Browsing by Author "Ssetaala, Ali"

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    High HIV-1 prevalence, risk behaviours, and willingness to participate in HIV vaccine trials in fishing communities on Lake Victoria, Uganda
    (Journal of the International AIDS Society, 2013) Kiwanuka, Noah; Ssetaala, Ali; Mpendo, Juliet; Wambuzi, Matthias; Nanvubya, Annet; Sigirenda, Simon; Nalutaaya, Annet; Kato, Paul; Nielsen, Leslie; Kaleebu, Pontiano; Nalusiba, Josephine; Sewankambo, Nelson K
    HIV epidemics in sub-Saharan Africa are generalized, but high-risk subgroups exist within these epidemics. A recent study among fisher-folk communities (FFC) in Uganda showed high HIV prevalence (28.8%) and incidence (4.9/100 person-years). However, those findings may not reflect population-wide HIV rates in FFC since the study population was selected for high-risk behaviour. Between September 2011 and March 2013, we conducted a community-based cohort study to determine the population representative HIV rates and willingness to participate (WTP) in hypothetical vaccine trials among FFC, Uganda. At baseline (September 2011January 2012), a household enumeration census was done in eight fishing communities (one lakeshore and seven islands), after which a random sample of 2200 participants aged 1849 years was selected from 5360 individuals. Interviewer-administered questionnaire data were collected on HIV risk behaviours and WTP, and venous blood was collected for HIV testing using rapid HIV tests with enzyme-linked immunosorbent assay (EIA) confirmation. Adjusted prevalence proportion ratios (adj.PPRs) of HIV prevalence were determined using log-binomial regression models. Overall baseline HIV prevalence was 26.7% and was higher in women than men (32.6% vs. 20.8%, pB0.0001). Prevalence was lower among fishermen (22.4%) than housewives (32.1%), farmers (33.1%) and bar/lodge/restaurant workers (37%). The adj.PPR of HIV was higher among women than men (adj.PPR 1.50, 95%; 1.20, 1.87) and participants aged 3039 years (adj.PPR 1.40, 95%; 1.10, 1.79) and 4049 years (adj.PPR 1.41, 95%; 1.04, 1.92) compared to those aged 1824 years. Other factors associated with HIV prevalence included low education, previous marriage, polygamous marriage, alcohol and marijuana use before sex. WTP in hypothetical vaccine trials was 89.3% and was higher in men than women (91.2% vs. 87.3%, p 0.004) and among island communities compared to lakeshore ones (90.4% vs. 85.8%, p 0.004). The HIV prevalence in the general fisher-folk population in Uganda is similar to that observed in the ‘‘high-risk’’ fisher folk. FFC have very high levels of willingness to participate in future HIV vaccine trials.
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    Mobility for maternal health among women in hard-to-reach fishing communities on Lake Victoria, Uganda; a community-based cross-sectional survey
    (BMC health services research, 2021) Ssetaala, Ali; Ssempiira, Julius; Nanyonjo, Gertrude; Okech, Brenda; Chinyenze, Kundai; Bagaya, Bernard; Price, Matt A.; Kiwanuka, Noah; Degomme, Olivier
    Maternal mortality is still a challenge in Uganda, at 336 deaths per 100,000 live births, especially in rural hard to reach communities. Distance to a health facility influences maternal deaths. We explored women’s mobility for maternal health, distances travelled for antenatal care (ANC) and childbirth among hard-to-reach Lake Victoria islands fishing communities (FCs) of Kalangala district, Uganda. Methods: A cross sectional survey among 450 consenting women aged 15–49 years, with a prior childbirth was conducted in 6 islands FCs, during January-May 2018. Data was collected on socio-demographics, ANC, birth attendance, and distances travelled from residence to ANC or childbirth during the most recent childbirth. Regression modeling was used to determine factors associated with over 5 km travel distance and mobility for childbirth. Results: The majority of women were residing in communities with a government (public) health facility [84.2 %, (379/450)]. Most ANC was at facilities within 5 km distance [72 %, (157/218)], while most women had travelled outside their communities for childbirth [58.9 %, (265/450)]. The longest distance travelled was 257.5 km for ANC and 426 km for childbirth attendance. Travel of over 5 km for childbirth was associated with adolescent girls and young women (AGYW) [AOR = 1.9, 95 % CI (1.1–3.6)], up to five years residency duration [AOR = 1.8, 95 % CI (1.0-3.3)], and absence of a public health facility in the community [AOR = 6.1, 95 % CI (1.4–27.1)]. Women who had stayed in the communities for up to 5 years [AOR = 3.0, 95 % CI (1.3–6.7)], those whose partners had completed at least eight years of formal education [AOR = 2.2, 95 % CI (1.0-4.7)], and those with up to one lifetime birth [AOR = 6.0, 95 % CI (2.0-18.1)] were likely to have moved to away from their communities for childbirth. Conclusions: Despite most women who attended ANC doing so within their communities, we observed that majority chose to give birth outside their communities. Longer travel distances were more likely among AGYW, among shorter term community residents and where public health facilities were absent.
