Unsafe Abortion:Health advocates drag Uganda’s Parliament to Court

By Beatrice Nyangoma

Dr. Charles Kiggundu a Senior gynacologist at Mulago National Referral hospital sees atleast 15 women who have undergone unsafe abortion. These are as young as 9 and 15 years and as old as 40 years.

He says that these have various reasons why they decide to terminate pregnancies.

“I have a university student who has been impregnanted five times by her father and she has procured abortion five times. Many girls opt to terminate pregnancies that are as a result of incest and rape.”he says

He says that as much as this girl can afford to have a safe abortion, many of the others use rudimentsry means to terminate pregnancies.

Dr. Kiggundu emphasises that lack of a clear legislation in Uganda has led to many girls and women procuring unsafe abortion most of whom resulting into deaths.

“Unsafe Abortion continues to constitute a serious public health, human rights and social equity issue that affects millions of women in sub – Saharan Africa, and causes 29,000 deaths annually.”he says

“Women of all social standings seek abortion services, but it is mostly young women and poor women who die or suffer long term consequences from unsafe abortion due to the severe socio-economic deprivation they encounter. Providing access to safe abortion is a critical step towards reducing the unacceptably high rates of maternal death in Africa.” Kiggundu notes  

According to World Health Organisation, of the 6.4 million abortions in Africa carried out in 2008, only 3% were safe. One quarter of unsafe abortions occurred among adolescents aged 15-19, and 60% were among women under age 25. Additionally, unsafe abortion accounts for 13% of global maternal deaths and up to 40% of maternal mortality in African countries.  

Meanwhile, Uganda has one of the highest rates of unsafe abortion in Eastern Africa. It is a leading cause of maternal morbidity and mortality in the country, contributing to approximately 26% of the estimated 6,000 maternal deaths every year, and the estimated 40% of admissions for emergency obstetric care. Unsafe abortion places a huge cost on the public health system; approximately Ushs 7.5 billion are spent annually to treat complications.

A national abortion incidence study found that 15 out of every 1,000 Ugandan women of reproductive age were treated for abortion complications in 2003. Poor, rural women are at increased risk of unsafe abortion, 68–75% experienced complications, compared with the 17% complication rate for non-poor urban women.

According to Kiggundu, Uganda’s restrictive abortion laws permits abortion only to save the life of a pregnant woman. However, conflicting and restrictive interpretations of the abortion provisions under the 1995 Constitution of Uganda, the Penal Code Act and National Reproductive Health Policies have created confusion about the correct legal status of abortion.

According to a study conducted by Human Rights Awareness and Promotion Forum- HRAPF between 2011 and 2015, in seven main police station in Kampala, atleast four people were arrested every year in relation to abortion. Linette du Toit, the Research and Advocacy Officer at HRAPF says that nationally 182 arrests were made on abortion charges noting that few of the health workers are arrested.

Its a gainst this background, that  Prof. Ben Twinomujuni a Law don at Makerere University together with Center for Human Rights and Development-CEHURD filed a petitioned seeking that the constitutional court  orders the Executive and Legislative arms of government to pass a law  regulating termination of pregnancies to reduce maternal mortality rates that arise from  unsafe abortions.

The law dons in their petition filed on March 3 2017, contend that the existing legislation only permits abortion in exceptional circumstances such as a life of a mother at risk, but doesn’t protect young girls and married women who may get unwanted pregnancies hence resorting to unsafe abortion methods.

The petitioners argue that other African countries like Kenya, Rwanda, Ethiopia, Ghana and Tunisia, which are similar in social and economic circumstances as Uganda, deliberately developed laws to protect the rights of women by prescribing circumstances under which a woman is allowed to terminate her pregnancy.

“We do not see any reason as to why Uganda should not borrow a leaf from its neighbours and take an essential step to   protect the lives of women who continue dying day by day due to unsafe abortions,” reads part of the petition.

“Because the government has not operationalized Article 22(2) of the 1995 constitution of Uganda as a way of clarifying the parameters for legal abortion, healthcare providers are unable to provide safe and legal abortion services, while law enforcement officials and judicial officers do not effectively enforce or implement laws that permit abortion thus denying women and girls access to safe and legal abortion services.”Twinomujuni notes

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The secret to achieving prevention of mother-to-child HIV transmission at Reach Out Mbuya

By Beatrice Nyangoma

Embracing the community based approach to end mother-to-child HIV transmission.

Mother-to-child HIV transmission, accounts for more than 90% of new childhood infections. But this can be reduced by providing a HIV-positive mother access effective antiretroviral therapy (ART) and support services during pregnancy, delivery, and breastfeeding.

As one of the implementers of prevention of mother-to-child HIV transmission (PMTCT) services Reach Out Mbuya is one of the entities that has provided 1288 ,3464 exposed infants with zero HIV transmission to children. This has been possible by offering mothers with services to prevent transmission of HIV to their babies through sustainable and high-quality programs that if other entities embraced, Uganda would go along way to further reducing mother to child HIV infections.

HIV Testing and Diagnosis:

For mothers who are pregnant, HIV counselling and testing is the first and most critical step in reducing mother-to-child transmission. We have a team of community staff and trained nurses who follow up these mothers and at the time of delivery they are referred to government local health facility. Rom has a team of counselors to offer each mother visiting our supported facilities counseling and testing services.

Prenatal Treatment: ART, when taken throughout pregnancy, delivery and breastfeeding, can reduce the risk of HIV transmission to an infant. Mothers who test HIV-positive during their prenatal visits at ROM supported sites are immediately linked to lifelong ART and counselled on benefits of enrolment and retention on treatment.

Safe Childbirth: Safe childbirth is an important consideration for all expectant mothers and particularly for HIV-positive Mothers. Our mothers are   referred government local health facility

Postnatal Care: Reach Out Mbuya works within maternity and child wellness clinics throughout to offer a variety of integrated postnatal care services. The infants are followed up to 8months then discharged from the programme mothers are encouraged to practice safe infant feeding practices in and outside the context of HIV.

