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Service relevance, access and utilisation experiences of male survivors of domestic violence: a case of Mubende District, Uganda
No full textA dissertation submitted to the college of Humanities and Social Sciences in partial fulfillment for the award of a Master of Arts degree in Social Sector Planning and Management (MASSPM) of Makerere UniversityThe study has its basis on the National Plan to prevent Gender Based Violence. Abused males’ syndrome has not been so much explored in Uganda despite evidence of the significant increase in domestic violence against males by females and other family members. This study aimed to understand male survivors of domestic violence experiences of the relevance, access and utilization of services in Mubende district, Uganda. To achieve the objective, this was done using a qualitative approach and phenomenological design. The phenomenological design was deemed suitable for studying the male survivors lived experience. Data was collected at one point in time. A sample size of 23 participants was interviewed with 14 male survivors and 9 service providers using the In-depth interviews and Key informant interviews respectively. The significance of the study was help understand the male survivors of domestic self-reported experiences of service relevance, access and utilisation as well as guide policy development on domestic violence among males and inform targeted programming and project implementation to improve the relevance, access and utilization of services by male survivors of domestic violence. The results from the study showed that, government having no male service providers in the study area was making it harder for male survivors to seek help through female service providers. The study also showed rampant domestic violence against males in Mubende but males still defined their male ego which makes them accept suffering in silence without separating from their families, hoping that things might change at some point. In order to fight domestic violence against males, the issue of inclusiveness in government projects and other players’ projects, should be felt by males and services should be provided equitably. Males felt left out regarding domestic violence initiatives
Revolutionizing the PhD Process: a critical examination and innovative reforms
No full textA bookRevolutionizing the PhD Process: A Critical Examination and Innovative Reforms is a provocative and deeply personal book that fearlessly challenges the entrenched biases, stigma, and barriers that have long plagued the pursuit of a doctoral degree. With unflinching honesty, Isaac Christopher Lubogo exposes the systemic flaws that perpetuate inequalities, stifle creativity, and prioritize conformity over character. This seminal work deconstructs the cult of publication and citation metrics, decolonizes knowledge production, and disrupts dominant epistemologies. Lubogo presents alternative metrics for evaluating research quality and impact, innovative pedagogies for studentcentered learning, and explores alternative degree pathways and credentialing systems. By sharing his personal struggles and triumphs, Lubogo humanizes the PhD journey, revealing the emotional labor and mental health costs that accompany this esteemed academic pursuit. This book is a rallying cry for reform, urging academics, administrators, and policymakers to join forces in revolutionizing the PhD process, making it more inclusive, supportive, and impactful for all
Adolescent mothers' experiences and support needs during the care of their preterm babies at Kawempe National Referral Hospital.
No full textA dissertation submitted to the Makerere University in partial fulfilment of the requirements for the award of master of Medicine in Paediatrics and Child HealthBackground: Neonatal Intensive Care Unit (NICU) admission following preterm delivery is associated with physical and emotional challenges to mothers due to the uncertainty of neonatal outcomes and prolonged duration of hospital stay. These experiences could be heightened among adolescent mothers due to the unpreparedness for the role and the social difficulties that follow early motherhood. Objective: This study explored the experiences and support needs of adolescent mothers with admitted preterm neonates at a tertiary hospital in Uganda. Methods: An exploratory qualitative study was conducted in the NICU of Kawempe National Referral Hospital (KNRH). Audio-recorded in-depth interviews with 21 adolescent mothers and 14 key informant interviews with their caregivers and healthcare workers were done. Data was transcribed, translated, and analysed using an inductive approach guided by the social-ecological model (SEM). Results: Most adolescent mothers reported positive experiences at the interpersonal level and negative experiences at the intrapersonal and institutional levels. The positive experiences included the joy of motherhood, support from family, partners, and other mothers, and physical support from the hospital. The negative experiences