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Item FACTORS AND CHALLENGES ASSOCIATED WITH EXCLUSIVE BREASTFEEDING AMONG WORKING MOTHERS ATTENDING THE YOUNG CHILD CLINIC AT GULU REGIONAL REFERRAL HOSPITAL(Gulu University, 2026) NALINDA CHRISTINEBackground: Exclusive breastfeeding (EBF) remains suboptimal among working mothers despite efforts by WHO and UNICEF to promote it. Balancing employment and childcare may create challenges that limit mothers’ ability to practice EBF. However, limited information exists on the factors and challenges influencing EBF among working mothers attending the Young Child Clinic at Gulu Regional Referral Hospital. This study therefore aimed to determine the prevalence, factors, and challenges influencing EBF among working mothers attending the clinic. Methods: The study was carried out at Gulu Regional Referral Hospital at the Young Child Clinic (YCC). 415 working breastfeeding mothers with infants aged 0-12 months, living in Gulu city and attending Young Child Clinic, were interviewed using a semi-structured questionnaire to get the factors and challenges associated with exclusive breastfeeding. Systematic sampling was used to select the study participants. Data were analysed using robust modified Poisson regression to determine the independent factors and challenges associated with EBF. Results: The mean age of the working breastfeeding mothers was 28 years (SD 5.6), and the mean age of infants was 5.2 months (SD 2.5). 75 (18%) practiced EBF for six completed months. Independent factors associated with EBF at multivariate analysis were; initiating breastfeeding within one month after birth (aPR=0.62, 95% CI=0.47-0.82, P=0.001) and good attitude (aPR=0.75, 95% CI=0.59- 0.94, P=0.011), were positively associated with EBF, while mothers earning less than 500,000UGX, (aPR=1.2, 95%CI=1.05-1.59, P=0.016) and mothers who reported that breastfeeding made working difficult (aPR=2.15, 95% CI=1.31–3.51, P=0.002) were negatively associated with EBF. Reported challenges were insufficient breast milk, problems with the nipples and breasts, not being well, lack of support from their spouses and limited time for breastfeeding. Conclusion: The practice of EBF among working mothers attending Young Child Clinic at Gulu RRH is still very low. Significant factors associated with exclusive breastfeeding included maternal monthly income, initiation of breastfeeding within the first hour after delivery, maternal attitude towards exclusive breastfeeding, and difficulties experienced with breastfeeding due to work. . These findings highlight the need for supportive maternity and workplace breastfeeding policies, targeted breastfeeding education, and livelihood support for postpartum mothers to address barriers to exclusive breastfeeding among working mothers in attending YCC at GRRHItem PREVALENCE AND FACTORS ASSOCIATED WITH UNINTENDED PREGNANCY AMONG WOMEN ATTENDING ANTENATAL CARE AT GULU REGIONAL REFERRAL HOSPITAL, NORTHERN UGANDA(Gulu University, 2026) NAKYEYUNE LILLIAN MONICABackground: Unintended pregnancy contributes to adverse maternal, neonatal, psychosocial, and socioeconomic outcomes. Evidence among the general population of women attending antenatal care in northern Uganda remains limited. Objective: To assess the prevalence and factors associated with unintended pregnancy among women receiving antenatal care (ANC) at Gulu Regional Referral Hospital, Northern Uganda. Methods: A facility-based cross-sectional study was conducted among 414 pregnant women attending antenatal care at Gulu Regional Referral Hospital from 1st April to 25th May 2025. Participants were selected through systematic random sampling, and trained midwife research assistants administered a structured questionnaire. Modified Poisson regression with robust variance estimation was used to estimate crude and adjusted prevalence ratios with 95% confidence intervals. Statistical significance was considered at p < 0.05. Results: Among 414 participants, the median age was 24 years (IQR: 21-29). The prevalence of unintended pregnancy was 40.1% (166/414; 95% CI: 35.4%-44.9%). After adjustment, women who attended antenatal care without their partners were 1.6 times more likely to have unintended pregnancy than their counterparts (aPR = 1.6; 95% CI: 1.03–2.53; p = 0.035). No other variable showed a statistically significant adjusted association. No measured variable demonstrated clear independent statistical evidence of association in the adjusted analysis. Conclusions: Two in five women attending antenatal care reported an unintended pregnancy. Attendance without a partner was associated with a higher prevalence of unintended pregnancy after