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Item Trusted sources of information on COVID-19 vaccines during the pandemic in Uganda:(Research squares, 2023-10-17) Oloya, Johnson Nyeko; Alema, Nelson Onira; Okot, Christopher; Olal, Emmanuel; Ikoona, Eric Nzirakaindi; Oyat, Freddy Wathum Drinkwater; Steven, Baguma; Ochula, Denish Omoya; Olwedo, Patrick Odong; Pebolo, Francis Pebalo; Atim, Pamela Okot; Okot, Godfrey Smart; Nantale, Ritah; Aloyo, Judith; Kitara, David LagoroBackground. COVID-19 has dramatically impacted communities worldwide, especially in developing countries. To successfully control the COVID-19 pandemic, more than 80% vaccination coverage was required, and the flow of correct information to the population was critical. However, misinformation and disinformation could impact this, increasing COVID-19 vaccine hesitancy in some communities. Several studies have assessed the effect of misinformation and disinformation on COVID-19 vaccine acceptance and other responses to the pandemic in the African continent. Thus, the most trusted sources of information on COVID-19 vaccines to the population is critical for successfully managing and controlling the pandemic. This study aimed to assess the most trusted sources of information on COVID-19 vaccines during the pandemic in northern Uganda. Methods. We conducted a cross-sectional study on 587 adult population members in northern Uganda. Stratified and systematic sampling methods were used for selecting participants from twenty-four health facilities in the Acholi subregion. Data were collected using an interviewer-administered questionnaire with an internal validity of Cronbach's α=0.72. A local IRB approved the study, and Stata version 18 was used for data analysis. A Pearson Chi-square (χ2) analysis was conducted to assess the association between trusted sources of information on COVID-19 vaccines among study participants and selected independent variables. Fisher's exact test assessed association when cell value following crosstabulation was ≤5. A P-value <0.05 was used as evidence for an association between the trusted sources of information and independent variables. All results were presented as frequencies and proportions and Chi-square or Fisher's exact test P-values at 95% Confidence Intervals (CI). Results: In a study of 587, most participants were males, 335(57.1%), in the age group of 25-34 years, 180(31.4%), and the most trusted source of information on COVID-19 vaccines were the traditional media sources such as Televisions, Radios, and Newspapers, 349(33.6%). There was no significant association between sex and sources of information on COVID-19 vaccines. However, by age group population, it was significantly associated with internet use (14.7% versus 85.3%; p=0.02), information from family members (9.4% versus 90.6%; p<0.01), and the Government/Ministry of Health (37.9% versus 62.1%; p<0.01). In addition, it was significantly associated with internet use (32.2% versus 67.8%; p=0.03), healthcare providers (32.5% versus 67.5%; p<0.018), the Government/Ministry of Health (31.1% versus 68.9%; p<0.01), and scientific articles (44.7% versus 55.3%; p<0.01) in healthcare workers compared to non-health workers. Conclusion. The most substantial finding from our study was that the most trusted sources of information on COVID-19 vaccines in northern Uganda were Television, Radio, and Newspapers. There were no significant differences in the most trusted sources of information on COVID-19 vaccines between the sexes but significant differences by age groups and occupations, with the younger age groups and non-healthcare workers having more trust in TVs, Radios, and Newspapers. For effective management of an epidemic, there is a need for accurate communication so that misinformation, disinformation, and malinformation do not disrupt the flow of information to communities.Item Episiotomy related morbidities measured using redness, edema, ecchymosis, discharge and apposition scale and numerical pain scale among primiparous women in Mulago National Referral Hospital, Kampala, Uganda(Pan African Medical Journal, 2020-08-26) Pebolo, Pebalo Francis; Ajeani, Judith; Kaye Kabonge, DanIntroduction: episiotomy induced inflammatorysigns like redness, edema, ecchymosis and pain may remain beyond the period of hospitalization and can be objectively measured using redness, edema, ecchymosis, discharge and apposition (REEDA) scale. Pain in the postpartum period is a common problem and can be measured using the numerical pain scale (NPS). Episiotomy is normally poorly executed and poorly repaired with little attention to the subtle pain-free scar. Postpartum perineal pain has been found to affect more people with episiotomy compared to spontaneous perineal tears or contusion in the first two weeks. This study was aimed at comparing NPS and REEDA scores in the first two weeks of postpartum among primiparous parturients with or without episiotomy in Mulago National Referral Hospital. Methods: a prospective cohort study conducted by recruiting primiparous women systematically on the first postnatal day and categorizing them into episiotomy and no episiotomy group. NPS and REEDA scale were taken at baseline and 2 weeks postpartum. Results: the mean total REEDA score for primiparous women among the episiotomy group was significantly higher both on day 1 and day 14 with p-values <0.0001 and <0.0001 respectively as well as the day 14 mean NPS pvalue 0.001. Conclusion: episiotomy, a