COVID19 Fuels SGBV Cases in Refugee Camp

By Beatrice Nyangoma

There is worry that cases of sexual and gender based violence (SGBV) are on the rise in Kyaka II refugee settlement camp in Kyegegwa district. It has been noted that although generally there has been cases of SGBV, the situation has been worsened by the recent lockdown as a result of the corona virus pandemic.

According to Mr. Muswa Munguoriek, the Local Council one chairman of Itambabiniga village in the refugee settlement, the situation has been worsened by the fact that the allowances to each individual refugee was reduced by 30% since the lock down.

“Every person in the family used to get a monthly allowance of Shs. 31,000 but since the COVID19 lockdown, this amount has been reduced to only Shs. 22,000. This is a very big reduction especially to families with many children. But even with the little, the men after receiving it decide to get other women and abandon the families until this money is finished while others drink it away.” he said.

Muswa also notes that in order to increase their montly allowances, some couples have decided to instead have more children so that they get more money and yet this increases the burden of looking after such huge families.

He also notes that many men are being abused by their female partners but they cannot report for fear of being mocked.

Mwasa revealed this while meeting Action for Development- ACFODE team that was on a fact finding mission on impact of COVID19 on SGBV cases. This is under the project dubbed; “STOP!-Prevention of Sexual and Gender Based Violence in refugee camps and the Neighborhoods in Uganda.” The project is supported by partners EIRENE and uses model couples and community activists to influence positive change against SGBV.

The couples are identified through the village chairpersons and these are also agents of change in communities. The model couples strategy is aimed at setting positive example to the rest of the refugee and the host communities on how to prevent SGBV.

ACFODE also donated an assortment of personal protective equipment to refugees in camp.  The donation is aimed at preventing the spread of corona virus disease among the refugees and the host communities.

The items include hand washing facilities, sanitizers, masks, among others to the village chairpersons and the refugees.

Happy Ainomugisha, the STOP project coordinator said that the situation in the refugee camp requires immediate attention especially in preventing and rehabilitating cases of SGBV.

“The young girls in this camp are likely not to go back to school due to pregnancy since they are not going to school. The cases of SGBV are likely to increase further due to poverty in the homes. We plan to construct a peace hut as part of this project with an objective of having psycho-social support for those who have gone through SGBV.” she said

Benson Natuhwera, the Community Services Assistant in the camp under the Office of the Prime Minister appreciated ACFODE for the work being done in the camp and host communities in a bid to prevent SGBV.

He also said that since there are no gatherings allowed during this time, they have resorted to use of mega phones, boda boda talk-talk and radio talk shows. He however expressed concern over the lack of protective gears for the law enforcers like police officers.

“Sometimes a case of GBV can be reported to police but because the police officers do not have face masks and sanitizers, they may not respond to that case. So we request for support from the partners to have the officers protected so that they respond to these cases.”he said

Additionally, with support from partners EIRENE; ACFODE procured motor cycles for the field staff in a bid to strengthen their capacity to move to communities to create awareness about COVID19 prevention measures and SGBV.

Kyaka II’s refugee population has quadrupled since December 2017, following the arrival of tens of thousands of refugees from DRC fleeing conflict and inter-ethnic violence in North Kivu and Ituri. With more than 113,000 refugees already living in the settlement, Kyaka II will soon reach maximum capacity.

Health workers lack training on snakebite management- survey

At least 92% of health workers in public health facilities have not received any training on management and treatment of snakebites.  This is according to a survey conducted between October 2017 and March 2018 by Coalition for Health and Social Development (HEPS-Uganda) and Health Action International (HAI).

The survey was conducted in 144 public health facilities and shows that 593 snakebites cases were recorded during this period while only 4% of the facilities stock antivenom at the moment.

Anthony Ssebagereka, the HEPS-Uganda Survey Manager while presenting the survey results in Kampala, however, noted that the total number of snakebite cases as well as deaths recorded in Uganda on an annual basis remains unknown as no research has been conducted and 70 percent of the same is estimated to go unreported.

Sophie von Bernus said that globally there are up to 2.7 million envenoming every year which causes 400,000 disabilities and between 81,000–138,000 deaths but up to 70% of the cases go unreported as victims seek treatment from traditional healers.

“Snakebites mostly affect the impoverished rural communities with little access to effective treatment. Antivenom is very costly up to UGX 800,000 per vial and sometimes not effective as it is region and snake-specific,” she said

Jimmy Awany an official from Uganda Wildlife Education Center noted that there is a need for the government to set up a venom milking center to avoid importation as this is very costly and thus limiting access by snakebite victims.

Moses Lyagoba, the Assistant District Health Officer in Kamuli district said that there is a need for training the health workers about snakebite management. He also urged for sensitization of the public on the need to go to health facilities in case they are bitten by snakes.

“Kamuli district in the last financial year purchased anti-venoms worth 10 million shillings but the drugS expired before getting a single victim to treat. The people need to be told about seeking medical treatment in case of a snakebite instead of resorting to traditional healers,” he said

Robinah Kaitiritimba, the Executive Director of Uganda National Health Consumers’ Organization (UNHCO) said that there are wide knowledge gap and myths about snake bites which need to be handled. She said that many people run to traditional healers for treatment instead of seeking medical attention from the health facilities.

Thomas Obua, from Pharmacy Department, MoH said that pharmacy department is committed to working with civil society to ensure that the right antivenom is supplied in areas that are affected. “But for now we are buying anti-venoms from the emergency fund,” he said.

Egumah Pie a Vector Control Officer MoH and liaison person for snakebites noted that the ministry of health needs to develop a working document to guide stakeholders on snakebite management.

He also said that the vector control division will work with the pharmacy department and other stakeholders to ensure that quality antivenoms are procured and distributed to the right areas.

