Browsing by Author "Ojiambo Wandera, Stephen"
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Item Alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in fishing communities of Lake Victoria, Uganda(BMC public health, 2021) Ojiambo Wandera, Stephen; Mbona Tumwesigye, Nazarius; Walakira, Eddy J.; Kisaakye, Peter; Wagman, JenniferFew studies have investigated the association between alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in fishing communities from eastern and central Uganda. Therefore, we aimed to determine the association between alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in the fishing communities on the shores of Lake Victoria, in Uganda. Methods: We conducted multivariable logistic regression analyses of HIV risk behavior using cross-sectional data from 501 young people from Mukono (Katosi landing site) and Namayingo districts (Lugala landing site). Results: Almost all (97%) respondents reported at least one HIV risk behavior; more than half (54%) reported engagement in three or more HIV risk behaviors. Results from the adjusted model indicate that alcohol use, working for cash or kind, being married, and having multiple sexual partners increased the odds of HIV risk behavior. IPV was not associated with HIV risk behavior. Conclusion: Interventions to promote consistent condom use and fewer sexual partnerships are critical for young people in the fishing communities in Uganda.Item Determinants of access to healthcare by older persons in Uganda: a cross-sectional study(International journal for equity in health, 2015) Ojiambo Wandera, Stephen; Kwagala, Betty; Ntozi, JamesOlder persons report poor health status and greater need for healthcare. However, there is limited research on older persons’ healthcare disparities in Uganda. Therefore, this paper aimed at investigating factors associated with older persons’ healthcare access in Uganda, using a nationally representative sample. Methods: We conducted secondary analysis of data from a sample of 1602 older persons who reported being sick in the last 30 days preceding the Uganda National Household Survey. We used frequency distributions for descriptive data analysis and chi-square tests to identify initial associations. We fit generalized linear models (GLM) with the poisson family and the log link function, to obtain incidence risk ratios (RR) of accessing healthcare in the last 30 days, by older persons in Uganda. Results: More than three quarters (76%) of the older persons accessed healthcare in the last 30 days. Access to healthcare in the last 30 days was reduced for older persons from poor households (RR = 0.91, 95% CI: 0.83-0.99); with some walking difficulty (RR = 0.90, 95% CI: 0.83-0.97); or with a lot of walking difficulty (RR = 0.84, 95% CI: 0.75-0.95). Conversely, accessing healthcare in the last 30 days for older persons increased for those who earned wages (RR = 1.08, 95% CI: 1.00-1.15) and missed work due to illness for 1–7 days (RR = 1.19, 95% CI: 1.10-1.30); and 8–14 days (RR = 1.19, 95% CI: 1.07-1.31). In addition, those who reported non-communicable diseases (NCDs) such as heart disease, hypertension or diabetes (RR = 1.09, 95% CI: 1.01-1.16); were more likely to access healthcare during the last 30 days.Item 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, AllenThere 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.Item 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, AllenThere 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.Item 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, BenjaminHealth 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.Item Factors associated with self-reported ill health among older Ugandans: A cross sectional study(Archives of gerontology and geriatrics, 2015) Ojiambo Wandera, Stephen; Golaz, Valerie; Kwagala, Betty; Ntozi, JamesThere is limited research on the prevalence and factors associated with self-reported ill health among older people in Uganda. Objective: Therefore, the aim of this paper was to estimate the prevalence of self-reported ill health and to identify associated risk factors among older people (age 50+) in Uganda. Materials and methods: We conducted secondary analysis of a cross sectional survey data from a weighted sample of 2382 older persons from the 2010 Uganda National Household survey. We used frequency distributions for descriptive statistics, chi-square tests (significance set at 95%) to identify initial associations and multivariable logistic regressions reporting odds ratios to examine observed associations with self-reported ill health. Results: Over half (62%) of the older people reported ill health in the 30 days preceding the survey. Selfreported ill health was positively associated with being a woman, being among the oldest old, living in the eastern region, being a household head, being Catholic, self-reported non-communicable diseases (NCDs) and being disabled.Item “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, FredAdolescents (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.Item Integrating Family Planning Data in Uganda’s Health Management Information System(Research gate, 2018) Ojiambo Wandera, Stephen; Kwagala, Betty; Nankinga, Olivia; Ndugga, Patricia; Kabagenyi, AllenUganda’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.Item 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, BettyFamily 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.Item 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, StephenParent-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.Item 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, AllenStudies 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.Item Predictors of modern contraceptive use during the postpartum period among women in Uganda: a population-based cross sectional study(BMC public health, 2015) Rutaremwa, Gideon; Kabagenyi, Allen; Ojiambo Wandera, Stephen; Jhamba, Tapiwa; Akiror, Edith; Nviiri, Hellen LaetitiaThe rationale for promotion of family planning (FP) to delay conception after a recent birth is a best practice that can lead to optimal maternal and child health outcomes. Uptake of postpartum family planning (PPFP) remains low in sub-Saharan Africa. However, little is known about how pregnant women arrive at their decisions to adopt PPFP. Methods: We used 3298 women of reproductive ages 15–49 from the 2011 UDHS