Department of Public Health

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    Specialty career preferences among final year medical students at Makerere University College of health sciences, Uganda :
    (BMC, 2021) Kuteesa, Job; Musiime, Victor; Munabi, Ian G.; Mubuuke, Aloysius G.; Opoka, Robert; Mukunya, David; Kiguli, Sarah
    Background: Uganda has an imbalanced distribution of the health workforce, which may be influenced by the specialty career preferences of medical students. In spite of this, there is inadequate literature concerning the factors influencing specialty career preferences. We aimed to determine the specialty career preferences and the factors influencing the preferences among fifth year medical students in the School of Medicine, Makerere University College of Health Sciences (MakCHS). Methods: A sequential explanatory mixed methods study design with a descriptive cross-sectional study followed by a qualitative study was used. A total of 135 final year medical students in MakCHS were recruited using consecutive sampling. Self-administered questionnaires and three focus group discussions were conducted. Quantitative data was analysed in STATA version 13 (StataCorp, College Station, Tx, USA) using descriptive statistics, chi-square tests and logistic regression. Qualitative data was analysed in NVIVO version 12 (QRS International, Cambridge, MA) using content analysis. Results: Of 135 students 91 (67.4%) were male and their median age was 24 years (IQR: 24, 26). As a first choice, the most preferred specialty career was obstetrics and gynecology (34/135, 25.2%), followed by surgery (27/135, 20.0%), pediatrics (18/135, 13.3%) and internal medicine (17/135, 12.6%). Non-established specialties such as anesthesia and Ear Nose and Throat (ENT) were not selected as a first choice by any student. Female students had 63% less odds of selecting surgical related specialties compared to males (aOR = 0.37, 95%CI: 0.17–0.84). The focus group discussions highlighted controlled lifestyle, assurance of a good life through better financial remuneration and inspirational specialists as facilitators for specialty preference. Bad experience during the clinical rotations, lack of career guidance plus perceived poor and miserable specialists were highlighted as barriers to specialty preference. Conclusion: Obstetrics and Gynecology, Surgery, Pediatrics and Internal Medicine are well-established disciplines, which were dominantly preferred. Females were less likely to select surgical disciplines as a career choice. Therefore, there is a need to implement or establish career guidance and mentorship programs to attract students to the neglected disciplines. Keywords: Career, Medical, Preferences, Specialty, Student
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    High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension :
    (BMC, 2021) Ingabire, Prossie Merab; Ojji, Dike B.; Rayner, Brian; Ogola, Elijah; Damasceno, Albertino; Jones, Erika; Dzudie, Anastase; Ogah, Okechukwu S.; Poulter, Neil; Sani, Mahmoud U.; Barasa, Felix Ayub; Shedul, Grace; Mukisa, John; Mukunya, David; Wandera, Bonnie; Batte, Charles; Kayima, James; Pandie, Shahiemah; Mondo, Charles Kiiza; CREOLE Study Investigators
    Background: Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction. Objectives: To estimate the prevalence and factors associated with non-dipping pattern and determine the efect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods: This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results: The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium>140 mmol/l (OR=1.72, 95% CI 1.17–2.51, p-value 0.005), a higher of cesystolic BP (OR=1.03, 95% CI 1.01–1.05, p-value 0.003) and a lower ofce diastolic BP (OR=0.97, 95% CI 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar’s Chi2 0.71, p-value 0.40). Conclusion: There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Keywords: Non-dipping pattern, Dipping pattern, Uncontrolled hypertension, Black African
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    Factors associated with childhood overweight and obesity in Uganda :
    (BMC, 2021) Sserwanja, Quraish; Mutisya, Linet M.; Olal, Emmanuel; Musaba, Milton W.; Mukunya, David
