Browsing by Author "Anguzu, Ronald"
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Item Adherence to COVID-19 preventive measures and its association with intimate partner violence among women in informal settings of Kampala, Uganda(PLOS Global Public Health, 2022) Anguzu, Ronald; Kabagenyi, Allen; Cassidy, Laura D.; Kasasa, Simon; Shour, Abdul R.; Musoke, Bernadette N.; Mutyoba, Joan N.Cases of coronavirus disease 2019 (COVID-19) detected, and COVID-19 associated mortality increased since the first case was confirmed in Uganda. While adherence to WHO-recommended measures to disrupt COVID-19 transmission has since been implemented, it has been reported to be sub-optimal. An increase in intimate partner violence (IPV) cases was linked to enforcement of COVID-19 lockdowns and other preventive measures especially in informal settings of Kampala. We determined the association between adherence to COVID-19 preventive measures and intimate partner violence among women dwelling in informal settings in Kampala, Uganda. Between July and October 2020, we conducted a three-month prospective cohort study of 148 women living in informal settlements of Kampala during the COVID-19 lockdown and easing of restrictive measures. Participants were surveyed at baseline, at 3-weeks and 6-weeks (endline). The dependent variable was adherence to COVID-19 preventive measures (remained adherent vs poorly adherent) between baseline and endline surveys. This composite outcome variable was computed from implementing all four variables: social distancing, wearing face masks, frequent hand washing and use of hand sanitizers at baseline and endline surveys. The key independent variable was IPV measured as experiencing at least one form of physical, emotional, or sexual IPV. Covariates were age, education, marital status, household size, occupation, and having problems getting food. Adjusted logistic regression analyses tested the independent association between adherence to COVID-19 preventive measures and intimate partner violence. Among 148 respondents, the mean age (SD) was 32.9 (9.3) years, 58.1% were exposed to at least one form of IPV, and 78.2% had problems getting food. Overall, 10.1% were poorly adherent to COVID-19 preventive measures during the first COVID-19 wave. After controlling for potential confounders, remaining adherent to COVID-19 preventive measures were more likely to experience intimate partner violence when compared to women who were poorly adherent to COVID-19 preventive measures during the first COVID-19 wave in Uganda [OR 3.87 95%CI (1.09, 13.79)]. Proportions of women in informal settlements of Kampala experiencing at least one form of IPV during the first COVID-19 wave is substantial. Remaining adherent to preventive measures for COVID-19 transmission may increase IPV exposure risk among women living in informal settlements in Kampala. Contextualizing COVID-19 interventions to the needs of marginalized and vulnerable women and girls in informal settings of Kampala is warranted. Processes to integrated violence prevention and response strategies into the Uganda COVID-19 prevention strategy are underscored.Item Age and Gender Differences in Trends and Impact of Depression on Quality of Life in the United States, 2008-2016(Women's Health Issues, 2021) Anguzu, Ronald; Nagavally, Sneha; Dawson, Aprill Z.; Walker, Rebekah J.; Egede, Leonard E.We aimed to examine age and gender differences in the relationship between depression and quality of life among United States adults. Medical Expenditure Panel Survey data for 2008 to 2016 on 227,663 adults were analyzed. The dependent variable, quality of life, included physical component summary scores and mental component summary scores from the Short Form Health Survey. The key independent variable, depression, was measured using the two-item Patient Health Questionnaire. General linear regression models examined the relationship between quality of life and depression. Models were adjusted for individual and environmental characteristics, symptom status, functional and biological status, and health perceptions and were stratified by gender and age. In adjusted models, mental component summary scores were significantly lower among those with depression compared with those without depression (β = –0.39; 95% confidence interval [CI], 0.38 to –1.16) and lower among women compared with men (β = –0.10; 95% CI, 0.10 to –1.31). Models stratified by gender and age found women with depression ages 40 to 64 (β = –0.07; 95% CI, 0.07 to –0.20) and 65 or older (β = –0.08; 95% CI, 0.08 to –0.24) had significantly lower physical component summary scores compared with those without depression. Among men with depression, those ages 18 to 39 (β = –0.03; 95% CI, 0.03 to –0.10) and 40 to 64 (β = –0.09, 95% CI, 0.08 to –0.26) had lower physical component summary scores compared with those without depression. Women and men of all ages with depression had significantly lower mental component summary scores compared with those without depression. Public health interventions and clinical approaches to address depression in women and men should target functional status in men and perceptions of health in women.Item Association between perceived ethnic discrimination and receipt of COVID-19 vaccine in pregnancy or postpartum(American Journal of Obstetrics & Gynecology, 2023) Jaeke, Elisha; Anguzu, Ronald; Greenberg, Rachel; Palatnik, AnnaPregnant patients receiving prenatal care at a Midwestern academic institution were approached between June 2021 and March 2022 to complete a web-based Perceived Ethnic Discrimination Questionnaire (PED-Q). The PED-Q is a validated 17-item scale