adjustment for measured factors. Antenatal and family planning services should assess pregnancy intention and provide woman-centred counselling, with partner involvement guided by each woman’s preference. Further research should examine the relationship and contextual factors underlying unintended pregnancy.Item DEFAULT RATES, ASSOCIATED FACTORS, AND HEALTH WORKER PERCEPTIONS AMONG CHILDREN AGED 6–59 MONTHS IN OUTPATIENT THERAPEUTIC CARE FOR SEVERE ACUTE MALNUTRITION AT GULU REGIONAL REFERRAL HOSPITAL, UGANDA(Gulu University, 2025) KAMULEGEYA DAVID PETERSONBackground: Outpatient Therapeutic Care (OTC) programs are critical for managing uncomplicated severe acute malnutrition (SAM) in children. However, high treatment default rates undermine recovery, particularly in Northern Uganda, where evidence on contributing factors and frontline worker perspectives/experiences remains limited. Objective: To determine the default rates and factors associated with treatment default among children aged 6–59 months enrolled in OTC at Gulu Regional Referral Hospital (GRRH), and to explore health worker experiences and perceptions with the program. Methods: A sequential explanatory mixed-methods design was used. The quantitative phase involved retrospective chart review of 411 child records from the OTC program at GRRH (July 2022–June 2024). Data were extracted from the integrated nutrition register and analysed in STATA 17 using descriptive statistics, bivariate tests, and multivariable logistic regression. The qualitative phase used a phenomenological approach. Semi-structured in-depth interviews were conducted with nine purposively selected health workers. Transcripts were thematically analysed until saturation was reached. Results: Among 411 children, 57.2% were male, 66.2% were under 24 months, over half weighed <7 kg, and 67.6% had non-edematous SAM. The treatment default rate was 24.8%. Bivariate analysis showed significant associations between default and HIV status (p = 0.01), lower admission weight (p = 0.02), and weight <7 kg (p = 0.03), but no variable remained significant in multivariable analysis. Qualitative analysis revealed six thematic domains: program organization, causes of default, consequences, prevention strategies, systemic challenges, and programmatic recommendations. Key causes of default included transport barriers, RUTF stockouts, , staff absenteeism, seasonal agricultural demands, caregiver misinformation, misconceptions, and negligence, caregiver-level challenges (e.g., Domestic violence, family separation, poverty, inadequate social support, and cultural beliefs), and child-level comorbidities (e.g., HIV, TB, cerebral palsy). Conclusion: Outpatient therapeutic care treatment default at GRRH is high and influenced by structural, clinical, and caregiver-related barriers. While no factors were statistically associated with default, qualitative findings highlight the need for decentralization, consistent supplies, and strengthened caregiver support to improve adherence and recovery in OTC.Item PREVALENCE AND FACTORS ASSOCIATED WITH HIV VIRAL LOAD SUPPRESSION AND QUALITY OF LIFE AMONG ADOLESCENTS WITH HIV AND ON ART CARE IN KITGUM DISTRICT, NORTHERN UGANDA(Gulu University, 2026-09-29) Okidi, PaulBackground In Uganda, HIV RNA viral load suppression among adolescents living with HIV remains below the 95% global target, ranging from 68.6% to 81%. Achieving and maintaining viral load suppression is essential for optimal health outcomes and may also contribute to better quality of life (QOL) by reducing HIV-related morbidity and supporting physical, psychological, and social well-being. However, adolescents living with HIV continue to experience challenges that may compromise both treatment outcomes and QOL. Previous studies have reported relatively higher QOL scores in the social and psychosocial domains (71.6%–82.4%), with lower scores in the physical and environmental domains. This study therefore determined the prevalence of HIV RNA viral load suppression and associated factors and assessed QOL among adolescents with HIV in Kitgum District, Northern Uganda. Methods: We conducted a cross-sectional analytical study between October 2025 and March 2026 among adolescents aged 10–19 years who had received ART for at least one year and had a written HIV RNA viral load result. Sociodemographic and psychosocial data were collected using interviewer-administered questionnaires, while clinical information was extracted from patients' medical records. Viral load suppression was defined as an HIV RNA viral load <1,000 copies/mL. Descriptive statistics summarized participant characteristics and the prevalence of viral load suppression. Factors