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New study: 46% of Women in Uganda say they had unintended pregnancies in 2021

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Women in Uganda continue to report high levels of unintended pregnancies. Results from Phase 2 cross-sectional survey of the Performance Monitoring for Action -PMA Uganda project at Makerere University School of Public Health (MakSPH) show that 46 percent of pregnancies in 2021 were unintended.

Of the 2,159 women of ages 15-49 from across the 141 enumeration areas (villages) in 15 sub regions of Uganda interviewed by the study team, at least 54% said their current/ recent pregnancy was intended.

The women were asked whether they were pregnant by intention of their most recent birth or current pregnancy. 33% said they wanted a pregnancy later while a total of 13% said they wanted no more children but ended up getting pregnant.

The proportion of those who had unintended pregnancy varied from the those that were in urban and rural areas. For instance, a whopping 48.5% of those who had unintended pregnancies were rural based women while 35.9% were in urban areas.

Also, results show that more than 50% of women who said they never wanted to be pregnant or wished to delay child birth were aged 35 and above. A higher proportion (more than 60%) of women who experienced unintended pregnancy in 2021 were teenagers aged between 15 and 19.

MakSPH, PMA Uganda project  Co-Principal Investigator Dr. Simon Peter Kibira
MakSPH, PMA Uganda project Co-Principal Investigator Dr. Simon Peter Kibira addressing media after the dissemination of the results at Golden Tulip Hotel in Kampala.

The enumeration areas are sampled by the Uganda Bureau of statistics (UBOS). The survey was conducted together with the Ministry of Health, supported by Jhpiego, a Johns Hopkins University Affiliate, MakSPH and the Uganda Bureau of Statistics – UBOS and the overall technical guidance from the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.

At MakSPH, PMA Uganda project is led by Principal Investigator Dr. Fredrick Makumbi and Co-Principal Investigator Dr. Simon Peter Kibira. The results were released on February 15, during a stakeholder breakfast engagement meeting at Golden Tulip in Kampala.

For trends in use of contraceptives among married women, the prevalence stands at 50.2%. “It is the first time we are hitting this indicator and the modern method of family planning standing at 43%. So, we are rising though not first enough given the Covid-19 implications for the last 1-3 years. But it is amazing that we have had some adoption from the Ministry of Health and the implementing partners and the results show that at least, there is progress,” says Dr. Simon Peter Kibira, the PMA Uganda Co-Principal Investigator.

Dr. Kibira cites that among a few challenges Uganda has faced is the struggle with the quality of services provided. For instance, data shows that only 43% of women were told about the side effects of a modern contraceptive method they were using, how to cope up with them, and the availability of other alternative methods.

“This is not a good indicator and we still have a long way to go around that,” he says.    

The survey interrogated service delivery points offering Family Planning services in 255 public health facilities and 118 private facilities that included 46 hospitals, 58 Health Center 4s and 96 Health Center IIIs and 55 Health Center 2s.

There was a general drop in stock outs for family planning services. For instance, Oral contraceptive pills in public health facilities stood at 48% in 2021 down from 68% in 2020.

According to the Principal Investigator Dr. Fredrick Makumbi the study team assessed availability of family planning services largely in public health facilities because they are many and can give stable statistics.

PMA Uganda project Principal Investigator Dr. Fredrick Makumbi presenting results of the PMA family planning survey 2021
PMA Uganda project Principal Investigator Dr. Fredrick Makumbi presenting results of the PMA family planning survey 2021

“Implant stockouts were very common compared to the IUDs which had lower use. What about Oral contraceptive pills stockouts, I daresay nearly half of the facilities were stocked out either at the time of the survey or in the past three months,” Dr. Makumbi.

The reasons advanced for stock out of FP commodities in Public Service Delivery Points, a higher percentage (46%) of the facilities said they had ordered but not received shipment. At least 20% said they had ordered but not received right quantities while 9% said there was unexpected increased consumption and just 2.8% said they lacked stock due to COVID-19 disruption.

“For as long as Family Planning partners, Ministry of Health and the rest as mobilizing and creating awareness, people are coming and using the methods and particularly in this study 9% said they did not have enough pills,” Dr. Makumbi says.

