Browsing by Author "Nakiyingi-Miiro, Jessica"
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Item Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network)(International journal of epidemiology, 2016) Reniers, Georges; Lutalo, Tom; Wamukoya, Marylene; Urassa, Mark; Nakiyingi-Miiro, Jessica; Hosegood, Vicky; Wringe, Alison; Marston, Milly; Maquins, Sewe; Levira, Francis; Zaba, BasiaThe Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network) was established in 2005 and aims to: (i) broaden the evidence base on HIV epidemiology for informing policy; (ii) strengthen analytical capacity for HIV research; and (iii) foster collaboration between study sites.1 All of the study sites participating in the ALPHA Network are independently managed and have their own scientific agendas and tailored research methodologies, but share a common interest in HIV epidemiology and its interactions with the socio-demographic characteristics of the populations they cover. The ALPHA Network study sites and their institutional affiliations are described in Table 1, and their geographical distribution is shown in Figure 1. Several of the ALPHA Network study sites have published site-specific profiles that contain more detail.2–10 Most of the ALPHA Network study sites are also members of the INDEPTH Network of demographic surveillance sites [http:// www.indepth-network.org/].Item Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA)(The Lancet, 2013) Zaba, Basia; Calvert, Clara; Marston, Milly; Isingo, Raphael; Nakiyingi-Miiro, Jessica; Lutalo, Tom; Crampin, Amelia; Robertson, Laura; Herbst, Kobus; Ronsmans, CarineModel-based estimates of the global proportions of maternal deaths that are in HIV-infected women range from 7% to 21%, and the eff ects of HIV on the risk of maternal death is highly uncertain. We used longitudinal data from the Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA) network to estimate the excess mortality associated with HIV during pregnancy and the post-partum period in sub-Saharan Africa. Methods The ALPHA network pooled data gathered between June, 1989 and April, 2012 in six community-based studies in eastern and southern Africa with HIV serological surveillance and verbal-autopsy reporting. Deaths occurring during pregnancy and up to 42 days post partum were defi ned as pregnancy related. Pregnant or postpartum person-years were calculated for HIV-infected and HIV-uninfected women, and HIV-infected to HIVuninfected mortality rate ratios and HIV-attributable rates were compared between pregnant or post-partum women and women who were not pregnant or post partum. Findings 138 074 women aged 15–49 years contributed 636 213 person-years of observation. 49 568 women had 86 963 pregnancies. 6760 of these women died, 235 of them during pregnancy or the post-partum period. Mean prevalence of HIV infection across all person-years in the pooled data was 17·2% (95% CI 17·0–17·3), but 60 of 118 (50·8%) of the women of known HIV status who died during pregnancy or post partum were HIV infected. The mortality rate ratio of HIV-infected to HIV-uninfected women was 20·5 (18·9–22·4) in women who were not pregnant or post partum and 8·2 (5·7–11·8) in pregnant or post-partum women. Excess mortality attributable to HIV was 51·8 (47·8–53·8) per 1000 person-years in women who were not pregnant or post partum and 11·8 (8·4–15·3) per 1000 person-years in pregnant or post-partum women. Interpretation HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24% of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women.Item InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries(Global Health Action, 2013) Byass, Peter; Calvert, Clara; Nakiyingi-Miiro, Jessica; Lutalo, Tom; Michael, Denna; Crampin, Amelia; Gregson, Simon; Takaruza, Albert; Robertson, Laura; Herbst, Kobus; Todd, Jim; Zaba, BasiaReliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are scanty, even though that is the region where most of the world’s AIDS deaths occur. There is therefore a great need for reliable and valid public health tools for assessing AIDS mortality. Objective: The aim of this article is to validate the InterVA-4 verbal autopsy (VA) interpretative model within African populations where HIV sero-status is recorded on a prospective basis, and examine the distribution of cause-specific mortality among HIV-positive and HIV-negative people. Design: Data from six sites of the Alpha Network, including HIV sero-status and VA interviews, were pooled. VA data according to the 2012 WHO format were extracted, and processed using the InterVA-4 model into likely causes of death. The model was blinded to the sero-status data. Cases with known pre-mortem HIV infection status were used to determine the specificity with which InterVA-4 could attribute HIV/AIDS as a cause of death. Cause-specific mortality fractions by HIV infection status were calculated, and a person-time model was built to analyse adjusted cause-specific mortality rate ratios. Results: The InterVA-4 model identified HIV/AIDS-related deaths with a specificity of 90.1% (95% CI 88.7 91.4%). Overall sensitivity