceptive uptake at 6 weeks postpartum is encouraged but it is not very effective since there is low attendance during this visit. Additionally, some women may have become sexually active by the visit at 6 weeks postpartum leading to early conception. Objectives This study sought to determine contraceptive uptake in the immediate postpartum period and the associated factors among women delivering at Kawempe Hospital. Methods This study employed a cross-sectional study design where 397 women aged 18–49 years were recruited using systematic random sampling. The women who were discharged within 72 h after delivery were considered. Data collection was done using an interviewer-a...
Introduction While urban areas are often perceived and reported as better off due to the wide ava... more Introduction While urban areas are often perceived and reported as better off due to the wide availability of and apparent proximity to services, family planning (FP) access among the marginalized communities such as slums might be worse. Although evidence on access to FP in urban space is illusive, just like rural poor, the urban poor residents are characterized by multidimensional challenges that not only limit the population from accessing voluntary FP (VFP) services but also expose them to unplanned sexual intercourse and ultimately unplanned pregnancies and other related consequences. In this study we seek to augment and strengthen existing efforts towards increasing coverage and uptake of VFP in Jinja city and Iganga Municipality, central eastern Uganda. Our primary question is “what interventions can effectively be packaged and delivered to increase uptake of VFP and promote urban thriving. Methods We propose to use the Human-Centered Design (HCD) approach to understand the n...
Contraception and reproductive medicine, Apr 12, 2023
Background High levels of unmet need for contraception and unwanted pregnancies are high in devel... more Background High levels of unmet need for contraception and unwanted pregnancies are high in developing countries despite efforts to reduce them. Long-acting reversible contraceptive (LARC) methods are more than 99% effective in preventing pregnancy. Discontinuation of LARC within the first year of initiation contributes to the high levels of unmet need. This study aimed to determine the prevalence and factors associated with the first-year discontinuation of LARC at Kawempe National Referral hospital. Methods A facility-based cross-sectional study was conducted from February 2020 to June 2021. We consecutively recruited 354 participants who discontinued a LARC (intrauterine device {IUD} and sub-dermal implant) during the study period after informed written consent. Data on duration of use, reasons for discontinuation, and factors associated were collected using a face-to-face interviewer-administered questionnaire and review of client records. Early LARC discontinuation was defined as the termination of the contraception within the first 12 months of use. Data were entered using SPSS version 14/0 and analyzed in STATA version 15. Prevalence was expressed as a proportion while logistic regression was used to assess factors associated with early LARC discontinuation. Variables with a p-value of < 0.05 were considered statistically significant. Results The proportion of first-year discontinuation of LARC was 29%. Women Age less than 25 years (OR = 5.07; 95% CI: 1.1-24.8) and those who desired a family size of fewer than four children (OR = 3.19; 95%CI: 1.2-8.7) were more likely to discontinue the LARC within 12 months of initiation after multivariate analysis. Method-related reasons for removal were painful menstrual cramps for implants, recurrent infections for IUDs, and a non-side effect reason was the desire to get pregnant. Conclusion A high proportion of women discontinue LARC within 12 months following initiation. Young adults and those who desire small families are more likely to have first-year discontinuation of LARC. We recommend age-specific
International journal of gynaecology and obstetrics, Sep 19, 2022
ObjectivesTo understand the relationship between informed choice and long‐acting reversible contr... more ObjectivesTo understand the relationship between informed choice and long‐acting reversible contraceptive (LARC) use among women aged 15–49 years in Uganda after adjusting for potential confounding.MethodsThis cross‐sectional study uses data from the 2016 Uganda Standard Demographic and Health Survey. Thomas‐Rao corrections to a χ2 test were used for the bivariable analysis. A design‐adjusted multivariable logistic regression was used to estimate the association between informed choice and LARC use. Propensity score matching was conducted as a sensitivity analysis.ResultsIn all, 3646 women were included in the analysis and 975 reported using a LARC. In the design‐adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% confidence interval 1.61–2.43) times higher among women who reported informed choice compared with those who did not. The subsequent propensity score analysis reported similar findings.ConclusionProviding informed choice can help to increase the number of women who use LARC in Uganda. As such, the Ugandan Ministry of Health should further expand access to family planning counseling as it could contribute to the reduction of unplanned pregnancies across Uganda with the use of LARC.
