Browsing by Author "Ruzaaza, Gad N."

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    Adolescents’ Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms
    (International journal of environmental research and public health, 2018) Kemigisha, Elizabeth; Nyakato, Viola N.; Bruce, Katharine; Ruzaaza, Gad N.; Mlahagwa, Wendo; Ninsiima, Anna B.; Coene, Gily; Leye, Els; Michielsen, Kristien
    Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense—i.e., body image, self-esteem, and gender equitable norms—and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10–14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7–28) and median 22 (IQR: 19, 24, possible range: 5–25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11–44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended.
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    Evaluation of a school based comprehensive sexuality education program among very young adolescents in rural Uganda
    (BMC Public Health, 2019) Kemigisha, Elizabeth; Bruce, Katharine; Ivanova, Olena; Leye, Els; Coene, Gily; Ruzaaza, Gad N.; Ninsiima, Anna B.; Mlahagwa, Wendo; Nyakato, Viola N.; Michielsen, Kristien
    Limited research has been conducted on the effectiveness of sexuality education for very young adolescents (VYAs) ages 10–14 years in Sub-Saharan Africa. Furthermore, evaluations of sexuality education programs often report outcomes of risky sexual practices, yet positive aspects of sexuality are hardly studied and rarely reported. This study evaluates the effectiveness of a Comprehensive Sexuality Education (CSE) intervention for VYAs in Uganda, analyzing both positive and negative outcome indicators. Methods: We conducted a mixed methods study, incorporating a cluster randomized trial (NCT03669913) among pupils in 33 randomly selected primary schools in Mbarara district. This was followed by a qualitative evaluation of the intervention in 4 schools that included 14 in-depth interviews and 3 focus group discussions distributed among pupils, teachers and parents. Quantitative data were analyzed using ordered logistic regression to compare differences in the change from baseline to endline between the intervention and control arms. We conducted bivariate analysis and multiple regression analysis controlling for key covariates, including age, gender, school location (rural vs urban), truancy, and orphanhood. Qualitative data were analyzed by thematic approach using ATLAS TI. Results: Between July 2016 and August 2017, 1096 pupils were recruited. Outcomes were studied among 380 pupils in the intervention arm and 484 pupils in the control arm. The proportion of pupils who ever had sex increased from 9 to 12.1% in intervention compared to 5.2 to 7.4% in the control group between baseline and endline, however the differences between groups were not statistically significant. We found greater improvements in sexual and reproductive health (SRH) knowledge among intervention schools (AOR: 2.18, 95% CI: 1.66–2.86) and no significant differences in self-esteem, body image or gender equitable norms. Qualitative evidence echoes perceived SRH knowledge acquisition, increased their perception of SRH related risks, and intentions to delay sexual intercourse to prevent unwanted pregnancy, HIV and other STIs.
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    Institutional and contextual obstacles to sexuality education policy implementation in Uganda
    (Sex education, 2020) Ninsiima, Anna B.; Coene, Gily; Michielsen, Kristien; Najjuka, Solome; Kemigisha, Elizabeth; Ruzaaza, Gad N.; Nyakato, Viola N.; Leye, Els
    The successful implementation of sexuality education policy for young people has been shown to depend on a sound legislative and institutional framework. This article shows that both institutional factors and contextual obstacles have impeded the implementation of sexuality education policy in Uganda. Qualitative research techniques were employed in the form of systematic document reviews and extensive field-work with 64 participants, of which 32 were in-depth interviews with policymakers and key stakeholders in Kampala and Mbarara districts. In addition, four focus group discussions (n = 32) were conducted with teachers. The analysis was carried out thematically and manually, using open and axial coding. It was found that policy success was primarily limited by two broad factors: firstly, by institutional weaknesses such as a lack of capacity, inadequate financial commitment, poor coordination between relevant ministries and ineffective monitoring, and regulatory frameworks; secondly, by social, cultural and religious norms that give informal power to religious and cultural leaders. Two strategies are suggested as potential ways forward: (i) a commitment to both the human and financial resources needed to monitor adolescent sexual, and reproductive health programmes, but more importantly (ii) the initiation of negotiations with cultural and religious leaders to yield more positive outcomes.
