Browsing by Author "Nakyanjo, Neema"
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Item Assessing the promotion of urine-diverting dry toilets through school-based demonstration facilities in Kalisizo, Uganda(Journal of Water, Sanitation and Hygiene for Development, 2016) Trimmer, John T.; Nakyanjo, Neema; Ssekubugu, Robert; Sklar, Marc; Mihelcic, James R.; Ergas, Sarina J.Urine-diverting dry toilets (UDDTs) are designed to recover nutrients and organic matter from human excreta for agricultural reuse. Their wider implementation could help address problems in areas where water scarcity limits coverage of sanitation systems and declining soil fertility jeopardizes nutritional security. Demonstration facilities can improve stakeholders’ views of UDDTs; however, it is uncertain whether these facilities should be located at households or institutions. Using a novel methodological approach that included qualitative data collection before and after introduction of demonstration UDDTs and quantitative monitoring of treatment conditions, this study evaluated changes in local attitudes and knowledge resulting from a UDDT promotion strategy at two primary schools in Uganda. Before introduction, students had little knowledge of UDDT facilities, while most attitude-related statements conveyed negative viewpoints and skepticism. After introduction and six months of operation, students exhibited increased knowledge, and 68% of attitude-related statements conveyed positive opinions that focused on the UDDTs’ long-term economic value and their role in creating a more hygienic school environment. These changes were seen in facility users and in other students at the schools who were non-users. In the future, with these improved perceptions, students could become compelling representatives for UDDTs within their communities, potentially increasing adoption.Item Contraceptive knowledge, perceptions, and concerns among men in Uganda(BMC Public Health, 2017) Thummalachetty, Nityanjali; Mathur, Sanyukta; Mullinax, Margo; DeCosta, Kelsea; Nakyanjo, Neema; Lutalo, Tom; Brahmbhatt, Heena; Santelli, John S.Low contraceptive uptake and high unmet need for contraception remain significant issues in Uganda compared to neighboring countries such as Kenya, Ethiopia, and Rwanda. Although prior research on contraceptive uptake has indicated that male partners strongly influence women’s decisions around contraceptive use, there is limited in-depth qualitative research on knowledge and concerns regarding modern contraceptive methods among Ugandan men. Methods: Using in-depth interviews (N = 41), this qualitative study investigated major sources of knowledge about contraception and perceptions of contraceptive side effects among married Ugandan men. RESULTS: Men primarily reported knowledge of contraceptives based on partner’s experience of side effects, partner’s knowledge from health providers and mass media campaigns, and partner’s knowledge from her peers. Men were less likely to report contraceptive knowledge from health care providers, mass media campaigns, or peers. Men’s concerns about various contraceptive methods were broadly associated with failure of the method to work properly, adverse health effects on women, and severe adverse health effects on children. Own or partner’s human immunodeficiency virus (HIV) status did not impact on contraceptive knowledge. Conclusions: Overall, we found limited accurate knowledge about contraceptive methods among men in Uganda. Moreover, fears about the side effects of modern contraceptive methods appeared to be common among men. Family planning services in Uganda could be significantly strengthened by renewed efforts to focus on men’s knowledge, fears, and misconceptions.Item Estimation of Ascaris lumbricoides egg inactivation by free ammonia treatment of ash-amended UDDT vault products using stored urine in Uganda(Journal of Water, Sanitation and Hygiene for Development, 2016) Trimmer, John T.; Nakyanjo, Neema; Ssekubugu, Robert; Sklar, Marc; Mihelcic, James R.; Ergas, Sarina J.Urine-diverting dry toilets (UDDTs) are designed to recover nutrients and organic matter from human excreta for use as agricultural amendments, and have been promoted in many developing countries, including Uganda. Wider UDDT implementation could help address problems in areas where water scarcity limits sanitation coverage and/or declining soil fertility jeopardizes growing populations’ nutritional security. However, concerns have been raised regarding the safety of recovered UDDT vault products, which may contain persistent pathogens such as Ascaris lumbricoides eggs. A. lumbricoides eggs can be inactivated through elevation of free ammonia levels. This study assessed the feasibility of a secondary ammonia treatment strategy for UDDT ash-amended vault products using urine. Treatment parameters were measured in mixtures of urine, ash-amended vault products, and wood ash, a model was developed to account for temperature fluctuations, and A. lumbricoides egg inactivation times were estimated using a previously published model. A mixture containing two parts urine and one part ash-amended vault products was estimated to provide 2-log10 inactivation after 3 months of indoor storage (daily mean temperatures: 22.8±0.3 WC) or 2 months of outdoor storage (25.9±1.3 WC). This strategy could improve the safety of recovered products for agricultural use to improve the nutritional security of vulnerable