In May 2017 at the World Health  Assembly, snakebites were categorized as category A neglected tropical disease urging member states to prioritize venomous snakebites following.

Adolescent girls to champion HIV/AIDS 90- 90- 90 Targets in Uganda.

Adolescent girls and young mothers have come up to champion efforts of achieving the 90-90-90 strategy. A concept introduced by the United Nation’s programme on HIV/AIDS in 2013, 90-90-90 is a set of goals. The idea is that by 2020, 90% of people who are HIV infected will be diagnosed, 90% of people who are diagnosed will be on antiretroviral treatment and 90% of those who receive antiretrovirals will be virally suppressed. Viral suppression is when a person’s viral load – or the amount of virus in an HIV-positive person’s blood – is reduced to an undetectable level.

The strategy is an attempt to get the HIV epidemic under control and is based on the principal of universal testing and treating. What is central to “test and treat” approaches is that if one can identify people early on in their infection, and start treatment so they become virally suppressed, the onward transmission of HIV will be prevented and this will impact on HIV incidence at a population level.

In a bid to achieve this, president of the Republic of Uganda H.E Yoweri Kaguta Museveni March 2017 launched The Presidential Fast Track Initiative.  And in its report launched  in June year, people get an estimate of 884 get infected with HIV every day in Uganda and  20,000 deaths occurred as a result of the epidemic in 2017 alone.  Also, it is estimated that Uganda has 1,324,685 people living with HIV/AIDS. Unfortunately, 24% of these according to the report were young girls below the age of 19 years.

According to WHO 2015 state of global adolescent health, HIV/AIDS is the leading cause of deaths among young people 10 – 25 years in Sub- Saharan Africa. HIV infection still remains a big burden among young people in Uganda.

The HIV epidemic in Uganda continues to disproportionately affect young women. In 2014, HIV prevalence among young women aged 15-24 in Uganda was estimated at 3.72% and 2.32% for men, reaching the peak of 9.1 % among young women 20-24 years of age. These figures translate into 570 young women 15-24 acquiring HIV every week, according the 2014 UNAIDS data. UNAIDS further reported that 1 in 4 new infections among women aged 15 and 49 years in Uganda occurs in women aged between 15 and 24 years.

It is against this background that with support from HER VOICE FUND, Uganda Youth Health Forum-UYAHF, a youth led organization in partnership with the National AIDS Commissions held an orientation dialogue for adolescent girls and young women and key HIV stakeholder to facilitate dialogue and learning on the National HIV/AIDS and Global Fund Processes.

The Orientation and dialogue meeting organized under the theme: “Putting Adolescent Girls and Young Women at the Center of National efforts to achieving the 90 90 90 HIV targets”, was aimed at mobilizing adolescent girls and young women to enhance their knowledge on the National HIV/AIDS Response, status of the epidemic trends and Global Fund processes at national level, amplify their voices to demand for increased and meaningful adolescent girls participation in policy and programmatic decision making processes with a view of ensuring that National HIV/AIDS and Global Fund processes fully and directly address their specific needs and aspiration.

Carol Atuhaire, a young mother says that it is very important that the girls are involved in spreading the word to their peers about HIV/AIDS.

“I’m excited that I will be among the girls mentoring my peers. I have already been talking to the young girls about the misconceptions about HIV/AIDS, prevention methods and the importance of adherence to drugs for those who are already infected.”she said

Dr. Sabrina Kitaka from department of pediatrics, at Makerere University says that it is important that the young girls speak for the young girls. She also noted that the dialogue was timely as the latest figures on HIV prevalence among young girls are alarming. She noted that many of the young girls are not empowered to say no to sex while others don’t have the right information about the virus.

“We have a crisis in the country and we cannot just burry our heads in the sand as our young girls are dying as a result of HIV/AIDS. We need to support them with information and Sexual Reproductive Health Services.” She said.

Dr. Daniel Byamukama, an HIV/AIDS expert working with Uganda AIDS Commission said that whereas it seems obvious that young people have information about HIV/AIDS, the reverse is true that many of them are ignorant. He says that this could be one of the reasons why they are affected most.

“According to the Uganda Population HIV/AIDS Assessment report, only 45% and 46% of female and males respectively have accurate information about prevention. Whilst the age of sexual debut has been rising in Uganda, condom use remains low while inter-generational sex and trans-generation sex remains prevalent and uptake of HIV testing services and safe male circumcision remain low as well.” he said

Brian Ssensalire an HIV advocate from Uganda Network of Young People Living with HIV-UNYPA, noted that peer to peer model is the best strategy of engaging the young girls living with HIV/AIDS. He also noted that the young girls should be looked at as key stakeholders and should be involved in decision making at all levels instead of engaging them at the time of implementation.

“Young people are comfortable to talk with their peers confidently about matters of sex. But most of our health facilities have old people to attend to the young girls and thus many of them ignore health facilities resulting into wrong decisions.” he said

Whereas prevention remains one of  the major ways of prevention, the country is facing a national wide stock-out of sexual reproductive health commodities especially condoms as a result of donors changing priorities to fund. This means that the youth are not in position to access condoms resulting into risky sexual behaviors like unsafe sex and thus increasing the risks of contracting HIV/AIDS and other STIs. Additionally there is still a lot of stigma and discrimination attributed to adolescent and young people’s condom use for especially by the society siting morals and cultural values.

According to a survey dubbed, “Sexual & Reproductive Health Commodities: Measuring Prices, Availability & Affordability conducted by HEPS Uganda in 2017, Stock-outs of commodities were at 36% of all public health facilities.

However, Kitaka says that the government of Uganda has to up its game and prioritize financing the health sector internally and putting in place functional supportive and and protective laws that protect girls from various form of sexual and gender based violence, stigma, discrimination and other human rights violations.

Syson Namaganda, the National Coordinator of the Country Co-ordination Mechanism for Global Fund-CCM implored the young people to involve themselves in planning, implementation and monitoring the global fund process.