In terms of education background, the study noticed a difference in women of primary and secondary levels of education in terms of contraceptive use.

“The highly educated have a significantly high proportion of use of modern planning methods implying that education is key, factor and we need to make sure that women, men and couples using family planning are educated,” says Dr. Kibira.

The Uganda Family Planning Costed Implementation Plan, 2015–2020, launched by the government in November 2014 sought to increase the modern contraceptive prevalence rate among married women to 50 percent by 2020. This target was however not met.

According to Dr. Kibira, we have not yet reached it even in 2022 currently at 47.7%. “We are still struggling a little bit and if we work on that we, shall make sure that we hit on the target of 50%, and that’s for 2020. Much as we set a conservative target, there are adaptations we have seen otherwise we wouldn’t see any usage of family planning methods during Covid-19,” he said.  

He adds that what has contributed to the high prevalence rate for contraceptives has been   the use of modern methods and therefore the adaptations by the Ministry of Health and other implementing partners worked citing that if they did not work, Uganda would have seen worse indicators.

“Regardless of the effects of Covid-19, I am glad we had good indicators. I think this Covid-19 situation could have been a speed jump because couples stayed at home hence exposed to having more sex and that would lead them to take on the modern family planning method. And sometimes you have the challenges and the same challenge propel you to better indicators,” he noted.

In each of the 141 numeration areas the research team interviewed all eligible women aged 15 and 49 years in 35 households.

“We interview and we ask them issues about sex, and if there is any form of pregnancy control method being used. If someone says condom, implants or any other method, we don’t go ahead to interrogate why they are using that method. We are actually interested in asking, if you are not using, then why are you not using,” says Dr. Kibira.  

There are various family planning methods and women / couples should be at liberty to choose with full information at the facility where you are receiving the method, for example among the pills, injectables, IUDs.

Notably Dr. Kibira asserts that implants and IUDs are long acting reversible methods and they are the most active compared to the short-term methods that are recommendable for people who want longer time delays for example space for 5 years.

He adds that; “The beauty with long term methods is that they are cheaper, effective and offer long years of protection and it should be ideal that people use what is ideal to their needs either short term and long term and it’s a choice.”

Dr. Makumbi says each development partner has a role to play in ensuring access to family planning services to Ugandans. “I think everyone of us has an opportunity to play their role, we generate evidence, we work with Ministry of Health, implementing partners, Population Council and everybody so that we can have evidence-informed decisions and that can make a significant difference and I am glad to see members of parliament who can help us support when all this information comes to parliament.”

Dr. Charles Ayume the Chair of the Committee on Health in Parliament of Uganda interacts with journalists after the release of the findings of PMA results at Golden Tulip Hotel in Kampala
Dr. Charles Ayume the Chair of the Committee on Health in Parliament of Uganda interacts with journalists after the release of the findings of PMA results at Golden Tulip Hotel in Kampala

Dr. Charles Ayume the Chair of the Committee on Health in Parliament of Uganda said they (committee) were extremely happy to engaging in a dissemination of PMA results citing that it sharpens the way they tackle issues on the floor of parliament.

“We really want a parliament that articulates issues based on evidence and very strong data. We do not only represent our constituencies, we are also dutybound to represent the views of health workers on the floor of parliament and good enough we have health workers on the committee,” said Dr. Ayume.

Adding that; “this is where data is produced. But then fortunately or unfortunately the policies are made on the floor of parliament. So if you don’t arm us well, then we do a poor job on the floor. We pledge total support.”

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METS Newsletter May 2024

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The newly appointed CDC Uganda Country Director, Dr. Adetinuke Mary Boyd (7th from left) met with country implementing partner Executive Directors to get insights on ongoing projects, discussed leveraging of partnerships as well as strategizing for how best to strengthen health systems. Infectious Diseases Institute (IDI)-McKinnell Knowledge Centre, Makerere University, Kampala Uganda, East Africa.

The Monitoring and Evaluation Technical Support (METS) Program is a 5-year CDC-supported collaboration of Makerere University School of Public Health (MakSPH), the University of California San Francisco (UCSF) and Health Information Systems Program (HISP Uganda).

