NRU :: Browsing by Author "Nabukalu, Dorean"

Browsing by Author "Nabukalu, Dorean"

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Alcohol use during pregnancy in Rakai, Uganda
(Plos one, 2021) Wynn, Adriane; Nabukalu, Dorean; Lutalo, Tom; Wawer, Maria; Chang, Larry W.; Kiene, Susan M.; Serwadda, David M.; Sewankambo, Nelson; Nalugoda, Fred; Kigozi, Godfrey; Wagman, Jennifer A.
Antenatal alcohol use is linked to adverse maternal and neonatal outcomes. Uganda has one of the highest rates of alcohol use in sub-Saharan Africa, but the prevalence of antenatal alcohol use has not been reported in the Rakai region. Methods We used cross-sectional data from pregnant women in the Rakai Community Cohort Study between March 2017 and September 2018. Using bivariate and multivariable analyses, we assessed associations between self-reported antenatal alcohol use and sociodemographic characteristics, intimate partner violence (IPV), and HIV status. Results Among 960 pregnant women, the median age was 26 years, 35% experienced IPV in the past 12 months, 13% were living with HIV, and 33% reported alcohol use during their current pregnancy. After adjusting for marital status, education, smoking, and HIV status; Catholic religion (AOR: 3.54; 95% CI: 1.89–6.64; compared to other), bar/restaurant work (AOR: 2.40; 95% CI: 1.17–4.92; compared to agriculture), >one sex partner in past year (AOR: 1.92; 95% CI: 1.17–3.16), a partner that drank before sex in past year (AOR: 2.01; 95% CI: 1.48–2.74), and past year IPV (AOR: 1.55; 95% CI: 1.14–2.11) were associated with antenatal alcohol use. Conclusion We found that alcohol use during pregnancy was common and associated with religion, occupation, higher numbers of past year sex partners, having a partner who drank before sex in the past 12 months, and IPV experience. More research is needed to understand the quantity, frequency, and timing of antenatal alcohol use; and potential impacts on neonates; and to identify services that are acceptable and effective among pregnant women.
Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda
(Nature Communications, 2020) Grabowski, Mary Kate; Lessler, Justin; Bazaale, Jeremiah; Nabukalu, Dorean; Nankinga, Justine; Nantume, Betty; Ssekasanvu, Joseph; Reynolds, Steven J.; Ssekubugu, Robert; Nalugoda, Fred; Kigozi, Godfrey; Kagaayi, Joseph; Santelli, John S.; Kennedy, Caitlin; Wawer, Maria J.; Serwadda, David; Chang, Larry W.; Gray, Ronald H.
HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.
Mortality in women of reproductive age in rural South Africa
(Global Health Action, 2013) Nabukalu, Dorean; Klipstein-Grobusch, Kerstin; Herbst, Kobus; Newell, Marie-Louise
Objective: To determine causes of death and associated risk factors in women of reproductive age in rural South Africa. Methods: Deaths and person-years of observation (pyo) were determined for females (aged 15 49 years) resident in 15,526 households in a rural South African Demographic and Health Surveillance site from 2000 to 2009. Cause of death was ascertained by verbal autopsy and ICD-10 coded; causes were categorized as HIV/TB, non-communicable, communicable/maternal/perinatal/nutrition, injuries, and undetermined (unknown). Characteristics of women were obtained from regularly updated household visits, while HIV and self-reported health status was obtained from the annual HIV surveillance. Overall and cause-specific mortality rates (MRs) with 95% confidence intervals (CI) were calculated. TheWeibull regression model (HR, 95% CI) was used to determine risk factors associated with mortality. Results: A total of 42,703 eligible women were included; 3,098 deaths were reported for 212,607 pyo. Overall MRwas 14.6 deaths/1,000 pyo (95% CI: 14.1 15.1), peaking in 2003 (MR 18.2/1,000 pyo, 95% CI: 16.4 20.1) and declining thereafter (2009: MR 9.6/1,000 pyo, 95% CI: 8.4 10.9). Mortality was highest for HIV/TB (MR 10.6/1,000 pyo, 95% CI: 10.2 11.1), accounting for 73.1% of all deaths, ranging from 61.2% in 2009 to 82.7% in 2002. Adjusting for education level, marital status, age, employment status, area of residence, and migration, all-cause mortality was associated with external migration (adjusted hazard ratio, or aHR), 1.70, 95% CI: 1.41 2.05), self-reported poor health status (aHR 8.26, 95% CI: 2.94 23.15), and HIV-infection (aHR 7.84, 95% CI: 6.26 9.82); external migration and HIV infection were also associated with causes of mortality other than HIV/TB (aHR 1.62, 95% CI: 1.12 2.34 and aHR 2.59, 95% CI: 1.79 3.75). Conclusion: HIV/TB was the leading cause of death among women of reproductive age, although rates declined with the rollout of HIV treatment in the area from 2004. Women’s age, external migration status and HIV-positive status were significantly associated with all-cause and cause-specific mortality.