“The currently running three, year global fund grant amounting to about USD 400 million targets improving the health of all Ugandan citizens including; young people and if you are not involved in the process, it means that you will just be at the receiving end. You should be in position to guide the policy makers on the areas that urgently need funding because you know best of your needs.” She said. She also noted that the CCM operates under a board and constituencies and hence young women need to lobby to be represented on the standing committees of each constituencies.

Patrick Mwesigwa, the team leader at UYAHF said that the young girls have been left out in policy programing and decision making processes in regards to National HIV/AIDS Response and Global Fund and other girls centered HIV progams and that this is bound to change.

“We are glad that we are now setting the agenda to empower the young girls to make and amplify their voices on issues that affect their health and well-being especially HIV/AIDS. We are going to support the young women in this country to lobby for girls advisory committees for Ministry of Health, National AIDS Commission, UNFPA and other AIDS service organizations running HIV/AIDS programs that target adolescent girls.

Pre-eclampsia in pregnant mothers leading cause of maternal deaths

Salima Nanfuka, 36, a resident of Bunangwe Zone in Kamuli municipality started feeling dizzy, her face and feet started swelling and she was generally weak when she was five months pregnant. This was unusual from her three previous pregnancies.

“I was not feeling normal at all. But people kept on telling me that this was a sign that I was expecting twins or triplets. I was excited until when I went to hospital and I was told that I was suffering from a condition known as pre-eclampsia as a result of high blood pressure. The doctor told me that I had delayed to go for antenatal care so that the condition would be managed at an early stage of pregnancy.” she says

At seven months, Nanfuka delivered a prematurely, but the baby passed on after two weeks.

“Up to now am not sure what caused the condition. I want to have another child but am afraid my body may swell and lose the baby again.” she says

Lilian Nabalyango, a registered mid wife at Kamuli hospital says that most pregnant mothers delay to go for antenatal care and management of pre-eclampsia is complicated when the pregnancy is in advanced stages.

“Most mothers have no information about the condition as they tend to think that they are bewitched and instead of going to hospitals, they use other alternatives such as local herbs.” She says

A survey conducted by the Coalition for Health Promotion and Social Development-HEPS Uganda in several rural health facilities in Kamuli district revealed that many of them lack capacity to manage mothers with pre-eclampsia.

Nabalyango also notes that the frequent stock out of essential medicines for managing the condition such as magnesium sulphate complicates the situation.

“We receive atleast three mothers suffering from pre-eclampsia on a weekly basis and in most cases we have stock outs of magnesium sulphate which we use to stabilize the mothers. We tell them to buy from private facilities but there are those who are unable to afford so we get stranded.” she adds

Dr. Annette Nakimuli a Pre-eclampsia specialist at Mulago National Referral Hopsital says that the condition is a life-threatening, pregnancy-induced high blood pressure disorder that can lead to seizures or convulsions and other fatal complications in the last half of a pregnancy and postpartum.

She adds that in Uganda, 336 women die from pregnancy and childbirth-related causes per 100,000 live births. Hypertensive disorder during pregnancy, such as preeclampsia and eclampsia is one of the most common causes of maternal deaths after postpartum hemorrhage accounting for 6% of maternal deaths.

“For the mother, complications of preeclampsia and eclampsia cause illness for an extended period of time and are strongly associated with the future development of a range of debilitating non-communicable diseases such as cardiovascular disease, type II diabetes and renal impairment.”she notes

Flavia Nambi an enrolled midwife at Nankandulo HC IV, in Kamuli district says that the health center is facing challenges in managing mothers with the condition. She says that the facility has a non- functional theater ad Blood Pressure machine.

“We receive an average of 30 pregnant women who come for antenatal services on a daily basis and record at least 80 deliveries every month. But sometimes we fail to take their blood pressure because our machine is non-functional. Also those whom we diagnose clinically are referred immediately to Kamuli hospital where there is a functional theatre.”

The referral system of mothers from lower health facilities to the main hospital is also a challenge since there are no ambulances.

Robert Kizito, the Assistant in Charge of Nabirumba HC III says that mothers have to use motor cycles to reach Kamuli hospital. He however notes that sometimes the mothers are stranded especially in the night when they cannot get access to motor cycle riders.

Moses Lyagoba, Kamuli district Assistant District Health Officer in charge of maternal and child health says that most health workers in the district also lack capacity to manage the condition. He says that the knowledge gaps among the medics can lead to wrong diagnosis thus endangering the lives of mothers.

Lyagoba also says that mothers need to be sensitized about the condition so that lives are saved. “Hypertension cannot be self-detected. This means that mothers who report to hospitals late are treated of eclampsia instead of pre-eclampsia which is very deadly.” he says

The situation is not unique to the rural health facilities as records from Mulago National Referral hospital also have almost similar challenges.

Dr.Evelyn Nabunya, the clinical head of the Directorate of Obstetrics and Gynaecology in Mulago hospital says that in 2017, the ward received 520 mothers with severe pre-eclampsia, 132 with eclampsia, 14 Postpartum Eclampsia and 12 maternal deaths. She notes that the frequent stock-out of essential drugs such as Magnesium Sulphate is the biggest challenge the hospital faces in managing mothers with pre-eclampsia.

Denis Kibira the Executive Director at HEPS-Uganda says that the frequent stock outs of essential medicines puts the lives of pregnant mothers at risk.

“Magnesium Sulphate is a must have drug by all health facilities at any time for proper management of mothers with Pre-eclampsia. But this is not the case as in-charges have reported that they never have the drug at the time it is needed most.” he says.

However, with the support from Uganda’s policy makers, there is hope that the situation will be addressed. During a breakfast meeting organised by HEPS-Uganda on 25th May 2018 at Sheraton Hotel, the Speaker of Parliament Rt.Hon. Rebecca Alitwala Kadaga pledged to move the issue to the floor of parliament.

