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Chronicity of self-harming behaviors among adolescent teenage girls living in refugee settlements in Northern Uganda
(BMC Psychology, 2024) Kaggwa Mark Mohan; Abaatyo Joan; Otika Donald; Pebalo Francis Pebolo; Bongomin Felix Bongomin
Background: Self-harming ideations demand targeted research due to their persistent nature, especially among female adolescents within refugee populations who face unique challenges that can exacerbate self-harming tendencies. This study aimed to assess the factors associated with self-harming ideations chronicity among female teenagers living in refugee settlement in Northern Uganda. Method This cross-sectional study used a pretested questionnaire to assess self-harming ideations and other demographic characteristics. Ordinal logistic regression was used to determine factors associated with chronicity of self-harm ideations. Results: Of 385 participants, the prevalence of self-harming ideations was 4.2% (n = 16) for acute, 8% (n = 31) for subacute, and 3.1% (n = 12) for chronic. The likelihood of having more chronic self-harming ideations increased with having ever been pregnant (adjusted odds ratio [aOR] = 3.78, 95% Confidence Interval [CI] = 1.57–9.08). However, having a spouse as the family head reduced the likelihood of having more chronic self-harming ideations (aOR = 0.19, 95% CI = 0.04–0.95). Conclusions: The persistence of self-harming thoughts among female teenagers in Northern Ugandan refugee settlements varies. Pregnancy history is associated with a higher chance of prolonged self-harming thoughts while having a spouse as the family’s head is linked with a lower likelihood. Examining different demographic and familial elements when addressing the mental well-being of female teenage refugees is vital. It stresses the necessity for customized interventions and support networks targeting the reduction of self-harm behaviors among this vulnerable group.
Comparing visual estimation and hematocrit change in the assessment of blood loss among women undergoing cesarean delivery in a tertiary facility in northern Uganda
(Therapeutic advances in reproductive health, 2024) Robert Edilu; Ritah Nantale; Aaron Sanvu; James Ecuut; Alban Odong; Felix Bongomin; Jackline Ayikoru,; Baifa Arwinyo,; Sande Ojara; Pebalo Francis Pebolo
Background: Cesarean section poses a fourfold risk for postpartum hemorrhage (PPH), necessitating accurate blood loss estimation to enable timely interventions. However, the conventional visual estimation method often leads to underestimation, resulting in undiagnosed PPH even in our setting, Uganda. Yet, the quantitative standard techniques remain underutilized. Objective: We compared visual and calculated blood loss among women undergoing cesarean delivery at Gulu Regional Referral Hospital in northern Uganda. Design: We employed a cross-sectional study design. Methods: We enrolled pregnant women scheduled for cesarean section and determined both calculated and visually estimated blood loss. Data analysis involved using Pearson’s moment correlation coefficient to compare the two methods and logistic regression to determine the factors associated with PPH. Results: We included 105 participants, most were primigravida (n = 100, 43%), aged 15–24 years (n = 100, 52%), with term gestation (n = 100, 75%). The mean visual estimated blood loss (vEBL) was 235.3 ± 123.7 ml (interquartile range (IQR) 50–600 ml), while the calculated estimated blood loss (cEBL) was 435.0 ± 1328.2 ml (IQR −11,182.1–2226.7 ml). Visual estimation underestimated blood loss in 90% of cases (n = 100), and 21% (n = 21) had undiagnosed PPH (>1000 ml blood loss). None of the respondents had PPH (>1000 ml blood loss) following vEBL. There was a small positive correlation between both methods (vEBL and cEBL; r = 0.1165; p = 0.2482). Women aged >35 years were 1.60 times more likely to experience PPH than their counterparts aged 25–34 years (adjusted odds ratio (AOR): 1.60; 95% CI: 1.11–2.30, p < 0.011). Chorioamnionitis increased the risk of PPH by 2.2 times (AOR: 2.20; 95% CI: 1.20–4.05, p < 0.012). Conclusion: The visual estimation technique significantly underestimated blood loss in up to 90% of cases, particularly during emergency cesarean sections. Among the 21% of cases diagnosed with PPH based on calculated blood loss, advanced maternal age and chorioamnionitis were notable contributing factors. Routine hemoglobin and hematocrit testing in obstetric care can be effectively utilized to objectively assess blood loss, aiding in the accurate diagnosis and management of PPH. Implementing these measures, even in resourceconstrained settings, can significantly reduce the morbidity and mortality associated with PPH
Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda
(BMC Malaria Journal, 2024) Solomon Oguta; Brian Serumaga; Lameck Odongo; Donald Otika; Jackline Ayikoru; Raymond Otim; Francis Pebolo Pebalo