included financial difficulties, fear for the baby’s life, unfamiliarity with the baby's care, abandonment by family, unapproachable hospital staff, exhausting routines and discomfort on the wards. The support needs included financial and emotional support from the family and partners, and informational support from healthcare workers.Conclusions: This study shows that despite the presence of support from family and partners, adolescent mothers with preterm neonates face individual and institutional challenges while caring for their babies and require support to ensure their well-being and that of their neonates. We recommend strengthening hospital-based support systems through the training of healthcare workers in adolescent-responsive services and enhancing social welfare services.Fogarty International Center of the National Institutes of Health, U.S Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC), and President’s Emergency Plan for AIDS’ Relief (PEPFAR) under award number 1R25TW01121
Mammographic findings and BI-RADS concordance in women attending a community outreach program in Uganda
No full textA dissertation submitted in partial fulfillment of the requirements for the award of a Master of Medicine Degree in Radiology at Makerere UniversityIntroduction: The incidence and mortality of breast cancer in Uganda are on the rise. The Improving Breast Cancer Care Coordination (IBCCC) program was initiated to bring breast cancer screening and diagnostic services closer to women in hard-to-reach communities all over Uganda. This is the first mammography community outreach, where participants receive immediate (on-site) readings. The level of agreement between mammographic BI-RADS readings taken in the community (on-site) and those taken in the standard radiological reporting unit (off-site) is unknown. This study utilised data from the IBCCC program to shed more light on these knowledge gaps. Main Objective: To describe the mammographic findings and determine the BI-RADS concordance between on-site and off-site readings for women attending a community outreach breast cancer early detection program in Northern Uganda. Methods: The study utilised a cross-sectional design. It used data from 201 participants from 9th January 2023 to 5th September 2023 who attended the program. Participants were selected by simple random sampling. Their mammographic images and other data were obtained from the program’s database on an external hard drive. Statistical analysis was performed using Stata version 15.0. Summary statistics were calculated for all variables. The BI-RADS concordance was assessed using the Kappa (k) statistic comparing on-site to off-site mammogram readings. Results: The mean participant age was 51 years. Most participants reported at least one symptom (70.6%); the most common symptom was pain (47.8%). The most common breast composition was scattered fibroglandular density (38.3%). Sixty-nine participants (34.3%) had a mass. Thirty-four (16.9%) participants had calcifications and of those, nine (26.5%) had suspicious morphology. Off-site readings awarded a BI-RADS score of 4 or 5 to 18.4% of participants, and the BI-RADS concordance was moderate; 0.58 (95% CI: 0.44 – 0.71).
Conclusion: A significant proportion of women in this study had BI-RADS 4 and 5, suggesting late presentation in the community. The BI-RADS concordance was moderate between on-site and off-site readings. Recommendations: The Ministry of Health should conduct more community outreach programs to encourage screening for breast cancer and reduce late presentation. Healthcare institutions should facilitate subspecialist training and continuous medical education for radiologists to improve the reproducibility of mammography interpretations
Prevalence and factors associated with non-screening of siblings of children attending the Sickle Cell Clinic of Mulago National Referral Hospital
No full textA dissertation submitted to the Department of Paediatrics and Child Health as a partial fulfillment of the award of a master of Medicine in Paediatrics and Child Health.Background: Sickle cell disease (SCD) is the most common inherited hemoglobinopathy caused by an abnormal Haemoglobin S and is characterized by recurrent pain episodes and chronic anemia, progressive organ damage, and poor quality of life. Early diagnosis with early institution of treatment is key in mitigating SCD-associated morbidity and mortality. In Uganda, neonatal screening for SCD was rolled out in 2014, in the high burden districts; however, no universal newborn screening program exists largely due to cost implications. As such, most children are diagnosed later in life, usually after complications have already manifested. Screening of siblings of known sickle cell patients has the potential to bridge the gap in the diagnosis of SCD in countries where newborn screening is not universal.
Study objective: The objective of this study was to determine the prevalence and factors associated with the non-screening of siblings of sickle cell disease patients attending SCC of Mulago NRH.
