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Item Determinants of wasting among children aged 6-59 months in Palabek refugee settlement Lamwo district Uganda(Muni University, 2025-11-21) Yumati, AlfredBackground Millions of young children under-five years are in jeopardy due to wasting as it stands at 6.6% globally Feckan (2011) and 75% of these live in lower middle-income countries. WHO (2017). With East Africa at 5.2% Hossain et al., (2022) and Uganda at 2.6% UBOS (2023). Palabek refugee settlement has experienced a repeated surge in wasting more than 5% WHO threshold in the past three years notably 9.7% in 2021, 7.7% in 2022 and highest of all the refugee settlements at 13.9% in 2023(IPC 2023). Despite interventions determinants of wasting in Palabek is little known about and explored. These study aimed to identify determinants of child wasting and provide recommendations to inform policy and programing. Methodology A mixed method cross-sectional study design was used where data was collected, cleaned and analyzed quantitatively and qualitatively. A simple systematic random sampling strategy was used to select study households after obtaining list of households with children aged 6-59m from village health team (VHT) members. In the quantitative analysis, modified Poisson regression was used to get the explanatory variables which explained Wasting. In the qualitative method 5 FGD interviews were conducted to get the insights of the community about nutrition programs. Result Prevalence of wasting among children was 9.1% and associated factors such as late start of complementary feeding, healthcare access point >5 km, child’s age, more than two children under five years in single household were key in explaining wasting status of children, the community expressed challenges such as environmental shocks, economic shocks and negative cultural beliefs as determinants of wasting although perception on nutrition program is positive. Conclusion It is this combination of biological, behavioral, economic and geographic elements that risked children in a cycle of infection and undernutrition, shaping how severe wasting is endangering lives, these findings call for a comprehensive, integrated approach in response, inclusive of addressing cultural perceptions on child wasting while considering efforts to restore family livelihood, access to healthcare and community socio behaviour change communication strategies.Item Understanding the reasons for delayed antenatal care initiation among pregnant women in Adumi HC IV Ayivu west division, Arua city: a qualitative phenomenological study(Muni University, 2025-11-25) Dramile, DanielBackground: Timely initiation of antenatal care (ANC) within the first trimester is a cornerstone of improving maternal and neonatal health outcomes. Despite its established benefits and being a key target of the Ugandan Ministry of Health and world health organization (WHO,) a significant proportion of pregnant women in Uganda, particularly in the West Nile sub-region initiate ANC late. At Adumi Health Center IV in Arua City, 71.8% of pregnant women begin care after 12 weeks of gestation, hence hindering early risk detection and management. The specific reasons for this persistent delay in this local context remained unclear, thus necessitating this investigation. Methods: This qualitative phenomenological study was conducted at Adumi HC IV, Ayivu West Division, and Arua City. Data were collected through 20 in-depth interviews with purposively selected pregnant women who initiated ANC after 12 weeks, one key informant interview with senior midwife, and three focus group discussions with spouses and Village Health Team members. Semi-structured guides were used, interviews were audio recorded, transcribed, and translated. Data were analyzed using thematic analysis with QDA miner lite software. Findings: The findings revealed several key themes influencing ANC attendance. First, the journey to seeking care was initiated by cues to action, which were supported by comprehensive knowledge of ANC, including its timing, purpose, activities, and benefits, as well as self-efficacy and confidence in acting on this knowledge. However, this journey was often hindered by significant barriers and challenges. These obstacles appeared at multiple levels, including individual and motivational barriers such as personal attitudes and lack of motivation for early initiation; systemic and practical barriers related to healthcare facilities and community health workers; and socio cultural and interpersonal barriers like prevailing cultural norms and the critical role of partner