Theses and Dissertations

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    Prevalence of home births and associated factors A Cross sectional study in Paicho Sub County, Gulu District, Northern Uganda
    (Gulu University, 2026-10) Lalweny Dorah
    Background Home births, prevalent globally at 28% pose significant risks, especially in countries that are under developed. The study focused on prevalence, associated factors, and outcomes of home births in Paicho Sub- County, Gulu District, Uganda. Methods Between March and May 2024, a cross-sectional study was conducted among women who gave birth in the last 36 months. Data was collected using interview-guided questionnaires and analyzed using multivariable logistic regression in Stata version 14. Snowball sampling, non-probability sampling technique was used to recruit participants in the study. Results A total of 394 women with a mean age of 28 6.5 years were recruited. The prevalence of home births approximately 15%, (59/394), with 64% (38/59) attended to by traditional birth attendants 75% (296/394) attended ANC at least 4 or more times. Factors associated with home birth includes ANC attendance > 4 times (aOR-0.02, 95% CI: 0.007-0.029), p=0.002), previous home birth experience (aOR-2.67 (95% CI: 1.40-5.09), p=0.003), and availability of transport means, (aOR=4.87, (95% CI: 1.42-16.65), p=0.003), risks of complications among home birth vs. risk of complication among facility birth (33/59 vs. 40/335), including prolonged labor (31.8% vs. 5.6%), obstructed delivery (4.1% vs. 0.7%), there is higher number of referral among home birth compared to facilities birth (52.5% vs. 7.8%). Conclusion Study result show prevalence of home delivery is associated to high risk of complication with high rates of referrals. Promoting group ANC with comprehensive healthcare packages will equip mothers to reduce home births.
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    Isoniazid Preventive Therapy Initiation and Associated Factors among People Living with HIV on Antiretroviral Therapy (ART) in Atiak HCIV, Amuru District, Northern Uganda
    (Gulu University, 2026-10) Oneka George Brown
    Background: The global annual new TB cases is over ten million in number, particularly among individuals who are immunocompromised. Those living with HIV are particularly at risk and highly likely to progress from the latent stage of TB to active disease. TB remains the most common cause of death among PLWHA, contributing to approximately one-third of HIV-related fatalities. By 2019, only about half (49%) of HIV-positive individuals newly initiated on ART program worldwide had been initiated on IPT. There is limited data on the initiation of IPT in Amuru district, hence the need for study. Objective: To determine the initiation of Isoniazid Preventive Therapy and establish the factors contributing to the initiation among eligible patients with HIV on ART in Atiak HCIV in Amuru District. Methodology: Secondary data from ART cards in ART Clinic for the period of January to December 2023 were collected using a prepared checklist. HIV+ individuals on Antiretroviral treatment and not having active TB were included in the study. Analysis of the data was facilitated using Stata version 14.0 statistical software. Results: A total of 427 patient-level data were screened, and a total sample of 425 were enrolled as study participants through systematic random sampling while 2 participants were eliminated due to incomplete information. Females constituted over half of the study participants (62.9%), while 37.41% were males. Participants who had been on ART for durations of 6 to 10 years constituted the majority (34.8%) of the study participants, while those who had been on care for less than 1 year formed the least category (5.18%). Initiation of IPT was found to be at 93.41% (n=397), while non-initiation was at 6.59% (n=28). The duration on ART of more than one year was found to be associated with initiation of IPT. Conclusion: The coverage of IPT was found to be 93.41% which is relatively high and supports the WHO recommendation as well as findings from other studies. Longer duration on ART from 6-10years was associated with high coverage. Recommendation: Retention in care, which is a core objective of HIV care, is an important factor in achieving high coverage of IPT. Thus, more emphasis should be put in achieving high level of retention in comprehensive HIV care as this positively impacts on TB prevention through high IPT coverage. Appointment keeping should be encouraged as this directly impacts on IPT initiation.