measuring perceived interpersonal racial and ethnic discrimination through four domains: workspace/school domain, exclusion domain, stigma domain, and threat domain, with each domain containing questions rated on a five-point Likert scale ranging from “never” to “very often”. All four domains were summarized in a lifetime discrimination score ranging from 1 to 5. The primary outcome was receipt of COVID-19 vaccination. A multivariate logistic regression model was used to examine the association between “lifetime discrimination score” and COVID-19 vaccination in pregnancy or postpartum.Item Association of prepregnancy diabetes and average birth-weight infant mortality by pregnancy body mass index: Findings from CDC's national vital statistics system, 2011(APHA, 2019) Shour, Abdul; Muehlbauer, Alice; Anguzu, Ronald; Walker, Rebekah; Carter, Catherine; Cassidy, Laura; Egede, LeonardPrepregnancy diabetes is associated with neonatal mortality of low birthweight newborns,however, little is known about the association of prepregnancy diabetes and mortality among babies with average birthweight (≥7lbs). We examined Average Birth-Weight Infant Mortality (ABIM), by pregnancy Body Mass Index for women diagnosed with diabetes prior to pregnancy. Data from CDC's NVSS-Linked Birth-Infant Death dataset, 3,638,143 newborns in 2011 were analyzed. The outcome was ABIM, defined as annual deaths per 1,000 live births with birthweight of ≥7pounds. The independent variable was self-reported diabetes (of any type) prior to pregnancy. Covariates were maternal co-morbidities, hospital and infant characteristics. Underlying causes of death (ICD codes 10th Revision) was included. Chi-square tests, stratified models and adjusted logistic regression analysis were conducted using STATA/SE v.15.1. P-values < 0.05 were considered statistically significant. Results: 7,419 average birthweight newborns died before their first birthday. ABIM was prevalent among diabetic mothers (0.3%), women who smoked (0.5%), infants born ≥37 weeks (0.4%) and African Americans (0.3%), with 65% of deaths occurring during post-neonatal period. The leading causes were congenital malformations (25.35%) and SIDS (20.0%). The odds of ABIM were 2 times higher for obese diabetic mothers (95%CI:1.6-2.8) compared to non-diabetic obese mothers. Among infants born ≥37 weeks, the odds of ABIM were 2 times higher for all BMI categories compared to infants born <37 weeks. Obese-diabetic mothers, smokers and full-term infants were at increased risk of ABIM, and particularly congenital malformations and SIDS. Interventions should focus on reducing maternal obesity, smoking and promoting safe sleep.Item Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study(BMJ open, 2018) Ogwang, Rodney; Anguzu, Ronald; Akun, Pamela; Ningwa, Albert; Kayongo, Edward; Idro, RichardPlasmodium falciparum is epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This study examined the relationship between P. falciparum infection and seizure control in children with a unique epilepsy type, the nodding syndrome.Item Body mass index and persistent hypertension in patients with hypertension disorders of pregnancy one-year postpartum(American Journal of Obstetrics & Gynecology, 2023) Anguzu, Ronald; Livergood, M Christine; Fitzgerald, Garrett; Palatnik, AnnaThis was a retrospective cohort study of patients with HDP (defined as gestational hypertension or preeclampsia) in a single US Midwestern academic institution from 2014 to 2018. The primary outcome was persistent hypertension at one-year postpartum, defined as systolic blood pressure (BP) ≥130 mm Hg or diastolic BP ≥80 mm Hg. Both categorical BMI (model 1) (normal, overweight, and obese) and continuous BMI (model 2) were examined as predictor variables. Descriptive statistics and logistic and linear regression analyses were run for categorical and continuous BMI respectively. Odds ratios (OR) and 95% confidence intervals (CI) were reported.Item Building capacity for geospatial cancer research in Uganda: a feasibility study(The Lancet Global Health, 2019) Beyer, Kirsten; Lukande, Robert; Kasasa, Simon; Kavanya, Gray; Nambooze, Sarah; Amulen, Phoebe; Cassidy, Laura; Tumwesigye, Nazarius; Babikako, Harriet; Anguzu, Ronald; Oyana, Tonny; Wabinga, HenryThere is a growing epidemic of cancer and other non-communicable diseases in sub-Saharan Africa. Targeted, specific, cost-effective strategies are needed to manage the growing burden of cancer. In high-resource settings, geospatial analysis has transformed cancer control through geographic targeting of interventions and policies. A similar approach could improve cancer control in sub-Saharan Africa; however, georeferenced cancer data and increased geospatial research capacity are needed. Here, we aimed to assess the feasibility of geocoding and mapping small-area cancer data from a cancer registry in Uganda. We established a partnership including the Makerere University Department of Pathology, School of Public Health and College of Computing and Information Sciences, the Kampala Cancer Registry, Uganda, and the Medical College of Wisconsin, USA. The overarching goal of our multidisciplinary and multi-institutional partnership is to increase geospatial cancer research capacity at Makerere University to enhance the prioritisation and targeting of limited cancer prevention and control resources in Uganda. Two medical students from the Medical College of Wisconsin, mentored by faculty at their own institution and Makerere University, worked in Kampala with registry staff to identify, enter, and quality-check geographic codes of residence for approximately 1522 cervical cancer records from 2005 