Background When the COVID-19 vaccines arrived in Uganda in early March of 2021, there was a lack of information on the vaccine acceptance in the population due to many factors, mainly misinformation and disinformation circulating in the Ugandan social and mainstream media. This study aimed to determine factors associated with COVID-19 vaccine acceptance among the adult population in northern Uganda. Methods We conducted a cross-sectional study among the 723-adult population in northern Uganda. Participants were selected randomly from the nine districts of the Acholi sub-region. Ethical approval was obtained from a local IRB, and SPSS version 20.0 was used for data analysis at a multivariable logistic regression. A p-value less than 0.05 was considered significant. Results The most significant finding was that COVID-19 vaccine acceptance among the adult population in northern Uganda was at 580/723(80.22%) and was significantly associated with those with comorbidities AoR = 0.397, 95%CI: 0.233,0.674; p = 0.001; those who agreed that vaccines in health facilities in northern Uganda were safe AoR = 0.724, 95%CI:0.597,0.878;p = 0.001; graduates AoR = 2.781,95%CI:1.278,6.052;p = 0.010; females AoR = 0.616, 95%CI:0.396,0.957; p = 0.031; Catholics AoR = 1.703,95%CI:1.048,2.765;p = 0.032; Baganda tribe AoR = 3.829,95%CI:1.170,7.790;p = 0.026; non-smokers AoR = 7.349,95%CI:1.767,30.566;p = 0.006; ex-smokers AoR = 8.687,95%CI:1.052,71.734;p = 0.045; Agago district AoR = 2.950,95%CI: 1.118,7.789; p = 0.029, and Lamwo district AoR = 2.781, 95%CI:1.278,6.052; p = 0.010. Conclusion COVID-19 vaccine acceptance among the study population was encouragingly high despite the disinformation and misinformation in the Ugandan media. The independent determinants of COVID-19 vaccine acceptance were among females, those who agreed that vaccines in health facilities were safe, those with comorbidities, graduates, Catholics, Baganda tribe, ex-smokers and non-smokers, and participants from Agago and Lamwo districts. The fear of contracting the coronavirus and the fear of death if not vaccinated contributed significantly to the COVID-19 vaccine acceptance in northern Uganda. There is a need for health managers to engage, sensitize and mobilize the population on the COVID-19 vaccine and vaccination using the VHTs and the catholic church structures, which remain critically important for the vaccination campaign if the high COVID-19 vaccine acceptance in the sub-region is to be maintained or improved.

BackgroundThe advent of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. As of December 2021, there is inadequate data on the outcome of hospitalized patients suffering from COVID-19 in Africa. This study aimed at identifying factors associated with hospital mortality in patients who suffered from COVID-19 at Gulu Regional Referral Hospital in Northern Uganda from March 2020 to October 2021.MethodsThis was a single-center, retrospective cohort study in patients hospitalized with confirmed SARS-CoV-2 at Gulu Regional Referral Hospital in Northern Uganda. Socio-demographic characteristics, clinical presentations, co-morbidities, duration of hospital stay, and treatments were analyzed, and factors associated with the odds of mortality were determined.ResultsOf the 664 patients treated, 661 (99.5%) were unvaccinated, 632 (95.2%) recovered and 32 (4.8%) died. Mortality was highest in diabetics 11 (34.4%), cardiovascular diseases 12 (37.5%), hypertensives 10 (31.3%), females 18 (56.3%), ≥50-year-olds 19 (59.4%), no formal education 14 (43.8%), peasant farmers 12 (37.5%) and those who presented with difficulty in breathing/shortness of breath and chest pain 32 (100.0%), oxygen saturation (SpO2) at admission <80 4 (12.5%), general body aches and pains 31 (96.9%), tiredness 30 (93.8%) and loss of speech and movements 11 (34.4%). The independent factors associated with mortality among the COVID-19 patients were females AOR = 0.220, 95%CI: 0.059–0.827; p = 0.030; Diabetes mellitus AOR = 9.014, 95%CI: 1.726–47.067; p = 0.010; Ages of 50 years and above AOR = 2.725, 95%CI: 1.187–6.258; p = 0.018; tiredness AOR = 0.059, 95%CI: 0.009–0.371; p < 0.001; general body aches and pains AOR = 0.066, 95%CI: 0.007–0.605; p = 0.020; loss of speech and movement AOR = 0.134, 95%CI: 0.270–0.660; p = 0.010 and other co-morbidities AOR = 6.860, 95%CI: 1.309–35.957; p = 0.020.ConclusionThe overall Gulu Regional Hospital mortality was 32/664 (4.8%). Older age, people with diabetics, females, other comorbidities, severe forms of the disease, and those admitted to HDU were significant risk factors associated with hospital mortality. More efforts should be made to provide “additional social protection” to the most vulnerable population to avoid preventable morbidity and mortality of COVID-19 in Northern Uganda.

