BackgroundAdolescents living with human immunodeficiency virus (HIV) die owing to acquired immune deficiency syndrome (AIDS)-related causes more than adults. Although viral suppression protects people living with HIV from AIDS-related illnesses, little is known about viral outcomes of adolescents in sub-Saharan Africa where the biggest burden of deaths is experienced. This study aimed to identify the factors associated with viral load suppression among HIV-positive adolescents (10–19 years) receiving antiretroviral therapy (ART) in Uganda.MethodsWe conducted a cross-sectional study among school-going, HIV-positive adolescents on ART from August to September 2016. We recruited 238 adolescents who underwent ART at a public health facility and had at least one viral load result recorded in their medical records since 2015. We collected the data of patients’ demographics and treatment- and clinic-related factors using existing medical records and questionnaire-guided face-to-face interviews. For outcome variables, we defined viral suppression as < 1000 copies/mL. We used multivariate logistic regression to determine factors associated with viral suppression.ResultsWe analyzed the data of 200 adolescents meeting the inclusion criteria. Viral suppression was high among adolescents with good adherence > 95% (adjusted odds ratio [AOR] 2.73, 95% confidence interval [95% CI, 1.09 to 6.82). However, 71% of all adolescents who did not achieve viral suppression were also sufficiently adherent (adherence > 95%). Regardless of adherence status, other risk factors for viral suppression at the multivariate level included having a history of treatment failure (AOR 0.26, 95% CI, 0.09 to 0.77), religion (being Anglican [AOR 0.19, 95% CI, 0.06 to 0.62] or Muslim [AOR 0.17, 95% CI, 0.05 to 0.55]), and having been prayed for (AOR 0.38, 95% CI, 0.15 to 0.96).ConclusionMore than 70% of adolescents who experienced virologic failure were sufficiently adherent (adherence > 95). Adolescents who had unsuppressed viral loads in their initial viral load were more likely to experience virologic failure upon a repeat viral load regardless of their adherence level or change of regimen. The study also shows that strong religious beliefs exist among adolescents. Healthcare provider training in psychological counseling, regular and strict monitoring of adolescent outcomes should be prioritized to facilitate early identification and management of drug resistance through timely switching of treatment regimens to more robust combinations.Electronic supplementary materialThe online version of this article (10.1186/s41182-019-0135-z) contains supplementary material, which is available to authorized users.

European Union's 7th Framework Programme for research and technological development.

BackgroundThis study assessed willingness to pay for National Health Insurance Fund (NHIF) among public servants in Juba City. NHIF is the proposed health insurance scheme for South Sudan and aims at achieving universal health coverage for the entire nation’s population. One compounding issue is that over the years, governments’ spending on healthcare has been decreasing from 8.4% of national budget in 2007 to only 2.2% in 2012.MethodsA cross-sectional study design using contingent evaluation was employed; data on willingness to pay was collected from 381 randomly selected respondents and 13 purposively selected key informants working for the national, state and Juba County in September 2015. Qualitative data were analysed using conceptual content analysis. T-tests and linear regressions were performed to determine association between WTP for NHIF and independent variables.ResultsUp to 381 public servants were interviewed, of which 68% indicated willingness to pay varying percentages of total monthly individual income for NHIF. Over two-thirds (67.8%) of those willing to pay could pay up to 5% of their total monthly income, 22.9% could pay up to 10% and the rest could pay 25%. Over 80% were willing to pay up to 50 SSP (1 USD = 10 SSP) premiums for medical consultation, laboratory services and drugs. The main factors influencing the respondents’ decisions were awareness, alternative sources of income, household size, insurance cover and religion.ConclusionsWillingness to pay is mainly influenced by awareness, alternative sources of individual income, household size, insurance cover and religion. Most of the public servants were aware of and willing to pay for NHIF and prefer a premium of up to 5% of total monthly income. There is need to create awareness and reach out to those who do not know about the scheme in addition to a detailed analysis of other stakeholders. Consideration could be made by the Government of South Sudan to start the scheme at the earliest opportunity since the majority of the respondents were willing to contribute towards it.

IntroductionThe intake of folic acid before conception and during the first trimester of pregnancy can prevent spina bifida. This paper describes folic acid intake in women in Gulu district in northern Uganda.MethodsStructured interviews were held with 394 women attending antenatal care (ANC), 15 mothers of children with spina bifida, and 35 health workers in 2012 and 2013. SPSS16 was used for data analysis.Results1/4 mothers of children with spina bifida took folic acid during late pregnancy, none preconception. None had knowledge about folic acid and spina bifida prevention. 33.5% of women attending ANC had ever heard about spina bifida, 1% knew folic acid intake can prevent spina bifida. 42.4% took folic acid supplements in late pregnancy, 8.1% during the first trimester, none preconception. All women said to have eaten food rich in folic acid. None were aware about fortified foods. 7% of health workers understood the importance of early folic acid intake. All health workers recommended folic acid intake to women attending ANC. 20% of the health workers and 25% of the women said folic acid supplements are not always available.ConclusionFolic acid intake is limited in northern Uganda. This is attributed to limited education and understanding of women and health workers about the importance of early folic acid intake, late presentation of women at ANC, poor supply chain and dilapidated health services caused by war and poverty. A combination of food fortification, sensitization of health workers, women, and improving folic acid supply is recommended.

