Browsing by Author "Kemigisha, Elizabeth"
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Item Adolescents’ Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms(International journal of environmental research and public health, 2018) Kemigisha, Elizabeth; Nyakato, Viola N.; Bruce, Katharine; Ruzaaza, Gad N.; Mlahagwa, Wendo; Ninsiima, Anna B.; Coene, Gily; Leye, Els; Michielsen, KristienMeasures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense—i.e., body image, self-esteem, and gender equitable norms—and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10–14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7–28) and median 22 (IQR: 19, 24, possible range: 5–25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11–44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended.Item cross-sectional mixed-methods study of sexual and reproductive health knowledge, experiences and access to services among refugee adolescent girls in the Nakivale refugee settlement, Uganda(Reproductive Health, 2019) Ivanova, Olena; Rai, Masna; Mlahagwa, Wendo; Tumuhairwe, Jackline; Bakuli, Abhishek; Nyakato, Viola N.; Kemigisha, ElizabethBackground: Humanitarian crises and migration make girls and women more vulnerable to poor sexual and reproductive health (SRH) outcomes. Nevertheless, there is still a dearth of information on SRH outcomes and access to SRH services among refugee girls and young women in Africa. We conducted a mixed-methods study to assess SRH experiences, knowledge and access to services of refugee girls in the Nakivale settlement, Uganda. Methods: A cross-sectional survey among 260 adolescent girls 13–19 years old was conducted between March and May 2018. Concurrently, in-depth interviews were conducted among a subset of 28 adolescents. For both methods, information was collected regarding SRH knowledge, experiences and access to services and commodities. The questionnaire was entered directly on the tablets using the Magpi® app. Descriptive statistical analysis and multinomial logistic regression were performed. Qualitative data was transcribed and analysed using thematic content analysis. Results: A total of 260 participants were interviewed, with a median age of 15.9 years. The majority of girls were born in DR Congo and Burundi. Of the 93% of girls who had experienced menstruation, 43% had ever missed school due to menstruation. Regarding SRH knowledge, a total of 11.7% were not aware of how HIV is prevented, 15.7% did not know any STI and 13.8% were not familiar with any method to prevent pregnancy. A total of 30 girls from 260 were sexually active, of which 11 had experienced forced sexual intercourse. The latter occurred during conflict, in transit or within the camp. A total of 27 of 260 participants had undergone female genital mutilation (FGM). The most preferred sources for SRH information was parents or guardians, although participants expressed that they were afraid or shy to discuss other sexuality topics apart from menstruation with parents. A total of 30% of the female adolescents had ever visited a SRH service centre, mostly to test for HIV and to seek medical aid for menstrual problems. Conclusions: Adolescent refugee girls lack adequate SRH information, experience poor SRH outcomes including school absence due to menstruation, sexual violence and FGM. Comprehensive SRH services including sexuality education, barrier-free access to SRH services and parental involvement are recommendedItem Dramatic effects of COVID-19 public health measures and mass reverse migration on youth sexual and reproductive health in rural Uganda(Paediatrics & Child Health,, 2022) Khan, Sundus; Kemigisha, Elizabeth; Turyakira, Eleanor; Chaput, Kathleen; Kabakyenga, Jerome; Kyomuhangi, Teddy; Manalili, Kimberly; Brenner, Jennifer L.Introduction: Youth (aged 10 to 24 years) comprise nearly one-third of Uganda’s population and often face challenges accessing sexual and reproductive health (SRH) services, with a disproportionately high incidence of negative SRH outcomes. Responding to COVID-19, Uganda implemented strict public health measures including broad public transportation, schooling, and business shut-downs, causing mass reversemigration of youth from urban schools and workplaces back to rural home villages. Our study aimed to qualitatively describe the perceived unintended impacts of COVID-19 health measures on youth SRH in two rural districts. Methods: Semi-structured focus group discussions (FGD) and key informant interviews (KII) with purposively selected youth, parents, community leaders, community health worker (CHW) coordinators and supervisors, health providers, facility and district health managers, and district health officers were conducted to explore lived experiences and impressions of the impacts of COVID-19 measures on youth SRH. Interviews were recorded, transcribed, and coded using deductive thematic analysis. Results: Four COVID-19-related themes and three subthemes resulted from 15 FGDs and 2 KIIs (n=94). Public transportation shutdown and mandatory mask-wearing were barriers to youth SRH care-seeking. School/workplace closures and subsequent urban youth migration back to rural homes increased demand at ill-prepared, rural health facilities, further impeding care-seeking. Youth reported fear of discovery by parents, which deterred SRH service seeking. Lockdown led to family