Background: All pregnant mothers in Uganda are given sulfadoxine-pyrimethamine (SP, Fansidar ®) for presumptive treatment of malaria in pregnancy from 14 weeks of gestation, every four weeks, until delivery. However, prenatal mothers still fall sick of malaria. This study aimed to assess the factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital. Methods: This was a cross-sectional study at Gulu Regional Referral Hospital antenatal clinic from July to August 2023. Consecutive sampling was used. An interviewer-administered questionnaire was used to collect sociodemographic characteristics, physical examination findings and blood samples taken for rapid diagnostic test (RDT) for malaria. A positive RDT was taken as the presence of malaria infection in pregnancy. Data was pre-processed in STATA ®15, and logistic regression analysis was done in RStudio 4.2.2. Variables with p < 0.05 were taken as independently associated with malaria in pregnancy and reported as adjusted risk ratios (aRR). Results: Three hundred fifty (350) pregnant women were recruited; 96% of them slept under mosquito nets daily, while more than half of them (51.7%) had not yet taken SP (IPTp) during their current pregnancy. Prevalence of anaemia (Hb < 11.0 g/dl) was 46.0%. Twenty-four per cent of the mothers were in the first trimester, 56.3% in the second and 19.7% in the third. The prevalence of malaria in pregnancy was 39.7% (95% CI 34.5–45.1%), equally distributed throughout the trimesters. Anaemia (aRR = 4.99, 95%CI 3.10–8.05, p < 0.001) and tertiary level of education (aRR = 0.29, 95% CI 0.14–0.62, p = 0.001) were significantly associated with malaria in pregnancy. Not sleeping under a mosquito net (aRR = 3.79, 95% CI 0.95–15.16, p = 0.059) may be a factor associated with malaria in pregnancy. Conclusion: Four in every ten mothers had malaria infection, with anaemia being a risk factor, while a tertiary levelof education was protective against malaria in pregnancy.
Prediction of low birth weight at term in low resource setting of Gulu city, Uganda: a prospective cohort study
(PAMJ, 2022-11-08) Silvia Awor; Rosemary Byanyima; Benard Abola; Paul Kiondo; Christopher Garimoi-Orach; Jasper Ogwal-Okeng; Annettee Nakimuli; Dan Kabonge Kaye
Introduction: despite the widespread poverty in Northern Uganda resulting in undernutrition, not all mothers deliver low birth weight babies. Therefore, we developed and validated the risk prediction models for low birth weight at term in Northern Uganda from a prospective cohort study. Methods: one thousand mothers were recruited from 16 - 24 weeks of gestation and followed up until delivery. Six hundred and eighty-seven mothers delivered at term. The others were either lost to follow-up or delivered preterm. Used proportions to compute incidence of low birth weight at term, build models for prediction of low birth weight at term in RStudio. Since there were few low birth weight at term, were generated synthetic data using ROSE-package in RStudio by over-sampling low birth weights and under sampling normal birth weights, and evaluated the model performance against the synthetic data using K (10) - fold cross-validation. Results: mean age was 26.3 years with an average parity of 1.5. Their mean body mass index was 24.7 and 7.1% (49 of 687) had lateral placenta. The incidence of low birth weight was 5.7% (39 of 687). Predictors of low birth weight were gravidity, level of education, serum alanine aminotransferase (ALT), serum gamma-glutamyl transferase (GGT), lymphocyte count, placental location, and end diastolic notch in the uterine arteries. This predicted low birth weight at term by 81.9% area under the curve (AUC), 76.1% accuracy, 72.9% specificity, and 79.1% sensitivity. Conclusion: a combination of gravidity, level of education, serum ALT, serum GGT, lymphocyte count, placental location, and end-diastolic notch in the uterine arteries can be used for screening for low birth weight in prenatal clinics for screening low birth weight at term.
Prediction of Preeclampsia Using Routinely Available Care: A Review of Literature
(Journal of African Interdisciplinary Studies, 2022-01) Silvia Awor; Rosemary Byanyima; Benard Abola; Annettee Nakimuli; Christopher Garimoi Orach; Paul Kiondo; Dan Kaye; Jasper Ogwal-Okeng
Women of Afro-Caribbean racial origin are at increased risks of adverse pregnancy outcomes including preeclampsia. This is probably related to low socio-economic status among these communities. With limited resources allocated for health care, there has been a growing need to predict preeclampsia to enable frequent follow up of those at risk, for early diagnosis and treatment to minimize adverse outcomes. Risk prediction models have been developed in some parts of Africa, using maternal history and physical examination, uterine artery Doppler sonography, maternal full haemogram, liver and renal function tests with at least 50% accuracy and 70% AUC. The study concludes that routine prediction of preeclampsia in Africa is limited, although with a potential to save lives.