populations.Item Experiences of Sexual Coercion Among Adolescent Women: Qualitative Findings From Rakai District, Uganda(Journal of interpersonal violence, 2008) Wagman, Jennifer; Baumgartner, Joy Noel; Geary, Cindy Waszak; Nakyanjo, Neema; Ddaaki, William George; Serwadda, David; Gray, Ron; Nalugoda, Fred Kakaire; Wawer, Maria J.Limited data from low-income countries are available on the continuum of coercive experiences, the contexts in which they occur, and how adolescent women perceive and respond to coercion. This article presents results from focus group discussions and in-depth interviews with pregnant and never pregnant sexually active female adolescents, aged 15 to 17, residing in Rakai District, Uganda, to examine sexual coercion, its context, and the links between coercion and adolescent reproductive health outcomes, including early sexual debut and pregnancy. Informants described multiple forms of sexual coercion, including coerced or forced intercourse, unwanted sexual touching, verbal harassment, and transactional sex. Sexual coercion was perceived to be a normal part of intimate relationships; in particular, informants felt that a woman’s lack of decision-making authority, including choices on sexual encounters, was implicit to marriage. This information may help violence prevention programs develop a range of strategies for addressing sexual coercion among adolescents.Item Menstrual Hygiene Knowledge among Adolescents Girls in Rural Rakai District, Uganda(APHA., 2017) Lubinga, Rachel; Nalugoda, Fred; Nakyanjo, Neema; Babirye, Estellah; Nakazibwe, Tahiya; Oyewande, Christiana; Okoror, TitilayoThere is limited research on menstrual hygiene knowledge among rural adolescents’ girls in Rakai District of Uganda, although research shows that over 57% of girls aged 11-13 absent themselves from school in Uganda due to menstrual-related challenges. It is estimated that about half of the girl pupils miss 1-3 days of school per month, translating into a loss of 8-24 school days per year (approximately 11% of the learning time). This is due largely to lack of menstrual hygiene management support (unpublished data). While the focus of research on menstrual hygiene has been carried out in urban areas, there is a need to examine this issue in rural communities. As part of a larger study on menstrual hygiene management, this study assessed the knowledge level among girls who participated in girls’ training workshops. Methods: In collaboration with the Rakai Health Sciences Program, training workshops on reproductive health and empowerment activities were organized in six different locations across Rakai District rural communities. The decision to organize the workshops was based on prior field work that indicated the challenges adolescent girls were having in managing their menstrual hygiene, and missing school due to these challenges. Announcements about the workshops were made at various schools in the district, and school administrators were provided with flyers to distribute. Workshop Training modules included fundamentals of the female reproductive cycle, such as ‘loving your body as it changes’, maintaining cleanliness, and ‘finding your voice’. Workshops were facilitated by health educators. All the girls completed an assent form for minors, while parents completed consent forms. Participants were then divided into groups of 11-14 years old and 15-17 years old. All participants completed demographic questionnaire, and a 10-item knowledge survey to assess their knowledge, and identify gaps that were then addressed during the workshops. All participants received gift packs that included sanitary pads among other items.244 girls participated in the study. Most participants were 14 to 16 years old (73%). While many reported that menstruation is not a disease (74%), and can cause pain (92%), most responded that pregnant women can menstruate (91%), and menstrual blood comes from the stomach where food is digested (72%). Girls ages 16-17 had a higher average number of correct responses than girls aged 12-15, although this difference was not statistically significant (t=1.89, p=0.06). Average number of correct answers was 2.44. There is a need for health education programs on menstrual hygiene, which is essential in efforts to reduce absenteeism, reproductive tract infections and improve health of adolescent girls.Item Perceptions of Adolescent Pregnancy Among Teenage Girls in Rakai, Uganda(Global qualitative nursing research, 2017) Maly, Christina; McClendon, Katherine A.; Baumgartner, Joy Noel; Nakyanjo, Neema; Ddaaki, William George; Serwadda, David; Nalugoda, Fred Kakaire; Wawer, Maria J.; Bonnevie, Erika; Wagman, Jennifer A.The leading causes of death and disability among Ugandan female adolescents aged 15 to 19 years are pregnancy complications, unsafe abortions, and childbirth. Despite these statistics, our understanding of how girls perceive adolescent pregnancy is limited. This qualitative study explored the social and contextual factors shaping the perceptions of adolescent pregnancy and childbirth among a sample of 12 currently pregnant and 14 never pregnant girls living in the rural Rakai District of Uganda. Interviews were conducted to elicit perceived risk factors for pregnancy, associated community attitudes, and personal opinions on adolescent pregnancy. Findings indicate that notions of adolescent pregnancy are primarily influenced by perceptions of control over getting