 

Refugees in Uganda deprived of basic services- Report

People living in Uganda’s refugee hosting districts – both people from host communities and refugees – are deprived of basic services like water, sanitation and shelter.

 This is according to a study on Child Poverty and Deprivation in Refugee Hosting Areas  conducted by the Economic Policy Research Center (EPRC), the University of Cardiff and UNICEF, which assessed child poverty, deprivation and social service delivery in refugee and host communities in West Nile, the South West, and Kampala.

“This study represents the first attempt to compare child poverty and deprivation in host and refugee communities in Uganda” said Sarah Ssewanyana, EPRC’s Executive Director. “Globally, it represents the first application of a consensual approach to measuring poverty and deprivation in emergency situations.”

The study also found out that refugee children are more deprived than children from host communities, ranging from 8 per cent to 32 per cent depending on the item.  For example, the report states “refugee children are much less likely to receive gifts on special occasions and less likely to have new sets of clothes than host children.

” For some basic services such as water, sanitation and shelter, recent arrivals are the most deprived. Within five years of residence, however, deprivation rates among refugees are on a par with those of host communities; the reason being that levels of deprivation among host communities are already high.” reads part of the study

“We need to go beyond emergency response to build the systems and capacities of all social services in refugee hosting districts,” said Dr. Doreen Mulenga, UNICEF’s Representative in Uganda.  “Only by doing so – with health, nutrition, education, water, sanitation, and child protection services, among others – will we reduce the multiple deprivations experienced by tens of thousands of refugee children and children in host communities.”

The study recommends expansion of access to basic social services and improve quality and efficiency; improve institutional mechanisms for delivering social services; boost household food security; introduce the accelerated education programme and improving the balance between refugee and host community programming.

Access to SRH Commodities for women still a challenge- Report

Christine Nagasha, (23) a resident of Isingiro district dropped out of school while in senior two after she realized that she was pregnant. The man responsible for her pregnancy, who was also her schoolmate disowned the pregnancy leaving her in a dilemma. Going back home, her parents threw her out of the house asking that she goes to the person responsible for the pregnancy to take care of her.

Nagasha was left homeless with no one to run to so she resorted to sleeping in churches with no food to eat.

“I would move from household to another to get petty jobs, but people were also not paying me while my status was also affecting my health since I was not having regular meals. By the time I was due for labour, I had nothing to use so some midwives abandoned me for other mothers who had the requirements.” she narrates

Nagasha notes that one of the elderly midwives in the hospital identified her struggles and she purchased some items such as a kaveera, cotton wool and some baby clothes.

“After giving birth I stayed in the hospital despite being discharged because I had nowhere to go. After one month, a good samaritan took me on as one of her children and that’s how I survived.” she says

Nagasha notes that she regrets the pregnancy because it frustrated her education and yet the boy who was responsible for the pregnancy continues with schooling.

This case contributes to the statistics where thousands of girls drop out of school because of unwanted pregnancies. From the 24% in the previous surveys, the 2016 Uganda Demographic Health Survey put teenage pregnancy at 25%. Thus a slight increase in a statistic that’s already amongst the highest in sub-Saharan Africa. This means 1 in every 4 girls aged between 15-19 years in Uganda is either pregnant or already having their first baby.

Nagasha wishes she had known about family planning to protect herself from such a situation. “I would like to appeal to government to ensure that the girls are educated about their sexuality and how they can stay in school without pregnancies. The midwives in hospitals should also understand that some girls are abandoned by their parents and relatives and so go into labour without the requirements.” She appeals

Although she is aware of the different Family planning commodities that she can choose from to avoid another unwanted pregnancy, she couldn’t get a long term method from her nearest health facility.

Nagasha shared her story during the women’s day pre-event press conference at Imperial Royale hotel in Kampala. The conference was convened by Health Systems Advocacy project partners which include HEPS-Uganda, ACHEST and Amref Health Africa.

The press conference was aimed at launching a survey report on accessibility, affordability and availability of Sexual Reproductive Health Commodities in 124 public, private and Mission hospitals.

According to Denis Kibira, the Executive Director HEPS-Uganda noted that the survey results indicated frequent stock-outs of SRH commodities especially long term family planing methods were highly demanded but unavailable in the public facilities.

“In general, SRHC availability was inconsistent. Birth control pills were available in only 47% of facilities. Also, contraceptives were generally more commonly available in the public sector than in other sectors: injectable contraceptive, the most commonly used contraceptive in Uganda, was available in 86% of public sector facilities, but only available in 57% private and 25% of mission sector facilities.” he noted

The survey also indicates that stock-outs were quite common in the public sector (12%), and lasted on average almost 20 days per month while in the public sector specific SRH Commodities were stocked-out at up to 36% of all facilities.

“The suboptimal availability of contraceptives makes it difficult to access the commodities, which likely contributes to the about 30% of women in Uganda who were experiencing unmet needs for family planning in 2015.” Kibira noted

The 2016 Uganda Health Demographic Survey-UDHS indicated that maternal mortality has reduced from 438 to 368 deaths per 100,000 live births. However, according to Kibira, the survey indicates rampant stockouts of Magnesium Sulphate, a drug prescribed for pregnant mothers with onset of high blood pressure, also called pre-eclampsia, one of the leading causes of maternal deaths.

He also adds that there is inconsistent availability of other pregnancy drugs such as dexamethasone, used in the management of preterm labour whose availability was also low in the public at 36%, private 55% and mission 43%.

“Oxytocin, used to induce labour and in the prevention and treatment of post-partum haemorrhage, was commonly available in the public sector (90%) but less commonly available in the private and mission sectors. Misoprostol, also used to induce labour, was commonly available in the public sector (88%) but less common in the private and mission sectors (50%and 55% respectively.” he said

Dr. Patrick Kagurusi from Amref Health Uganda said that the government needs to review the budget for SRH services.

