Clarke International University

Prolonged sitting is linked to poor health outcomes; however, its context, particularly work versus leisure, and its economic impact are less understood. This study examined the extent and context of daily sitting time and its association with annual healthcare costs at midlife in a large Finnish cohort. A sample (n=7147) of Finnish adults at the 46-year (46-yr) follow-up point of the Northern Finland Birth Cohort 1966 study was used. Data were collected between 2012 and 2014, including self-reported sitting time (work and leisure) and healthcare costs estimated from self-reported visits to public, private, and occupational primary healthcare services using unit costs based on the Finnish Institute for Health and Welfare. Finally, a generalized linear model (gamma distribution with log link), was used to examine the associations between sitting time and annual healthcare costs. Total sitting time was 7.3 ± 3.3 hours per day (h·d⁻¹), including 4.0 ± 2.2 h·d⁻¹ during leisure and 3.4 ± 2.6 h·d⁻¹ at work. In adjusted GLM analyses, participants in the second quartile of work-related sitting (1.01-3.00 h·d⁻¹) had approximately 20% higher annual primary healthcare costs compared with those in the lowest quartile (p = 0.025). Leisure-time sitting showed no independent association. In this population-based cohort, work-related sitting, but not leisure-time sitting, was associated with higher annual primary healthcare costs. These findings highlight the potential economic impact of occupational sedentary behavior and suggest that work-related sitting should be considered in future strategies and studies addressing sedentary behavior in workplace settings.

The postpartum period is crucial for maternal and newborn health but remains a high-risk phase in low-resource settings like Somalia, where psychosocial support is often lacking. Social support (including practical help), emotional care, and health education are essential for recovery and well-being. Despite Somalia’s high maternal mortality, little research has focused on first-time mothers’ experiences. This study explored their experiences of postpartum support at Banadir Hospital in Mogadishu. An exploratory phenomenological design guided this study. Data was collected through 16 individual interviews, two focus group discussions (12 participants), and 10 key informant interviews with healthcare workers, totaling 38 participants. Purposive sampling ensured the selection of participants with relevant experiences, and data saturation determined the final sample size. Interviews were conducted in Somali, audio-recorded with consent, and transcribed verbatim. Inductive thematic content analysis was performed using NVivo 11. Methodological rigor was maintained through triangulation, member checking, reflexive journaling, peer debriefing, and a comprehensive audit trail. Three major themes emerged that reflected the postpartum social support experiences of first-time mothers. They received initial physical support primarily from family members, including mothers, mothers-in-law, and spouses. However, this assistance was limited and diminished significantly after the first month due to financial constraints and competing responsibilities. Emotional support was insufficient and primarily provided by healthcare workers rather than family, reflecting limited awareness of postpartum mental health needs and signs of depression. Informational support was critically inadequate, with mothers reporting unmet needs for structured guidance on newborn care, infant danger signs, and maternal health; they relied predominantly on informal sources, including family and neighbors, who often provided conflicting or inaccurate information. Overall, although postpartum support mechanisms exist, they are fragmented, inconsistent, and insufficient to meet first-time mothers’ holistic physical, emotional, and informational needs. The study highlights the urgent need for policy action to enhance postpartum care systems. This includes workforce capacity building and structured follow-up in fragile settings like Somalia. Strengthening postpartum social support through trained health workers, family engagement, and peer programs can improve maternal and neonatal outcomes.