    Background: Childhood obesity is an emerging public health problem globally. Although previously a problem of high-income countries, overweight and obesity is on the rise in low- and middle-income countries. This paper explores the factors associated with childhood obesity and overweight in Uganda using data from the Uganda Demographic and Health Survey (UDHS) of 2016. Methods: We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4338 children less than 5 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Overweight and obesity were combined as the primary outcome. Children whose BMI z score was over two were considered as overweight while those with a BMI z score greater than three were considered as obese. We used multivariable logistic regression to determine factors associated with obesity and overweight among children under 5 years of age in Uganda. Results: The prevalence of overweight and obesity was 5.0% (217/4338) (95% CI: 4.3–5.6), with overweight at 3.9% (168/4338: 95% CI: 3.2–4.3) and obesity at 1.1% (49/4338: 95% CI: 0.8–1.5). Mother’s nutritional status, sex of the child, and child’s age were associated with childhood obesity and overweight. Boys were more likely to be overweight or obese (aOR = 1.81; 95% CI 1.24 to 2.64) compared to girls. Children who were younger (36 months and below) and those with mothers who were overweight or obese were more likely to have obesity or overweight compared to those aged 49–59 months and those with underweight mothers respectively. Children from the western region were more likely to be overweight or obese compared to those that were from the North. Conclusion: The present study showed male sex, older age of the children, nutritional status of the mothers and region of residence were associated with obesity and overweight among children under 5 years of age. Keywords: Prevalence, Obesity, Overweight, Children and Uganda
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    Contraceptive uptake in eastern Uganda: was the 2020 target of 50% modern contraceptive rate achieved?
    (BMC, 2021) Birungi, Julian Daisy; Tumukunde, Prossy; Nekaka, Rebecca; Nteziyaremye, Julius
    Background: Contraception is a worthwhile and cost effective investment that has potential to spur national development. It is important in averting significant maternal and childhood morbidity and mortality. No wonder countries with low contraceptive prevalence rates (CPR) have poor maternal and childhood health indicators. Consequently, during the 2012 London conference Uganda set a target of improving modern CPR (mCPR) to 50% by 2020. We report how eastern Uganda is faring on this commitment and identify the factors associated with contraceptive uptake. Methods: Using a cross-sectional study design, we recruited 418 sexually active women aged 15-49 years who had come to nurse their sick ones in a tertiary hospital. We used systematic sampling to recruit participants. Data was collected using an interviewer administered pretested questionnaire, analyzed using STAT version 19. Results: Of the 418 women respondents, 15.6% were teens while 50% were aged 20-29 years. Significantly, 64.59% were married. The majority, 78.7% were informally employed, and more than 62% were Christians. Moreover, 97.8% were formal educated and 52.2% had 1-4 living children. The overall contraceptive prevalence was 33.7% while mCPR was 30.86%. Significantly whereas 36.6% had ever used contraception, 29.7% had never. The top contraceptives choices were injectables (56.7%), implants (27%), calendar method (6.4%) and abstinence (2.8%). Significantly, 99.8% were aware of contraception and, radio (91%) and health workers (82%) being major sources of information. Significant factors affecting uptake include age and marital status, youngest child’s age, decision when to have next child, history of sexually transmitted disease, partner’s age and support. Conclusion: The contraceptive prevalence rates are below the national average and the London target despite significant awareness among women. Efforts to increase uptake should include male involvement, continued dissemination of information and reinforcing sexual and reproductive health education in schools. This will help to demystify misconceptions, misapprehensions and myths about contraceptives. Keywords: Contraception, London 2012 summit, Male support, Uganda
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    Vaginal colonization with antimicrobial-resistant bacteria among women in labor in central Uganda :
    (BMC, 2021) Tumuhamye, Josephine; Steinsland, Hans; Bwanga, Freddie; Tumwine, James K.; Ndeezi, Grace; Mukunya, David; Namugga, Olive; Kasede, Agnes Napyo; Sommerfelt, Halvor; Nankabirwa, Victoria
