Browsing by Author "Atuhaire, Leonard"

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    A Multilevel Decomposition of Time Variation in the Risks of Infant Mortality in Rural Uganda: UDHS 1995–2016
    (East African Journal of Health and Science, 2023) Odur, Benard; Nansubuga, Elizabeth; Wamala, Robert; Atuhaire, Leonard
    The study assessed the contribution of maternal, child, paternal, household, proximate, and community-level factors to infant mortality risk time variation in rural Uganda between 1995 and 2016. Five rounds of Uganda Demographic and Health Survey data sets were used, and a multilevel mixed-effect logistic regression model was applied to decompose the contribution of different factors to time variation in the risks of infant mortality. All live births that were made five years before the surveys of 1995, 2001, 2006, 2011, and 2016 were considered, with infants who did not survive beyond one year treated as the outcome variable analysis, excluding those who were born less than 12 months before the survey. The fixed part of the model helped us detect the significant variables in determining infant mortality, and yet the random part of the model helped us quantify the amount of time variation in the risks of infant mortality explained by the selected variables. The child-level determinants of infant mortality were sex, birth order, and weight. Among the maternal factors, the study revealed that marital status, access to ANC, use of contraceptives, maternal education level, and preceding birth interval were consistent deterrents of infant mortality, while household size, sanitation, and wealth index remained critical. While controlling for other factors in the rural areas, time variation in the risks of infant mortality was dependent on community factors (such as region, community hygiene, and prenatal care utilization rate), proximate factors (such as access to prenatal care, contraceptives use, place of delivery, and the number of ANC visits), maternal factors (such as marital status, educational level, age, parity, preceding birth interval, desire for pregnancy, and breastfeeding), and endowment. It was observed that the changes in the risks of infant mortality over the period were explained by community (30.7%), proximate (22.7%), maternal (41.0%), and endowment (37.9%). Child-level factors explained 28.2%, and paternal-level education level explained only 30.1%. Remarkably, household-level factors captured 32.3% of the changes in infant mortality. A higher proportion of the explained variation in the risk of infant mortality across communities (PCV) was captured by child, paternal, maternal endowment, and household factors. Interventions to accelerate the reduction in infant mortality should target birth spacing to at least two years, girl child education to at least o level, joint household decision-making in having children, avoiding teenage pregnancies, postnatal care utilization, enforcing at least four ANC visits during pregnancy, improving household sanitation, and increasing access to safe water at household-levels
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    Determinants of unintended pregnancies among currently married women in Uganda
    (Journal of Health, Population and Nutrition, 2020) Wasswa, Ronald; Kabagenyi, Allen; Atuhaire, Leonard
    Unintended pregnancies are no longer bound to teenagers or school-going children, married women in Uganda, as well do experience such pregnancies though little has been investigated on them. This study examines the determinants of unintended pregnancies among currently married women in Uganda. Methods: In this study, we used data from the 2016 Uganda Demographic and Health Survey (UDHS) which comprised of 10,958 married women aged 15–49 years who have ever been pregnant. The analysis was done using descriptive analysis, logistic regression, and the generalized structural equation model. Results: The study showed that 37% of pregnancies among married women were unintended. Young women, living in poor households, staying in rural areas, women in the Eastern and Northern region, Muslim women, lack of knowledge on ovulation period, discontinuation of contraceptives, non-use of and intention for contraceptives, high age at sexual debut, high age at first birth, and high parity were directly associated with a higher risk of unintended pregnancies. Relatedly, discontinuation of contraceptives regardless of the place of residence, region, woman’s age, education, household wealth, access to family planning messages were associated with higher odds of unintended pregnancies. Older women and those in rural areas who had more children were also at a higher risk of similar pregnancies. However, having more children while using contraceptives, being educated, living in a wealthier household, and having access to family planning messages significantly lowered the risk of unintended pregnancies. Conclusion: Increased access to family planning messages, empowering women as well as having improved household incomes are key preventive measures of unintended pregnancies. There is a need to provide quality contraceptive counseling through outreaches so that women are informed about the different contraceptive methods and the possible side effects. Having a variety of contraceptive methods to choose from and making them accessible and affordable will also encourage women to make informed choices and reduce contraceptive discontinuation. All these coupled together will help women have their desired family sizes, increase the uptake of contraceptives and significantly reduce unintended pregnancies.
