Browsing by Author "Ekstrom, Anna Mia"
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Item The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda(African health sciences, 2009) Beyeza-Kashesya, Jolly; Kaharuza, Frank; Mirembe, Florence; Neema, Stella; Ekstrom, Anna Mia; Kulane, AsliSixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda, we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus, we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples. Methods: A cross-sectional survey of 114 HIV discordant couples in Kampala, and in-depth interviews with 15 purposively selected couples. Quantitative data were analyzed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2.Item Domestic violence as risk factor for unwanted pregnancy and induced abortion in Mulago Hospital, Kampala, Uganda(Tropical Medicine & International Health, 2006) Kaye, Dan K.; Mirembe, Florence M.; Bantebya, Grace; Johansson, Annika; Ekstrom, Anna MiaTo compare pregnancy intention and domestic violence among women with induced and spontaneous abortion. Case-control study in Mulago Hospital, Uganda, from September 2003 to June 2004 of 942 women seeking post-abortion care. Direct inquiry, records review and clinical examination identified 333 with induced abortion (cases) and 609 with spontaneous abortion (controls), who were compared regarding socio-demographic characteristics, contraceptive use, domicile (rural or urban, nuclear or extended families), pregnancy intention, household decision-making and domestic violence. Data was analysed with EPI-INFO and STATA, using Student t-test and analysis of variance for continuous and chi-square for categorical variables. Stratified and multivariate logistic regression analyses were used to adjust for confounding and interaction at the 95% confidence level. Cases significantly differed from controls as they were younger or more often single; had lower parity and education, less household decision-making and fewer living children. They were similar to controls (P > 0.05) regarding employment, spouse’s age, years spent in marital relationship and domicile. Cases more frequently (P < 0.001) had mistimed, unplanned or unwanted pregnancy at conception and presentation. Cases were more likely to have a recent history of domestic violence (physical, sexual or psychological) [OR: 18.7 (95%CI: 11.2–31.0)] after adjusting for age, pregnancy intention and marital status. Domestic violence is a risk factor for unwanted pregnancy and induced abortion among women seeking post-abortion care.Item Domestic violence during pregnancy and risk of low birthweight and maternal complications: a prospective cohort study at Mulago Hospital, Uganda(Tropical Medicine & International Health, 2006) Kaye, Dan K.; Mirembe, Florence M.; Bantebya, Grace; Johansson, Annika; Ekstrom, Anna MiaTo investigate whether domestic violence during pregnancy is a risk factor for antepartum hospitalization or low birthweight (LBW) delivery. A prospective cohort study was conducted in Mulago hospital, Kampala, Uganda, among 612 women recruited in the second pregnancy trimester and followed up to delivery, from May 2004 through July 2005. The exposure (physical, sexual or psychological violence during pregnancy) was assessed using the Abuse Assessment Screen. The relative and attributable risks of LBW and antepartum hospitalization were estimated using multivariate logistic regression analysis. The 169 women [27.7% 95% CI (24.3–31.5%)] who reported domestic violence during pregnancy did not differ significantly from the unexposed regarding sociodemographic characteristics, but differed significantly (P < 0.05) regarding domicile variables (had less household decision-making power, more resided in extended families and more had unplanned pregnancy). They delivered babies with a mean birthweight 2647.5 ± 604 g, on average 186 g [(95% CI 76–296); P ¼ 0.001] lower than those unexposed. After adjusting for age, parity, number of living children, pregnancy planning, domicile and number of years in marriage, the relative risk (RR) of LBW delivery among women exposed to domestic violence was 3.78 (95% CI 2.86–5.00). Such women had a 37% higher risk of obstetric complications (such as hypertension, premature rupture of membranes and anaemia) that necessitated antepartum hospitalization [RR 1.37 (95% CI 1.01–1.84)]. In this pregnancy cohort, domestic violence during pregnancy was a risk factor for LBW delivery and antepartum hospitalization.Item My Partner wants a child: A cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda(BMC Public Health, 2010) Beyeza-Kashesya, Jolly; Ekstrom, Anna Mia; Kaharuza, Frank; Mirembe, Florence; Neema, Stella; Kulane, AsliThe percentages of couples in HIV sero-discordant relationships range from 5 to 31% in the various countries of Africa. Given the importance of procreation and the lack of assisted reproduction to avoid partner transmission, members of these couples are faced with a serious dilemma even after the challenge of disclosing their HIV status to their spouses. Identifying the determinants of the decision to have children among sero-discordant couples will help in setting reproductive intervention priorities in resource-poor countries. We conducted a survey among 114 mutually disclosed sero-discordant couples (228 individuals) receiving HIV care at four centres in Greater Kampala, between June and December 2007. The data we collected was classified according to whether the man or the woman was HIV-positive. We carried out multivariate logistic regression modelling to determine factors (age, gender, and the influences of relatives and of health workers, ART knowledge, and disclosure) that are independently associated with a desire for children.Item “Not a Boy, Not a Child”: A Qualitative Study on Young People’s Views on Childbearing in Uganda(African journal of reproductive health, 2010) Beyeza-Kashesya, Jolly; Neema, Stella; Ekstrom, Anna Mia; Kaharuza, Frank; Mirembe, Florence; Kulane, AsliTo understand reasons for persistent high fertility rate, we explored perceptions and influences of fertility motivation among young people from Uganda. Qualitative inquiry was used, data were organised using NVivo 2 package and latent content analysis performed. Major themes that emerged on factors that entrench high fertility included “Sustenance of ‘men’s blood’ through the male child”; “poverty, joblessness and child bearing”, and “other socio-cultural issues: religion, kin, elders and child bearing”. Factors that reduce fertility included “perception on women emancipation, job security and couple fertility communication”. Young peoples’ views on motivation for childbearing in Uganda are embedded in cultural norms and linked strongly to patriarchy, social respectability and women’s sustenance. Innovative cultural practices and programs that increase women’s social respectability such as emphasis that a girl can be heir and inherit her father’s property are needed to reduce sonpreference and fertility rates in the younger generation (Afr J Reprod Health 2010; 14[1]:71-81).Item The Social Construction and Context of Domestic Violence in Wakiso District, Uganda(An International Journal for Research, Intervention and Care, 2005) Kaye, Dan K.; Mirembe, Florence; Ekstrom, Anna Mia; Bantebya, Grace; Johansson, AnnikaThis study explored community perceptions of factors associated with domestic violence, with an emphasis on events occurring during pregnancy. Ten focus group discussions, 14 key-informant interviews and four case vignettes were conducted in Wakiso district, Uganda between August and December 2003. Data were analyzed using thematic content analysis. Perceived motives and meanings, triggering as well as associated factors, perceived coping mechanisms and community support available for reducing domestic violence, especially that occurring during pregnancy, were identified. Urban migration, changing cultural values and men’s unemployment shift the balance of power in gender relations. Resultant male uncertainty and gender antagonism is associated with domestic violence. Family institutions such as extended family structure, relatives and in-laws were perceived as offering little protection. Factors triggering violence included failed negotiation of sexual relations, disagreement concerning the division of labor within the household and misconceptions about the physical and physiological changes, both dietary and behavioral, which occur in pregnancy.