associated with viral load suppression were assessed using modified Poisson regression with robust variance estimation to obtain adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI). Significance of the statistical tests was considered at p<0.05, and quality of life was assessed using Stata version 16. Results: A total of 261 adolescents were enrolled; 137 (52.5%) were female, 146 (55.9%) were aged 15–19 years, with 15 years as a median age (IQR: 13–17). Overall, 190 adolescents achieved HIV viral load suppression, corresponding to a prevalence of 72.8% (95% CI: 66.9%–78.1%). After adjustment for potential confounders, the prevalence of suppressed viral load was 29% higher among adolescents with a CD4+ T-cell count ≥500 cells/mm³ as compared to those with CD4+ T-cell counts <500 cells/mm³ (aPR=1.29, 95% CI: 1.07–1.54; p=0.003). Conversely, adolescents who had experienced ART interruption had a 27% lower prevalence of viral load suppression than those with no history of treatment interruption (aPR=0.73, 95% CI: 0.57–0.92; p=0.008). Overall, 132 (75.43%) adolescents on ART had a moderate quality of life scores; highest score of 72% (IQR: 64%-76% in the physical domain and the lowest score of 67% (IQR: 60%- 74%) in the environmental domain. Conclusions: Viral load suppression among adolescents on ART was suboptimal, with approximately three-quarters achieving suppression. Higher CD4+ T-cell counts were associated with greater viral load suppression, while ART interruption was associated with lower suppression. Most adolescents reported a moderate quality of life, with the environmental domain recording the lowest scores. These findings underscore the importance of interventions that promote uninterrupted ART and address broader factors affecting adolescents’ quality of life.Item PREVALENCE AND FACTORS ASSOCIATED WITH ACUTE WATERY DIARRHOEA IN CHILDREN AGED UNDER-FIVE YEARS WITH SEVERE MALNUTRITION AT GULU REGIONAL REFERRAL HOSPITAL, GULU CITY, UGANDA.(Gulu University, 2026-10-06) SSEMWOGERERE TADEOBackground: Diarrhoea remains a leading cause of death among children under five years, and the risk is highest in children with severe acute malnutrition (SAM). This study determined the prevalence of acute watery diarrhoea (AWD) and its associated factors, and the prevalence of dehydration and shock, among children under five years with SAM at Gulu Regional Referral Hospital (GRRH), Uganda. Methods: A hospital-based cross-sectional study was conducted among 425 children under five years admitted with SAM at GRRH between July and September 2025. Every second eligible child was selected by systematic random sampling. Data were collected from caregivers using an interviewer-administered questionnaire, and dehydration was assessed at recruitment by a trained nutritionist. AWD was defined as three or more loose or watery stools in 24 hours on any day in the two weeks before the interview. Data were analysed using Stata version 18. Modified Poisson regression with robust standard errors was used to estimate crude and adjusted prevalence ratios (aPR). Variables with p<0.20 at bivariable analysis, together with child age, sex and maternal age, were entered into the multivariable model, and p<0.05 was considered statistically significant. Results: The median age of the children was 15 months (IQR: 8–25) and 52.5% (n=223) were female. The prevalence of AWD was 45.6% (95% CI: 40.9–50.4). Use of wells as the main source of drinking water (aPR: 1.31, 95% CI: 1.01–1.70) and caregiver-reported immunisation (aPR: 1.62, 95% CI: 1.03–2.54) were independently associated with AWD. Maternal education was associated with AWD at bivariable analysis but not after adjustment (p=0.063). Dehydration was present in 13.2% (95% CI: 9.9–16.4) of all children and in 28.4% of those with AWD; moderate dehydration was the most common grade (44.6%). Shock was not recorded separately from dehydration, so its prevalence could not be estimated. Conclusions: Nearly half of the children admitted with SAM had AWD and about one in eight was dehydrated. Drinking water from wells was the main modifiable factor associated with AWD. Every child with SAM should be screened for recent diarrhoea, dehydration and shock at admission, and household water safety should be part of caregiver counselling. The positive association with immunisation most likely reflects care-seeking behaviour and selection into the hospital sample rather than an effect of vaccines.Item FACTORS ASSOCIATED WITH HIV RNA VIRAL NON-SUPPRESSION AMONG CHILDREN AND ADOLESCENTS LIVING WITH HIV ATTENDING PUBLIC HEALTH FACILITIES IN GULU CITY, UGANDA(Gulu University, 2024-05-20) Lanyero VentrinaBackground: Viral load testing is the gold standard for anti-retroviral therapy (ART) monitoring. Achieving viral suppression is central to abating HIV complication. Evidence suggests that children and adolescents with HIV (CAWH) have much lower viral load suppression rates. However, data on the incidence of viral load non-suppression and its associated factors among CAWH in Northern Uganda is scarce. Objective: To assess the factors associated with HIV RNA viral load non-suppression among CAWH in Gulu city, Uganda. Methods: A retrospective cohort study, utilizing a data abstraction tool to collect information on HIV RNA viral load non suppression at 6, 12, 18, 24 months and at the latest follow-up among 218 CAWH at public facilities in Gulu city. Bivariate and multivariate Cox proportional hazards models were used to identify the factors associated with viral load non suppression. Hazard ratio with 95% CI and p-value were used to assess the strength and statistical significance of association. Results: The median age of the 218 participants was 12.5 (IQR: 7-18) years and majority (70.2%, n=153) were female. A total of 99 (45.4%) had viral load non-suppression during the follow-up period. The overall incidence rate of HIV viral load non suppression was 10.3 cases per 100 person-years and the median time to viral load non-suppression was 0.49 years. Age<5 years [Adjusted Hazard Ratio (aHR)]:2.59; 95% CI: 1.30-5.17), poor adherence to ART (aHR:1.96; 95% CI: 1.21-3.17), non-disclosure (aHR:2.19; 95% CI: 1.27-3.80), late WHO clinical stage (Stage III and IV) (aHR:3.07; 95% CI: 1.41-6.69), and having economic challenges (aHR:2.13; 95% CI: 1.32-3.42) were significantly associated with viral non suppression. Conclusion: HIV viral load non suppression among CAWH was high. The time to non-viral load suppression after ART initiation was 6months. Age less than five years, poor adherence to ART, non-disclosure of HIV status, advanced WHO clinical stage, and having economic challenges were associated with viral non suppression. There is need for continuous adherence monitoring and economic empowerment of caregivers of CAWH, with more attention given to children under five years. Keywords: HIV, ART, Viral load, Non-suppression, Children and Adolescents, UgandaItem Prevalence, types of injuries sustained and factors associated with boda-boda accidents in Gulu city(Gulu University, 2026-10-27) Banya AnthonyIntroduction: Motorcycle related injuries are a significant global public health problem, particularly in developing countries. Despite their widespread use in urban areas of Uganda, there is limited information on motorcycle safety, accident prevalence and factors associated with boda-boda accidents. This study aimed to identify the burden of boda-boda accidents and factors that can be modified to prevent accidents in Gulu City. Methodology: A cross-sectional study design was used in this study, with structured questionnaires administered to collect data from 422 study participants. The participants were enrolled using a systematic sampling technique to participate in the study. Primary outcome variable was a self-reported involvement in boda-boda accident in the past. Bivariate and multivariate modified Poisson regression analyses were performed using Stata version 16, factors with p-vale < 0.2 transferred for multivariable analysis. Lifetime history of accident at 95% confidence interval with P < 0.05 was considered statistically significant. Results: We found life time prevalence of boda-boda accident in Gulu City was 60.4%; Accident in the past 1 year was at 23.9%. At multivariable analysis, younger and active age group 20-29, 30-39 (aPR=1.68; p=0.002) and (aPR=2.19; p=0.000) respectively), carrying more than one passenger (aPR =1.77; p=0.001), high speed aPR=0.58; P< 0.001 and higher alcohol AUDIT scores (aPR =1.29; P=0.002) were significantly associated with increased risk of boda-boda accident. Bruises (64%) cut wounds (25%) and fractured bone (11%) were the types of injuries sustained following boda-boda accident. The accidents involved the upper limb (38.2%), lower limb (29.3%), head (26.9%), chest (4.7%) and abdomen (0.4 %). Conclusion: both the life time and the recent accident’s prevalence by boda-boda cyclists (60.4% and 23.9% respectively) were high. At multivariable analyses, socio-economically active, younger ages, high speed, carrying more than one passenger and higher alcohol AUDIT scores were significantly associated with boda-boda accident. Recommendations: A regular road safety training program especially to the socio-economically active and younger cyclists; police authority be strengthened to enforce road traffic policies that inhibit