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    Stigma, HIV/AIDS treatment seeking behavior among youth living with HIV in Kampala city, Uganda
    (Makerere University, 2024-01) Kiwanuka, Anthony
    This study sought to discover to what extent stigma affects HIV and AIDS treatment-seeking behavior among youths aged 18-24 in Kampala city. It also examines how anticipated stigma and non- disclosure of HIV status affects health-seeking behavior, and the experiences of living with HIV and AIDS. The study employed qualitative approaches involving purposive selection of study participants who included youths living with HIV. Data was collected through in-depth interviews, Focus Group Discussions, and Key Informant Interviews. It was analyzed using thematic and content methods that were phenomenological. This study was guided by theories of stigma including Goffman and Deacon’s sustainable theory of health – related stigma as well as cognitive behavioral theory and coping. All the youths in this study suffered self-stigma the first time they were diagnosed with HIV. They further felt other forms of stigma namely: internal, social, and discrimination. Being HIV positive was associated with punishment for bad behavior. Apportioning blame to HIV positive youths as self-inflicted by the community was common, thus, affecting youths' urge to seek treatment. Youths’ fear of rejection and discrimination pervaded all aspects and their lives; from home to clinics, and community. Seeking treatment was not a common practice among HIV positive youths. Fear of rejection, lack of disclosure, denial and being asymptomatic, belief in witchcraft and other spiritual beliefs were key barriers to seeking treatment. This study highlights that the youth felt most stigmatized in comparison to other groups. Interactions and negative experiences in government healthcare settings contributed to a reduced engagement around seeking healthcare. To combat stigma and discrimination, interventions must focus on the individual, environment and policy levels. What is needed now is the political will and resources to support and scale up stigma reduction activities through health care settings in Uganda, to engage youth into empowerment groups of self determination and social change, work with social workers’ organizations and use law to advance legal protection. The key recommendations from this research include the empowerment of the stigmatized group, i.e. the YLWHA, as well as their involvement in the design and implementation of prevention programs. Furthermore the focus of health education for behavior change communication strategies are family members or those with significant relationships to YLWHA, and health care providers, who were the major groups found to discriminate against PLWHA.
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    Knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban areas of central Uganda
    (Scientific Research Publishing, 2016-07) Rukundo, Annamaria; Muwonge, Mathias M.; Mugisha, Danny; Aturwanaho, Dickens; Kasangaki, Arabat; Bbosa, Godfrey S.
    HIV/AIDS has remained a challenge in Uganda among adolescent despite the ABC strategy used globally to prevent HIV infection. The study assessed the knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban schools of central Uganda. A cross sectional study using self-administered questionnaires and structured interviews was used to collect data from adolescents in secondary schools in Kampala and Buikwe districts. Eight schools were randomly selected with 4 schools in each district. A total of 245 students from schools were recruited in the study with 120 and 125 students from urban Kampala and rural Buikwe district schools respectively. Data were analyzed using SPSS version 11. The results were expressed as percentages in a 2 × 2 tables. The mean age of the participants was 15.9 ± 2.5 years. Results showed that 95.1% participants had knowledge on HIV/AIDS in both urban and rural schools and 27.4% knew all the modes of HIV transmission. About 83.7% knew the ABC strategy for HIV prevention and 37.6% would talk about HIV/AIDS mainly with friends. For HIV cure, 62.0% of study participants reported non-cure and 24.9% were not sure. The remaining 13.1% of the study participants in both urban and rural schools reported that HIV can be cured. And the modes of curing HIV that were mentioned by participants included spiritual healing, transmitting it to others through sexual intercourse and that antiretroviral (ARVs) drugs can cure it as well as that it can be cured abroad. About 65.7% of participants reported recognition of one with HIV/ AIDS and by having red lips, being sickly; weight loss, skin rash and being very rich were mentioned. About 39.2% of the study participants mentioned that they cannot get infected with HIV and can’t contract HIV at all and 18.4% believed that chances of getting HIV infection were high. On perception and attitude on condoms and their use, participants reported that it is a sign of mistrust, reduces sexual pleasures and they are embarrassing to buy. Majority of the participants in both urban and rural schools had some knowledge on HIV/AIDS and the ABC strategy for HIV prevention. However, there was a knowledge gap on the various modes of HIV transmission and prevention. There was misconception of the participants on HIV/AIDS cure, condom use and on the chances of contracting HIV. About the source of HIV/AIDS information, majority of the participants were getting information on HIV/AIDS from friends of which some information was misleading. This false information could be the reason for the increased HIV prevalence reported among the adolescents in the schools. Generally, participants had some knowledge on HIV/AIDS though they had knowledge gap on HIV transmission and prevention.
