NRU :: Browsing by Author "Ndugga, Patricia"

Browsing by Author "Ndugga, Patricia"

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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
Correlates of uptake of optimal doses of sulfadoxine‑pyrimethamine for prevention of malaria during pregnancy in East‑Central Uganda
(Malaria Journal, 2020) Mbonye, K. Martin; Kirwana, B. Venantius; Ndugga, Patricia; Kikaire, Bernard; Baleeta, Keith; Kabagenyi, Allen; Asiimwe, Godfrey; Twesigye, Rogers; Kadengye T., Damazo; Dathan, Byonanebye M.
In 2012, the World Health Organization recommended that pregnant women in malaria-endemic countries complete at least three (optimal) doses of intermittent preventive treatment (IPTp) using sulfadoxinepyrimethamine (SP) to prevent malaria and related adverse events during pregnancy. Uganda adopted this recommendation, but uptake remains low in East-Central and information to explain this low uptake remains scanty. This analysis determined correlates of uptake of optimal doses of IPTp-SP in East-Central Uganda. Methods: This was a secondary analysis of the 2016 Uganda Demographic Health Survey data on 579 women (15–49 years) who attended at least one antenatal care (ANC) visit and had a live birth within 2 years preceding the survey. Uptake of IPTp-SP was defined as optimal if a woman received at least three doses; partial if they received 1–2 doses or none if they received no dose. Multivariate analysis using multinomial logistic regression was used to determine correlates of IPTp-SP uptake. Results: Overall, 22.3% of women received optimal doses of IPTp-SP, 48.2% partial and 29.5% none. Attending ANC at a lower-level health centre relative to a hospital was associated with reduced likelihood of receiving optimal doses of IPTp-SP. Belonging to other religious faiths relative to Catholic, belonging to a household in the middle relative to poorest wealth index, and age 30 and above years relative to 25–29 years were associated with higher likelihood of receiving optimal doses of IPTp-SP. Conclusions: In East-Central Uganda, uptake of optimal doses of IPTp-SP is very low. Improving institutional delivery and household wealth, involving religious leaders in programmes to improve uptake of IPTp-SP, and strengthening IPTp-SP activities at lower level health centers may improve uptake of IPTp-SP in the East-Central Uganda.
Determinants of Early Postnatal Care Attendance in Uganda: Further Analysis of the 2016 Demographic and Health Survey
(DHS Working Papers, 2019) Ndugga, Patricia; Namiyonga, Noor Kassim; Sebuwufu, Deogratious
The first two days after childbirth present the highest risk of dying for a mother. Providing postnatal care within the first two days after childbirth can help avert maternal mortality because it allows early detection of problems that could result in adverse maternal health outcomes. Unfortunately, knowledge of the uptake of early postnatal care (EPNC), which is imperative for informing policies aimed at reducing maternal mortality, remains low in Uganda. Therefore, the purpose of this study is to investigate the determinants of early postnatal care attendance among Ugandan women of reproductive age. Methods: This study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey (UDHS). The study sample comprised 5,471 women of reproductive age 15–49 who delivered a child in the 2 years preceding the survey. We used logistic regression to identify factors associated with use of early postnatal care. Andersen’s Behavioral Model of health services utilization guided the selection of independent variables. Results: Our findings showed that 50% of mothers used EPNC services for their most recent delivery in the 2 years preceding the survey. Women’s residence, education level, religion, wealth status, marital status, occupation, antenatal care (ANC) attendance, place of delivery, birth order, perceived accessibility of health facilities, and access to mass media messages were associated with greater use of EPNC. Women in urban areas were more likely to use EPNC than women in rural areas, at 63% versus 46%. Nearly two-thirds of the women with secondary education or higher (64%) received EPNC compared with less than half of women with no education (47%) and women with a primary education (44%). Receipt of EPNC was more common among women who attended at least four ANC visits for their most recent birth, at 54%, versus 43% among women who did not receive the recommended four or more ANC visits. The percentage of women receiving EPNC was much higher among women who delivered at a health facility, either a public facility (63%) or private facility (65%), versus only 9% among women who delivered at home. Multivariate analysis showed that delivery at a health facility was the most important determinant of early postnatal care attendance. Even so, the fact that only about two-thirds of women who delivered at a health facility received early postpartum care shows substantial room for improvement. Conclusion: To increase mothers’ use of EPNC services and improve maternal survival in Uganda, policies and programs could promote and strengthen health facility delivery and ensure that EPNC services are provided to all women before discharge. Interventions should target women who deliver at home, women who attend fewer than four ANC visits, and women with a primary education.
