Browsing by Author "Lugada, Eric"

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    COVID-19 Risk Behaviors in Humanitarian Settings: A Crosssectional Study among Conflict Refugees in Uganda
    (International Journal of Community Medicine and Public Health, 2021) Lawoko, Stephen; Seruwagi, Gloria; Muhangi, Denis; Ochen, Eric A.; Okot, Betty; Lugada, Eric; Masaba, Andrew; Ddamulira, Dunstan P.; Luswata, Brian; Nakidde, Catherine L.; Kaducu, Felix
    Worldwide, behavioral change interventions are at the core of prevention efforts to contain the novelCorona Virus (COVID-19). While the evidence base to inform such interventions in the general population is growing, equivocal research in humanitarian populations is lacking. The current study describes the nature, extent and predictors of COVID-19 risk behaviors among conflict refugees in Uganda in a bid to inform prevention strategies for humanitarian settings. Cross-sectional survey data on COVID-19 risk-behaviors, demographic, socio-economic, behavioral and clinical variables was gathered from 1014 adult refugees drawn from 3 refugee settlements in Uganda, using two-staged cluster sampling. Data was analyzed using t-test, Analysis of Variance (ANOVA) and Multivariable Linear Regression.Many refugees (25-70%) were involved in hygiene, congestion and nutritional/physical activity related risk behaviors likely to contribute to community transmission of COVID-19. Refugees living in rural settlements, of male sex, young age and low socio-economic status were at heightened risk of exposure to COVID-19 risk behaviors.Physical activity and healthy nutritional practices reduced the likelihood of COVID-19 risk behavior. Indulgence in COVID-19 risk behaviors increased the risk of developing COVID-19 symptoms.COVID-19 risk behaviors among conflict refugees in Uganda are multifaceted in nature, widespread in extent and associated with symptom development, signaling for high risk for COVID-19 transmission in humanitarian settings. The data on predictors of COVID-19 risk behaviors have unmasked underlying inequalities, holding promise for development of evidence-based interventions to meet the needs of most vulnerable clusters in the refugee community.
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    Differences in Adverse Events Related to Voluntary Male Medical Circumcision Between Civilian and Military Health Facilities in Uganda
    (Research Square, 2021) Ogweng Obangaber, Lucky; Seruwagi, Gloria; Nabaggala, Maria Sarah; Lugada, Eric; Bwayo, Denis; Nyanzi, Abdul; Rwegyema, Twaha; Wamundu, Cassette; Lawoko, Stephen; Kasujja, Vincent; Asiimwe, Evarlyne; Musinguzi, Ambrose; Kikaire, Bernard; Kiragga, Agnes
    Voluntary medical male circumcision (VMMC) significantly reduces the risk of acquiring HIV in men. Despite the percentage of circumcised men (15-49 years) in Uganda increasing over time, some populations are not taking up the surgical procedure. The government of Uganda and implementing partners have responded to this lack of VMMC coverage among key populations by intensifying introducing innovative strategies that increase demand particularly among military personnel using the WHO’s MOVE strategy. As a surgical intervention, it is critical that VMMC services are safe for clients and that adverse events or complications are minimized. This paper describes the prevalence and trends of adverse events reported among military mobile camps in comparison to civilian sites in Uganda. Methods: A prospective study conducted in eighteen (18) public health facilities between March and August 2019. Of these nine (9) were providing care to civilian populations while nine (9) served the military population and catchment areas. Descriptive statistics, Chi-square test and trends analysis were carried out to describe profile of advance events among civilian and military facilities over the study period. Results: The highest proportions of VMMC were done among persons aged 15 to 19 years whereas among military camps the highest proportions of circumcision among males aged 20 to 24 years. Regarding site of circumcision, the highest proportions of VMMC were done at outreaches, with higher levels in military camps compared to civilian camps. For the proportions of adverse events reported, higher proportions were reported in civilian camps compared to military camps (Total – 1.3% vs 0.2%; p- value<0.05). For trends analysis, results indicate that there was no statistically significant trend for both civilian and military number of adverse events reported for the four quarters in 2020 (P-value =0.315 for civilian and P=0.094 for the military). Conclusions: The MOVE model is great for scaling up VMMC 48 in specialized populations such as military. Can also be adapted in other populations if contextual bottlenecks are identified and collectively addressed by key stakeholders – leadership, community engagement and using a largely horizontal approach offer promising possibilities and outcomes.
