Papers by Steven Ndugwa Kabwama
Male Circumcision and Condom Use Behaviour: A Meta-Analysis
Two Clusters of Meningococcal Meningitis in Bunyangabu District, Uganda: October, 2017
Background: On 13 November 2017, the Uganda Ministry of Health through the Public Health Emergenc... more Background: On 13 November 2017, the Uganda Ministry of Health through the Public Health Emergency Operations Centre was notified of an unknown illness that caused sudden deaths of 3 children in Bunyangabu District. The case-patients presented with fever, convulsions, loss of consciousness and neck stiffness. We investigated to establish the cause, scope of outbreak and recommend preventive measures. Methods: We defined a suspected case as onset of fever, neck stiffness and any of the following: convulsions, loss of consciousness, headache, vomiting, nausea in a resident of Kabonero or Kateebwa sub-counties, Bunyangabu District from 1 September to 30 November 2017. We reviewed medical records and conducted active case finding in affected communities. We analyzed case data by person, place and time and assessed vaccination status of the case-patients. A cerebro spinal fluid (CSF) sample from one case-patient for laboratory analysis was collected and tested using standard gram stainin...
The Pan African medical journal, 2017
Introduction : tobacco use and the exposure to tobacco smoke is one of the most preventable cause... more Introduction : tobacco use and the exposure to tobacco smoke is one of the most preventable causes of death and disability globally. The risk is even higher among daily tobacco users. The World Health Organization (WHO) has recommended that surveillance of major risk factors for Non Communicable Diseases (NCDs) such as tobacco use is imperative to predict the future burden of NCDs, identify interventions to reduce future burden and monitor emerging patterns and trends. In 2014 the first Uganda nation-wide NCD risk factor survey was carried out to estimate the prevalence of major NCD risk factors. We analyzed data from this survey to estimate the prevalence of daily tobacco use and associated risk factors. Methods : a nationally representative sample was drawn stratified by the four regions of the country. The WHO’s STEPwise tool was used to collect data on demographic and behavioral characteristics including tobacco use, physical and biochemical measurements. Tobacco use was divided...
Journal of Community Health
There is growing evidence of the challenges with adherence to COVID-19 prevention measures and th... more There is growing evidence of the challenges with adherence to COVID-19 prevention measures and the effect of the prevention measures on the health of populations in various parts of the world but with limited documentation in sub-Saharan Africa. We assessed COVID-19 awareness, adoption of COVID-19 prevention measures, and the effects of COVID-19 lockdown on the mental health status, socioeconomic disruptions and engagement in unhealthy behaviours among 2500 in-and out-ofschool adolescent boys and young men (ABYM) aged 10-24 years in Kampala, Uganda. 74.8% (n = 1869) were in-school; nearly half (47.3%, n = 1182) were aged 15-19 years. Although > 80% were aware of at least two COVID-19 prevention measures, only 22.2% (n = 555) reported that they always wore a face mask while in a public place; 40.9% (n = 1023) always washed their hands with soap and running water while 17.6% (n = 440) always avoided gatherings of more than five people. COVID-19 lockdown led to: (a) increased mental health challenges (e.g. 1.2% [n = 31] contemplated committing suicide); (b) limited ability to meet basic needs (e.g. 62.0% [n = 1549] found it difficult to afford a diverse/balanced diet); (c) socioeconomic disruptions (e.g. 30.3% [n = 756] experienced a reduction in income) and (d) engagement in unhealthy behaviours (e.g. 62% [n = 1554] reported a sedentary life style such as excessive watching of TV). These effects were more pronounced among older adolescent boys (15-19 years) and young men (20-24 years) and out-of-school compared to in-school ABYM. Our findings suggest a need for appropriate health promotion, mental health and socioeconomic interventions targeting ABYM in Kampala, Uganda.
In abstract and throughout the text, the authors should ensure that they use "female sex wor... more In abstract and throughout the text, the authors should ensure that they use "female sex workers (FSW)" rather than "sex workers (SW)", as the latter one can refer to both male and female sex workers. However, female sex workers are the target population in this study Response: Thanks for this observation, we have written the whole document to reflect female sex workers * (Methods): More description of the ocmmunit0based HIV service delivery models would be helpful here e.g., what do they entail, when were they implemented, etc. Response: Thanks for this observation, we have briefly described the community based HIV delivery models in the abstract line 20 to 23 and more details under the description of the community based HIV service delivery model in the method section line In the definition of sex workers, did the authors consider a specific time period? For example, a women who sold sex for money or other items/benefits in what time period? Currently? Recently...