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    Prevalence and correlates of HIV infection among adolescents and young people living in fishing populations along Lake Victoria Fishing Communities in Uganda
    (Pan African Medical Journal, 2020) Nanyonjo, Gertrude; Asiki, Gershim; Ssetaala, Ali; Nakaweesa, Teddy; Wambuzi, Mathias; Nanvubya, Annet; Mpendo, Juliet; Okech, Brenda; Kato Kitandwe, Paul; Nielsen, Leslie; Nalutaaya, Annet; Welsh, Sabrina; Ssentalo Bagaya, Bernard; Chinyenze, Kundai; Fast, Pat; Price, Matt; Kiwanuka, Noah
    fishing communities in Uganda are key populations for HIV, with persistently higher prevalence and incidence than the general population. Methods: between March and August 2014, a cross sectional survey was conducted in 10 fishing communities of Lake Victoria in Uganda. Data was collected on socio-behavioural characteristics using interviewer administered questionnaires and venous blood collected for HIV testing. Prevalent HIV infections among adolescents and young people aged 13 to 24 years was estimated and the factors associated with those infections determined using multi variable logistic regression modelling. Results: HIV prevalence was 10.8% among the 630 (96.5%) who provided a blood sample. Females were 3.5 times as likely to have HIV infection as males (aOR=3.52, 95% CI: 1.34-9.22). Young people aged 20-24 years were twice as likely to be HIV infected as those aged 13-19 years (aOR=1.77, 95% CI: 0.05-2.10), participants without formal education or those who had studied up to primary level were more likely to be HIV infected than those who had post primary education ((aOR=2.45, 95% CI: 1.19-5.07) or (5.29 (1.35-20.71) respectively). Reporting more than one sexual partner in the past 6 months was associated with HIV prevalent infection than those reporting no sexual partners (aOR=6.44, 95% CI: 1.27-32.83). Conclusion: adolescents and young people aged 13-24 years in fishing communities around Lake Victoria, Uganda, have a high HIV prevalence, with females having a three-fold higher level than males. These findings highlight the need to improve HIV prevention among young females living in these fishing communities.
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    Skilled Birth Attendance Among Women in Hard to Reach Island Fishing Communities on Lake Victoria; A Cross- Sectional Survey
    (Research Square, 2020) Ssetaala, Ali; Nanyonjo, Gertrude; Okech, Brenda; Chinyenze, Kundai; Price, Matt A.; Kiwanuka, Noah; Degomme, Olivier
    Maternal deaths continue to be a major challenge for maternal health in Uganda. Maternal deaths are at 336 maternal deaths per 100,000 live births, especially in rural hard to reach communities. Skilled birth attendance is key to preventing most maternal deaths. Rural fishing communities on Lake Victoria, Uganda could among communities with poor maternal health outcomes. We evaluated the extent of, and factors associated with skilled births attendance by women in fishing communities along Lake Victoria, Uganda at the most recent childbirth. Methods: A cross sectional survey among 486 consenting women aged 15-49 years, who were pregnant or had a birth or abortion in the past 6 months was conducted in 6 island fishing communities of Kalangala district, Uganda, during January-May 2018. Interviewer administered questionnaires were used to collect data on sociodemographics, antenatal care and skilled birth attendance during the most recent childbirth. Regression modeling was used to determine factors associated with women’s skilled birth attendance among 450 women with a previous childbirth. Results: Majority of women had a skilled delivery during the most recent birth [86.9%,(391/450)], with less than two in five skilled births being at the islands [34.0%, (133/391)]. Women who received any one of the seven assessed ANC components were twice as likely to have had a skilled childbirth as those who didn’t receive any ANC components (AOR=2.1; 95% CI:1.1-4.0). Joint participant and partner health decisions, reporting no prior pregnancy loss, fewer than two lifetime births and none fishing related partner occupation were also associated with a likelihood of having had a skilled birth during the most recent delivery. Conclusion: Skilled births attendance is still low in these island fishing communities. Tailored interventions to expand provision of components of ANC may improve women’s skilled birth attendance in these islands.