support. Conclusion and Recommendations: The delay in starting ANC at Adumi HC IV was not mainly due to a lack of knowledge, but rather a way to cope with serious structural, economic, and social challenges. Simply providing health education won't be enough. A variety of strategies are suggested, such as offering specific incentives for registering in the first trimester, setting up community outreach clinics, promoting male involvement, and integrating programs to reduce poverty and address economic difficulties.Item Prevalence and factors associated with Epstein - Barr virus infection among children in northern Uganda(Muni University, 2025-11-14) Chara, CharlesBackground: Epstein-Barr virus (EBV) is implicated in infection-related cancers such as Burkitt lymphoma (BL). However, the epidemiology of EBV in children in Sub-Saharan Africa (SSA) remains poorly understood. This study examined EBV seropositivity and genome prevalence in children from Northern Uganda. Method: A nested cross-sectional study was conducted between May 2024 and March 2025, enrolling 101 participants. Plasma samples from apparently healthy children were analysed using a dual-testing strategy involving Polymerase Chain Reaction (PCR) and Enzyme Linked Immunosorbent Assay (ELISA) for EBV infection. Socio-demographic data were collected and analysed using bivariate and multivariable Poisson regression with robust variances and analysis of covariance, with significance at P < 0.05. Results: EBV seroprevalence was 36.7% (95% CI: 26– 48), and genome prevalence by PCR was 27.8% (95% CI: 18.9 – 39.0). EBV viral load results had negligible effect sizes (group means: 0.977 in PCR positive vs 0.805 in PCR negative) and not significantly associated with EBV serology results (95% CI 0.81– 1.153). PCR positivity was associated with sex, tribe, malaria exposure, and household structure. Male children had lower PCR positivity than females (aPR = 0.4, 95% CI 0.16–0.99). Acholi (aPR = 0.13, 95% CI 0.04–0.45) and Lugbara (aPR = 0.16, 95% CI 0.04–0.7) tribes showed lower PCR positivity rates than the Alur. Children with no malaria exposure (aPR = 5.9, 95% CI 1.29–26.98) and living with one parent (aPR = 4.6, 95% CI 1.31–16.13) were linked to higher PCR positivity. By EBV serology, tribe and guardian education were key factors. Acholi (aPR = 0.27, 95% CI 0.11–0.68), Lugbara (aPR = 0.19, 95% CI 0.04–0.80), and Aringa (aPR = 0.35, 95% CI 0.13–0.93) tribes exhibited lower seropositivity rates. Guardians with no formal education were associated with higher seropositivity (aPR = 3.3, 95% CI 1.18–9.18). Conclusion: These results highlight the burden of EBV infection in Northern Uganda and also shed light on the dynamic transmission patterns influenced by sociocultural, environmental, and possibly genetic factors. Future longitudinal studies may be necessary to evaluate the mechanisms driving the observed associations.Item Determinants of timely first antenatal care visit among pregnant women in Maracha district, northwestern Uganda – a cross-sectional study(Muni University, 2025-11-18) Asibo, Gift PatrickBackground: Pregnant women should make contacts with professional healthcare providers within twelve weeks of conception, to enable timey screening for pre-existing conditions, danger signs and their management as well as birth preparedness planning. Unfortunately, the proportion of women seeking timely first antenatal care visit has remained universally low, especially in the low and middle-low-income countries. Objective: To examine the factors associated with timely first antennal care visit among pregnant attending antenatal care services in Maracha district. Methodology: In three (03) selected health facilities within Maracha district, a cross-sectional study was conducted among 532 pregnant women. A multistage sampling involving quota sampling followed by simple random sampling was done and participants given informed consent. Quantitative data was collected using a pretested semi-structured interviewer administered questionnaires. Descriptive analysis was done using frequencies and percentages while bivariate and multivariable analyses were performed using a modified Poisson regression. Results: Out of the 532 participants, 165(31%) had timely first antenatal care visit. According to the multivariable analysis, the obstetric characteristic that was significantly associated with timely first antenatal care visit was the history of delivery by caesarean section in recent past pregnancy, aPR=0.548, 95% CI [0.398, 0.755], p<0.001, with a marginal statistical significance for planned pregnancy, aPR=0.687, 95% CI [0.467, 