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A comparative study of nutritional status, complementary foods and feeding practices for children 6 - 23 months old in landslides prone Bududa District
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements leading to the award of a Master of Science Degree in Applied Human Nutrition of Makerere University.Background: Bududa district located in Eastern Uganda experiences frequent landslides and floods resulting into food insecurity which predisposes children 6-23months to undernutrition. This study aimed at assessing the nutritional status of children, feeding practices and quality of complementary foods fed to children in Bukalasi sub-county (affected by landslides) and Bubiita (control) in 2019/2020 Methodology: A comparative cross-sectional survey was conducted. Through 5-stage sampling technique 191 households with children, aged 6-23 months were selected. Using a structured questionnaire, parents/care-givers identified four commonly used complementary foods (CFs). Child nutritional status was categorized according to World Health Organization (WHO) standards. Four focus group discussions (FGD) with mothers, explored commonly used complementary foods, methods of preparation and optimization of foods for analysis. A chi-square tested the association between child nutritional status and categorical variables of gender, age, Minimum Acceptable Diet (MAD) and the socio-economic factors of the household. A means comparison was done by ANOVA for Minimum Dietary Diversity (MDD) with the socio-economic factors and age of children with the amount of nutrients taken. Statistical significance was set at p<0.05. Pearson‘s Bivariate correlation was done to establish the relationship between different variables (child’s age group, feeding frequency, dietary diversity and nutrients intake). Qualitative data was transcribed, coded and categorised into themes and facts so as to establish a sequence of patterns and associations related to the phenomenon being investigated. Results: Child undernutrition in the study area was higher than at national level with a very high prevalence of stunting (40.5%), very high prevalence of underweight (20.7%) and medium prevalence of wasting (8.1%). More children in Bukalasi were significantly underweight than Bubiita (p<0.05). Main source of food was associated with underweight in both the affected and control Sub-counties (p<0.05). Unlike children 6-8months, majority of children aged 9-23months met their food diversity score (p<0.05). Source of income and main source of food were associated with children not meeting their Minimum Acceptable Diet (MAD) (p=0.008 and p=0.003 respectively). The study area had unsafe water with risk levels of e-colis among other microorganisms which were too numerous to count (TNTC), Maize flours from both sub-counties were heavily contaminated with Aflatoxins with levels above the national and EU regulatory limits (10ppb) and (5 ppb) respectively. Conclusion and recommendation: Childhood undernutrition was observed among children from both sub-counties. Notably, the prevalence of stunting, wasting and underweight was higher among children in the disaster affected Bukalasi sub-county and more prevalent in males. Complementary foods provided to the children were deficient of micronutrients especially iron and contaminated with aflatoxins especially in groundnuts and aflatoxins. The water that was used for preparing complementary food for the children was also contaminated with E. coli. Therefore, the government and other stakeholders should design specific interventions to not only combat malnutrition among children but also guide and support caregivers in the selection of safe food items and their formulation for complementary dishes
Perceived tenure security in collaborative forest management: a case of Budongo forest, mid-western Uganda.