traumatic obstetric procedure, that heals slowly and with persistent perineal pain compare to spontaneous perineal contusion or tears.Item Perceptions of COVID-19 vaccine among different adult age group populations in Northern Uganda: a cross-sectional study(Journal of Global Health Reports., 2022-07-28) Kitara, David L; Baguma, Steven; Okot, Christopher; Acullu, Denis; Ochula, Denis; Okot, Pamela A; Odong, Patrick O; Okot, Smart G; Pebolo, Francis P; Oyat, Freddy W Drinkwater; Ikoona, Eric N; Alema, Nelson O; Oloya, Johnson N; Aloyo, Judith; Oballim, LawenceBackground: At the time when COVID-19 was declared a pandemic in March 2020, its spread in the African continent was slow. However, confirmed cases of the virus have since risen steadily over the years in the African continent for many reasons. This study aimed to determine factors associated with perceptions of COVID-19 vaccines among adult age-group populations in northern Uganda. Methods: We conducted this study as part of a larger study to determine factors associated with COVID-19 vaccine hesitancy/acceptance among 723 adult age-group populations selected by stratified and systematic sampling approaches from northern Uganda. We used a questionnaire with an internal validity of Cronbach’s α= 0.772. A five-point Likert scale, with responses categorized as strongly agree “SA”, agree “A”, neutral “N”, disagree “DA”, and strongly disagree “SD”, was used to assess participants’ perceptions on COVID-19 vaccines. A multivariable regression analysis was conducted with P-value set at <0.05. Results: Overall, 723 participated in the study with a mean age of 31.4 years (standard deviation,SD, +10.1). The majority 54.5% (n=394) were males. There were no significant differences in perceptions of COVID-19 vaccines among age-group populations (adjusted odds ratio, aOR=0.99, 95% confidence interval, CI=0.98-1.01). Key finding include: (i) it was important to take a COVID-19 vaccine (aOR=1.02, 95% CI=1.00-1.04); (ii) vaccines have unlikely unforeseen side effects (aOR=0.98, 95% CI=0.97-0.99); (iii) vaccines were unlikely being promoted for commercial gains (aOR=0.98, 95% CI=0.97-0.99); and children could take COVID-19 vaccines (aOR=1.02, 95% CI=1.00-1.03). Stratified by age-groups, the 20–29-year-old perceived COVID-19 vaccines developed in Uganda as unlikely safe and effective (aOR=0.59, 95% CI=0.35-0.97), and COVID-19 vaccines have likely unforeseen side-effects (aOR=2.1, 95% CI=1.3-3.6). While the ≥50-year-old group perceived that COVID-19 vaccines were unlikely being promoted for commercial gains (aOR=0.2, 95% CI=0.1-0.6). Conclusions: There were no substantial differences in perceptions on COVID-19 vaccines in adult age-group populations in northern Uganda. The determinants of COVID-19 vaccine perceptions were its importance against the virus; vaccines have unlikely unforeseen side-effects, and children could take it. Stratified by age-groups, some age-groups perceived COVID-19 vaccines developed in Uganda as unlikely safe and unlikely being promoted for commercial gainsItem 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 PeboloBackground: 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.Item 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, AnnetteeA 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.Item Polycystic ovarian syndrome: diagnostic challenges in resource-poor settings (Ugandan perspectives)(PAMJ Clinical Medicine., 2021-01-29) Pebolo, Francis Pebalo; Auma, Anna Grace; Alobo, GasthonyPolycystic 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 endocrinologistsItem Chronicles of an uncommon term abdominal pregnancy with successful outcome: a case report(BioMed Central, 2024-01-24) Magezi, Joad; Wacha, Joshua; Pebalo, Pebolo FrancisAbstract Background Intra-abdominal pregnancies, while rare, present with unique diagnostic and management challenges. We present a case of a 25-year-old para 2+1, black African woman, who was referred from a peripheral Health Centre level IV in the Northern part of Uganda to a Regional Referral Hospital due to an abnormal presentation with easily palpable fetal parts. This case emphasizes the signifcance of prompt diagnosis, interdisciplinary collaboration, surgical planning, and managing the placenta in advanced intra-abdominal pregnancies. Case presentation A 25 year African black female, para 2+1 upon arrival at Regional Referral Hospital, a University Teaching Hospital during a weekend, an ultrasound was sourced from a nearby private clinic revealing an extra-uterine intra-abdominal pregnancy at 38 weeks of gestation and she was promptly sent back to the University Teaching Hospital. Following this diagnosis, the patient, who hailed from a remote village over 30 km away, returned to her family for discussions. After three days, she was readmitted. Emergency laparotomy unveiled an omental gestation sac with extensive placental attachment. A live female infant was delivered successfully, placenta was left in situ. The post-operative course was uneventful, with initial concerns about inadequate breast milk fow which resolved after placental removal during the second exploratory laparotomy. Conclusion This case highlights the uncommon occurrence of an advanced intra-abdominal pregnancies and emphasizes the importance of multi-disciplinary teamwork and placental management. The favorable outcome in the management was based on thorough assessment of the placental location, attachments and blood supply during