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    Pre-exposure prophylaxis use among female sex workers in Gulu city, Uganda:
    (Sage Publications, 2023-08-14) Bongomin, Felix; Kibone, Winnie; Okot, Jerom; Ouma, Simple; Madraa, Grace; Ojara, Francis Williams; Musoke, David; Pebalo, Francis Pebolo
    Background: Pre-exposure prophylaxis (PrEP) is an important intervention for reducing the risk of HIV transmission among high-risk populations such as female sex workers in Africa, where HIV prevalence remains high. We aimed to assess the use of PrEP among female sexworkers in Gulu, Uganda. Methods: In this community-based cross-sectional study, we included HIV-negative female sex workers purposely selected from hotspots within Gulu city, Uganda between February and March 2023. A semi-structured questionnaire was administered to collect data on sociodemographic characteristics, reproductive data, sexual practices, and self-reported PrEP use in the past 3months. Symptoms of depression were screened using Patient Health Questionnaire-2 tool. Predictors of PrEP use was determined using modified Poisson regression analysis model. p<0.05 was considered statistically significant. Results: We enrolled 273 female sex workers with a median age of 27 (interquartile range:24–32) years. Overall, 181 (66.3%) participants used PrEP. PrEP use was associated with;regular source of income beside sex work [adjusted prevalence ratio (aPR): 3.7, 95% confidence interval (CI): 2.11–6.35, p<0.001], being in a polygamous marriage (aPR: 6.9, 95% CI: 1.32–35.77, p=0.022), practicing sex work in both rural and urban areas (aPR: 2.5, 95% CI:1.49–4.35, p<0.001), having symptoms of depression (aPR: 3.3, 95% CI: 1.43–7.74, p=0.005), and use of postexposure prophylaxis (PEP) in the past 12months (aPR: 0.31, 95% CI: 0.17–0.59,p<0.001). Conclusion: Almost two in three of the female sex workers in Gulu city were currently using PrEP. Previous use of PEP was associated with lower use of PrEP. These findings suggest the need for targeted interventions to increase PrEP uptake and decrease HIV acquisition in this high-risk population among female sex workers, especially those with low income and limited access to healthcare.
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    Comparing Flipped Classroom with Traditional Instruction for Post-Partum Intra-Uterine Device Training Among Medical Students in a Ugandan Public University:
    (Research squares, 2023-09-07) Pebalo, Francis Pebolo; Bongomin, Felix; Awor, Sylvia; Arwinyo, Baifa; Ojara, Sande; Opee, Jimmy; Ayikoru, Jackline; Okot, Jerom; Ssenuni, Eric; Ouma, Simple; Nakimuli, Annettee
    A two-arm, quasi-experimental design was used. The FC group underwent a pre-recorded lecture and video on PPIUD insertion, followed by interactive sessions and procedural practice. The traditional group received an hour-long lecture and onsite skills demonstration, followed by skill practice. Paired t tests were used to determine knowledge and skills acquisition in each group and independent samples t tests was be used to compare groups. Stata version 17 and GraphPad Prism version 9 were used for analysis. Results A total of 67 students were included in the final analysis, 37 in the traditional group and 30 in the FC group. There was a significant improvement in post-test scores compared to pre-test scores in both groups p < 0.001. The mean post-test score was higher for FC compared to the traditional teaching methods group although, it was not statistically significant (p = 0.069). Certain categories of students performed better with FC, especially those who failed pre-tests p = 0.021), in bachelor or of medicine and bachelor of surgery (MBChB) year 3 class (p = 0.011), students who joined the university directly from advanced level certificate (p = 0.018) and aged younger than 25 years (p = 0.002). There was no statistically significant difference in the mean procedure performance score between the intervention and the traditional teaching methods (p = 0.634). Conclusion The FC had shown a positive impact on the knowledge and skills of medical students indicating its role in reproductive health training in resource-limited settings. Additionally, future studies could investigate how FC can combined with other teaching methods to create a blended learning approach that maximizes the benefits and enhanced learning.