Methods: A total of 380 caretakers of children with SCD attending the clinic, were interviewed in a descriptive cross-sectional study at the Mulago Sickle Cell clinic. Enrollment was done by systematic sampling and a structured interviewer-administered questionnaire was used to collect data from the caretakers. Kobo collect was used for data collection and entry and was exported to strata 17.0 for analysis. The proportion of siblings of SCD patients attending the Mulago Sickle cell clinic, who are tested for SCD status was reported. Multivariate Poisson regression was used to identify the factors associated with non-screening of siblings of SCD patients. Factors with a p-value <0.05 were regarded as significant.
Results: The prevalence of non-screening of siblings of SCD patients was 72.1%. The primary sickle cell disease patient factors like being the firstborn, age above 5 years at the time of diagnosis, the parent having initiated that patient’s screening process at diagnosis, the patient having displayed SCD symptoms by the time of diagnosis, and the caretaker being aware of their own SCD status were associated with non-screening of the siblings.
Conclusion: Sibling non-screening prevalence is high; there is a need for more proactiveness by clinicians to initiate SCD screening, Health education should be given to all people, sibling screening should be thought about as an alternative SCD screening measure, and a qualitative study is recommended to better understand the associated factors.HEPI - SHSSU (Health Professions Education and Training for Strengthening the Health System and Services in Uganda
Prevalence and Factors Associated with Hypovitaminosis D among Children on Treatment with Anti-Seizure Medications at Mulago Hospital
No full textA Thesis is Submitted to the Directorate of Research and Graduate Training in Fulfillment of the Requirements for the Award of a Degree of Master of Medicine in Paediatrics and Child Health, Makerere University.Introduction: Epilepsy is the most common neurological disease in childhood that often requires long term treatment with anti-seizure medications. These drugs increase the metabolism of vitamin D posing a significant risk for hypovitaminosis D. We aimed to determine the prevalence and factors associated with hypovitaminosis D among children taking antiseizure medications at Mulago Hospital. Methods: The study was a cross-sectional study conducted at Mulago Hospital between February 2023 and May 2023 involving children between 1 and18 years taking anti-seizure medications. Upon obtaining consent, we administered a structured questionnaire and performed a physical examination on the participants. Serum 25-hydroxyvitamin D (25(OH)D)
was measured using the electrochemiluminescence method. Hypovitaminosis D was defined as 25(OH)D <30 ng/ml: vitamin D insufficiency (VDI) and deficiency (VDD) were 21-29 ng/ml and <20 ng/ml respectively. The prevalence of Hypovitaminosis D was obtained as a proportion of those with 25(OH)D <30 ng/ml of the total enrolled in the study. Factors associated with
Hypovitaminosis D were determined using multivariable logistic regression at 5% level of significance.Results: We recruited 177 participants and analyzed 175; mean age was 7.2 ± 4.6 years, and 60.6% (106) of the participants were male. The prevalence of; hypovitaminosis D was 42.9%, VDD was 32 (18.3%) and VDI was 43 (24.6%). Compared to children being exposed to sunlight for > 60 minutes daily, children with no sunlight exposure had a 54% increase in odds of hypovitaminosis D (aOR-1.54, 95% CI 1.022-2.322). Conclusion and recommendation: The prevalence of hypovitaminosis D among children taking anti-seizure medications at Mulago hospital was high. Vitamin D supplements and increased sunlight exposure may be given to all children on Antiseizure medications who are not being exposed to sunlight. A prospective cohort study should be done to establish a temporal relationship between hypovitaminosis D and Anti-seizure medications in Uganda.This Research was supported by the National Institute of Neurological Disorders and Stroke of
the National Institute of Health under Award Number D43N11856
Geo Statistical Modelling of Spatial- Temporal Patterns of Wet and Dry Conditions at a Local Scale in Uganda