Introduction Long-acting reversible contraceptive (LARC) methods are superior to other modern bir... more Introduction Long-acting reversible contraceptive (LARC) methods are superior to other modern birth control methods in preventing pregnancy as they are highly effective and have a low failure rate. The Ugandan Ministry of Health has prioritized providing long-acting reversible contraception (LARC) and ensuring informed choice within the context of family planning. This study aims to understand the relationship between informed choice and LARC use among women aged 15-49 in Uganda after adjusting for potential confounding. Methods This cross-sectional study utilizes data from the 2016 Uganda Standard Demographic and Health Survey. Thomas-Rao corrections to a chi-square test were used for the bivariable analysis. A design-adjusted multivariable logistic regression was used to estimate the association between informed choice and LARC use. Propensity score matching was conducted as a sensitivity analysis. Results In all, 3,646 women were included in the analysis and 975 reported using a LARC. In the design-adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% CI 1.61-2.43) times higher among women who reported informed choice compared to those who did not. The subsequent propensity score analysis reported similar ndings. Discussion Providing informed choices can help increase the number of women who utilize LARCs in Uganda. As such, the Ugandan Ministry of Health should further expand access to family planning counselling as it could contribute to the reduction of unplanned pregnancies across Uganda through the use of LARCs. Signi cance: There is currently no research on the association between informed choice and long-term reversible contraception (LARC) use in Uganda. More broadly, research in relation to informed choice and LARC use in sub-Saharan Africa is largely descriptive. This association is important to understand because Uganda has one of the highest unplanned pregnancy and fertility rates in the world. The study will contribute to a better understanding of family planning counselling in Uganda, which may be useful in developing future family planning programs and interventions. As such, this will help reduce the overall unplanned pregnancy rate in Uganda.
Introduction: Pelvic organ prolapse (POP) is associated with negative physical, social, psycholog... more Introduction: Pelvic organ prolapse (POP) is associated with negative physical, social, psychological, and sexual experiences. There is paucity of data in low and middle income countries like Uganda. The purpose of this study was to describe clinical characteristics and outcomes of patients undergoing surgery for POP from 2007 to 2016. Methods: The study was conducted at Mulago National Referral Hospital from 2014 to 2016. We conducted a retrospective review of the urogynecology surgical records using a standardized medical record abstraction form. Data of 222 POP patients were abstracted and managed using REDCap. Analysis was performed using Stata statistical software, v14. Results: The mean participant age and parity was 57 years and 7 respectively. Ninety four percent of participants presented with a mass protruding from the vagina, 38% with uterine prolapse and 32% with cystocoele. Anaemia and hypertension were common comorbidities. Women underwent a variety of surgery types, and 35% experienced persistent pain post-operatively. At hospital discharge, 83% had achieved either complete resolution or improvement in their condition. Conclusions: Measures encouraging presentation for care as soon as symptoms are experienced and reduction of total fertility rate will be beneficial. Patients with POP should be routinely screened for anaemia and hypertension.
International Journal of Gynecology & Obstetrics
ObjectivesTo understand the relationship between informed choice and long‐acting reversible contr... more ObjectivesTo understand the relationship between informed choice and long‐acting reversible contraceptive (LARC) use among women aged 15–49 years in Uganda after adjusting for potential confounding.MethodsThis cross‐sectional study uses data from the 2016 Uganda Standard Demographic and Health Survey. Thomas‐Rao corrections to a χ2 test were used for the bivariable analysis. A design‐adjusted multivariable logistic regression was used to estimate the association between informed choice and LARC use. Propensity score matching was conducted as a sensitivity analysis.ResultsIn all, 3646 women were included in the analysis and 975 reported using a LARC. In the design‐adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% confidence interval 1.61–2.43) times higher among women who reported informed choice compared with those who did not. The subsequent propensity score analysis reported similar findings.ConclusionProviding informed choice can help to increase th...