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    Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting district
    (Conflict and Health, 2021) Seruwagi, Gloria; Nakidde, Catherine; Otieno, Felix; Kayiwa, Joshua; Luswata, Brian; Lugada, Eric; Ochen, Eric Awich; Muhangi, Denis; Okot, Betty; Ddamulira, Dunstan; Masaba, Andrew; Lawoko, Stephen
    The negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for COVID-19 management and implementation experiences in Uganda’s refugee-hosting districts.A cross sectional, mixed-method descriptive study in 17 health facilities in 7 districts from 4 major regions. Total sample size was 485 including > 370 health care workers (HCWs). HCW knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. The quantitative data was processed and analysed using SPSS 26, and statistical significance assumed at p < 0.05 for all statistical tests. Bloom's cutoff of 80% was used to determine threshold for sufficient knowledge level and practices with scores classified as high (80.0–100.0%), average (60.0–79.0%) and low (≤ 59.0%). HCW implementation experiences and key stakeholder opinions were further explored qualitatively using interviews which were audio-recorded, coded and thematically analysed.On average 71% of HCWs were knowledgeable on the various aspects of COVID-19, although there is a wide variation in knowledge. Awareness of symptoms ranked highest among 95% (p value < 0.0001) of HCWs while awareness of the criteria for intubation for COVID-19 patients ranked lowest with only 35% (p value < 0.0001). Variations were noted on falsehoods about COVID-19 causes, prevention and treatment across Central (p value < 0.0356) and West Nile (p value < 0.0161) regions. Protective practices include adequate ventilation, virtual meetings and HCW training. Deficient practices were around psychosocial and lifestyle support, remote working and contingency plans for HCW safety. The work environment has immensely changed with increased demands on the amount of work, skills and variation in nature of work. HCWs reported moderate control over their work environment but with a high level of support from supervisors (88%) and colleagues (93%).HCWs preparedness is inadequate in some aspects. Implementation of healthcare interventions is constrained by the complexity of Uganda’s health system design, top-down approach of the national response to COVID-19 and longstanding health system bottlenecks. We recommend continuous information sharing on COVID-19, a design review with capacity strengthening at all health facility levels and investing in community-facing strategies.
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    Healthworker preparedness for COVID‑19 management and implementation experiences: a mixed methods study in Uganda’s refugee‑hosting districts
    (Conflict and Health, 2021) Seruwagi, Gloria; Nakidde, Catherine; Otieno, Felix; Kayiwa, Joshua; Luswata, Brian; Lugada, Eric; Awich Ochen, Eric; Muhangi, Denis; Okot, Betty; Ddamulira, Dunstan; Masaba, Andrew; Lawoko, Stephen
    The negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for COVID-19 management and implementation experiences in Uganda’s refugee-hosting districts. Methods: A cross sectional, mixed-method descriptive study in 17 health facilities in 7 districts from 4 major regions. Total sample size was 485 including > 370 health care workers (HCWs). HCW knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. The quantitative data was processed and analysed using SPSS 26, and statistical significance assumed at p < 0.05 for all statistical tests. Bloom’s cutoff of 80% was used to determine threshold for sufficient knowledge level and practices with scores classified as high (80.0–100.0%), average (60.0– 79.0%) and low (≤ 59.0%). HCW implementation experiences and key stakeholder opinions were further explored qualitatively using interviews which were audio-recorded, coded and thematically analysed. Results: On average 71% of HCWs were knowledgeable on the various aspects of COVID-19, although there is a wide variation in knowledge. Awareness of symptoms ranked highest among 95% (p value < 0.0001) of HCWs while awareness of the criteria for intubation for COVID-19 patients ranked lowest with only 35% (p value < 0.0001). Variations were noted on falsehoods about COVID-19 causes, prevention and treatment across Central (p value < 0.0356) and West Nile (p value < 0.0161) regions. Protective practices include adequate ventilation, virtual meetings and HCW training. Deficient practices were around psychosocial and lifestyle support, remote working and contingency plans for HCW safety. The work environment has immensely changed with increased demands on the amount of work, skills and variation in nature of work. HCWs reported moderate control over their work environment but with a high level of support from supervisors (88%) and colleagues (93%). Conclusions: HCWs preparedness is inadequate in some aspects. Implementation of healthcare interventions is constrained by the complexity of Uganda’s health system design, top-down approach of the national response to COVID-19 and longstanding health system bottlenecks. We recommend continuous information sharing on COVID-19, a design review with capacity strengthening at all health facility levels and investing in community-facing strategies.