Highlights of the METS May 2024 Newsletter

  • Enhancing Response to Sexual and Gender-Based Violence
    • Responding to and preventing Sexual and Gender-Based Violence (SGBV) and Violence Against Children (VAC) are critical components of Uganda’s national HIV prevention program. METS developed a new app designed to improve support for SGBV survivors. This followed an assessment in December 2022, that revealed gaps in service access and coordination in Fort Portal and Kampala Regions.
    • The METS team, in collaboration with regional implementing partners, is scaling up the app’s use in pilot districts such as Masaka, Kiryandongo, Fort Portal, and Mubende. The team visited facilities and police stations to install the app and train selected focal persons on its use.
  • Assessing Readiness for Integrated HIV and NCD Care Services
    • METS supported the Ministry of Health to conduct a site readiness assessment for integrated delivery of HIV and Non-Communicable Diseases (NCD) services from 22nd to 26th April 2024, in collaboration with the US Centers for Disease Control and Prevention (CDC), and various implementing partners. The activity was conducted in selected health facilities in Acholi, Mubende, Kayunga, and Rwenzori regions to determine their feasibility for participating in a comprehensive NCD evaluation.
    • The 48 facilities visited have already integrated NCD services (mental Health, diabetes, and hypertension). Of these, 78% have integrated mental health services in their PMTCT clinics. 40% of the facilities have a dedicated NCD services physicians /doctor in the ART Clinic, 29% have doc have dedicated physicians in the PMTCT clinics. 90%. Most of the facilities have clinical and nurses in the ART than PMTCT facilities but more nurses offering NCD services in PMTCT sites.
  • Digitalizing the health sector through strategic partnerships
    • In collaboration with CDC and METS, the MoH organized a national Electronic Medical Records (EMR) stakeholders meeting to orient stakeholders on the national EMR agenda and transition towards a comprehensive digital health facility package. Key actions discussed included expanding the rollout of the EMR and Community Health Information System (eCHIS) and urging development partners to support prioritized health information and digital health investments.
    • The introduction of electronic medical records (EMRs) in health facilities aims to improve the quality of health service delivery by providing real-time accountability transparency, and traceability of medical supplies, monitoring health worker absenteeism, enhancing patient satisfaction through efficient care provision, reducing unnecessary or duplicate diagnostic tests, and offering easy access to management reports for decision-making. Additionally, EMRs will lay the foundation for the implementation of national health insurance.
  • UgandaEMR+ Implementation Showcased at Kisenyi HCIV
    • METS and Reach Out Mbuya (ROM) showcased the implementation of UgandaEMR+ to representatives from the USG and the Ministry of Health (MoH) at Kisenyi HCIV. The visit was aimed at providing a clear understanding of the system’s functionality at the health facility, which serves over 1,200 outpatients daily and supports over 1600 clients on ART.
    • Dr. Peter Akonyera, the ART Clinic In Charge shared positive end-user experiences, noting simplified data use and analysis, efficient data retrieval, and the system’s popularity among users despite existing challenges. He appreciated METS’ support in maintaining system synchronization. The data visualization tools have been particularly useful for clinicians to manage patient schedules and workload distribution effectively, ensuring timely and efficient healthcare delivery.
  • METS Showcases Research at INTEREST 2024 Conference in Benin
    • The International Conference on HIV Treatment, Pathogenesis, and Prevention Research (INTEREST) brought together global scientists to share cutting-edge knowledge in HIV diagnosis, treatment, and prevention. The conference also aimed to build a community of African physicians and scientists to develop local solutions for managing HIV and preventing its transmission.
    • METS submitted an abstract titled “Enhancing HIV Case Identification through a National HIV Testing Services (HTS) Continuous Quality Improvement” based on support to the Ministry of Health (MoH) in designing, implementing, and evaluating initiatives to increase the identification of HIV-positive clients, crucial for achieving the global target of 95% of people living with HIV (PLHIV) knowing their status.
  • Gallery
    • New CDC Director meets Country implementing partner Executive Directors
    • UgandaEMR+ support supervision at Kisenyi HCIV visit
    • EMR Stakeholders meeting
    • CBS guidelines meeting
    • INTEREST 2024 conference – Benin
    • Key Populations assessment – Ishaka district

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SIMCS-Trial Vacancy Announcement: Twenty-Five (25) Research Assistants

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An elevated shot of the School of Health Sciences and School of Medicine Building, College of Health Sciences (CHS), Makerere University. Mulago Campus, Kampala Uganda, East Africa.

