Background Evidence suggests use of herbal and conventional medicines in the treatment of Sickle ... more Background Evidence suggests use of herbal and conventional medicines in the treatment of Sickle Cell Disease (SCD). We examined factors associated with caregivers’ use of combined herbal and conventional medicine to treat children with SCD. Methods A cross-sectional study was conducted at Jinja Regional Referral Hospital between January and March 2022. Caregivers of children with SCD aged 1 to 18 years attending the Sickle Cell Clinic were interviewed using structured questionnaires. We collected data on caregivers’ socio-demographic characteristics, perceptions of and intentions to use either or both therapies, self-reported use of either or both therapies and community and health-related factors. A multivariable logistic regression model was computed to assess the factors independently associated with caregivers’ use of combined therapy, using Stata version 15.0. Results 372 caregivers were interviewed. On average, respondents were aged 34.3 years (Standard Deviation [SD]: ±9.8 y...
Pre-Exposure Prophylaxis (PrEP) is a known HIV prevention strategy for high-risk populations howe... more Pre-Exposure Prophylaxis (PrEP) is a known HIV prevention strategy for high-risk populations however, some high-risk communities have not yet fully embraced it. We sought to determine willingness to take PrEP and the associated factors among high-risk adolescent boys and young men (ABYM) in Masese fishing community, Jinja district, Eastern Uganda. We conducted a cross-sectional study, between October and November 2020, using a semi-structured questionnaire among ABYM aged 10–24 years in Masese fishing community, Eastern Uganda. We surveyed 479 participants, who had two or more sexual partners with inconsistent or no condom use. We carried out modified Poisson regression analysis to determine factors associated with willingness to take PrEP.Of 479 high-risk ABYM, 86.4% (n = 414) were willing to take PrEP. Confidence in PrEP safety (adj.PR = 1.56; 95%CI: 1.55, 2.24), availability of PrEP in areas easily accessible by ABYM (adj.PR = 1.40; 95%CI: 1.25, 1.57), and perceiving oneself as b...
Background The skin is a major route of infection in the neonatal period, especially in low birth... more Background The skin is a major route of infection in the neonatal period, especially in low birthweight (LBW) infants. Appropriate and safe neonatal skin care practices are required to reduce this risk. The perceptions and beliefs of mothers and other caregivers towards various neonatal skin care practices in our setting have been documented. Data from Asia suggests that the application of emollient to the skin of LBW infants can promote growth, reduce serious neonatal infections, and potentially reduce mortality. This is the first study to explore the acceptability of emollients and massage as part of neonatal skin care in a low-resource setting in sub-Saharan Africa (SSA) that is representative of the majority of government health facilities in Uganda and many in SSA. Objective To explore perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda. Methods We conducted a qualitative study consisting of three focus group discussions ...
Background: Reproductive autonomy is a key ingredient in driving the agenda for increased access ... more Background: Reproductive autonomy is a key ingredient in driving the agenda for increased access to and utilization of self care-oriented family planning (FP) methods. We assessed current contraceptive use, contraception decision-making processes and interest in self care-oriented contraception among adolescent girls and young women (AGYW) in Uganda. Methods: This secondary analysis used cross-sectional data from 2109 sexually-active AGYW aged 10-24 years obtained from a national survey conducted in September 2020. AGYW were asked if they had ever used or were currently using any FP method. Current contraceptive users were asked about who made the decision to use contraception in general and the specific FP methods that they were currently using in particular (i.e. respondent, partner, respondent and partner, or provider); those who made the decision to use contraception on their own were considered to have had contraception decision-making autonomy. We used a modified multivariable...
Background: Despite increased access to modern contraception among young women globally, little ... more Background: Despite increased access to modern contraception among young women globally, little is known about modern contraceptive use among women working in the informal sector who are usually missed out on in most national surveys. We assessed the factors associated with modern contraceptive use among young market women in Kampala, Uganda. Methods: This was a cross-sectional study conducted among 343 young women aged 15-24 years, working at St. Balikuddembe Market in Kampala, the Capital City of Uganda. Data were collected on socio-demographic and behavior characteristics including the current use of modern FP methods. We computed the proportion of young women who reported the current use of modern FP methods and determined the factors associated with the current use of modern FP methods using a modified Poisson regression model. Results: Of 343 young market women, 56% (192) were food handlers. Nearly half of the women (48.4, n=166) had at least one biological child. Forty-se...
