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Qureshi MJ, Miller AP, Mugamba S, Kyasanku E, Nalugoda F, Bulamba RM, Kigozi G, Nakigozi G, Nkale J, Kato P, Nalwoga GK, Watya S, Wagman JA. Women's access to family planning and experiences of reproductive coercion during the COVID-19 lockdown in two districts of Uganda. Heliyon 2024; 10:e30216. [PMID: 38765155 PMCID: PMC11098776 DOI: 10.1016/j.heliyon.2024.e30216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024] Open
Abstract
Background In March 2020, Uganda enforced country-wide restrictions to control the spread of SARS-CoV-2, categorizing some health services, including family planning (FP), as non-essential. Globally, similar COVID-19 restrictions have been associated with increased vulnerability to reproductive coercion (RC) among women, due to changes in FP service availability and restricted access by partners. This study aims to investigate these dynamics in Uganda, specifically examining the impact of the COVID-19 lockdown on women's access to FP, their experiences of RC, and the relationship between RC and intimate partner violence (IPV). Methods We conducted a cross-sectional analysis of data from 960 women participating in the AMBSO Population Health Surveillance Study (APHS) between August 2020 and March 2021 across Wakiso (N = 164) and Hoima (N = 796) districts in Uganda. Our analysis focused on women who were sexually active in the past month, using bivariate analyses to explore the associations between RC and recent experiences of sexual, physical, and verbal IPV. Findings The most commonly reported FP methods were injectables (36.8 %) and implants (16 %). Despite the COVID-19 lockdown, less than one percent of participants reported an inability to access their preferred FP method. Notably, 3 % of the women experienced RC in the past 12 months. There was a significant association between RC and sexual IPV (p < 0.0001), as well as physical IPV (p < 0.0001). Instances of verbal IPV were observed to have tripled during the lockdown period. Interpretation An increase in verbal IPV was found among women during the COVID-19 lockdown. Additionally, a notable association emerged between other forms of IPV and an increased risk of RC. Despite the lockdown, access to FP remained high, which could be attributed to the prevalent use of long-acting FP methods.
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Affiliation(s)
- Mira J. Qureshi
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Amanda P. Miller
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Stephen Mugamba
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Emmanuel Kyasanku
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Fred Nalugoda
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Robert Malyabe Bulamba
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Godfrey Kigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Gertrude Nakigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - James Nkale
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Phillip Kato
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Grace Kigozi Nalwoga
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Stephen Watya
- Africa Medical and Behavioral Sciences Organization (AMBSO), Plot 7441, Nansana, Hoima Road, Wakiso, P.O Box 37565 Kampala, Uganda
| | - Jennifer A. Wagman
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Miller AP, Appa A, Muyindike W, Fatch R, Kekibiina A, Beesiga B, Adong J, Emenyonu N, Marson K, Getahun M, Kamya M, Chamie G, Camlin CS, Hahn JA. A Qualitative Exploration of Intimate Partner Violence Among HIV/TB Coinfected Persons With Problematic Alcohol Use Participating in an Incentive-Based Alcohol/Medication Adherence Intervention in Uganda During COVID-19. Violence Against Women 2024:10778012231225229. [PMID: 38196278 PMCID: PMC11231058 DOI: 10.1177/10778012231225229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
In Uganda, four in ten women report experiencing intimate partner violence (IPV) in the past year. Salient drivers of IPV in sub-Saharan Africa include stress related to household finances, alcohol use, and partner infidelity. We conducted 42 interviews with participants (n = 32) in the Drinkers' Intervention to Prevent Tuberculosis (DIPT) study which included economic incentives, and their partners (n = 10) to understand how participating in DIPT during COVID-19 lockdown restrictions impacted relationship dynamics in intimate partnerships. Our findings highlight the need to develop policies to address root causes of IPV and to ensure continuity of IPV services in future pandemics. Policy and programming recommendations based on study results are presented.