high speed, alcohol use or carrying more passengers while cycling; the city authority to improve on road infrastructure, helmet rider jacket use be encouraged and further research be conducted to minimize boda-boda accidents.Item PREVALENCE AND ASSOCIATED FACTORS OF MALNUTRITION AMONG SCHOOL CHILDREN IN MOROTO DISTRICT, KARAMOJA SUB-REGION, NORTHERN UGANDA(Gulu University, 2026-10-27) Edimu David MarkBackground: Malnutrition continues to pose a significant public health burden among primary school-aged children, leading to both physical and cognitive impairments. Affected children often experience weakened immunity and frequent absenteeism from school, limiting their academic performance and development potential. Objective: This study sought to determine the prevalence and associated determinants of malnutrition among primary school pupils in Moroto District, Eastern Uganda. Methods: A cross-sectional study design was employed using a multistage random sampling approach. Anthropometric measurements were taken, and structured questionnaires were administered for data collection. Data was cleaned and entered in Microsoft Excel before analysis using SPSS version 22 and WHO AnthroPlus version 1.0.4. Descriptive statistics were used to summarize participants’ characteristics and feeding practices. Chi-square tests were used to assess associations between malnutrition and predictor variables, while Poisson regression was used to identify independent predictors, reported as adjusted prevalence ratios (aPRs) with 95% confidence intervals. Statistical significance was set at p < 0.05. Results: Among the 388 primary school children aged 8–17 years included in the study, 58 (15.1%; 95% CI: 11.8–19.0%) were stunted, including 21 (5.5%; 95% CI: 3.6–8.2%) who were severely stunted. Thinness was observed in 64 (16.5%; 95% CI: 13.1–20.5%) children, including 10 (2.6%; 95% CI: 1.4–4.7%) with severe thinness. Overweight and obesity were observed in 20 (5.2%; 95% CI: 3.4–7.8%) and 2 (0.5%; 95% CI: 0.1–1.9%) children, respectively. In multivariable analysis, higher family meal frequency was independently associated with stunting (aPR = 1.325, 95% CI: 1.010–1.739; p = .042). Having a greater number of children under five years in the household was independently associated with thinness (aPR = 1.300, 95% CI: 1.007–1.678; p = .044), while reported reduction in the number of meals was inversely associated with thinness (aPR = 0.435, 95% CI: 0.223–0.849; p = .015). Conclusion: Malnutrition remains highly prevalent among school-going children in Moroto District. Age and female gender emerged as significant correlates of stunting and wasting. Targeted, gender-sensitive nutrition interventions and community-based programs are crucial to reduce these alarming rates and enhance child health and educational outcomes.Item Prevalence and Factors associated with fever related school absenteeism among school going children in Abim district North Eastern Uganda(Gulu university, 2026) oyugi franciscoBackground: Fever-related school absenteeism remain a major a public health challenge globally affecting school going children worldwide. Evidence on school absenteeism largely focuses on malaria, with limited evidence on the prevalence and determinants of fever-related school absenteeism in rural North-Eastern Uganda. This study therefore aimed to determine the prevalence and factors associated with fever-related school absenteeism among school going children in Abim district, North Eastern Uganda. Methods: A school-based cross-sectional study was conducted among 355 school going children aged 10-17 years in upper primary (P.5-P.7) in 5 selected primary schools in Abim district “between March and April 2025”. Data was collected using semi- structured questionnaires in English or Leb-thur. Participants were selected through stratified random sampling. Information on socio-demographic characteristic was collected. Descriptive statistics and modified Poisson regression analyses was performed using STATA 18.0. Association between independent variables and fever related school absenteeism was reported as adjusted prevalence ratio with corresponding Confidence interval and p<0.05 considered statically significant Results: A total of 355 participants with a mean age of 14 (SD 1.5) years were enrolled. More than half of participants were males (56%, n=199) and most of the learners 39% (n=136) were in P.5. Majority of the participants, 60.56% (n=215) missed school due to fever. Factors independently associated with fever-related school absenteeism were being in primary seven (aPR: 1.33, 95% CI=1.07-1.66, p=0.009), and learners who reported to their parents first whenever