dataset, who had a birth in the 5 years preceding the survey. We then applied both descriptive analyses comprising Pearson’s chi-square test and later a binary logistic regression model to analyze the relative contribution of the various predictors of uptake of modern contraceptives during the postpartum period. Results: More than a quarter (28%) of the women used modern family planning during the postpartum period in Uganda. PPFP was significantly associated with primary or higher education (OR=1.96; 95% CI=1.43-2.68; OR=2.73; 95% CI=1.88-3.97 respectively); richest wealth status (OR=2.64; 95% CI=1.81-3.86); protestant religion (OR=1.27; 95% CI=1.05-1.54) and age of woman (OR=0.97, 95% CI=0.95-0.99). In addition, PPFP was associated with number of surviving children (OR=1.09; 95 % CI=1.03-1.16); exposure to media (OR=1.30; 95% CI=1.05-1.61); skilled birth attendance (OR=1.39; 95% CI=1.12-1.17); and 1–2 days timing of post-delivery care (OR=1.68; 95% CI=1.14-2.47). Conclusions: Increasing reproductive health education and information among postpartum women especially those who are disadvantaged, those with no education and the poor would significantly improve PPFP in Uganda.Item Prevalence and correlates of disability among older Ugandans: evidence from the Uganda National Household Survey(Global health action, 2014) Ojiambo Wandera, Stephen; Ntozi, James; Kwagala, BettyNationally representative evidence on the burden and determinants of disability among older people in sub-Saharan Africa in general, and Uganda in particular, is limited. Objective: The aim of this study was to estimate the prevalence and investigate the correlates of disability among older people in Uganda. Design: We conducted secondary analysis of data from a sample of 2,382 older persons from the Uganda National Household Survey. Disability was operationalized as either: 1) having a lot of difficulty on any one question; 2) being unable to perform on any one question; or, 3) having some difficulty with two of the six domains. We used frequency distributions for description, chi-square tests for initial associations, and multivariable logistic regressions to assess the associations. Results: A third of the older population was disabled. Among all older persons, disability was associated with advancement in age (OR 4.91, 95% CI: 3.38 7.13), rural residence (0.56, 0.37 0.85), living alone (1.56, 1.07 2.27), separated or divorced (1.96, 1.31 2.94) or widowed (1.86, 1.32 2.61) marital status, households’ dependence on remittances (1.48, 1.10 1.98), ill health (2.48, 1.95 3.15), and non-communicable diseases (NCDs) (1.81, 0.80 2.33). Gender was not associated with disability among older persons. Conclusions: Disability was associated with advancement in age, rural residence, living alone, divorced/ separated/widowed marital status, dependence on remittances, ill health, and NCDs. Interventions to improve health and functioning of older people need to focus on addressing social inequalities and on the early preventive interventions and management of NCDs in old age in Uganda.Item Prevalence and risk factors for self-reported noncommunicable diseases among older Ugandans: a cross-sectional study(Global Health Action, 2015) Ojiambo Wandera, Stephen; Ntozi, James; Kwagala, BettyThere is limited evidence about the prevalence and risk factors for non-communicable diseases (NCDs) among older Ugandans. Therefore, this article is aimed at investigating the prevalence of selfreported NCDs and their associated risk factors using a nationally representative sample. Design: We conducted a secondary analysis of the 2010 Uganda National Household Survey (UNHS) using a weighted sample of 2,382 older people. Frequency distributions for descriptive statistics and Pearson chisquare tests to identify the association between self-reported NCDs and selected explanatory variables were done. Finally, multivariable complementary log log regressions to estimate the risk factors for self-reported NCDs among older people in Uganda were done. Results: About 2 in 10 (23%) older persons reported at least one NCD [including hypertension (16%), diabetes (3%), and heart disease (9%)]. Among all older people, reporting NCDs was higher among those aged 60 69 and 70 79; Muslims; and Pentecostals and Seventh Day Adventists (SDAs). In addition, the likelihood of reporting NCDs was higher among older persons who depended on remittances and earned wages; owned a bicycle; were sick in the last 30 days; were disabled; and were women. Conversely, the odds of reporting NCDs were lower for those who were relatives of household heads and were poor. Conclusions: In Uganda, self-reported NCDs were associated with advanced age, being a woman, having a disability, ill health in the past 30 days, being rich, depended on remittances and earning wages, being Muslim, Pentecostal and SDAs, and household headship. The Ministry of Health should prevent and manage NCDs by creating awareness in the public and improving the supply of essential drugs for these health conditions. Finally, there is a need for specialised surveillance studies of older people to monitor the trends and patterns of NCDs over time.Item Spousal sexual violence, sexual behavior and sexually transmitted infections among ever-married women in Uganda(African Population Studies, 2010) Ojiambo Wandera, Stephen; Ntozi, James P. M.; Kwagala, BettyDespite the increasing recognition of the significance of spousal sexual violence in developing countries, evidence on its consequences for reproductive health remains limited. The aim of the paper was to examine the relationship between spousal sexual violence (SSV) and sexually transmitted infections (STIs) using a sample of 1749 ever-married women, from the 2006 Uganda Demographic and Health Survey. Pearson Chi-square tests and binary logistic regressions were used to investigate associations between SSV, STIs and selected reproductive health outcomes. From the analyses, 25% and 15% of ever-married women experienced SSV and reported STIs, respectively in the last 12 months. Women who experienced SSV were twice more likely to have had STIs in the last 12 months compared to those who did not. SSV is an important social and public health problem having implications on women's reproductive health and interventions to improve it should directly address the issue of spousal sexual violence.