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    HIV viral load suppression following intensive adherence counseling among people living with HIV on treatment at military-managed health facilities in Uganda
    (International Journal of Infectious Diseases, 2021) Kikaire, Bernard; Ssemanda, Michael; Asiimwe, Alex; Nakanwagi, Miriam; Rwegyema, Twaha; Seruwagi, Gloria; Lawoko, Stephen; Asiimwe, Evarlyne; Wamundu, Cassette; Musinguzi, Ambrose; Lugada, Eric; Turesson, Elizabeth; Laverentz, Marni; Bwayo, Denis
    Uniformed service personnel have an increased risk of poor viral load suppression (VLS). This study was performed to evaluate the outcomes of interventions to improve VLS in the 28 military health facilities in Uganda. Methods: This operational research was conducted between October 2018 and September 2019, among people living with HIV (PLHIV) in the 28 health facilities managed by the military in Uganda. Patients with a viral load (VL) > 10 0 0 copies/ml received three sessions of intensive adherence counselling (IAC), 1 month apart, after which a repeat VL was done. The main outcome was the proportion with a sup- pressed VL following IAC. Results: Of the 965 participants included in this analysis, 592 (61.4%) were male and 367 (38.3%) were female. Average age was 35.5 ±13.7 years, and 87.8% had at least one IAC session. At least 48.2% had a suppressed repeat VL. IAC increased the odds of VLS by 82% ( P = 0.004), with adjusted OR of 1.56 ( P = 0.054). An initial VL > 10 0 0 0 copies/ml, being on antiretroviral therapy for at least 2 years, being male, and being < 18 years of age were associated with repeat VL non-suppression. Conclusions: IAC marginally improved VL suppression. There is a need to improve IAC in military health facilities.
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    Psychological Distress and Social Support among Conflict Refugees in Urban, Semi-rural and Rural Settlements in Uganda: Burden and Mechanisms of Association
    (Burden and Mechanisms of Association., 2021) Lawoko, Stephen; Nakidde, Catherine; Lugada, Eric; Ssematiko, Maria; Ddamulira, Dunstan P.; Masaba, Andrew; Luswata, Brian; Ochen, Eric A.; Okot, Betty; Muhangi, Denis; Gloria, Seruwagi
    Recent research shows that psychological distress is on the rise globally as a result of the COVID-19 pandemic and restrictions imposed on populations to manage it. We estimated the burden of psychological distress and scrutinized the role that social support may play in moderating psychological distress among conflict refugees in urban, semi-rural and rural settlements in Uganda during the COVID-19 pandemic.Cross-sectional survey data on psychological distress, social support, demographics, socioeconomic and behavioral variables was gathered from 1014 adult refugees randomly sampled from urban, semi-rural and rural refugee settlementsin Uganda, using two-staged cluster sampling. Research instruments were checked for reliability using Cronbach’s Alpha. T-test, Analysis of Variance (ANOVA) and Multivariable Linear Regression were applied to analyse the data in SPSS-version 22. Statistical significance was assumed at p<0.05. Refugees resident in rural/semi-rural settlements exhibited higher levels of psychological distress, lower levels of social interaction and lower levels of social attachment than peers resident in urban settlements. However, they reported, on the other hand, higher adequacy of social interaction and higher adequacy of social attachment than peers resident in urban settlements. Adequacy of social interaction and attachment were directly associated with psychological distress and acted as stress buffers in the relationship between psychological distress and rural/urban settlement. There is a settlement-inequality (i.e. rural vs. urban) in psychological distress and social support among conflict refugees in Uganda. Both the direct and buffering effects of adequacy of social interaction and attachment can explain the rural/urban discrepancy in psychological distress, with important implications for Mental Health and Psychosocial Support (MHPSS) interventions.