“The Ugandan government should increase its budget allocation for the purchase of sexual reproductive health commodities.  Specifically, the Ministry of Finance, Planning and Economic Development (MoFPED) must avert future stock-outs through increased budget allocations for sexual reproductive health commodities to Increase affordability and availability of reproductive health commodities to all persons in the reproductive age group. Measures to avoid delayed financial disbursements that contribute to stock-outs of all commodities must also be considered.” he noted

Paul Gabula of ACHEST notes that the government needs to retain the health workforce such that long term family planning methods can easily be administered to those in need.

The report also indicates that staffing is especially challenging in remote, rural areas, where some facilities have less than 30 percent of positions filled.

“Attracting and retaining skilled health workers continues to be a challenge for the government-led health sector in Uganda; according to the 2015/16 annual sector performance report, only 71 percent of approved positions have been filled.” he said

Why female health workers do not trust their public workplaces with their babies

Sister Carol (not real name) has been working in the paediatric clinic in one of the hospitals in central Uganda.

Carol wants her true identity to stay hidden if she is to talk to me freely, because she is afraid for her job. Before being transferred to the paediatrics department, Carol had been working as a midwife for more than five years at the hospital, starting immediately after her midwifery course.

It is also during this time that she met the love of her life and decided to start a family. Carol took her antenatal care from the same hospital since she was confident of her work colleagues, and trusted the hospital work.

“My husband and I decided to get our services from here, because [we felt] if I was not confident of the system I was serving, then I was not worthy to be called a service provider. We talked about it and decided I would deliver our first child from this hospital. In any case, we had no alternative; we couldn’t afford private services,” she says.

internet photo

When she was eight months pregnant, Carol took her ‘mama kit’ suitcase into the midwives’ room at the hospital, just in case.

“What I did not do was book a doctor who would work on me. Something I regret up to now. I arrived at the hospital in labour on a Wednesday evening and everything happened so fast. One of my colleagues, a nurse was taking her ward rounds when I arrived. My husband was still at work so I was all alone at the hospital,” she remembers.

With the labour pains intensifying, Carol could not get a doctor immediately. Her colleague was trying to call for help too, but in vain.

“Being a midwife, I knew what to do and yes, I started pushing. Since the doctor my colleague had contacted had promised to arrive shortly, I knew it was now upon me to [step in for myself] until the doctor arrived. But he never showed up ‘shortly’; by the time he did, it was too late. The baby was halfway out and it had suffocated because I delayed,” she says, in tears.

Carol says although she had been reading stories of mothers and babies dying due to neglect, it had never occurred to her that she could be a victim.

Lightning strikes twice

“Being a very religious couple, we prayed about it and decided not to blame anyone but to try again,” she notes.

Six months later, Carol conceived again and the couple again chose to deliver at the same facility.

“This time I talked to one of my close colleagues and asked them to be around whenever I would be due. But then, the baby came sooner than we expected, at seven months. It was 2am when I felt labour pains. I thought it was just false pains, so I just walked to the hospital like any expectant mother, to have a checkup,” she says.

“I don’t know how I did not see this coming, yet I had examined so many mothers who would have premature babies. Whereas I would refer such mothers to bigger hospitals, it was too late for me. The baby was coming and my hospital did not have incubators. I looked on; no ambulance to rush me to the next hospital. My husband was upcountry.”

Again, in the hospital where Carol had served with diligence, she lost her baby under avoidable circumstances. She had to undergo a caesarian section birth to remove the dead foetus and save her life.

“The hospital I had served for so long had failed me in my desire to have children. When my husband got the news, it was devastating. We decided not to have any more kids until we were financially stable to foot medical bills in a private facility,” she says.

After losing two babies from a hospital where she has served for more than seven years, ushering thousands of mothers into the family way, Carol lost trust in the services offered by her employer.

“I filed my complaints to the district health monitoring unit and also to the ministry of health. But I only received promises, especially from the district health service commission, of how they were going to investigate the circumstances under which I had lost my babies,” she adds.

At one point, Carol contemplated quitting her job.

“I trusted the system of which I am part, so much. I thought the government was providing good services and the patients were just good at not appreciating. But after my experience, I realized I was wrong and thought of leaving the system completely; how would the patients trust my services after my experience?” she ponders.

Do as I say…

Carol’s story relates to so many female health workers who opt for private health facilities for their own maternal health needs. Dr Sarah Ogobi, the in-charge Luwero Health Center IV, says government should devise a system that allows female health workers to access decent maternity services.

“When I was going to give birth to my second child, I had been posted here as an in-charge for three years. I wondered how I was going to have my child at this health center where I knew I had no access to a gynaecologist. Our ambulance is rarely functional, because of fuel and sometimes it has mechanical issues,” she says.

Ogobi says she could not imagine herself going through what other mothers do when they seek maternal health services from the health center she manages.

“It is terrible! Sometimes you look at a mother and you almost shed tears because you cannot help her even when you badly want too. Sometimes we have no power, no drugs, no referral means and in such situations, the health workers do what is in their power; if God wills and the baby and mother survive, we are happy,” she says.

Ogobi chose to have her baby in Mulago National Referral hospital’s private wing.

Even then, “I had to pay Shs 600,000 for a normal delivery, with no consideration that I was a medical doctor.”

She wants government to expedite health insurance for female health workers, who have to regularly seek expensive reproductive health services that their own points of service cannot give them.

“I had to part with more than half of my miserable pay to have a child. I had to run away from my own health center that I manage, because I was afraid I could have complications that may not be managed.”

Sister Ezeresi Nannyanja, the Deputy Principle Nursing Officer at Nakaseke hospital says apart from the general demands that need to be addressed by the government, there is need to prioritize female health workers.

“I gave birth to all my children at Mengo hospital where I was working then, because I trusted the services. In fact, health workers are not even charged for maternity services at the hospital, something that not only motivates the workers, but also builds trust among other clients, because we use our own services,” she says.