surgery. It demonstrates the possibility of reduced risk of massive bleeding if there is a delayed removal of placenta with favorable attachment. This is particularly important for milk letdown as well as reducing the needs of blood transfusion in resource limited settings.Item Factors associated with utilization of standard days method of family planning among market vendors in Gulu City(PAMJ Clinical Medicine., 2021-12-09) Acire, Robin; Acidri, Philip; Angolere, Pasquale; Pebalo, Francis PeboloIntroduction: standard days method (SDM) is a family planning method in which users avoid unprotected sexual intercourse during cycle days 8 through 19. Its efficacy is 95% and 88% in perfect and typical use respectively when used among women whose cycles are between 26-32 days. Classified as a modern contraceptive, can be used to bridge the gap brought by fear of side effects, cost, cultural and religious opposition to the modern hormonal method. The study, therefore, seeks to look at the factors associated with choosing or continuing to use SDM as a method of family planning in the Gulu City main market. Methods: this was a cross-sectional analytical study among women of reproductive age in Gulu main. Results: a total of 248 women were included in the final analysis. Women who heard about SDM, understand their menstrual cycle, believe in a high possibility of conception within their cycle, have very good thoughts and good thoughts about the method were more likely to choose or continue using the method; P-values 0.061, 0.08, 0.002,0.001 and, 0.001 respectively. Recommendation to use the method was a positive predictor for using the method, P-value <0.001, meanwhile, some knowledge and little knowledge about the method were negative predictive factors for using SDM, P-values 0.038 and 0.020 respectively. Conclusion: intervention aimed at improving knowledge about SDM among the population may help increase use of SDM to reduce incidences of unintended pregnancies and meet contraceptive unmet needs among women not comfortable using the modern hormonal contraceptives.Item Characteristics of the COVID-19 Patients Treated at Gulu Regional Referral Hospital, Northern Uganda: A Cross-Sectional Study(Journal of Infectious Diseases & Therapy, 2022) Okot, Christopher; Baguma, Steven; Alema Onira, Nelson; Odong Agings, Willis; Arwinyo, Baifa; Elima, James; Apiyo, Paska; Layet, Paska; Pebalo Pebolo, Francis; Acullu, Denis; Oloya, Johnson Nyeko; Oyat, Freddy Wathum Drinkwater; Oola, Janet; Aloyo, Judith; Ikoona, Eric Nzirakaindi; Kitara, David LagoroBackground: Coronavirus Disease 2019 (COVID-19) is a severe respiratory disease that results from infection with a new coronavirus (SARS-CoV-2). One of the most critical issues related to the COVID-19 is the high rate of spread, millions of people have been infected around the world, and hundreds of thousands of people have died till now. However, reports from Africa paint a different picture of the SARS-CoV-2 and its effects on the population. Objectives: The objective of this study was to describe the characteristics of the COVID-19 patients treated at the Gulu Regional Referral Hospital and determine factors associated with COVID-19 manifestations, socio-demographic characteristics, and treatment outcomes from March 2020 to October 2021. Methods: A retrospective data abstraction of all COVID-19 hospital admissions registered in the Gulu Health Management Information System (HMIS) database and other tools were conducted. The period of study was from March 2020 to October 2021. Data that met the inclusion criteria were consecutively abstracted from the Gulu Hospital HMIS database. A local IRB approved the study. SPSS version 25.0 was used for data analysis, and a p-value of 0.05 was considered significant. Results: Data suggests there were three waves of COVID-19 in Uganda. Those with comorbidities, e.g., Diabetes mellitus 38(5.7%), hypertension 83(12.5%), cardiovascular diseases 58(8.7%), HIV and AIDS 61(9.2%), and other comorbidities such as liver cirrhosis and Hepatitis B 40(6.0%) were more susceptible and presented with more severe forms of the disease. Antibiotics 662(99.7%), steroids 73(11.0%), vitamin C 564(84.9%), Ivermectin 7(1.1%), and Vitamin D 24(3.6%) were the most used medicines for the treatment of COVID-19 patients. Most COVID-19 patients were unvaccinated 661(99.5%). However, the recovery rate was 632(95.2%). The commonest complications were pneumonia 60(9.0%), chronic fatigue 49(7.4%), acute respiratory distress syndrome (ARDS) 37(5.6%), depression 20(3.0%), systemic infections 19(2.9%), nightmares 15(2.3%) and septic shock 8(1.2%). The Adjusted Odds Ratios (AOR) on factors associated with recovery were treatment with steroids AOR=138.835 at 95% CI:12.258-1572.50;p<0.000 and Vitamin D AOR=31.4780 at 95% CI:1.902520.98; p=0.016. Conclusion: This study showed successful management of COVID-19 patients in low-resource settings with a recovery rate of 95.2%. The admission pattern suggests Uganda had three waves of COVID-19, contrary to the official government position of two. Treatment with steroids and Vitamin D is associated with the recovery among COVID-19 patients. There is a need to conduct more extensive studies on the role played by the two drugs in the successful recovery of COVID-19 patients.Item 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, FelixBackground: 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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