Browsing by Author "Seruwagi, Gloria"

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    COVID-19 Risk Behaviors in Humanitarian Settings: A Crosssectional Study among Conflict Refugees in Uganda
    (International Journal of Community Medicine and Public Health, 2021) Lawoko, Stephen; Seruwagi, Gloria; Muhangi, Denis; Ochen, Eric A.; Okot, Betty; Lugada, Eric; Masaba, Andrew; Ddamulira, Dunstan P.; Luswata, Brian; Nakidde, Catherine L.; Kaducu, Felix
    Worldwide, behavioral change interventions are at the core of prevention efforts to contain the novelCorona Virus (COVID-19). While the evidence base to inform such interventions in the general population is growing, equivocal research in humanitarian populations is lacking. The current study describes the nature, extent and predictors of COVID-19 risk behaviors among conflict refugees in Uganda in a bid to inform prevention strategies for humanitarian settings. Cross-sectional survey data on COVID-19 risk-behaviors, demographic, socio-economic, behavioral and clinical variables was gathered from 1014 adult refugees drawn from 3 refugee settlements in Uganda, using two-staged cluster sampling. Data was analyzed using t-test, Analysis of Variance (ANOVA) and Multivariable Linear Regression.Many refugees (25-70%) were involved in hygiene, congestion and nutritional/physical activity related risk behaviors likely to contribute to community transmission of COVID-19. Refugees living in rural settlements, of male sex, young age and low socio-economic status were at heightened risk of exposure to COVID-19 risk behaviors.Physical activity and healthy nutritional practices reduced the likelihood of COVID-19 risk behavior. Indulgence in COVID-19 risk behaviors increased the risk of developing COVID-19 symptoms.COVID-19 risk behaviors among conflict refugees in Uganda are multifaceted in nature, widespread in extent and associated with symptom development, signaling for high risk for COVID-19 transmission in humanitarian settings. The data on predictors of COVID-19 risk behaviors have unmasked underlying inequalities, holding promise for development of evidence-based interventions to meet the needs of most vulnerable clusters in the refugee community.
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    Differences in Adverse Events Related to Voluntary Male Medical Circumcision Between Civilian and Military Health Facilities in Uganda
    (Research Square, 2021) Ogweng Obangaber, Lucky; Seruwagi, Gloria; Nabaggala, Maria Sarah; Lugada, Eric; Bwayo, Denis; Nyanzi, Abdul; Rwegyema, Twaha; Wamundu, Cassette; Lawoko, Stephen; Kasujja, Vincent; Asiimwe, Evarlyne; Musinguzi, Ambrose; Kikaire, Bernard; Kiragga, Agnes
    Voluntary medical male circumcision (VMMC) significantly reduces the risk of acquiring HIV in men. Despite the percentage of circumcised men (15-49 years) in Uganda increasing over time, some populations are not taking up the surgical procedure. The government of Uganda and implementing partners have responded to this lack of VMMC coverage among key populations by intensifying introducing innovative strategies that increase demand particularly among military personnel using the WHO’s MOVE strategy. As a surgical intervention, it is critical that VMMC services are safe for clients and that adverse events or complications are minimized. This paper describes the prevalence and trends of adverse events reported among military mobile camps in comparison to civilian sites in Uganda. Methods: A prospective study conducted in eighteen (18) public health facilities between March and August 2019. Of these nine (9) were providing care to civilian populations while nine (9) served the military population and catchment areas. Descriptive statistics, Chi-square test and trends analysis were carried out to describe profile of advance events among civilian and military facilities over the study period. Results: The highest proportions of VMMC were done among persons aged 15 to 19 years whereas among military camps the highest proportions of circumcision among males aged 20 to 24 years. Regarding site of circumcision, the highest proportions of VMMC were done at outreaches, with higher levels in military camps compared to civilian camps. For the proportions of adverse events reported, higher proportions were reported in civilian camps compared to military camps (Total – 1.3% vs 0.2%; p- value<0.05). For trends analysis, results indicate that there was no statistically significant trend for both civilian and military number of adverse events reported for the four quarters in 2020 (P-value =0.315 for civilian and P=0.094 for the military). Conclusions: The MOVE model is great for scaling up VMMC 48 in specialized populations such as military. Can also be adapted in other populations if contextual bottlenecks are identified and collectively addressed by key stakeholders – leadership, community engagement and using a largely horizontal approach offer promising possibilities and outcomes.