Prediction of stillbirth low resource setting in Northern Uganda
(BMC, 2022-11-19) Silvia Awor; Rosemary Byanyima; Benard Abola; Paul Kiondo; Christopher Garimoi Orach; Jasper Ogwal‑Okeng; Dan Kaye; Annettee Nakimuli
Background: Women of Afro-Caribbean and Asian origin are more at risk of stillbirths. However, there are limited tools built for risk-prediction models for stillbirth within sub-Saharan Africa. Therefore, we examined the predictors for stillbirth in low resource setting in Northern Uganda. Methods: Prospective cohort study at St. Mary’s hospital Lacor in Northern Uganda. Using Yamane’s 1967 formula for calculating sample size for cohort studies using finite population size, the required sample size was 379 mothers. We doubled the number (to>758) to cater for loss to follow up, miscarriages, and clients opting out of the study dur‑ ing the follow-up period. Recruited 1,285 pregnant mothers at 16–24 weeks, excluded those with lethal congenital anomalies diagnosed on ultrasound. Their history, physical findings, blood tests and uterine artery Doppler indices were taken, and the mothers were encouraged to continue with routine prenatal care until the time for delivery. While in the delivery ward, they were followed up in labour until delivery by the research team. The primary outcome was stillbirth 24+weeks with no signs of life. Built models in RStudio. Since the data was imbalanced with low stillbirth rate, used ROSE package to over-sample stillbirths and under-sample live-births to balance the data. We cross-vali‑ dated the models with the ROSE-derived data using K (10)-fold cross-validation and obtained the area under curve (AUC) with accuracy, sensitivity and specificity. Results: The incidence of stillbirth was 2.5%. Predictors of stillbirth were history of abortion (aOR=3.07, 95% CI 1.11—8.05, p=0.0243), bilateral end-diastolic notch (aOR=3.51, 95% CI 1.13—9.92, p=0.0209), personal history of preeclampsia (aOR=5.18, 95% CI 0.60—30.66, p=0.0916), and haemoglobin 9.5 – 12.1 g/dL (aOR=0.33, 95% CI 0.11—0.93, p=0.0375). The models’ AUC was 75.0% with 68.1% accuracy, 69.1% sensitivity and 67.1% specificity. Conclusion: Risk factors for stillbirth include history of abortion and bilateral end-diastolic notch, while haemoglobin of 9.5—12.1 g/dL is protective.
Prediction of low birth weight at term in low resource setting of Gulu city, Uganda: a prospective cohort study
(PAMJ, 2022-11-08) Silvia Awor; Rosemary Byanyima; Benard Abola; Paul Kiondo; Christopher Garimoi-Orach; Jasper Ogwal-Okeng; Annettee Nakimuli; Dan Kabonge Kaye
Introduction: despite the widespread poverty in Northern Uganda resulting in undernutrition, not all mothers deliver low birth weight babies. Therefore, we developed and validated the risk prediction models for low birth weight at term in Northern Uganda from a prospective cohort study. Methods: one thousand mothers were recruited from 16 - 24 weeks of gestation and followed up until delivery. Six hundred and eighty-seven mothers delivered at term. The others were either lost to follow-up or delivered preterm. Used proportions to compute incidence of low birth weight at term, build models for prediction of low birth weight at term in RStudio. Since there were few low birth weight at term, were generated synthetic data using ROSE-package in RStudio by over-sampling low birth weights and under sampling normal birth weights and evaluated the model performance against the synthetic data using K (10) - fold cross-validation. Results: mean age was 26.3 years with an average parity of 1.5. Their mean body mass index was 24.7 and 7.1% (49 of 687) had lateral placenta. The incidence of low birth weight was 5.7% (39 of 687). Predictors of low birth weight were gravidity, level of education, serum alanine aminotransferase (ALT), serum gamma-glutamyl transferase (GGT), lymphocyte count, placental location, and enddiastolic notch in the uterine arteries. This predicted low birth weight at term by 81.9% area under the curve (AUC), 76.1% accuracy, 72.9% specificity, and 79.1% sensitivity. Conclusion: A combination of gravidity, level of education, serum ALT, serum GGT, lymphocyte count, placental location, and end-diastolic notch in the uterine arteries can be used for screening for low birth weight in prenatal clinics for screening low birth weight at term.
Incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Uganda: a prospective
(BMC Pregnancy and Childbirth, 2024) Geoffrey Okot; Samuel Omara; Musa Kasujja; Francis Pebolo Pebalo; Petrus Baruti; Naranjo Almenares Ubarnel
Background: High rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda. Materials and methods: This was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05. Results: Of the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were: maternal age ≥ 35 years (aRR = 1.72, CI:1.194–2.477, p value = 0.004 Conclusions: The study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies.