Tobacco control in the context of the COVID-19 pandemic in Uganda: a policy implementation review
Journal of Global Health Reports
Background The COVID-19 pandemic has caused more than 900,000 deaths globally. The risk of mortal... more Background The COVID-19 pandemic has caused more than 900,000 deaths globally. The risk of mortality is higher for people with pre-existing conditions such as cancers, respiratory and cardiovascular diseases and diabetes for which tobacco use is a known risk factor. We conducted a study to explore how efforts to address the COVID-19 pandemic in Uganda have been integrated with tobacco control policies to generate evidence to inform policy decisions about the public health response in general and tobacco control interventions in particular. Methods We conducted a desk based review of ‘grey’ literature data sources (i.e. data that were not included in peer reviewed journals) with information about tobacco and COVID-19 in Uganda. Data were also obtained from stakeholders involved tobacco control via an online survey and telephone interviews. Findings A total of 136 data sources were identified, of which 107 were eligible for data extraction. The online stakeholder consultation involved invitations to 61 participants of whom 33 (54%) took part via the online survey while 5 (8.2%) opted for telephone interviews. In the context of the COVID-19 prevention interventions, social media can be a powerful platform for communicating anti-tobacco messages such as the vulnerability of tobacco users to COVID-19 and the exacerbated disease severity among COVID-19 patients with history of tobacco use. Two thirds (n=20, 65%) of survey respondents expected a tobacco tax increase to address health, economic and wider policy impacts of the COVID-19 crisis. Conclusions Advocacy should be conducted for taxation of tobacco products to reduce consumption and generate revenue to support public health investments. Public health institutions involved in the COVID-19 response should reject donations from the tobacco industry and its allies as is stipulated in the Framework Convention on Tobacco Control and the Uganda Tobacco Control Act 2015. The COVID-19 pandemic also offers an opportunity to promote tobacco cessation and strengthening tobacco control policy implementation by recognizing the role of tobacco use in exacerbating COVID-19 health outcomes.
International Journal of Environmental Research and Public Health
Limited research exists on pregnant women’s knowledge, attitudes, and behavior concerning COVID-1... more Limited research exists on pregnant women’s knowledge, attitudes, and behavior concerning COVID-19 in sub-Saharan Africa. We performed a cross-sectional study among 648 pregnant women in Fort Portal, Uganda, after the first lockdown starting in June 2020. Structured interviews were conducted at three different facilities during routine antenatal care, assessing sociodemographic background, knowledge of COVID-19, prevention behavior adherence, and psycho-emotional stress levels. We performed descriptive analyses and examined associated factors using multivariable logistic regression. In Fort Portal Region, 32.8% of pregnant women had a higher knowledge regarding the COVID-19 pandemic, while all women at least heard of COVID-19. 88.6% of the women showed low self-reported prevention behavior adherence. More than one third of the pregnant women experienced high psycho-emotional stress related to the pandemic (39.8%). The odds for psycho-emotional stress were increased among the age gro...
BackgroundAlcohol use leads to about 3 million deaths globally. The alcohol industry employs mark... more BackgroundAlcohol use leads to about 3 million deaths globally. The alcohol industry employs marketing strategies to establish their brands in the lives of young people at a time when addictive behaviors are initiated and reinforced. We conducted a survey among adolescent boys and young men (ABYM) to estimate the prevalence of alcohol use and associated factors using the Health Belief Model as the guiding framework. MethodsThe study was conducted among ABYM in- or out-of-school aged 10-24 years in Kampala, Uganda. We used questions adopted from the Global School-based Student Health Survey and the WHO STEPwise approach to Surveillance questionnaire to collect data. The dependent variable was alcohol use within 30 days before the interview. We also asked about predictors such as alcohol use by siblings, parents/ guardians, school status among others. We used odds ratios obtained via a logistic regression model as the measure of association.ResultsA total of 2500 ABYM participated, of...