Background Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2), a virus that causes COVID-19, has overwhelmingly interrupted human activities worldwide, especially in the low-to-middle income countries. Not much is reported about exclusive challenges and opportunities presented by the COVID-19 pandemic in some remote communities in Africa. Objective The objective of this study was to assess the community’s views and perspectives on the challenges and opportunities of the COVID-19 pandemic in Northern Uganda. Methods We interviewed 36 participants (age range, 28-63 years), including health workers, civil servants, members of civil society, security forces, politicians, and staff of local government administration who were members of COVID-19 district task forces in Northern Uganda using qualitative study methods between August and September 2021. The initial selection of participants was purposeful, but the snowballing technique was later used to select others. The interview questions were pre-tested among health workers and laypersons who were not part of the main study. Participants described how the COVID-19 pandemic presented challenges and opportunities, and the experience could be used to strengthen community resolves to control the pandemic and any other in the future. A local IRB approved this study. Data were analyzed using thematic analysis. Results The current study findings revealed challenges but many opportunities during the COVID-19 pandemic in this community, including loss of lives and livelihoods, increased poverty, lack of personal protection equipment, uncertainties, stress, and anxiety among health workers in the community. However, it also offered opportunities for quality family time, increased engagement, sensitization, and mobilization of communities for health, improved general security of persons and property, increased budgets and logistics for government departments, reduced incidences of diarrheal diseases and road traffic accidents, increased incomes for task force members, and more interactions among members during task force meetings. Conclusion Although the COVID-19 pandemic presented enormous challenges to low-to-middle-income countries, there are opportunities in some communities that are worth mentioning. Information obtained in this study has practical lessons that disease control experts could use to develop strategies to organize communities better and conduct disease surveillance activities for the COVID-19 pandemic and others.

Background At the time when COVID-19 was declared a pandemic in March 2020, its spread in the African continent was slow. However, confirmed cases of the virus have since risen steadily over the years in the African continent for many reasons. This study aimed to determine factors associated with perceptions of COVID-19 vaccines among adult age-group populations in northern Uganda. Methods We conducted this study as part of a larger study to determine factors associated with COVID-19 vaccine hesitancy/acceptance among 723 adult age-group populations selected by stratified and systematic sampling approaches from northern Uganda. We used a questionnaire with an internal validity of Cronbach’s α= 0.772. A five-point Likert scale, with responses categorized as strongly agree “SA”, agree “A”, neutral “N”, disagree “DA”, and strongly disagree “SD”, was used to assess participants’ perceptions on COVID-19 vaccines. A multivariable regression analysis was conducted with P-value set at <0.05. Results Overall, 723 participated in the study with a mean age of 31.4 years (standard deviation, SD, +10.1). The majority 54.5% (n=394) were males. There were no significant differences in perceptions of COVID-19 vaccines among age-group populations (adjusted odds ratio, aOR=0.99, 95% confidence interval, CI=0.98-1.01). Key finding include: (i) it was important to take a COVID-19 vaccine (aOR=1.02, 95% CI=1.00-1.04); (ii) vaccines have unlikely unforeseen side effects (aOR=0.98, 95% CI=0.97-0.99); (iii) vaccines were unlikely being promoted for commercial gains (aOR=0.98, 95% CI=0.97-0.99); and children could take COVID-19 vaccines (aOR=1.02, 95% CI=1.00-1.03). Stratified by age-groups, the 20–29-year-old perceived COVID-19 vaccines developed in Uganda as unlikely safe and effective (aOR=0.59, 95% CI=0.35-0.97), and COVID-19 vaccines have likely unforeseen side-effects (aOR=2.1, 95% CI=1.3-3.6). While the ≥50-year-old group perceived that COVID-19 vaccines were unlikely being promoted for commercial gains (aOR=0.2, 95% CI=0.1-0.6). Conclusions There were no substantial differences in perceptions on COVID-19 vaccines in adult age-group populations in northern Uganda. The determinants of COVID-19 vaccine perceptions were its importance against the virus; vaccines have unlikely unforeseen side-effects, and children could take it. Stratified by age-groups, some age-groups perceived COVID-19 vaccines developed in Uganda as unlikely safe and unlikely being promoted for commercial gains.