financial hardship, isolation, and overcrowding; youth mistreatment, gender-based violence, and forced marriage ensued with some youth reportedly entering partnerships as a means of escape. Idleness and increased social contact were perceived to lead to increased and earlier sexual activity. Reported SRH impacts included increased severity of infection and complications due to delayed care seeking, and surges in youth sexually transmitted infections, pregnancy, and abortion. Conclusion: COVID-19 public health measures reportedly reduced youth care seeking while increasing risky behaviours and negative SRH outcomes. Investment in youth SRH programming is critical to reverse unintended pandemic effects and regain momentum toward youth SRH targets. Future pandemic management must consider social and health disparities, and mitigate unintended risks of public health measures to youth SRH.Item Effect of women’s intra-household bargaining power on postnatal and infant healthcare in rural Uganda–Results from a cross sectional survey in Kyenjojo district(Midwifery, 2020) Kadengye, Damazo T.; Atahigwa, Catherine; Kampire, Pamela; Mucunguzi, Stephen; Kemigisha, Elizabeth; Nyakato, Viola N.; Kiwuwa-Muyingo, SylviaGlobal estimates by the United Nations inter-agency group for child mortality show that as of 2017, under-five mortality rate had decreased by 58%, from an estimated rate of 93 deaths per 10 0 0 live births in 1990 to 39 deaths per 10 0 0 live births. In the same period, Uganda achieved noticeable progress with the risk of a child dying before five years of age decreasing by 71% from 187 to 49 deaths per 10 0 0 live births ( UNICEF Data, 2019 ; You et al., 2015 ), and under five mortality dropped from 177 to 64 per 10 0 0 live births ( Uganda Bureau of Statistics [UBOS] and ICF Interna- tional, 2017 ). Despite significant improvements, utilization of ma- ternal and child healthcare services still remains a major area of concern with substantial disparities amongst women living in de- veloping countries, most especially those in the rural areas with unacceptably low levels of access to services ( Beegle et al., 2001 ; World Health Organisation [WHO], 2016 ). Although utilization of antenatal care services (ANC) is being promoted through interven- tions to enhance attendance and skilled health care at birth, less attention has been given to postnatal care in preventing complica- tions and ensuring better maternal and child health care.Item Evaluation of a school based comprehensive sexuality education program among very young adolescents in rural Uganda(BMC Public Health, 2019) Kemigisha, Elizabeth; Bruce, Katharine; Ivanova, Olena; Leye, Els; Coene, Gily; Ruzaaza, Gad N.; Ninsiima, Anna B.; Mlahagwa, Wendo; Nyakato, Viola N.; Michielsen, KristienLimited research has been conducted on the effectiveness of sexuality education for very young adolescents (VYAs) ages 10–14 years in Sub-Saharan Africa. Furthermore, evaluations of sexuality education programs often report outcomes of risky sexual practices, yet positive aspects of sexuality are hardly studied and rarely reported. This study evaluates the effectiveness of a Comprehensive Sexuality Education (CSE) intervention for VYAs in Uganda, analyzing both positive and negative outcome indicators. Methods: We conducted a mixed methods study, incorporating a cluster randomized trial (NCT03669913) among pupils in 33 randomly selected primary schools in Mbarara district. This was followed by a qualitative evaluation of the intervention in 4 schools that included 14 in-depth interviews and 3 focus group discussions distributed among pupils, teachers and parents. Quantitative data were analyzed using ordered logistic regression to compare differences in the change from baseline to endline between the intervention and control arms. We conducted bivariate analysis and multiple regression analysis controlling for key covariates, including age, gender, school location (rural vs urban), truancy, and orphanhood. Qualitative data were analyzed by thematic approach using ATLAS TI. Results: Between July 2016 and August 2017, 1096 pupils were recruited. Outcomes were studied among 380 pupils in the intervention arm and 484 pupils in the control arm. The proportion of pupils who ever had sex increased from 9 to 12.1% in intervention compared to 5.2 to 7.4% in the control group between baseline and endline, however the differences between groups were not statistically significant. We found greater improvements in sexual and reproductive health (SRH) knowledge among intervention schools (AOR: 2.18, 95% CI: 1.66–2.86) and no significant differences in self-esteem, body image or gender equitable norms. Qualitative evidence echoes perceived SRH knowledge acquisition, increased their perception of SRH related risks, and intentions to delay sexual intercourse to prevent unwanted pregnancy, HIV and other STIs.Item “Girls Have More Challenges; They Need to Be Locked Up”: A Qualitative Study of Gender Norms and the Sexuality of Young Adolescents in Uganda(International journal of environmental research and public health, 2018) Ninsiima, Anna B.; Leye, Els; Michielsen, Kristien; Kemigisha, Elizabeth; Nyakato, Viola N.; Coene, GilyUnequal power and gender norms expose adolescent girls to higher risks of HIV, early marriages, pregnancies and coerced sex. In Uganda, almost half of the girls below the