NRU :: Browsing by Author "Ssali, Sarah N."

Browsing by Author "Ssali, Sarah N."

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Evaluation of the Cooking Cultures and Practices in Rural Uganda
(Journal of Sustainable Bioenergy Systems, 2021) Kisiki Nsamba, Hussein; Ssali, Robert; Ssali, Sarah N.; Matovu, Fahad; Wasswa, John; Kivumbi Balimunsi, Hussein
Many communities across the globe still practice poor cooking cultures as part of their well-being to prepare food and other heating activities. Such bad cooking practices are not environmentally friendly, are wasteful and have adverse health effects. This work presents the results of the survey that was conducted to establish the existing cooking practices commonly used in Uganda, identify the commonly used fuel during cooking, identify perceptions on improved cooking stoves (ICS), perceived preferences during cooking as well as identify whether users are aware of the health challenges due to poor cooking and describe community opinions of ICS for rural communities in Uganda. The interviews were conducted on household levels across all the regions covering Uganda’s major rural regions. It was observed that the largest population of rural Ugandans still use the 3 stone stove fire for cooking with a percentage of 53.5%, Charcoal stove, 27.3%, Improved cooking stove, 16.9%, Electric cookers,1.2%, LPG 0.7% and biogas 0.5% for the preparation of their various types of cooked foods while forest firewood is the commonly used biomass fuel for cooking with a percentage of 66.8% compared to Charcoal, Briquettes, Saw dust and others with a percentage of 27.1%, 0.7%, 0.7%, 1.1% respectively. This reveals the great majority of users whose life is at risk as 3 stone stoves are characterized by low efficiency and high smoke production which increases the health risks of the users as well as increase the risk of deforestation rates. Household cooks showed great willingness to pay for a novel stove type in all the 4 regions but from the survey data, it was indicated that the preferences varied from one region to another with a great majority preferring minimal smoke production with increased heat retention capacity.
Gendered lives, gendered Vulnerabilities: An intersectional gender analysis of exposure to and treatment of schistosomiasis in Pakwach district, Uganda
(PLOS NEGLECTED TROPICAL DISEASES, 2023) Ssali, Sarah N.; Rosemary, Morgan; Nakiranda, Salama; Opio, Christopher K.; Mariam, Otmani del Barrio
Introduction Schistosomiasis is a neglected tropical disease (NTD) that is endemic in Uganda, despite several interventions to eliminate it. It is transmitted when people infected with it pass on their waste matter into fresh water bodies used by others, consequently infecting them. Several studies have demonstrated gender and age differences in prevalence of schistosomiasis and NTDs such as lymphatic filariasis and soil transmitted helminths. However, few intersectional gender analysis studies of schistosomiasis have been undertaken. Using the World Health Organisation (WHO)’s intersectional gender analysis toolkit, this study was undertaken to identify which social stratifiers most intersected with gender to influence vulnerability to and access to treatment for schistosomiasis disease, to understand how best to implement interventions against it. Methodology This was a qualitative study comprising eight focus group discussions (FGDs) of community members, disaggregated by age, sex and location, and 10 key informant interviews with health care providers and community leaders. The Key informants were selected purposively while the community members were selected using stratified random sampling (to cater for age, sex and location). The data was analysed manually to identity key themes around gender, guided by a gender and intersectionality lens. Results The study established that while the River Nile provided livelihoods it also exposed the community to schistosomiasis infection. Gender relations played a significant role in exposure to and access to treatment for schistosomiasis. Traditional gender roles determined the activities men and women performed in the private and public spheres, which in turn determined their exposure to schistosomiasis and treatment seeking behaviour. Gender relations also affected access to treatment and decision making over family health care. Men and some women who worked outside the home were reported to prioritise their income earning activities over seeking health care, while women who visited the health facilities more regularly for antenatal care and to take sick children were reported to have higher chance of being tested and treated in time, although this was undermined by the irregular and infrequent provision of praziquantel (PZQ) mass drug administration. These gender relations were further compounded by underdevelopment and limited economic opportunities, insufficient health care services, as well as the respondent’s age and location. Conclusions The study concludes that vulnerability to schistosomiasis disease and treatment occurred within a complex web of gender relations, culture, poverty, limited economic opportunities and insufficient health services delivery, which together undermined efforts to eliminate schistosomiasis. This study recommends the following: a) increased public health campaigns around schistosomiasis prevention and treatment; b) more regular PZQ MDA at home and schools; c) improved health services delivery and integration of services to include vector control; d) prioritising NTDs; e) providing alternative economic activities; and f) addressing negative gender norms that promote social behaviours which negatively influence vulnerability, treatment seeking and decision making for health.