Introduction: Although COVID-19 first spread slowly in the African continent, confirmed virus cases have risen steadily since March 2020. The rapid spread of SARS-CoV-2 can be attributed to its numerous characteristics, including its high transmissibility, asymptomatic persons’ ability to shed the virus, vast numbers of asymptomatic persons, or mild symptoms but with the ability to transmit the virus, new variants, and super-spreading events. Poor public health practices, disbeliefs, myths, and misconceptions about the virus and its origin in many African communities are the other reasons for its rapid spread. This study aimed to determine the perceptions of the adult population in northern Uganda on the COVID-19 vaccine acceptance, disaggregated by age groups.Methods: A cross-sectional study was conducted between March and April 2022 to assess COVID-19 vaccine acceptance among seven hundred and twenty-three adult populations selected randomly from the nine districts of the Acholi sub-region. A five-point Likert scale with responses categorized as Strongly Agree, "SA," Agree, "A," Neutral, "N," Disagree, "DA," and Strongly Disagree, "SD" was used to assess participants' acceptance of the COVID-19 vaccines. Ethical approval was obtained from a local IRB, and SPSS version 20.0 was used to perform multivariable logistic regression to identify factors associated with vaccine acceptance. A p-value less than 0.05 was considered significant.Results: The most significant finding was that COVID-19 vaccine acceptance among the adult population in northern Uganda disaggregated by age groups was not statistically significant (χ2=3.956; p=0.142). COVID-19 vaccine acceptance among the age groups was associated with trust in the information from the mainstream media χ2=20.105; p=0.000; Government of Uganda χ2=19.900; p=0.028 and social media 10.745; p=0.030. The independent predictors on perceptions of the COVID-19 vaccine acceptance among age groups were; Participants strongly agreed on its importance to protect them from the virus AoR=4.99;95% CI:1.626-15.337;p=0.005; Agreed that the vaccine would protect them from the virus AoR=3.44;95%CI:1.225-9.650;p=0.019; strongly agreed that the side effects of the vaccine would stop them from receiving the vaccine AoR=0.330; 95%CI:0.125-0.856; p=0.023; They were neutral on whether the side effects of the COVID-19 vaccine would stop them from getting a COVID-19 jab AoR= 0.320; 95%CI:0.108-0.952;p=0.027; would not accept to pay for the COVID-19 vaccine AoR=0.280;95%CI:0.093-0.866; p=0.027; Agreed that children could take a COVID-19 vaccine AoR= 0.260; 95%CI:0.105-0.626;p=0.003; Strongly agreed that children could return to school before the COVID-19 vaccination AoR= 2.330; 95%CI:1.103-4.916;p=0.027; and agreed that children could return to school before taking COVID-19 vaccines AoR= 3.320; 95%CI:1.225-9.014;p=0.018.Conclusion: COVID-19 vaccine acceptance among the study population disaggregated by age group was not significant despite the disinformation and misinformation in the Ugandan media. The independent determinants of COVID-19 vaccine acceptance were the importance of the vaccine in protecting against the virus, that the vaccine’s side effects could stop them from taking the vaccine, and that children could take the COVID-19 jab but could return to school before taking the COVID-19 jab. The fear of family members contracting the virus and self-isolation when infected contributed significantly to the COVID-19 vaccine acceptance among participants in northern Uganda. There is a need for health managers to engage, sensitize and mobilize the population by addressing concerns about long-term and immediate side effects to increase the COVID-19 vaccine uptake in this community.

Background: Overweight and obesity are emerging public health problems globally and are independent risk factors for heart, blood vessels, reproductive health, and metabolic disorders. This study aimed to determine the correlates and prevalence of overweight and obesity among women of reproductive age (15-49 years) in Sierra Leone using secondary data analysis of the Demographic Health Survey of 2019. Methods: This study was based on the 2019 Sierra Leone Demographic Health Survey (SLDHS) that used a two-stage stratified cluster sampling technique. A total of 7514 non-pregnant women of reproductive age (15-49 years) were used in the analysis. Simple descriptive, bivariable, and multivariable regression analyses were conducted with a significant p-value set at <0.05. Results: The prevalence of overweight and obesity among women of reproductive age in Sierra Leone was 19.7% and 7.4%, respectively. Overweight was more likely among women of 15-19 age group (adjusted Odds Ratios, aOR=1.933,95%CI:1.532-2.348;p<0.001); women from the north (aOR=1.308,95%CI:1.104-1.581;p<0.006); women without formal education (aOR=1.211,95%CI:1.009-1.454;p<0.040); in