Prevalence and correlates of men’s and women’s alcohol use in agrarian, trading and fishing communities in Rakai, Uganda
(PLoS ONE, 2020) Wagman, Jennifer A.; Nabukalu, Dorean; Miller, Amanda P.; Wawer, Maria J.; Ssekubugu, Robert; Nakowooya, Hadijja; Nantume, Betty; Park, Eunhee; Hahn, Judith A.; Serwadda, David M.; Sewankambo, Nelson K.; Nalugoda, Fred; Kigozi, Godfrey
Uganda has one of the highest rates of alcohol use in sub-Saharan Africa but prevalence and correlates of drinking are undocumented in the Rakai region, one of the earliest epicenters of the HIV/AIDS epidemic in East Africa. Methods We analyzed cross-sectional data from 18,700 persons (8,690 men, 10,010 women) aged 15–49 years, living in agrarian, trading and fishing communities and participating in the Rakai Community Cohort Study (RCCS) between March 2015 and September 2016. Logistic regression models assessed associations between past year alcohol use and sociodemographic characteristics, other drug use and HIV status, controlling for age, religion, education, occupation, marital status, and household socioeconomic status. Results Past year alcohol prevalence was 45%. Odds of drinking were significantly higher in men (versus women) and fishing communities (versus agrarian areas). Odds of drinking increased with age, previous (versus current) marriage and past year drug use. By occupation, highest odds of drinking were among fishermen and (in women) bar/restaurant workers. Alcohol-related consequences were more commonly reported by male (vs. females) drinkers, among whom up to 35% reported alcohol dependence symptoms (e.g., unsteady gait). HIV status was strongly associated with alcohol use in unadjusted but not adjusted models. Conclusions Alcohol use differed by gender, community type and occupation. Being male, living in a fishing community and working as a fisherman or restaurant/bar worker (among women) were associated with higher odds of drinking. Alcohol reduction programs should be implemented in Uganda’s fishing communities and among people working in high risk occupations (e.g., fishermen and restaurant/bar workers).
Prevalence and risk factors of metabolic dysfunction- associated steatotic liver disease in south Central Uganda: A cross-sectional survey
(Wiley Subscription Services, Inc, 2024-04-09) Enriquez, Rocio; Homsi, Mahmoud; Ssekubugu, Robert; Nabukalu, Dorean; Zeebari, Zangin; Marrone, Gaetano; Gigante, Bruna; Chang, Larry W; Reynolds, Steven J.; Nalugoda, Fred; Ekström, Anna Mia; Hagström, Hannes; Nordenstedt, Helena
Background: Despite numerous risk factors and serious consequences, little is known about metabolic dysfunction-associated steatotic liver disease (MASLD) at population level in Africa. Aim: The aim of the study was to estimate the prevalence and risk factors of MASLD in people living with and without HIV in Uganda. Methods: We collected data from 37 communities in South Central Uganda between May 2016 and May 2018. We estimated MASLD prevalence using the fatty liver index and advanced liver fibrosis using the dynamic aspartate-to-alanine aminotransferase ratio. We collected additional data on sociodemographics, HIV and cardiovascular disease (CVD) risk factors. We used multivariable logistic regression to determine the association between HIV, CVD risk factors and MASLD. Results: We included 759 people with HIV and 704 HIV-negative participants aged 35–49. MASLD prevalence was 14% in women and 8% in men; advanced liver fibrosis prevalence was estimated to be <1%. MASLD prevalence was more common in women (15% vs. 13%) and men (9% vs. 6%) with HIV. Being female (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.4–3.3) was associated with a higher odds of MASLD after adjustment for confounders; HIV infection was borderline associated with MASLD (OR = 1.4; 95% CI: 1.0–2.0). Conclusions: In a relatively young cohort in Uganda, 14% of women and 8% of men had MASLD. There was an indication of an association between HIV and MASLD in multivariable analysis. These data are the first to describe the population-level burden of MASLD in sub-Saharan Africa using data from a population-based cohort.