to 2014. Information about district (n=1520, 99·9%) and subcounty (n=1486, 97·6%) was available for the vast majority of cases, and the parish was identifiable for a large proportion of cases (n=1242, n=81·6%), with increasing availability in more recent years. A seed grant is supporting ongoing capacity building at the Kampala Cancer Registry, including the purchase of new computing hardware and software and the implementation of a revised geographic data collection protocol to support future geospatial analysis of Kampala Cancer Registry data.Item The conduct of maternal and perinatal death reviews in Oyam District, Uganda: a descriptive cross-sectional study(BMC women's health, 2016) Agaro, Caroline; Beyeza-Kashesya, Jolly; Waiswa, Peter; Sekandi, Juliet N.; Tusiime, Suzan; Anguzu, Ronald; Kiracho, Elizabeth EkirapaUganda like many developing countries still experiences high levels of maternal and perinatal deaths despite a decade of maternal and perinatal death review (MPDR) program. Oyam district has been implementing MPDR since 2008 with varying successes among the health facilities. This paper presents the factors that influence the conduct of maternal and perinatal death reviews in Oyam District, Uganda. This was a cross-sectional study where both qualitative and quantitative data were collected. Semi-structured interviews were administered to 66 health workers and ten key informants (KIs) to assess the factors influencing the conduct of MPDR. Univariate and Bivariate analysis of quantitative data was done using SPSS version 17.0. A Pearson Chi-Square test was done to determine factors associated with conduct of MPDR. Factors with a p-value < 0.05 were considered statistically significant. Qualitative data was analyzed using content analysis. Only 34.8 % of the health workers had ever participated in MPDR. The factors that influenced conduct of MPDR were existence of MPDR committees (p < 0.001), attendance of review meetings (p < 0.001) and knowledge of objectives of MPDR (p < 0.001), implementation of MPDR recommendations (p < 0.001), observed improvement in maternal and newborn care (p < 0.001) and provision of feedback (p < 0.001). Hindrance to conduct of MPDR was obtained from KIs: the health workers were not made aware of the MPDR process, committee formation and training of MPDR committee members was not effectively done, inadequate support supervision, and lack of financial motivation of MPDR committee members. Challenges to MPDR included: heavy workload to health workers, high number of perinatal deaths, and non-implementation of recommendations. The proportion of maternal and perinatal death reviews conducted in Oyam was low. This was due to poor initiation of the review process and a lack of support supervision. The district and Ministry of Health needs to put more emphasis on monitoring the conduct of maternal and perinatal death reviews by: forming and training MPDR committees and ensuring they are financially supported, providing overall coordination, and ensuring effective support supervision.Item Contraception utilization in women with pregestational diabetes(The European Journal of Contraception & Reproductive Health Care, 2022) Walker, Shannon L.; Anguzu, Ronald; Egede, Leonard E.; Palatnik, AnnaCross-sectional data on women aged 18–44 years from 2011 to 2017 National Survey of Family Growth (NSFG) was analysed. Maternal diabetes was defined as the presence of pre-gestational type 1 or type 2 diabetes. Bivariate and multiple logistic regression analyses were run to evaluate the association between the use of contraception and by contraception type: permanent, long-acting reversible contraception (LARC), other hormonal method, other non-hormonal method, and none, and maternal diabetes status, controlling for relevant covariates. Among the total study sample of 28,454, 1344 (4.7%) had pregestational diabetes. Unadjusted analysis showed women with a history of pregestational diabetes were more likely to use permanent contraception following pregnancy (58.0% vs. 38.7%, p < 0.001) or no contraception (27.2% vs. 24.5%, p < 0.001), but less likely to use LARC (3.4% vs. 11.7%, p < 0.001), other hormonal contraception (4.1% vs. 8.9%, p < 0.001), or other non-hormonal contraception (7.2% vs. 16.4%, p < 0.001). In adjusted analyses, permanent (aOR 1.62, 95% CI 0.72–2.26) remained significant, however the differences were no longer statistically significant: LARC (aOR 0.34, 95% CI 0.12–1.00); other hormonal (aOR 0.61, 95% CI 0.27–1.35); other non-hormonal (aOR 0.59, 95% CI 0.25–1.43); and None (aOR 1.11, 95% CI 0.65–1.89). In this analysis, we found that women with pregestational diabetes were more likely to use permanent contraception methods compared to women without pregestational diabetes; however over a quarter of women with pregestational diabetes did not use contraception between pregnancies.Item Decision-making and decisional conflict among couples seeking treatment for infertility(APHA., 2019) Anguzu, Ronald; Cusatis, Rachel; Fergestrom, Nicole; Cooper, Alexandra; Sandlow, Jay; Schoyer, Katherine D.Couples have multiple options for trying to treat infertility, and for many, decisional conflict may arise due to lack of information, uncertainty about options and potential risks, or challenges to personal values. We followed 34 opposite-sex couples who sought a new consult together in a reproductive health clinic (n=78).Participants completed semi-structured interviews and self-administered online surveys, including the DecisionalConflict Scale (DCS), at 6 timepoints over 12 months. The DCS assessed decisional conflict, reported as a totaland 5 subscale scores (informed, values