could not be calculated, because HIV-positive people die from a range of causes. In a person-time model including 1,739 deaths in 1,161,688 HIV-negative person-years observed and 2,890 deaths in 75,110 HIV-positive person-years observed, the mortality ratio HIV-positive:negative was 29.0 (95% CI 27.1 31.0), after adjustment for age, sex, and study site. Cause-specific HIV-positive:negative mortality ratios for acute respiratory infections, HIV/AIDS-related deaths, meningitis, tuberculosis, and malnutrition were higher than the all-cause ratio; all causes had HIV-positive:negative mortality ratios significantly higher than unity.Item Malaria prevention practices and associated environmental risk factors in a rural community in Wakiso district, Uganda(PLoS ONE, 2018) Musoke, David; Miiro, George; Ndejjo, Rawlance; Karani, George; Morris, Keith; Kasasa, Simon; Nakiyingi-Miiro, Jessica; Guwatudde, David; Musoke, Miph BosesBesides use of insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS), other complimentary measures including suitable housing structures, and environmental management that reduce breeding of malaria vectors, can be implemented at households to prevent the disease. However, most studies on malaria prevention have focused mainly on ITNs and IRS. The aim of this study was therefore to assess malaria prevention practices beyond ITNs and IRS, and associated environmental risk factors including housing structure in rural Wakiso district, Uganda. Methods A clustered cross-sectional survey was conducted among 727 households in Wakiso district. Data were collected using an interviewer-administered questionnaire and observational checklist. The questionnaire assessed participants' household practices on malaria prevention, whereas the checklist recorded environmental risk factors for malaria transmission, and structural condition of houses. Poisson regression modeling was used to identify factors associated with use of mosquito nets by households. Results Of the 727 households, 471 (64.8%) owned at least one mosquito net. Use of mosquito nets by households was higher with increasing education level of participantsÐprimary (aPR = 1.27 [95% CI: 1.00±1.60]), secondary (ordinary level) (aPR = 1.47 [95% CI: 1.16±1.85]) and advanced level / tertiary (aPR = 1.55 [95% CI: 1.19±2.01]), and higher household income (aPR = 1.09 [95% CI: 1.00±1.20]). Additionally, participants who were not employed were less likely to have mosquito nets used in their households (aPR = 0.83 [95% CI: 0.70±0.98]). Houses that had undergone IRS in the previous 12 months were 42 (5.8%), while 220 (43.2%) households closed their windows before 6.00 pm. Environmental risk factors found at households included presence of vessels that could potentially hold water for mosquito breeding 414 (56.9%), and stagnant water in compounds 144 (19.8%). Several structural deficiencies on houses that could promote entry of mosquitoes were found such as lack of screening in ventilators 645 (94.7%), and external doors not fitting perfectly into walls hence potential for mosquito entry 305 (42.0%). Conclusion There is need to increase coverage and utilisation of ITNs and IRS for malaria prevention in Wakiso district, Uganda. In addition, other malaria prevention strategies such as environmental management, and improving structural condition of houses are required to strengthen existing malaria prevention approaches.Item Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study(BMC women's health, 2018) Miiro, George; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Nakuya, Kevin; Musoke, Saidat; Namakula, Juliet; Francis, Suzanna; Torondel, Belen; Gibson, Lorna J.; Ross, David A.; Weiss, Helen A.Management of menstruation can present substantial challenges to girls in low-income settings. In preparation for a menstrual hygiene intervention to reduce school absenteeism in Uganda, this study aimed to investigate menstruation management practices, barriers and facilitators, and the influence of menstruation on school absenteeism among secondary school students in a peri-urban district of Uganda. Methods: Qualitative and quantitative studies were conducted among consenting girls and boys aged 14–17 years in four secondary schools in Entebbe sub-District, Uganda. Methods included group and in-depth interviews with students, a quantitative cross-sectional questionnaire, a prospectively self-completed menstrual diary, key informant interviews with policy makers, and observations of school water, sanitation and hygiene facilities. Multiple logistic regression was used to assess factors associated with school absenteeism during the most recent menstrual period. Results: Girls reported substantial embarrassment and fear of teasing related to menstruation in the qualitative interviews, and said that this, together with menstrual pain and lack of effective materials for menstrual hygiene management, led to school absenteeism. All policy makers interviewed reported poverty and menstruation as the key factors associated with school attendance. The 352 girls with questionnaire data had a median age of 16 (inter-quartile range (IQR) = 15,16) years, with median age at menarche of 13 (IQR = 13,14) years. Of these, 64 girls (18.7%) reported having stained their clothes and 69 (19. 