Browsing by Author "Ratib, Dricile"

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    Household income sources and mobility drivers of dietary diversity among refugees with hypertension and/or type 2 diabetes in Bidibidi Settlement, Uganda
    (Elsevier, 2026-04-23) Gyawali, Bishal; Ratib, Dricile; Dræbel, Tania Aase; Nanfuka, Esther Kalule; Nakanjako, Rita; Kyaddondo, David; Raju, Emmanuel; Bygbjerg, Ib Christian; Meyrowitsch, Dan Wolf; Skovdal, Morten
    Background Dietary diversity is a key indicator of food group variety and is widely used as a proxy for nutrient adequacy among individuals living with chronic conditions, such as hypertension (HTN) and type 2 diabetes mellitus (DM). In refugee settings, structural constraints may limit dietary diversity. However, evidence on dietary diversity among refugees already living with HTN and/or DM remains limited. This study aimed to examine the associations between household income sources and cross-border mobility and dietary diversity among refugees with HTN and/or DM in Bidibidi Refugee Settlement, northern Uganda. Methods We conducted a community-based cross-sectional survey between September and December 2024 among 1010 adult refugees with HTN and/or DM, recruited using a chain- referral sampling approach incorporating elements of respondent-driven sampling (RDS). Dietary diversity was assessed by a 24-hour recall and summarized as a dietary diversity score (DDS), calculated by summing the number of different food groups consumed (range 0–9). Household income sources (humanitarian aid, informal income, and formal income) was used as a proxy for socioeconomic status, and cross-border mobility was defined as self-reported return trips to South Sudan. Multivariable linear regression was used to examine associations with DDS, adjusting for potential confounders. Results Participants consumed an average of two food groups in the previous 24 hours (mean DDS 2.0 ± 0.64), indicating very low dietary diversity. In adjusted analyses, greater cross-border mobility was associated with lower dietary diversity. Compared with participants reporting no return trips, DDS was lower among those with one return trip (adjusted β = −0.28; 95% CI: −0.38 to −0.17) and among those with multiple return trips (adjusted β = −0.46; 95% CI: −0.57 to −0.35). Household income source was also associated with dietary diversity. Relative to reliance on humanitarian aid, formal income was associated with higher dietary diversity (adjusted β = 0.25; 95% CI: 0.10 to 0.41), while informal income was associated with lower dietary diversity (adjusted β = −0.10; 95% CI: −0.18 to −0.01). Conclusion Dietary diversity among refugees living with HTN and/or DM in Bidibidi Refugee Settlement was extremely limited and was associated with cross-border mobility and household income sources. These findings suggest that dietary patterns in this setting are shaped primarily by structural constraints affecting food access and livelihood opportunities among displaced populations. However, the cross-sectional design limits causal inference, and the use of unweighted chain-referral sampling limits the generalizability of the findings to the wider refugee population.
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    Prevalence and factors associated with neonatal hypothermia: a cross-sectional study among healthy term neonates in a peri-urban hospital in Northern Ugand
    (Springer Nature, 2025-10-08) Akao, Mary Grace; Nalwadda, Gorrette; Epuitai, Joshua; Ayebare, Elizabeth; Ndeezi, Grace; Ratib, Dricile; Tumwine, James K
    Background Neonatal hypothermia is highly prevalent even in warm tropical countries. Neonatal hypothermia increases the risk of morbidity and mortality. In Uganda, the prevalence of hypothermia is not known among healthy term neonates. Objective To determine the prevalence of neonatal hypothermia and the associated factors in Lira Regional Referral Hospital. Methods Hospital-based cross-sectional study was conducted in Northern Uganda. The interviewer-administered questionnaires and direct observations used to determine the initiation of warm-chain practices after delivery for 271 newborns. The axillary temperature of neonates was measured at intervals of 10 min, 30 min, one hour, and 2 h after birth. The multivariate binary logistic regression was done. The 95% confidence interval (CI) and p-value < 0.05 used to identify factors significantly associated with neonatal hypothermia. Results Neonatal hypothermia was 67.6% during the first two hours postnatal. Neonatal hypothermia was 64.5% at 10 min, 81% at 30 min, 76% at one hour and 49% at two hours postnatal. Hypothermia was significantly associated with low birth weight (Adjusted odds ratio (AOR) = 2.78; 95% CI: 1.01–7.62); male sex (AOR = 1.69; 95% CI: 1.04–3.33), not drying the newborn (AOR = 3.06, 95% CI: 1.64–5.72); no skin to skin contact within five minutes postnatal (AOR = 2.17, 95% CI: 1.15–4.10); and low maternal body temperature (AOR = 2.70, 95% CI: 1.49–4.76). Conclusions The prevalence of neonatal hypothermia was high in the first two hours. Neonates who were more likely to have hypothermia were male, not dried properly, low birth weight, no skin-to-skin contacts, and low maternal body temperature. Proper drying of the newborn and skin-to-skin contact can reduce the burden of neonatal hypothermia. There is a need to train the midwives on proper drying of the newborn, keeping the mother warm, and the importance of skin-to-skin contact in prevention of neonatal hypothermia among male and low birth neonates.
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    Working through community structures: the role of community health workers in cardio- metabolic disease care in Bidibidi, Uganda
    (Bristol University Press, 2026-02-05) Dræbel, Tania Aase; Gyawali, Bishal; Ratib, Dricile; Nakanjako, Rita; Nanfuka, Esther Kalule; Raju, Emmanuel; Kyanddodo, David; Skovdal, Morten
    This chapter examines how community health workers (CHWs) support refugees with diabetes and hypertension in accessing health services and engaging in self- and social care. Despite limited resources, CHWs perform three critical roles: 1. Relational Work: CHWs connect with the community, facilitate communication with healthcare staff, help patients re- engage with services, advocate for patients, and act as intermediaries. 2. Healthcare Work: CHWs monitor and screen for illnesses, refer complex cases, promote health, deliver medication, monitor adherence, and follow up with patients. 3. Community Engagement Work: CHWs assess community conditions, engage in sensitisation, and mobilise efforts. These three types of work are crucial to maintaining the continuity of care for refugees with chronic conditions. Our findings underscore the importance of CHWs and the need to integrate them into the formal healthcare system.