Liver and renal biochemical profiles of people with sickle cell disease in Africa: a systematic review and meta‑analysis of case‑control studies
(BMC, 2024-10-15) Silvia Awor; Felix Bongomin; Mark Mohan Kaggwa; Francis Pebalo Pebolo; Jackie Epila; Geoffrey Maxwell Malinga; Christine Oryema; Proscovia Nnamuyomba; Acaye Ongwech; David Musoke
Background: Sickle cell disease (SCD) is a genetic blood disorder characterized by a painful vaso-occlusive crisis due to the sickling of red blood cells in capillaries. Complications often lead to liver and renal dysfunctions, contributing to morbidity and mortality, particularly for children under 5. This systematic review and meta-analysis aimed to evalu ate the liver and renal functions of people with SCD (HbSS) compared to those without it (HbAA) in Africa. Methods: The protocol was registered with PROSPERO (CRD42022346771). We searched PubMed, Embase, Web of Science, and Google Scholar using the keywords “liver function”, “renal function”, “sickle cell disease”, and “Africa” on 6th May 2023 for peer-reviewed articles with abstracts in English. We included case-control studies compar ing SCD (HbSS) with controls without hemoglobinopathies (HbAA). We used the random-effect model to calculate the pooled average values for the blood tests of people with SCD in RStudio version 4.2.2. Systematic review registration PROSPERO CRD42022346771 Results: Overall, 17 articles were analyzed from five African countries involving 1312 people with SCD and 1558 controls. The pooled mean difference of liver enzymes aspartate transaminase (AST) was 8.62 (95% CI − 2.99–20.23, I2 = 97.0%, p < 0.01), alanine transaminase (ALT) 7.82 (95% CI − 0.16–15.80, I2 = 99%, p < 0.01) and alkaline phos phatase (ALP) − 2.54 (95% CI − 64.72 – 59.64, I2 = 99%, p < 0.01) compared to controls. The pooled mean difference for the renal biochemical profiles creatinine − 3.15 (95% CI − 15.02; 8.72, I2=99%, p < 0.01) with a funnel plot asym metry of t = 1.09, df = 9, p = 0.3048 and sample estimates bias of 6.0409. The pooled mean difference for serum urea was − 0.57 (95% CI − 3.49; 2.36, I2 = 99%, p < 0.01), and the estimated glomerular filtration (eGFR) rate was 19.79 (95% CI 10.89–28.68 mL/min/1.73 m2, I2 = 87%, p < 0.01) compared to controls. Conclusion: People with SCD have slightly elevated liver enzymes and estimated glomerular filtration rates com pared to controls in Africa. With all the heterogeneity (I2) > 50%, there was substantial variation in the reported articles’ results.
Prediction of preterm birth at St. Mary’s Hospital Lacor, Northern Uganda: a prospective cohort study
(African Health Sciences,, 2024-06) Silvia Awor; Rosemary Byanyima; Benard Abola; Annettee Nakimuli; Christopher Orach; Paul Kiondo; Jasper Ogwal Okeng; Dan Kaye
Background: Preterm birth causes over 2% of perinatal mortality in Africa. Screening in prenatal clinics, may be used to identify women at risk. This study developed and validated second-trimester prediction models of preterm birth, using maternal socio-demographic characteristics, sonographic findings, and laboratory parameters in Northern Uganda. Methods: This prospective cohort study recruited 1,000 pregnant mothers at 16 - 24 weeks, and assessed their socio-demographic and clinical characteristics. Preterm birth (delivery after 28 and before 37 weeks) was the primary study outcome. Multi-variable analyses were performed, built models in RStudio, and cross-vaidated them using K (10)-fold cross-validation. Results: The Incidence of preterm birth was 11.9% (90 out of 774). The predictors of preterm birth were multiple pregnancies, personal history of preeclampsia, history of previous preterm birth, diastolic hypertension, serum ALP<98IU, white blood cell count >11000 cells/µl, platelet lymphocyte ratio >71.38, serum urea of 11-45 IU. These predicted preterm birth by 69.5% AUC, with 62.4% accuracy, 77.2% sensitivity, and 47.1% specificity. Conclusion: Despite low specificity, these models predict up to 77.2% of those destined to have a preterm birth, and may be used for second-trimester preterm birth screening in low-resource clinics
Exploring the utilization of postabortion care services and related factors among women at a tertiary health facility
(Womens Health, 2024) Ayikoru Jackline; Jimmyy Opee; Felix Bongomin; Harriet Akello; Sandra Fiona Atim; Pebalo Francis Pebolo
Background: Abortion-related complications are the third leading cause of maternal mortality in Uganda, accounting for approximately one-fourth of all maternal deaths. Most are preventable through adequate use of the full package of postabortion care (PAC) services. Objective: We aimed to assess the level of utilization of PAC services and the associated sociodemographic, obstetric, gynecological, and system-related factors at a high-volume tertiary health facility in Northern Uganda. Design: A cross-sectional survey was conducted among women receiving PAC at the Gulu Regional Referral Hospital from March 2023 to June 2023. Participants were recruited consecutively and exit interviews were conducted using structured questionnaires. Methods: Utilization of PAC was defined as the use of four or more of the following: counseling, emergency treatment, family planning services, linkage to other sexual and reproductive health services, and community health service provider cooperation. Modified Poisson regression analysis was used to determine the independent predictors of PAC utilization. Results: A total of 364 participants