Knowledge Management Strategies and Applications, Nov 21, 2017
The aim of this chapter is to critically reflect definitions of hazard, risk, and risk perception... more The aim of this chapter is to critically reflect definitions of hazard, risk, and risk perception and their assessments used in different scientific disciplines and give examples of the potential implications for scientific discussions, knowledge management, and risk communication. Scientists with backgrounds in public health, psychology, environmental health, occupational health, engineering, sociology, and medicine were asked for a definition of hazard, risk, risk assessment, and risk perception seen from their specific scientific disciplines. Hazard is generally seen as an adverse event or condition. For most risk definitions, probability and severity are important aspects. Often a quantification of risk is desired, whereas risk perception is seen as a subjective appraisal and a cognitive construct. As risk perceptions are based on a combination of knowledge and individual values and affects, it may not provide a reliable guidance for risk management decisions on a societal level. Discipline differences are mainly connected to terminology and interpretation of key concepts, but the differences are based on different tasks and perspectives. For dealing with controversies in science across disciplines, an acceptance and appreciation of terminology and perspectives from different scientific disciplines are needed to ensure a transparent risk assessment process.
The first reported human Rift Valley Fever outbreak in Uganda, 2016
Pan African Medical Journal Conference Proceedings
Introduction : on 8 March 2016, the Ministry of Health received a report of a suspected case of v... more Introduction : on 8 March 2016, the Ministry of Health received a report of a suspected case of viral hemorrhagic fever (VHF) in Kabale Regional Referral Hospital. By 15th March, there were two laboratory confirmed cases of Rift Valley Fever (RVF). We conducted the investigation to assess the scope of the outbreak, identify its source and risk factors in order to inform public health interventions for controlling the outbreak. Methods : a suspected case was defined as acute onset of fever (> 37.5°C), negative malaria test, and at least two of the following three symptoms: Headache, Muscle or joint pain and any gastroenteritis symptom (nausea, vomiting, abdominal pain, and diarrhea). A Probable Case was any person meeting the suspect case definition with deranged liver functions tests plus at least one of the following; bleeding symptoms, such as: bleeding from the nose, vomiting blood, coughing out blood (without history of TB), blood in stool, blood in urine; sudden change in vision, jaundice, any unexplained death. A confirmed case was a suspected or probable case that is laboratory confirmed by detection of RVF nucleic acid by reverse-transcriptase polymerase chain reaction (RT-PCR) or demonstration of serum IgM or IgG antibodies by ELISA. We found cases by going to the affected communities and health facilities in the catchment areas where the confirmed cases came from. Results : the investigation revealed 2 confirmed cases. In-depth interviews revealed that the symptom onset for the primary case was February 13th while onset date for the secondary case was February 18th. A review of the records in the health centers in the vicinity of the area where the primary case originated also did not reveal any increase in febrile illnesses. Prior to symptom onset of the primary case, one farmer reported 3 successive goat abortions every month from October 2015 to December 2015. In February 2015, one farmer also reported 3 cow abortions within the same week. Conclusion : There appears to be an outbreak among the livestock however there is no increase in febrile illnesses in the community. Health education should be done in the community to promote use of mosquito nets and protection of abattoir workers. The ministry of Agriculture, Animal Industries and Fisheries (MAAIF) should work with the Ministry of Health to assess the existence of the virus among the animals and mosquitoes. MAAIF should also ensure enforcement of the laws prohibiting the sale and consumption of sick or dead animals. All animals in the area should be vaccinated against RVF and health workers should be sensitized to consider RVF as a differential diagnosis in non-malaria febrile illness.
European Journal of Public Health, 2015
Materia Socio Medica
Introduction: The protective benefit of male circumcision against spreading HIV is well establish... more Introduction: The protective benefit of male circumcision against spreading HIV is well established. Aim: The objective of this Meta-analysis was to investigate behavioral risk compensation measured as the change in condom use behavior in light of knowledge of the benefits of circumcision. Material and Methods: A systematic search was conducted from 6 bibliographic databases for studies that quantitatively assessed a link between male circumcision and condom use behavior. Pooled odd ratios (OR) of condom use during any sexual activity were generated from three cohort studies and two Randomized Control Trails (RCT) that were included in the review. Results: The pooled effects from cohort and RCTs were not statistically significant at 6 months followup (OR=0.91, 95% CI: 0.57-1.45), at 12 months (OR=1.08, 95% CI=0.87-1.34) and 24 or more months (OR=1.11, 95% CI: 0.85, 1.45). Conclusion: Male circumcision does not influence condom use behavior in the medium and short term.
