Browsing by Author "Kiwanuka, Suzanne"

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Factors Associated with Uptake of Contraceptives among HIV Positive Women on Dolutegravir based Anti-Retroviral Treatment at Health Centres of Kampala Capital City Authority. A cross sectional study in Uganda.
    (BMC Women's Health, 2022) Mbabazi, Leah; Nabaggala, Mariah Sarah; Kiwanuka, Suzanne; Kiguli, Juliet; Okoboi, Stephen; Laker, Eva; Castelnuovo, Barbara; Lamorde, Mohammed; Kiconco, Arthur; Amperiize, Mathius
    In May 2018, the World Health Organisation issued a teratogenicity alert for HIV positive women using dolutegravir (DTG) and emphasised increased integration of sexual and reproductive services into HIV care to meet contraceptive needs of HIV positive women. However, there are scarce data on the impact of this guidance on contraceptive uptake. Objective To investigate the uptake of contraceptives and the factors affecting the uptake of contraceptive services among the HIV positive women of reproductive age who use DTG. Methods A cross-sectional survey was conducted from April 2019 to July 2019, in five government clinics in central Uganda where DTG was offered as the preferred first-line antiretroviral treatment (ART) regimen. We randomly selected 359 non-pregnant women aged 15-49 years using DTG-based regimens. We used interviewer administered questionnaires to collect data on demographics, contraceptive use, social and health system factors. We defined contraceptive uptake as the proportion of women using any method of contraception divided by the total number of women on DTG during the review period. We described patients’ characteristics using descriptive statistics. Factors associated with contraceptive uptake were investigated using Poisson regression at multivariable analysis (STATA 14). Results Of the 359 participants, the mean age was 37(SD=6.8), half 50.7% had attained primary level of education and average monthly income <100,000Ushs. The overall level of Contraceptive uptake was 38.4%, modern contraceptive uptake was 37.6% and 96.4% of the participants had knowledge of contraceptives. The most utilised method was the injectable at 58.4% followed by condoms 15%, IUD 10.7%, pills 6.4%, implants 5.4%, and least used was sterilization at 0.7%. Predictor factors that increased likelihood of contraceptive uptake were; religion of others category AIRR=1.53(95% CI: 1.01, 2.29) and parity 3-4 children AIRR=1.48(95% CI: 1.14, 1.92). Reduced rates were observed for age 40-49 years AIRR=0.45(95% CI: 0.21, 0.94), unemployment AIRR 0.63(95% CI: 0.42, 0.94), not discussing FP with partner AIRR=0.39(95% CI: 0.29, 0.52) and not receiving FP counselling AIRR=2.86 (95% CI: 0.12, 0.73). Non-significant variables were facility, education level, marital status, sexual activity, experienced side effects of FP and knowledge on both contraceptives and DTG. Conclusion This study shows a low-level uptake of contraceptives and injectable was the most used method. It also indicated that FP counselling and partner discussion on FP increased contraceptive uptake. Therefore, more strategies should be put in place to increase male involvement in family planning programs and scale up the integration of family planning services into HIV care and management programs.
  • Thumbnail Image
    Item
    The future of knowledge brokering: perspectives from a generational framework of knowledge management for international development
    (Information Development, 2019) Cummings, Sarah; Kiwanuka, Suzanne; Gillman, Helen; Regeer, Barbara
    Knowledge brokering has a crucial role in the field of international development because it is able to act as a cognitive bridge between many different types of knowledge, such as between local and global knowledge. Much of the research on knowledge brokering has focused on knowledge brokering between research, policy and practice, rather than looking at its wider implications. In addition, there appears to be no literature on the future of knowledge brokering, either within or outside the development sector. Given the apparent absence of literature on the future of knowledge brokering, a discussion group was held with experts in the field of knowledge management for development (KM4D) in April 2017 to consider their opinions on the future of knowledge brokering. Their opinions are then compared to the generational framework of KM4D, developed in a series of iterations by researchers in mainstream (non-development) knowledge management (KM) and KM4D researchers. In this framework, five generations of KM4D with different key perspectives, methods and tools have been identified. Based on the inputs from the experts in the discussion group, the future of knowledge brokering practice in international development appears to resemble practice-based, fourth generation KM4D, while there is some evidence of the emergence of fifth generation KM4D with its more systematic, societal perspective on knowledge. Given that the Sustainable Development Goals are providing a universal framework which is relevant to both organizational and societal KM4D, a new systemic conceptualization of KM4D is proposed which brings both of these strands together in one integrated framework linked to the SDGs. The SDGs also support the call for a new knowledge brokering practice with a greater emphasis on brokering knowledge between organizational and societal actors.