7%) reported missing at least 1 day of school, during their most recent period. Missing school during the most recent period was associated with physical symptoms (headache (odds ratio (OR) = 2.15, 95%CI:1.20, 3.86), stomach pain (OR = 1.89, 95%CI:0.89, 4.04), back pain (OR = 1.75, 95%CI:0.97, 3.14), and with changing protection 4 or more times per 24 h period (OR = 2.08, 95%CI:1.06, 4.10). In the diary sub-study among 40 girls, school absence was reported on 28% of period-days, compared with 7% of non-period days (adjusted odds ratio = 5.99, 95%CI:4.4, 8.2; p < 0.001). Conclusion: In this peri-urban Ugandan population, menstruation was strongly associated with school attendance. Evaluation of a menstrual management intervention that address both psychosocial (e.g. self-confidence, attitudes) and physical (e.g. management of pain, use of adequate menstrual hygiene materials, improved water and sanitation facilities) aspects of menstruation are needed.Item Promising Perceptions, Divergent Practices and Barriers to Integrated Malaria Prevention in Wakiso District, Uganda: A Mixed Methods Study(PLoS ONE, 2015) Musoke, David; Miiro, George; Karani, George; Morris, Keith; Kasasa, Simon; Ndejjo, Rawlance; Nakiyingi-Miiro, Jessica; Guwatudde, David; Musoke, Miph BosesThe World Health Organization recommends use of multiple approaches to control malaria. The integrated approach to malaria prevention advocates the use of several malaria prevention methods in a holistic manner. This study assessed perceptions and practices on integrated malaria prevention in Wakiso district, Uganda. Methods A clustered cross-sectional survey was conducted among 727 households from 29 villages using both quantitative and qualitative methods. Assessment was done on awareness of various malaria prevention methods, potential for use of the methods in a holistic manner, and reasons for dislike of certain methods. Households were classified as using integrated malaria prevention if they used at least two methods. Logistic regression was used to test for factors associated with the use of integrated malaria prevention while adjusting for clustering within villages. Results Participants knew of the various malaria prevention methods in the integrated approach including use of insecticide treated nets (97.5%), removing mosquito breeding sites (89.1%), clearing overgrown vegetation near houses (97.9%), and closing windows and doors early in the evenings (96.4%). If trained, most participants (68.6%) would use all the suggested malaria prevention methods of the integrated approach. Among those who would not use all methods, the main reasons given were there being too many (70.2%) and cost (32.0%). Only 33.0%households were using the integrated approach to prevent malaria. Use of integrated malaria prevention by households was associated with reading newspapers (AOR 0.34; 95% CI 0.22 –0.53) and ownership of a motorcycle/car (AOR 1.75; 95%CI 1.03 – 2.98). Conclusion Although knowledge of malaria prevention methods was high and perceptions on the integrated approach promising, practices on integrated malaria prevention was relatively low. The use of the integrated approach can be improved by promoting use of multiple malaria prevention methods through various communication channels such as mass media.Item Self-Collection of Vaginal Swabs Among Adolescent Girls in a School-Setting in East Africa(Sexually transmitted diseases, 2019) Francis, Suzanna C.; Miiro, George; Nakuya, Kevin; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Nabaggala, Grace; Musoke, Saidat; Namakula, Juliet; Tanton, Clare; and On behalf of the MENISCUS project teamFew studies have evaluated the acceptability of self-collected vaginal swabs among young women in sub-Saharan Africa, including in school settings. We evaluated the acceptability of 2 conditions for the self-collection of swabs in secondary schools in Entebbe, Uganda.Assenting girls with parental consent from 3 secondary schools were provided instructions for sampling, and randomly allocated to self-collection of vaginal swabs with or without nurse assistance to help with correct placement of the swab. Swabs were tested for bacterial vaginosis by Gram stain. Participants were followed up after 1 to 2 days and 1 to 2 weeks and invited for a qualitative interview.Overall 96 girls were enrolled (median age, 16 years; interquartile range, 15–17 years). At the first follow-up visit, participants in both arms reported that instructions for sample collection were easy to understand, and they felt comfortable with self-collection. Girls in the nurse assistance arm reported feeling less relaxed (27% vs. 50%, P = 0.02) than those in the arm without nurse assistance, but more confident that they collected the sample correctly (96% vs. 83%, P = 0.04). About half (47%) of participants agreed that self-sampling was painful, but almost all (94%) would participate in a similar study