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    Uptake of Human Papilloma Virus vaccine among young women living in fishing communities in Wakiso and Mukono districts, Uganda
    (Public Library of Science, 2024-04) Laban, Muteebwa; Nanyonjo, Gertrude; Wambuzi, Mathias; Ssetaala, Ali; Basalirwa, Geofrey; Muramuzi, Dan; Lugemwa, Jacqueline Kyosiimire; Okech, Brenda; Mirzazadeh, Ali
    Human Papilloma Virus (HPV) is a preventable cause of cervical cancer, the commonest cancer among women in Uganda. The Uganda Ministry of Health included the HPV vaccine in the free routine immunization schedule since 2015. Five years after this policy, we assessed the uptake of the HPV vaccine and associated socio-demographic factors among young women living in fishing communities in Central Uganda in 2020. We analyzed secondary data from 94 young women aged 9–25 years who were recruited from the two fishing communities (Kasenyi landing site and Koome Island) in a primary study that aimed to promote awareness of maternal and childhood vaccines. We assessed uptake of the HPV vaccine as the proportion of participants who self-reported to have ever received at least one dose of the HPV vaccine. We assessed the socio-demographic factors associated with HPV vaccine uptake using a modified Poisson regression model adjusted for clustering by study site in STATA version 17. The mean (standard deviation) age of study participants was 21.1 (3.1) years and most (81.9%) of them were from Kasenyi landing site. The uptake of the HPV vaccine was 10.6% [95% Confidence Interval (CI) 5.6, 18.9]. After adjusting for covariates, being 13–19 years old (adjusted prevalence ratio [aPR] 5.52, 95%CI 1.69, 18.00) and of Catholic religion (aPR 5.55, 95%CI 1.53, 20.16) were significantly associated with HPV vaccine uptake. The HPV vaccine uptake was very low, despite the reported 99% national coverage of HPV vaccination program for the first dose at the end of 2019. Age and religion showed to be important determinants of the HPV vaccine uptake. Reasons for such very low uptake of HPV vaccinations need to be carefully assessed to find effective strategies to improve it.
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    Use of Modern Family Planning Methods in Fishing Communities of Lake Victoria, Uganda
    (PLoS One, 2015) Nanvubya, Annet; Ssempiira, Julius; Mpendo, Juliet; Ssetaala, Ali; Nalutaaya, Annet; Wambuzi, Mathias; Kitandwe, Paul; Bagaya, Bernard S.; Welsh, Sabrina; Asiimwe, Stephen; Nielsen, Leslie; Makumbi, Fredrick; Kiwanuka, Noah
    Fishing communities (FCs) in Uganda have high HIV infection rates but poor access to health services including family planning (FP). Although FP is a cost-effective public health intervention, there is a paucity of data on knowledge and use of modern FP in FCs. This study determined knowledge and use of modern FP methods in FCs of Uganda. Data were accrued from a 12-month follow up of 1,688 HIV-uninfected individuals, 18–49 years from 8 FCs along Lake Victoria, between September 2011 and March 2013. Data on knowledge and use of modern FP were collected through a semi-structured questionnaire. Prevalence Risk Ratios with corresponding 95% CIs were used to determine factors associated with Modern FP knowledge and use. The mean age was 31.4 years, with nearly half (48.8%) being females while more than half (58.6%) had attained up to primary education level. Knowledge of modern FP was high, 87.5% (1477/1688); significantly higher among females [adj. PRR = 4.84 (95% CI; 3.08, 7.61)], among older respondents (25–29 years) [adj. PRR = 1.83 (95% CI; 1.12, 2.99)] compared to younger ones (18–24 years) and among those conducting business [adj. PRR = 2.42(95% CI; 1.02, 5.74)] relative to those primarily in fishing. Just over a third (35.2%, 595/1688) reported use of at least one modern FP method. Use of modern FP methods was significantly higher among females [adj. PRR = 2.04 (95% CI; 1.56, 2.65, and among those reporting multiple sexual partnerships [adj. PRR = 2.12, 95% CI; 1.63, 2.76)]. Nonuse of modern methods was mostly due to desire for more children (30.6%), fear of side effects (12.2%) and partner refusal (5.2%).