BackgroundCanine Bud Extraction (CBE) is a process of removing or gouging children’s healthy canine tooth buds embedded underneath the gum using traditional unsterilized tools. The practice of CBE commonly known as false teeth removal continues to be an adopted cultural intervention of choice, in the prevention of morbidity and mortality from common childhood illnesses. However, it is a practice against the rights of the children with serious consequences. While CBE is associated with the perceived myth of curative gains, the agony emanating from the cultural practice exposes children to ill-health conditions such as dehydration, malnutrition, blood-borne diseases like HIV/AIDs, septicemia, fever and death. This research sought to understand the factors underpinning the practice of CBE among urban slum dwellers.MethodA cross-sectional study was conducted from five randomly selected slums in Makindye division; 298 household heads or guardians with children below 5 years, who had ever suffered from false teeth were interviewed. The variables measured included guardians’ socio-demographic profiles, determinants of CBE, common childhood illnesses assumed to be treated with CBE and the reported side-effects associated with the practice.ResultsOf the 298 respondents with children who had ever suffered from “false teeth” interviewed, 56.7% had two or more children below 5 years and 31.9% were from the central region. The proportion of households practicing CBE was 90.3%; 69.8% of the caretakers mentioned that it was done by traditional healers and for 12.1% by trained health workers (dentists). Number of children (OR = 2.8, 95% CI: 1.1–7.2) and the belief that CBE is bad (OR = 0.1, 95% CI: < 0.001, p < 0.001) had a statistically significant association with CBE. Additionally, number of children (χ2 = 4.9, p = 0.027) and 2 sets of beliefs (CBE treats diarrhea (χ2 = 12.8, p = 0.0017) and CBE treats fever (χ2 = 15.1, p = 0.0005) were independent predictors of CBE practice. A total of 55.7% respondents knew that there were side effects to CBE and 31% mentioned death as one of them.ConclusionThe high proportion of households practicing CBE from this study ought to awaken the perception that the practice is ancient. CBE in this community as the study suggests was strongly driven by myths. The strong belief that CBE is bad provides an opportunity for concerted effort by primary health care providers, policy makers and the community to demystify the myths associated with false teeth and the gains of CBE.

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Introduction: Dysentery, otherwise called bloody diarrhoea, is a problem of Public Health importance globally, contributing 54% of the cases of childhood diarrhoeal diseases in Kumi district, Uganda. We set out to assess the risk factors associated with the persistently high prevalence of childhood dysentery in Kumi district. Methods:We conducted an analytical matched case-control study, with the under five child as the study unit. We collected quantitative data from the mothers or caretakers of the under five children using semi-structured questionnaires and checklists and qualitative data using Key informer interview guides. Quantitative data was analysed using SPSS while qualitative data was analysed manually.Results: Under fives living in a household of more than 5 people had a 19.2 times higher risk of developing dysentery (OR 19.2,, and children from households with boiled their drinking water were less than 1% less likely to develop dysentery (OR <0.001, CI 0.1-0.5). There was neither difference between households that used piped water and the development of dysentery (OR 1.1,, nor households which had another child that had ever had dysentery in the household and having dysentery (OR 3.2,. Major dysentery risk factors were over-crowding and big family sizes but these were still un-known to the majority of the people, yet people tended to avoid safe water sources like piped water and protected wells or springs due to long distances, high piped water connecting costs and high water bills.Conclusion: Whereas most mothers were knowledgeable of the causes and prevention of dysentery, they did not actually practice what they knew. Sustained campaigns on dysentery prevention and control by the government and other stakeholders are needed.

Background: Mother To Child Transmission (MTCT) of HIV is a threat in resource limited countries like Uganda where breastfeeding is the largest source of HIV transmission in children below the age of 5 years. The study was done to assess the compliance of HIV positive breast-feeding mothers to the Ministry of Health (MoH) recommended Infant and Young Child Feeding (IYCF) options to prevent MTCT of HIV in Mukono district.Methodology: This study enrolled a total of 380 HIV positive mothers of age 17 to 44 years with infants aged four years and below attending Naggalama hospital, Mukono COU hospital, Mukono Municipality health centre IV and Kojja health centre IV. Results: The results of the study revealed that 62.11% of the respondents complied with the recommended MoH IYCF options while the rest did not. 25.69% mothers had HIV positive children. Mothers who had babies aged between 13-24 months and mothers with secondary education were 2.55 and 2.29 times respectively more likely to comply with IYCF options. Mothers who practiced mixed feeding after 6 months; exclusive replacement feeding after 6 months and having HIV positive children were 0.002; 0.02 and 0.13 times respectively less likely to comply with IYCF options. Conclusions: Age of child and education of the HIV positive mother, the feed type practiced by the mother after six months and the HIV test result of children were all found to be predictors of mothers’ compliance with the recommended IYCF options.