Background A rapid increase in community transmission of COVID-19 across the country overwhelmed ... more Background A rapid increase in community transmission of COVID-19 across the country overwhelmed Uganda’s health care system. In response, the Ministry of Health adopted the home-based care strategy for COVID-19 patients with mild-to-moderate disease. We determined the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care during the second wave in Kapelebyong district, in eastern Uganda. Methods We conducted a sequential explanatory mixed-methods study. We first collected quantitative data using an interviewer-administered questionnaire to determine characteristics and treatment outcomes of COVID-19 patients under home-based care. Cured at home was coded as 1 (considered a good outcome) while being admitted to a health facility and/or dying were coded as 0 (considered poor outcomes). Thereafter, we conducted 11 in-depth interviews to explore the experiences of COVID-19 patients under home-based care. Multivariable logistic regression was used...
International Journal of TROPICAL DISEASE & Health
The Corona Virus Disease - 19 (COVID-19) pandemic is one of the most devastating events in the hi... more The Corona Virus Disease - 19 (COVID-19) pandemic is one of the most devastating events in the history of human health for the last several decades. Our analysis aimed at a cross-section of events, models and theories surrounding the pandemic. These included mathematical modeling, lockdown diaries, Standard Operating Procedures (SOPs), religious approaches, and the 5G network theory among others. The Global economies have been checked negatively by the pandemic. The COVID - 19 – pandemic challenge, primed many innovations and adaptations for survival. Use of phones and ICT as well as proper handling of asymptomatic victims was necessary as it resolves the anxiety issue of the infection spread. Leadership from the President to the lowers levels was critical for the management of COVID -19 challenge in Uganda.
Background Universal access to safe drinking water, sanitation and hygiene services is an essenti... more Background Universal access to safe drinking water, sanitation and hygiene services is an essential component of keeping young people in school. However, much of the focus has been directed towards meeting the sanitation and hygiene needs of school-going adolescent girls and young women with limited attention to their male school-going counterparts. We determined the oral health status and good hand hygiene practices and the factors associated with good hand hygiene practices among adolescent boys and young men (ABYM) in Kampala, Uganda. Materials and methods This cross-sectional survey was conducted among 1,869 school-going ABYM, who were randomly selected at household level from the five administrative divisions of Kampala, Uganda. A modified Poisson regression model was used to establish the factors associated with good hand hygiene practices (i.e. defined as always washing hands before eating and after visiting the latrine or toilet) among ABYM in Kampala. Results Overall, 81.4%...
Introduction: Understanding and following HIV self-testing (HIVST) instructions is a critical ste... more Introduction: Understanding and following HIV self-testing (HIVST) instructions is a critical step in the use of HIVST kits. We analyzed data on pregnant women and their partners’ self-assessment on the usability of kits delivered by their pregnant women. Methods: Quantitative data were collected on 399 pregnant women and 238 male partners enrolled in the intervention arm of a large cluster-randomized HIVST trial. Each pregnant woman received HIVST demonstrations, detailed pictorial instructions on how to use OraQuick HIVST kits, and two kits; for herself and her male partner. Follow-up was at one month (baseline for male partners) and 3 months. Descriptive statistics were conducted to compare understanding and following of HIVST instructions by age and education level. Results: The proportion of those who understood HIVST instructions was almost the same (98%) for women and their partners, although partners (26.5%) were nearly twice as likely than women (16.0%) to report needing pr...
Introduction: The association between extra-spousal partnerships and HIV in married or cohabiting... more Introduction: The association between extra-spousal partnerships and HIV in married or cohabiting individuals remains controversial. We established the association between extra-spousal partnerships and HIV prevalence among married or cohabiting individuals in Rakai, Uganda.Methods: This secondary analysis uses data from a large cross-sectional study conducted among 2,135 married or cohabiting individuals aged 15-49 years in Rakai, Uganda, between November 2013 and February 2014. Data were collected on socio-demographic and behavioral characteristics, including extra-spousal partnerships. We used a modified Poisson regression model to assess the association between extra-spousal partnerships and HIV prevalence among married or cohabiting individuals living in three study communities with differing HIV prevalence. Stata version 14.0 was used for data analysis. Results: Of 2,103 respondents included in the analysis, 13.4% (282/2103) reported extra-spousal partnerships; 4.5% (n=49) amo...
