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Essential newborn care practices and determinants amongst mothers of infants aged 0-6 months in refugee settlements, Adjumani district, west Nile, Uganda.

ABSTRACT: BACKGROUND:Despite recent improvements in child survival, neonatal mortality remains high in most developing countries. Countries affected by humanitarian emergencies continue to report the highest neonatal mortality rates. OBJECTIVE:To assess essential newborn care practices and its determinants amongst mothers of infants aged 0-6 months in refugee settlements in Adjumani district. METHODS:A cross-sectional study was conducted among mothers of infants aged 0-6 months in refugee settlements, Adjumani district. A total of 561 mothers of infants were selected using systematic sampling technique from households. Data were collected using a semi-structured questionnaire. A composite outcome variable, Essential Newborn Care practices was created by merging different care practices (neonatal feeding, thermal care, and cord care). Multiple logistic regression analysis was used to determine predictors of Essential Newborn Care. RESULTS AND CONCLUSIONS:Over half (57%) of the mothers breastfed their newborns within one hour. Half (50.1%) of mothers cleaned the umbilical cord of their newborns. Only 17% of the newborns received optimal thermal care immediately after birth. Mothers aged 20-24 years (OR 0.38, CI 0.17-0.96) and those involved in subsistence farming (OR 0.67, CI 0.38-1.45) were less likely to practice good newborn care compared to those in other occupations. Newborn care practices were sub-optimal in this refugee setting. To improve newborn care practices, there is need to educate mothers through community-based health interventions in order to promote delayed bathing, ideal infant feeding, thermal and umbilical cord care.

SUBMITTER: Komakech H

PROVIDER: S-EPMC7179823 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Essential newborn care practices and determinants amongst mothers of infants aged 0-6 months in refugee settlements, Adjumani district, west Nile, Uganda.

Komakech Henry H Lubogo David D Nabiwemba Elizabeth E Orach Christopher Garimoi CG

PloS one 20200423 4

<h4>Background</h4>Despite recent improvements in child survival, neonatal mortality remains high in most developing countries. Countries affected by humanitarian emergencies continue to report the highest neonatal mortality rates.<h4>Objective</h4>To assess essential newborn care practices and its determinants amongst mothers of infants aged 0-6 months in refugee settlements in Adjumani district.<h4>Methods</h4>A cross-sectional study was conducted among mothers of infants aged 0-6 months in re ...[more]

PMID: 32324787

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Project description:BackgroundWhile 5% of 247 million global malaria cases are reported in Uganda, it is also a top refugee hosting country in Africa, with over 1.36 million refugees. Despite malaria being an emerging challenge for humanitarian response in refugee settlements, little is known about its risk factors. This study aimed to investigate the risk factors for malaria infections among children under 5 years of age in refugee settlements in Uganda.MethodsWe utilized data from Uganda's Malaria Indicator Survey which was conducted between December 2018 and February 2019 at the peak of malaria season. In this national survey, household level information was obtained using standardized questionnaires and a total of 7787 children under 5 years of age were tested for malaria using mainly the rapid diagnostic test. We focused on 675 malaria tested children under five in refugee settlements located in Yumbe, Arua, Adjumani, Moyo, Lamwo, Kiryadongo, Kyegegwa, Kamwenge and Isingiro districts. The extracted variables included prevalence of malaria, demographic, social-economic and environmental information. Multivariable logistic regression was used to identify and define the malaria associated risk factors.ResultsOverall, malaria prevalence in all refugee settlements across the nine hosting districts was 36.6%. Malaria infections were higher in refugee settlements located in Isingiro (98.7%), Kyegegwa (58.6%) and Arua (57.4%) districts. Several risk factors were significantly associated with acquisition of malaria including fetching water from open water sources [adjusted odds ratio (aOR) = 1.22, 95% CI: 0.08-0.59, P = 0.002], boreholes (aOR = 2.11, 95% CI: 0.91-4.89, P = 0.018) and water tanks (aOR = 4.47, 95% CI: 1.67-11.9, P = 0.002). Other factors included pit-latrines (aOR = 1.48, 95% CI: 1.03-2.13, P = 0.033), open defecation (aOR = 3.29, 95% CI: 1.54-7.05, P = 0.002), lack of insecticide treated bed nets (aOR = 1.15, 95% CI: 0.43-3.13, P = 0.003) and knowledge on the causes of malaria (aOR = 1.09, 95% CI: 0.79-1.51, P = 0.005).ConclusionsThe persistence of the malaria infections were mainly due to open water sources, poor hygiene, and lack of preventive measures that enhanced mosquito survival and infection. Malaria elimination in refugee settlements requires an integrated control approach that combines environmental management with other complementary measures like insecticide treated bed nets, indoor residual spraying and awareness.

