ObjectiveTo assess the level of knowledge and use of the lactational amenorrhoea method (LAM) among adolescents in Uganda between 2006 and 2016 using nationally representative data from Demographic and Health Surveys (DHS).DesignCross-sectional design involving analysis of three DHS (2006, 2011, and 2016) in Uganda.SettingThe data collection took place in Uganda. The DHS are nationally representative surveys on a wide range of indicators including contraception knowledge and use.ParticipantsA total of 1948 (2006), 2026 (2011) and 4276 (2016) adolescents (15–19 years) and 1662 (2006), 1666 (2011) and 3782 (2016) young women (20–24 years) were included.Primary outcome measureUse of LAM among adolescents and young women with a live birth within 6 months before each survey.ResultsIn 2016, less than 1.0% (95% CI: 0.2% to 3.5%) of eligible adolescents correctly used LAM, and 56.3% (95% CI: 48.8% to 63.6%) were passively benefitting from LAM. The median duration of postpartum amenorrhoea (PPA) among adolescents in 2016 was 6.9 months, declining from 8.3 months in 2006. Compared with adolescents (56.7%), eligible young women had higher knowledge of LAM (64.1%) and higher median PPA duration (8.0 months) in 2016. The percentage of eligible adolescents who met the LAM criteria irrespective of whether they reported LAM use (were protected by LAM) decreased from 76.4% (95% CI: 66.5% to 84.0%) in 2006 to 57.2% (95% CI: 49.5% to 64.6%) in 2016. More than 50.0% (95% CI: 49.2% to 63.8%) of eligible adolescents were aware of LAM in 2016, increasing from 6.0% (95% CI: 2.5% to 13.8) in 2006.ConclusionDespite increasing awareness of LAM, reported and correct use of LAM was low among adolescents who could benefit from this method in Uganda, and declining over time. Support for adolescents to harness the benefits of correct LAM use should be increased. Additional research is needed to better understand the dynamics of LAM use in adolescents, including the transition to use of other modern contraceptive methods.

Background Healthcare providers (HCPs) are at an elevated occupational health risk of hepatitis B virus infections. Post-exposure prophylaxis (PEP) is one of the measures recommended to avert this risk. However, there is limited evidence of HCPs’ awareness of hepatitis B PEP. Therefore, this study aimed to establish awareness of hepatitis B PEP among HCPs in Wakiso, a peri-urban district that surrounds Uganda’s capital, Kampala. Methods A total of 306 HCPs, selected from 55 healthcare facilities (HCFs) were interviewed using a validated structured questionnaire. The data were collected and entered using the Kobo Collect mobile application. Multivariable binary logistic regression was used to establish the factors associated with awareness of hepatitis B PEP. Results Of the 306 HCPs, 93 (30.4%) had ever heard about hepatitis B PEP and 16 (5.2%) had ever attended training where they were taught about hepatitis B PEP. Only 10.8% were aware of any hepatitis B PEP options, with 19 (6.2%) and 14 (4.6%) mentioning hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine, respectively as PEP options. Individuals working in the maternity department were less likely to be aware of hepatitis B PEP (AOR = 0.10, 95% CI = 0.02–0.53). There was a positive association between working in a healthcare facility in an urban setting and awareness of hepatitis B PEP (AOR = 5.48, 95% CI = 1.42–21.20). Hepatitis B screening and vaccination were not associated with awareness of PEP. Conclusions Only one-tenth of the HCPs were aware of any hepatitis B PEP option. Awareness of hepatitis B PEP is associated with the main department of work and working in a healthcare facility in an urban setting. This study suggests a need to sensitise HCPs, especially those in rural HCFs and maternity wards on hepatitis B PEP. The use of innovative strategies such as e-communication channels, including mobile text messaging might be paramount in bridging the awareness gap.

Objective: To assess the level of knowledge and use of lactational amenorrhea method (LAM) among adolescents in Uganda between 2006 and 2016 using nationally representative data from Demographic and Health Surveys (DHS). Design: Cross-sectional design involving analysis of three DHS (2006, 2011, and 2016) in Uganda. Setting: The data was collected in Uganda. The DHS are nationally representative surveys on a wide range of indicators including contraception knowledge and use. Participants: A total of 8,250 adolescents (15-19 years) and 7,110 young women (20-24 years) were included. Primary outcome measure: Use of LAM among adolescents and young women with a livebirth within six months before each survey. Results: In 2016, less than 1% of eligible adolescents correctly used LAM and 56% were passively benefitting from LAM. The median duration of postpartum amenorrhea (PPA) among adolescents in 2016 was 6.9 months, declining from 8.3 months in 2006. Compared to adolescents, eligible young women had higher knowledge of LAM and higher medianPPA duration in 2016. The percentage of eligible adolescents who met the LAM criteria irrespective of whether they reported LAM use (protected by LAM) decreased from 76% in 2006 to 57% in 2016. More than 50% of eligible adolescents were aware of LAM in 2016, increasing from 6% in 2006, potentially in part due to change in survey question. Conclusion: Despite increasing awareness of LAM, reported and correct use of LAM was low among adolescents who could benefit from this method in Uganda, and declining over time. Support for adolescents to harness the benefits of correct LAM use should be increased. Additional research is needed to better understand the dynamics of LAM use in adolescents, including the transition to use of other modern contraceptive methods.

Background: The availability, reliability and quality of immunization data is critical to the success of any immunization program. Poor quality data result into unreliable projections, planning, and programmatic implementation, which ultimately undermine immunization investments. Uganda, like many other developing countries, faces challenges of unreliable estimates for her immunization target population. Strengthening immunization data quality and use for improving immunization program performance are critical steps towards improving coverage and equity of immunization programs.The goal of this study was to determine the effectiveness of using community health workers (CHWs) to obtain quality and reliable data that can be used for planning and evidence-based response actions. Methods: A three phased cluster randomized trial in which 5 health facilities were randomized in two groups to (i) receive a package of interventions including monthly health unit immunization data audit meetings, and defaulter tracking and linkage through home visits; and (ii) to serve as a control group between July and September 2020 was conducted. Immunization coverage in both arms was determined before and after the interventions. In addition, key informant and in-depth interviews were conducted to explore the feasibility of the interventions. Results: Overall, a total of 2,048 eligible children were registered by CHWs which compares to the district estimated population of 1,889. The study further showed that it is feasible to use CHWs to track and link defaulters to points of services: More than two thirds (68%) of the defaulters were tracked and linked to immunization services. Immunization coverage for specific antigens was significantly higher in the intervention health facilities as compared to that in the control health facilities: DPT3 95.6% vs 88.4% (p=0.004); MR 88.9% vs 81.9% (p=0.048); BCG 81.4% vs 55.5% (p<0.001); OPV3 93.9% vs 87.1% (p=0.014); PCV3 95.0% vs 88.4% (p=0.011); and Rota2 92.8% vs 84.5% (p=0.006).Conclusion: Use of CHWs to obtain reliable population estimates is feasible and can be useful in areas with consistent poor immunization coverage to estimate target population. Facilitating monthly health unit immunization data audit meetings to identify, track and link defaulters to immunization services is effective in increasing immunization coverage and equity.