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    Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda’s refugee-hosting district
    (Conflict and Health, 2021) Seruwagi, Gloria; Nakidde, Catherine; Otieno, Felix; Kayiwa, Joshua; Luswata, Brian; Lugada, Eric; Ochen, Eric Awich; Muhangi, Denis; Okot, Betty; Ddamulira, Dunstan; Masaba, Andrew; Lawoko, Stephen
    The negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for COVID-19 management and implementation experiences in Uganda’s refugee-hosting districts.A cross sectional, mixed-method descriptive study in 17 health facilities in 7 districts from 4 major regions. Total sample size was 485 including > 370 health care workers (HCWs). HCW knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. The quantitative data was processed and analysed using SPSS 26, and statistical significance assumed at p < 0.05 for all statistical tests. Bloom's cutoff of 80% was used to determine threshold for sufficient knowledge level and practices with scores classified as high (80.0–100.0%), average (60.0–79.0%) and low (≤ 59.0%). HCW implementation experiences and key stakeholder opinions were further explored qualitatively using interviews which were audio-recorded, coded and thematically analysed.On average 71% of HCWs were knowledgeable on the various aspects of COVID-19, although there is a wide variation in knowledge. Awareness of symptoms ranked highest among 95% (p value < 0.0001) of HCWs while awareness of the criteria for intubation for COVID-19 patients ranked lowest with only 35% (p value < 0.0001). Variations were noted on falsehoods about COVID-19 causes, prevention and treatment across Central (p value < 0.0356) and West Nile (p value < 0.0161) regions. Protective practices include adequate ventilation, virtual meetings and HCW training. Deficient practices were around psychosocial and lifestyle support, remote working and contingency plans for HCW safety. The work environment has immensely changed with increased demands on the amount of work, skills and variation in nature of work. HCWs reported moderate control over their work environment but with a high level of support from supervisors (88%) and colleagues (93%).HCWs preparedness is inadequate in some aspects. Implementation of healthcare interventions is constrained by the complexity of Uganda’s health system design, top-down approach of the national response to COVID-19 and longstanding health system bottlenecks. We recommend continuous information sharing on COVID-19, a design review with capacity strengthening at all health facility levels and investing in community-facing strategies.
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    Healthworker preparedness for COVID‑19 management and implementation experiences: a mixed methods study in Uganda’s refugee‑hosting districts
    (Conflict and Health, 2021) Seruwagi, Gloria; Nakidde, Catherine; Otieno, Felix; Kayiwa, Joshua; Luswata, Brian; Lugada, Eric; Awich Ochen, Eric; Muhangi, Denis; Okot, Betty; Ddamulira, Dunstan; Masaba, Andrew; Lawoko, Stephen
    The negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for COVID-19 management and implementation experiences in Uganda’s refugee-hosting districts. Methods: A cross sectional, mixed-method descriptive study in 17 health facilities in 7 districts from 4 major regions. Total sample size was 485 including > 370 health care workers (HCWs). HCW knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. The quantitative data was processed and analysed using SPSS 26, and statistical significance assumed at p < 0.05 for all statistical tests. Bloom’s cutoff of 80% was used to determine threshold for sufficient knowledge level and practices with scores classified as high (80.0–100.0%), average (60.0– 79.0%) and low (≤ 59.0%). HCW implementation experiences and key stakeholder opinions were further explored qualitatively using interviews which were audio-recorded, coded and thematically analysed. Results: On average 71% of HCWs were knowledgeable on the various aspects of COVID-19, although there is a wide variation in knowledge. Awareness of symptoms ranked highest among 95% (p value < 0.0001) of HCWs while awareness of the criteria for intubation for COVID-19 patients ranked lowest with only 35% (p value < 0.0001). Variations were noted on falsehoods about COVID-19 causes, prevention and treatment across Central (p value < 0.0356) and West Nile (p value < 0.0161) regions. Protective practices include adequate ventilation, virtual meetings and HCW training. Deficient practices were around psychosocial and lifestyle support, remote working and contingency plans for HCW safety. The work environment has immensely changed with increased demands on the amount of work, skills and variation in nature of work. HCWs reported moderate control over their work environment but with a high level of support from supervisors (88%) and colleagues (93%). Conclusions: HCWs preparedness is inadequate in some aspects. Implementation of healthcare interventions is constrained by the complexity of Uganda’s health system design, top-down approach of the national response to COVID-19 and longstanding health system bottlenecks. We recommend continuous information sharing on COVID-19, a design review with capacity strengthening at all health facility levels and investing in community-facing strategies.
