Browsing by Author "Kagoya, Enid Kawala"

Now showing 1 - 9 of 9
  • No Thumbnail Available
    Item
    Catching babies, carrying traditions : the voices and practices of traditional birth attendants in Mayuge District, East central Uganda.
    (BMC, 2025) Kagoya, Enid Kawala; Auma, Proscovia; Mugabi, Joshua; Kawala, Elizabeth; Asabawebwa, Deogratias; Mugahi, Richard; Mutunda, Brenda Doreen; Gamubaka, Richard; Namaganda, Agnes; Nsubuga, Allan G.; Akello, Jackline; Waako, Paul; Mugabe, Kenneth
    Background: Traditional Birth Attendants (TBAs) continue to support maternal and newborn care in rural Uganda, particularly where access to formal health facilities is limited. Their roles are deeply embedded in local culture and community trust, yet national policies provide inconsistent guidance on their engagement within the formal health system. Objective: To explore the evolution, experiences, practices, challenges, and perceived support needs of TBAs in Mayuge District, and examine their interaction with formal health structures. Methods: A qualitative narrative study was conducted with 15 purposively selected TBAs from all sub-counties of Mayuge District. In-depth interviews lasting 60 to 90 min were held at participants’ homes or workplaces. Participants described and demonstrated their maternal care practices. Audio recordings were transcribed, translated, and analyzed thematically. Results: Seven key themes emerged from the study: (1) Historical Developments and Evolution of TBAs, highlighting diverse pathways into practice such as apprenticeship, family mentorship, formal Ministry of Health training, and community programs; (2) Practices, Methods, and Approaches, detailing TBAs’ provision of antenatal, delivery, and postnatal care, and management of maternal and newborn complications using both traditional and modern methods including newborn resuscitation; (3) Infection Prevention and Control, revealing variable use of personal protective equipment and inconsistent waste disposal practices constrained by limited resources; (4) Maternal and Perinatal Death Surveillance and Response (MPDSR) Process, illustrating TBAs’ limited participation in formal death notifications and reviews; (5) Referral Process, highlighting complex referral behaviors involving health facilities, fellow TBAs, and traditional healers; (6) Socio-Cultural Influences on TBA Services, encompassing the impact of poverty, gender roles, community trust, and cultural norms; and (7) Challenges in Providing Safe and Effective Care, including barriers such as negative attitudes from health workers, transport difficulties, competition, and lack of formal support. Conclusion: TBAs in Mayuge District play a vital role in culturally grounded maternal care but face numerous challenges due to limited formal integration and support. Strategies are needed to strengthen collaboration, provide targeted training, and clarify policy to improve maternal and newborn health outcomes in underserved areas. Keywords: Traditional birth attendants, Maternal and newborn health, Socio-cultural determinants, Referral practices, Health system integration, Rural uganda
  • No Thumbnail Available
    Item
    Community perspectives regarding preparedness, response and prevention of ebola virus disease amidst COVID-19 pandemic, an exploratory descriptive qualitative study using a community engagement approach in Mbale City.