Sporadic outbreaks of crimean-congo haemorrhagic fever in Uganda, July 2018-January 2019
PLOS Neglected Tropical Diseases
Introduction Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne, zoonotic viral disease that... more Introduction Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne, zoonotic viral disease that causes haemorrhagic symptoms. Despite having eight confirmed outbreaks between 2013 and 2017, all within Uganda’s ‘cattle corridor’, no targeted tick control programs exist in Uganda to prevent disease. During a seven-month-period from July 2018-January 2019, the Ministry of Health confirmed multiple independent CCHF outbreaks. We investigated to identify risk factors and recommend interventions to prevent future outbreaks. Methods We defined a confirmed case as sudden onset of fever (≥37.5°C) with ≥4 of the following signs and symptoms: anorexia, vomiting, diarrhoea, headache, abdominal pain, joint pain, or sudden unexplained bleeding in a resident of the affected districts who tested positive for Crimean-Congo haemorrhagic fever virus (CCHFv) by RT-PCR from 1 July 2018–30 January 2019. We reviewed medical records and performed active case-finding. We conducted a case-control study and...
Trends of alcohol abuse using surveillance data from the Health Management Information System (HMIS) of Uganda
Pan African Medical Journal Conference Proceedings
Tobacco Induced Diseases
INTRODUCTION Preferential option for some tobacco products over others might be attributed to inh... more INTRODUCTION Preferential option for some tobacco products over others might be attributed to inherent misconceptions about the harmfulness of tobacco. We analysed data from Uganda's Global Adult Tobacco Survey (GATS) to assess misconceptions about the harmfulness of tobacco and associated factors. METHODS Data were obtained from the 2013 Uganda Global Adult Tobacco Survey (GATS) of persons in Uganda of age ≥15 years among 8508 participants selected using a multi-stage sampling design to provide nationally representative estimates of the adult population. Participants were asked about perceptions of the harmfulness of smoking, using smokeless tobacco and whether all kinds of cigarettes are equally harmful. Weighted logistic regression analysis was used to find factors associated with the dependent variables. RESULTS Among daily smokeless tobacco users, 98 (62%) were unaware that smokeless tobacco causes serious illness. Compared with participants without formal education, participants with primary education were less likely to be unaware that smoking causes serious illness (AOR=0.64, 95% CI: 0.48-0.84) as were participants with secondary education (AOR=0.28, 95% CI: 0.19-0.42) and participants with University education or higher (AOR=0.26, 95% CI: 0.11-0.58). Compared with participants who did not use any smokeless tobacco products, participants who used smokeless tobacco products less than daily were more likely to be unaware that smokeless tobacco causes serious illness (AOR=1.39, 95% CI: 0.54-3.61) as were participants who used smokeless tobacco products daily (AOR=5.87, 95% CI: 3.67-9.40). Compared with participants who did not use any smoked tobacco products, participants who used smoked tobacco products less than daily were more likely to believe that all cigarettes are equally harmful (AOR=2.40, 95% CI: 1.32-4.37) as were participants who used smoked tobacco products daily (AOR=3.08, 95% CI: 2.37-4.00). CONCLUSIONS There is a high level of unawareness about the harmfulness of tobacco use particularly among tobacco users. The National Tobacco Control Program should prioritise public awareness and education about the dangers of tobacco use in the Tobacco Control Policy and National Tobacco Control Strategic Plan.
Public health surveillance, outbreak investigations and response to an outbreak of a bleeding illness in Hoima and Buliisa districts, Western Uganda, Sep-Oct 2015
Pan African Medical Journal Conference Proceedings
BMC Women's Health
Background Women remain disproportionally affected by the HIV/ AIDS epidemic because of sociocult... more Background Women remain disproportionally affected by the HIV/ AIDS epidemic because of sociocultural factors including violence perpetrated by intimate partners. Among HIVpositive (HIV+) women, intimate partner violence (IPV) affects engagement in care and reproductive health outcomes. We analyzed data from a national survey to estimate the prevalence of IPV among HIV+ women in care and associated factors. Methods The study was conducted among 5198 HIV+ women in care. Data were collected on socio-demographic characteristics, self-reported couple HIV status, mutual HIV status disclosure and IPV. IPV was assessed by asking participants whether their current husband or partner ever hit, slapped, kicked or did anything to hurt them physically, and whether their current husband or partner ever physically forced them to have intercourse or perform any sexual acts against their will. Women who responded “yes” were classified as having ever experienced IPV. Modified Poisson regression was ...