age of 18 are already married or pregnant, which poses a danger to the lives of young girls. This study explores the social construction of gender norms from early childhood, and how it influences adolescents’ agency. Contrary to the mainstream theory of agency, which focuses on the ability to make informed choices, adolescents’ agency appears constrained by context-specific obstacles. This study adopted qualitative research approaches involving 132 participants. Of these, 44 were in-depth interviews and 11 were focus group discussions, parcelled out into separate groups of adolescents (12–14 years), teachers, and parents (n = 88), in Western Uganda. Data were analysed manually using open and axial codes, and conclusions were inductive. Results show that gender norms are established early in life, and have a very substantial impact on the agency of young adolescents. There were stereotypical gender norms depicting boys as sexually active and girls as restrained; girls’ movements were restricted; their sexual agency constrained; and prevention of pregnancy was perceived as a girl’s responsibility. Programs targeting behavioural change need to begin early in the lives of young children. They should target teachers and parents about the values of gender equality and strengthen the legal system to create an enabling environment to address the health and wellbeing of adolescents.Item Institutional and contextual obstacles to sexuality education policy implementation in Uganda(Sex education, 2020) Ninsiima, Anna B.; Coene, Gily; Michielsen, Kristien; Najjuka, Solome; Kemigisha, Elizabeth; Ruzaaza, Gad N.; Nyakato, Viola N.; Leye, ElsThe successful implementation of sexuality education policy for young people has been shown to depend on a sound legislative and institutional framework. This article shows that both institutional factors and contextual obstacles have impeded the implementation of sexuality education policy in Uganda. Qualitative research techniques were employed in the form of systematic document reviews and extensive field-work with 64 participants, of which 32 were in-depth interviews with policymakers and key stakeholders in Kampala and Mbarara districts. In addition, four focus group discussions (n = 32) were conducted with teachers. The analysis was carried out thematically and manually, using open and axial coding. It was found that policy success was primarily limited by two broad factors: firstly, by institutional weaknesses such as a lack of capacity, inadequate financial commitment, poor coordination between relevant ministries and ineffective monitoring, and regulatory frameworks; secondly, by social, cultural and religious norms that give informal power to religious and cultural leaders. Two strategies are suggested as potential ways forward: (i) a commitment to both the human and financial resources needed to monitor adolescent sexual, and reproductive health programmes, but more importantly (ii) the initiation of negotiations with cultural and religious leaders to yield more positive outcomes.Item Poverty, gender and reproductive justice. A qualitative study among adolescent girls in Western Uganda(Health & Sexuality, 2020) Ninsiima, Anna B.; Michielsen, Kristien; Kemigisha, Elizabeth; Nyakato, Viola N.; Leye, Els; Coene, GilyLow socio-economic status has been consistently identified as a primary risk factor for sexual and reproductive health violations affecting young women. This study shows how poverty interacts with gender power relations to impact upon adolescent girls’ sexual and reproductive lives in Western Uganda. Qualitative research with 147 participants was undertaken. This comprised 59 in-depth interviews and 11 focus group discussions with groups of 12–14 year-old young women, teachers and parents. Data were analysed manually using open and axial coding, and conclusions were generated inductively. Findings reveal that young women are restricted in exercising their sexual and reproductive rights not only by poverty and unequal gender relations, but also by corruption and poor service provision. In contrast to interventions using liberal rights-based approaches, we advocate the use of a ‘marketplace of options’ since access to sexual and reproductive health services is very limited for poor girls and not evenly distributed. Moreover, while poverty and unequal gender relations render girls vulnerable to sexual coercion and violence, the criminal justice system is often weak, leaving victims powerless. Investment in appropriate resources and inclusive and affordable access to justice is essential to advance young women’s sexual and reproductive health.Item Prevalence of depressive symptoms and associated factors among adolescents living with HIV/AIDS in South Western Uganda(AIDS care, 2019) Kemigisha, Elizabeth; Zanoni, Brian; Bruce, Katharine; Menjivar, Ricardo; Kadengye, Damazo; Atwine, Daniel; Rukundo, Godfrey Z.Adolescents living with HIV (ALHIV) are prone to depression, which can have detrimental effects including disease progression, poor treatment adherence and mortality. We aimed to determine the prevalence of depressive symptoms and their associated factors among ALHIV in Uganda. We conducted a cross-sectional survey among ALHIV (10–19 years) attending urban and rural clinics in Mbarara, Uganda between March and May 2017. Presence of depressive symptoms was assessed using