Browsing by Author "Gemzell-Danielsson, Kristina"

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    Adherence to modern contraceptives among female refugee adolescents in northern Uganda: A prospective single cohort study
    (A prospective single cohort study, 2022) Bakesiima, Ritah; Gemzell-Danielsson, Kristina; Beyeza-Kashesya, Jolly; Ayebare, Elizabeth; Cleeve, Amanda; Larsson, Elin C.; Nabirye, Rose C.
    Background: Contraceptive adherence is the current and consistent use of a contraceptive method as prescribed by a health worker or family planning provider so as to prevent pregnancy. Globally, adherence is lowest among adolescents. This has greatly contributed to the high burden of adolescent pregnancies. Adherence and reasons for discontinuation among refugee adolescents are poorly understood. The aim of this study was to determine the rates and predictors of adherence to modern contraceptives among female refugee adolescents in northern Uganda. Methods: A prospective single cohort study, nested into a randomised controlled trial (RCT) assessing the effect of peer counselling on acceptance of modern contraceptives. The RCT was conducted among female refugee adolescents in Palabek refugee settlement, northern Uganda. The study involved 272 new starters of modern contraceptives who were followed up for six months from May 2019 to January 2020. The outcome was measured at one, three and six months after receiving a contraceptive method. Data was analysed using STATA version 14.0. Results: Adherence rates were low and reduced over time. By the end of the six months, only 44% of the participants were using a contraceptive method. The commonest reasons for non-adherence were side effects and partner prohibition. Participants using long acting reversible contraceptives (LARC) were more likely to adhere compared to those who were using short acting reversible contraceptives (SARC) (OR: 3.37, 95% CI: 1.914-5.937, p=<0.001). There was no difference in adherence between participants who received peer counselling and those who received routine counselling. Conclusion: Adherence to modern contraceptives was low, leaving adolescents at risk of unintended pregnancies. Participants using LARC were more likely to adhere than those using SARC. Interventions addressing fear of side effects and partner prohibition should be studied and implemented to enable adherence to modern contraceptives
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    Effectiveness of Early versus Standard Intrauterine Contraception following Medical 2 Management of First Trimester Incomplete Abortions: A Non-Inferiority Open-Label 3 Randomized Control Trial in central Uganda
    (2025) Kayiga, Herbert; Looft-Trägårdh, Emelie; Kakaire, Othman; Cleeve, Amanda; Rujumba, Joseph; Sekikubo, Musa; Tumwesigye, Nazarius M.; Byamugisha, Josaphat; Gemzell-Danielsson, Kristina
    Background: With paucity of information on ideal timing for intrauterine contraception placement, we set out to determine the effectiveness of early insertion (within one week) versus standard insertion (two-four weeks) of intrauterine contraception after medical management of first trimester incomplete abortions in central Uganda. Methods: In a multicenter non-inferiority trial at five public health facilities in central Uganda, 1,050 women with first trimester incomplete abortions managed by sublingual misoprostol, were recruited upon giving informed consent. After selecting either Copper or Levonorgestrel intrauterine devices (IUDs), participants were randomly assigned to early or standard insertion arms in a ratio of 1:1. The primary outcome was IUD expulsion rates at six-months. The non-inferiority margin was set at 5% for the upper limit of the confidence interval (CI) for the absolute risk difference. The trial was registered at ClinicalTrials.gov NCT05343546. Findings: Between 8th July 2023 to 31st May 2024, 528 (50·3%) participants were assigned to early and 522 (49·7%) participants to standard insertion arms. About 531 (50·6%) participants chose Levonorgestrel IUDs, 489 (46·6%) participants chose copper IUDs, while 30 (2·9%) participants opted against IUDs. In an intention-to-treat analysis, expulsion occurred in 23 (4·4%) of 528 participants in the early insertion arm and in 24 (4·6%) of 522 participants in the standard arm; Adjusted Risk Difference (standard-early) was -0·00006 (95% CI: -0·0008 to 0·00066, p = 0·93). No serious adverse events occurred in both arms. The IUD continuation rates at six-months were 91·1% in the early and 90·2% in the standard insertion arms. Interpretation: Early IUD insertion after medical treatment of first trimester incomplete abortions was non-inferior to standard IUD insertion with respect to expulsion. Early IUD insertion may help to prevent unintended pregnancies.