    (Research Square, 2024) Kagoya, Enid Kawala; Nsubuga, Allan G.; Ewing, Helen; Atuhairwe, Irene; Ijangolet, Esther; Otim, Eric; Ronald, Kibuuka; Jesca, Atugonza; Okello, Francis; Nakattudde, Prossy; Nyangoma, Faith; Namara, Racheal; Nakabaale, Mark; Nakawuka, Betty; Nakawuki, Ashley; Kizito, Prisca; Waako, Paul; Wandabwa, Julius; Makoko, Tonny Brian; Musaba, Milton; Ahaisibwe, Bonaventure; Barugahare, Banson
    Background: Ebola virus disease (EVD) is a rare and deadly infectious hemorrhagic fever disease. Four of the 6 known Ebola virus species can cause human disease. Since 1976, EVD outbreaks have been recorded sporadically in East, Central, and West Africa. Uganda has experienced 6 documented outbreaks of EVD since 2000 that can be attributed to 3 species of Ebola viruses (Zaire, Sudan, and Bundibugyo). Despite substantial advances in clinical management, the case fatality ratio for EVD remains high, reaching more than 60% for the Zaire Ebola virus in 2018–2020. Methods. The study followed a descriptive qualitative study design. Data were collected using an interviewer-administered questionnaire with both closed and open-ended questions. Data were analysed using ATLAS Pro. Results: Our results illustrate the lack of health education in the community among the different categories of people and this comes from an emic perspective. We identified 4 high-level themes and 19 subthemes, (1) Knowledge of Ebola Virus Disease, (2) Prevention of EVD in the community, (3) Preparedness for Ebola Virus Disease, and (4) Community response to Ebola Virus Disease and the final thematic area (4) which included giving first aid, using traditional medicines, and approaching a health facility among others. Conclusions: With all the available information about the previous outbreaks in Uganda, it is surprising that less effort was made this time round to take local sensibilities and culture into account among other social factors contributing to the poor practices of masses toward the EVD, preparedness, prevention, and response. Keywords: Ebola Virus Disease, Preparedness, Response and Prevention, Community Engagement
  • No Thumbnail Available
    Item
    Coping mechanisms for students with mental disorders : an exploratory qualitative study at Busitema University’s Mbale and Busia campuses.
    (PLOS One, 2025) Kagoya, Enid Kawala; Mpagi, Joseph; Waako, Paul; Muhwezi, Martha R. L.; Namaganda, Agnes; Nsubuga, Allan G.; Atala, Christine Etoko; Okello, Francis; Okibure, Ambrose; Kibuuka, Ronald; Wandera, Ernest; Ndamanywa, Kalisiti; Kirabira, Joseph
    In recent years, Ugandan universities have faced a rising incidence of mental health issues among students, with prevalence rates of mental disorders reaching up to 60% among undergraduates. These challenges significantly impact both academic performance and social interactions. This study aimed to investigate the coping mechanisms among students with mental disorders at Busitema University. We conducted 42 key informant interviews with students diagnosed with mental disorders, as determined by the Mini International Neuropsychiatric Interview. Interviews were guided by a structured protocol developed by the research team, and all participants provided informed consent. The interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. This approach was chosen for its efficiency and directness. Nvivo software facilitated the coding and organization of themes. The study identified several coping strategies used by students at the two Busitema University campuses. Five main themes emerged: Alcohol and Substance Use, Use of Sedatives, Social and Personal Initiatives, Seeking Counseling Services, Withdrawal and Confrontation, and Faith Healing. Various subthemes were also noted, including substance use, withdrawal, confrontations, witchcraft, participation in co-curricular activities, abortions, and seeking psychosocial support. These findings are detailed in Table 2. Addressing the mental health challenges faced by university students requires a thorough understanding of their coping strategies. While some strategies are self-developed, others involve university-led interventions. It is crucial to reinforce effective coping mechanisms and address detrimental ones to improve students’ mental health outcomes. Mental disorders, coping strategies, university students, Uganda
  • No Thumbnail Available
    Item
    Exploring barriers and facilitators of preceptorship in undergraduate health professions education : insights from a qualitative needs assessment among preceptors in Eastern Uganda.