Empowerment, intimate partner violence and skilled birth attendance among women in rural Uganda
(Reproductive health, 2016) Kwagala, Betty; Nankinga, Olivia; Ojiambo Wandera, Stephen; Ndugga, Patricia; Kabagenyi, Allen
There is limited research on how the empowerment of women and intimate partner violence (IPV) are associated with skilled birth attendance (SBA) among rural women in Uganda. Therefore, the aim of this paper was to investigate the association between women’s empowerment, their experience of IPV and SBA in rural Uganda. Methods: Using data from the Uganda Demographic and Health Survey (UDHS), we selected 857 rural women who were in union, had given birth in the last 5 years preceding the survey and were selected for the domestic violence (DV) module. Frequency distributions were used to describe the background characteristics of the women and their partners. Pearson’s chi-squared (χ2) tests were used to investigate the associations between SBA and women’s empowerment; and partners’ and women’s socio-demographic factors including sexual violence. Multivariable logistic regression analyses were used to examine the association between SBA and explanatory variables. Results: More than half (55 %) of the women delivered under the supervision of skilled birth attendant. Women’s empowerment with respect to participation in household decision-making, property (land and house) (co)ownership, IPV, and sexual empowerment did not positively predict SBA among rural women in Uganda. Key predictors of SBA were household wealth status, partners’ education, ANC attendance and parity. Conclusions: For enhancement of SBA in rural areas, there is a need to encourage a more comprehensive ANC attendance irrespective of number of children a woman has; and design interventions to enhance household wealth and promote men’s education.
Empowerment, partner’s behaviours and intimate partner physical violence among married women in Uganda
(BMC public health, 2013) Kwagala, Betty; Ojiambo Wandera, Stephen; Ndugga, Patricia; Kabagenyi, Allen
There is dearth of knowledge and research about the role of empowerment, partners’ behaviours and intimate partner physical violence (IPPV) among married women in Uganda. This paper examined the influence of women’s empowerment and partners’ behaviours on IPPV among married women in Uganda. Methods: The 2011 Uganda Demographic and Health Survey data were used, selecting a weighted sample of 1,307 women in union considered for the domestic violence module. Cross tabulations (chi-square tests) and multivariate logistic regressions were used to identify factors associated with IPPV. Results: The prevalence of IPPV among women in union in Uganda is still high (41%). Women’s occupation was the only measure of empowerment that was significantly associated with IPPV, where women in professional employment were less likely to experience IPPV. Women from wealthy households were less likely to experience IPPV. IPPV was more likely to be reported by women who had ever had children and witnessed parental IPPV. IPPV was also more likely to be reported by women whose husbands or partners: accused them of unfaithfulness, did not permit them to meet female friends, insisted on knowing their whereabouts and sometimes or often got drunk. Women who were afraid their partners were also more likely to report IPPV.
Facilitators, best practices and barriers to integrating family planning data in Uganda’s health management information system
(BMC health services research, 2019) Ojiambo Wandera, Stephen; Kwagala, Betty; Nankinga, Olivia; Ndugga, Patricia; Kabagenyi, Allen; Adamou, Bridgit; Kachero, Benjamin
Health management information systems (HMIS) are instrumental in addressing health delivery problems and strengthening health sectors by generating credible evidence about the health status of clients. There is paucity of studies which have explored possibilities for integrating family planning data from the public and private health sectors in Uganda’s national HMIS. This study sought to investigate the facilitators, best practices and barriers of integrating family planning data into the district and national HMIS in Uganda. Methods: We conducted a qualitative study in Kampala, Jinja, and Hoima Districts of Uganda, based on 16 key informant interviews and a multi-stakeholder dialogue workshop with 11 participants. Deductive and inductive thematic methods were used to analyze the data. Results: The technical facilitators of integrating family planning data from public and private facilities in the national and district HMIS were user-friendly software; web-based and integrated reporting; and availability of resources, including computers. Organizational facilitators included prioritizing family planning data; training staff; supportive supervision; and quarterly performance review meetings. Key behavioral facilitators were motivation and competence of staff. Collaborative networks with implementing partners were also found to be essential for improving performance and sustainability. Significant technical barriers included limited supply of computers in lower level health facilities, complex forms, double and therefore tedious entry of data, and web-reporting challenges. Organizational barriers included limited human resources; high levels of staff attrition in private facilities; inadequate training in data collection and use; poor culture of information use; and frequent stock outs of paper-based forms. Behavioral barriers were low use of family planning data for planning purposes by district and health facility staff.
