NRU :: Browsing by Author "Wasswa, Ronald"

Browsing by Author "Wasswa, Ronald"

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Analysis of the Prevalence of the Preferred Methods of Contraception During the COVID 19 Lockdown in Uganda: A Multinomial Logistic Regression Study
(A Multinomial Logistic Regression Study, 2021) Sseninde, Julius; Kabagenyi, Allen; Kyadondo, Betty; Nyachwo, Evelyne; Kiragga, Agnes; Wasswa, Ronald
In 2020 limitations to family planning information, access and utilization were exacerbated by the COVID-19 pandemic and lockdown, globally incapacitating various channels to family planning information, access and, utilization. This study sought to analyze the prevalence of the preferred methods of contraception during the COVID 19 lockdown in Uganda using multinomial logistic regression. Method Data were analyzed using univariate, bivariate, logistic, and multinomial logistic regression models from the post-intervention telehealth cross-sectional survey. Results Out of the 244 women surveyed, more than three quarters (80%) used their preferred methods of family planning, while almost half of the participants (46%) used the Short-Acting Methods as a preferred method of Family planning. The logistic regression showed that older-aged participants, fear of security personnel, and fear that my spouse will know that the partner is using family planning as their biggest challenge plus participants who agreed that they won’t continue using family planning after the lockdown were less likely to use the preferred method of family planning. However, participants whose biggest challenge to accessing family planning information, and utilization was lack of money, those who received an extremely adequate number of messages during the intervention, and those who were already using family planning before the intervention were more likely to use their preferred method of family planning. From the multinomial model, participants whose biggest challenges in accessing family planning services during the lockdown were fear of unwanted pregnancy, and fear if implant expires in her body were relatively more likely to use Long-term Acting Reversible Contraceptives than Short-Acting Contraceptives as their preferred method of Family Planning. While participants who were relatively less likely to use LARC compared to SAC were those already using family planning before the start of the intervention. Conclusions We recommend prioritizing family planning information, access and utilization as one of the essential services during the lockdown, with more emphasis on an intervention that addresses age-specific needs and partner privacy issues. Addressing the use of LARC among women who are already using contraceptives is equally paramount in cases of lockdown and health facility closures
Determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006– 2016: analysis of the Uganda Demographic and Health Surveys
(BMJ Open, 2021) Wasswa, Ronald; Kabagenyi, Allen; Muhumuza Kananura, Rornald; Jehopio, Joseph; Rutaremwa, Gideon
Teenage pregnancy has become a public health concern in Uganda because of its negative consequences to both the mother and child. The objective of this study was to examine the determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006– 2016. Study design A retrospective national cross-sectional study. Setting Uganda. Participants Uganda Demographic and Health Survey secondary data of only female teenagers aged 15–19 years. The samples selected for analyses were 1936 in 2006; 2048 in 2011 and 4264 in 2016. Outcome measure The primary outcome was teenage pregnancy. Analysis was performed using the logistic regression, equiplots, concentration curve, normalised concentration index, decomposition of the concentration index and Oaxaca-type decomposition. Results The prevalence of teenage pregnancy has seemingly remained high and almost constant from 2006 to 2016 with the risk worsening to the disadvantage of the poor. Household wealth-index, teenagers’ years of education, early sexual debut and child marriage were the main key predictors and contributors of the large inequality in teenage pregnancy from 2006 to 2016. Conclusion Teenage pregnancy is disproportionately prevalent among different subpopulations of adolescent girls in Uganda. We therefore recommend policy actions to sensitise communities and enforcement of child rights and child protection laws to stop child marriages. There is also need to promote girl child education, improving household incomes, and intensifying mass media awareness on the risks of early pregnancies. Further, ensuring that villages have operational adolescent and youth friendly services as well as incorporating sex education and other different adolescent reproductive health programmes in school curriculum will be key measures in reducing the large inequality in teenage pregnancy.
Determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006– 2016: analysis of the Uganda Demographic and Health Surveys
(British Medical Journal Publishing Group, 2021-11) Wasswa, Ronald; Kabagenyi, Allen; Kananura, Rornald Muhumuza; Jehopio, Joseph; Rutaremwa, Gideon
Objective Teenage pregnancy has become a public health concern in Uganda because of its negative consequences to both the mother and child. The objective of this study was to examine the determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006–2016.Study design A retrospective national cross-sectional study.Setting Uganda.Participants Uganda Demographic and Health Survey secondary data of only female teenagers aged 15–19 years. The samples selected for analyses were 1936 in 2006; 2048 in 2011 and 4264 in 2016.Outcome measure The primary outcome was teenage pregnancy. Analysis was performed using the logistic regression, equiplots, concentration curve, normalised concentration index, decomposition of the concentration index and Oaxaca-type decomposition.Results The prevalence of teenage pregnancy has seemingly remained high and almost constant from 2006 to 2016 with the risk worsening to the disadvantage of the poor. Household wealth-index, teenagers’ years of education, early sexual debut and child marriage were the main key predictors and contributors of the large inequality in teenage pregnancy from 2006 to 2016.Conclusion Teenage pregnancy is disproportionately prevalent among different subpopulations of adolescent girls in Uganda. We therefore recommend policy actions to sensitise communities and enforcement of child rights and child protection laws to stop child marriages. There is also need to promote girl child education, improving household incomes, and intensifying mass media awareness on the risks of early pregnancies. Further, ensuring that villages have operational adolescent and youth friendly services as well as incorporating sex education and other different adolescent reproductive health programmes in school curriculum will be key measures in reducing the large inequality in teenage pregnancy.
Determinants of unintended pregnancies among currently married women in Uganda
(Journal of Health, Population and Nutrition, 2020) Wasswa, Ronald; Kabagenyi, Allen; Atuhaire, Leonard
Unintended pregnancies are no longer bound to teenagers or school-going children, married women in Uganda, as well do experience such pregnancies though little has been investigated on them. This study examines the determinants of unintended pregnancies among currently married women in Uganda. Methods: In this study, we used data from the 2016 Uganda Demographic and Health Survey (UDHS) which comprised of 10,958 married women aged 15–49 years who have ever been pregnant. The analysis was done using descriptive analysis, logistic regression, and the generalized structural equation model. Results: The study showed that 37% of pregnancies among married women were unintended. Young women, living in poor households, staying in rural areas, women in the Eastern and Northern region, Muslim women, lack of knowledge on ovulation period, discontinuation of contraceptives, non-use of and intention for contraceptives, high age at sexual debut, high age at first birth, and high parity were directly associated with a higher risk of unintended pregnancies. Relatedly, discontinuation of contraceptives regardless of the place of residence, region, woman’s age, education, household wealth, access to family planning messages were associated with higher odds of unintended pregnancies. Older women and those in rural areas who had more children were also at a higher risk of similar pregnancies. However, having more children while using contraceptives, being educated, living in a wealthier household, and having access to family planning messages significantly lowered the risk of unintended pregnancies. Conclusion: Increased access to family planning messages, empowering women as well as having improved household incomes are key preventive measures of unintended pregnancies. There is a need to provide quality contraceptive counseling through outreaches so that women are informed about the different contraceptive methods and the possible side effects. Having a variety of contraceptive methods to choose from and making them accessible and affordable will also encourage women to make informed choices and reduce contraceptive discontinuation. All these coupled together will help women have their desired family sizes, increase the uptake of contraceptives and significantly reduce unintended pregnancies.
Disruption in Essential Health Service Delivery: A Qualitative Study on Access to Family Planning Information and Service Utilization During the First Wave of COVID-19 Pandemic in Uganda
(Open Access Journal of Contraception, 2022) Kabagenyi, Allen; Kyaddondo, Betty; Baelvina Nyachwo, Evelyne; Wasswa, Ronald; Bwanika, John Mark; Kabajungu, Enid; Kiragga, Agnes
Coronavirus disease 2019 (COVID-19) remains a challenge to public health with profound impact on people’s lives. With several mitigation measures implemented to curb the spread of COVID-19, these impacted on access and utilization of general health services including family planning (FP) services. The objective of the study was to understand the extent to which COVID-19 interrupted access and utilization of FP services as well as highlight the challenges faced during the lockdown in Uganda. Methods: A qualitative study was carried out in August and September 2020 across the country. A total of 21 key informant interviews among researchers, policy makers, funding agencies, district family planning focal persons, district health officers and service providers with implementing partners were conducted. These were conducted using face to face (7), phone calls (11) and zoom (3) meetings. All interviews were audio recorded and transcribed verbatim. Transcripts were used to identify and generate codes, sub themes and themes. Analysis was done using the thematic framework analysis and results presented in themes. Results: Five themes were identified in this study which included; (i) financial and psychosocial needs, (ii) mobility hindrances, (iii) disrupted service delivery, (iv) responsive reproductive health services. The financial and psychosocial needs themes included: household and individual financial constraints, unpredictable future and community acceptance, loss of employment and unemployment, misconceptions and unintended pregnancies; while mobility hindrances included; restricted movement, high transport costs, and difficulty in finding transport. Conclusion: Results showed that the pandemic had immediate and significant long-term effects on family planning service accessibility, utilization and delivery. The study recommends implementation of telehealth services, country-wide sensitization on use of long-term contraceptive methods, empowering village health teams and making family planning services mandatory and free to all private facilities in order to lower any disruptions during pandemics.