    Background: According to WHO (CISMAC. Centre for Intervention Science in Maternal and Child Health), the antimicrobial-resistant bacteria considered to be clinically most important for human health and earmarked for surveillance include extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant bacteria, methicillin-resistant (MRSA) and, macrolide-lincosamide-streptogramin B -resistant vancomycin-resistant (VRSA) Staphylococcus aureus and vancomycin-resistant Enterococcus (VRE). If these bacteria are carried in the female genital tract, they may be transmitted to the neonate causing local or systemic neonatal infections that can be difficult to treat with conventionally available antimicrobials. In order to develop effective treatment strategies, there is a need for updated information about the prevalence of colonization with important antimicrobial-resistant pathogens. Objective: We sought to estimate the prevalence of vaginal colonization with potentially pathogenic and clinically important AMR bacteria among women in labour in Uganda and to identify factors associated with colonization. Methods: We conducted a cross-sectional study among HIV-1 and HIV-2-negative women in labour at three primary healthcare facilities in Uganda. Drug susceptibility testing was done using the disk diffusion method on bacterial isolates cultured from vaginal swabs. We calculated the prevalence of colonization with potentially pathogenic and clinically important AMR bacteria, in addition to multidrug-resistant (MDR) bacteria, defined as bacteria resistant to antibiotics from ≥3 antibiotic classes. Results: We found that 57 of the 1472 enrolled women (3.9% prevalence; 95% Confidence interval [CI] 3.0%, 5.1%) were colonized with ESBL-producing Enterobacteriaceace, 27 (1.8%; 95% CI 1.2%, 2.6%) were colonized with carbapenem-resistant Enterobacteriaceae, and 85 (5.8%; 95% CI 4.6%, 7.1%) were colonized with MRSA. The prevalence of colonization with MDR bacteria was high (750/1472; 50.9%; 95% CI 48.4%, 53.5%). Women who were ≥30 years of age had higher odds of being colonized with MDR bacteria compared to women aged 20–24 years (OR 1.6; 95% CI 1.1, 2.2). Conclusion: Most of the women included in our study were vaginally colonized with potentially pathogenic MDR and other clinically important AMR bacteria. The high prevalence of colonization with these bacteria is likely to further increase the incidence of difficult-to-treat neonatal sepsis. Keywords: Antimicrobial resistance, Multidrug resistance, MDR, ESBL, MRSA, MLSB, Carbapenem-resistant bacteria, Vaginal colonization
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    Continuum of maternity care in Zambia:
    (BMC, 2021) Sserwanja, Quraish; Musaba, Milton W.; Mutisya, Linet M.; Olal, Emmanuel; Mukunya, David
    Background: Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia. Methods: We used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. Complete continuum of care was considered when a woman had; at least four antenatal care (ANC) contacts, utilized a health facility for childbirth and had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25. Results: Of the 7,325 women, 38.0% (2787/7325) (95% confidence interval (CI): 36.9-39.1) had complete continuum of maternal healthcare. Women who had attained tertiary level of education (adjusted odds ratio (AOR): 1.93, 95% CI: 1.09-3.42) and whose partners had also attained tertiary level of education (AOR: 2.58, 95% CI: 1.54-4.32) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated ANC after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.27-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces. Conclusion: Level of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services. Keywords: Continuum of care, Antenatal care, Postnatal care, Childbirth, Utilization, Women and Zambia
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    Factors associated with over-nutrition among men 15-54years in Uganda:
    (Nutrition and Metabolic Insights, 2021) Arinda, Ivan Kato; Sserwanja, Quraish; Nansubuga, Sylvia; Mukunya, David; Akampereza, Phiona