    (BMC, 2025) Wani, Solomon; Nantale, Ritah; Atuhairwe, Irene; Makoko, Brian Tonny; Okello, Francis; Waako, Paul; Twineamatsiko, Andrew; Agaba, Brian; Nyalihama, Alain; Kibuule, Dan; Kagoya, Enid Kawala
    Background: Clinical preceptorship plays a critical role in bridging theoretical knowledge and practical skills for health professions students. In resource-constrained settings like Eastern Uganda, understanding what facilitates effective preceptorship is essential for improving clinical education outcomes. This study explores the barriers and facilitators to preceptorship among clinical preceptors and faculty at Busitema University, Mbale College of Health Sciences, and Mbale Regional Referral Hospital. Methods: We conducted 15 in-depth interviews with clinical preceptors, including faculty and clinical staff from Busitema University, Mbale College of Health Sciences, and Mbale Regional Referral Hospital. Participants were purposively selected based on experience, education level, medical care, and leadership roles. We conducted the interviews between May 2024 and June 2024, audio-recorded, were transcribed verbatim, and thematically analyzed using Atlas.ti version 9. Results: Three key facilitators and six barriers to preceptorship emerged from the analysis. The facilitators included: support from Seed Global Health through donations of medical tools, equipment, and healthcare worker training; strong commitment and willingness among health workers at Mbale Regional Referral Hospital to teach students; and, support from faculty and postgraduate students at Busitema University. Barriers were: high numbers of students in clinical settings; poor communication and coordination between academic institutions and clinical sites; limited preceptorship skills and knowledge among clinical preceptors; shortages of faculty preceptors; insufficient time for clinical rotations; and inadequate models and equipment for simulation-based teaching. To address these challenges, preceptors recommended better coordination and student orientation, phased placement in smaller groups, training and refresher courses to strengthen preceptorship capacity, increased faculty presence in wards, and provision of essential medical equipment. Conclusion: Effective preceptorship in resource-limited settings depends on leveraging facilitators while addressing persistent barriers. External partnerships, staff commitment, and faculty support are valuable enablers, but their impact is undermined by overcrowding, poor coordination, and resource shortages. Actionable strategies such as structured communication between training institutions and hospitals, phased student placement, targeted preceptor training, and investments in teaching equipment can mitigate barriers and reinforce facilitators. Strengthening these systems is vital for sustaining high-quality clinical education in Uganda and similar contexts. Keywords: Preceptorship, Barriers, Facilitators, Medical education, Uganda
  • No Thumbnail Available
    Item
    Factors associated with longer hospital stay following caesarean section birth at a tertiary hospital in Eastern Uganda.
    (Research Square, 2025) Thaddeus, Jude Mulowooza; Tweheyo, Ronald; Babuya, Jonathan; Atuhairwe, Irene; Makoko, Brian Tonny; Waako, Paul; Twineamatsiko, Andrew; Agaba, Brian; Stephen, Obbo; Kavuma, Pontian Kiwanuka; Kibuule, Dan; Kayemba, Frank; Kagoya, Enid Kawala
    Background. Caesarean Section(C/S) is a lifesaving procedure for both the mother and the baby but it is associated with various post-operative complications and longer hospital stays. Prolonged Hospitalization after a Caesarean section can be stressful for both the healthcare providers and the mothers while also risking them acquiring hospital acquired infections. Factors related to longer hospital stays among mothers delivered by C/S have not been well explored. This study aimed to determine the factors associated with longer (> 4 days) hospital stay following Caesarean birth at Mbale Regional Referral Hospital. Methods This was a retrospective cross-sectional study carried out at Mbale Regional Referral Hospital (MRRH) between December 2023 and May 2024 accessed in June 2024. A total of 536 patient files of women who underwent Caesarean section were randomly selected and reviewed. Data on social demographics, obstetric characteristics and other surgical details including outcomes was extracted and recorded using an online data collection tool. Descriptive analysis to summarise the data and logistic regression to identify factors associated with longer hospital stays were done, and P-values < 0.05 significance level at a 95% confidence interval were considered. Results The mean hospital stay was 4.02 days (SD ± 2.87). Nearly half of the women (47.6%) were referred from other health facilities with most caesarean sections (70.9%) sanctioned by junior house officers. Preoperative prophylactic antibiotics were administered in 85.4% and spinal anaesthesia was used in 98.5% of the Csections. In multivariable analysis, lack of a complete blood count, vaginal preparation, intravenous fluids before surgery and a patient undergoing general anesthesia were significantly related to longer hospital stays. Conclusion Multiple factors are associated with longer hospital stays at Mbale Regional Referral Hospital. Improvement of evidence-based practices such as the intravenous fluids, vaginal preparation and basic laboratory investigations before surgery and use of spinal anesthesia can help to reduce hospital stay and its associated risks. Keywords: Caesarean section, longer hospital stay, postoperative complications
  • No Thumbnail Available
    Item
    Income-based disparities in perceived benefits and challenges of virtual global health activities during the COVID-19 pandemic : mixed methods analysis.
