Objective: The utilization of Antenatal Care (ANC) services to the recommended time by WHO is still low in developing countries. In Uganda, about 990,000 women become pregnant annually, 90 to 94% of whom attend at least the first ANC visit while 65% and 58% of them attend four or more times in urban and rural areas respectively with eventual health facility birth at about 62%, homebirth and TBA together at about 38%. The study determined antenatal care attendance and the mother’s choice of birthplace in Uganda. Materials and methods: Using electronic databases mainly Google Scholar, Science Direct, PubMed and African Journals Online, and journal articles of international Website, 70,195 articles were identified but only 19 met the Cochrane review inclusion criteria hence were reviewed. Results: Reviewed studies attribute a decline in antenatal care visits and subsequent choice of birthplace to institutional, demographic and socio-economic factors. The demographic factors are maternal age (mothers less than eighteen years are less likely to utilize maternal health services than those above), marital status, occupation, residency, distance from home to the health facility, and parity. The socio-economic factors are mothers’ and partners’ levels of education (less educated women and their partners are less likely to utilize ANC), household income which affects transportation and medical bills, cultural norms and taboos, patriarchy society, enrollment on ANC in the third trimester, and intrinsic factors of attending ANC such as obtaining ANC card to present in case of emergency. Institutional factors include quality of medical care, availability of logistics and supplies, and health workers’ influence in terms of attitude, referral, competences, and staffing. Conclusion: Pregnant women who attend ANC are more likely to deliver in the health facility than those who do not at all. To enable them to attend ANC to full term and have a health facility delivery, their empowerment for increased self-efficacy through education, sustainable livelihood training and provision of subsidized capital alongside partner involvement. The facilitation of health facilities would also attract them.

Summary The status of sexual and reproductive health of youths and adolescents in urban areas across the globe is alarming. Evidence from Uganda Aids Indicator Survey 2011 indicates that over 31% youths who have never married are engaged in sexual intercourse but have never tested for HIV. Gambling is clearly on the increase in major towns and cities drawing in several youths. However, the risk that this practice poses on the youth's sexual behavior has not been investigated in Uganda. This study intended to fill this gap. This study examined the sexual risk associated with gambling among youths in Rubaga Division of Kampala Capital City of Uganda. The study employed a quantitative cross sectional design to survey 397 youths aged 15 to 24 years. It employed a systematic sampling scheme in selecting households with youths who responded to the household survey questionnaire. Results showed that more male than female youths are engaged in gambling, majority of whom start gambling below 18 years. Most of the gambling youths are pulled by competition with peers and desire to earn money. Compared with nongambling youths, gambling youths have more sexual encounters, initiate sexual activity at a young age, have unprotected sex, have sex with more than one partner whom they do not know their HIV status, and have sex under the influence of alcohol. The study recommends for government to form and enforce policies to regulate gambling with a view of minimizing its associated risks especially unsafe sex. Through the ministry of health and civil society organizations, government can create programs to reach the gambling youths with sexual reproductive health services.

Background Maternal mental health (MMH) problems, such as perinatal depression, maternal anxiety, suicide ideation and puerperal psychosis among others, have a significant impact on maternal morbidity and mortality, as well as the health and development of children. One in every four pregnant women and one in every five postpartum women in low-income countries, suffer from maternal mental health (MMH) problems. Despite this, MMH screening, diagnosis, and reporting remain scanty in Uganda. Consequently, this study aimed to investigate the knowledge, practices, and impediments that maternity care workers face when screening and managing women with maternal mental health disorders in health facilities in south-western Uganda. Methods In-depth interviews were conducted with 22 health-care professionals who work in maternity care departments in primary and tertiary healthcare facilities in southwestern Uganda to investigate their medical knowledge, clinical practices, and challenges related to the screening and management of maternal mental health problems. Using qualitative content analysis, distinct categories and subcategories were found. Results Medical staff especially midwives lacked specialized training in screening and managing women with maternal mental health problems They screened and managed MMH problems solely based on history and physical examination, and they referred nearly every mother displaying signs of mental illness because they felt ill-prepared to handle them. On the other hand, medical staff with some level of specialized training in mental health particularly staff working in mental health units, were more likely to use a mental health screening tool in addition to history and physical examination; and to treat any women exhibiting signs and symptoms of maternal mental problems without referring them. Lack of in-service training on maternal mental health, poorly coordinated referral systems, reluctance of mentally ill to visit medical facilities, scarcity of mental health specialists, and shortage of relevant medications were identified as the major challenges. Age, experience level, or gender had no effect on screening or management practices. Conclusions The results suggest that specialized training in mental health, and particularly maternal mental health, is essential for the effective screening and management of maternal mental health conditions in South Western Uganda.