they had fever (aPR: 1.49, 95% CI=1.25-1.78, p= <0.001) whereas learners who have access to clean and safe drinking water at school were 0.79 times less likely to missed school due to fever (aPR: 0.79, 95% CI=0.62-0.99, p=0.048). Conclusion: Fever-related school absenteeism was common among learners in Abim District, highlighting fever as an important barrier to regular school attendance. Absenteeism was associated with learners’ class level, who they informed first when they had fever, and access to clean and safe drinking water at school. Schools and stakeholders should strengthen health education, access to safe water drinking water at school, and parental involvement in the timely management of fever. Strengthening school health monitoring and data quality can enhance planning, timely interventions and help reduce fever-related school absenteeismItem Human Immunodeficiency Virus Pre-Exposure Prophylaxis adherence, retention and associated factors among users at Kitgum General Hospital, Northern Uganda(Gulu University, 2026) Akanyo JoyceIntroduction: Pre-exposure prophylaxis (PrEP) prevents HIV infection when taken consistently by individuals at high risk but adherence and long-term retention remain a major challenge, in resource-limited settings like Northern Uganda where retention rates remain suboptimal, jeopardizing the effectiveness of this prevention strategy. Objectives: To determine PrEP retention rates, identify factors associated with dropout from PrEP use, and explore barriers and facilitators to adherence and retention among PrEP users at Kitgum General Hospital Methods: A mixed-methods study was used, combining retrospective cohort design and qualitative in-depth interviews. Quantitative data were extracted from medical records to assess retention rates at 1, 3, and 6 months and to identify factors associated with drop out and analysed using survival analysis. Qualitative interviews explored personal experiences, barriers, and facilitators influencing adherence and retention and analyzed thematically. Results: A total of 1,102 PrEP user records were reviewed, with a mean age of 28.1± 8.6 years; mostly males (n = 610, 55.3%), and 78.8% resided in urban areas. PrEP retention declined from 81.2% (n=895) at 1 month to 45.0% (n=496) at 3 months and 24.2% (n=267) at 6 months. Factors independently associated with dropout included younger age (aHR = 0.98, 95% CI: 0.98–0.99, p < 0.001), primary education (aHR = 0.74, 95% CI: 0.62–0.89, p = 0.001), longer distance to the facility (aHR = 1.01, 95% CI: 1.00–1.01, p = 0.017), facility-based entry (aHR = 2.55, 95% CI: 2.18–2.97, p < 0.001), and priority population status (aHR = 1.26, 95% CI: 1.06–1.51, p = 0.010).. Key barriers to adherence and retention included stigma, fear of disclosure, side effects, misconceptions, pill burden and treatment fatigue, low perceived risk and service gaps, while facilitators included awareness, motivation to protect self and partner, negative HIV test results, acceptability and availability of PrEP, integration, adherence strategies, peer support, and positive healthcare experiences. Conclusion: Overall, PrEP retention at Kitgum General Hospital was low, highlighting the need to address stigma, structural barriers, and improve community support and service integrationItem ACCEPTABILTY OF HIV PRE- EXPOSURE PROPHYLAXIS, ASSOCIATED FACTORS, AND EXPERIENCES AMONG HIV NEGATIVE FEMALE SEX WORKERS IN GULU CITY, NORTHERN UGANDA: A MIXED-METHOD STUDY(Gulu University, 2026) Alwedo ImmaculateBackground: Female sex workers (FSWs) are at heightened risk of HIV infection due to their structural, economical and socio-cultural vulnerabilities. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool however; its acceptability varies across settings. This study aimed to assess the acceptability and identify factors associated with PrEP among HIV-negative FSWs in Gulu City, Northern Uganda. Methods: A concurrent mixed-method study was conducted among 301 HIV-negative FSWs aged 18 years and above in Gulu City, Northern Uganda. Participants were purposively sampled and interviewed using a structured questionnaire. Quantitative data were analyzed using multivariable logistic regression to determine Adjusted Odds Ratios (AORs), 95% confidence intervals (CIs), and statistical significance at P < 0.05. Additionally, in-depth qualitative interviews were conducted with a purposive sub-sample of nine participants to explore attitudes, beliefs, and experiences regarding PrEP use. Thematic analysis was used to interpret qualitative data, complementing quantitative findings. Results: Of 301 participants, most were predominantly aged 25–34 years 48.2 %( n=145) with primary 