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    Factors Associated with COVID-19 Vaccine Hesitancy in Uganda: A Population-Based Cross-Sectional Survey
    (International Journal of General Medicine, 2022) Kabagenyi, Allen; Wasswa, Ronald; Nannyonga, Betty K.; Nyachwo, Evelyne B.; Kagirita, Atek; Nabirye, Juliet; Atuhaire, Leonard; Waiswa, Peter
    Vaccination toward coronavirus disease (COVID-19) has been recommended and adopted as one of the measures of reducing the spread of this novel disease worldwide. Despite this, vaccine uptake among the Ugandan population has been low with reasons surrounding this being unknown. This study aimed to investigate the factors associated with COVID-19 vaccine hesitancy in Uganda. Methods: A cross-sectional study was conducted on a total of 1042 adults in the districts of Mukono, Kiboga, Kumi, Soroti, Gulu, Amuru, Mbarara and Sheema from June to November 2021. Data were analyzed using STATA v.15. Barriers to vaccination were analyzed descriptively, while a binary logistic regression model was used to establish the factors associated with COVID-19 vaccine hesitancy. Results: Overall, COVID-19 vaccine hesitancy was 58.6% (611). Respondents from urban areas and those in the eastern or northern region had increased odds of vaccine hesitancy. Further, higher education level and having knowledge on how COVID-19 is transmitted significantly reduced the odds of vaccine hesitancy. The study also noted individual perception such as COVID-19 kills only people with underlying medical conditions, as well as limited awareness on vaccine types or vaccination areas as the main reasons to vaccine hesitancy. Relatedly, other misconceptions like the ability of the vaccine to cause infertility, or spreading the virus into the body, and acknowledgment of alcohol as a possible cure were other reasons for vaccine hesitancy. Conclusion: The proportion of COVID-19 vaccine hesitancy is still high among the population with this varying across regions. This is driven by low education level and limited awareness on the vaccination as well as perceived myths and misconceptions. The study recommends mass sensitization of the population on the benefits of vaccination using various channels as well as rolling out community-based outreach vaccination campaigns across the country.
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    A Novel Symptom Cluster Analysis among Ambulatory HIV/AIDS Patients in Uganda
    (AIDS care, 2015) Namisango, Eve; Harding, Richard; Katabira, Elly T.; Siegert, Richard J.; Atuhaire, Leonard; Moens, Katrien; Taylor, Steve
    Symptom clusters are gaining importance given HIV/AIDS patients experience multiple, concurrent symptoms. This study aimed to: determine clusters of patients with similar symptom combinations; describe symptom combinations distinguishing the clusters; and evaluate the clusters regarding patient socio-demographic, disease and treatment characteristics, quality of life (QOL) and functional performance. This was a cross-sectional study of 302 adult HIV/AIDS outpatients consecutively recruited at two teaching and referral hospitals in Uganda. Socio-demographic and seven-day period symptom prevalence and distress data were self-reported using the Memorial Symptom Assessment Schedule. QOL was assessed using the Medical Outcome Scale and functional performance using the Karnofsky Performance Scale. Symptom clusters were established using hierarchical cluster analysis with squared Euclidean distances using Ward’s clustering methods based on symptom occurrence. Analysis of variance compared clusters on mean QOL and functional performance scores. Patient subgroups were categorised based on symptom occurrence rates. Five symptom occurrence clusters were identified: Cluster 1 (n = 107), high–low for sensory discomfort and eating difficulties symptoms; Cluster 2 (n = 47), high–low for psycho-gastrointestinal symptoms; Cluster 3 (n = 71), high for pain and sensory disturbance symptoms; Cluster 4 (n = 35), all high for general HIV/AIDS symptoms; and Cluster 5 (n = 48), all low for mood-cognitive symptoms. The all high occurrence cluster was associated with worst functional status, poorest QOL scores and highest symptom-associated distress. Use of antiretroviral therapy was associated with all high symptom occurrence rate (Fisher’s exact = 4, P < 0.001). CD4 count group below 200 was associated with the all high occurrence rate symptom cluster (Fisher’s exact = 41, P < 0.001). Symptom clusters have a differential, affect HIV/AIDS patients’ self-reported outcomes, with the subgroup experiencing high-symptom occurrence rates having a higher risk of poorer outcomes. Identification of symptom clusters could provide insights into commonly co-occurring symptoms that should be jointly targeted for management in patients with multiple complaints.