IntroductionInnovative strategies are needed to disseminate HIV prevention messages across commun... more IntroductionInnovative strategies are needed to disseminate HIV prevention messages across communities efficiently, as well as reduce HIV stigma while promoting HIV prevention. This randomized controlled trial will evaluate the efficacy of a social network-based group intervention, Game Changers, which trains persons living with HIV (PLWH) to encourage members of their social network to use HIV protective behaviorsMethodsPLWH in HIV care for at least one year will be randomly assigned to receive the 8-session group advocacy training intervention or no-intervention control group. Each enrolled PLWH (index participant) will be asked to recruit up to four social network members (alter participant). Assessments will be administered at baseline and month 6, 12 and 18 to both index and alter participants. The primary outcomes are HIV testing and condom use among alter participants; secondary outcomes are engagement in HIV prevention advocacy and internalized HIV stigma among index partici...
We examined the association of HIV prevention advocacy with social network members (alters) on al... more We examined the association of HIV prevention advocacy with social network members (alters) on alter condom use behavior, and factors that may mediate and moderate this relationship, among people living with HIV (PLWH) in Uganda. Ninety PLWH completed all assessments (baseline and 5- and 8-month follow-ups). Internalized HIV stigma, HIV disclosure self-efficacy, positive living behavior (i.e., condom use), and advocacy self-efficacy were examined as mediators (at 5-month follow-up) of the association between condom use advocacy and perceived alter condom use. Individual socio-demographic and social network characteristics at baseline were examined as moderators. Among alters who received condom use advocacy in the months prior to both baseline and 5-month follow-up, 69.9% (51/73) were perceived to mostly/always use condoms at either the 5- or 8-month follow-up, which was significantly higher than the 36.4% (235/645) of alters who received none or less advocacy. Participants’ internalized HIV stigma and consistent condom use mediated the association of advocacy and perceived consistent condom use among alters; the participant having any secondary education and the alter being male were associated with increased magnitude of the associations between advocacy and alter condom use. These findings highlight the importance of sustained advocacy to promote consistent condom use, and the value of anti-stigma and positive living interventions as mechanisms for enhancing effective advocacy.
A Dissertation submitted in partial fulfilment for the award of the degree of Master of Public He... more A Dissertation submitted in partial fulfilment for the award of the degree of Master of Public Health of Makerere University
Background Evidence suggests use of herbal and conventional medicines in the treatment of Sickle ... more Background Evidence suggests use of herbal and conventional medicines in the treatment of Sickle Cell Disease (SCD). We examined factors associated with caregivers’ use of combined herbal and conventional medicine to treat children with SCD. Methods A cross-sectional study was conducted at Jinja Regional Referral Hospital between January and March 2022. Caregivers of children with SCD aged 1 to 18 years attending the Sickle Cell Clinic were interviewed using structured questionnaires. We collected data on caregivers’ socio-demographic characteristics, perceptions of and intentions to use either or both therapies, self-reported use of either or both therapies and community and health-related factors. A multivariable logistic regression model was computed to assess the factors independently associated with caregivers’ use of combined therapy, using Stata version 15.0. Results 372 caregivers were interviewed. On average, respondents were aged 34.3 years (Standard Deviation [SD]: ±9.8 y...
Pre-Exposure Prophylaxis (PrEP) is a known HIV prevention strategy for high-risk populations howe... more Pre-Exposure Prophylaxis (PrEP) is a known HIV prevention strategy for high-risk populations however, some high-risk communities have not yet fully embraced it. We sought to determine willingness to take PrEP and the associated factors among high-risk adolescent boys and young men (ABYM) in Masese fishing community, Jinja district, Eastern Uganda. We conducted a cross-sectional study, between October and November 2020, using a semi-structured questionnaire among ABYM aged 10–24 years in Masese fishing community, Eastern Uganda. We surveyed 479 participants, who had two or more sexual partners with inconsistent or no condom use. We carried out modified Poisson regression analysis to determine factors associated with willingness to take PrEP.Of 479 high-risk ABYM, 86.4% (n = 414) were willing to take PrEP. Confidence in PrEP safety (adj.PR = 1.56; 95%CI: 1.55, 2.24), availability of PrEP in areas easily accessible by ABYM (adj.PR = 1.40; 95%CI: 1.25, 1.57), and perceiving oneself as b...