pregnant and readiness for childbearing. Premarital pregnancy was perceived as negative whereas postmarital pregnancy was regarded as positive. Greater understanding of the individual and contextual factors influencing perceptions can aid in development of salient, culturally appropriate policies and programs to mitigate unintended adolescent pregnancies.Item Process evaluation of the SHARE intervention for preventing intimate partner violence and HIV infection in Rakai, Uganda(Evaluation and program planning, 2018) Wagman, Jennifer A.; Gray, Ronald H.; Nakyanjo, Neema; McClendond, Katherine A.; Bonneviea, Erika; Namatovu, Fredinah; Kigozi, Grace; Kagaayi, Joseph; Wawer, Maria J.; Nalugoda, FredThe Safe Homes And Respect for Everyone (SHARE) intervention introduced an intimate partner violence (IPV) prevention approach into Rakai Health Sciences Program, an established HIV research and service organization in Uganda. A trial found exposure to SHARE was associated with reductions in IPV and HIV incidence. This mixed methods process evaluation was conducted between August 2007 and December 2009, with people living in SHARE intervention clusters, to assess awareness about/participation in SHARE, motivators and barriers to involvement, and perceptions of how SHARE contributed to behavior change. Surveys were conducted with 1407 Rakai Community Cohort Study participants. Qualitative interviews were conducted with 20 key informants. Most (77%) were aware of SHARE, among whom 73% participated in intervention activities. Two-thirds of those who participated in SHARE felt it influenced behavior change related to IPV. While some felt confident to take part in new IPV-focused activities of a well-established program, others were suspicious of SHARE’s motivations, implying awareness raising is critical. Many activities appealed to the majority (e.g., community drama) while interest in some activities was limited to men (e.g., film shows), suggesting multiple intervention components is ideal for wide-reaching programming. The SHARE model offers a promising, acceptable approach for integrating IPV prevention into HIV and other established health programs in sub-Saharan Africa.Item Qualitative Assessment of Barriers and Facilitators of PrEP Use Before and After Rollout of a PrEP Program for Priority Populations in South‑central Uganda(AIDS and Behavior, 2021) Ddaaki, William; Strömdahl, Susanne; Teresa Yeh, Ping; Rosen, Joseph G.; Jackson, Jade; Nakyanjo, Neema; Kagaayi, Joseph; Kigozi, Godfrey; Nakigozi, Gertrude; Grabowski, M. Kathryn; Chang, Larry W.; Reynolds, Steven J.; Nalugoda, Fred; Ekström, Anna Mia; Kennedy, Caitlin E.Uganda piloted HIV pre-exposure prophylaxis (PrEP) for priority populations (sex workers, fishermen, truck drivers, discordant couples) in 2017. To assess facilitators and barriers to PrEP uptake and adherence, we explored perceptions of PrEP before and experiences after rollout among community members and providers in south-central Uganda. We conducted 75 indepth interviews and 12 focus group discussions. We analyzed transcripts using a team-based thematic framework approach. Partners, family, peers, and experienced PrEP users provided adherence support. Occupational factors hindered adherence for sex workers and fishermen, particularly related to mobility. Pre-rollout concerns about unskilled/untrained volunteers distributing PrEP and price-gouging were mitigated. After rollout, awareness of high community HIV risk and trust in PrEP effectiveness facilitated uptake. PrEP stigma and unexpected migration persisted as barriers. Community-initiated, tailored communication with successful PrEP users may optimize future engagement by addressing fears and rumors, while flexible delivery and refill models may facilitate PrEP continuation and adherence.Item Self-collected samples as an additional option for STI testing in low-resource settings: a qualitative study of acceptability among adults in Rakai, Uganda(BMJ Publishing Group Ltd, 2023-11) Ogale, Yasmin Parvizi; Grabowski, Mary Kathryn; Nabakka, Proscovia; Ddaaki, William; Nakubulwa, Rosette; Nakyanjo, Neema; Nalugoda, Fred; Kagaayi, Joseph; Kigozi, Godfrey; Denison, Julie A; Gaydos, Charlotte; Kennedy, Caitlin EAbstract Introduction Self-collected samples (SCS) for sexually transmitted infection (STI) testing have been shown to be feasible and acceptable in high-resource settings. However, few studies have assessed the acceptability of SCS for STI testing in a general population in low-resource settings. This study explored the acceptability of SCS among adults in south-central Uganda. Methods Nested within the Rakai Community Cohort Study, we conducted semistructured interviews with 36 adults who SCS for STI testing. We analysed the data using an adapted version of the Framework Method. Results Overall, SCS was acceptable to both male and female participants, regardless of whether they reported recent STI symptoms. Perceived advantages of SCS over provider-collection included increased privacy and confidentiality, gentleness and efficiency. Disadvantages included the lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic. Most participants preferred provider-collected samples to SCS. Nevertheless, almost all said they would recommend SCS and would do it again in the future. Conclusion SCS are acceptable among adults in this low-resource setting and could be offered as an additional option to expand STI diagnostic services.