1.009], p=0.055. The health systems characteristics that were significantly associated with timely first antenatal care visit were included having a means of transport, either private or public, aPR=0.596, 95% CI [0.405, 0.877], p=0.009; and frequency of integrated outreaches in their communities, aPR=0.634, 95% CI [0.432, 0.930], p=0.020. Conclusion: Only 31% of timely first Antenatal care visit implies a public health problem in Maracha. Interventions should target awareness creation to impact a positive mindset change about utilization of timely first antenatal care services, as well as improve access to antenatal care services for better pregnancy outcomes in Maracha.Item Determinants of utilization of postnatal care services among postpartum women in Juba County, South Sudan(Muni University, 2025-11-18) Amanzuru , Jude Tadeo KomaBackground The postpartum period is a critical phase for both postpartum women and newborns, accounting for a significant proportion of maternal and neonatal morbidity and mortality. The WHO recommends a minimum of four PNC visits within 42 days after childbirth to promote healthy practices and address complications. However, PNC utilization remains low globally, particularly in Africa and South Sudan. In Juba, no prior quantitative studies had assessed PNC uptake. This study aimed to identify key determinants influencing PNC service utilization among postpartum women in Juba County, South Sudan. Methodology A community-based analytical cross-sectional study with a quantitative approach was conducted from 20th May to 30th July 2025. A total of 511 postpartum women who had delivered within 6 weeks to 24 months prior were selected using multistage sampling. Data were collected using a structured, pre-tested interviewer-administered questionnaire and analyzed using binary logistic regression, with statistical significance set at p < 0.05. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Results Of the respondents, 256 (50.1%) were aged 25–34 years, 273 (53.4%) had attained primary education, and 464 (90.8%) were married. Most 483 (94.5%) identified as Christians, and 270 (52.8%) were housewives. Only 121 (23.7%) had attended two or more PNC visits. High parity (five or more children) was associated with lower odds of PNC utilization (aOR = 0.53, 95% CI: 0.28–0.97, p = 0.043). Satisfaction with previous PNC visits increased the likelihood of utilization (aOR = 2.70, 95% CI: 1.16–6.80, p = 0.027), as did high knowledge of newborn danger signs (aOR = 5.02, 95% CI: 1.40–21.79, p = 0.019).Item Knowledge, attitude, and willingness to provide first aid to trauma victims: a cross-sectional study among boda-boda riders in Arua city(Muni University, 2025-11-17) Acidri, PhillipBackground. Road traffic accidents (RTAs) significantly contribute to mortality and morbidity. Mortality can be reduced by up to 4.5% with pre-hospital care administered by lay first responders. Boda-boda riders are likely victims of RTAs and likely first responders to RTA victims. The study aimed to study the knowledge, attitude, and willingness of boda-boda riders to provide first aid to victims of RTAs. Methods. A cross-sectional analytic study was conducted between June and July 2025. A multi stage sampling method was used to recruit the participants. A semi-structured questionnaire was used to collect quantitative data. Chi-square and Logistic regression analysis were performed in STATA to assess the association between socio-demographic characteristics, knowledge, attitude, and willingness. Results. A total of 368 participants, mainly males with a mean age of 30.6 (SD = 8.1) years, were recruited into the study. The average first aid knowledge of the riders was 56%, with up to 66.6% of them having a positive attitude towards first aid. Notably, a surprisingly low percentage (42.9%) were willing to provide first aid to victims of RTA. Riders with at least a secondary level of education were found to have more knowledge (χ²=29.1, p=0.01), a positive attitude to first aid (χ²=12.6, p=0.006), and were willing to provide first aid in the event of trauma (p=0.038). Riders who had ever received training in first aid were also found to have more knowledge (χ² = 56.6, p = 0.01) and were more willing to provide first aid (p = 0.019). Equally, a previous history of road traffic accidents had a statistically significant relationship with knowledge (χ² = 14.1, p = 0.01). Optimal knowledge of and positive attitude towards first aid were good predictors of willingness to provide first aid, with odds of riders with optimal knowledge willing to provide first aid two times that of riders with sub-optimal