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    Hepatitis B virus sero prevalence and associated factors among pregnant women and their male partners attending Gulu regional referral hospital antenatal clinic
    (Gulu University, 2026) OTIM PATRICK
    Background: Hepatitis B virus (HBV) infection remains a major public health concern due to its potential to cause chronic liver disease, cirrhosis, and hepatocellular carcinoma. In Uganda, pregnant women are routinely screened for HBV during antenatal care (ANC); however, screening of male partners and evidence on HBV seroprevalence and sero-concordance and discordance among couples remain limited, particularly in Northern Uganda. Understanding the burden of HBV infection and associated factors among couples attending ANC is essential for informing integrated screening, vaccination, and prevention strategies. Objective: To determine Hepatitis B Virus (HBV) seroprevalence and associated factors among pregnant women and their partner attending antenatal care (ANC) clinic of Gulu Regional Referral hospital (GRRH), Gulu, Uganda. Methods: Between December 2023 and February 2024, a hospital-based, cross-sectional study was conducted among eligible pregnant women and their male partners attending ANC of GRRH. Following systematic random sampling, pretested questionnaire was administered by an interviewer. Blood samples were collected for HBV surface antigen (HBsAg) rapid test, which was performed according to the manufacturer’s instructions. Quantitative data was analysed using logistic regression in STATA version 15 SE. P<0.05 was considered statistically significant. Results: A total of 242 couple pairs were enrolled. Overall, 8.3% (n=40/484) participants were seropositive for HBsAg; A mong the males, Male partners (10.7%, n=26/242) and among pregnant women (5.8%, n=14/242). Sero-concordance 87.6% (212/242), (Male partners negative [-ve] and pregnant women [-ve]; 83.5%, n=202/242), (Male partners positive [+ve] and pregnant women [+ve]; 4.1%, n=10/242) and sero-discordance was 12.4% (30/242), (Male partners +ve and pregnant women -ve; 8.7%, n=21/242), (Male partners -ve and pregnant women +ve; 3.7%, n=9/242). Factors associated with positive HBsAg were, being male (adjusted odds ratio [aOR]: 2.45, 95% Confidence Interval [CI], 1.15 - 5.21, p=0.02), daily alcohol consumption (aOR: 4.73, 95% CI: 1.40 -16.04, p=0.01), and no prior vaccination against HBV (aOR: 12.01, 95% CI: 4.07 - 35.65, p<0.001). Conclusion: There is a high HBsAg seropositivity rate, particularly among male partners of pregnant women. Male sex, daily alcohol consumption, and lack of prior HBV vaccination were significantly associated with infection. There is an urgent need for couple-based HBV screening during antenatal care, targeted vaccination of unvaccinated individuals, and counselling on alcohol reduction. In addition, strengthening and sensitising young people on premarital HBV screening is essential to reduce transmission
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    FACTORS INFLUENCING REFERRAL RATE AMONG WOMEN ATTENDING POST ABORTION CARE AT ST. MARY’S HOSPITAL-LACOR AND GULU REGIONAL REFERRAL HOSPITAL, NORTHERN UGANDA
    (Gulu University, 2025-01) Opee Jimmy
    Background: Abortion-related deaths account for over 75% of all maternal deaths in sub-Saharan Africa. Most abortion-related deaths and complications are preventable by appropriate post-abortion care (PAC) services. Referral is a critical aspect in the chain of management of women experiencing abortion. Objective: To assess the factors influencing referral rate among women attending post-abortion care at St. Mary’s Hospital-Lacor and Gulu Regional Referral Hospital, Gulu, Uganda. Methods: An embedded mixed-methods study was conducted at St. Mary’s Hospital-Lacor and Gulu Regional Referral Hospital from July to December 2023. Quantitative and qualitative data were collected concurrently using structured questionnaires, and one-on-one interviews were conducted with purposefully selected participants, respectively. Factors influencing referral were assessed quantitatively using logistic regression and qualitatively using thematic analysis and reported using the Capability, Opportunity, and Motivation to Behavior (COM-B) framework. Results: Quantitatively, 152 participants with a median age of 26 (interquartile range: 21-32) years were enrolled. Overall, 46 (30.3%) participants were referral cases. The proportion of referred cases were about 15.5-fold higher among women from rural residences compared to those from urban areas (adjusted odds ratio (aOR): 15.5; 95% confidence interval (CI): 4.44—53.83, p<0.001), compared to women between 20 and 34 years, those younger than 20 years old (aOR: 2.8, 95% CI: 1.02—7.56, p=0.046). Qualitatively, four themes emerged as drivers to referral: 1) lack of expertise of healthcare professionals, 2) low capacity at low-level healthcare facilities, 3) financial constraints, and 4) transport challenges. Conclusions: Approximately one-third of women attending post-abortion care were referred, with significantly higher rates among those from rural areas. There is a pressing need to enhance post-abortion care services at low-level healthcare facilities, especially in rural settings and among women under 20 years.