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    HIV viral load suppression following intensive adherence counseling among people living with HIV on treatment at military-managed health facilities in Uganda
    (International Journal of Infectious Diseases, 2021) Kikaire, Bernard; Ssemanda, Michael; Asiimwe, Alex; Nakanwagi, Miriam; Rwegyema, Twaha; Seruwagi, Gloria; Lawoko, Stephen; Asiimwe, Evarlyne; Wamundu, Cassette; Musinguzi, Ambrose; Lugada, Eric; Turesson, Elizabeth; Laverentz, Marni; Bwayo, Denis
    Uniformed service personnel have an increased risk of poor viral load suppression (VLS). This study was performed to evaluate the outcomes of interventions to improve VLS in the 28 military health facilities in Uganda. Methods: This operational research was conducted between October 2018 and September 2019, among people living with HIV (PLHIV) in the 28 health facilities managed by the military in Uganda. Patients with a viral load (VL) > 10 0 0 copies/ml received three sessions of intensive adherence counselling (IAC), 1 month apart, after which a repeat VL was done. The main outcome was the proportion with a sup- pressed VL following IAC. Results: Of the 965 participants included in this analysis, 592 (61.4%) were male and 367 (38.3%) were female. Average age was 35.5 ±13.7 years, and 87.8% had at least one IAC session. At least 48.2% had a suppressed repeat VL. IAC increased the odds of VLS by 82% ( P = 0.004), with adjusted OR of 1.56 ( P = 0.054). An initial VL > 10 0 0 0 copies/ml, being on antiretroviral therapy for at least 2 years, being male, and being < 18 years of age were associated with repeat VL non-suppression. Conclusions: IAC marginally improved VL suppression. There is a need to improve IAC in military health facilities.
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    Maternal and newborn health needs for women with walking disabilities; “the twists and turns”: a case study in Kibuku District Uganda
    (International journal for equity in health, 2019) Apolot, Rebecca R.; Ekirapa, Elizabeth; Waldman, Linda; Morgan, Rosemary; Aanyu, Christine; Mutebi, Aloysius; Nyachwo, Evelyne B.; Seruwagi, Gloria; Kiwanuka, Suzanne N.
    In Uganda 13% of persons have at least one form of disability. The United Nations’ Convention on the Rights of Persons with Disabilities guarantees persons with disabilities the same level of right to access quality and affordable healthcare as persons without disability. Understanding the needs of women with walking disabilities is key in formulating flexible, acceptable and responsive health systems to their needs and hence to improve their access to care. This study therefore explores the maternal and newborn health (MNH)-related needs of women with walking disabilities in Kibuku District Uganda. Methods: We carried out a qualitative study in September 2017 in three sub-counties of Kibuku district. Four In-depth Interviews (IDIs) among purposively selected women who had walking disabilities and who had given birth within two years from the study date were conducted. Trained research assistants used a pretested IDI guide translated into the local language to collect data. All IDIs were audio recorded and transcribed verbatim before analysis. The thematic areas explored during analysis included psychosocial, mobility, health facility and personal needs of women with walking disabilities. Data was analyzed manually using framework analysis. Results: We found that women with walking disabilities had psychosocial, mobility, special services and personal needs. Psychosocial needs included; partners’, communities’, families’ and health workers’ acceptance. Mobility needs were associated with transport unsuitability, difficulty in finding transport and high cost of transport. Health facility needs included; infrastructure, and responsive health services needs while personal MNH needs were; personal protective wear, basic needs and birth preparedness items. Conclusions: Women with walking disabilities have needs addressable by their communities and the health system. Communities, and health workers need to be sensitized on these needs and policies to meet and implement health system-related needs of women with disability.