were enrolled in the study. Overall, 21.1% (n = 77) of the participants had used four or more PAC services. Having a supportive partner (adjusted prevalence ratio (aPR): 1.9, 95% confidence interval (CI): 1.19–2.88, p = 0.006), knowledge on PAC services (aPR: 1.7, 95% CI: 1.19–2.48, p = 0.004), low parity (aPR: 2.2, 95% CI: 1.16–4.35, p = 0.016), nulliparity (aPR: 2.4 95% CI: 1.19–4.73, p = 0.014), and provision of privacy(physical privacy during prescription, counseling, procedures) (aPR: 2.3 95% CI: 1.14–4.47, p = 0.02), were significantly associated with utilization of PAC. Overall, only one in five participants utilized four or more PAC services. Use of four or more PAC services was significantly associated with women having a supportive partner, knowledge of PAC services, low parity, nulliparity, and provision of privacy while receiving PAC services. Conclusion: Approaches such as advocating male partner involvement, bridging the knowledge gap through health education, and promoting respectful care may improve the utilization of PAC services
Partnering to Improve Mentorship Capacity for Ugandan Reproductive Health Researchers: Program Description and Evaluation
(2024) Julie M. Buser; Ella August; Faelan E; Jacobson-Davies; Felix Bongomin; Edward Kumakech; Rachel Gray,; Pebalo Francis Pebolo; Anna Grace Auma; Tamrat Endale; Yolanda R
Abstract. Mentorship is essential to health researchers in achieving their full potential and advancing public health. In most low-resource settings, there is a paucity of training on how to be a successful mentor. The Center for International Reproductive Health Training at the University of Michigan conducted and evaluated a workshop at two universities in Uganda for mentors of new reproductive health research grant awardees. The program aimed to strengthen mentors’ mentorship skills and to identify ways to foster institutional support for mentoring. Mentors rated their post-training skills using a 5-point Likert scale (not skilled to extremely skilled) immediately and 3 months after the training. Ten of 19 mentors who participated in the training completed the evaluation. The majority were 41 to 50 years old, male, midcareer faculty. Immediately after the training, mentors rated themselves (mean 6 SD) highest in knowledge of research ethics (4.4 6 0.5), fostering independence in mentees (4.3 6 0.9), and understanding the benefits of mentoring (3.9 6 1.1). Mentors felt least confident in fostering institutional change to support mentorship (3.3 6 0.8), communication (3.5 6 0.5), and overcoming adversity (3.5 6 0.8). The two most important things the mentors learned were how to appreciate and manage diversity and how they can benefit from mentorship. Barriers to mentoring that persisted after the program ended included lack of time and institutional resources. Enhancing mentorship training opportunities will foster a generation of scientists who are more supported, skilled, and productive in research, leading to better reproductive and public health outcomes in their communities.
“We Cure Sickle Cell Disease with Herbs”: Perspectives of Herbal Medicine Practitioners Treating Sickle Cell Disease in the Acholi SubRegion
(DovePress, Taylor & Francis Group, 2025-07-28) Awor, Silvia; Opee, Jimmyy; Denis Ocaya,; Ocaya, Jimmy; Abola, Benard; Malinga, Geoffrey Maxwell; Oryema, Christine; Arwenyo, Beatrice; Ongwech, Acaye; Musoke, David; Nnamuyomba, Proscovia; Epila, Jackie
Background: Sickle cell disease (SCD) is a genetic blood disorder that results in the deformation of red blood cells under low oxygen conditions, causing vaso-occlusive crises and severe complications. While hydroxyurea has been introduced as a treatment for SCD, herbal medicines remain widely used across Africa. Northern Uganda has a high SCD prevalence of 20.5%, yet limited research exists on alternative treatment options within local communities. This study aimed to explore the perspectives of herbal medicine practitioners in the Acholi sub-region. Methods: We conducted in-depth interviews between October and December 2024 involving 24 herbal medicine practitioners in the Acholi sub-region, selected through referrals and non-probability snowball sampling. All data collected were recorded, transcribed verbatim, and analyzed using thematic content analysis, and emerging themes were presented. Results: All participants believed herbal medicine could cure SCD, and the majority reported successfully treating patients. However, some practitioners remembered some patients who reported being sick with sickle cell crises many years after the “cure”. “When they report improvement, I stop medication after some time…” thereafter, “I encourage them to go to the hospital, but they do not. They can stay without falling sick for a long time and declare themselves healed”. Findings suggest herbal medicines are commonly used for SCD management in the Acholi sub-region. Most herbal medicine practitioners rely on the hospital diagnoses, although a few can tell who has sickle cell disease by looking at or touching them. A lot of mistrust exists between herbal medicine practitioners, the government, and researchers. This hinders efforts to integrate traditional medicine into mainstream healthcare and limits opportunities for scientific validation. Conclusion: Herbal medicine practitioners believe herbs can treat sickle cell disease; however, further research is needed to investigate the nature of these herbs and their mechanisms of action, thereby facilitating the integration of herbal medicine into conventional care. We discuss some implications of the study for practice and policy