    Background: Globally and in Sub-Saharan Africa (SSA), the prevalence of overweight and obesity are on the rise. Data on overweight and obesity among men are scarce. Objective: We aimed to determine the prevalence and factors associated with over-nutrition among men in Uganda. Methods: We used Uganda Demographic and Health Survey (UDHS) 2016 data of 5,408 men aged 15 to 45 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Multivariable logistic regression was used to determine factors associated with over-nutrition among 15 to 54-year-old men in Uganda. Results: The prevalence of over nutrition was 9.1%, where that of overweight was 7.9% (95% CI 7.2-8.7 and obesity was1.2% (95% CI 0.9-1.5). Men who were aged 25 to 34 (AOR=3.28; 95% CI: 1.92-5.59), 35-44 (AOR=4.51; 95% CI: 2.61-7.82) and 45 to 54 (AOR=4.28; 95% CI: 2.37-7.74) were more likely to have over-nutrition compared to those aged 15 to 24 years. Married men (AOR=2.44; 95% CI: 1.49-3.99) were 2 times more likely to have over-nutrition than men who were not married. Men in the central region (AOR=1.78; 95% CI: 1.22-2.60) were 1.78 times more likely to have over-nutrition than men in the northern region. Men who were in the richest wealth index quintiles were 10 times more likely to have over-nutrition compared to those in the poorest wealth index quintile (AOR=9.38: 95 % CI 5.14-17.10). Conclusion: The factors associated with over-nutrition among Ugandan men in our study were increasing age, marital status, increasing wealth and region of origin. This shows the need for measures to abate the regional development inequalities, need to promote physical activity among older men and need to improve on the knowledge of nutrition and dietetic practices for married couples and men of different social classes. Keywords: Over-nutrition, prevalence, men and Uganda
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    Prevalence and predictors of delayed initiation of breastfeeding among postnatal women at a tertiary hospital in Eastern Uganda: a cross-sectional study
    (BMC, 2023) Kusasira, Loyce; Mukunya, David; Obakiro, Samuel; Kiyimba, Kenedy; Nekaka, Rebecca; Ssenyonga, Lydia; Mbwali, Immaculate; Napyo, Agnes
    Background The rates for the delayed initiation of breastfeeding in Uganda remain unacceptably high between 30% and 80%. The reasons for this are not well understood. We aimed to determine the prevalence and predictors for the delayed initiation of breastfeeding in Eastern Uganda. Methods This study employed a cross-sectional study design. A total of 404 mother-infant pairs were enrolled onto the study between July and November, 2020 at Mbale regional referral hospital (MRRH). They were interviewed on socio-demographic related, infant-related, labour and delivery characteristics using a structured questionnaire. We estimated adjusted odds ratios using multivariable logistic regression models. All variables with p<0.25 at the bivariate level were included in the initial model at the multivariate analysis. All variables with p<0.1 and those of biological or epidemiologic plausibility (from previous studies) were included in the second model. The variables with odds ratios greater than 1 were considered as risk factors; otherwise they were protective against the delayed initiation of breastfeeding. Results The rate of delayed initiation of breastfeeding was 70% (n=283/404, 95% CI: 65.3 – 74.4%). The factors that were associated with delayed initiation of breastfeeding were maternal charateristics including: being single (AOR=0.37; 95%CI: 0.19–0.74), receiving antenatal care for less than 3 times (AOR=1.85, 95%CI: 1.07–3.19) undergoing a caesarean section (AOR=2.07; 95%CI: 1.3–3.19) and having a difficult labour (AOR=2.05; 95%CI: 1.25–3.35). Infant characteristics included: having a health issue at birth (AOR=9.8; 95%CI: 2.94–32.98). Conclusions The proportion of infants that do not achieve early initiation of breastfeeding in this setting remains high. Women at high risk of delaying the initiation of breastfeeding include those who: deliver by caesarean section, do not receive antenatal care and have labour difficulties. Infants at risk of not achieving early initiation of breastfeeding include those that have a health issue at birth. We recommend increased support for women who undergo caesarean section in the early initiation of breastfeeding. Breastfeeding support can be initiated in the recovery room after caesarean delivery or in the operating theatre. The importance of antenatal care attendance should be emphasized during health education classes. Infants with any form of health issue at birth should particularly be given attention to ensure breastfeeding is initiated early. Keywords Delayed initiation of breastfeeding, Early initiation of breastfeeding, Breastfeeding, Infants, Lactating women