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    Polycystic ovarian syndrome: diagnostic challenges in resource-poor settings (Ugandan perspectives)
    (PAMJ Clinical Medicine., 2021-01-29) Pebolo, Francis Pebalo; Auma, Anna Grace; Alobo, Gasthony
    Polycystic ovarian syndrome is the most common cause of anovulatory infertility accounting for up to 40% of the reasons for visiting a doctor. The Ugandan government has recognized infertility as a major problem affecting over five million people, yet polycystic ovarian syndrome is not included in the Ugandan Clinical Guidelines, hence it´s not part of the Uganda minimum healthcare package. Lack of guidelines means diagnosis is a challenge and many cases have delayed or no diagnosis. Early diagnosis is good for awareness of associated risks such as infertility, dysfunctional uterine bleeding,endometrial cancer, obesity, diabetes, dyslipidemia, hypertension, and cardiovascular diseases. Clinical laboratories are handy in the diagnosis as well as follow-up of PCOS cases and in most rural settings, these are lacking, confounded by the lack of skilled frontline workers such as gynecologists and reproductive endocrinologists
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    Prevalence of Teenage Pregnancy and Associated Factors in Agago District, Uganda:
    (Taylor & Francis, 2023-08-07) Okot, Christopher; Laker, Florence; Okwir Apio, Pamela; Madraa, Grace; Kibone, Winnie; Pebolo, Francis Pebalo; Bongomin, Felix
    Background: Teenage pregnancy remains a common public health and social problem associated with negative health outcomes. Wedetermined the prevalence and factors associated with teenage pregnancy among teenage girls aged 13–17 years in Agago district,Uganda. Methods: We conducted a community-based, cross-sectional study between October and November 2020 in Lapono Sub-County, Agago district among teenage girls 13–17 years. Multi-stage sampling technique was used. Parishes, villages, and households were randomly selected (computer generated random numbers were used for household selection). In each household, one participant was randomly selected for interview and pregnancy testing. We collected data on socio-demographic factors using a pre-tested semistructured questionnaire. All eligible participants were tested for urine human chorionic gonadotropin (hCG). Multivariable logistic regression analysis was done to determine independent predictors of teenage pregnancy, with p<0.05 considered statistically significant. Results: A total of 289 eligible participants, with a mean age of 15.1±1.5 years, were enrolled. Most (n=246, 81.5%) participants had attained primary education, 18 (6.2%) were married, 41 (14.2%) used alcohol, 62 (21.5%) had a history of sexual intercourse and 32 (11.1%) were sexually abused. The prevalence of teenage pregnancy was 2.8% (n=8). Factors significantly associated with teenage pregnancy were alcohol consumption (adjusted odds ratio (aOR): 13.2, 95% Confidence Interval (95% CI): 1.7–100.6, p=0.013) and having secondary/tertiary education (aOR: 10.2, 95% CI: 1.5–71.9, p=0.02). Conclusion: The study findings suggest that teenage pregnancy is still a public health and social problem in Agago district, Uganda. Interventions discouraging alcohol consumption and promoting education among teenagers are key in addressing the burden of teenage pregnancies in the district.
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    Is the 14% cesarean section rate in Gulu Regional Referral Hospital justifiable?
    (. PAMJ Clinical Medicine, 2021-03-26) Pebolo, Francis Pebalo; Baguma, Steven; Auma, Anna Grace
    Worldwide, cesarean section (CS) rates haveincreased tremendously in recent years, especially among high-income countries, raising concernsabout the over-utilization of CS without added benefits, and in the sub-Saharan African region, therate is at its lowest (7.3%). In Uganda, the CS rate stands at 6% and is seen to be higher (11%) among first-order births indicating a high incidence of primary CS. Despite the low rate of CS in Uganda,there are massive gaps in the provision of obstetric procedure with some women receiving unnecessary surgeries, and the facility-based CS rate is projected to increase to 32% by end of 2021. Notwithstanding the increasing facility rates of CS, Gulu Regional Referral Hospital (GRRH) rate has remained low in the years 2017-2019, with lower levels maternal mortality ratio and fresh stillbirths´ rates compared to the national average. Prolonged labor is one of the commonest indications for primary CS accounting for more than 50% among nulliparous women and this is linked to progress of labor usually measured using cervical dilatation. World Health Organization (WHO) recommended a change in cervical dilatation from 4cm to 5cm as a threshold for the active phase of the first stage of labor, as away to reduce unnecessary labor intervention including the CS. Lack of standard reporting tools such as the WHO Robson´s ten group classification in Uganda make comparisons of CS rate between/within facility/facilities worrisomely difficult.