Paying to Normalize Life: Monetary and Psychosocial Costs of Realizing a Normal Life in the Context of Free Antiretroviral Therapy Services in Uganda
(Journal of the International Association of Providers of AIDS Care (JIAPAC), 2019) Kalule Nanfuka, Esther; Kyaddondo, David; Ssali, Sarah N.; Asingwire, Narathius
Antiretroviral therapy (ART) is considered the treatment that enables people living with HIV (PLHIV) to lead a “normal life”. In spite of the availability of free treatment, patients in resource-poor settings may continue to incur additional costs to realize a normal and full life. This article describes the monetary expenses and psychosocial distress people on free ART bear to live normally. We conducted in-depth interviews with 50 PLHIV on ART. We found that the demands of treatment, poverty, stigma, and health-system constraints interplay to necessitate that PLHIV bear continuous monetary and psychosocial costs to realize local values that define normal life. In the context, access to free medicines is not sufficient to enable PLHIV in resource-poor settings to normalize life. Policy makers and providers should consider proactively complementing free ART with mechanisms that empower PLHIV economically, enhance their problem-solving capacities, and provide an enabling environment if the objective of normalizing life is to be achieved.
Reasons for Disclosure of HIV Status by People Living with HIV/AIDS and in HIV Care in Uganda: An Exploratory Study
(AIDS patient care and STDs, 2010) Ssali, Sarah N.; Atuyambe, Lynn; Tumwine, Christopher; Segujja, Eric; Nekesa, Nicolate; Nannungi, Annet; Ryan, Gery; Wagner, Glenn; Tumwine, Christopher; Segujja, Eric; Nekesa, Nicolate; Nannungi, Annet; Ryan, Gery; Wagner, Glenn
Most studies of HIV disclosure in Africa have focused on disclosure to spouses and sexual partners, and particularly among women. Few have examined disclosure to family, friends, and others. Understanding the reasons for disclosure and nondisclosure and how these reasons differ by disclosure target is needed for effective prevention interventions. Using a case study design and content analysis, this study explored whether the reasons for disclosure decisions differ by the nature of the relationship to the disclosure target. Semi structured interviews were conducted with 40 HIV clients in Kampala, with even stratification by gender and age. Most (95%) respondents reported disclosing to someone; among these, 84% disclosed to family members, 63% to friends, 21% to workplace colleagues, and 18% to others. Of the 24 participants who had a spouse, 13 (54%) reported disclosing to a spouse. The most common reasons for disclosure were to receive support (76%), associated with disclosure to family members; relationship ties (76%), associated with disclosure to all target types; explaining change in behavior or appearance (61%), associated with disclosing to family and friends; and HIV prevention (50%), associated with disclosure to spouse/partner and friends. The most common reasons for nondisclosure were: fear of abandonment, particularly among young women disclosing to spouse/partner; inaccessibility to the disclosure target; and not wanting to worry/upset the disclosure target. This exploratory analysis suggests that reasons for disclosure and nondisclosure differ depending on the targets of disclosure, highlighting the need for tailoring interventions for improving disclosure decisions making and outcomes.
Revisiting choice: gender, culture and privatized health care in Uganda
(Agenda, 2011) Ssali, Sarah N.
Neo-liberal reformers of health care assume that accessing health care in a privatized health care system is a matter of choice. However, choices are mediated through an array of social relationships, which are in turn determined by culture. Culture, in many settings, is often the blueprint for social relations, determining appropriate masculine and feminine roles and identities. Simply introducing user fees to expand health care options is not enough to change the gender roles and identities pertaining to health care access and provision. Using gender roles and identities in the context of user fees, this focus highlights the extent to which health care processes are gendered. It demonstrates that culture interacts with, mediates and even modifies what would appear as a market process of ‘free’ choice of health care. It shows that, while women are able to identify openings within culture, which they can use to further their own agenda, culture is also capable of permeating new policies and strategies to the disadvantage of women.