Comparing static and outreach immunization strategies and associated factors in Uganda, Nov-Dec 2016
Pan African Medical Journal
Archives of Public Health
Introduction: Adequate consumption of fruits and vegetables has protective benefits against devel... more Introduction: Adequate consumption of fruits and vegetables has protective benefits against development of coronary heart disease, hypertension and chronic obstructive pulmonary disease. However, approximately 2.7 million deaths annually can be attributed to inadequate fruit and vegetable consumption. We analyzed data from a countrywide survey in Uganda, to estimate the prevalence of adequate fruit and/ or vegetable consumption, and identify associated factors. Methods: Data were collected using the World Health Organization STEPwise approach to surveillance, a standard approach to surveillance of risk factors for Non Communicable Diseases. Fruit and vegetable consumption was assessed by asking participants the number of days in a typical week they eat fruits or vegetables and the number of servings eaten in one of those days. Adequate fruit and/ or vegetable consumption was defined as consuming 5 or more servings of fruits and/ or vegetables per day in a typical week. We used modified Poisson regression analysis to estimate prevalence risk ratios (PRRs) and identify factors associated with eating 5 or more servings of fruits and/ or vegetables per day, per week. Results: Of 3962 participants, 484 (12.2%) consumed 5 or more servings of fruits and/ or vegetables per day in a typical week. Participants who were married or cohabiting were more likely to consume at least 5 servings of fruits and/ or vegetables per day in a typical week compared with those who had never been married PRR = 1.51 [95% CI 1.07-2.14]. Compared with participants from Western region, those from Central region were more likely to consume 5 or more servings of fruits and/ or vegetables per day in a typical week, PRR = 3.54 [95% CI 2.46-5.10] as were those from Northern, PRR = 2.90 [95% CI 2.00-4.23] and Eastern regions PRR = 1.60 [95% CI 1.04-2.47]. Conclusions: Fruit and vegetable consumption in Uganda is low and does not differ significantly across social and demographic characteristics, except marital status and geographical region of residence. There is a need to develop and strengthen policies that promote adequate consumption of fruits and vegetables in the Ugandan population.
BMC Obesity
Background: Overweight and obesity are associated with health complications the gravity of which,... more Background: Overweight and obesity are associated with health complications the gravity of which, vary with the regional deposition of the excess fat. The Body Mass Index (BMI) is often used to measure obesity although is an inferior predictor of cardiovascular disease risk mortality and morbidity compared with measures of abdominal obesity. We analyzed data from Uganda's 2014 World Health Organization (WHO) STEPwise approach to surveillance of Non-communicable diseases (NCDs) survey to estimate the prevalence of abdominal obesity and associated factors to provide information on the prevention and control of overweight and obesity. Methods: Data were collected using the WHO STEPS protocol. Waist measurement was taken using a non-stretchable standard tape measure midway between the lowest rib and iliac crest with the subject standing at the end of gentle expiration. Participants with waist circumference > 102 cm for men and 88 cm for women were classified as abdominally obese. We used weighted modified Poisson regression with robust error variance to estimate the prevalence of abdominal obesity and associated factors. Results: Of the 3676 participants, 432 (11.8%) were abdominally obese; with the prevalence higher among females 412 (19.5%) compared with males 20 (1.3%). Compared with males, female participants were more likely to be abdominally obese Adjusted Prevalence Rate Ratio (APRR) 7.59 [5.58-10.33]. Participants who were married or cohabiting APRR 1.82 [1. 29-2.57] and participants who were separated or divorced APRR 1.69 [1.17-2.46] were more likely to be abdominally obese compared with those who had never married before. Compared with rural dwellers, participants from urban areas were more likely to be abdominally obese APRR 1.29 [1.09-1.53]. Compared with participants with normal blood pressure, those with elevated blood pressure were more likely to be abdominally obese APRR 1.83 [1.57-2.14]. Compared with participants without any education, those with secondary education were more likely to be abdominally obese APRR 1.42 [1.12-1.78]. Conclusions: There is a high prevalence of abdominal obesity among adults in Uganda which puts many at risk of developing associated metabolic complications. These data provide useful information for developing interventions and formulation of policies for the control and prevention of abdominal obesity in Uganda.
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Papers by Steven Ndugwa Kabwama