Safety and efficacy of herbal medicines for the management of sickle cell disease in Africa: a systematic review and meta-analysis
(PAMJ One Health, 2024-12-16) Awor, Silvia; Bongomin, Felix; Kaggwa, Mark Mohan; Pebalo, Pebolo Francis; Kivumbi, Ronald Muganga; Malinga, Geoffrey Maxwell; Ongwech, Acaye; Nnamuyomba, Proscovia; Oryema, Christine; Abola, Benard; Epila, Jackie; Musoke, David
This systematic review and meta-analysis evaluated the safety and efficacy of herbal remedies used to manage sickle cell disease (SCD) in Africa. Before the advent of western medicine, people depended on herbal medicines for treating different illnesses. Using herbal medicines to sickle cell disease (SCD) is still common in Africa. However, data on the safety and efficacy of any of these remedies are limited. We searched PubMed, Embase, Google Scholar and Web of Science from inception to 11thJanuary 2024 using the keywords "herbal medicine" and "sickle cell" and the name of each of the countries in Africa without language restrictions. We included cross-sectional studies that reported the safety or efficacy of herbal medicine for managing sickle cell disease. Two reviewers assessed all included studies for suitability for inclusion in this review. All included articles were assessed using ROBINS-1, a tool for assessing the risk of bias in non-randomized studies of interventions. We used the randomeffect model to pool the efficacy and safety profiles of the herbal medicines using RStudio version 4.2.2. Overall, we included five studies involving 1,489 individuals with SCD. Of these, 789 (53.0%) used herbal remedies like Aloe barbadensis (Aloe vera), Zingiber officinale (ginger), Cymbopogon citratus (lemongrass), Forever Living products, Golden Neo-Life Diamite International (GNLD) diet supplements and ginseng products. About 22.9% (181 out of 789) of the participants who used herbal remedies reported side effects, while 38.5% (304 out of 789) reported improving their symptoms. There was a high risk of publication bias in the articles included in this review. The pooled adverse effects of the herbal medicines for SCD treatment were 48% lower (Odds ratio: 0.52, 95% confidence interval (CI): 0.26 - 1.05, I²= 82%, p<0.01) while the pooled efficacy of herbal remedies for treating SCD was nearly 100% higher (odds ratio= 2.07, 95% confidence interval 0.99 - 4.32, I²= 78%, p<0.01) among the users than controls. However, these findings were not statistically significant. Our findings indicate no significant difference in the safety and efficacy of herbal medicines among people with SCD who used or did not use herbal remedies. However, the sample sizes of the primary studies were small. Thus, more extensive controlled studies with better-defined endpoints are required to inform the use of herbal medicines in managing SCD in Africa.
Exploring the utilization of postabortion care services and related factors among women at a tertiary health facility in Gulu, Northern Uganda
(Sega Sexual and Reproductive Health Across Africa: Challenges and Opportunities, 2024-10-11) Ayikoru, Jackline; Opee, Jimmy; Bongomin, Felix; Atim, S.Fiona; Pebalo Pebolo, Francis
Background: Abortion-related complications are the third leading cause of maternal mortality in Uganda, accounting for approximately one-fourth of all maternal deaths. Most are preventable through adequate use of the full package of postabortion care (PAC) services. Objective: We aimed to assess the level of utilization of PAC services and the associated sociodemographic, obstetric, gynecological, and system-related factors at a high-volume tertiary health facility in Northern Uganda. Design: A cross-sectional survey was conducted among women receiving PAC at the Gulu Regional Referral Hospital from March 2023 to June 2023. Participants were recruited consecutively and exit interviews were conducted using structured questionnaires. Methods: Utilization of PAC was defined as the use of four or more of the following: counseling, emergency treatment, family planning services, linkage to other sexual and reproductive health services, and community health service provider cooperation. Modified Poisson regression analysis was used to determine the independent predictors of PAC utilization. Results: A total of 364 participants were enrolled in the study. Overall, 21.1% (n = 77) of the participants had used four or more PAC services. Having a supportive partner (adjusted prevalence ratio (aPR): 1.9, 95% confidence interval (CI): 1.19–2.88, p = 0.006), knowledge on PAC services (aPR: 1.7, 95% CI: 1.19–2.48, p = 0.004), low parity (aPR: 2.2, 95% CI: 1.16–4.35, p = 0.016), nulliparity (aPR: 2.4 95% CI: 1.19–4.73, p = 0.014), and provision of privacy(physical privacy during prescription, counseling, procedures) (aPR: 2.3 95% CI: 1.14–4.47, p = 0.02), were significantly associated with utilization of PAC. Overall, only one in five participants utilized four or more PAC services. Use of four or more PAC services was significantly associated with women having a supportive partner, knowledge of PAC services, low parity, nulliparity, and provision of privacy while receiving PAC services. Conclusion: Approaches such as advocating male partner involvement, bridging the knowledge gap through health education, and promoting respectful care may improve the utilization of PAC services.