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    Emergency Contraception and Fertility awareness among University Students in Kampala, Uganda
    (African health sciences, 2006) Byamugisha, Josaphat K.; Mirembe, Florence M.; Faxelid, Elisabeth; Gemzell-Danielsson, Kristina
    Uganda has a high maternal mortality ratio with unsafe abortions being one of the major causes. Young people are particularly vulnerable to unsafe induced abortion with its sequelae. Emergency contraception (EC) may reduce unsafe abortions if easily accessible and acceptable. To determine knowledge about, ever use and attitudes towards EC among resident and non-resident female first year university students in Kampala. This Cross sectional study was carried out at Makerere University from January to March 2005.Out of 5971 females admitted in the academic year 2004/2005,379 answered a self administered questionnaire. The students were approached individually and given the questionnaire if they consented. Results: The mean age of the participants was 21 years. Less than half (45.1%) had ever heard about emergency contraceptive pills (ECPs).The most common sources of information about EC were friends (34%),media (24.8%) and schools (19.4%) .The ever pregnancy rate was 3.4 percent and 42 percent were in a steady relationship of three or more months. The contraceptive ever-use rate was 14.5 percent. Among the users the most common methods were condoms (48.9%) and withdrawal (23.4%). Emergency contraceptive pills had been used by seven students. Forty two percent did not know the time interval within which ECPs can work and one third thought it would interrupt an ongoing pregnancy. Thirty five percent did not know when in the menstrual cycle they were likely to conceive. The majority of the students were against over the counter (OTC) availability of EC because of fear of misuse. Knowledge about Emergency contraception and fertility awareness is low among the female first year university students. Friends and the media are an important source of EC information. Awareness and knowledge of EC should be increased.
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    Healthcare providers’ perceptions on post abortion intrauterine contraception: A qualitative study in central Uganda
    (PloS one, 2024) Kayiga, Herbert; Looft-Tragårdh, Emelie; Cleeve, Amanda; Kakaire, Othman; Tumwesigye, Nazarius M.; Byamugisha, Josaphat; Gemzell-Danielsson, Kristina
    Despite access to post abortion intrauterine contraception, the uptake of Intrauterine devices (IUDs) in Uganda remains low. Whether the perceptions of healthcare providers towards IUDs have a role in the provision of post abortion IUDs remains unclear. We explored perceptions on post abortion IUD provision among healthcare providers in Uganda, focusing on barriers and facilitators in regards to provision and uptake. Methods Between 1st August 2022 and 30th September 2022, forty-five in-depth interviews were conducted among healthcare providers of different cadres at sixteen public health facilities in central Uganda. We used the case study design to explore the healthcare providers’ perceptions. The interviews were primarily to help us understand the perceptions of healthcare providers towards IUDs. All interviews were audio-recorded and transcribed verbatim. Themes were identified using the conventional inductive content analysis. Results From the analysis, three themes emerged. Theme one covered health system related barriers in regards to IUD provision such as healthcare providers’ and health facility challenges. The second theme focused on the challenges in post abortion contraceptive counselling focusing on IUDs. The third theme covered the motivating factors and participants’ views on how to scale up IUD uptake and provision within post abortion care in Uganda. We found that lack of appropriate knowledge and skills on IUD provision, and heavy workloads, negatively impacted IUD provision. Inadequate facilities, IUD stock-outs, and minimal community sensitization also limited the utilization of IUDs. Furthermore, language barriers, community misconceptions around IUDs, long travel distances to the health facility, and partner refusal, contributed to the low uptake of post abortion IUDs. To address the identified barriers and scale up post abortion IUD provision, participants recommended addressing health system barriers, regular in-service refresher trainings, mentoring and supervision. They emphasized the importance of addressing contraceptive misconceptions and men’s opposition to IUDs through community sensitization. Conclusion In this study we identified several barriers to post abortion IUD provision, highlighting an urgent need to address health system barriers including healthcare providers’ skills and knowledge gaps, supply chain challenges, and to ensure that facilities are conducive to quality contraceptive counselling. Provision of on-job refresher trainings, mentoring and supervision, are key motivators that can be utilized in supporting healthcare providers towards post abortion IUD provision. To further increase uptake, efforts are needed to dispel contraceptive myths and misconceptions at the community level.