Factors associated with modern contraceptive use among young and older women in Uganda; a comparative analysis
(BMC public health, 2014) Asiimwe, John Bosco; Ndugga, Patricia; Mushomi, John; Manyenye Ntozi, James Patrick
Much of the research literature about the use of family planning generalizes contraceptive use among all women, using age as a covariate. In Uganda, a country with divergent trends in modern family planning use, this study was set to explore whether or not the predictors of contraceptive use differ by age. This was assessed by using data from the 2011 Uganda Demographic and Health Survey (UDHS). Methods: We restricted the sample from each round to fecund, non-pregnant married women age 15–34 who were sexually active within one year prior to the survey, resulting in a sample of 2,814 women. We used logistic regression with age variable used as an interaction term to model the relationship between selected independent variables and the outcome variable (modern contraception use) for each group of women. Results: We found that the key factors associated with use of modern contraceptives varied among young and older married women age 15–24 and 25–34 respectively. Results showed that perception on distance to health facility, listening to radio and geographical differences exhibited significant variability in contraceptive use among the young and the older women. Other key factors that were important for both age groups in explaining contraceptive use were; desire to have children after two years and education level. Conclusions: Addressing contraceptive use among old and young women in Uganda requires concerted efforts that target such women to address the socio economic barriers that exist. There is need for increased access of family planning service to the population through strengthening the use of Village Health Teams (VHTs) whose service is currently limited in coverage (MoH, 2009). Given the variation in contraceptive use between the two age groups, our findings further suggest that there is need for variability in media targeting among the young and the older women categories for improved use of modern contraceptives, for instance using alternative media strategies to reach the young women. Family planning policies should also be tailored to address the specific needs of different age groups of women with varied geographical locations.
“If your mother does not teach you, the world will…”: A qualitative study of parent-adolescent communication on sexual and reproductive health issues in Border districts of eastern Uganda
(Research square, 2022) Ndugga, Patricia; Kwagala, Betty; Ojiambo Wandera, Stephen; Kisaakye, Peter; Mbonye, Martin K.; Ngabirano, Fred
Adolescents (10–19 years) in developing countries experience a host of sexual and reproductive (SRH) challenges, with detrimental SRH and socio-economic consequences. These include early sexual debut, sexually transmitted infections including HIV, unsafe abortions, teenage pregnancy, and early childbearing. Parent-adolescent communication about SRH has significant potential to reduce adolescents’ risky sexual behaviors. However, communication between parents and adolescents is limited. We assessed the facilitators and barriers to parent-adolescent communication about sexual and reproductive health in two border districts of Eastern Uganda. Methods A community-based cross-sectional qualitative study was conducted in the border districts of Busia and Tororo in Eastern Uganda. Data collection entailed 8 Focus Group Discussions comprising parents, adolescents (10–17 years) and 26 Key Informants. Interviews were audio-recorded, transcribed, and translated into English. Thematic analysis was conducted with the aid of NVIVO 12 software. Results Parent-adolescent communication about SRH was not common. Facilitators of parent-adolescent communication were: good parent-child relationship, role of the mother, education level, and exposure of the parent. Parents are, however, limited by sexual and reproductive health-related cultural norms, inadequate capacity for parents to address pertinent SRH issues, busy schedules, poor modeling by parents, and inability to meet children’s /household basic needs. Conclusion Parents’ ability to communicate with their children is hindered by cultural barriers and inadequate knowledge. There is a need to equip parents with adequate information and skills to ease communication. Additionally, parent-adolescent communication on sexual and reproductive health should be integrated into parenting interventions so as to improve SRH communication between parents and children.
Integrating Family Planning Data in Uganda’s Health Management Information System
(Research gate, 2018) Ojiambo Wandera, Stephen; Kwagala, Betty; Nankinga, Olivia; Ndugga, Patricia; Kabagenyi, Allen
Uganda’s health management information system (HMIS) was established in 1985 to collect and analyze national data on morbidity from communicable and noncommunicable diseases, reproductive health, family planning (FP), and immunization (Kintu, et al., 2004). The routine health data reporting system has evolved to the current platform known as the district health information system, version 2 (DHIS 2), which began in 2011 in a few districts and was rolled out to all districts in Uganda in 2012 (Kiberu, et al., 2014). Few studies have explored the mechanisms for integrating FP data from the public and private health sectors in Uganda’s national HMIS. This study aimed to investigate the barriers, facilitators, and best practices of integrating these FP data in the district and national HMIS in Uganda. Methods: We conducted a qualitative study in Kampala, Jinja, and Hoima Districts. Primary data were collected from 16 key informant interviews (KIIs) and a multistakeholder dialogue (MSD) workshop comprised of 11 participants. The KIIs included three Ministry of Health (MOH) officers, three HMIS focal persons at nongovernmental organizations, four HMIS focal persons who were district biostatisticians or medical records officers, and six providers who were medical records officers at public and private health facilities. We conducted a systematic review of the HMIS in sub-Saharan African countries that are FP priorities for the United States Agency for International Development (USAID). The systematic literature review covered 2008–2016.