Mengo hospital is a private hospital run by the Church of Uganda. The same cannot be said of many public healthcare facilities, where drugs, essentials and staffing are not readily available.

Nannyanga says the female health workers at Nakaseke hospital prefer to give birth at private health facilities than the district hospital.

“And the reasons are valid; our doctors are never here, especially in the night even when they have staff houses. But we understand that their pay is miserable and therefore they have to find other jobs to fill the financial gap,” she says.

The female health practitioners’ concerns come during a national health workers’ strike, under their umbrella Uganda Medical Association, demanding better pay and better working conditions. The health workers want enhanced allowances for overtime, housing, transport, medical risk, and retention, among other demands.

This article was also published in the Weekly Observer: http://observer.ug/lifestyle/56117-why-female-health-workers-do-not-trust-their-public-workplaces-with-their-babies.html

 

I attempted suicide eight times after testing HIV positive-Beauty Queen

By Beatrice Nyangoma

There is no easy time to any one as a time when one tests HIV/AIDS positive. In fact one of the first thoughts that come to one’s mind is death! One thinks that they are dead or about to die but they are just buying time.

Martha Clara Nakato 21, tried unsuccessfully to commit suicide eight times after she tested HIV positive at the age of 14. Whereas most people go for testing after having unprotected sex, Clara was still a virgin, in fact she tested having accompanied her twin brother who had had several unprotected sexual encounters and felt at risk.

“My twin brother Wasswa asked me to accompany him for an HIV test, at my age I did not find it really important to test because I was still a virgin and I mean I did not have any information on HIV. But you know, as a teenager, I was inquisitive and just wanted to go through what my twin brother was so I took the test that we both at the same time.” she narrates

As the twins waited for the results, Martha was strong because she expected the obvious results, there was no way her results could turn out positive.

“I was instead feeling nervous on behalf of my brother. At that time Wasswa was not even talking to me, he was shivering. He started telling me the girls she had slept with and those he suspects could have infected him in case the results came out positive, I felt pity for him.” she adds

Results coming out, Nakato was found HIV positive instead and her twin brother Wasswa was negative. “I told the nurse that there was a mistake, it’s my brother who is positive and not me. The nurse meant what she was telling me! It was true; I was positive of HIV/AIDS.” she added.

But how did Martha get infected?

“The health facility from which we tested was near our home and our dad was known to most of the facility staff. I requested the nurse to take me home because all I could think about was going to a high way and get knocked by a vehicle, but I wanted my father to know my status first.”

Nakato with the company of her brother and the nurse broke the news to her father. He was however furious at the nurse who made HIV/AIDS tests on her children without his consent and he even threatened to take a legal action against the health facility.

She was instead confused as the only person whom she expected to understand her situation was not helping either. “I mean, I knew nothing about sex, I was still a virgin and am tested positive and the only person who I expected to stand with and support me was instead angry that I knew my status.” she says

That evening, Nakato went to a shop and bought rat poison to end her life because she had no one left to listen to her problems but also she felt  dead anyway.

Nakato was however unsuccessful after she was rushed for medical attention before it would have any impact on her.

Her father would the following day tell her how she was born with the HIV virus and that her mother had died of HIV as opposed to lung cancer like they claimed.

“Growing up we knew that our mother had died of lung cancer but it wasn’t until I tested HIV positive that my father spoke the truth. The doctors were able to prevent the virus from passing on from my mother to my twin brother but it was the case for me because I came two hours later.” she says

Having known how she acquired the virus, Nakato did not want to go through the long term ailment like her mother and so she tried several means of ending her life. From over drinking alcohol, to jumping from buildings to drowning herself in a swimming pool but unsuccessfully.

But how did she reach 14 years without falling sick like many other children born with the virus?

“I happen to come from a well to do family where we had a family doctor who would be there in case of any ailment. So it was very hard to know what I was suffering from because my job was to only take the medicines given to me without knowing what exactly I was taking.”she notes

Her father also told her that she had been taking Septrine since her childhood as one of the medication for the virus.

Nakato’s father later took her to Kamwokya Caring Community where she used to pick her medication. From there she started interacting with the people in her same category and learnt how to move on positively.

However, Nakato recalls that the biggest challenge was at school she would regularly falling sick and would miss classes.

“I told some of my close friends at school about my status and they instead spread the word around the school. Everyone was looking at me as a walking dead person. I felt like leaving school and wait for my day to die since I  had attempted to commit suicide for eight times and I was unsuccessful.”

Nakato was forced to change to a day school because she needed frequent medical attention and she couldn’t handle the stigma at the boarding school.

In 2014, while in senior six, Nakato was introduced to The Aids Support Organization-TASO from where she got a different picture to life.

“I met my age mates who were going through situations that were worse than mine. Some of them had lived  reckless lives but they were positive towards life. They were adherent to the drugs, they studied what the disease they are living with requires and they were making changes in society. I was inspired, and since then I have preached about HIV/AIDS with evidence.” she says beaming with a smile

In her advocacy work, Nakato has met thousands of youth in schools and tertiary institutions to sensitize them on HIV/AIDS.

“I joined music, dance and drama clubs and last year I contested for the Young positives beauty pageant and I was voted as the queen for the central region. This pageant has taken me to places and I have also inspired more young positive girls to look at life differently. I hope to do more work after I complete my bachelors’ course at Kyambogo university.” she adds

Nakato appeals to the government to construct or gazette youth friendly corners in health facilities so that they get the right counseling about HIV.

“I think I attempted suicide because I had no one to talk to me before and after testing. This is a component missing in our health facilities that a 15 year old will wait from the same health Centre reception with a 40 year old and both will be attended by the same person and yet these two age groups have different information needs.” Nakato says

The Uganda Population-Based HIV Impact Assessment (UPHIA) national survey conducted in August 2016 and March this, the prevalence of HIV among adults aged 15 and 64 in Uganda is 6.2%.