  • Thumbnail Image
    Item
    ‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda
    (BMJ Global Health, 2017) Tweheyo, Raymond; Daker-White, Gavin; Reed, Catherine; Davies, Linda; Kiwanuka, Suzanne; Campbell, Stephen
    Published evidence on the drivers of absenteeism among the health workforce is mainly limited to high-income countries. Uganda suffers the highest rate of health workforce absenteeism in Africa, attracting attention but lacking a definitive ameliorative strategy. This study aimed to explore the underlying reasons for absenteeism in the public and private ‘not-for-profit’ health sector in rural Uganda. Methods We undertook an empirical qualitative study, located within the critical realist paradigm. We used case study methodology as a sampling strategy, and principles of grounded theory for data collection and analysis. Ninetyfive healthcare workers were recruited through focus groups and in-depth interviews. The NVivo V.10 software package was used for data management. Results Healthcare workers’ absenteeism was explained by complex interrelated influences that could be seen to be both external to, and within, an individual’s motivation. External influences dominated in the public sector, especially health system factors, such as delayed or omitted salaries, weak workforce leadership and low financial allocation for workers’ accommodation. On the other hand, low staffing—particularly in the private sector—created work overload and stress. Also, socially constructed influences existed, such as the gendered nature of child and elderly care responsibilities, social class expectations and reported feigned sickness. Individually motivated absenteeism arose from perceptions of an inadequate salary, entitlement to absence, financial pressures heightening a desire to seek supplemental income, and educational opportunities, often without study leave. Conclusion Health workforce managers and policy makers need to improve governance efficiencies and to seek learning opportunities across different health providers.
  • Thumbnail Image
    Item
    Priority setting and equity in COVID-19 pandemic plans: a comparative analysis of 18 African countries
    (Health Policy and Planning, 2021) Kapiriri, Lydia; Kiwanuka, Suzanne; Biemba, Godfrey; Velez, Claudia; Razavi, Donya; Abelson, Julia; Essue, Beverley M.; Danis, Marion; Goold, Susan; Noorulhuda, Mariam; Nouvet, Elysee; Sandman, Lars; Williams, Iestyn
    Priority setting represents an even bigger challenge during public health emergencies than routine times. This is because such emergencies compete with routine programmes for the available health resources, strain health systems and shift health-care attention and resources towards containing the spread of the epidemic and treating those that fall seriously ill. This paper is part of a larger global study, the aim of which is to evaluate the degree to which national COVID-19 preparedness and response plans incorporated priority setting concepts. It provides important insights into what and how priority decisions were made in the context of a pandemic. Specifically, with a focus on a sample of 18 African countries’ pandemic plans, the paper aims to: (1) explore the degree to which the documented priority setting processes adhere to established quality indicators of effective priority setting and (2) examine if there is a relationship between the number of quality indicators present in the pandemic plans and the country’s economic context, health system and prior experiences with disease outbreaks. All the reviewed plans contained some aspects of expected priority setting processes but none of the national plans addressed all quality parameters. Most of the parameters were mentioned by less than 10 of the 18 country plans reviewed, and several plans identified one or two aspects of fair priority setting processes. Very few plans identified equity as a criterion for priority setting. Since the parameters are relevant to the quality of priority setting that is implemented during public health emergencies and most of the countries have pre-existing pandemic plans; it would be advisable that, for the future (if not already happening), countries consider priority setting as a critical part of their routine health emergency and disease outbreak plans. Such an approach would ensure that priority setting is integral to pandemic planning, response and recovery.