Factors Associated with COVID-19 Vaccine Hesitancy in Uganda: A Population-Based Cross-Sectional Survey
(International Journal of General Medicine, 2022) Kabagenyi, Allen; Wasswa, Ronald; Nannyonga, Betty K.; Nyachwo, Evelyne B.; Kagirita, Atek; Nabirye, Juliet; Atuhaire, Leonard; Waiswa, Peter
Vaccination toward coronavirus disease (COVID-19) has been recommended and adopted as one of the measures of reducing the spread of this novel disease worldwide. Despite this, vaccine uptake among the Ugandan population has been low with reasons surrounding this being unknown. This study aimed to investigate the factors associated with COVID-19 vaccine hesitancy in Uganda. Methods: A cross-sectional study was conducted on a total of 1042 adults in the districts of Mukono, Kiboga, Kumi, Soroti, Gulu, Amuru, Mbarara and Sheema from June to November 2021. Data were analyzed using STATA v.15. Barriers to vaccination were analyzed descriptively, while a binary logistic regression model was used to establish the factors associated with COVID-19 vaccine hesitancy. Results: Overall, COVID-19 vaccine hesitancy was 58.6% (611). Respondents from urban areas and those in the eastern or northern region had increased odds of vaccine hesitancy. Further, higher education level and having knowledge on how COVID-19 is transmitted significantly reduced the odds of vaccine hesitancy. The study also noted individual perception such as COVID-19 kills only people with underlying medical conditions, as well as limited awareness on vaccine types or vaccination areas as the main reasons to vaccine hesitancy. Relatedly, other misconceptions like the ability of the vaccine to cause infertility, or spreading the virus into the body, and acknowledgment of alcohol as a possible cure were other reasons for vaccine hesitancy. Conclusion: The proportion of COVID-19 vaccine hesitancy is still high among the population with this varying across regions. This is driven by low education level and limited awareness on the vaccination as well as perceived myths and misconceptions. The study recommends mass sensitization of the population on the benefits of vaccination using various channels as well as rolling out community-based outreach vaccination campaigns across the country.
Multilevel Mixed Effects Analysis of Individual and Community Factors Associated With Unmet Need for Contraception Among Married Women in Four East African Countries
(Research Square, 2021) Kabagenyi, Allen; Wasswa, Ronald; Henry, Nsobya; Paulino, Ariho; Sseninde, Julius; Rusatira, Jean Christophe
Although use of contraceptives is an expression of a woman’s reproductive control, unmet need for contraception remains high and a public concern among married women in East Africa. Limited literature has explored the associated factors in the region. This study examined the individual and community level factors associated with unmet need for contraception among married women in Burundi, Rwanda, Tanzania and Uganda. Methods: The study utilized data from the four most recent demographic and health surveys on the following selected samples of women in Burundi (8767), Rwanda (6472), Tanzania (7417) and Uganda (10288). Analyses were conducted using multilevel mixed effect logistic regressions with random community and country level effects. Results: Findings showed that: 20%, 22%, 28% and 33% of the married women in Rwanda Tanzania, Uganda and Burundi respectively had unmet need for contraception. Young married women, low education level, low wealth quintile, higher number of living children, couples that are not staying together, husband’s desire for more children, history of child death, women who are not working, no access to family planning messages, long distances to health facilities, and husbands as decision-makers on women’s health care were associated with high level of unmet need for contraception. Also, low community wealth, low community use of modern contraceptives, higher community age at marriage, higher community mean number of living children and lower community age at sexual debut were found to be significantly associated with high risk of unmet need for contraception in at least one of the countries. Conclusions: The findings suggest the need to design programs and policies that ensure awareness and access to modern contraceptive services among all disadvantaged communities and unique groups like couples who are not staying together through increased outreaches and increased mass media campaigns. In addition, concerted efforts aimed at raising the educational levels of people to bring about change in social and cultural norms that influence the husbands desire for higher number of children are much needed. Deliberate efforts of empowering women through education, job creation, and reproductive health decisions will significantly reduce the levels of unmet need for contraception in East Africa.
