Browsing by Author "Nansubuga, Elizabeth"

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    A Multilevel Decomposition of Time Variation in the Risks of Infant Mortality in Rural Uganda: UDHS 1995–2016
    (East African Journal of Health and Science, 2023) Odur, Benard; Nansubuga, Elizabeth; Wamala, Robert; Atuhaire, Leonard
    The study assessed the contribution of maternal, child, paternal, household, proximate, and community-level factors to infant mortality risk time variation in rural Uganda between 1995 and 2016. Five rounds of Uganda Demographic and Health Survey data sets were used, and a multilevel mixed-effect logistic regression model was applied to decompose the contribution of different factors to time variation in the risks of infant mortality. All live births that were made five years before the surveys of 1995, 2001, 2006, 2011, and 2016 were considered, with infants who did not survive beyond one year treated as the outcome variable analysis, excluding those who were born less than 12 months before the survey. The fixed part of the model helped us detect the significant variables in determining infant mortality, and yet the random part of the model helped us quantify the amount of time variation in the risks of infant mortality explained by the selected variables. The child-level determinants of infant mortality were sex, birth order, and weight. Among the maternal factors, the study revealed that marital status, access to ANC, use of contraceptives, maternal education level, and preceding birth interval were consistent deterrents of infant mortality, while household size, sanitation, and wealth index remained critical. While controlling for other factors in the rural areas, time variation in the risks of infant mortality was dependent on community factors (such as region, community hygiene, and prenatal care utilization rate), proximate factors (such as access to prenatal care, contraceptives use, place of delivery, and the number of ANC visits), maternal factors (such as marital status, educational level, age, parity, preceding birth interval, desire for pregnancy, and breastfeeding), and endowment. It was observed that the changes in the risks of infant mortality over the period were explained by community (30.7%), proximate (22.7%), maternal (41.0%), and endowment (37.9%). Child-level factors explained 28.2%, and paternal-level education level explained only 30.1%. Remarkably, household-level factors captured 32.3% of the changes in infant mortality. A higher proportion of the explained variation in the risk of infant mortality across communities (PCV) was captured by child, paternal, maternal endowment, and household factors. Interventions to accelerate the reduction in infant mortality should target birth spacing to at least two years, girl child education to at least o level, joint household decision-making in having children, avoiding teenage pregnancies, postnatal care utilization, enforcing at least four ANC visits during pregnancy, improving household sanitation, and increasing access to safe water at household-levels
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    Contraceptive Uptake Among Married Women in Uganda: Does Empowerment Matter?
    (African Population Studies, 2014) Kibira, Simon P. S.; Ndugga, Patricia; Nansubuga, Elizabeth; Sewannonda, Andrew; Kwagala, Betty
    Although contraceptive prevalence increased from 24% to 30% between 2006 and 2011, this uptake is still below global level of 62% and low levels of women empowerment could be a factor. Data was extracted from 2011 UDHS to examine associations between women’s empowerment and contraceptive uptake. We developed four empowerment indices symbolising economic and social empowerment, established associations between them and contraceptive use. Most women (83%) were from the rural areas and 61% were married for 10+ years. Most (59%) scored low on power over earnings and domestic violence indices. All indices independently were positively associated with contraceptive use, but only the reproductive health rights index was significant before (OR 2.13, 95% CI; 1.52-2.98) and after adjusting for background characteristics (AOR 1.72, 95% CI; 1.07-2.73). Empowered women were more likely to use contraceptives. More efforts in sensitisation of women about their sexual and reproductive health rights as well as ensuring more control over their earnings
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    Experiences and intentions of Ugandan household tuberculosis contacts receiving test results via text message: an exploratory study
    (BMC public health, 2020) Ggita, Joseph M.; Katahoire, Anne; Meyer, Amanda J.; Nansubuga, Elizabeth; Nalugwa, Talemwa; Turimumahoro, Patricia; Ochom, Emmanuel; Ayakaka, Irene; Haberer, Jessica E.; Katamba, Achilles; Armstrong-Hough, Mari; Davis, J. Lucian
    The World Health Organization (WHO) recommends household contact investigation for tuberculosis (TB) in high-burden countries. However, household contacts who complete evaluation for TB during contact investigation may have difficulty accessing their test results. Use of automated short-messaging services (SMS) to deliver test results could improve TB status awareness and linkage to care. We sought to explore how household contacts experience test results delivered via SMS, and how these experiences influence follow-up intentions. Methods: We conducted semi-structured interviews with household contacts who participated in a randomized controlled trial evaluating home sputum collection and delivery of TB results via SMS (Pan-African Clinical Trials Registry #201509000877140). We asked about feelings, beliefs, decisions, and behaviors in response to the SMS results. We analyzed the content and emerging themes in relation to the Theory of Planned Behavior. Results: We interviewed and achieved thematic saturation with ten household contacts. Nine received TB-negative results and one a TB-positive result. Household contacts reported relief upon receiving SMS confirming their TB status, but also said they lacked confidence in the results delivered by SMS. Some worried that negative results were incorrect until they spoke to a lay health worker (LHW). Household contacts said their long-term intentions to request help or seek care were influenced by perceived consequences of not observing the LHW’s instructions related to the SMS and follow-up procedures; beliefs about the curability of TB; anticipated support from LHWs; and perceived barriers to responding to an SMS request for further evaluation. Conclusion: Household contacts experienced relief when they received results. However, they were less confident about results delivered via SMS than results delivered by LHWs. Delivery of results by SMS should complement continued interaction with LHWs, not replace them.