clarity, support, uncertainty and effective decision). A DCS total score of25 is associated with implementing a decision. Paired t-tests identified differences in DCS between women and men within couples. Mixed models predicted changes in DCS over time, adjusting for sociodemographic and fertility-related factors. Average DCS scores were highest before the initial consult. Women’s scores were highest on the uncertainty subscale while men’s were highest on the informed subscale. Within couples, men had significantly higher decisional conflict than women pre-consult (48.9 vs. 40.2, p=0.037) and at 2 months (28.9 vs 22.1, p=0.015), but differences at other time points were not significant. In adjusted models, total DCS scores declined over time, with women, on average, reaching the DCS threshold for implementing a decision at 2 months while for men it was not until 4 months. Decisional conflict is high among couples seeking treatment for infertility. On average, women resolved decisional conflict more quickly than men. Decision support that includes both partners is needed.Item Doxycycline for the treatment of nodding syndrome: a randomised, placebo-controlled, phase 2 trial(Elsevier Ltd, 2024-07) Idro, Richard; Ogwang, Rodney; Anguzu, Ronald; Akun, Pamela; Ningwa, Albert; Abbo, Catherine; Giannoccaro, Maria P; Kubofcik, Joseph; Mwaka, Amos D; Nakamya, Phellister; Opar, Bernard; Taylor, Mark; Nutman, Thomas B; Elliott, Alison; Vincent, Angela; Newton, Charles R; Marsh, KevinNodding syndrome is a poorly understood neurological disorder that predominantly occurs in Africa. We hypothesised that nodding syndrome is a neuroinflammatory disorder, induced by antibodies to Onchocerca volvulus or its Wolbachia symbiont, cross-reacting with host neuronal proteins (HNPs), and that doxycycline can be used as treatment.BACKGROUNDNodding syndrome is a poorly understood neurological disorder that predominantly occurs in Africa. We hypothesised that nodding syndrome is a neuroinflammatory disorder, induced by antibodies to Onchocerca volvulus or its Wolbachia symbiont, cross-reacting with host neuronal proteins (HNPs), and that doxycycline can be used as treatment.In this randomised, double-blind, placebo-controlled, phase 2 trial, we recruited participants from districts affected by nodding syndrome in northern Uganda. We included children and adolescents aged 8-18 years with nodding syndrome, as defined by WHO consensus criteria. Participants were randomly assigned (1:1) to receive either 100 mg doxycycline daily or placebo for 6 weeks via a computer-generated schedule stratified by skin microscopy results, and all parties were masked to group assignment. Diagnoses of O volvulus and antibodies to HNPs were made using luciferase immunoprecipitation system assays and immunohistochemistry. The primary outcome was change in the proportion with antibodies to HNPs, assessed at 24 months. All participants were included in safety analyses, and surviving participants (those with samples at 24 months) were included in primary analyses. Secondary outcomes were: change in concentrations of antibodies to HNPs at 24 months compared with baseline; proportion of participants testing positive for antibodies to O volvulus-specific proteins and concentrations of Ov16 or OVOC3261 antibodies at 24 months compared with baseline; change in seizure burden, proportion achieving seizure freedom, and the proportions with interictal epileptiform discharges on the diagnostic EEG; overall quality of life; disease severity at 24 months; and incidence of all-cause adverse events, serious adverse events, and seizure-related mortality by 24 months. This trial is registered with ClinicalTrials.gov, NCT02850913.METHODSIn this randomised, double-blind, placebo-controlled, phase 2 trial, we recruited participants from districts affected by nodding syndrome in northern Uganda. We included children and adolescents aged 8-18 years with nodding syndrome, as defined by WHO consensus criteria. Participants were randomly assigned (1:1) to receive either 100 mg doxycycline daily or placebo for 6 weeks via a computer-generated schedule stratified by skin microscopy results, and all parties were masked to group assignment. Diagnoses of O volvulus and antibodies to HNPs were made using luciferase immunoprecipitation system assays and immunohistochemistry. The primary outcome was change in the proportion with antibodies to HNPs, assessed at 24 months. All participants were included in safety analyses, and surviving participants (those with samples at 24 months) were included in primary analyses. Secondary outcomes were: change in concentrations of antibodies to HNPs at 24 months compared with baseline; proportion of participants testing positive for antibodies to O volvulus-specific proteins and concentrations of Ov16 or OVOC3261 antibodies at 24 months compared with baseline; change in seizure burden, proportion achieving seizure freedom, and the proportions with interictal epileptiform discharges on the diagnostic EEG; overall quality of life; disease severity at 24 months; and incidence of all-cause adverse events, serious adverse events, and seizure-related mortality by 24 months. This trial is registered with ClinicalTrials.gov, NCT02850913.Between Sept 1, 2016, and Aug 31, 2018, 329 children and adolescents were screened, of whom 240 were included in the study. 140 (58%) participants were boys and 100 (42%) were girls. 