Modern contraceptive use among sexually active men in Uganda: does discussion with a health worker matter?
(MC Public Health, 2014) Kabagenyi, Allen; Ndugga, Patricia; Ojiambo Wandera, Stephen; Kwagala, Betty
Family planning programs have recently undergone a fundamental shift from being focused on women only to focusing on men individually, or on both partners. However, contraceptive use among married men has remained low in most high-fertility countries including Uganda. Men’s role in reproductive decision-making remains an important and neglected part of understanding fertility control both in high-income and low-income countries. This study examines whether discussion of family planning with a health worker is a critical determinant of modern contraceptive use by sexually active men, and men’s reporting of partner contraceptive use. Methods: The study used data from the 2011 Uganda Demographic and Health Survey comprising 2,295 men aged 15–54 years. Specifically, analyses are based on 1755 men who were sexually active 12 months prior to the study. Descriptive statistics, Pearson’s chi-square test, and logistic regression were used to identify factors that influenced modern contraceptive use among sexually active men in Uganda. Results: Findings indicated that discussion of family planning with a health worker (OR =1.85; 95% CI: 1.29–2.66), region (OR = 0.41; 95% CI: 0.21–0.77), education (OR =2.13; 95% CI: 1.01–4.47), wealth index: richer (OR = 2.52; 95% CI: 1.58–4.01), richest (OR = 2.47; 95% CI: 1.44–4.22), surviving children (OR = 2.04; 95% CI:1.16–3.59) and fertility preference (OR = 3.50; 95% CI: 1.28–9.61) were most significantly associated with modern contraceptive use among men. Conclusions: The centrality of the role of discussion with health workers in predicting men’s participation in family planning matters may necessitate creation of opportunities for their further engagement at health facilities as well as community levels. Men’s discussion of family planning with health workers was significantly associated with modern contraceptive use. Thus, creating opportunities through which men interact with health workers, for instance during consultations, may improve contraceptive use among couples.
Parent–child communication on sexual and reproductive health in border districts of Eastern Uganda
(Sex Education, 2022) Kisaakye, Peter; Ndugga, Patricia; Kwagala, Elizabeth; Kayitale Mbonye, Martin; Ngabirano, Fred; Ojiambo Wandera, Stephen
Parent-child communication concerning sexual and reproductive health (SRH) has significant potential to reduce children’s risky sexual behaviour. Despite these benefits, few parents communicate with their children about SRH issues in Uganda. Using multistage stratified sampling in a cross-sectional survey, we estimated the prevalence and investigated the factors that were associated with recent parent-child communication among 600 children (10- 17 years) in border districts of Uganda (Busia and Tororo). Results indicated that 61% of children reported to having received parentchild communication on SRH. Communication was more likely to happen among children living in urban areas (OR=4.88; 95% CI=1.79-13.33), boys (OR=1.84; 95% CI=1.13-3.00), those aged 15- 19 years (OR=2.59; 95% CI=1.51-4.46) and among children from households that owned a mobile phone (OR=2.11; 95% CI=1.05- 4.21) than their counterparts. Parent-child communication was also higher among children who were comfortable discussing SRH issues (OR=27.12; 95% CI=16.02-45.89) and children from Tororo district (OR=2.34; 95% CI=1.36-4.01). The findings provide a rich understanding of the factors associated with Parent-child communication in the border districts of Uganda. These results provide a basis for policy enactment or revision regarding the encouragement of parent-child communication about SRH in Uganda.