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Affiliation(s)
- Amanda P Miller
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Winnie Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Julian Adong
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nneka Emenyonu
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kara Marson
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Moses Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Judith A Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Brathwaite R, Magorokosho N, Namuwonge F, Tutlam N, Neilands TB, McKay MM, Ssewamala FM. Typology and correlates of parental stress among caregivers of children with DBDs in low-resourced communities in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002306. [PMID: 37610998 PMCID: PMC10446180 DOI: 10.1371/journal.pgph.0002306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023]
Abstract
Disruptive Behavior Disorders (DBDs) is one of the most common mental health problems among children in Uganda and SSA. Yet, to our knowledge no research has studied parenting stress (PS) among caregivers of children with DBDs, or investigated which risk factors originate from the child, parent, and contextual environment. Using a rigorous analytical approach, we aimed to: 1) identify different types and; 2) examine factors associated with PS and how correlates differ according to the type of stress experienced among caregivers of children with DBDs in low-resourced Ugandan communities. We used data from 633 caregivers of children with DBDs from SMART-Africa Uganda study. PS, was measured using the 36-item Parenting Stress Index-Short Form (PSI-SF). To identify focal correlates related to child/parent/contextual environment, we performed variable importance screening using the Stata command -gvselect- and specified mixed/melogit multilevel modeling with random effects. Secondly, focal correlates were included in the cross-fit partialing out lasso linear/logistic regression (double machine-learning) model. Caregivers mostly experienced stress from parental distress and caring for a child with difficult behavior. As scores increased by one unit on: caregiver mental health distress, PSI-SF increased by 0.23 (95% CI = 0.15, 0.32) (reflecting higher stress levels); Child difficulties, PSI-SF increased by 0.77 (95% CI = 0.52, 1.02). Contrastingly, for every one unit increase in family cohesion scores, PSI-SF decreased by 0.54 (95% CI = -0.84, -0.23). Caregivers with college/diploma/undergraduate/graduate education had less stress than those completing primary only or never attended school [Coefficient = -8.06 (95% CI = -12.56, -3.56)]. Family financial supporters had significantly higher Parental distress than caregivers who were not [Coefficient = 2.68 (95% CI = 1.20, 4.16)]. In low-resource settings like Uganda where mental health support is limited, community-based family-focused and economic empowerment interventions that improve community support systems and address financial barriers can reduce stress levels of caregivers of children with DBDs.
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Affiliation(s)
- Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Natasja Magorokosho
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Flavia Namuwonge
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Nhial Tutlam
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Torsten B. Neilands
- Division of Prevention Science, University of California, San Francisco, San Francisco, California, United States of America
| | - Mary M. McKay
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Fred M. Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
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Webb L, Kyaddondo D, Ford T, Bergqvist A, Cox N. Psychosocial health in adolescent unmarried motherhood in rural Uganda: Implications for community-based collaborative mental health education, and empowerment strategies in the prevention of depression and suicide. Transcult Psychiatry 2023; 60:537-551. [PMID: 36628461 PMCID: PMC10486171 DOI: 10.1177/13634615221147361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Teenage pregnancy rates in Uganda are among the highest in sub-Saharan Africa. Child marriage is often the result of unmarried teenage pregnancy and is recognised by Uganda's government as a form of sexual violence and an outcome of inequality. However, unmarried motherhood incurs stigma and shame within traditionally living rural communities. Using co-produced Open Space and ethnographic methods, we examined the psychosocial impact of unmarried motherhood on girls and their communities, and explored problem-solving with key local stakeholders. Findings indicate that girls experience extreme stress, social exclusion and rejection by their families, and experience bereavement from school expulsion and the loss of their career aspirations. Depressive symptoms and suicidal behaviour are reportedly not uncommon among this population group. Community and family efforts to promote marriage for these mothers to avoid social stigma increased the mothers' feelings of depression, whereas mothers who became independent appeared to fare better psychologically. Community members and local stakeholders demonstrated a willingness to act locally to reduce the negative impacts of unmarried motherhood but lacked knowledge and support resources. Our findings indicate that mental health promotion for teenage mothers is likely to be better served through empowerment strategies rather than marriage and, in a context of poor mental health service access, there is a substantial role for community mobilisation and the promotion of self-help strategies to support teenage mothers. This study raises important points regarding different community understandings of depression and indicates collaboration between professionals and communities for a values-based approach.