  • Thumbnail Image
    Item
    The private sector in knowledge brokering for international development: what the experts say
    (Information Development, 2020) Cummings, Sarah; Kiwanuka, Suzanne; Regeer, Barbara
    This article contributes to the emerging body of knowledge on the role of the private sector in knowledge brokering in international development because very little is known about the role of the private sector. It attempts to validate the findings of the only literature review to date (Kiwanuka et al, In Press) on the subject and other literature on knowledge brokering by consulting international experts in the field of knowledge brokering, identifying policy and research implications. The conceptual lens employed is the ‘extended’ Glegg and Hoens’ (2016) meta-framework of knowledge brokering, in combination with the cognitive, relational and structural aspects of social capital (Nahapiet and Ghoshal 1998). An online questionnaire survey was distributed to international experts in both the private, public and civil society sectors with some 203 respondents. The questions were developed on the basis of the literature. Respondents from the private sector and their colleagues from the public sector and civil society placed considerable emphasis on opportunities to meet, the existence of personal relationships and brokering by third parties as catalysts to working with the private sector. In addition to developing recommendations for policymakers, the paper has added to the emerging body of academic knowledge on the private sector as an unusual suspect in knowledge brokering and provides a conceptual framework linking social capital to knowledge brokering roles. Policymakers and funders can facilitate cooperation between the private sector and other development actors by creating physical spaces and funding instruments to encourage collaboration with the private sector. One of the novel findings is that the public sector needs to be better prepared to collaborate with the private sector.
  • Thumbnail Image
    Item
    Road safety compliance among motorcyclists in Kawempe Division, Kampala, Uganda: a crosssectional study
    (International Journal of Injury Control and Safety Promotion, 2019) Ndagire, Margaret; Kiwanuka, Suzanne; Paichadze, Nino; Kobusingye, Olive
    Motorcyclists are vulnerable road users in Uganda and 21.7% (3912/18,016) experienced crashes in 2012. This study determined the prevalence of and factors associated with compliance to selected road safety measures (helmet use, retro-reflective jackets use, riding permit and carrying one passenger) among commercial motorcyclists in Kawempe, from April to June 2014 using interviewer administered questionnaires. Total compliance was 0.9% and 24.4% to at least 3/4 measures. Compliance by measure was; 7.6% retroreflective jackets, 28.8% riding permits, 69.4% helmet use and 86.1% carrying one passenger. The associated factors were; knowing that (training before one starts to ride prevents crashes, Adjusted-odds-ratio (AOR) ¼ 2.38 (1.36–4.19), maintaining the motorcycle in good condition prevents crashes, AOR ¼ 0.34 (0.15–0.77) and padding reduces impact of road traffic injury, AOR ¼ 0.37 (0.15–0.89)). Prevalence to compliance is very low. Road safety messages should highlight the importance of all road safety measures to improve compliance.
  • Thumbnail Image
    Item
    Which contextual factors facilitate successful implementation of Community Score Cards in Uganda?
    (Future Health Systems, 2018) Ekirapa- Kiracho, Elizabeth; Apolot, Rebecca Racheal; Kiwanuka, Suzanne
    Community Score Cards (CSCs) are a participatory monitoring and evaluation tool often used to improve responsiveness, quality and accessibility of health services, as well as accountability by the different stakeholders who are responsible for improving the performance of these services. This issue brief describes the factors that facilitate the CSC implementation process, based on the lessons learnt from a CSC project on maternal and newborn health service delivery and utilization in six sub-counties of Kibuku district in Uganda. District and sub-county stakeholders led the implementation of the CSC, with support from Makerere University School of Public Health (MakSPH). Four rounds of scoring were undertaken between November 2017 and September 2018.