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of the Degree of Master of Science in Environment and Natural Resources of Makerere University.Perceived tenure security is widely recognized as a key determinant of land use decisions. The level of perceived tenure security shapes community participation in conservation activities, sustainable resource use, and benefit-sharing arrangements. Collaborative Forest Management (CFM) has been promoted to enhance local resource users’ forest tenure security to achieve win-win forest conservation and livelihood outcomes. This study investigated the role of perceived tenure security in CFM in Budongo Central Forest Reserve in mid-western Uganda. Specifically, it sought to (i) assess the level of perceived tenure security in CFM (ii) examine the factors influencing perceived tenure security and (iii) examine the relationship between perceived tenure security and participation in collaborative forest management activities. Quantitative data was collected from 180 households in villages surrounding Budongo Central Forest Reserve. In addition focus group discussions, and key informant interviews were held with leaders of three CFM groups (Budongo Good Neighbours Conservation Association, Siiba Conservation Environment and Development Association and Karujubu Forest Adjacent Community Association) and other opinion leaders in the area. Descriptive statistics, binary logistic regression and one-way Analysis of Variance (ANOVA) were run to analyze the quantitative data while content analysis was used for the qualitative data. The research findings reveal that CFM participants exhibit significantly higher levels of perceived tenure security than non-participants, particularly regarding their access, withdrawal, and management rights. Socio-demographic factors such as age, education, income, and proximity to forests significantly influenced these perceptions. There was a positive relationship between perceived tenure security and participation in CFM activities which highlights the importance of secure tenure in fostering community involvement and sustainable forest management practices. However, challenges such as limited awareness about CFM activities, resource constraints, and conflicts over forest use hinder broader community participation. Strengthening perceived tenure security requires targeted education campaigns, improved local infrastructure, and support for income-generating activities, alongside inclusive decision-making processes and formalized tenure rights to ensure equitable forest resource access and foster participation in CFM. Future research should explore gender disparities in participation, the role of traditional roles knowledge and societal expectations in shaping perceived forest tenure security.Consolidating Early Career Academic Programme (CECAP) project
Perceived barriers, knowledge and attitudes towards help seeking for mental health services among Makerere University students
No full textA research dissertation submitted to the School of Psychology for partial fulfillment of the requirement for the award of degree of Master of Science in Clinical Psychology of Makerere UniversityThis study was to investigate the associations between Perceived Barriers, Knowledge and Attitudes towards Help Seeking for Mental Health Services within the Makerere university student population. A purposive sample of 182 students aged 19-40 participated in a quantitative, correlational study with a focus on modulation effects. Four corresponding hypotheses were formulated and tested to provide a comprehensive understanding of these relationships, aiming to contribute valuable insights from the students. Data was collected through structured questionnaires measuring barriers, knowledge and health-seeking attitudes for mental health and services. A positive correlation emerged between barriers and knowledge and (r = .363, p 0.01). There was no significant association between barriers and attitudes towards help-seeking (r = .054, p > 0.05). Knowledge moderated the relationship between perceived barriers and attitudes towards help-seeking (moderation r = -.342 to .0160, p < 0.01). These findings highlight the importance of knowledge in addressing mental health barriers. The positive correlation between Barriers and Knowledge might be explained by heightened awareness leading to discomfort with seeking help. Alternatively, the moderating effect could indicate that students with more knowledge are better equipped to navigate barriers due to their understanding of the importance of seeking help and available resources. This study emphasizes the need for comprehensive mental health education that addresses both knowledge and potential barriers to accessing services. Future research could explore the underlying reasons for the seemingly counterintuitive positive correlation between Barriers and Knowledge.
Prevalence of systemic candidiasis, drug-resistant Candida species, and associated factors among febrile patients with cancer at Uganda Cancer Institute
No full textA dissertation submitted in partial fulfillment of the requirement for the award of the degree of Master of Medicine in Internal Medicine of Makerere UniversityBackground: A significant proportion of cancer-related deaths in sub-Saharan Africa are secondary to infections. Patients with cancer are at risk of fungal infections due to their lowered immunity and when these infections are drug-resistant, the outcomes can be even worse. Data is urgently needed on the prevalence of systemic candidiasis, drug-resistant Candida species, and associated factors among cancer patients in Uganda.
Objective: The primary objective was to determine the prevalence of systemic candidiasis, drug-resistant Candida species, and associated factors among febrile cancer patients admitted to the Uganda Cancer Institute (UCI). Secondarily, the study aimed to investigate the prevalence of bacteremia, antimicrobial susceptibility profiles, and associated factors.
Methods: This cross-sectional study was conducted at UCI from March to May 2024. Convenience sampling was used to enroll all febrile cancer patients at admission or during their hospital stay until the sample size was reached. Blood cultures from these patients were performed, and microbial growth was identified. Antimicrobial susceptibility testing was conducted using the Kirby-Bauer disk diffusion method
Results: A total of 123 participants, with a mean age of 43.0±16.0 years, were enrolled in the study. The cohort included 68 females (55.3%), 37 patients (30.1%) with hematological malignancies, and 86 patients (69.9%) with solid malignancies. None of the blood samples grew Candida or any fungal species. However, 18 (14.6%) blood samples grew bacteria; 10 (55.6%) Gram-negative bacilli and 8 (44.4%) Gram-positive cocci. E. coli (n=6, 60%) was the most isolated Gram-negative bacilli, and coagulase-negative Staphylococci (CoNS) (n=6, 75%) was the most isolated Gram-positive cocci. For coagulase-negative Staphylococci (CoNS), resistance to penicillin was 83.3% (n=5) and 66.7% (n=4) for cefoxitin, ciprofloxacin, erythromycin, and trimethoprim-sulphamethoxazole. For E. coli, 83.3% (n=5) of the isolates were resistant to cefotaxime, ceftazidime, ceftriaxone, and cefuroxime and 66.7% (n=4) to ciprofloxacin. There were no statistically significant factors associated with bacteremia in this study.
