Volunteer community drug distributors (CDDs) have been vital to progress made in the elimination of onchocerciasis and lymphatic filariasis; two neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). However, formative work in Côte d’Ivoire and Uganda revealed that CDDs can encounter considerable challenges during mass drug administration (MDA). CDDs must be resilient to overcome these challenges, yet little is known about their resilience. This mixed-methods study explored the resilience of CDDs in Côte d’Ivoire and Uganda. The characteristics and experiences of 248 CDDs involved in the 2018 MDAs in Côte d’Ivoire (N = 132) and Uganda (N = 116) were assessed using a micronarrative survey. Thematic analysis of CDDs’ micronarratives was used to identify challenges they encountered during MDA. Resilience was assessed using the Connor-Davidson Resilience Scale 25 (CD-RISC-25). Variables from the micronarrative survey found to be individually associated with mean CD-RISC-25 score (P<0.05) through bivariate analyses were included in a multiple linear regression model. Post-hoc, country-specific analyses were then conducted. Thematic analysis showed that CDDs encountered a wide range of challenges during MDA. The aggregate model revealed that CDDs who had positive relationships or received support from their communities scored higher on the CD-RISC-25 on average (P<0.001 for both), indicating higher resilience. These trends were also observed in the country-specific analyses. Mean CD-RISC-25 scores were unaffected by variations in district, age, gender, and length of involvement with the NTD program. Community support during MDA and positive community-CDD relationships appear to be associated with CDDs’ personal capacity to overcome adversity. Involving communities and community leadership in the selection and support of CDDs has the potential to benefit their well-being. This study establishes the CD-RISC-25 as a useful tool for assessing the resilience of CDDs. Further research is needed to understand, promote, and support the resilience of this valuable health workforce, upon which NTD programs depend.
Background: Menstrual health is an increasingly recognised public health issue, defined as complete physical, mental, and social wellbeing in relation to the menstrual cycle. The MENISCUS trial aims to assess whether a multi-component intervention addressing physical and emotional aspects of menstrual health improves educational attainment, mental health problems, menstrual management, self-efficacy and quality of life among girls in secondary school in Uganda. Methods: The study is a parallel-arm cluster randomised controlled trial with 60 schools (clusters) in Wakiso and Kalungu districts, with a mixed-methods process evaluation to assess intervention fidelity and acceptability, and economic and policy analyses. The schools will be randomised 1:1 to immediate intervention or to optimised usual care, with delayed intervention delivery. The intervention includes creation of a Menstrual Health Action Group at schools, and NGO-led training of trainers on puberty education, development of a drama skit, delivery of a menstrual health kit including reusable pads and menstrual cups, access to pain management strategies including analgesics, and basic improvements to school water, sanitation and hygiene facilities. Baseline data will be collected from Secondary 2 students in 2022 (median age ~15.5 years), with endline after one year of intervention delivery (~3600 females and a random sample of ~900 males). The primary outcomes assessed in girls are i) examination performance based on the Mathematics, English and Biology curriculum taught during the intervention delivery (independently assessed by the Uganda National Examinations Board); and ii) mental health problems using the Total Difficulties Scale of the Strengths and Difficulties 25-item questionnaire. Secondary outcomes are menstrual knowledge and attitudes in girls and boys; and, in girls only, menstrual practices, self-efficacy in managing menstruation, prevalence of urogenital infections, school and class attendance using a self-completed menstrual daily diary, and confidence in maths and science. Discussion: The trial is innovative in evaluating a multi-component school-based menstrual health intervention addressing both physical and emotional aspects of menstrual health, and using a “training of trainers” model designed to be sustainable within schools. If found to be cost-effective and acceptable, the intervention will have potential for national and regional scale-up.Trial registration {2a}: ISRCTN: 45461276 registered on 16th September 2021. http://www.isrctn.com/ISRCTN45461276.
Background Although modern contraceptives are the most effective way for averting unintended pregnancies and related adverse reproductive events for the mother and baby, their use in Uganda remains low compared to the national target for the year 2020. Adolescents and young people start using modern contraceptives at 23.8 years, yet most of them have had sexual intercourse by age 16. The objective of the study was to determine the knowledge of, and factors associated with the current use of modern contraceptives among young people 10–24 years in central and western Uganda. Methods This was a cross cross-sectional study. Data was collected from 289 in- and out-of-school young people aged 10–24 years in five districts of western and central Uganda between July and August 2020. Digital questionnaires designed in Census and Survey Processing System (CSPro) version 7.5.1 were used. Data was transferred to Stata 15.1 for analysis. Modified Poisson regression at bivariable and multivariable analysis was used to determine the factors associated with modern contraceptive use. Results About 62.6% of the respondents had high knowledge of modern contraceptives. Most respondents were highly knowledgeable on injectable contraceptives 278 (96.2%) and male condoms (96.5%). Emergency contraceptives were known by only 138 (47.8%) of the respondents. In addition, the current use of modern contraceptives was 58.5% (169). Modern contraceptive use was significantly associated with being aged 20–24 years (Adj. PRR = 0.69, 95%CI; 0.52–0.90), p = 0.007; not residing with someone as a sexual partner (Adj. PRR = 0.71, 95%CI; 0.57–0.88), p = 0.002; and being a student (Adj. PRR = 1.37, 95% CI; 1.04–1.79), p = 0.023. Conclusion Young people 10–24 years in central and western Uganda were highly knowledgeable about modern contraceptives, particularly injectables, and condoms, but least knowledgeable about emergency contraceptives. Respondents who were students compared to non-students were more likely to be using modern contraceptives, while those aged 20–24 years and those not staying with their sexual partners were less likely to use modern contraceptives. Awareness campaigns among young people aged 20–24 years and those co-residing with a sexual partner will be necessary to improve modern contraceptive use among young people aged 10–24 years.
Whether post-conflict reconciliation programmes are able to change hostile behaviours is not known. This study sought to assess the influence of reconciliation programmes on the reconciliation attitudes of war-affected adolescents in two communities in Northern Uganda. Four hundred and forty five adolescents within two communities, one with and the other without interventions were assessed for exposure to war-related and daily stressors and place of residence using hierarchical regression analysis to predict reconciliation attitudes. Adolescents in the non-intervention community recorded more positive and also more negative reconciliation attitudes; exposure to daily and war-related stressors was more positively associated with increasing reconciliation attitudes among adolescents in the non-intervention than those in the intervention community. Overall the programmes recorded limited impact on reconciliation attitudes, perhaps due to the pervasive adverse social situation of the people. Conclusion: there is a need for multi-pronged, collaborative programme efforts targeting holistic recovery programmes with focus on changing negative reconciliation attitudes.
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