Browsing by Author "Makumbi, Fredrick E."

Now showing 1 - 6 of 6
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    Enhancers and barriers to uptake of male circumcision services in Northern Uganda: a qualitative study
    (AIDS care, 2020) Nanteza, Barbara M.; Makumbi, Fredrick E.; Gray, Ronald H.; Serwadda, David; Kennedy, Caitlin E.
    Uganda adopted voluntary medical male circumcision (VMMC) in 2010, but uptake remains disproportionately low in the Northern region despite implementing several demand creation strategies. This study explored the socio-cultural and structural enhancers and barriers to uptake of VMMC services in Gulu, a district in Northern Uganda where uptake is lowest. In September 2016, we conducted 19 focus group discussions, 9 in-depth interviews, and 11 key informant interviews with 149 total participants. Data were collected and analyzed thematically using both inductive and deductive approaches, then framed in four levels of the social ecological model. Enhancers included adequate knowledge about VMMC services, being young and single, partner involvement, peer influence, perceived increased libido after circumcision, and availability of free and high-quality VMMC services. Barriers included sexual abstinence during wound healing, penile appearance after circumcision, religion, culture, and misconceptions. Optimizing enhancers and addressing barriers could increase VMMC service uptake in northern Uganda.
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    Epidemiology and preclinical management of dog bites among humans in Wakiso and Kampala districts, Uganda: Implications for prevention of dog bites and rabies
    (PloS one, 2020) Kisaka, Stevens; Makumbi, Fredrick E.; Majalija, Samuel; Bangirana, Alexander
    In rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must immediately wash bite wound for 15 minutes with water, soap, and a disinfectant before seeking medical care. This study investigated the epidemiology of dog bites and the determinants of compliance to these pre-clinical guidelines requirements among dog bite victims from high rabies-burden areas of Wakiso and Kampala, Uganda. An explanatory sequential mixed-methods study design was used. Quantitative data were collected from 376 dog-bite patients at two healthcare facilities. Qualitative data were also collected through 13 in-depth interviews with patients, healthcare workers, herbalists, and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized linear models were used to determine factors associated with compliance. Nearly half (190, 51%) of the patients were from Wakiso District and 293 (77.9%) had grade II wounds. Most of the wounds (171, 45.5%) were on the legs. Two-thirds of the bites occurred in public places. Only 70 (19%) of the bite patients had complied with pre-clinical guidelines. Nearly half of the patients had applied substances that were not recommended e.g. herbs (47/193), antiseptics (46/193), “black stone” (25/193), and unknown creams (10/193). Factors negatively associated with compliance included: being aged 15 years or older, adjPR = 0.70 (0.47–0.92) and knowing the dog owner, adjPR = 0.65 (0.36–0.93). However, attainment of secondary or higher education, adjPR = 1.76 (1.24–3.79), being in employment, adjPR = 1.48 (1.09–2.31), perception that the dog was sick, adjPR = 1.47 (1.02–2.72) and knowledge about the dog’s subsequent victim(s) adjPR = 0.35 (0.17–0.70) were positively associated with compliance. High occurrence of dog bites in public places by free-roaming dogs suggests the need for deliberate promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.
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    Knowledge and correlates of use of safer conception methods among HIV-infected women attending HIV care in Uganda
    (Reproductive health, 2019) Gwokyalya, Violet; Beyeza-Kashesya, Jolly; Bwanika, John B.; Matovu, Joseph K. B.; Mugerwa, Shaban; Arinaitwe, Jim; Kasozi, Dickson; Bukenya, Justine; Kindyomunda, Rosemary; Wagner, Glenn J.; Makumbi, Fredrick E.; Wanyenze, Rhoda K.
    Many people living with HIV would like to have children but family planning (FP) services often focus on only contraception. Availability of safer conception services is still very low in most low income countries. In this study we assessed the knowledge and use of safer conception methods (SCM) among HIV infected women in HIV care in Uganda to inform integration of safer conception in existing FP services. Methods: Data were accrued from a nationally representative cross-sectional survey of 5198 HIV+ women aged 15– 49 years from 245 HIV clinics in Uganda. Knowledge and use of safer conception methods and associated factors were determined. The measure of association was prevalence ratio (PR) with corresponding 95% confidence intervals, obtained using a modified Poisson regression via generalized linear models. All the analyses were conducted using STATA version 12.0. Results: Overall knowledge of any safer conception method was 74.1% (3852/5198). However only 13.2% knew 3 to 4 methods, 18.9% knew only 2 methods and 42% knew only one method. Knowledge of specific SCM was highest for timed unprotected intercourse (TUI) at 39% (n = 2027) followed by manual self-insemination (MSI) at 34.8% (n = 1809), and pre-exposure prophylaxis (PrEP) at 24.8% (n = 1289). Knowledge of SCM was higher in the Eastern region (84.8%, P < 0.001), among women in HIV-discordant relationships (76.7%, p < 0.017), and those on ART (74.5%, p < 0.034). Overall, 1796 (34.6%) women were pregnant or reported a birth in the past 2 years—overall use of SCM in this group was 11.6% (209/1796). The odds of use of SCM were significantly lower in Kampala [adj. PR = 0.489(0.314, 0.764)] or Eastern region [adj.PR = 0.244; (0.147, 0.405)] compared to Northern region. Higher odds of SCM use were associated with HIV status disclosure to partner [adj.PR = 2.613(1.308, 5.221)] and sero-discordant compared to HIV+ concordant relationship [adj.PR = 1.637(1.236, 2.168)]. Pre-existing knowledge of any one SCM did not influence SCM use.