120 (50%) participants were allocated to receive doxycycline and 120 (50%) to receive placebo. At recruitment, the median duration of symptoms was 9 years (IQR 6-10); 232 (97%) participants had O volvulus-specific antibodies and 157 (65%) had autoantibodies to HNPs. The most common plasma autoantibodies were to human protein deglycase DJ-1 (85 [35%] participants) and leiomodin-1 (77 [32%] participants) and, in cerebrospinal fluid (CSF), to human DJ-1 (27 [11%] participants) and leiomodin-1 (14 [6%] participants). On immunohistochemistry, 46 (19%) participants had CSF autoantibodies to HNPs, including leiomodin-1 (26 [11%]), γ-aminobutyric acid B receptors (two [<1%]), CASPR2 (one [<1%]), or unknown targets (28 [12%]). At 24 months, 161 (72%) of 225 participants had antibodies to HNPs compared with 157 (65%) of 240 at baseline. 6 weeks of doxycycline did not affect the concentration of autoantibodies to HNPs, seizure control, disease severity, or quality of life at the 24-month follow-up but substantially decreased Ov16 antibody concentrations; the median plasma signal-to-noise Ov16 ratio was 16·4 (95% CI 6·4-38·4), compared with 27·9 (8·2-65·8; p=0·033) for placebo. 14 (6%) participants died and, other than one traffic death, all deaths were seizure-related. Acute seizure-related hospitalisations (rate ratio [RR] 0·43 [95% CI 0·20-0·94], p=0·028) and deaths (RR 0·46 [0·24-0·89], p=0·028) were significantly lower in the doxycycline group. At 24 months, 96 (84%) of 114 participants who received doxycycline tested positive for antibodies to Ov16, compared with 97 (87%) of 111 on placebo (p=0·50), and 74 (65%) participants on doxycycline tested positive for antibodies to OVOC3261, compared with 57 (51%) on placebo (p=0·039). Doxycycline was safe; there was no difference in the incidence of grade 3-5 adverse events across the two groups.FINDINGSBetween Sept 1, 2016, and Aug 31, 2018, 329 children and adolescents were screened, of whom 240 were included in the study. 140 (58%) participants were boys and 100 (42%) were girls. 120 (50%) participants were allocated to receive doxycycline and 120 (50%) to receive placebo. At recruitment, the median duration of symptoms was 9 years (IQR 6-10); 232 (97%) participants had O volvulus-specific antibodies and 157 (65%) had autoantibodies to HNPs. The most common plasma autoantibodies were to human protein deglycase DJ-1 (85 [35%] participants) and leiomodin-1 (77 [32%] participants) and, in cerebrospinal fluid (CSF), to human DJ-1 (27 [11%] participants) and leiomodin-1 (14 [6%] participants). On immunohistochemistry, 46 (19%) participants had CSF autoantibodies to HNPs, including leiomodin-1 (26 [11%]), γ-aminobutyric acid B receptors (two [<1%]), CASPR2 (one [<1%]), or unknown targets (28 [12%]). At 24 months, 161 (72%) of 225 participants had antibodies to HNPs compared with 157 (65%) of 240 at baseline. 6 weeks of doxycycline did not affect the concentration of autoantibodies to HNPs, seizure control, disease severity, or quality of life at the 24-month follow-up but substantially decreased Ov16 antibody concentrations; the median plasma signal-to-noise Ov16 ratio was 16·4 (95% CI 6·4-38·4), compared with 27·9 (8·2-65·8; p=0·033) for placebo. 14 (6%) participants died and, other than one traffic death, all deaths were seizure-related. Acute seizure-related hospitalisations (rate ratio [RR] 0·43 [95% CI 0·20-0·94], p=0·028) and deaths (RR 0·46 [0·24-0·89], p=0·028) were significantly lower in the doxycycline group. At 24 months, 96 (84%) of 114 participants who received doxycycline tested positive for antibodies to Ov16, compared with 97 (87%) of 111 on placebo (p=0·50), and 74 (65%) participants on doxycycline tested positive for antibodies to OVOC3261, compared with 57 (51%) on placebo (p=0·039). Doxycycline was safe; there was no difference in the incidence of grade 3-5 adverse events across the two groups.Nodding syndrome is strongly associated with O volvulus and the pathogenesis is probably mediated through an O volvulus induced autoantibody response to multiple proteins. Although it did not reverse disease symptoms, doxycycline or another prophylactic antibiotic could be considered as adjunct therapy to antiseizure medication, as it might reduce fatal complications from acute seizures and status epilepticus induced by febrile infections.INTERPRETATIONNodding syndrome is strongly associated with O volvulus and the pathogenesis is probably mediated through an O volvulus induced autoantibody response to multiple proteins. Although it did not reverse disease symptoms, doxycycline or another prophylactic antibiotic could be considered as adjunct therapy to antiseizure medication, as it might reduce fatal complications from acute seizures and status epilepticus induced by febrile infections.Medical Research Council (UK).FUNDINGMedical Research Council (UK).For the Luo translation of the abstract see Supplementary Materials section.TRANSLATIONFor the Luo translation of the abstract see Supplementary Materials section. MEDLINE - AcademicItem Epilepsy in Onchocerca volvulus Sero-Positive Patients From Northern Uganda—Clinical, EEG and Brain Imaging Features(Frontiers in Neurology, 2021) Ogwang, Rodney; Ningwa, Albert; Akun, Pamela; Bangirana, Paul; Anguzu, Ronald; Mazumder, Rajarshi; Abbo, Catherine; Mwaka, Amos Deogratius; Idro, RichardGlobally, epilepsy is the most common chronic neurological disorder. The incidence in sub-Saharan Africa is 2-3 times higher than that in high income countries. Infection by Onchocerca volvulus may be an underlying risk factor for the high burden and based upon epidemiological associations, has been proposed to cause a group of disorders—Onchocerca associated epilepsies (OAE) like nodding syndrome (NS). To improve our understanding of the disease spectrum, we described the clinical, electroencephalographic (EEG) and magnetic resonance imaging (MRI) features