47.5% (n=143) or secondary education 40.5% (n=122) and 66.5% (n=200) reporting no employment outside sex work. Condom use was inconsistent, with 63.8% (n=192) sometimes using condoms and 18.3% (n=55) never using them. Majority 81.4% (n=245) accepted to use PrEP when availed to them. Higher education (primary: AOR=3.63, 95% CI: 1.29–10.19; secondary: AOR=8.23, 95% CI: 2.64–25.69; tertiary: AOR=6.43, 95% CI: 1.03–40.06), monthly income UGX 100,001–500,000 (AOR=2.42, 95% CI: 1.26–4.65), and sometimes using condoms (AOR=2.37, 95% CI: 1.00–5.59) remained independently associated with PrEP acceptability while age, marital status, living arrangement, and never using condoms were not. Awareness of PrEP was also a key determinant, with 96.3% (n=236) of acceptors aware of it compared to 3.7% (n=9) among non-acceptors. Qualitative findings highlighted that perceived HIV risk, peer influence, convenience, and cultural beliefs shaped attitudes toward PrEP use. Conclusion: PrEP acceptability among HIV negative FSWs in Gulu City is high and strongly influenced by education, income, and sexual risk behaviors. To improve PrEP acceptability; programs should expand PrEP modality options and interventions targeting lower-educated FSWs, address economic and behavioral barriers, and leverage peer networks to enhance PrEP uptake. These findings underscore the need for integrated and responsive HIV prevention interventions targeting FSWs in urban Uganda.Item PREVALENCE AND FACTORS ASSOCIATED WITH EMERGENCY CONTRACEPTIVE USE AMONG FEMALE STUDENTS OF GULU UNIVERSITY.(Gulu University, 2025-11-17) Mukembo RobertEmergency Contraceptive (EC) use after unprotected and unplanned sexual intercourse is critical, especially in active sexually reproductive populations like university students. This prevents unwanted pregnancies and associated abortions hence improved maternal health outcomes. This study investigated the prevalence and factors associated with emergency contraceptive use among female students of Gulu University. Methodology. This was a cross-sectional study involving female students, aged 18-49 years, at Gulu University from November 2023 to February 2024. Stratified random sampling was used to select 415 participants from different faculties and years of study. Self-administered questionnaires collected data on socio-demographic, health system &reproductive factors and individual factors on EC use. The collected data were processed and analysed using computer based statistical software Programs, STATA 18. Categorical variables were summarized using frequencies and percentages. Numerical data were summarized using mean and standard deviation, depending on the normality of the data. The results were presented in tables, graphs. Bivariate analysis was performed to determine each of explanatory variables with outcome variable (utilization) and variables with p<0.2 during bivariate analysis were entered to multivariable analysis. Poisson regression tests was used to identify the association between the use of emergency contraception and the predictor variables because the prevalence of the outcome was greater than 10%. P-value less than 0.05 at 95% CI was taken as statistically significant. Results A total of 415 participants with mean age + SD (24.54 ±4.80) and mostly third years (36.1%) were interviewed. There was a low utilization of EC, 41.9% (n=174). The key determinats of EC use were being in third year of study and previous use of regular contraceptives (aPR = 0.81, p = 0.009, 95% CI = 0.69-0.94) and (aPR = 1.23, p < 0.001, 95% CI = 1.11-1.37) respectively. Participants had good knowledge and positive attitudes towards EC with sexual partners 30.9% and female friends, 22.2% being the main sources of information on EC. Conclusion. Overall, this study found a low level of Emergency Contraceptive use. Year of study and previous use of regular contraceptives were strongly associated with EC use. Targeted interventions, tailored to students year of study are needed to improve awareness and uptake of emergency contraception.Item Prevalence of home births and associated factors A Cross sectional study in Paicho Sub County, Gulu District, Northern Uganda(Gulu University, 2026-10) Lalweny DorahBackground 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.Item 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 BrownBackground: 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.Item 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 PATRICKBackground: 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 transmissionItem 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 JimmyBackground: 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.