No full textA thesis submitted to the directorate of research and graduate training for the award of the degree of doctor of philosophy of Makerere University.The uncertainties surrounding climate change have made it imperative for economies such as Uganda's that depend on agriculture to model wet and dry conditions at the local scale. Wet and dry conditions have profound effects at the local scale, including irregular crop yields, intense flooding, landslides, water scarcity, and extended droughts. Information on local patterns of wet and dry conditions decentralizes decision and policymaking to adapt and minimize the resulting negative outcomes at a local scale while facilitating the development of emerging concepts such as precision agriculture, climate insurance, and climate proofing. However, information on local patterns has often been done using globally scaled models. The globally scaled models introduce geographic ambiguity, resulting in a net underestimation of wet and dry conditions at a local scale. This study created a geostatistical-oriented approach with the hypothesis that geostatistics will improve the modelling of wet and dry conditions at a local scale using satellite-gridded datasets to minimize geographic ambiguity. The gridded datasets were converted to SPI for wet and dry condition representation, integrated into a space-time cube, and geostatistical modelling was performed using the Get-Ord Gi* statistic, Mann Kendal rank correlation, PELT algorithm, nugget sill ratio, and the forecast and validation root mean square errors. Results from the study reveal that satellite-gridded datasets are an alternative estimate of in situ precipitation data. They also reveal that geostatistical modelling enables local scale modelling with input from satellite-gridded datasets. The results further show that within an area of multiple localities, different geostatistical algorithms are required to forecast wet and dry conditions depending on the degree of precipitation variability at a locality. The research results also revealed an optimal scale of 0.020*0.020 at district coverage.
In terms of contribution, this research validates alternative precipitation data, provides a geostatistical approach for modelling local wet and dry conditions, and spatially allocates forecast algorithms optimal for forecasting wet and dry conditions at different localities aiding in the development of local policy initiatives. Further research on localizing space-time cube analysis should explore multi-sensor, multi-scale modelling of meteorological conditions, and also focus on household scales.-Makerere University Staff Development, Welfare and Retirement Benefits Committe
Paediatric procedural sedation and or analgesia in the emergency unit: A cross-sectional study of practice at Mulago National Referral Hospital
No full textBackground: Paediatric Procedural Sedation and or Analgesia (PPSA) is the recommended standard of practice for children undergoing painful and distressing procedures outside the operating room, however, globally practice may vary. In Sub-Saharan Africa, data on the practice of PPSA is lacking. This study aimed to determine the current practice and outcomes of PPSA in the Accident & Emergency unit of Mulago National Referral Hospital to inform future standardization of care.
Methods: This cross-sectional study, undertaken in 2024, collected data on children ≤ 17 years of age, scheduled for a procedure under sedation and/or analgesia, using specifically designed and pretested observational checklists, including patient demographics, pre-procedure assessment and preparation, intra-procedural and post-procedural care, average sedation scores attained, pain control and adverse events observed. Data was coded and stored using Epi-data (v4.6) and analysed using Stata (v16.0). Analysis was undertaken to determine the number of sedations/analgesia done, the baseline PPSA practice and immediate outcomes.
Results: 183 children undergoing procedures at A&E were recruited for the study. Majority were male, 104/183 (56.8%) and the median age (IQR) was 8 (4-12) years. Most procedures performed were orthopaedic, 149/183 (81.4%). Only 15/183 (8.2%) children got both sedation and analgesia, 4/183 (2.2%) got sedation only while 164/183 (89.6%) got analgesia only. Propofol was the most used sedative while lignocaine + paracetamol was most used analgesia. Most children, 92/183 (50.3%) had pain scores ≥8 and adverse events occurred in 6/15 (40%) of the children who got both sedation and analgesia.
Conclusion: This study reveals that PPSA practice in this setting is largely divergent from recommended standards, highlighting a great need for training of providers and setting guidelines to standardize care
Assessing tolling a as a means of road infrastructure development in Uganda: a case of Kampala Entebbe Expressway
No full textA research report submitted to the College of Business and Management Sciences in partial fulfillment of the requirements for the award of a degree of Master of Business Administration of Makerere University.The purpose of the study was to assess tolling as a means of road infrastructure development in Uganda, using Kampala-Entebbe Expressway as a case study, the study was guided by three objectives; to examine the relevance of tolling as a means of road infrastructure development in Uganda, to establish the challenges associated with tolling in the roads’ subsector in Uganda and to suggest strategies of improving road tolling as a means of road infrastructure development in Uganda.