of children with epilepsy and sero-positive for Onchocerca volvulus (possible OAEs other than nodding syndrome). Twenty-nine children and adolescents with non-nodding syndrome OAE in northern Uganda were enrolled. A diagnosis of OAE was made in patients with epilepsy and seizure onset after age 3 years, no reported exposure to perinatal severe febrile illness or traumatic brain injury, no syndromic epilepsy diagnosis and a positive Ov-16 ELISA test. Detailed clinical evaluation including psychiatric, diagnostic EEG, a diagnostic brain MRI (in 10 patients) and laboratory testing were performed. Twenty participants (69%) were male. The mean age was 15.9 (standard deviation [SD] 1.9) years while the mean age at seizure onset was 9.8 (SD 2.9) years. All reported normal early childhood development. The most common clinical presentation was a tonic-clonic seizure. The median number of seizures was 2 (IQR 1–4) in the previous month. No specific musculoskeletal changes, or cranial nerve palsies were reported, neither were any vision, hearing and speech difficulties observed. The interictal EEG was abnormal in the majority with slow wave background activity in 52% (15/29) while 41% (12/29) had focal epileptiform activity. The brain MRI showed mild to moderate cerebellar atrophy and varying degrees of atrophy of the frontal, parietal and occipital lobes. The clinical spectrum of epilepsies associated with Onchocerca may be broader than previously described. In addition, focal onset tonic-clonic seizures, cortical and cerebellar atrophy may be important brain imaging and clinical features.Item Examining the Factors Associated With Sexual Violence Against Women in Sierra Leone: A Nationwide Cross Sectional Study(Journal of interpersonal violence, 2022) Shour, Abdul Rahman; Anguzu, Ronald; Zhou, Yuhong; Beyer, KirstenIn 2019, Sierra Leone declared national emergency over rape and other forms of sexual violence (SV), hence diverting resources from other issues to tackle SV. However, little is known about nationwide risk/protective factors for SV, and this has been a source of critique for the new policy. To fill this gap in knowledge, we investigated the factors for SV toward women using a nationally representative sample. We analyzed the 2013 Demographic and Health Survey (DHS) data, including 16,658 women, aged 15–49 years. The outcome was current SV, defined as being physically forced to have sexual intercourse within the last 12 months. We examined respondent’s background, sexual activities, and experience of domestic violence (DV). Logistic regression analyses were performed using STATA/SE v.15.1, accounting for survey design and sample weights. Values of p less than .05 were considered statistically significant. ArcMap was used to demonstrate geographic distribution of SV cases. We found that about 258 (6.3%) women reported SV. In adjusted analysis, women in the north (than south; 2.88, 95% CI = [1.44, 5.75]) and women circumcised between the ages of 1 and 14 (1.67, 95% CI = [1.10, 2.54]) reported higher risk of SV, respectively. Women who had sex more than 25 times per year were 6.9 times more likely to report SV, compared with those with 1 to 24 times (6.91, 95% CI = [1.48, 32.19]). The odds of SV were 6 times higher among women who reported experiencing recent physical violence (5.86, 95% CI = [2.49, 13.80]) or history of SV (6.34, 95% CI = [2.57, 15.65]). In conclusion, this study adds to the literature by providing information on major factors associated with SV toward women in Sierra Leone using a nationally representative sample. Women in the north (Tonkolili), circumcised between the ages of 1 and 14, had sex more than 25 times per year, reported physical violence (12 months before the survey) and SV (ever forced to have sex) reported higher risk for current SV. While more research is needed, these findings will help inform the current emergency operations against SV in Sierra Leone.Item Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda(BMC health services research, 2022) Anguzu, Ronald; Cassidy, Laura D.; Beyer, Kirsten M. M.; Babikako, Harriet M.; Walker, Rebekah J.; Dickson‑Gomez, JuliaUganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda. We conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis. Participants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse. Our findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships.Item Family planning counseling during antenatal care and postpartum contraceptive uptake in Africa: a systematic review protocol(JBI Evidence Synthesis, 2016) Sempeera, Hassard; Kabagenyi, Allen; Anguzu, Ronald; Muhumuza, Christine; Hassen, Kalkidan; Sudhakar, Morankaromen in low-income countries face a greater risk of unwanted pregnancy and unsafe abortions compared with women in developed countries. This increased risk has been attributed to the high demand and limited access to family planning services by women in this setting. Research shows that one in every four women aged 15–49 years who are married or in a relationshipwould wish to timeor control their child bearing but are not using any method of family planning. Despite the fact that contraceptive use has a direct and positive impact on reducing global maternal deaths by almost a third each year, this opportunity has not been fully exploited in lowincome countries particularly those in Africa.Item High parity predicts use of long-acting reversible contraceptives in the extended postpartum period among women in rural Uganda(Contraception and reproductive medicine, 2018) Anguzu, Ronald; Sempeera, Hassard; Sekandi, Juliet N.The use of implants and Intra-uterine devices (IUD) during the