again. Qualitative data showed that participants preferred self-collection without nurse assistance to preserve privacy. Bacterial vaginosis prevalence was 14% (95% confidence interval, 8–22).In this setting, self-collection of vaginal swabs in secondary schools was acceptable and feasible, and girls preferred self-collection without nurse assistance. Self-collection of swabs is an important tool for the detection, treatment and control of reproductive tract infections in girls and young women.Item Self-Collection of Vaginal Swabs Among Adolescent Girls in a School-Setting in East Africa(Sexually transmitted diseases, 2019) Francis, Suzanna C.; Miiro, George; Nakuya, Kevin; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Nabaggala, Grace; Musoke, Saidat; Namakula, Juliet; Tanton, Clare; Torondel, Belen; Ross, David A.; Weiss, Helen A.Few studies have evaluated the acceptability of self-collected vaginal swabs among young women in sub-Saharan Africa, including in school settings. We evaluated the acceptability of 2 conditions for the self-collection of swabs in secondary schools in Entebbe, Uganda. Methods: Assenting girlswith parental consent from3 secondary schools were provided instructions for sampling, and randomly allocated to selfcollection of vaginal swabs with or without nurse assistance to help with correct placement of the swab. Swabs were tested for bacterial vaginosis by Gram stain. Participants were followed up after 1 to 2 days and 1 to 2 weeks and invited for a qualitative interview. Results: Overall 96 girls were enrolled (median age, 16 years; interquartile range, 15–17 years). At the first follow-up visit, participants in both arms reported that instructions for sample collection were easy to understand, and they felt comfortablewith self-collection.Girls in the nurse assistance arm reported feeling less relaxed (27% vs. 50%, P = 0.02) than those in the armwithout nurse assistance, but more confident that they collected the sample correctly (96% vs. 83%, P = 0.04). About half (47%) of participants agreed that self-sampling was painful, but almost all (94%) would participate in a similar study again. Qualitative data showed that participants preferred self-collection without nurse assistance to preserve privacy. Bacterial vaginosis prevalence was 14% (95% confidence interval, 8–22). Conclusions: In this setting, self-collection of vaginal swabs in secondary schools was acceptable and feasible, and girls preferred self-collection without nurse assistance. Self-collection of swabs is an important tool for the detection, treatment and control of reproductive tract infections in girls and young women.Item Soccer-based promotion of voluntary medical male circumcision: A mixed-methods feasibility study with secondary students in Uganda(PLoS ONE, 2017) Miiro, George; DeCelles, Jeff; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Muzira, Philip; Ssembajjwe, Wilber; Musoke, Saidat; Gibson, Lorna J.; Hershow, Rebecca B.; Francis, Suzanna; Torondel, Belen; Ross, David A.; Weiss, Helen A.The Ugandan government is committed to scaling-up proven HIV prevention strategies including safe male circumcision, and innovative strategies are needed to increase circumcision uptake. The aim of this study was to assess the acceptability and feasibility of implementing a soccer-based intervention (ªMake The Cutº) among schoolboys in a peri-urban district of Uganda. The intervention was led by trained, recently circumcised ªcoachesº who facilitated a 60-minute session delivered in schools, including an interactive penalty shootout game using metaphors for HIV prevention, sharing of the coaches' circumcision story, group discussion and ongoing engagement from the coach to facilitate linkage to male circumcision. The study took place in four secondary schools in Entebbe sub-district, Uganda. Acceptability of safe male circumcision was assessed through a cross-sectional quantitative survey. The feasibility of implementing the intervention was assessed by piloting the intervention in one school, modifying it, and implementing the modified version in a second school. Perceptions of the intervention were assessed with in-depth interviews with participants. Of the 210 boys in the cross-sectional survey, 59% reported being circumcised. Findings showed high levels of knowledge and generally favourable perceptions of circumcision. The initial implementation of Make The Cut resulted in 6/58 uncircumcised boys (10.3%) becoming circumcised. Changes made included increasing engagement with parents and improved liaison with schools regarding the timing of the intervention. Following this, uptake improved to 18/69 (26.1%) in the second school. In-depth interviews highlighted the important role of family and peer support and the coach in facilitating the decision to circumcise. This study showed that the modified Make The Cut intervention may be effective to increase uptake of safe male circumcision in this population. However, the intervention is time-intensive, and further work is needed to assess the cost-effectiveness of the intervention conducted at scale.