Conclusions: The absence of Candida species in blood cultures may be influenced by the relatively low sensitivity of blood cultures in detecting candidemia, and the potential impact of prior antifungal therapy. The high resistance rates among bacterial isolates highlight the growing burden of antimicrobial resistance at UCI.Merc
Incidence, risk factors and outcomes of post-anaesthetic complications: A prospective cohort study in Mulago Adult Post-anesthesia Care Unit
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of the degree of Master of Medicine in Anaesthesia and Critical Care of Makerere University.Abstract
Background: Post-anaesthetic complications in the post-anaesthesia care unit (PACU) are common and significantly impact patient outcomes often leading to increased morbidity, prolonged PACU stay, and unplanned ICU admissions whose bed availability is limited. The post-anaesthetic standardised clinical pathway improves the early detection of patients at risk of deterioration for better outcomes. This study sought to determine the incidence, risk factors, and outcomes for post-anaesthetic complications in Mulago National Referral Hospital (MNRH). Method: We conducted a prospective cohort study at MNRH PACU that recruited 370 Adult participants, 18 years and above between June and August 2023. Data was collected with REDCap and exported to STATA 17 for analysis. A modified Poisson generalised linear model (GLM) with standard robust error analysis generated Crude Risk Ratio (CRR) at bivariable and Adjusted Risk Ratio (ARR) at multivariable determined the association between postanaesthetic complication and the risk factors. The association between the complications and outcome was determined by the Fisher Exact test. A 95% confidence interval (CI) was calculated. p‐value < 0.05 was considered as statistically significant. Results: The incidence of post-anaesthetic complications in PACU was 74%, and most (40.8%) of the participants had multiple complications. Hypothermia was encountered frequently at (50.5%), followed by tachycardia at (24.1%) and pain at 16.8%. Multivariable analysis showed that factors associated with post-anaesthesia complications in PACU include; intraoperative complications (hypotension ARR 1.23; 95% CI 1.08-1.41 p=0.003, significant blood loss ARR 1.29; 95% CI 1.09-1.52 p=0.002 & hypoxia ARR 1.38: 95% CI 1.21-1.56 p<0.001), intraoperative opioid use (ARR 1.68; 95% CI 1.15-2.46 p=0.008), and 2-3 hours duration of anaesthesia (ARR 1.35; 95% CI 1.12-1.63 p=0.002). The majority of the participants (98.2%) had favourable outcomes and 1.8% unfavourable outcomes were prolonged PACU stay. Conclusion: Given the high incidence of post-anaesthesia complications, coupled with the identified risk factors, standardising PACU care as per WHO recommendation is crucial. Key strategies include; equipping the PACU to enhance patient monitoring, warming of patients and increasing the PACU nurse-to-patient ratio to 1:2 to manage complications better and improve patient outcomes
Correlates of aids-related mortality among patients on antiretroviral therapy in Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of the degree of Master of Statistics of Makerere UniversityIn this “test and treat” era of HIV and AIDS management, the persistently higher mortality rate among PLWH compared to non-HIV individuals in low-income countries remains questionable. This study aimed to investigate the reasons for AIDS-related deaths employing Accelerated Failure Time models which have not been fully exploited. Secondary data from AHF, Uganda Cares Masaka Regional Referral Hospital was used to study the influence of socio-demographic, personal and behavioural factors and, patient clinical features on time to death. A retrospective study was carried out considering patients who were diagnosed with HIV and started ART from January 2009 through January 2020. The Kaplan-Meier (KM) estimate of the survival function, log rank chi test and multivariate log normal Accelerated Failure Time model were employed. p<0.05 was considered. Our results revealed that, being male (TR=0.299, p=0.000), disclosure of HIV status to other family members (TR=0.311, p=0.006), being at an advanced stage of disease progression stage III (TR=0.126, p=0.001) and stage IV (TR=0.023, p=0.000), and having viral load count greater or equal to 1000 copies/ml (TR=0.523, p=0.028) were associated with shorter time of survival. In addition, patients who attended the voluntary counselling sessions had longer survival time compared to those who did not attend (TR=2.261, p=0.006) and patients on ART whose body weight is 50 kg and above had longer time of survival compared to those with weight below 50kg. In conclusion, being male, not attending counselling sessions, disclosure of HIV status to other family members rather than spouse or sexual partners, weighing below 50kg, being at an advanced stage of disease progression (stage III and stage IV) and having viral load count greater or equal to 1000 copies/ml at baseline are associated with shorter survival time and dying earlier. Therefore, future research should focus on interventions targeting patient population groups with less survival time yet are already initiated on ART