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    Pain Among Ambulatory HIV/AIDS Patients: Multicenter Study of Prevalence, Intensity, Associated Factors, and Effect
    (The Journal of Pain, 2012) Namisango, Eve; Harding, Richard; Atuhaire, Leonard; Ddungu, Henry; Katabira, Elly; Muwanika, Fred Roland; Powell, Richard A.
    This study aimed to determine the prevalence, intensity, associated factors, and effect of pain among ambulatory HIV/AIDS patients. Three-hundred two adult ambulatory HIV/AIDS patients were consecutively recruited from HIV/AIDS outpatient clinics at 2 teaching hospitals in Uganda. The presence and intensity of pain were self-reported using the Brief Pain Inventory (BPI); symptom data were collected using the Memorial Symptom Assessment Scale (MSAS-SF); and quality of life (QOL) was assessed using the Medical Outcome Scale-HIV. Forty-seven percent reported pain in the 7 days prior to the survey and pain was a symptom at the time of diagnosis for 68%. On the 0 to 10 numeric scale, 53% reported mild pain (1–4 rating), 20% reported moderate pain (5–6 rating) while 27% reported severe pain (7–10 rating). Gender was not associated with pain intensity, but reduced functional performance, increasing number of symptoms, advanced HIV disease , physical symptom distress (MSAS-SF), and number of health comorbidities were significantly associated with pain intensity (P < .04). Increasing pain intensity was associated with greater functional ability impairment (BPI functional interference index) and poorer QOL. Pain is a common symptom among ambulatory HIV/AIDS patients and has a debilitating effect on QOL. There is a significant unmet need for pain relief in the population.
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    Parametric Versus Non-Parametric Models for Predicting Infant Mortality within Communities in Uganda using the 2016 Uganda Demographic and Health Survey Data
    (East African Journal of Health and Science, 2023) Odur, Benard; Nansubuga, Elizabeth; Odwee, Jonathan; Atuhaire, Leonard
    Machine learning techniques have been infrequently used to identify community-based infant mortality risks. Achieving SDG 3 Targets 3.2 and 3.3 could be expedited by early detection of at-risk infants within communities. This study aimed to devise a community-centric algorithm for predicting infant mortality. We analysed UDHS 2016 data containing birth records for 22,635 children born within the five years preceding the survey, excluding those born within a year of the interview date. Twelve machine learning models were evaluated for their predictive capabilities using the area under the receiver operating characteristic curve (AUC ROC) in Python. Data subsets were divided into training and testing sets in a 2:1 ratio. Among the evaluated models, CatBoost showed superior performance with an AUC ROC of 74.9%. The five most influential variables for the CatBoost model were postnatal care utilisation, paternal age, household size, preceding birth interval, and maternal age. While the algorithm’s best performance was achieved using 28 variables, it still exhibited robust predictive power when limited to the top 8 or 10 variables. Hence, CatBoost stands out as an effective tool for identifying community-based infant mortality risks