Browsing by Author "Kyegombe, Nambusi"

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    Adapting a complex violence prevention intervention: a case study of the Good School Toolkit in Uganda
    (BioMed Central Ltd, 2024-02) Grundlingh, Heidi; Kyegombe, Nambusi; Namy, Sophie; Nakuti, Janet; Laruni, Yvonne; Nanyunja, Barbrah; Muluusi, Hassan; Nakiboneka, Mastula; Mukuwa, Aggrey; Tanton, Clare; Knight, Louise; Naker, Dipak; Devries, Karen
    Abstract BACKGROUNDAdaptation is a key strategy to extend the reach of evidence-based interventions to prevent violence in new populations, but there is a dearth of practical case examples. The Good School Toolkit was developed by Ugandan NGO Raising Voices for use in primary schools (GST-P). We describe our systematic approach to adapting the GST-P for use in secondary schools in Uganda, and reflect on the utility of the process as well as limitations of existing adaptation frameworks.METHODSWe adapted the GST-P in four phases, which included: I) clarifying the logic model and core intervention components using a streamlined process; II) conducting formative research (cross-sectional survey, focus groups, etc.) to understand the new population; III) selecting and preparing new intervention components and modifying existing intervention components; and IV) pretesting new intervention components with teachers and students in Uganda.RESULTSWe identified core components using a logic model. Formative research showed results largely in line with our apriori hypotheses. Teacher violence remained highly prevalent in secondary versus primary schools (> 65% of secondary students reported past year exposure), while peer violence significantly increased (secondary = 52% vs. primary girls = 40%, P < 0.001; secondary = 54% vs. primary boys = 44%, P = 0.009) in secondary versus primary schools. Significantly more secondary girls (51%) than secondary boys (45%) reported past year dating/intimate partner violence (P = 0.03). Inequitable, gendered educational practices emerged as a salient theme, perceived to heighten female students' vulnerability to violence. In light of these findings, we made several adjustments to the adapted intervention. We strengthened existing teacher and peer violence intervention components. We also developed, pretested and revised new program components to prevent dating violence and promote 'gender fairness in schools'. Finally, original activities were modified to support engagement with school administration and promote increased student agency in secondary schools.CONCLUSIONSBased on our experience, it was difficult to apply mechanistic models to clarify the intervention logic of the GST-P, a complex multicomponent intervention, and simpler methods may be sufficient. Our team had high levels of contextual knowledge before the adaptation, and formative research to understand the new target population provided only limited additional insight. In similar situations, a simplified approach to mapping the core intervention components, qualitative research to understand the new target population, and pre-testing of new intervention components may be the most informative elements of systematic adaptation processes. MEDLINE - Academic
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    Adolescent girls’ perceived readiness for sex in Central Uganda - liminal transitions and implications for sexual and reproductive health interventions
    (Taylor & Francis, 2022-03) Kyegombe, Nambusi; Buller, Ana Maria; Meiksin, Rebecca; Wamoyi, Joyce; Muhumuza, Richard; Heise, Lori
    Young women in Uganda are at risk of negative sexual and reproductive health outcomes, in part because of sex with older men. Theoretically grounded in the concept of liminality, this paper examines perceived markers of adolescent girls’ suitability for sexual activity. In 2014, we conducted 19 focus group discussions and 44 in-depth interviews in two communities in Uganda. Interviews were conducted using a semi-structured tool, audiorecorded and transcribed verbatim. Interviews examined markers of transition between childhood, adolescence and adulthood and how these were seen as relating to girls’ perceived readiness for sex. Analysis was thematic. Pre-liminal status was most often accorded to childhood. Sex with a child was strongly condemned. Physical changes during puberty and children’s increasing responsibility, autonomy and awakening sexuality reflected a liminal stage during which girls and young women were not necessarily seen as children and were increasingly described as suitable for sex. Being over 18, leaving home, and occupying ‘adult’ spaces reflected post-liminal status and perceived appropriateness for sexual activity including for girls under the age of 18. Interventions that seek to prevent early sexual debut and sexual activity with older men have the potential to reduce sexual and reproductive health risks.
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    Effects and costs of a multi-component menstrualhealth intervention (MENISCUS) on mental health problems, educational performance, and menstrual health in Ugandan secondary schools: an open-label, school-based, cluster-randomised controlled trial
    (The Lancet Global Health, 2025) Kate, Andrews Nelson; Stephen, Lagony; Kansiime, Catherine; Torondel, Belen; Clare, Tanton; Ndekezi, Denis; Mugenyi, Levicatus; Batuusa, Ratifah; Baleke, Christopher; Katherine, A. Thomas; Ssesanga, Titus; Bakanoma, Robert; Namirembe, Prossy; Tumuhimbise, Aggrey; Nanyonga, Beatrice; Nambi, Rodah; Obicho, Edward; Ssenyondwa, Denis; Bucci, Daria; Sophie, Belfield; Ocen, Agnes Akech; Nakalema, Shamirah; Alezuyo, Connie; Matovu, Fred; Neema, Stella; Kyegombe, Nambusi; Giulia, Greco; John, Jerrim; Chris, Bonell; Janet, A. Seeley; Helen A. Weiss
    Background Menstrual health is a human rights issue, affecting mental health, wellbeing, and education. We assessed the effectiveness and costs of a school-based multi-component menstrual health intervention (“MENISCUS”) to improve mental health problems and educational performance. Methods We conducted a cluster-randomised trial in 60 Ugandan secondary schools, randomised 1:1 to the intervention or control condition (printed government menstrual health materials). The intervention included creating action groups, strengthening teacher-delivered puberty education, distributing menstrual kits, supporting student-led drama skits, providing pain-management strategies, and improving school water and sanitation facilities. Primary outcomes were mental health problems using the Strength and Difficulties Questionnaire (SDQ) Total Difficulties Score and independently-assessed educational performance. Secondary outcomes included menstrual knowledge, attitudes, practices, and self-efficacy, school attendance, confidence, symptomatic urinary tract infections, and quality of life in females, plus knowledge and attitudes in males. We estimated intention-to-treat intervention effects using mixed-effects models accounting for school clustering and adjusted for randomisation strata and baseline school-level means of outcomes. Registration: ISRCTN45461276. Findings Between 21 March and 5 July 2022, 3841 female students participated in baseline assessments (89.7% of those eligible) and between 5 June and 22 August 2023, 3356 participated in endline assessments. At endline, there was no evidence of a difference in mental health problems (mean SDQ score: 10.8 vs 10.7 in intervention vs control arms; adjusted mean difference [aMD] 0.05, 95% CI -0.40 to 0.50) or educational performance (mean z-score: 0.20 vs 0.12; aMD 0.05, 95% CI -0.11 to 0.20). There was strong evidence for effects on menstrual health-related outcomes. Interpretation Improving multiple dimensions of menstrual health in secondary schools in Uganda is feasible and important for health and human rights but is not sufficient to improve mental health or educational performance over one year.