Randomised trial of early infant circumcision performed by clinical officers and registered nurse midwives using the Mogen clamp in Rakai, Uganda
(BJU international, 2017) Kankaka, Edward N.; Murungi, Teddy; Kigozi, Godfrey; Makumbi, Frederick; Nabukalu, Dorean; Watya, Stephen; Kighoma, Nehemiah; Nampijja, Resty; Kayiwa, Daniel; Nalugoda, Fred; Serwadda, David; Wawer, Maria; Gray, Ronald H.
To assess the safety and acceptability of early infant circumcision (EIC) provided by trained clinical officers (COs) and registered nurse midwives (RNMWs) in rural Uganda. Subjects and Methods We conducted a randomised trial of EIC using the Mogen clamp provided by newly trained COs and RNMWs in four health centres in rural Rakai, Uganda. The trial was registered with clinicaltrials.gov # NCT02596282. In all, 501 healthy neonates aged 1–28 days with normal birth weight and gestational age were randomised to COs (n = 256) and RNMWs (n = 245) for EIC, and were followed-up at 1, 7 and 28 days. Results In all, 701 mothers were directly invited to participate in the trial, 525 consented to circumcision (74.9%) and 23 were found ineligible on screening (4.4%). The procedure took an average of 10.5 min. Adherence to follow-up was >90% at all scheduled visits. The rates of moderate/severe adverse events were 2.4% for COs and 1.6% for RNMWs (P = 0.9). All wounds were healed by 28 days after circumcision. Maternal satisfaction with the procedure was 99.6% for infants circumcised by COs and 100% among infants circumcised by RNMWs. Conclusions EIC was acceptable in this rural Ugandan population and can be safely performed by RNMWs who have direct contact with the mothers during pregnancy and delivery. EIC services should be made available to parents who are interested in the service.
Sexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda
(AIDS Care, 2018) Kankaka, Edward N.; Ssekasanvu, Joseph; Prodger, Jessica; Nabukalu, Dorean; Nakawooya, Hadijja; Ndyanabo, Anthony; Kigozi, Godfrey; Gray, Ronald
Objective: To determine whether circumcision of HIV-positive men is associated with increased subsequent sexual risk behaviors which may place their female partners at risk. Methods: Newly circumcised and uncircumcised HIV-positive men in the Rakai Community Cohort Study were followed from baseline (July 2013–January 2015) to determine trend in sexual risk behaviors and association of circumcision with subsequent sexual risk behaviors at follow up (February 2015–September 2016). Risk behaviors included sexual activity, alcohol before sex, transactional sex, multiple sex partners, casual sex partners, and inconsistent condom use with casual partners. The association was evaluated using modified Poisson regression, and sensitivity analyses were performed after multiple imputation with chained equations for missing data. Results: We identified 538 eligible men, of whom 113(21.0%) were circumcised at baseline and 425 (79.0%) were uncircumcised. Men in fishing communities were more likely to be circumcised (p = 0.032) as well as those exposed to targeted HIV messaging (p < 0.001). Overall, 188(34.9%) men were lost to follow up and most were uncircumcised (p = 0.020). Among those followed up, behaviors remained largely unchanged with no differences by circumcision status. Transactional sex appeared to be associated with circumcision in unadjusted analyses (PR = 1.58, 95%CI = 1.01,2.48; p = 0.045, p = 0.05) and adjusted analyses (adj.PR = 1.54, 95%CI = 1.06,2.23; p = 0.022). However, the association was no longer significant in sensitivity analyses after accounting for loss to follow up (adj.PR = 1.43, 95%CI = 0.98,2.08; p = 0.066). No association with circumcision was observed for other sexual risk behaviors. Conclusion: We found no association between circumcision of HIV-positive men and subsequent sexual risk behavior.