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Aims: To review how social reintegration and rehabilitation processes are being executed among obstetric patients in Sub-Saharan Africa and highlight projects and programs involved. Methods: This is a systematic review involving a search of relevant literature from PubMed, Google scholar, PsychINFO, African Journals Online, Australian Journals Online, and open access journal of international organizations such as WHO, UNFPA, USAID, Engender Health, Fistula Foundation, and Fistula Care Plus published between 1978 to date. Of the 46 articles identified, 25 were suitable for achievement of this study’s purpose. Results: Sub-Saharan African countries have recognized the overall burden of obstetric fistula and have devised strategies for its’ holistic management. Most countries have National Obstetric Fistula Strategic Frameworks which emphasize multi-sectoral and multidisciplinary approaches other than medical paradigm. Extraordinary among others are: Nigeria, Uganda, Tanzania and Guinea while some countries such as Benin Republic, Chad, Malawi, Mali, and Zambia lack support the at policy level, and have inadequate community outreach programmes. Social reintegration and rehabilitation have been done through the identification of individual patient’s need/s. Upon discharge from hospital, they are counseled, given soap, clothes, transportation fund and are referred to community based projects for elementary education and skills development. Projects and programmes aiming to combat obstetric fistula and restore patients’ self-worth and dignity are: Lamaneh Suisse, and Delta Survie in Mali, Dimol in Niger, Medecins Sans Frontieres (MSF) in Burundi, FORWARD in Nigeria and Sierra Leone, Handicap International in Benin Republic, Women For Africa in Ghana and Liberia, TERREWODE and CoRSU both in Uganda, Hamlin Fistula Ethiopia in Ethiopia, and Safe Motherhood Initiative, Fistula Foundation, Fistula Care Plus, Engender Health, UNFPA, AMREF for Health, WHO and others which cut across the region. Conclusions: Most Sub-Saharan countries have registered progress in assuring effective social reintegration and rehabilitation of obstetric fistula patients although some are still grappling with the issue due to lack of political commitment and inadequate outreach programmes. There is scanty information regarding reintegration and rehabilitation before obstetric fistula repair and yet it would hasten physical and mental wellbeing of the patients as they await repair.

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Introduction: Self-medication is defined as medication taken on one's own initiative or on the advice of pharmacist or any other lay person. It is one of the leading cause for the ever threatening drug resistance for various drugs. Medical students are future physicians and prescribers. It is important to know how they use medicines and what the pattern is. Hence, assessing their practice on this sensitive issue will help in planning interventions to prevent irrational use of medicines. Objective: To determine the prevalence and pattern of self-medication among medical students. Methods: A cross-sectional study was done among the medical students of a private college in Central Kerala using a pre-tested semi-structured questionnaire which had questions regarding common drugs used for self-medication, ailments, reasons, source & also awareness about dose, course & side effects of the drug used. Results: Prevalence of self-medication was 95%. Commonly self-medicated drugs include antipyretics 253(78.06%) and analgesics 158(58.8%). Diseases which are commonly self-medicated are fever 273(84.4%) and aches & pain 184(56.4%). Majority of students were self-medicating due to mild nature of illness 236(72.9%). Common source of self-medicated drugs were pharmacy for 248(76.5%), family &friends for 137(42.2%). Conclusions: Prevalence of self-medication was found to be very high among medical students. Considering the fact that the respondents are future prescribers, correct, timely use of drugs need to be stressed. But they were using the drugs only for common ailments and not for serious diseases.

Background This study set out to investigate how incentives for mothers, health workers and boda–boda riders can improve the community-based referral process and deliveries in the rural community of Busoga region in Uganda. Both the monetary and non-monetary incentives have been instrumental in the improvement of deliveries at health centres. Methods The study was a 2 arm cluster non-randomized control trial study design; with intervention and control groups of mothers, health workers and boba–boda (commercial motor-cycle) riders from selected health centres and communities in Busoga region. Among the study interventions was the provision of incentives to mothers, health workers (midwives and VHTs) and boda–boda riders for a duration of 6 months. Monetary and non-monetary incentives were applied in this study, namely; provision of training, training allowances, refreshments during the training, payment of transport fares by mothers to boda–boda riders, free telephone calls through establishment of a pre-paid Closed Caller User Group (CUG) and provision of bonus airtime to all registered CUG participants and rewards to best performers. The study used a mixed methods design. Descriptive statistical analysis was computed using STATA version 14 for the quantitative data and thematic analysis for qualitative data. Results Findings revealed that incentives improved community-based referrals and health facility deliveries in the rural community of Busoga. The proportion of mothers who delivered from health centres and used boda–boda transport were 70.5% in the intervention arm and only 51.2% in the control arm. Of the mothers who delivered from the health centres, majority (69.4%) were transported by trained boda–boda riders while only 30.6% were transported by un-trained boda–boda riders. And of the mothers transported by the boda boda riders, 21.3% in the intervention arm reported that the riders responded to their calls within 20 min, an improvement from 4.3% before the intervention. Mothers who were responded to between 21–30 min increased from 31.4% to 69.6% in the intervention arm while in the control arm, it only increased from 37.1% to a dismal 40.3%. Interestingly, as the time interval increased, the number of boda–boda riders who delayed to respond to mothers’ calls reduced. In the intervention arm, only 6.2% of the mothers stated that boda–boda riders took as many as 31–60 min’ time interval to respond to their calls in post intervention compared to a whopping 54.9% in the pre intervention time. There was little change in the control arm from 53.2% in the pre intervention to 41.2% in the post intervention. Conclusion Incentives along the maternal health chain are key and the initiative of incentivising the categories of stakeholders (mothers, midwives, the VHTs and the boda–boda riders) has demonstrated that partnerships are very critical in achieving better maternal outcomes (health facility-based deliveries) as a result of proper referral processes.