Makerere University College of Health Sciences School of Medicine in collaboration with Baylor College of Medicine received funding from US National Institutes of Health – Fogarty International Center to carry out a study on “Development and evaluation of an information management and communication system for population-wide point of-care infant sickle cell disease screening (SIMCS-Trial)”. The program seeks to recruit 25 research assistants at its study sites. 

Roles and responsibilities  

  • Identify and screen participants for possible enrolment into the study according to the Study Protocol.
  • Obtain informed consent from caregivers of eligible participants as per protocol accordance with GCP and HSP principles.
  • Counsel and explain study procedures to the caregivers of study participants using the mobile app.
  • Enrol eligible participants into the study to meet the study accrual targets.
  • Complete study CRFs, correctly and accurately in compliance with trial procedures/ SOPs and GCP standards.
  • Ensure study participants’ safety and privacy, data integrity and confidentiality.
  • Participate in collection of appropriate study samples/specimens from the participants as per protocol and SOPs as well as performing the test.
  • Carry out any other duties as assigned by superiors in line with your work.

Required Qualification and experience 

  • A degree in any health-related discipline, and registered with the relevant national bodies.
  • Knowledge and familiarity with Microsoft word, Excel, PowerPoint and Access as well as basic internet applications 
  • Skills in using common relevant computer packages and mobile technology for data collection
  • Previous work in a research environment is added advantage.
  • Basic knowledge of clinical research regulatory procedures. 
  • Good Clinical Practice (GCP) training and Research Ethics training skills and knowledge
  • Excellent command of English (written and oral) as well as the local languages (Luganda or Lusoga)
  • Excellent interpersonal skills to develop relationships with participants.
  • Experience of living and or working both in urban and rural environment.
  • Team-working skills to work effectively as part of a multidisciplinary healthcare team 
  • Time management skills and ability to handle multiple tasks simultaneously.
  • Highly organized, detail-oriented and self-motivated/driven. 
  • Ability to handle multiple tasks simultaneously. 
  • Ability to professionally communicate in writing, verbally or other means deemed appropriate. 

Reports to: The SIMCS Co-Investigator/SIMCS Trial Coordinator 

Expected start date: July 2024

How to apply: 1-page type written application letter addressed to the Principal Investigator SIMCS Trial MakCHS SOM together with current CV, copies of academic certificates, and recommendation letters from two past employers should be e-mailed as ONE PDF DOCUMENT to makimpact22@gmail.com

Deadline for receiving applications: Friday 20th June 2024 at 5:00 pm

Only shortlisted candidates will be invited to the interview. 

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CTCA Call for Proposals: Enhance Tobacco Control Institutional Capacity in Africa

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Call for Proposals - Project Title: Enhance Tobacco Control Institutional Capacity in Africa; Grant #339. Deadline 30th June 2024, by 5pm EAT. The Centre for Tobacco Control in Africa (CTCA), School of Public Health, College of Health Sciences (CHS), Makerere University, Kampala Uganda, East Africa.

Project Title: Enhance Tobacco Control Institutional Capacity in Africa; Grant #339

Introduction:

The Centre for Tobacco Control in Africa (CTCA) received funding from the African Capacity Building Foundation (ACBF) for the 2024-2026 to implement a project on institutional capacity. The project investments are geared towards sustaining human resource capacity and knowledge generation to reduce use of all forms of tobacco products in Africa. Specifically, the project aims to:

  1. Enhance training opportunities for African governments and relevant actors in tobacco control in
    the continent
  2. Increase access to knowledge for guiding tobacco use prevention and control in Africa
  3. Reinforce the institutional development of CTCA for an optimal performance of its functions
    and processes.