Primiparous women's preparedness and lived experiences of episiotomy at St. Mary's Hospital, Lacor, Gulu, Northern Uganda
No full textA dissertation submitted to the Department of Obstetrics and Gynecology in partial fulfillment leading to the award of a Master’s Degree of Medicine in Obstetrics and Gynecology of Makerere University.Introduction: Episiotomies are still widely performed globally with 40% of primiparous women at St. Mary’s Hospital, Lacor undergoing the procedure. There is a paucity of data on whether primiparous women understand the indications, consenting procedures, and their lived experiences thereafter and following discharge from the hospital. This study explored the primiparous women’s preparedness and lived experiences of episiotomy at St. Mary’s Hospital, Lacor.
Methods: A phenomenological study in the Post-natal and Immunization Clinic of St. Mary’s Hospital, Lacor, was conducted among 20 primiparous women who had episiotomy during childbirth at the 6th week to 18 months of follow-up and six (6) health workers as Key informants (KIs). In-depth audio-recorded interviews for women and KI interviews for healthcare providers were conducted, transcribed verbatim, and analyzed manually using both deductive and inductive thematic techniques guided by the socio-ecological model (SEM) as the theoretical framework.
Results: The study conducted in-depth interviews and key informant interviews from January to March 2024, with participants averaging 22 years of age. Most were married and had at least a secondary education. Primiparous women were not adequately prepared for episiotomy. Positive outcomes of episiotomy included successful delivery and enhanced sexual enjoyment, while negative outcomes included perineal pain, bleeding, emotional distress, prolonged healing, and painful intercourse. Inadequate anesthesia at the health facility level was a major concern.
Conclusion: The study revealed gaps in Antenatal Care (ANC) education on episiotomy as women did not receive specific teachings on it and informed consent for episiotomy did not provide alternatives, benefits and risks, and affirmation for the procedure. Additionally, positive experiences such as successful childbirth and the procedure being perceived as safe compared to the cesarean section were noted, while perineal pain and painful sexual intercourse were the negative experiences.
Recommendations: Comprehensive health education encompassing teachings on episiotomy should be practiced at the ANC unit for primigravidae. Facility-based checklist for obtaining informed consent on episiotomy should availed at the Maternity Unit. Continuous medical education should be given to all health workers in the obstetrics and gynecology department on episiotomy including the aspects of the technique, analgesia, and post-delivery care.Corti Foundatio
Gender disparities in the downstream nodes of the rice value chain in Eastern Uganda : roles, labour time allocation, and empowerment
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of Collaborative Master of Science in Agricultural and Applied Economics of Makerere University.Developing country governments and development organizations have labored to integrate both men and women in post-production value chains as a strategy for poverty alleviation, economic growth, employment generation, gender equality, and improved well-being. Despite the rapid mainstreaming of inclusiveness in policy discourse, remarkably little literature sheds light on the changes over time in post-production agricultural value chains. This study addresses this gap. Using data collected from 515 downstream rice value chain actors in Eastern Uganda, the study analyzes the distribution of roles, allocation of time, and empowerment among women and men. It also assesses the determinants of their time allocation to the downstream nodes of the rice value chain using linear regression. To account for endogeneity, the study used the two-step control function approach in the treatment-effects model to determine the effect of engagement in downstream nodes of the rice value chain on the empowerment of men and women. Results showed that the downstream nodes of the rice value chain and most of the activities are dominated by men. Women on the other hand dominated activities that were less renumerated such as sorting and cleaning rice and preparing food for workers. Findings on time allocation showed that men and women spend 5-8 hours per day in the downstream nodes of the rice value chain with men spending significantly more time than women. Time allocation to the downstream nodes of the rice value chain depends on the sex of the actor, association membership, engagement in non-agricultural activities, engagement in rice production, and marital status. The Individual Empowerment Index showed that the mean individual empowerment score for men is significantly higher than for women. Men are also more empowered than women in the income, leadership, and time allocation domains. Women on the other hand are more empowered than men in the household livelihood domain. Engagement in milled rice trading was found to significantly lower the empowerment scores of women. The study recommends efforts to increase women’s visibility in post-production nodes of agricultural value chains. The study recommends strategies such as improvement in infrastructure that reduces household labor, such as reliable water and electricity supply to reduce the domestic work burden for women, enabling them to invest more time in productive. The study also recommends the creation of gender awareness through education especially in the early years to eliminate stereotypes