    (JMIR, 2025) Zhou, Shuo; Kagoya, Enid Kawala; Coria, Alexandra; Beck, Alyssa; Evert, Jessica; Haque, Marina; Lamb, Molly M.; Rule, Amy RL; Umphrey, Lisa
    Background: Global health activities (GHAs) can potentially reduce health disparities by facilitating resource sharing, promoting medical education and professional development worldwide, and enhancing collaboration among high-income countries (HICs) and low- and middle-income countries (LMICs). However, the COVID-19 pandemic disrupted in-person GHAs due to strict infection control and travel restrictions. To ensure the continuity of GHAs and further address health inequity, virtual GHAs (VGHAs) are gaining traction. Objective: Our research aimed to understand how people perceive the benefits and challenges of VGHAs, analyze and compare whether HIC and LMIC respondents have different perceptions of virtual and in-person GHAs, and summarize suggestions for improvement to inform the future development of VGHAs. Methods: We conducted a cross-sectional web-based survey during the COVID-19 pandemic in early 2022. Eligible participants were adult students, trainees, or professionals who participated in, created, taught, or facilitated GHAs. We thematically analyzed participants’ free-text responses regarding their perceptions of the benefits and challenges of virtual and in-person GHAs. The patterns differed depending on whether respondents were from HICs or LMICs; thus, we compared frequencies of each theme between the 2 groups. Results: A total of 154 respondents from 34 countries were included in the analysis. Key benefits of VGHAs were improved access to global health resources or content, reduced cost, easier scheduling and planning, expanded remote participation, and wider participation and reach. The themes that emerged as challenges of VGHAs included a lack of infrastructure to engage virtually, being less motivated and engaged, a lack of in-person and hands-on experience, and challenges with virtual communication and collaboration. LMIC respondents, compared to HIC counterparts, were more likely to identify reduced cost (26/67, 39% LMIC compared to 20/87, 23% HIC; χ21=4.5; P=.03) and expanding knowledge, experience, or skills (15/67, 22% LMIC compared to 8/87, 9% HIC; χ21=5.2; P=.02) as benefits of VGHAs, lack of infrastructure to engage virtually as a challenge of VGHAs (38/67, 57% LMIC compared to 31/87, 36% HIC; χ21=6.8; P=.009), and to suggest improving the content to be more interesting and relevant (6/67, 9% LMIC compared to 1/87, 1% HIC; χ21=5.3, P=.02). In contrast, HIC respondents were more likely to identify fostering continuity of relationship or activities (28/87, 32% HIC compared to 6/67, 9% LMIC; χ21=11.9; P<.001) as a benefit of VGHAs and being less engaged and motivated to participate virtually (43/87, 49% HIC compared to 19/67, 28% LMIC; χ21=7.0; P=.008) as a challenge of VGHAs. Conclusions: Our findings add to the existing literature by understanding how GHA participants from HICs and LMICs perceive the benefits and challenges of VGHAs differently. These data help elucidate what makes VGHAs acceptable to global health partners and suggest improvements to ensure partner needs are served equitably within the partnership. Keywords global health (129); virtual (59); in-person (5); perceived benefits and challenges (1); COVID-19 pandemic (128); medical education (710)
  • No Thumbnail Available
    Item
    Sacred birth, clean hands : infection prevention as ritual and practice among traditional birth attendants in Mayuge district, east central Uganda.