Multilevel mixed effects analysis of individual and community level factors associated with modern contraceptive use among married women in Uganda
(BMC Public Health, 2021) Wasswa, Ronald; Kabagenyi, Allen; Ariho, Paulino
In spite of the universal right for women to decide freely for themselves when, and how many children they want to have in life, married women in Uganda are less likely to use modern contraceptives as compared to other marital categories. This study examines the individual and community factors associated with modern contraceptive use among married women in Uganda. Methods: The study used data from the 2016 Uganda Demographic and Health Survey which comprised of 8671 married women aged 15–49 years who were fecund and non-pregnant at the time of the survey. Analysis was done using a multilevel mixed-effects logistic regression model. Results: Findings showed that married women who were; Muslims (AOR = 0.78, CI = 0.66–0.91), had more than five children (AOR = 0.76, CI = 0.61–0.98), staying in communities with high poverty (AOR = 0.78, CI = 0.65–0.93), with older age at first birth (AOR = 0.94, CI = 0.92–0.96) as well as having spousal age difference of more than 9 years (AOR = 0.86, CI = 0.76–0.98) were associated with low modern contraceptive use. Women living in communities with higher age at first marriage (AOR = 0.93, CI = 0.88–0.98) or higher sexual debut (AOR = 0.91, CI = 0.85–0.98) were also associated with reduced odds of modern contraception. In addition, older women (AOR = 1.03, CI = 1.01– 1.04), having secondary/higher education (AOR = 1.93, CI = 1.58–2.37), living in a rich household (AOR = 1.32, CI = 1.14–1.53), short distance to health facility (AOR = 1.18, CI = 1.06–1.31), high community education (AOR = 1.38, CI = 1.17–1.62), high community exposure to family planning messages (AOR = 1.24, CI = 1.08–1.42), and communities with high proportion of women working (AOR = 1.22, CI = 1.06–1.39) were more likely to use modern contraceptives. Conclusion: The study revealed that both individual and community factors were important in explaining the factors associated with modern contraceptive use among married women in Uganda. Therefore, there is need to invest in community based programs like: family planning outreach services, mass media campaigns and community mobilization activities to help in dissemination of family planning information, increase awareness and promotion in use of modern contraceptives. Also, expansion of higher education and the need to make family planning services available and accessible to areas with limited physical access to health facilities will lead to sustained increase in uptake of modern contraceptives.
Timing and quality of antenatal care among adolescent mothers in Luuka district, Uganda
(Research Square, 2022) Kayemba, Vincent; Kabagenyi, Allen; Ndugga, Patricia; Wasswa, Ronald; Waiswa, Peter
Effective Antenatal Care (ANC) is dependent on timely initiation of the first visit and quality care to mitigate risk factors in pregnancy. However, most adolescent mothers attend their first visit later than the recommended time while others do not receive all the required components of care. This study sought to examine the predictors associated with timing of the first ANC visit and receipt of the recommended components of care among adolescent mothers in Luuka district. Methods The study was carried out between March and May 2021 among 248 adolescent mothers aged 10-19 years from Luuka district, who were either pregnant or postpartum with infants aged 0-3 months. Data analyses were done using descriptive techniques, Pearson chi-square and Fisher’s exact tests of independence were done at bivariate level and thereafter binary logistic regression. Results Findings showed that majority of the adolescent mothers (82%) attended ANC for their most recent pregnancy or birth. Still, only 47% had timely ANC visit while 36% had all the recommended components of care. Having knowledge on dangers signs in pregnancy was a determinant of both receipt of all components of ANC (AOR = 6.57, 95%CI = 1.75 - 24.65) and early timing of the first visit (AOR = 0.35, 95%CI = 0.12 – 0.97). Further, the odds of making the first visit after the first trimester were highest among adolescent mothers who had ever given birth (AOR = 3.67, 95%CI:1.68 - 8.02) and those without independent decisions on health care (AOR = 3.45, 95%CI:1.04 - 11.42). Conclusion Knowledge of obstetric pregnancy danger signs, having ever given birth and decision making on health care seeking are pivotal determinants of adolescent mothers’ timing of the first ANC visit and uptake of the recommended components of care. We therefore recommend the need to sensitize adolescent mothers through different channels of media on the benefits of ANC. Also, ensuring accessibility and affordability of these services among health facilities will significantly increase the uptake and early timing of the antenatal care services among adolescent mothers in rural communities.

Browsing by Author "Wasswa, Ronald"

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