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    Marriage and the Risk of Incident HIV Infection in Rakai, Uganda
    (Journal of acquired immune deficiency syndromes, 2014) Nalugoda, Fred; Guwatudde, David; Bwaninka, John B.; Makumbi, Fredrick E.; Lutalo, Tom; Kagaayi, Joseph; Sewankambo, Nelson K.; Kigozi, Godfrey; Serwadda, David M.; Kong, Xiangrong; Wawer, Maria J.; Wabwire-Mangen, Fred
    Studies suggest that the prevalence of HIV is higher among long-term marital/consensual relationships than in the unmarried. We assessed the risk of incident HIV infection by marital status in rural Rakai, Uganda. Design: Longitudinal data from the Rakai Community Cohort Study between 1999 and 2011. Methods: We estimated HIV incidence per 100 person years (py) in sexually active individuals aged 15–49 years with a total of 44,179.6 py who were never married (women 2929 py and men 4261 py), currently married or in long-term consensual relationships (currently married women 29,823 py and men 21,299 py) and previously married (women 3563 py and men 1475). Poisson multivariable regression was used to estimate the unadjusted and adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of HIV acquisition. Results: The HIV incidence among currently married persons was 0.93/100 py, which was lower than that for the never-married (1.51/ 100 py) and previously married (2.85/100 py) persons. The risk of HIV acquisition was significantly lower in the currently married compared with that in the never married among women (Adj IRR = 0.26, 95% CI: 0.16 to 0.42), but not among men (Adj IRR = 0.69, 95% CI: 0.31 to 1.52). HIV incidence was lower among first marriages (0.73/100 py) compared with that among second- or higherorder marriages (1.38/100 py). Multiple sex partners significantly increased the risk of HIV acquisition in both women (Adj IRR = 2.53, 95% CI: 1.6 to 3.97) and men (Adj IRR = 1.77, 95% CI: 1.20 to 2.60). Conclusions: Current marriage especially first-order marriage was associated with a reduced risk of HIV acquisition in women, but not in men, and multiple sex partnerships increased HIV risk for both sexes.
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    Postcoital penile washing and the risk of HIV acquisition in uncircumcised men
    (AIDS, 2016) Makumbi, Fredrick E.; Ssempijja, Victor; Sekasanvu, Joseph; Ssekubugu, Robert; Kigozi, Godfrey; Watya, Stephen; Nakigozi, Gertrude; Serwadda, David; Wawer, Maria; Gray, Ronald H.
    Postcoital genital washing by uncircumcised men may affect the risk of male HIV acquisition. Method: We assessed the association between self-reported washing after sex in 2976 initially HIV-negative, uncircumcised men enrolled in a prospective cohort study in Rakai, Uganda. Results: Data from the 2976 participants who reported sexual intercourse in the past 12 months contributed 4290 visits, with 7316.6 person-years of observation during the 2-year follow-up. The overall HIV-incidence was 1.28/100 person-years 95%CI (1.04–1.57). About 91.0% of men reported washing their penis after sex, and their HIV incidence was 1.34/100 person-years (95%CI 1.08–1.66), compared with an incidence of 0.62/100 person-years (95%CI 0.17–1.60) in men who did not wash their penis after intercourse. Using Poisson multivariable regression, the adjusted incidence rate ratio of HIV acquisition associated with postcoital washing was 1.94 (95%CI 0.71–5.29). Conclusion: Postcoital penile washing, as practiced in this rural African population does not afford protection from HIV acquisition among uncircumcised men, and may increase risk.
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    The Ugandan Severe Acute Respiratory Syndrome -Coronavirus 2 (SARS-CoV-2) Model: A Data Driven Approach to Estimate Risk
    (medRxiv, 2020) Nannyonga, Betty; Kyobe Bosa, Henry; Woldermariam, Yonas T.; Kaleebu, Pontiano; Ssenkusu, John M.; Lutalo, Tom; Kirungi, Willford; Makumbi, Fredrick E.; Ssembatya, Vincent A.; Mwebesa, Henry G.; Atwine, Diana; Aceng, Jane R.; Wanyenze, Rhoda K.
    The first case of Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) was identified on March 21, 2020, in Uganda. The number of cases increased to 8,287 by September 30, 2020. By May throughout June, most of the cases were predominantly imported cases of truck drivers from neighbouring countries. Uganda responded with various restrictions and interventions including lockdown, physical distancing, hand hygiene, and use of face masks in public, to control the growth rate of the outbreak. By end of September 2020, Uganda had transitioned into community transmissions and most of the reported cases were locals contacts and alerts. This study assessed risks associated with SARS-CoV-2 in Uganda, and presents estimates of the reproduction ratio in real time. An optimal control analysis was performed to determine how long the current mitigation measures such as controlling the exposure in communities, rapid detection, confirmation and contact tracing, partial lockdown of the vulnerable groups and control at the porous boarders, could be implemented and at what cost. Methods: The daily confirmed cases of SARS-CoV-2 in Uganda were extracted from publicly available sources. Using the data, relative risks for age, gender, and geographical location were determined. Four approaches were used to forecast SARS-CoV-2 in Uganda namely linear exponential, nonlinear exponential, logistic and a deterministic model.