knowledge (aOR = 2.27, 95% CI= 1.40 – 3.98, p = 0.002) and the odds of riders with a positive attitude willing to provide first aid six times that of riders with negative attitude (aOR = 5.78, 95% CI= 3.30 – 9.88, p = 0.001) after adjusting for confounders Conclusion. The majority of riders had limited knowledge of first aid, with a significant proportion displaying a positive attitude, and a less than average proportion being willing to provide first aid. Factors associated with knowledge of first aid included educational level, prior first aid training, and history of RTA. That associated with attitude was educational level, and meanwhile, educational level and previous history of RTA were factors associated with willingness to provide first aid. An optimal knowledge of and positive attitude towards first aid were good predictors of willingness to provide first aid. First aid training targeting boda-boda riders should prioritize those with a lower level of education and those without prior first aid training experience. First aid training of lay persons working in public spaces needs to be embraced by Uganda. The training can also focus on the interpretation of legislature in UgandaItem Factors affecting the implementation of supplementary feeding programme in refugee settlements: a case of Rhino Camp Refugee Settlement in Terego and Madi-Okollo district(Muni University, 2025-11-26) Ngongo, SamuelBackground: Despite the implementation of Supplementary Feeding Programmes (SFPs) in Rhino Camp Refugee Settlement, child malnutrition remains a critical public health emergency, characterized by high rates of stunting, wasting, and anemia. The persistent high burden of malnutrition suggests significant underlying factors are impeding the effectiveness of these interventions, necessitating a systematic investigation. Methodology: A cross-sectional research design that integrated both quantitative and qualitative methods was employed. The study sampled 400 respondents, who were caregivers/guardians/parents, and 25 respondents, these included programme staff, programme managers(WFP) and administrators for Key informant interviews. Data were collected through structured survey questionnaires, focus group discussions (3 Zones)these were selected because of easy proximity to nationals who happen to be beneficiaries of SFPs, and key informant interviews. Quantitative data were analyzed in Stata version 15 using Pearson correlation and regression analysis, while qualitative data was analyzed using thematic analysis. Findings: The study identified two primary categories of influencing factors: Child-Related Factors: A positive correlation was found between child-related factors (appetite, palatability of supplements, health condition, and discrimination of food types) and SFP implementation success (r = 0.434, p < 0.001). Regression analysis confirmed these factors as significant predictors, accounting for 18.8% of the variance (B = 0.775, p < 0.001). Qualitatively, children readily accepted ready-to-use therapeutic/supplementary foods (RUTF/RUSF) but widely rejected Corn-Soya Blend (CSB++) porridge due to its taste and preparation burden. Programme Delivery-Related Factors: A strong positive correlation existed between programme delivery factors (accessibility, community sensitization, timing, funding, and human resources) and implementation success (r = 0.426, p < 0.001). These factors were significant predictors, explaining 18.2% of the variance (B = 0.416, p < 0.001). Key implementation challenges included inadequate funding leading to ration cuts and stockouts, long distances to distribution points, high beneficiary-to-staff ratios, and politicization of aid. Critically, insufficient general food rations led to the diversion and sharing of SFP supplements at the household level. Conclusion: The implementation of SFPs in Rhino Camp is significantly constrained by a complex interplay of child acceptability issues and systemic programme delivery barriers. The inadequacy of general food assistance fundamentally undermines the supplementary nature of the programme. Recommendations: To enhance programme effectiveness, it is recommended to (1) diversify and improve the palatability of food supplements to meet children's preferences; (2) secure flexible, multi-year funding to prevent stock-outs; (3) decentralize distribution points to improve accessibility; (4) increase staffing levels and invest in capacity building; and (5) enhance community sensitization and engagement strategies. Addressing these factors is crucial for improving nutritional outcomes among refugee and host community children.