Background The skin is a major route of infection in the neonatal period, especially in low birth... more Background The skin is a major route of infection in the neonatal period, especially in low birthweight (LBW) infants. Appropriate and safe neonatal skin care practices are required to reduce this risk. The perceptions and beliefs of mothers and other caregivers towards various neonatal skin care practices in our setting have been documented. Data from Asia suggests that the application of emollient to the skin of LBW infants can promote growth, reduce serious neonatal infections, and potentially reduce mortality. This is the first study to explore the acceptability of emollients and massage as part of neonatal skin care in a low-resource setting in sub-Saharan Africa (SSA) that is representative of the majority of government health facilities in Uganda and many in SSA. Objective To explore perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda. Methods We conducted a qualitative study consisting of three focus group discussions ...
Background: Reproductive autonomy is a key ingredient in driving the agenda for increased access ... more Background: Reproductive autonomy is a key ingredient in driving the agenda for increased access to and utilization of self care-oriented family planning (FP) methods. We assessed current contraceptive use, contraception decision-making processes and interest in self care-oriented contraception among adolescent girls and young women (AGYW) in Uganda. Methods: This secondary analysis used cross-sectional data from 2109 sexually-active AGYW aged 10-24 years obtained from a national survey conducted in September 2020. AGYW were asked if they had ever used or were currently using any FP method. Current contraceptive users were asked about who made the decision to use contraception in general and the specific FP methods that they were currently using in particular (i.e. respondent, partner, respondent and partner, or provider); those who made the decision to use contraception on their own were considered to have had contraception decision-making autonomy. We used a modified multivariable...
Background: Despite increased access to modern contraception among young women globally, little ... more Background: Despite increased access to modern contraception among young women globally, little is known about modern contraceptive use among women working in the informal sector who are usually missed out on in most national surveys. We assessed the factors associated with modern contraceptive use among young market women in Kampala, Uganda. Methods: This was a cross-sectional study conducted among 343 young women aged 15-24 years, working at St. Balikuddembe Market in Kampala, the Capital City of Uganda. Data were collected on socio-demographic and behavior characteristics including the current use of modern FP methods. We computed the proportion of young women who reported the current use of modern FP methods and determined the factors associated with the current use of modern FP methods using a modified Poisson regression model. Results: Of 343 young market women, 56% (192) were food handlers. Nearly half of the women (48.4, n=166) had at least one biological child. Forty-se...
Background A rapid increase in community transmission of COVID-19 across the country overwhelmed ... more Background A rapid increase in community transmission of COVID-19 across the country overwhelmed Uganda’s health care system. In response, the Ministry of Health adopted the home-based care strategy for COVID-19 patients with mild-to-moderate disease. We determined the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care during the second wave in Kapelebyong district, in eastern Uganda. Methods We conducted a sequential explanatory mixed-methods study. We first collected quantitative data using an interviewer-administered questionnaire to determine characteristics and treatment outcomes of COVID-19 patients under home-based care. Cured at home was coded as 1 (considered a good outcome) while being admitted to a health facility and/or dying were coded as 0 (considered poor outcomes). Thereafter, we conducted 11 in-depth interviews to explore the experiences of COVID-19 patients under home-based care. Multivariable logistic regression was used...
International Journal of TROPICAL DISEASE & Health
The Corona Virus Disease - 19 (COVID-19) pandemic is one of the most devastating events in the hi... more The Corona Virus Disease - 19 (COVID-19) pandemic is one of the most devastating events in the history of human health for the last several decades. Our analysis aimed at a cross-section of events, models and theories surrounding the pandemic. These included mathematical modeling, lockdown diaries, Standard Operating Procedures (SOPs), religious approaches, and the 5G network theory among others. The Global economies have been checked negatively by the pandemic. The COVID - 19 – pandemic challenge, primed many innovations and adaptations for survival. Use of phones and ICT as well as proper handling of asymptomatic victims was necessary as it resolves the anxiety issue of the infection spread. Leadership from the President to the lowers levels was critical for the management of COVID -19 challenge in Uganda.
Background Universal access to safe drinking water, sanitation and hygiene services is an essenti... more Background Universal access to safe drinking water, sanitation and hygiene services is an essential component of keeping young people in school. However, much of the focus has been directed towards meeting the sanitation and hygiene needs of school-going adolescent girls and young women with limited attention to their male school-going counterparts. We determined the oral health status and good hand hygiene practices and the factors associated with good hand hygiene practices among adolescent boys and young men (ABYM) in Kampala, Uganda. Materials and methods This cross-sectional survey was conducted among 1,869 school-going ABYM, who were randomly selected at household level from the five administrative divisions of Kampala, Uganda. A modified Poisson regression model was used to establish the factors associated with good hand hygiene practices (i.e. defined as always washing hands before eating and after visiting the latrine or toilet) among ABYM in Kampala. Results Overall, 81.4%...