poorest (aOR=1.501,95%CI:1.231-1.853;p<0.001) and poorer (aOR=1.419,95%CI:1.154-1.745;p=0.001) wealth indices. However, overweight was 39.9% less likely among 30-39-year (aOR=0.601,95%CI:0.507-0.713;p<0.001) and 49% less likely among 40-49-year (aOR=0.510,95%CI:0.415-0.628;p<0.001) age-groups. It was 27.3% less likely among married women (aOR=0.727,95%CI:0.613-0.863;p<0.001), 24.9% less likely in the south (aOR=0.751,95%CI:0.623-0.911;p=0.002), 38.2% and 48.7% less likely in richer (aOR=0.618,95%CI:0.494-0.773;p<0.001) and richest (aOR=0.513,95%CI:0.389-0.677;p<0.001) wealth indices, respectively. Also, obesity was more likely among women 15-19-year (aOR=2.051,95%CI:1.316-3.198;p=0.002); from the north (aOR=1.426,95%CI:1.038-1.958;p=0.044); in poorest (aOR=2.390,95%CI:1.618-3.532;p<0.001) and poorer (aOR=1.667,95%CI:1.151-2.415;p=0.007) wealth indices. However, it was 68.3% and 79.6% less likely among women 30-39-year (aOR=0.317,95%CI:0.241-0.419;p<0.001) and 40-49-year (aOR=0.204,95%CI:0.149-0.278;p<0.001) age-groups, respectively. It was 36.8% less likely among female-headed households (aOR=0.732,95%CI:0.590-0.909;p=0.005) and 24% less likely among married women (aOR=0.760,95%CI:0.580-0.995;p=0.046); 26.2% less likely in the south (aOR=0.738,95%CI:0.550-0.992;p=0.044); 62.1% and 75.9% less likely in richer (aOR=0.379,95%CI:0.266-0.540;p<0.001) and richest (aOR=0.241,95%CI:0.159-0.367;p<0.001) wealth indices, respectively; and 39.9% less likely among women who listened to radios (aOR=0.601,95%CI:0.507-0.713;p<0.001). Conclusion: The prevalence of overweight and obesity among women of reproductive age (15-49 years) in Sierra Leone was higher compared to world data. Younger age groups, northern region, poorest and poorer wealth indices, and women without formal education were more likely to be overweight and obese. However, overweight and obesity were less likely among older age-groups, married, southern region, richer and richest wealth indices, female-headed households, and listening to radios. There is an urgent need for policymakers in Sierra Leone to tackle overweight and obesity among women of reproductive age (15-49 years) if the current trends are to be reversed.

Background: Undernutrition of non-pregnant women of childbearing age is pertinent for maternal and offspring health. This study aimed to determine the prevalence and factors associated with undernutrition, underweight, and stunting, among women of reproductive age (15-49 years) in Sierra Leone using secondary data analysis of the 2019 Demographic Health Survey. Methods: Anthropometric measurements and maternal characteristics were obtained from the Sierra Leone Demographic Health Survey (SLDHS) of 2019. The heights and weights of women were measured, and BMI in kg/m2 was calculated. Based on the World Health Organization's recommendations, stunting was defined as having heights <145cm, and underweight as BMI <18 kg/m2. Multivariable logistic regression analyses were conducted to identify correlates of undernutrition, with a significance level of p<0.05. Results: A total of 7,514 women of reproductive age, 15-49 years, participated in this study. The prevalence of stunting and underweight was 1.5% (113/7514) and 6.7%(502/7,514), respectively. Women with primary education had a 47% lower likelihood of stunting (adjusted Odds Ratio [aOR]=0.53, 95% Confidence Interval [CI]: 0.30-0.94;p=0.029) than secondary education. Similarly, women in the poorest wealth index had a 51% lower likelihood of stunting (aOR=0.49,95%CI:0.27-0.88;p=0.017) than middle wealth index. However, underweight was 1.48 times more likely among women with a parity of one-to-four (aOR=1.48,95% CI:1.08-2.03;p=0.015) than women who had never given birth. Additionally, underweight was 1.41 times more likely among women who listened to radios (aOR=1.41,95% CI:1.14-1.74;p=0.002) than those who did not. Notably, age groups of 15-19 years and 40-49 years had a 54% (aOR=0.46,95%CI:0.34-0.62;p<0.001) and 34% (aOR=0.66,95%CI:0.45-0.97;p=0.035) lower likelihood of underweight, respectively, than 20-29-year age group. Women with primary education had a 26% lower likelihood of underweight (aOR=0.74,95%CI:0.56-0.99;p=0.042) than secondary education. However, none of the wealth indices were significantly associated with underweight. Conclusion: The prevalence of underweight and stunting among women of reproductive age, 15-49 years, in Sierra Leone was lower compared to regional and world data. This study highlights similarities and differences in this population's prevalence and correlates of stunting and underweight. Primary education was less likely in both underweight and stunting, while parity of one-to-four and listening to radios were significantly associated with underweight. Further trend studies using DHS data from 2010, 2014, and 2019 are warranted to understand the dynamics of undernutrition in Sierra Leone.