post-partum period is very low in Uganda especially in rural settings. Long-acting reversible contraceptives (LARC) are known to be the most cost-effective for prevention of unintended pregnancy and unsafe abortions. This study aimed at determining the factors associated with long-acting reversible contraceptive use among women in the extended postpartum period in rural Uganda. We conducted a household-based, cross-sectional study among 400 women in two rural communities in Mityana district, central Uganda. Eligible women were aged 15 to 45 years who had childbirth within 12 months of study enrollment in September 2014. The outcome variable was self-reported use of a LARC method, either IUD or implants in the extended postpartum period. The main independent variables were previous childbirths (parity), fertility desire, willingness to use modern contraception, duration of postpartum period and previous pregnancies (gravidity). A logistic regression model was run in STATA v12.0 to compute adjusted odds ratios (AOR) for factors that predicted LARC use statistically significant at p < 0.05. Four hundred respondents had a mean age of 27 years (SD = 12) and only 8.5% reported using a LARC method. Use of IUD and implant was 1.8% and 10.4% respectively. Most women using LARC (44.1%) had five or more childbirths (p = 0.01), 70.8% of non-LARC users were willing to use modern contraceptives (p = 0.07) and 2.5% ever had an induced abortion. Having five or more childbirths was independently associated with LARC use in the extended postpartum period (AOR = 4.07, 95%CI 1.08–15.4). Willingness to use modern contraception, desire for more children and postpartum duration had no significant association with LARC use in the extended postpartum period. This study revealed low use of LARC within twelve months of child birth despite women’s willingness to use them. High parity (≥5 childbirths) predicted LARC use. The next logical step is to identify barriers to using LARC in the extended postpartum period and design appropriate interventions to increase access and use especially in multi-parous women.Item High-resolution disease maps for cancer control in low-resource settings: A spatial analysis of cervical cancer incidence in Kampala, Uganda(Journal of Global Health, 2022) Beyer, Kirsten; Kasasa, Simon; Anguzu, Ronald; Lukande, Robert; Nambooze, Sarah; Nansereko, Brendah; Oyana, Tonny; Savino, Danielle; Feustel, Kavanya; Wabinga, HenryThe global burden of cervical cancer is concentrated in low-and middle-income countries (LMICs), with the greatest burden in Africa. Targeting limited resources to populations with the greatest need to maximize impact is essential. The objectives of this study were to geocode cervical cancer data from a population-based cancer registry in Kampala, Uganda, to create high-resolution disease maps for cervical cancer prevention and control planning, and to share lessons learned to optimize efforts in other low-resource settings.Item Household poverty, schooling, stigma and quality of life in adolescents with epilepsy in rural Uganda(Epilepsy & Behavior, 2021) Anguzu, Ronald; Akun, Pamela; Katairo, Thomas; Abbo, Catherine; Ningwa, Albert; Ogwang, Rodney; Mwaka, Amos Deogratius; Idro, RichardEpilepsy remains a leading chronic neurological disorder in Low- and Middle-Income Countries. In Uganda, the highest burden is among young rural people. We aimed to; (i) describe socio-economic status (including schooling), and household poverty in adolescents living with epilepsy (ALE) compared to unaffected counterparts in the same communities and (ii) determine the factors associated with the overall quality of life (QoL). This was a cross-sectional survey nested within a larger study of ALE compared to age-matched healthy community children in Uganda. Between Sept 2016 to Sept 2017, 154 ALE and 154 healthy community controls were consecutively recruited. Adolescents recruited were frequency and age-matched based on age categories 10–14 and 15–19 years. Clinical history and standardized assessments were conducted. One control participant had incomplete assessment and was excluded. The primary outcome was overall QoL and key variables assessed were schooling status and household poverty. Descriptive and multivariable linear regression analysis were conducted for independent associations with overall QoL. Mean (SD) age at seizure onset was 8.8 (3.9) years and median (IQR) monthly seizure burden was 2 (1–4). Epilepsy was associated with living in homes with high household poverty; 95/154 (61.7%) ALE lived in the poorest homes compared to 68/153 (44.5%) of the healthy adolescents, p = 0.001. Nearly two-thirds of ALE had dropped out of school and only 48/154 (31.2%) were currently attending school compared to 136/153 (88.9%) of healthy controls, p < 0.001. QoL was lowest among ALE who never attended school (p < 0.001), with primary education (p = 0.006) compared to those with at least secondary education. Stigma scores [mean(SD)] were highest among ALE in the poorest [69.1(34.6)], and wealthy [70.2(32.2)] quintiles compared to their counterparts in poorer [61.8(31.7)], medium [68.0(32.7)] and wealthiest [61.5(33.3)] quintiles, though not statistically significant (p = 0.75). After adjusting for covariates, ALE currently attending school had higher overall QoL compared to their counterparts who never attended school (β = 4.20, 95%CI: 0.90,7.49, p = 0.013). QoL scores were higher among ALE with ≥secondary education than those with no or primary education (β = 10.69, 95%CI: 1.65, 19.72). rural area are from the poorest households, are more likely to drop out of school and have the lowest QoL. Those with poorer