Project description:BackgroundAppropriate breastfeeding is vital for infant and young child nutrition. Annually, oral clefts affect 0.73 per 1000 children in Uganda. Despite this low incidence, children with a cleft face breastfeeding difficulty which affect their nutrition status. In addition, knowledge on maternal experiences with breastfeeding and support is limited. We explored maternal perceptions, experiences with breastfeeding and support received for their children 0 to 24 months with a cleft attending Comprehensive Rehabilitative Services of Uganda (CoRSU) Hospital.MethodsThis cross-sectional study combined quantitative and qualitative methods. We consecutively recruited 32 mothers of children with a cleft aged 0 to 24 months attending CoRSU hospital between April and May 2018. A structured questionnaire collected data on breastfeeding practices and device use (n = 32). To gain a broad understanding of mothers' perceptions and experiences with breastfeeding and support received, we conducted two Focus Group Discussions (in each, n = 5), and 15 In Depth Interviews. Descriptive statistics were analyzed using SPSS software. Qualitative data were analyzed thematically.ResultsOf the 32 children with a cleft, 23(72%) had ever breastfed, 14(44%) were currently breastfeeding, and among those under 6 months, 7(35%) exclusively breastfed. Of 25 mothers interviewed in IDIs and FGDs, 17(68%; IDIs = 8/15, FGD1 = 5/5 and FGD2 = 4/5) reported the child's failure to latch and suckle as barriers to breastfeeding. All ten mothers who used the soft squeezable bottle reported improved feeding. Nineteen (76%) mothers experienced anxiety and 14(56%), social stigma. Family members, communities and hospitals supported mothers with feeding guidance, money, child's feeds and psycho-social counselling. Appropriate feeding and psycho-social support were only available at a specialized hospital which delayed access.ConclusionsBreastfeeding practices were sub-optimal. Mothers experienced breastfeeding difficulties, anxiety and social stigma. Although delayed, feeding, social and psycho-social support helped mothers cope. Routine health care for mothers and their children with a cleft should include timely support.

Project description:BACKGROUND:Family-level predictors, including caregiver depression, are considered important influences on adolescent mental health. Adolescent depression and anxiety in refugee settings is known to be a significant public health concern, yet there is very limited literature from humanitarian settings focusing on the relationship between caregiver mental health and adolescent mental health. In the context of a larger study on child protection outcomes in refugee settings, researchers explored the relationship between caregiver depression and adolescent mental health in two refugee settlements, Kiryandongo and Adjumani, in Uganda. METHODS:Adolescents between 13 and 17 and their caregivers participated in a household survey, which included measures of adolescent anxiety and depression, and caregiver depression. Analysis was conducted using multiple logistic regression models, and results were reported for the full sample and for each site separately. RESULTS:In Kiryandongo, a one-unit increase in a caregiver's depression score tripled the odds that the adolescent would have high levels of anxiety symptoms (AOR: 3.0, 95% CI: 1.4, 6.1), while in Adjumani, caregiver depression did not remain significant in the final model. Caregiver depression, gender and exposure to violence were all associated with higher symptoms of adolescent depression in both sites and the full sample, for example, a one unit increase in caregiver depression more than tripled the odds of higher levels of symptoms of adolescent depression (AOR: 3.6, 95% CI: 2.0, 6.2). Caregiver depression is a consistently significantly associated with adverse mental health outcomes for adolescents in this study. CONCLUSIONS:Adolescent well-being is significantly affected by caregiver mental health in this refugee context. Child protection interventions in humanitarian contexts do not adequately address the influence of caregivers' mental health, and there are opportunities to integrate child protection programming with prevention and treatment of caregivers' mental health symptoms.