Many obstetric fistula patients remain untreated or present late to treatment despite increasing ... more Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uga nda. We explored women's perceptions of the cause of their obstetric fistula and their treatment seeking behaviours, including barriers and facilitators to timely care access. In-depth interviews and focus group discussions were conducted from June-August 2014 among 33 women treated for obstetric fistula at Mulago Hospital, Kampala. Data were analysed to describe dimensions and commonalities of themes identified under perceived causes and treatment seeking experiences, and their intersection. Perceived obstetric fistula causes included delays in deciding on hospital delivery, lengthy labour, injury caused by the baby, health worker incompetence, and traditional beliefs. Treatment seeking timing varied. Early treatment seeking was facilitated by awareness of treatment availability through referral, the media, community members, and support by partners and ...
Fistula-related stigma is common. The absence of a unifying conceptual framework prevents a nuanc... more Fistula-related stigma is common. The absence of a unifying conceptual framework prevents a nuanced understanding of the nature of fistula-related stigma, comparison across contexts and the ability to contrast with other stigmas. It also hinders intervention development. We conducted in-depth interviews or focus groups with 60 women who had undergone fistula surgery 6-24 months prior at Mulago Hospital in Kampala, Uganda in 2014. Transcripts were analysed for experiences and consequences of enacted, anticipated and internalised stigma. Narratives revealed experiences with enacted stigma, including gossip, verbal abuse and social exclusion. Women also anticipated and feared stigma in the future. Internalised stigma reports revealed shame and low self-esteem: self-worth reduction, feeling disgraced and envisioning no future. Consequences included social isolation, changes to normal activities, non-disclosure and poor mental health. Refining stigma theory to specific conditions has resulted in a more nuanced understanding of stigma dimensions, manifestations, mechanisms and consequences, permitting comparison across contexts and populations and the development of stigma-reduction interventions. These lessons should be applied to fistula, acknowledging unique features: concealability, the potential for treatment, lack of community awareness and the social consequences of stillbirth. Reducing fistula-related stigma requires timely surgery and supportive care, stigma-reduction interventions and addressing the complex societal structures that perpetuate fistula.
STUDY QUESTION Is a mechanical hand-held device for removing a single-rod subdermal contraceptive... more STUDY QUESTION Is a mechanical hand-held device for removing a single-rod subdermal contraceptive implant safe for implant users? SUMMARY ANSWER In terms of safety, the device is non-inferior to the standard technique for implant removal. WHAT IS KNOWN ALREADY An easy-to-use device for removing a subdermal contraceptive implant may be helpful in settings where skilled providers are in short supply. Prior to this study, the only report on the world’s first hand-held, mechanical device with build-in incisor was a Swedish study using earlier versions of the product. STUDY DESIGN, SIZE, DURATION From December 2019 to November 2020, we conducted a three-arm, open-label non-inferiority randomized trial involving 225 Ugandan women to assess safety (primary outcome) and measure implant removal efficacy (secondary outcomes) of a newly developed, hand-held device, compared to the standard removal technique. PARTICIPANTS/MATERIALS, SETTING, METHODS We randomized participants desiring removal o...
Background: Female genital fistula, largely caused by prolonged obstructed labour, is treated by ... more Background: Female genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Avoiding pregnancy for a minimum period post-repair is generally recommended to ensure adequate healing, so contraceptive preferences and use are important for optimizing post-repair outcomes. Methods: We examined contraceptive preferences and use in the year following genital fistula surgery using mixed-methods. 60 Ugandan women were enrolled starting in December 2014 with data collection completed in August 2016. Sociodemographic characteristics, fistula-related incontinence, sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n=30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use. Results: Median participant age was 28 years (interquartile range [IQR]: 21–36 years), and almost half (48%) were married o...
Background: The shortage and mal-distribution of surgical specialists in sub-Saharan African coun... more Background: The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level. Methods: 37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations. Results: Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting. Conclusion: Whereas surgical task shifting was viewed as a short-term measure alongside efforts to train and retain adequate numbers of surgical specialists, efforts to upscale its use were widely encouraged.
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Papers by Othman Kakaire