Partners’ controlling behaviors and intimate partner sexual violence among married women in Uganda
(BMC Public Health, 2015) Ojiambo Wandera, Stephen; Kwagala, Betty; Ndugga, Patricia; Kabagenyi, Allen
Studies on the association between partners’ controlling behaviors and intimate partner sexual violence (IPSV) in Uganda are limited. The aim of this paper was to investigate the association between IPSV and partners’ controlling behaviors among married women in Uganda. Methods: We used the 2011 Uganda Demographic and Health Survey (UDHS) data, and selected a weighted sample of 1,307 women who were in a union, out of those considered for the domestic violence module. We used chi-squared tests and multivariable logistic regressions to investigate the factors associated with IPSV, including partners’ controlling behaviors. Results: More than a quarter (27%) of women who were in a union in Uganda reported IPSV. The odds of reporting IPSV were higher among women whose partners were jealous if they talked with other men (OR = 1.81; 95% CI: 1.22-2.68), if their partners accused them of unfaithfulness (OR = 1.50; 95% CI: 1.03-2.19) and if their partners did not permit them to meet with female friends (OR = 1.63; 95% CI: 1.11-2.39). The odds of IPSV were also higher among women whose partners tried to limit contact with their family (OR = 1.73; 95% CI: 1.11-2.67) and often got drunk (OR = 1.80; 95% CI: 1.15-2.81). Finally, women who were sometimes or often afraid of their partners (OR = 1.78; 95% CI: 1.21-2.60 and OR = 1.56; 95% CI: 1.04-2.40 respectively) were more likely to report IPSV. Conclusion: In Uganda, women’s socio-economic and demographic background and empowerment had no mitigating effect on IPSV in the face of their partners’ dysfunctional behaviors. Interventions addressing IPSV should place more emphasis on reducing partners’ controlling behaviors and the prevention of problem drinking.
Socio-Demographic Factors Associated with Contra- ceptive Use among Young Women in Comparison with Older Women in Uganda
(Research on Humanities and Social Sciences, 2014) Asiimwe, John Bosco; Ndugga, Patricia; Mushomi, John
Much of the research literature about the use of family planning generalizes contraceptive use among all women, using age as a covariate. In Uganda, a country with divergent trends in modern family planning use among younger and older married women, we hypothesize that factors associated with contraceptive use operate in a fundamentally different way among married women in two age groups: 15-24 and 25-34. We tested this hypothesis using data from the Uganda Demographic and Health Survey (UDHS) in 2006 and 2011. We restricted the sample from each round to fecund, non-pregnant married women age 15-34 who were sexually active within one year prior to the survey, resulting in a sample of 2,802 women in 2006 and 2,814 women in 2011. In Uganda, as in most countries, the level of modern contraceptive use is much lower among younger married women compared with older women. We used logistic regression to model the relationship between selected independent variables and the outcome variable (current use of modern contraception) for each group of women in each year. We found that the key factors associated with current use of modern contraceptives among younger married women age 15-24 in both 2006 and 2011 were residence and desire for children, while among women age 25-34, the significant factors associated with contraceptive use in both rounds were education level, household wealth and desire for children. The findings suggest that increasing secondary education for women and improving the livelihood of the population overall is important. Family planning programs should be intensified to meet the needs of young married women in rural areas of the country.
Timing and quality of antenatal care among adolescent mothers in Luuka district, Uganda
(Research Square, 2022) Kayemba, Vincent; Kabagenyi, Allen; Ndugga, Patricia; Wasswa, Ronald; Waiswa, Peter
Effective Antenatal Care (ANC) is dependent on timely initiation of the first visit and quality care to mitigate risk factors in pregnancy. However, most adolescent mothers attend their first visit later than the recommended time while others do not receive all the required components of care. This study sought to examine the predictors associated with timing of the first ANC visit and receipt of the recommended components of care among adolescent mothers in Luuka district. Methods The study was carried out between March and May 2021 among 248 adolescent mothers aged 10-19 years from Luuka district, who were either pregnant or postpartum with infants aged 0-3 months. Data analyses were done using descriptive techniques, Pearson chi-square and Fisher’s exact tests of independence were done at bivariate level and thereafter binary logistic regression. Results Findings showed that majority of the adolescent mothers (82%) attended ANC for their most recent pregnancy or birth. Still, only 47% had timely ANC visit while 36% had all the recommended components of care. Having knowledge on dangers signs in pregnancy was a determinant of both receipt of all components of ANC (AOR = 6.57, 95%CI = 1.75 - 24.65) and early timing of the first visit (AOR = 0.35, 95%CI = 0.12 – 0.97). Further, the odds of making the first visit after the first trimester were highest among adolescent mothers who had ever given birth (AOR = 3.67, 95%CI:1.68 - 8.02) and those without independent decisions on health care (AOR = 3.45, 95%CI:1.04 - 11.42). Conclusion Knowledge of obstetric pregnancy danger signs, having ever given birth and decision making on health care seeking are pivotal determinants of adolescent mothers’ timing of the first ANC visit and uptake of the recommended components of care. We therefore recommend the need to sensitize adolescent mothers through different channels of media on the benefits of ANC. Also, ensuring accessibility and affordability of these services among health facilities will significantly increase the uptake and early timing of the antenatal care services among adolescent mothers in rural communities.

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