Project description:BackgroundImmunisation remains the most cost-effective public health intervention in preventing morbidity and mortality due to Vaccine-Preventable Diseases (VPDs). The study aims to compare the differences in immunisation coverage amongst children aged 0 to 23 months living in slums of Kampala city and Iganga as rural districts in Uganda.MethodsThis study utilises data from a cross-sectional survey done in 2019 in the slums of Kampala City and the rural district of Iganga within the Health and Demographic Surveillance Site (HDSS). It included 1016 children aged 0-23 months and their parents. A logistic regression model was used to analyse the relationship between multiple independent variables and the binary dependent variables (fully immunised) using Stata statistical software. The measures of association were odds ratios reported with a corresponding 95% confidence interval.ResultsOut of the 1016 participants, 544 participants live in the rural area and 472 participants in the slums. Slums had 48.9% (n = 231) of fully immunised children whilst rural areas had 43.20% (n = 235). The multivariate analysis showed that children living in slums are more likely to be fully immunised as compared to their counterparts in rural areas (Odds ratio:1.456; p = 0.033; CI:1.030-2.058). Immunisation coverage for BCG (98.9%), Polio 0 (88.2%), Penta1 (92.7%), and Pneumo1 (89.8%) were high in both settlements. However, the dropout rate for subsequent vaccines was high 17%, 20% and 41% for Penta, pneumococcal and rota vaccines respectively. There was poor uptake of the new vaccines with slums having 73.4% and 47.9% coverage for pneumococcal and rota vaccines respectively and rural areas had 72.1% and 7.5% for pneumococcal and rota vaccines respectively.ConclusionThe low full immunisation status in this study was attributed to the child's residence and the occupation of the parents. Lack of education and poor access to messages on immunisation (inadequate access to mass media) are other contributing factors. Educational messages on the importance of immunisation targeting these underserved populations will improve full immunisation coverage.

Project description:IntroductionUrban refugee youth remain underserved by current HIV prevention strategies, including HIV self-testing (HIVST). Examining HIVST feasibility with refugees can inform tailored HIV testing strategies. We examined if HIVST and mobile health (mHealth) delivery approaches could increase HIV testing uptake and HIV status knowledge among refugee youth in Kampala, Uganda.MethodsWe conducted a three-arm pragmatic controlled trial across five informal settlements grouped into three sites in Kampala from 2020 to 2021 with peer-recruited refugee youth aged 16-24 years. The intervention was HIVST and HIVST + mHealth (HIVST with bidirectional SMS), compared with standard of care (SOC). Primary outcomes were self-reported HIV testing uptake and correct status knowledge verified by point-of-care testing. Some secondary outcomes included: depression, HIV-related stigma, and adolescent sexual and reproductive health (SRH) stigma at three time points (baseline [T0], 8 months [T1] and 12 months [T2]). We used generalized estimating equation regression models to estimate crude and adjusted odds ratios comparing arms over time, adjusting for age, gender and baseline imbalances. We assessed study pragmatism across PRECIS-2 dimensions.ResultsWe enrolled 450 participants (50.7% cisgender men, 48.7% cisgender women, 0.7% transgender women; mean age: 20.0, standard deviation: 2.4) across three sites. Self-reported HIV testing uptake increased significantly from T0 to T1 in intervention arms: HIVST arm: (27.6% [n = 43] at T0 vs. 91.2% [n = 135] at T1; HIVST + mHealth: 30.9% [n = 47] at T0 vs. 94.2% [n = 113] at T1]) compared with SOC (35.5% [n = 50] at T0 vs. 24.8% [ = 27] at T1) and remained significantly higher than SOC at T2 (p<0.001). HIV status knowledge in intervention arms (HIVST arm: 100% [n = 121], HIVST + mHealth arm: 97.9% [n = 95]) was significantly higher than SOC (61.5% [n = 59]) at T2. There were modest changes in secondary outcomes in intervention arms, including decreased depression alongside increased HIV-related stigma and adolescent SRH stigma. The trial employed both pragmatic (eligibility criteria, setting, organization, outcome, analysis) and explanatory approaches (recruitment path, flexibility of delivery flexibility, adherence flexibility, follow-up).ConclusionsOffering HIVST is a promising approach to increase HIV testing uptake among urban refugee youth in Kampala. We share lessons learned to inform future youth-focused HIVST trials in urban humanitarian settings.