Smoker characteristics and trends in tobacco smoking in Rakai, Uganda, 2010–2018
(Tobacco Induced Diseases, 2022) Nalugoda, Fred; Nabukalu, Dorean; Ssekasanvu, Joseph; Ssekubugu, Robert; Hoe, Connie; Kagaayi, Joseph; Sewankambo, Nelson K.; Serwadda, David M.; Wawer, Maria J.; Grabowski, Kate M.; Reynolds, Steven J.; Kigozi, Godfrey; Gray, Ronald H.; Yeh, Ping T.; Chang, Larry W.
Tobacco use is a major public health concern, particularly in low- and middle-income countries where 80% of the world’s smokers reside. There is limited population-based data from rural Africa on patterns of tobacco smoking and smoker characteristics. We assessed trends in rates of smoking, characteristics of smokers, and factors associated with smoking using repeat population-based cross-sectional surveys in south-central Uganda. METHODS Data accrued over five survey rounds (2010–2018) of the Rakai Community Cohort Study (RCCS) from consenting individuals aged 15– 49 years including sociodemographic and behavioral characteristics and smoking status. Proportions of smokers per survey were compared using χ2 test for trends, and factors associated with smoking were assessed by multivariable logistic regression. RESULTS The prevalence of tobacco smoking in the general population declined from 7.3% in 2010–2011 to 5.1% in 2016–2018, p<0.001. Smoking rates declined among males (13.9–9.2%) and females (2.2–1.8%) from 2010– 2011 to 2016–2018. Smoking prevalence was higher among previously married (11.8–11.7%) compared to currently (8.4–5.3%) and never married persons (3.1–1.8%) from 2010–2011 to 2016–2018. Older age (≥35 years) was associated with higher odds of smoking (AOR=8.72; 95% CI: 5.68– 13.39 in 2010–2011 and AOR=9.03; 95% CI: 5.42–15.06 in 2016–2018) compared to those aged <35 years (AOR=4.73; 95% CI: 3.15–7.12 in 2010–2011 and AOR=4.83; 95% CI: 2.95–7.91 in 2016–2018). Primary and secondary/higher education level was significantly associated with lower odds of smoking (AOR=0.20; 95% CI: 0.14–0.29 in 2010–2011 and AOR=0.26; 95% CI: 0.18–0.39 in 2016–2018) compared to no education (AOR=0.43; 95% CI: 0.31–0.59 in 2010–2011 and AOR=0.48; 95% CI: 0.34–0.68 in 2016–2018). Number of sexual partners and HIV status were not associated with smoking. CONCLUSIONS We observed declining trends in tobacco smoking in the Rakai region of rural Uganda. Smoking was more prevalent in men, older individuals, individuals who were previously married, and individuals with lower education. The decline in smoking may be due to tobacco control efforts, but there is a continued need to target sub-populations with higher smoking prevalence.
Transactional Sex, Alcohol Use and Intimate Partner Violence Against Women in the Rakai Region of Uganda
(AIDS and Behavior, 2021) Miller, Amanda P.; Pitpitan, Eileen V.; Nabukalu, Dorean; Nalugoda, Fred; Nakigozi, Gertrude; Kigozi, Godfrey; Grabowski, Mary K.; Kennedy, Caitlin E.; Wagman, Jennifer A.
Transactional sex (TS) is prevalent in sub-Saharan Africa. Women’s engagement in TS is linked with HIV infection; little is known about the relationship between TS, intimate partner violence (IPV) and alcohol use—established HIV risk behaviors. Using modified Poisson regression, we assessed associations between TS and physical, verbal and sexual IPV among 8248 women (15–49 years) who participated in the Rakai Community Cohort Study across forty communities in Uganda. An interaction term assessed moderation between alcohol use and TS and no significant interaction effects were found. In adjusted analysis, alcohol use and TS were significantly associated with all forms of IPV. In stratified analysis, TS was only associated with IPV in agrarian communities; alcohol use was not associated with physical IPV in trade communities or sexual IPV in trade and fishing communities. Identifying differences in IPV risk factors by community type is critical for the development of tailored interventions.

Browsing by Author "Nabukalu, Dorean"

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