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Affiliation(s)
- Lucy Webb
- Faculty of Health & Education, Manchester Metropolitan University
| | | | | | - Anna Bergqvist
- Faculty of Health & Education, Manchester Metropolitan University
| | - Nigel Cox
- Faculty of Health & Education, Manchester Metropolitan University
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Mugamba S, Ziegel L, Bulamba RM, Kyasanku E, Johansson Århem K, Sjöland CF, Miller AP, Nakigozi G, Nalwoga GK, Watya S, Kiwanuka N, Kagaayi J, Kiwanuka D, Ddaaki W, Wagman JA, Kigozi G, Ekström AM, Nalugoda F. Cohort Profile: The Africa Medical and Behavioral Sciences Organization (AMBSO) Population Health Surveillance (APHS) in rural, semi-urban and urban Uganda. Int J Epidemiol 2022; 52:e116-e124. [PMID: 35962975 PMCID: PMC10114126 DOI: 10.1093/ije/dyac164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/02/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stephen Mugamba
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda.,Makerere University Walter Reed Project, Kampala, Uganda
| | - Leo Ziegel
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Robert M Bulamba
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
| | | | - Katarina Johansson Århem
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Amanda P Miller
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Stephen Watya
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
| | - Noah Kiwanuka
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda.,School of Public Health, Makerere University, Kampala, Uganda
| | - Joseph Kagaayi
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda.,School of Public Health, Makerere University, Kampala, Uganda
| | | | - William Ddaaki
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
| | - Jennifer A Wagman
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Godfrey Kigozi
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Södersjukhuset, Stockholm, Sweden
| | - Fred Nalugoda
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
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Miller AP, Ddaaki WG, Bloom BE, Wirtz AL, Nakyanjo N, Kigozi G, Wagman JA. Perspectives of Women Living With HIV on Addressing Violence and Use of Alcohol During HIV Services: Qualitative Findings From Fishing Communities in Uganda. Violence Against Women 2022; 28:1483-1504. [PMID: 34139908 PMCID: PMC8678385 DOI: 10.1177/10778012211019054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The syndemic relationship between harmful alcohol use, intimate partner violence (IPV), and HIV is well established across international settings. Less is known about how these health issues are perceived by women living with HIV (WLWH), who are disproportionately affected by these intertwined epidemics. A qualitative study was undertaken with 20 WLWH in Rakai, Uganda, to assess their perceptions of how these issues have affected their lives and their communities and to assess the acceptability of integrating a screening and brief intervention for alcohol use and IPV into HIV posttest counseling. Recommendations for intervention programming arising from the results are discussed.
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Affiliation(s)
| | - William G. Ddaaki
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Neema Nakyanjo
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
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Miller AP, Mugamba S, Bulamba RM, Kyasanku E, Nkale J, Nalugoda F, Nakigozi G, Kigozi G, Nalwoga GK, Kagaayi J, Watya S, Wagman JA. Exploring the impact of COVID-19 on women's alcohol use, mental health, and experiences of intimate partner violence in Wakiso, Uganda. PLoS One 2022; 17:e0263827. [PMID: 35171949 PMCID: PMC8849444 DOI: 10.1371/journal.pone.0263827] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/27/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Uganda confirmed its first COVID-19 case in March 2020, leading to country-wide closures and a stay-at-home order. Infectious disease pandemics can overwhelm adaptive coping capacity (e.g., general self-efficacy and resilience) and increase the risk for mental distress. For individuals experiencing intimate partner violence (IPV) and cohabitating with a perpetrator, stay-at-home orders can also increase risk of violence, which can further exacerbate mental distress. The present study explores women's perceived self-efficacy and resilient coping, mental health outcomes (depression and COVID-19 related anxiety), hazardous alcohol use and IPV in the context of Uganda's national 2020 lockdown. METHODS A phone-based survey was undertaken from June-August of 2020 in Wakiso District, Uganda. The study sample consisted of Africa Medical and Behavioral Sciences Organization (AMBSO) Population Health Surveillance (APHS) study participants who agreed to be contacted for future research. The analytic sample was restricted to women aged 13-80 years. Bivariate analysis and multivariable models explored associations between experiences of IPV and measures of adaptive coping, mental health and alcohol use. RESULTS A total of 556 women aged 13-79 years (mean age of 33.4 years) participated. Over half (55%) were currently married. The majority (60%) reported a decrease in alcohol use during the lockdown. Nearly half of the sample were experiencing physical or verbal IPV and reported an increase in violence during the lockdown. In adjusted analysis, alcohol use was associated with four times greater odds of recent physical IPV (aOR 4.06, 95% CI = 1.65-10.02, p = 0.0024), while participants had lower odds of experiencing any form of IPV as general self-efficacy increased (aOR 0.95, 95% CI = 0.91-0.99, p = 0.0308). CONCLUSION Lockdown measures in Uganda may have mitigated increased alcohol consumption. IPV was exacerbated during lockdown; more than 2 in 5 IPV victims experienced increased physical or verbal violence. Development of programming and policies aimed at mitigating women's risk of IPV during future lockdowns are needed.
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Affiliation(s)
- Amanda P. Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, United States of America
| | - Stephen Mugamba
- Makerere University Walter Reed Project (MUWRP), Kampala, Uganda
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - Robert M. Bulamba
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - Emmanuel Kyasanku
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - James Nkale
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - Fred Nalugoda
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - Gertrude Nakigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - Godfrey Kigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - Grace K. Nalwoga
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - Joseph Kagaayi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - Stephen Watya
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Hoima, Uganda
| | - Jennifer A. Wagman
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
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