The study used descriptive cross-sectional research design that was reinforced by quantitative research approach while assessing tolling operations. The study used the population of 556 road users and Egis staff, from which a sample of 217 who were selected were stratified and later simple random sampling. Qualitative data was collected using self-administered questionnaires where respondents were asked to give their opinions based on Likert scale. Collected data was tested using CVI where all the three coefficient values for variables were above benchmark of 0.7.
Findings revealed that toll roads (the KEE) eases movement of freight passengers to and from Entebbe international airport and is user friendly because it rarely attracts traffic congestion, this is a toll road best practice. The major challenge is tolls are perceived by the public to be unnecessary additional tax burden thus some road users resort to other free usage alternative routes hence Expressway is underutilized, this is not a standard practice.
The study recommends adoption of best toll practices to be used as a foundation to improve tolling operations and adopt tolling as one of the means to road infrastructure development in Uganda. The study also recommends enhancing knowledge and awareness about road tolls to sustain road usage hence realization of the required revenue
Uptake and factors affecting utilisation of minimal access surgery by gynaecologists in Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment for the award of Master of Medicine in Obstetrics and Gynaecology of Makerere University.Background: Minimal access surgery (MAS) has several proven benefits for the management of most of the gynaecological conditions. However, there is limited data on the uptake and factors affecting utilization of these techniques by gynaecologists in Uganda. Therefore, we aimed to determine the utilization of MAS and associated factors among the gynaecologists in Uganda.
Objective: To assess the utilization and identify factors affecting the use of MAS by gynaecologists in Uganda. Methods: This was a mixed-methods study conducted from january to april 2024 involving a quantitative cross-sectional and qualitative approach conducted among gynaecologists registered with the Uganda Medical and Dental Practitioners Council and in active practice in public and private hospitals in Uganda. Participants inaccessible via online media channels or physically at the time of the study were excluded. The sample size was calculated using Slovin’s formula for the fine population and 182 gynaecologists systematically sampled. An online questionnaire was administered through e-mail or WhatsApp phone numbers and physical questionnaire were self-administered. Data was analysed using STATA Version 14 software and presented in tables. Qualitative data was collected through conducting key informants’ interview of the five purposively selected gynaecologists. This was written on paper and audio recorded, transcribed verbatim, coded and themes developed. Significance: The study results has yielded valuable insights for training institutions, policy makers, and implementers in Uganda. Results: A total of 160 participants, male 131 (82.0%), female 29(18.0), Overall, in the past one year, 30 (18.8%) performed MAS as primary surgeons, and 64 (40%) as both primary and/or assistant surgeon. Of the 64, 40 (62.5%) performed MAS in private not for profit hospitals. The most significant factors facilitating the uptake of MAS include budget allocation for MAS log odds 3.139, 95% CI 0.360388 – 5.918705, pv 0.027, practicing in private hospital log odds 4.403, 95% CI -0.19501 – 9.001383, pv 0.061, practicing at the national referral hospital log odds 5.320, 95% CI -0.42596 – 11.06614, pv 0.07 and the barrier is lack of supplies and utilities log odds -4.87448, 95% CI -10.1012 – 0.352214, pv 0.068. Qualitatively, a number of themes emerged as barriers to perform MAS: Lack of expertise, high cost of equipment’s, lack of institutional support meanwhile facilitators included: training, supportive hospital administration, team work and cost sharing. Conclusion: We found that 1 in 5 practicing gynaecologists practice MAS as a primary surgeon and commonly practiced in private not for profit hospitals. Findings from this study highlights valuable insights for training institutions, policy makers, and implementers