The survey also indicates a prevalence of 0.5% prevalence among children aged 0-14 years which is about 95,000 children living with HIV. It also reveals that among the young adults, there is a disparity in HIV prevalence by sex. HIV is almost four times higher among females than males aged 15-24 years.

This article was also published in the weekly Observer: https://observer.ug/lifestyle/56345-i-tried-suicide-eight-times-after-testing-hiv-positive.html

 

Uganda Struggles to Prevent Teenage pregnancies

By Beatrice Nyangoma

Immaculate Akankwasa 19, a resident of Karumere village, Kisoro town council in Kisoro district vividly recalls the day she went to hospital for a pregnancy test and she was found positive. At the age of 14 years, Immaculate had her dreams of being a nurse washed away. She could not be allowed to sit her Primary Level Education examinations and so she moved in with the father of the pregnancy.

“My parents forced the man responsible for the pregnancy to marry me and take care of me. After giving birth, the man asked me to go back to school and that he would be paying for my school fees. But when I reached senior two, he told me that he was tired of paying and he suggested that I sit home as he takes care of me.” she says.

Akankwasa would later get her second pregnancy unexpectedly because she had wanted to quit the marriage because the man had started mistreating her.

“I had started doing petty jobs like washing clothes for people in the village and I was planning to go back to my parents but then I realized I was pregnant again. Two months after giving birth, the man chased me from the house and I was left homeless with two children.” she says

Akankwasa is one of the girls that contribute to the statistics recorded by the Kisoro hospital every month of teenagers carry unwanted pregnancies.

According to Annie Modesta Budongo, the in-charge of the women’s ward at Kisoro hospital, the hospitals records an average of two girls who show up at the facility to get maternity services. She adds that every month the hospital records at least one case of botched abortion.

“We get girls as young as 13 years who come for antenatal services while others come seeking ways of getting the pregnancies terminated.” she says

In the month of July this year, Kisoro hospital recorded 250 deliveries out of which 61 were mothers aged between 10 and 19 years while 50 of a total of 256 deliveries were reported in September.

Francis Munyarubanza, the Kisoro district Education Officer notes that teenage pregnancies have increased the number of girls dropping out of school.

He notes that out of the 11,000 girls that enrolled in primary one in 2010, only 2,234 sat for the Primary Leaving Examinations meaning over 8,000 girls had dropped out.

“We don’t know what to do when it comes to teenage pregnancies. Whereas some girls drop out because of finances, the general picture shows that the highest percentage drop out because of unwanted pregnancies.” he notes

The situation is not unique to Kisoro district as Kabale teenage pregnancy statistics are equally alarming.

According to Mandera Immaculate, the Acting District Health officer, the district recorded 2,264 girls between the age of 10 and 19 out of the 15,278 women who went for antenatal services which is 14.8%.

Mandera notes that 1,637 teenage girls delivered from the public health facilities out of a total of 10,510 mothers which is 15.7%. In the same year 2015/16, 1,461 teenage girls sought for family planning services out of the 18,723 clients registered at health facilities which 7.8%.

Meanwhile the situation is more worrying in districts such as Kamuli as the number of teenage pregnancies continue to raise.

Carolyn Aruho, a Programs Officer for Coalition for Health Promotion and Social Development -HEPS-Uganda notes that many girls are opting for unsafe abortion which risks their lives.

Aruho noted that issues like child marriage and teenage pregnancy are dooming the future of the girls and there is need to join hands to fight this vice.

“7000 girls have attended antenatal in Kamuli District in 2017 which is alarming and  a number of them have had unsafe abortions resulting into death as many of these fear to go health facilities for post-abortion care. We need to speak up on their behalf.”

Contraceptives an option?

On 29^th September, the ministry of health rejected to launch revised guidelines that would see teenage girls access to contraceptives from public health facilities on grounds that the ministry had not made enough consultations with the stakeholders.

Budongo notes that even in the absence of approved guidelines by the ministry, she still gets cases where girls seek emergency pills. She adds that although she issues the contraceptives to them, she fears that she does this putting her job at risk.

“I am human too and a parent. I don’t feel comfortable when I deny such a girl in need contraception to secure her future. But I know the ministry has no policy for that and the only way explanation I can have in defense is that the family planning registration book has provision where we can record the teenagers.” she says

However, Ruzaza Christopher, the health services coordinator at the Diocese of Buhabura notes that the ministry of health officials should not pretend that they do not see what is happening in the country. He notes that the longer the government delays to launch the guidelines the more girls will drop out of school because of unwanted pregnancies.

“Let us put other factors aside and allow the girls who cannot abstain from sex to have access to contraceptives instead of letting them drop out of school. There is nothing as bad as a child growing up knowing that he/she was an unwanted child.” he says

He adds that the health ministry only needs to package the information well so that the girls know the side effects of contraceptives and how they risk getting infected by HIV.

Ruzaza however notes that the government needs to invest more in family planning commodities at health facilities if the policy is going to be effective.

“We already have an unmet need for contraceptives as a nation. This implies that if we are to have that provision for the teenagers, we need to double the supply.” he adds.

Dr. Stephen Nsabiyumva the Kisoro District Health Officer notes that the policy on contraceptives for teenage girls has been delayed. He says that the ministry of health has the mandate to ensure that the girls are not impregnated by provision of youth friendly services including contraception.

“Regardless of religion, culture and morality, we need the contraceptives urgently. We cannot continue looking at our girls dropping out of school and ending up in miserable lives and yet we can do something to prevent this.” he said

However, his education counterpart Runyabuzanza disagrees saying that this is likely to lead to more moral decay among the girls.

“I think we need a comprehensive policy on parenting. Giving girls contraceptives will just worsen the situation. Yes the statistics are alarming but contraceptives are not the solution. Let the ministry look at the other drivers of sexual promiscuity and address them as a whole.” he said

beatricenyangoma@gmail.com