Project description:BackgroundMalaria risk factors at household level are known to be complex, uncertain, stochastic, nonlinear, and multidimensional. The interplay among these factors, makes targeted interventions, and resource allocation for malaria control challenging. However, few studies have demonstrated malaria's transmission complexity, control, and integrated modelling, with no available evidence on Uganda's refugee settlements. Using the 2018-2019 Uganda's Malaria Indicator Survey (UMIS) data, an alternative Bayesian belief network (BBN) modelling approach was used to analyse, predict, rank and illustrate the conceptual reasoning, and complex causal relationships among the risk factors for malaria infections among children under-five in refugee settlements of Uganda.MethodsIn the UMIS, household level information was obtained using standardized questionnaires, and a total of 675 children under 5 years were tested for malaria. From the dataset, a casefile containing malaria test results, demographic, social-economic and environmental information was created. The casefile was divided into a training (80%, n = 540) and testing (20%, n = 135) datasets. The training dataset was used to develop the BBN model following well established guidelines. The testing dataset was used to evaluate model performance.ResultsModel accuracy was 91.11% with an area under the receiver-operating characteristic curve of 0.95. The model's spherical payoff was 0.91, with the logarithmic, and quadratic losses of 0.36, and 0.16 respectively, indicating a strong predictive, and classification ability of the model. The probability of refugee children testing positive, and negative for malaria was 48.1% and 51.9% respectively. The top ranked malaria risk factors based on the sensitivity analysis included: (1) age of child; (2) roof materials (i.e., thatch roofs); (3) wall materials (i.e., poles with mud and thatch walls); (4) whether children sleep under insecticide-treated nets; 5) type of toilet facility used (i.e., no toilet facility, and pit latrines with slabs); (6) walk time distance to water sources (between 0 and 10 min); (7) drinking water sources (i.e., open water sources, and piped water on premises).ConclusionRanking, rather than the statistical significance of the malaria risk factors, is crucial as an approach to applied research, as it helps stakeholders determine how to allocate resources for targeted malaria interventions within the constraints of limited funding in the refugee settlements.

Project description:IntroductionMany refugees face challenges accessing water, sanitation, and hygiene (WASH) services. However, there is limited literature on WASH access for refugee populations, including for menstrual health services. Unmet WASH access needs may therefore be hidden, amplifying morbidity and mortality risks for already vulnerable refugee populations. The aim of this study was therefore to quantitatively analyze WASH access among refugee camps, with a focus on households with women of reproductive age.MethodsThis was a cross-sectional study that utilized the Standardized WASH Knowledge, Attitude and Practice (KAP) Survey. A total of 5632 household questionnaires were completed by the United Nations Refugee Agency in 2019 in 21 refugee camps and settlements in Bangladesh, Kenya, South Sudan, Uganda, and Zimbabwe. WASH access (14 items) and social and geographic stratifiers were analyzed at the household-level including the refugee camp, country of the settlement, having women of reproductive age, members with disability/elderly status, and household size. We calculated frequencies, odds ratios, and performed bivariate and multivariate analyses to measure inequalities. We developed a Female WASH Access Index to characterize WASH access for households with women of reproductive age.ResultsMost refugee households had high levels of access to improved water (95%), low levels of access to waste disposal facility (64%) and sanitation privacy (63%), and very low access to basic sanitation (30%) and hand hygiene facility (24%). 76% of households with women of reproductive age had access to menstrual health materials. WASH access indicators and the Female WASH Access Index showed large inequalities across social and geographic stratifiers. Households with disabled or elderly members, and fewer members had poorer WASH access. Households with women of reproductive age had lower access to basic sanitation.ConclusionsLarge inequalities in WASH access indicators were identified between refugee sites and across countries, in all metrics. We found high levels of access to improved water across most of the refugee camps and settlements studied. Access to basic hygiene and sanitation, sanitation privacy, waste disposal, and menstrual health materials, could be improved across refugee sites. Households with women of reproductive age, with 4+ members, and without members with disability/elderly status were associated with higher WASH access. The female WASH access index piloted here could be a useful tool to quickly summarize WASH access in households with women of reproductive age.

Dataset Information

Essential newborn care practices and determinants amongst mothers of infants aged 0-6 months in refugee settlements, Adjumani district, west Nile, Uganda.

Publications

Essential newborn care practices and determinants amongst mothers of infants aged 0-6 months in refugee settlements, Adjumani district, west Nile, Uganda.

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