    (Research Square, 2025) Kagoya, Enid Kawala; Auma, Proscovia; Mugabi, Joshua; Kawala, Elizabeth; Asabawebwa, Deogratias; Mugahi, Richard; Waako, Paul; Mugabe, Kenneth; Barugahare, Banson
    This study explored how Traditional Birth Attendants (TBAs) in rural Uganda implement infection prevention and control (IPC) through a blend of cultural traditions and hygiene practices. Using ethnographic methods, including interviews and observations, it found that TBAs view cleanliness as both a sacred obligation and a critical part of protecting maternal health. Despite facing limited training and resources, TBAs showed a strong commitment to infection prevention, positioning them as essential yet often under-recognized actors in maternal care. Introduction The study investigated IPC practices among TBAs in rural Uganda, situating them within a broader cultural and spiritual framework. It emphasized how TBAs integrate traditional knowledge with selected biomedical practices to ensure maternal safety. This intersection of ritual and hygiene highlights the TBAs' central role in rural maternal healthcare. Objective The main objective was to explore how TBAs interpret, adapt, and implement IPC practices by drawing from both cultural beliefs and biomedical hygiene principles in the context of rural Uganda. Methods A qualitative research approach was used, involving in-depth interviews and direct observations with 15 TBAs in Mayuge District. Data collection focused on everyday IPC practices such as waste disposal, hand hygiene, and use of protective materials. Thematic analysis helped identify recurring patterns and contextual challenges in IPC implementation. Results The findings revealed that TBAs practice IPC through a hybrid model that blends ritual and hygiene. Placenta disposal, symbolic use of gloves, and improvised handwashing with soap, herbs, or oil were common. Despite limited formal training, TBAs showed innovation and commitment to safe deliveries, although resource scarcity and misalignment with formal guidelines posed challenges. Conclusion The study highlighted the creative and spiritually informed IPC strategies of TBAs in rural Uganda, showing how they skillfully navigate material shortages and cultural expectations. These frontline caregivers operate with dedication and contextual intelligence, underscoring the need for culturally sensitive training and support to enhance maternal and newborn outcomes in under-resourced settings. Keywords: Traditional Birth Attendants, Infection Prevention and Control, Maternal Health, Uganda, Ritual Hygiene, Hybrid Care Practices, Ethnography, Community Health, Safe Delivery, Cultural Beliefs
  • No Thumbnail Available
    Item
    ‘They treat you like their own’ perspectives and lived experiences of postpartum women seeking health services from traditional birth attendants (TBAs) in Mayuge district east central Uganda.
    (Research Square, 2025) Kagoya, Enid Kawala; Auma, Proscovia; Mugabi, Joshua; Kawala, Elizabeth; Asabawebwa, Deogratias; Mugahi, Richard; Mutunda, Brenda Doreen; Twineamatsiko, Andrew; Kabene, Mercy Jackline; Frank, Kayemba; Waako, Paul; Mugabe, Kenneth; Akello, Jackline
    Background In Uganda, despite ongoing efforts to promote skilled birth attendance, many women in rural communities continue to deliver with Traditional Birth Attendants (TBAs). Understanding the reasons behind this preference and the nature of care provided by TBAs is critical for informing maternal health policy and community-level interventions. Objective To explore the experiences, perceptions, and underlying factors influencing the continued use of TBAs for childbirth among postpartum women in Mayuge District, Eastern Uganda. Methods A descriptive qualitative study was conducted in Mayuge District. In-depth interviews were held with 12 postpartum women who had delivered with TBAs within the past six months. Participants were purposively selected to capture variation in age, parity, and location. Data were collected using a semi structured interview guide, audio-recorded, transcribed verbatim, and translated into English. Thematic analysis was conducted using both inductive and deductive coding in NVivo 13. Results Five overarching themes emerged: (1) Health System Barriers, including poor access to health facilities, transport challenges, and mistreatment by health workers; (2) Perceived Benefits of TBA Care, such as affordability, emotional support, privacy, and flexible payment options; (3) Traditional Practices and Beliefs, with participants emphasizing cultural alignment, spiritual care, and birth rituals provided by TBAs; (4) Health Risks and Limits of TBA Care, reflecting awareness of complications, delayed referrals, and lack of emergency support; and (5) Community Influence, where social norms, peer recommendations, and collective trust in TBAs shaped decision-making. A cross-cutting theme of husband and family involvement also significantly influenced birth location choices. Conclusion The continued reliance on TBAs is shaped by a complex interplay of structural barriers, cultural values, perceived advantages, and community dynamics. Interventions to improve maternal health in rural Uganda should address health system gaps, promote respectful and culturally sensitive facility-based care, and engage families and communities in birth preparedness efforts. Keywords: Traditional Birth Attendants, Postpartum Women, Maternal Health, Uganda, Qualitative Study, Health-Seeking Behavior, Cultural Beliefs, Health System Barriers, Community Influence.