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    Interrelationships between early antenatal care, health facility delivery and early postnatal care among women in Uganda: a structural equation analysis
    (Global Health Action, 2020) Atuhaire, Ruth; Atuhaire, Leonard K.; Wamala, Robert; Nansubuga, Elizabeth
    Early medical checkups during and after delivery are key strategies to detect, prevent and treat maternal health concerns. Knowledge of interrelationships between early Antenatal Care (ANC), skilled delivery and early postnatal care (EPNC) is essential for focused and well-targeted interventions. This paper investigated the interconnectedness between maternal health services in Uganda. Objective: This study examines the predictors of interrelationships between early antenatal care, health facility delivery and early postnatal care. Methods: We used a sample of 10,152 women of reproductive ages (15–49), who delivered a child five years prior to the 2016 Uganda Demographic and Health Survey. A generalized Structural Equation Model and STATA 13.0 software were used. Results: Early ANC was a mediating factor for health facility delivery (aOR=1.04; 95% CI=1.01- 1.14) and EPNC (aOR=1.1; 95% CI=1.05-1.26). Increased odds of early ANC utilization was directly associated with: Adult women aged 35-49 (aOR=1.18; 95% CI=1.10-1.35), having completed primary seven (aOR=1.68; 95% CI=1.56-1.84); distance to a health facility (aOR=1.35; 95% CI=1.23-1.73) and costs (aOR=1.85; 95% CI=1.31-2.12) not being a problem, available community workers (aOR=1.06; 95% CI=1.04-1.17), pregnancy complications (aOR=2.04; 95% CI=1.85-2.26) and desire for pregnancy (aOR=1.15; 95% CI=1.07-1.36). Through early ANC utilization, being married (aOR=1.16; (=1.04*1.10)), no distance issues ((aOR=1.40; (=1.04*1.35)) and complications (aOR=2.12; (=1.04*2.04)) indirectly influenced utilization of health facility delivery. Women aged 20-34 (aOR=1.01; (=0.92*1.1)), completing primary seven (aOR=1.85; (=1.69*1.1)) and no cost problems (aOR=2.04; (=1.85*1.1)) indirectly influenced EPNC. Conclusion: Early antenatal care was a mediating factor for health facility delivery and EPNC; and hence, there is need for more focus on factors for increased early antenatal care utilization. Women with higher education and those with no cost problems were more likely to have early ANC utilization, skilled delivery and EPNC; therefore there is need to design and implement policies targeting social and economically disadvantaged women.