Introduction: Understanding and following HIV self-testing (HIVST) instructions is a critical ste... more Introduction: Understanding and following HIV self-testing (HIVST) instructions is a critical step in the use of HIVST kits. We analyzed data on pregnant women and their partners’ self-assessment on the usability of kits delivered by their pregnant women. Methods: Quantitative data were collected on 399 pregnant women and 238 male partners enrolled in the intervention arm of a large cluster-randomized HIVST trial. Each pregnant woman received HIVST demonstrations, detailed pictorial instructions on how to use OraQuick HIVST kits, and two kits; for herself and her male partner. Follow-up was at one month (baseline for male partners) and 3 months. Descriptive statistics were conducted to compare understanding and following of HIVST instructions by age and education level. Results: The proportion of those who understood HIVST instructions was almost the same (98%) for women and their partners, although partners (26.5%) were nearly twice as likely than women (16.0%) to report needing pr...
Introduction: The association between extra-spousal partnerships and HIV in married or cohabiting... more Introduction: The association between extra-spousal partnerships and HIV in married or cohabiting individuals remains controversial. We established the association between extra-spousal partnerships and HIV prevalence among married or cohabiting individuals in Rakai, Uganda.Methods: This secondary analysis uses data from a large cross-sectional study conducted among 2,135 married or cohabiting individuals aged 15-49 years in Rakai, Uganda, between November 2013 and February 2014. Data were collected on socio-demographic and behavioral characteristics, including extra-spousal partnerships. We used a modified Poisson regression model to assess the association between extra-spousal partnerships and HIV prevalence among married or cohabiting individuals living in three study communities with differing HIV prevalence. Stata version 14.0 was used for data analysis. Results: Of 2,103 respondents included in the analysis, 13.4% (282/2103) reported extra-spousal partnerships; 4.5% (n=49) amo...
IntroductionInnovative strategies are needed to disseminate HIV prevention messages across commun... more IntroductionInnovative strategies are needed to disseminate HIV prevention messages across communities efficiently, as well as reduce HIV stigma while promoting HIV prevention. This randomized controlled trial will evaluate the efficacy of a social network-based group intervention, Game Changers, which trains persons living with HIV (PLWH) to encourage members of their social network to use HIV protective behaviorsMethodsPLWH in HIV care for at least one year will be randomly assigned to receive the 8-session group advocacy training intervention or no-intervention control group. Each enrolled PLWH (index participant) will be asked to recruit up to four social network members (alter participant). Assessments will be administered at baseline and month 6, 12 and 18 to both index and alter participants. The primary outcomes are HIV testing and condom use among alter participants; secondary outcomes are engagement in HIV prevention advocacy and internalized HIV stigma among index partici...
We examined the association of HIV prevention advocacy with social network members (alters) on al... more We examined the association of HIV prevention advocacy with social network members (alters) on alter condom use behavior, and factors that may mediate and moderate this relationship, among people living with HIV (PLWH) in Uganda. Ninety PLWH completed all assessments (baseline and 5- and 8-month follow-ups). Internalized HIV stigma, HIV disclosure self-efficacy, positive living behavior (i.e., condom use), and advocacy self-efficacy were examined as mediators (at 5-month follow-up) of the association between condom use advocacy and perceived alter condom use. Individual socio-demographic and social network characteristics at baseline were examined as moderators. Among alters who received condom use advocacy in the months prior to both baseline and 5-month follow-up, 69.9% (51/73) were perceived to mostly/always use condoms at either the 5- or 8-month follow-up, which was significantly higher than the 36.4% (235/645) of alters who received none or less advocacy. Participants’ internalized HIV stigma and consistent condom use mediated the association of advocacy and perceived consistent condom use among alters; the participant having any secondary education and the alter being male were associated with increased magnitude of the associations between advocacy and alter condom use. These findings highlight the importance of sustained advocacy to promote consistent condom use, and the value of anti-stigma and positive living interventions as mechanisms for enhancing effective advocacy.
A Dissertation submitted in partial fulfilment for the award of the degree of Master of Public He... more A Dissertation submitted in partial fulfilment for the award of the degree of Master of Public Health of Makerere University
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Papers by Joseph Matovu