seizure control are most affected. ALE should be included among vulnerable population groups and in addition to schooling, strategies for seizure control and addressing the epilepsy treatment gap in affected homes should be specifically targeted in state poverty eradication programs.Item Intimate partner violence and antenatal care utilization predictors in Uganda: an analysis applying Andersen’s behavioral model of healthcare utilization(BioMed Central Ltd, 2023-11) Anguzu, Ronald; Walker, Rebekah J; Babikako, Harriet M; Beyer, Kirsten M.M; Dickson-Gomez, Julia; Zhou, Yuhong; Cassidy, Laura DAbstract Background Optimal utilization of antenatal care (ANC) services improves positive pregnancy experiences and birth outcomes. However, paucity of evidence exists on which factors should be targeted to increase ANC utilization among women experiencing intimate partner violence (IPV) in Uganda. Objective To determine the independent association between IPV exposure and ANC utilization as well as the predictors of ANC utilization informed by Andersen’s Behavioral Model of Healthcare Utilization. Methods We analyzed 2016 Uganda Demographic and Health Survey data that included a sample of 1,768 women with children aged 12 to 18 months and responded to both ANC utilization and IPV items. Our outcome was ANC utilization, a count variable assessed as the number of ANC visits in the last 12 months preceding the survey. The key independent variable was exposure to any IPV form defined as self-report of having experienced physical, sexual and/or emotional IPV. Covariates were grouped into predisposing (age, formal education, religion, problem paying treatment costs), enabling (women’s autonomy, mass media exposure), need (unintended pregnancy, parity, history of pregnancy termination), and healthcare system/environmental factors (rural/urban residence, spatial accessibility to health facility). Poisson regression models tested the independent association between IPV and ANC utilization, and the predictors of ANC utilization after controlling for potential confounders. Results Mean number of ANC visits (ANC utilization) was 3.71 visits with standard deviation (SD) of ± 1.5 respectively. Overall, 60.8% of our sample reported experiencing any form of IPV. Any IPV exposure was associated with lower number of ANC visits (3.64, SD ± 1.41) when compared to women without IPV exposure (3.82, SD ± 1.64) at p = 0.013. In the adjusted models, any IPV exposure was negatively associated with ANC utilization when compared to women with no IPV exposure after controlling for enabling factors (Coef. -0.03; 95%CI -0.06,-0.01), and healthcare system/environmental factors (Coef. -0.06; 95%CI -0.11,-0.04). Predictors of ANC utilization were higher education (Coef. 0.27; 95%CI 0.15,0.39) compared with no education, high autonomy (Coef. 0.12; 95%CI 0.02,0.23) compared to low autonomy, and partial media exposure (Coef. 0.06; 95%CI 0.01,0.12) compared to low media exposure. Conclusion Addressing enabling and healthcare system/environmental factors may increase ANC utilization among Ugandan women experiencing IPV. Prevention and response interventions for IPV should include strategies to increase girls’ higher education completion rates, improve women’s financial autonomy, and mass media exposure to improve ANC utilization in similar populations in Uganda.Item Knowledge and attitudes towards use of long acting reversible contraceptives among women of reproductive age in Lubaga division, Kampala district, Uganda(BMC research notes, 2014) Anguzu, Ronald; Tweheyo, Raymond; Sekandi, Juliet N.; Zalwango, Vivian; Muhumuza, Christine; Tusiime, Suzan; Serwadda, DavidUganda has one of the highest total fertility rates globally and in Sub-Saharan Africa. Her high fertility is mainly attributed to the high unmet need for family planning. Use of Long-acting reversible contraceptives (LARC) is low (13%) in Uganda yet they are the most cost-effective contraceptives. This study aimed to assess the reproductive aged women’s knowledge, attitudes, and factors associated with use of LARC. A cross-sectional study was conducted involving 565 women (15–49 years) attending private and public health facilities in Lubaga division, Kampala district. Semi-structured questionnaires were used to measure knowledge, attitudes and factors associated with use of LARC; Intra-Uterine Devices, Implants and Injectables. The outcome variable was current use of LARC. A generalized linear regression model was run in STATA version12.0. Prevalence Risk Ratios for associations between current LARC use and independent factors were obtained and regarded significant at 95% CI with p < 0.05. Mean age (SD) and current use of LARC was 26.34 (5.35) and 31.7% respectively. Factors associated with current use of LARC were; previous use adj.PRR 2.89; (95% CI 2.29, 3.81), knowledge of implant administration site adj.PRR 1.83; (95% CI 1.17, 2.87), and perception that; male partner decisions positively influence their contraceptive choices adj.PRR 1.49; (95% CI 1.18, 1.88). Contrary, perception that LARC should be used by married women was negatively associated with use of LARC adj.PRR 0.63; (95% CI 0.44, 0.90). Knowledge about site of administration, previous use of LARC and women’s attitude that male partners’ choice influence their contraceptive decisions were positively associated with current use of LARC. Contrary, the attitude that LARC was for married women was negatively associated with its use. This study suggests a need to strengthen client education about LARC to dispel possible myths and to consider integrating male partner’s decision making in contraceptive choices for women.