Efficacy of the Gulu University Reproductive Health Simulation Training for final year medical students and interns: a before-and-after study
(Therapeutic Advances in Reproductive Health, 2024-04-09) Pebalo Pebolo , Francis; Okot, Jerom; Bongomin , Felix; Awor, Silvia; Arwinyo, Baifa; Ojara, Sande; Opee, Jimmyy; Jackline, Ayikoru; Ssennuni, Eric; Ouma, Simple
Background: Reproductive health emergencies, such as postpartum hemorrhage, contribute significantly to maternal and neonatal morbidity and mortality in Uganda due to knowledge and skills gaps. Medical interns, intern midwives, and nurses are crucial as frontline healthcare workers in responding to these emergencies. Our proposed hands-on strategy involves comprehensive simulation-based training (SBT) to equip these healthcare workers with the essential knowledge to manage common reproductive health emergencies and procedures in the country. Objectives: The study aimed to assess the effectiveness of comprehensive SBT in improving the knowledge of interns and fifth-year medical students on reproductive health emergencies and procedures at Gulu University and its Teaching Hospitals in Uganda. Design: A before-and-after study. Methods: A 4-day SBT was conducted for fifth-year medical students and interns (nurses, midwives, and doctors) at Gulu University Teaching Hospitals, focusing on reproductive health emergencies. Pre- and post-tests with 40 multiple-choice questions were used to evaluate knowledge enhancement, the scores were summarized as medians and interquartile ranges. Paired sample t-tests was used to test the difference in pre- and post-test scores. Independent sample t-tests compared median post-test results between interns and students, with a p-value
Exploring the utilization of postabortion care services and related factors among women at a tertiary health facility in Gulu, Northern Uganda
(Sega Publisher Sexual and Reproductive Health Across Africa: Challenges and Opportunities, 2024-10-11) Ayikoru, Jackline; Opee, Jimmy; Bongomin, Felix; Akello, Harriet; Atim, S.Fiona; Pebalo Pebolo, Francis
Background: Abortion-related complications are the third leading cause of maternal mortality in Uganda, accounting for approximately one-fourth of all maternal deaths. Most are preventable through adequate use of the full package of postabortion care (PAC) services. Objective: We aimed to assess the level of utilization of PAC services and the associated sociodemographic, obstetric, gynecological, and system-related factors at a high-volume tertiary health facility in Northern Uganda. Design: A cross-sectional survey was conducted among women receiving PAC at the Gulu Regional Referral Hospital from March 2023 to June 2023. Participants were recruited consecutively and exit interviews were conducted using structured questionnaires. Methods: Utilization of PAC was defined as the use of four or more of the following: counseling, emergency treatment, family planning services, linkage to other sexual and reproductive health services, and community health service provider cooperation. Modified Poisson regression analysis was used to determine the independent predictors of PAC utilization. Results: A total of 364 participants were enrolled in the study. Overall, 21.1% (n=77) of the participants had used four or more PAC services. Having a supportive partner (adjusted prevalence ratio (aPR): 1.9, 95% confidence interval (CI): 1.19–2.88, p=0.006), knowledge on PAC services (aPR: 1.7, 95% CI: 1.19–2.48, p=0.004), low parity (aPR: 2.2, 95% CI: 1.16–4.35, p=0.016), nulliparity (aPR: 2.4 95% CI: 1.19–4.73, p=0.014), and provision of privacy(physical privacy during prescription, counseling, procedures) (aPR: 2.3 95% CI: 1.14–4.47, p=0.02), were significantly associated with utilization of PAC. Overall, only one in five participants utilized four or more PAC services. Use of four or more PAC services was significantly associated with women having a supportive partner, knowledge of PAC services, low parity, nulliparity, and provision of privacy while receiving PAC services. Conclusion: Approaches such as advocating male partner involvement, bridging the knowledge gap through health education, and promoting respectful care may improve the utilization of PAC services.