Analyzing industrial electricity demand in Uganda from 1998 to 2022
No full textA dissertation submitted in partial fulfillment of the requirements for the award of Masters of Science in Quantitative Economics of Makerere UniversityThis study was conducted for the purpose of analyzing industrial electricity demand in Uganda from the year 1998 to 2022. To achieve this, descriptive statistical and econometric methodologies were utilized to analyze the influence of electricity price, industrial income (GDP) and Index of Industrial Production (IIP) on electricity demand. Using the Augmented Dickey-Fuller test, it was found out that variables are first difference stationary which is the necessary condition for a cointegrated system. A co integration test using the Johansen-Juselius method was used to determine if there is a long run relationship among electricity consumption, its price, index of production and the GDP of the industrial sector. The Error Correction Model was then applied to determine the short run elasticities and the Error Correction Term was interpreted to determine the speed at which electricity demand returns to equilibrium after a change in GDP, IIP and electricity price. The study revealed that in the short run, electricity price has no effect on quantity of electricity demanded. However, in the long run, electricity demand is price sensitive with a price elasticity of -0.14 in large industries. GDP has a positive influence on electricity demanded both in the short and long run. In the long run, the income elasticity for large and medium industry is 0.78 and 0.32 respectively and it is found to be 0.032 for the large industries in the short run. This makes electricity a normal good as well as a necessity for the industrial sector. IIP has a positive (0.06) and negative (-0.09) influence on electricity demand in large and medium industries respectively. This implies that large industries are more energy efficient as compared to medium industries. In both medium industry and large industry, there was convergence towards long run equilibrium at a rate of 0.4% and 0.11% respectively. Thus, there is a long run relationship among electricity consumption and electricity price, industrial income and index of industrial production. This study has revealed that electricity is a necessity and is thus a key input factor for the industrial sector in Uganda. Therefore, government regulatory bodies should take action by controlling the price of electricity and ensuring a steady supply of this indispensable input in Uganda’s industries. Also, it is recommended that new industries should consider purchasing and installing equipment with improved technologies to ensure efficient use of electricity in their production processes
Depression, social support and adherence to ART among people living with HIV/ AIDS at Wakiso Health Center IV
No full textA dissertation submitted to the School of Psychology as partial fulfillment for the award of a Masters of Arts in Counseling of Makerere UniversityThe researcher aimed at exploring the relationship between depression, social support, and adherence to antiretroviral therapy (ART) among people living with HIV/AIDS. A systematic random sampling strategy was used in the selection of 341 patients aged 18-35 years attending care at Wakiso Health Center IV in Uganda. Data were collected using self-administered questionnaires, including the Patient Health Questionnaire Scale, the Multi-dimensional Scale of Perceived Social Support, and the ART Adherence Scale. A correlation research design was employed and Pearson correlation coefficient was used to test the first three study hypotheses and PROCESS macro software was used in testing the fourth hypothesis. The results of this study indicated a significant relationships between depression and adherence to ART (r= -.46, p<0.05), social support and adherence (r=.17, p<0.05), and depression and social support (r= -.27, p<0.05). However, when it came to the fourth hypothesis, regression analysis revealed that social support did not substantially mitigate the link between depression and adherence (B=−0.001, p=.605. In conclusion, this indicated that while depression and social support independently affect ART adherence, social support does not buffer the negative impact of depression on ART adherence. Sensitization on the benefits of addressing depression and enhancing social support from all sources and in all forms may improve ART adherence among people living with HIV/AIDS. Integrated psychological and adherence support interventions are recommended to enhance health outcomes in this population