Social capital and resilience among people living on antiretroviral therapy in resource poor Uganda
(PLoS ONE, 2018) Kalule Nanfuka, Esther; Kyaddondo, David; Ssali, Sarah N.; Asingwire, Narathius
Despite the national roll-out of free HIV medicines in Uganda and other sub-Saharan African countries, many HIV positive patients on antiretroviral therapy (ART) are at risk of no adherence due to poverty and other structural and health system related constraints. However, several patients exhibit resilience by attaining and sustaining high levels of adherence amid adversity. Social capital, defined as resources embedded within social networks, is key in facilitating resilience but the mechanism through which it operates remains understudied. This article provides insights into mechanisms through which social capital enables patients on ART in a resource-poor setting to overcome risk and sustain adherence to treatment.
Sustaining social support for lifelong HIV treatment: Practices of patients on antiretroviral therapy in Uganda
(International Scholars Journals, 2019) Nanfuka, Esther K.; Kyaddondo, David; Ssali, Sarah N.; Asingwire, Narathius
Social support is recognized as a critical resource in promoting adherence to antiretroviral therapy (ART) in resource-poor settings. However, supporter burn-out and stigma may constrain access to social support in the long-term. Little is written about how ART clients overcome these barriers to continue accessing support for lifelong treatment. Therefore, this article examines practices that enable HIV patients in a resource-poor setting to overcome the constraints of stigma and burn-out to continue accessing treatment support. The article is based on data from an ethnographic study of 50 patients enrolled on ART at two treatment sites. Fifteen of these patients were followed-up for six months. The main methods of data collection included in-depth interviews and participant observation. Dependent patients overcame the constraints of stigma and burn-out through three main practices: regulating the frequency of requests for assistance, using secrecy and lies, and continuously reconstituting the treatment support group. The study concludes that stigma and burn-out are serious threats to sustaining social support and concomitant adherence to lifelong ART. Integration of mechanisms for empowering patients to manage burn-out and stigma in HIV service delivery may improve prospects for sustained ART adherence in resource-poor settings.
Using life histories to explore gendered experiences of conflict in Gulu District, northern Uganda: Implications for post-conflict health reconstruction
(South African Review of Sociology, 2016) Ssali, Sarah N.; Theobald, Sally
The dearth of knowledge about what life was like for different women and men, communities and institutions during conflict has caused many post-conflict developers to undertake reconstruction using standardized models that may not always reflect the realities of the affected populations. There is a need to engage with and understand the life experiences, transformations and social concerns of people affected by conflict before, during and after the conflict in order to develop appropriate and context embedded post-conflict reconstruction strategies. This article discusses how life histories were deployed to explore how the 20 year conflict in northern Uganda transformed people’s lives. It presents how 47 men and women lived, experienced and remembered the war in northern Uganda, and the implications for health care reconstruction
Voluntary HIV counselling and testing among men in rural western Uganda: Implications for HIV prevention
(BMC public health, 2008) Bwambale, Francis M.; Ssali, Sarah N.; Byaruhanga, Simon; Kalyango, Joan N.; Karamagi, Charles A. S.
Voluntary HIV counselling and testing (VCT) is one of the key strategies in the prevention and control of HIV/AIDS in Uganda. However, the utilization of VCT services particularly among men is low in Kasese district. We therefore conducted a study to determine the prevalence and factors associated with VCT use among men in Bukonzo West health sub-district, Kasese district. Methods: A population-based cross-sectional study employing both quantitative and qualitative techniques of data collection was conducted between January and April 2005. Using cluster sampling, 780 men aged 18 years and above, residing in Bukonzo West health sub-district, were sampled from 38 randomly selected clusters. Data was collected on VCT use and independent variables. Focus group discussions (4) and key informant interviews (10) were also conducted. Binary logistic regression was performed to determine the predictors of VCT use among men.

Browsing by Author "Ssali, Sarah N."

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