the Centre for Epidemiological Studies’ Depression scale. We interviewed 336 adolescents with a median age of 13 years, 62% of whom were female. A third (37%) had disclosed their HIV/AIDS status and 13% were sexually active. Overall, 154 (∼46%, [95% CI: 40.5– 51.2]) had depressive symptoms. On bivariate analysis, the odds of having depressive symptoms were higher among adolescents who were ≥ 15 years, had disclosed HIV status, traveled >30 min for routine care and had risky sexual practices. On multiple variable analysis, only travel time to the clinic of >30 min was independently associated with depressive symptoms (AOR = 1.6 [95% CI: 1.02–2.7]). With the high prevalence of depressive symptoms among ALHIV in Uganda, screening and prompt treatment of depression should be incorporated within their routine care.Item A Qualitative Study Exploring Menstruation Experiences and Practices among Adolescent Girls Living in the Nakivale Refugee Settlement, Uganda(International Journal of Environmental Research and Public Health, 2020) Kemigisha, Elizabeth; Rai, Masna; Mlahagwa, Wendo; Nyakato, Viola N.; Ivanova, OlenaGirls in low- and lower-middle income countries face challenges in menstrual health management (MHM), which impact their health and schooling. This might be exacerbated by refugee conditions. This study aimed at describing menstruation practices and experiences of adolescent girls in Nakivale refugee settlement in Southwestern Uganda. (2) Methods: We conducted a qualitative study from March to May 2018 and we intentionally selected participants to broadly represent di erent age groups and countries of origin. We conducted 28 semistructured interviews and two focus group discussions. Data were transcribed and translated into English. Analysis included data familiarization, manual coding, generation and refining of themes. (3) Results: Main findings included: (a) challenging social context with negative experiences during migration, family separation and scarcity of resources for livelihood within the settlement; (b) unfavorable menstruation experiences, including unpreparedness for menarche and lack of knowledge, limitations in activity and leisure, pain, school absenteeism and psychosocial e ects; (c) menstrual practices, including use of unsuitable alternatives for MHM and poor health-seeking behavior. (4) Conclusions: Amultipronged approach toMHMmanagement is crucial, including comprehensive sexual education, enhancement of parent–adolescent communication, health sector partnership and support from NGOs to meet the tailored needs of adolescent girlsItem Sexual health of very young adolescents in South Western Uganda: a cross-sectional assessment of sexual knowledge and behavior(Reproductive health, 2018) Kemigisha, Elizabeth; Bruce, Katharine; Nyakato, Viola N.; Ruzaaza, Gad N.; Ninsiima, Anna B.; Mlahagwa, Wendo; Leye, Els; Coene, Gily; Michielsen, KristienBackground: In most Sub-Saharan African countries, little is known about young adolescents’ sexual and reproductive health (SRH). Though some efforts have been made to understand and improve SRH of older adolescents, very young adolescents (VYAs) are often overlooked, and little is known about their sexual knowledge and behaviors. The goal of this study was to describe SRH knowledge, information-seeking, and sexual behavior of VYAs in Uganda. Methods: A cross-sectional survey was administered in 33 primary schools in June and July of 2016. Trained interviewers administered surveys to adolescents ages 10–14 regarding SRH knowledge, information-seeking, sexual behavior, and relevant covariates. Continuous variables were summarized as means (SD) or medians (IQR) whereas categorical variables were summarized as proportions (percentages). Results: A total of 1096 adolescents were included in this analysis, 81.8% of which were from rural areas, with a median age of 12. Regarding sexually transmitted infections (STIs) knowledge; 95% knew HIV while 37% knew other STIs apart from HIV. Although 47% knew at least one way in which HIV is acquired only 8% knew at least four ways. Regarding contraceptive knowledge, 56% mentioned at least one modern method of preventing pregnancy (condoms, pills, intrauterine devices, implants, or injections). The majority (85%) of VYAs reported accessing SRH information in the media with 35% reporting accessing media with sexual content while 10% vs 22% consulted their father or mother respectively and 31% a school source. At least 7.6% of VYAs had ever had sexual intercourse, 90% of which were not using any protection. Conclusion: Comprehensive SRH knowledge was low among VYAs in this study. Media remains an important source of information for SRH for this age group though it may be misused as some adolescents reported accessing sexual content that may be inappropriate. A large proportion of sexually active VYAs reported sexual risky behaviors. This study highlights the need for an accurate and more comprehensive SRH education approach for VYAs in Uganda at an opportune age before the majority engage in sexual behavior.Item A Systematic Review of Sexual and Reproductive Health Knowledge, Experiences and Access to Services among Refugee, Migrant and Displaced Girls and Young Women in Africa(International journal of environmental research and public health, 2018) Ivanova, Olena; Rai, Masna; Kemigisha, ElizabethAdolescent girls and