  • No Thumbnail Available
    Item
    Watching over life : practices and meanings of postpartum vital signs monitoring in eastern Uganda.
    (medRxiv, 2025) Babuya, Jonathan; Kayemba, Frank; Waiswa, Sinani; Nsubuga, Allan G.; Ewing, Helen; Atuhairwe, Irene; Ijangolet, Esther; Otim, Eric; Ronald, Kibuuka; Jesca, Atugonza; Okello, Francis; Nakattudde, Prossy; Nyangoma, Faith; Nakawuka, Betty; Kabahinda, Nichola; Kamwesigye, Assen; Apoya, Jill; Waako, Paul; Wandabwa, Julius; Musaba, Milton; Bonaventure, Ahaisibwe; Aeby, Tod; Nandutu, Sarah; Mugabe, Kenneth; Pangholi, Kennedy; Nahurira, Doreck; Agaba, Brian; Mbwali, Immaculate; Bahati, Johnson; Kagoya, Enid Kawala
    Introduction Postnatal deaths account for about one-third of maternal mortality in Low- and middle-income countries (LMICs). Nearly half occur within the first 24 hours and are preventable through continuous inpatient monitoring. This study assessed maternal mortality within the first 24 postnatal hours; and the current postpartum monitoring practices, including the availability of monitoring charts and the frequency of vital sign assessments in eastern Uganda. Methods This cross-sectional study reviewed the medical records of all postpartum women admitted at Mbale Regional Referral Hospital, Eastern Uganda, between August 2022 and February 2023. A semi-structured data extraction form was used. The outcome variable was postpartum monitoring; categorized as "No" for women with no vital signs monitored and "Yes" for those with at least one vital sign monitored. Descriptive analysis was performed using Stata Version 17.0, and Poisson regression was employed to explore the association between various factors and postpartum monitoring. Results Medical records of 2,717 postpartum mothers were reviewed. The median (interquartile range) age was 25(20-30) years. A minority (34%; 910/2717) of mothers had vital sign observation charts in their medical records and very few (4%; 110/2717) had a fluid balance chart. About 49 24% (651/2717) of mothers had at least one vital sign recorded. Blood pressure was the most (16.8%; 456/2717) recorded vital sign followed by pulse rate (13.6%; 369/2717). Respiratory rate and temperature were the least monitored vital signs with 1.2% and 1.1% records respectively. Mothers who delivered by C-section had a 151% higher prevalence of postpartum monitoring compared to those who had a vaginal delivery (aPR: 2.51; 95% CI: 2.19–2.89). Maternal mortality rate on the first postpartum day was 8.8 per 1000, with postpartum hemorrhage accounting for 61%. Conclusion Postpartum vital signs monitoring was low. LMICs need to devise means of automating the monitoring process.