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    Knowledge, attitudes and prescribing pattern of emergency contraceptives by health care workers in Kampala, Uganda
    (Acta obstetricia et gynecologica Scandinavica, 2007) Byamugisha, Josaphat K.; Mirembe, Florence M.; Faxelid, Elisabeth; Gemzell-Danielsson, Kristina
    Health care workers (HCWs) play an important role in making emergency contraceptives (ECs) available to clients. They can influence accessibility positively through counselling, prescribing or advocating the use of ECs. However, in some settings, HCWs have been blamed for unfavourable attitudes and lack of accurate information. Objective . To assess the knowledge, attitudes and prescribing pattern of EC by HCWs in Kampala district, Uganda. Methods. The total number of health units at different levels of health care delivery in Kampala (894) was obtained. Probability proportional to size (PPS) technique of sampling was applied. Some 247 HCWs completed a selfadministered questionnaire on their knowledge about EC, including methods, mechanism of action, prescription of EC, sources of information, attitudes towards EC, and if and how it should be made available. Results . Of the HCWs, 80% had knowledge of ECs. However, 1 in every 4 was not sure about the time limit within which EC is effective. A total of 50% of the participants had obtained information from a physician (26.4%) or from a training school (24%). The Yuzpe regimen was the most commonly mentioned and prescribed method of EC. The HCWs attitudes to EC were generally positive, and it was suggested that the community should be informed and sensitised about EC. There was a significant difference between having had a family planning educational update or not in the last year and knowledge of EC (p 0.005). Conclusion . Most HCWs were aware of EC, but some lacked important knowledge on its use or available methods. Recommendation. HCWs should have regular (annual) in-service training in reproductive health issues, such as counselling on EC. This will enable them to keep up to date with the current evidence-based recommendations in the field of contraceptive technology.
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    A randomized clinical trial of two emergency contraceptive pill regimens in a Ugandan population
    (Acta Obstetricia et Gynecologica, 2010) Byamugisha, Josaphat K.; Mirembe, Florence M.; Faxelid, Elisabeth; Tumwesigye, Nazarius M.; Gemzell-Danielsson, Kristina
    Recent trials on emergency contraception (EC) have indicated that levonorgestrel (LNG) used alone has fewer side-effects and is more efficacious than the Yuzpe regimen (high dose combined oral contraceptive pills). However, the experienced side-effects and acceptability may vary between different groups or societies. Objective. The primary objective of this study was to determine side-effects and acceptability of two emergency contraceptive pill (ECP) regimens among users in Kampala, Uganda. Study design. Randomized clinical trial. Methods. A total of 337 women were enrolled in a double blind randomized clinical trial. Women requesting ECPs within 72 hours after unprotected sexual intercourse received either LNG or the Yuzpe regimen. The women returned for follow-up after three days and a follow-up interview was performed after one year. Results. Levonorgestrel had significantly fewer side-effects than the Yuzpe regimen (p < 0.001). There was a significant association between having worries about the method and experiencing side-effects (p < 0.001). Most women (81%) were prime users of EC. The majority would recommend ECP to other clients. Conclusions. Levonorgestrel is a superior option to the Yuzpe regimen and should be promoted as the recommended ECP. Having worries about ECP may influence experience of the side-effects. Correct information is critical in promotion of ECP use.