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    Male involvement in utilization of emergency obstetric care and averting of deaths for maternal near misses in Rakai district in Central Uganda
    (African Population Studies, 2015) Nansubuga, Elizabeth; Ayiga, Natal
    Although studies have assessed male involvement in birth preparedness and complication readiness, little is known about their involvement after the onset of maternal near miss complications. This information is important in developing appropriate strategies for male involvement in accessing emergency obstetric care (EmOC) in order to reduce Uganda’s high maternal mortality ratio. The study examined the roles played by men after the onset of maternal near miss complications in Uganda. A qualitative study using narratives of 40 purposively selected maternal near misses and in-depth interviews of 10 randomly selected men was conducted. Results showed that men were involved in postpartum uptake of long term contraceptive methods, management of obstetric complications, decision making, social support, transport arrangements and provision of financial support to access EmOC. Therefore, men should be sensitized on the recommended haemorrhage medication during home births, the need for supervised deliveries and prompt referral of their wives to health facilities
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    Parametric Versus Non-Parametric Models for Predicting Infant Mortality within Communities in Uganda using the 2016 Uganda Demographic and Health Survey Data
    (East African Journal of Health and Science, 2023) Odur, Benard; Nansubuga, Elizabeth; Odwee, Jonathan; Atuhaire, Leonard
    Machine learning techniques have been infrequently used to identify community-based infant mortality risks. Achieving SDG 3 Targets 3.2 and 3.3 could be expedited by early detection of at-risk infants within communities. This study aimed to devise a community-centric algorithm for predicting infant mortality. We analysed UDHS 2016 data containing birth records for 22,635 children born within the five years preceding the survey, excluding those born within a year of the interview date. Twelve machine learning models were evaluated for their predictive capabilities using the area under the receiver operating characteristic curve (AUC ROC) in Python. Data subsets were divided into training and testing sets in a 2:1 ratio. Among the evaluated models, CatBoost showed superior performance with an AUC ROC of 74.9%. The five most influential variables for the CatBoost model were postnatal care utilisation, paternal age, household size, preceding birth interval, and maternal age. While the algorithm’s best performance was achieved using 28 variables, it still exhibited robust predictive power when limited to the top 8 or 10 variables. Hence, CatBoost stands out as an effective tool for identifying community-based infant mortality risks
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    Prevalence of maternal near miss and community-based risk factors in Central Uganda
    (International Journal of Gynecology & Obstetrics, 2016) Nansubuga, Elizabeth; Ayiga, Natal; Moyer, Cheryl A.
    Objective: To examine the prevalence of maternal near-miss (MNM) and its associated risk factors in a community setting in Central Uganda. Methods: A cross-sectional research design employing multi-stage sampling collected data from women aged 15–49 years in Rakai, Uganda, who had been pregnant in the 3 years preceding the survey, conducted between August 10 and December 31, 2013. Additionally, in-depth interviews were conducted. WHO-based disease and management criteria were used to identify MNM. Binary logistic regression was used to predict MNM risk factors. Content analysis was performed for qualitative data. Results: Survey data were collected from 1557 women and 40 in-depth interviews were conducted. TheMNMprevalence was 287.7 per 1000 pregnancies; the majority of MNMs resulted from hemorrhage. Unwanted pregnancies, a history of MNM, primipara, pregnancy danger signs, Banyakore ethnicity, and a partner who had completed primary education onlywere associated with increased odds of MNM (all P b 0.05). Conclusions: MNM morbidity is a significant burden in Central Uganda. The present study demonstrated higher MNM rates compared with studies employing organ-failure MNM-diagnostic criteria. These findings illustrate the need to look beyond mortality statistics when assessing maternal health outcomes. Concerted efforts to increase supervised deliveries, access to emergency obstetric care, and access to contraceptives are warranted.
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    Regional Differentials in Early Antenatal Care, Health Facility Delivery and Early Postnatal Care among Women in Uganda
    (Journal of Economics and Behavioral Studies, 2021) Atuhaire, Ruth; Wamala, Robert; Atuhaire, Leonard K.; Nansubuga, Elizabeth
    This study aimed at examining regional differentials in maternal healthcare services in Uganda. Using a sample of 1,521 women of reproductive ages (15-49) from Eastern and Western sub-regions of Uganda, and non-linear Oaxaca’ Blinder Multivariate Decomposition method, we assessed differentials in utilization of early antenatal care, health facility delivery and early postnatal care services among the women, henceforth, establishing main predictors of regional inequalities that will enable policymakers to make better evenly interventions and focused decisions. The study reveals that differentials in the utilization of maternal healthcare services are not only hindered by social and economic barriers, but also widespread disparities in the utilization of existing services. Significant differentials were attributed to both variation in women’s characteristics and effects of coefficients. Findings showed that the gap in early antenatal care would reduce on average by 31.6% and 34.7% of differences in availability of community health workers and media exposure respectively, were to disappear. Furthermore, the gap would increase on average by 68.8% and 12.6% in absence of the variation in effects of maternal education, and wealth respectively. The gap in health facility delivery would reduce on average by 24.6% and 37.2% of differences in community health worker availability and media exposure were to disappear respectively and increase on average by 54.9% in the absence of variations in effects of maternal education. The gap in EPNC would reduce on average by 18.5% and 17.17% of differences in maternal education and community health worker availability were to disappear respectively and increase on average by 52.8% and 8.4% in the absence of the variation in effects of maternal education and wealth respectively. Progress towards equitable maternal health care should focus more on strategies that guarantee even distribution of community health workers, broad dissemination of maternal healthcare information and girl child education completion in Uganda.