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    Prevalence and Factors Associated with Dental Caries Among Children and Adults in Selected Districts in Uganda
    (African Health Sciences, 2015-12) Kutesa, Annet; Kasangaki, Arabat; Nkamba, Moses; Muwazi, Louis; Okullo, Isaac; Rwenyonyi, Charles Mugisha
    Objective: The aim was to determine the prevalence and factors associated with dental caries among adults and children in seven districts of Uganda. Methods: Participants aged 11-13 (n=1230) and 35-44 years (n=648) were randomly selected from urban and rural areas of Gulu, Soroti, Jinja, Masaka, Kabale, Kabarole and Hoima districts. They were examined by 4 trained and calibrated dentists for dental caries using Decayed, Missing and Filled teeth index as described by World Health Organisation. Results: Overall mean DMFT score was 0.73 for children and 4.71 for adults. Generally, there was a higher mean DMFT score in the rural (2.19) compared to urban areas (1.97). In all the districts, except Hoima, there was a higher mean DMFT score of children in rural compared to urban. In adults, similar trend was mainly registered in Masaka, Hoima and Gulu dis tricts. Most participants (79.9%, n=1309) occasionally ate sugared snacks. Overall, 95% (n=1795) of the participants cleaned their teeth with plastic tooth brushes (71.7%) and chewing sticks (8.3%). Conclusion: Although the severity of dental caries was low, the disease was widespread in the study population. A high proportion of participants reported consumption of sugared snacks and drinks, which calls for oral health education.
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    Seasonality of Burkitt's lymphoma in Uganda
    (Indian Association of Oral and Maxillofacial Pathology, 2014-09) Muwazi, Louis; Rwenyonyi, Charles Mugisha; Kutesa, Annet; Kasangaki, Arabat; Kamulegeya, Adriane
    Background/Aims: Burkitt’s lymphoma is the most common childhood oral maxillofacial tumor in Africa and some studies have reported seasonal variation. Materials and Methods: All Burkitt’s cases diagnosed from 1969 to 2006, from all over Uganda, at the Makerere University’s Department of Pathology, were analyzed, to determine seasonal variation. This was done by evaluation of monthly and rainy versus dry season prevalence. Statistical analysis: The Wilcoxon test was used in both cases, to assess the statistical significance of differences in the diagnostic rates of Burkitt’s lymphoma, in comparison to nonspecific chronic inflammation, using the total as the denominator. Yearly variation in prevalence was examined by a Chi‑square test for linear trend. Mann‑Whitney tests were done to compare the climatic regions. Multivariate analysis of variance (MANOVA) was used to test for differences when gender, seasons and climatic regions were factored in. Results: Although monthly frequencies varied considerably over the period, none of the differences were statistically significant (Pearson’s 15.199, degrees of freedom df = 11, P = 0.174). Likewise, there was no statistically significant difference in the total number of Burkitt’s and nonspecific chronic inflammation biopsies handled at the Department during the rainy and dry seasons. Conclusion: Although the 38‑year period gave us sufficient numbers to use the Edward’s method for seasonality, it also meant that a lot of seasonal changes that occurred during the period were not taken into consideration. We hence feel that a review of this data with weather experts, so as to group the biopsies into accurate rainfall and dry patterns, would yield a more authoritative publication.
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    Task shifting in health service delivery from a decision and policy makers’ perspective: a case of Uganda
    (BMC, 2018) Baine, Sebastian Olikira; Kasangaki, Arabat; Baine, Euzobia Margaret Mugisha
    Background: Documented evidence shows that task shifting has been practiced in Uganda to bridge the gaps in the health workers’ numbers since 1918. The objectives of this study were to provide a synthesis of the available evidence on task shifting in Uganda; to establish levels of understanding, perceptions on task shifting and acceptability from the decision and policy makers’ perspective; and to provide recommendations on the implications of task shifting for the health of the population in Ugandan and human resource management policy. Methods: This was a qualitative study. Data collection involved review of published and unpublished literature, key informant interviews and group discussion for stakeholders in policy and decision making positions. Data was analyzed by thematic content analysis (ethical clearance number: SS 2444). Results: Task shifting was implemented with minimal compliance to the WHO recommendations and guidelines. Uganda does not have a national policy and guidelines on task shifting. Task shifting was unacceptable to majority of policy and decision makers mainly because less-skilled health workers were perceived to be incompetent due to cases of failed minor surgery, inappropriate medicine use, overwork, and inadequate support supervision. Conclusions: Task shifting has been implemented in Uganda for a long time without policy guidance and regulation. Policy makers were not in support of task shifting because it was perceived to put patients at risk of drug abuse, development of drug resistance, and surgical complications. Evidence showed the presence of unemployed higher-skilled health workers in Uganda. They could not be absorbed into public service because of the low wage bill and lack of political commitment to do so. Less-skilled health workers were remarked to be incompetent and already overworked; yet, the support supervision and continuous medical education systems were not well resourced and effective. Hiring the existing unemployed higher-skilled health workers, fully implementing the human resource motivation and retention strategy, and enforcing the bonding policy for Government-sponsored graduates were recommended.