young women are an overlooked group within conflict- or disaster-affected populations, and their sexual and reproductive health (SRH) needs are often neglected. Existing evidence shows that forced migration and human mobility make girls and women more vulnerable to poor SRH outcomes such as high risk sexual behaviors, lack of contraception use, STIs and HIV/AIDS. We performed a systematic literature review to explore knowledge, experiences and access to SRH services in this population group across the African continent. Two databases (PubMed and Web of Science) were searched and from 896 identified publications, 15 peer-reviewed articles published in English met the inclusion criteria for this review. These consisted of eight applied qualitative, five quantitative and two mixed-method study designs. The quality of the studies was evaluated by the mixed-methods appraisal tool (MMAT) using scores in percentages (0–100%). Available evidence indicates that knowledge of young women and girls regarding contraceptive methods, STIs and HIV/AIDS are limited. This population group often experiences gender-based and sexual violence and abuse. The access and availability of SRH services are often limited due to distances, costs and stigma. This review demonstrates that there is still a dearth of peer-reviewed literature on SRH related aspects among refugee, migrant and displaced girls and young women in Africa. The data disaggregation by sex and age should be emphasized for future research in this fieldItem A systematic review of the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in sub-Saharan Africa between 1986 and 2018: protocol for a systematic review of observational studies(Systematic reviews, 2018) Rukundo, Godfrey Z.; Kemigisha, Elizabeth; Ocan, Moses; Adriko, Wilson; Akena, Dickens H.Suicide is one of the leading causes of death among children and adolescents. Most studies about the burden and risk factors for suicide have been conducted in high-income countries. However, there is a dearth in the literature about the burden and risk factors for suicide among children and adolescents in low- and middle-income countries including within Sub-Saharan Africa (SSA). There is need to summarise the available literature about the burden and risk factors for suicide among children and adolescents in SSA. In this review, we will (a) determine the overall prevalence of suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA; (b) describe the methods (such as hanging, firearms, overdose, poisoning, drowning and burning) used for suicidal attempt, and completed suicide among children and adolescents in SSA; and (c) document the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA. Methods: The review will be conducted and reported in accordance to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. We will include journal articles that have documented the prevalence and risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents aged 5–19 years in SSA. We will also include accessible grey literature about the topic. Qualitative studies will be excluded from the study since they are limited in estimating prevalence. We will search different search engines including PUBMED, EMBASE, Psych-INFO, Cochrane Library, Africa wide-information and global health using suicide, adolescents and children, SSA as the keywords. We will use a meta-analysis, should we find that there is no heterogeneity between included studies. Discussion: This protocol describes a systematic review of observational studies reporting completed suicide, suicidal ideation and suicidal attempt among children and adolescents in sub-Saharan Africa. We anticipate that once this review is complete and published, our findings will be of interest to adolescents with suicidal behaviour, their families and caregivers, clinicians and other healthcare professionals, scientists and policy makers.Item Will district health centres use preloaded cell phones for pre-referral phone calls for women in labour: a randomized pilot study at Mbarara Regional Referral Hospital in southwest Uganda(Canadian Journal of Public Health, 2019) Kanyesigye, Hamson; Muhwezi, Obed; Kazungu, Christine; Kemigisha, Elizabeth; Woolcott, ChristyUganda is one of the developing countries with high maternal and infant mortality rates; maternal, 336 per 100,000 live births and infant, 43 per 1000 births respectively in 2016 (UDHS 2016). Adverse maternal-fetal outcomes in developing countries are primarily related to three delays: time to decision to seek health care, access to health services, and timely intervention at the health facility (Pacagnella et al. 2014; Thaddeus and Maine 1994). Given the high mortality rates in Uganda, there is a big need for improvement. Cell phone technology has been used in other African settings to potentially improve maternity care and referral systems (Oyeyemi and Wynn 2015; Lund et al. 2014; Murray and Pearson 2006). However, these interventions have centred on providing pregnant women with cell phones, an expensive intervention. Resources for such a large scale intervention are not readily available in our setting in southwest Uganda. We therefore piloted a more modest intervention, providing a mobile phone and recharged credit to the local health centre for the purpose of a pre-referral phone call to a dedicated number at the major regional referral hospital.