In 2020, CTCA developed a Tobacco Control Research Agenda (TCRA) with the aim of providing a guide for generating local evidence to drive tobacco control policy formulation and implementation in Africa.

Therefore, CTCA with support from ACBF is seeking researchers across the African continent to be awarded 6 small grants of USD 5000 to implement research that aligns with the TCRA thematic areas below:

  1. Patterns and trends of tobacco use and exposure for all tobacco products including the new
    products at country and regional levels (sex, age, region, types of products, new products).
  2. Effects of tobacco use and exposure on sustainable development (poverty, education, culture, food security, environment, HIV, TB, reproductive health, NCDs).
  3. Tobacco use and populations at risk (youth, young adults, women/gender, elderly, residents
    of urban areas, miltary, prisoners, mental health patients, populations in low socio-economic
    dwellings like slums).
  4. Tobacco control policy research and analysis (smoke free, TAPS, GHWs, ceasation) of cost
    effectiveness, impact, drivers, enablers, innovation, challenges, communication and advocacy
    for tobacco control.
  5. Sociocultural context of tobacco use
  6. Tobacco industry and tobacco control policy
  7. Tobacco production, alternative livelihoods and environment (distribution, value chain,
    environmental impact, historical and determinants of tobacco production)
  8. The economics of tobacco and tobacco control (product, pricing, illicit tobacco trade,
    taxation)

The full research Agenda can be accessed in English and in French.

Submissions

We are pleased to invite submissions from researchers based in Africa. Successful proposals should align with any of the 8 thematic areas of the CTCA Research Agenda. Innovative proposals that address critical issues and contribute to evidence-based policy and practice in the respective areas to inform Tobacco control in Africa are particularly encouraged.

Requirements

These grants will fund work that relates to the CTCA Research Agenda. Activities will include
proposal development, data collection and analysis, report writing and dissemination. All research to be implemented will be approved by the institutional review board and published in peer reviewed journals. These grants are intended for; 1) Researchers based in Tobacco Control Programs/Response; 2) post graduate students who would like to complete their research projects aligned to this call and 3) early and middle career researchers. It is required that this research is executed, and the report completed within 12 months. The applicant should have a mentor in an established institution.

Eligibility

Eligibility is restricted to Africa-based researchers. This refers to individuals who are (a) currently studying at a university or research institute in Africa, and/or b) currently working within a university, research institute, or in tobacco control in Africa. All persons associated with tobacco industry will not be funded and therefore should not apply. Successful applicants will be required to sign a declaration of interest that they do not have any relationship with tobacco industry.

Evaluation criteria

Proposals will be reviewed by a group of experts and researchers. Projects will be assessed against six, equally weighted evaluation criteria:

  • Knowledge contribution in respect to policy, strategy, and evidence to answer local
    challenges:
    Does the study articulate the research gap? Does study make a significant
    contribution toward advancing knowledge in the tobacco control field? Does it answer
    new questions or introduce novel methods, measures, or tobacco control interventions? Is
    it aligned to the WHO FCTC and tobacco control local context requirements? Does the
    study add to the existing body of research?
  • Policy relevance: Will results from the research have generalizable implications? How,
    if at all, will the “lessons learned” have relevance beyond the study? Will the study
    outcomes influence decisions in tobacco control?
  • Technical design: Do the methods appropriately answer the objectives and the questions
    outlined in the proposal? Is the proposed study feasible in one year?
  • Project viability: Are there any other logistical or political obstacles that might threaten
    the completion of the study, for example, government authorization or Human Subjects
    review, civil strife, social cultural sensitivity?
  • Value of research: Is the cost of the study commensurate with the value of expected
    contributions to policy? Are the planned activities justified and coherent?
  • Ethics: Reviewers will consider whether there are any risks of harm to research
    participants, what the proposed risk mitigation strategies are, and how the possible
    benefits of the research compare to the possible harms.

Application Process

Apply HERE not later than 30th June 2024, by 5pm EAT. Applicants are required to provide a
recommendation/support letter from their supervisors or heads of department.

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