“We provide the methods to others but we don’t use the methods ourselves”: challenges with utilization of modern contraception among Female Healthcare Workers at two tertiary teaching hospitals, Northern Uganda
(BMC Contraception and Reproductive Medicine, 2025-10-31) Opee, Jimmy; Opiro, Keneth; Manano, Priscilla; Sikoti , Margret; Ayikoru, Jackline; Akello, Harriet; Laker, F.Gladys; Wolters, K.Maria; Awor, Silvia; Pebalo Pebolo, Francis; Bongomin, Felix
Background Female Healthcare Workers (FHCWs) play a crucial role in advocating for, delivering modern contraceptive methods (MCM) to reproductive-age women and potential users. Despite the high frequency of women seeking healthcare annually, less than half receive adequate contraceptive counseling and services. Investigating FHCWs’ adherence to these practices and understanding the obstacles they encounter is essential. This study aimed to explore challenges with utilization of MCM among FHCWs at the two tertiary teaching hospitals in Northern Uganda. Methods We conducted a descriptive, cross-sectional study employing a qualitative approach at St. Mary’s Hospital Lacor (SMHL) and Gulu Regional Referral Hospital (GRRH), Northern Uganda. Qualitative data were explored using the principles of descriptive phenomenology to gain deeper insights into the experiences of twenty (20) FHCWs. Results Findings revealed various challenges faced by FHCWs, including patient barriers such as religious beliefs, contraceptive myths, fear of side effects, and provider barriers like lack of knowledge, training, and discomfort. Additionally, health system barriers like limited time and competing priorities were identified. Conclusion Female Healthcare workers experience challenges with utilization of MCM. Efforts should focus on enhancing contraceptive services, particularly in faith-based facilities and among married individuals. Besides, addressing perceived barriers at the patient, provider, and system levels through comprehensive health education, ensuring method availability, and provider training is imperative. Keywords Utilization, Modern contraception methods, Female healthcare workers, Gulu University Teaching Hospitals, Northern Uganda
Proportion and factors associated with intra procedural pain among women undergoing manual vacuum aspiration for incomplete abortion at Mbarara Regional Referral Hospital, Uganda
(Pan African Medical Journal, 2024-11-06) Opee, Jimmyy; Mayanja, Stephen Bawakanya; Kayondo, Musa; Tibaijuka, Leevan; Bongomin, Felix; Orach, Christopher Garimoi; Ngonzi, Joseph
Introduction: Intra-Procedural Pain (IPP) is common among women undergoing Manual Vacuum Aspiration (MVA) for incomplete abortion. Globally, the proportion varies between 60% to 90% while in sub-Saharan Africa including Uganda, the proportion varies between 80% to 98%. Intra procedural pain management during MVA includes a para-cervical block (using 1% lidocaine) or an opioid (using 100 mg of intravenous pethidine). The study aimed to determine the proportion and factors associated with IPP among women undergoing MVA for incomplete abortion at Mbarara Regional Referral Hospital (MRRH). Methods: we conducted a cross-sectional study among 207 women who underwent MVA for incomplete abortion between December 2020 and May 2021. An interviewer-administered structured questionnaire was used, and pain assessment was done using the Visual Analogue Scale (VAS) considering an IPP as a pain score of 6 or more. The participant characteristics were summarized. The proportion of women with IPP was calculated. We performed multivariable logistic regression to determine the factors associated with IPP. Results: we consecutively enrolled 207 women with a mean age of 25.8 ± 5.8 years. The proportion of women with IPP undergoing MVA at MRRH was 82.6%, 95% C.I 76.8 - 87.2. The factors significantly associated with IPP were age and cervical dilatation. The odds of IPP increased with decreasing age of the women; compared to older women aged >30 years, teenagers aged <20 years; aOR: 8, 95% CI 1.8534.61; p=0.005, while women aged 20-24 years; aOR: 3.45, 95% CI 1.47-8.20; p=0.004 and those aged 25-30 years; aOR: 2.84, 95% CI 1.20-6.74; p=0.018. Women with cervical dilatation of 1-2 cm had the odds of IPP increased; aOR: 2.27, 95% CI 1.11-4.62; p=0.024 compared to a cervical dilation of 3-4 cm. Conclusion: majority of women undergoing MVA at MRRH experienced IPP. Younger women and those with cervical dilatation 1-2 cm are more likely to experience IPP. We recommend optimised and personalised pain management strategies for women undergoing MVA.
“We provide the methods to others but we don’t use the methods ourselves”: challenges with utilization of modern contraception among Female Healthcare Workers at two tertiary teaching hospitals, Northern Uganda
(Contraception and Reproductive Medicine, 2024-10-31) Opee, Jimmy; Opiro, Keneth; Manano, Priscilla; Sikoti, Margret; Ayikoru, Jackline; Akello, Harriet; Laker, Fiona Gladys; Wolters, K. Maria; Awor, Silvia; Pebalo Pebolo, Francis; Bongomin, Felix
Background Female Healthcare Workers (FHCWs) play a crucial role in advocating for, delivering modern contraceptive methods (MCM) to reproductive-age women and potential users. Despite the high frequency of women seeking healthcare annually, less than half receive adequate contraceptive counseling and services. Investigating FHCWs’ adherence to these practices and understanding the obstacles they encounter is essential. This study aimed to explore challenges with utilization of MCM among FHCWs at the two tertiary teaching hospitals in Northern Uganda. Methods We conducted a descriptive, cross-sectional study employing a qualitative approach at St. Mary’s Hospital Lacor (SMHL) and Gulu Regional Referral Hospital (GRRH), Northern Uganda. Qualitative data were explored using the principles of descriptive phenomenology to gain deeper insights into the experiences of twenty (20) FHCWs. Results Findings revealed various challenges faced by FHCWs, including patient barriers such as religious beliefs, contraceptive myths, fear of side effects, and provider barriers like lack of knowledge, training, and discomfort. Additionally, health system barriers like limited time and competing priorities were identified. Conclusion Female Healthcare workers experience challenges with utilization of MCM. Efforts should focus on enhancing contraceptive services, particularly in faith-based facilities and among married individuals. Besides, addressing perceived barriers at the patient, provider, and system levels through comprehensive health education, ensuring method availability, and provider training is imperative.

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