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    Risk factors for human anthrax outbreak in Kiruhura District, Southwestern Uganda: a population-based case control study
    (PAMJ - One Health, 2021) Migisha, Richard; Mbatidde, Irene; Agaba, David C.; Turyakira, Eleanor; Tumwine, Gabriel; Byaruhanga, Aggrey; Siya, Aggrey; Ruzaaza, Gad N.; Kirunda, Halid
    Introduction: in 2018, Uganda experienced recurrent outbreaks of anthrax in both humans and livestock. We aimed to determine risk factors for human anthrax outbreak among residents of Kazo County, Kiruhura District, south-western Uganda. Methods: we conducted an unmatched case control study during March-April 2019. We defined a case as having had anthrax infection reported to be diagnosed by a healthcare worker in a resident of Kazo County between May 1st, 2018 and June 1st, 2018. A control was a resident in the nearest neighboring household who had not been diagnosed with anthrax between May 1st and June 1st and who had no symptoms suggestive of anthrax in May 2018. We obtained participants' sociodemographic, clinical and exposure characteristics using a structured questionnaire. We performed logistic regression to identify risk factors for human anthrax. Results: we recruited 101 participants (28 cases and 73 controls) with median age of 34 (IQR; 26-47) years; most (61.4%) were female. The overall attack rate was 1.9%, while the most common clinical manifestations were ulcers (96.4%) and fever (96.4%). The risk factors for contracting human anthrax were: slaughtering of anthrax infected animals (aOR=5.74; 95%CI: 1.39-23.8), consuming of anthrax infected meat (aOR=6.4; 95%CI: 1.53- 6.7) and being male (aOR=12.8; 95%CI: 3.31-49.1).
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    Sexual health of very young adolescents in South Western Uganda: a cross-sectional assessment of sexual knowledge and behavior
    (Reproductive health, 2018) Kemigisha, Elizabeth; Bruce, Katharine; Nyakato, Viola N.; Ruzaaza, Gad N.; Ninsiima, Anna B.; Mlahagwa, Wendo; Leye, Els; Coene, Gily; Michielsen, Kristien
    Background: In most Sub-Saharan African countries, little is known about young adolescents’ sexual and reproductive health (SRH). Though some efforts have been made to understand and improve SRH of older adolescents, very young adolescents (VYAs) are often overlooked, and little is known about their sexual knowledge and behaviors. The goal of this study was to describe SRH knowledge, information-seeking, and sexual behavior of VYAs in Uganda. Methods: A cross-sectional survey was administered in 33 primary schools in June and July of 2016. Trained interviewers administered surveys to adolescents ages 10–14 regarding SRH knowledge, information-seeking, sexual behavior, and relevant covariates. Continuous variables were summarized as means (SD) or medians (IQR) whereas categorical variables were summarized as proportions (percentages). Results: A total of 1096 adolescents were included in this analysis, 81.8% of which were from rural areas, with a median age of 12. Regarding sexually transmitted infections (STIs) knowledge; 95% knew HIV while 37% knew other STIs apart from HIV. Although 47% knew at least one way in which HIV is acquired only 8% knew at least four ways. Regarding contraceptive knowledge, 56% mentioned at least one modern method of preventing pregnancy (condoms, pills, intrauterine devices, implants, or injections). The majority (85%) of VYAs reported accessing SRH information in the media with 35% reporting accessing media with sexual content while 10% vs 22% consulted their father or mother respectively and 31% a school source. At least 7.6% of VYAs had ever had sexual intercourse, 90% of which were not using any protection. Conclusion: Comprehensive SRH knowledge was low among VYAs in this study. Media remains an important source of information for SRH for this age group though it may be misused as some adolescents reported accessing sexual content that may be inappropriate. A large proportion of sexually active VYAs reported sexual risky behaviors. This study highlights the need for an accurate and more comprehensive SRH education approach for VYAs in Uganda at an opportune age before the majority engage in sexual behavior.