<title>Abstract</title> Background Non‑communicable diseases (NCDs) have become the leading cause of death worldwide, accounting for about 74% of the global disease burden. East African health systems are confronted with a ‘double burden’ as they continue to manage infectious diseases while facing a rising tide of chronic conditions such as cardiovascular disease and diabetes. Rapid urbanisation, demographic growth and constrained resources have intensified this challenge. Methods The study conducted a cross‑national comparative analysis of Kenya, Uganda, Rwanda and South Sudan to evaluate health‑system readiness for NCDs. Demographic and epidemiological trends from 2000‑2021 were assessed using data from WHO “Health at a Glance” country profiles and related datasets. Health‑system capacity was benchmarked using the WHO Health‑System Building Blocks (service delivery, workforce, information systems, access to medicines, financing and governance) and NCD Progress Monitor domains (governance, risk‑factor reduction, health‑system response and surveillance). Descriptive statistics were generated from aggregated data, and policy information was synthesised from documents and literature. Ethical approval was not required since only publicly available secondary data were used. Results All countries experienced population growth and increased life expectancy, but the pace varied. Rwanda achieved the largest improvement (about + 20.9 years), followed by Uganda (+ 17.2 years), Kenya (+ 12.4 years) and South Sudan (+ 7.1 years). In 2021, NCDs accounted for roughly half of deaths in Rwanda, 38% in Kenya and 37% in Uganda, whereas communicable diseases remained predominant in South Sudan. Kenya’s projected gains towards WHO “Triple‑Billion” targets are the highest (approximately 10.6 million more people enjoying better health, 4.6 million gaining essential services and 13.1 million receiving better emergency protection), while South Sudan is expected to make minimal progress. Policy analysis revealed that most countries have NCD strategies but struggle with implementation due to limited financing and workforce capacity; Kenya leads in policy development, Rwanda has integrated NCD care into primary care, whereas Uganda and South Sudan lag behind. Tobacco control laws are common, but comprehensive alcohol regulation exists only in Kenya and Rwanda, and none of the countries strongly regulate marketing of unhealthy foods. Health facilities often lack diagnostic equipment and trained personnel, and surveillance systems remain weak. Conclusions Health‑system preparedness for NCDs in East Africa is heterogeneous. Rwanda has advanced into an NCD‑dominant mortality profile, Kenya shows moderate progress, and Uganda and South Sudan remain at earlier stages of the epidemiological transition. Strengthening primary health care, enforcing risk‑factor legislation, investing in surveillance systems and securing sustainable financing are essential to address the growing burden of non‑communicable diseases and promote equitable health outcomes.

Introduction: Youth substance abuse is a rising public health concern globally. Over the past 20 years, youth substance abuse among youths aged 14-17 has risen to 71% in Kampala, Uganda. This study examines the patterns and impact of substance abuse among youths in Bushenyi District, Western Uganda. Aim: To assess patterns and impact of substance abuse among youths in Bushenyi District, Western Uganda. Methods: Quantitative data collected via structured questionnaires completed by 381 youths aged between 18 and 30 years were examined using chi-square and multivariate regression analysis. Quantitative findings were combined with thematic analysis of qualitative data gathered from focus group discussions (FGDs) and key informant interviews (KIIs). Results: Socially normalized and readily available substances through peer networks and unofficial supply chains were alcohol, marijuana, khat, and shisha. There were statistically significant correlations (p &lt; 0.05) between substance usage and health problems. The findings revealed that 46.7% of users experienced withdrawal symptoms, 49.8% experienced blackouts, and 74% reported mental health issues. Only 19.4% of users sought therapy. Social repercussions included neglecting family responsibilities (32.5%), losing friendships (60.9%), and family conflict (51%). In terms of income generation, 28.4% turned to crime to support their habits, with 39.4% citing problems at work. Depression, parental neglect, and fighting when intoxicated were all validated as significant predictors by multivariate analysis. Conclusion: Youth substance abuse in Bushenyi District, Western Uganda, is a complex issue fueled by peer pressure, sociocultural acceptance, and a lack of proper mental health care.

BackgroundWorldwide, postnatal care (PNC) has been declared to be the hallmark of mother-child health care after delivery. This study aimed to assess the utilization of early postnatal care (EPNC) services and identify the factors influencing their use among postpartum mothers at Masafu General Hospital in Busia District, Eastern Uganda.MethodologyA cross-sectional, hospital-based study in a rural setting in Eastern Uganda was conducted in January 2025. A questionnaire was used to collect data from a sample of 234 postpartum women. Bivariate and multivariate logistic regressions were used to estimate factors associated with utilization of EPNC services, and variables with a p-value <0.05 were considered statistically significant.ResultsWhile 64.5% of postpartum mothers utilized EPNC services within the first week post-delivery, only 30.5% received care consistent with WHO recommendations for EPNC. Results showed that being aged between 18 and 27 and/or above 37 years (adjusted odds ratio (AOR) = 10.4, 95% confidence interval (CI) = 5.1-21.7, p = 0.01 and AOR = 18.5, 95% CI = 1.2-27.7, p = 0.04, respectively), mode of delivery (AOR = 16.0, 95% CI = 6.4-39.7, p = 0.00), maternal level of knowledge on EPNC (AOR = 5.8, 95% CI = 2.4-14.2, p = 0.01), long waiting time before receiving PNC services (AOR = 13.4, 95% CI = 1.9-9.6, p = 0.01), walking for less than 5 km to the health unit (AOR = 0.03, 95% CI = 0.0-0.6, p = 0.02), attending antenatal care (ANC) clinic at least four times (AOR = 0.01, 95% CI = 0.0-0.4, p = 0.01), attaining at more than primary level of education (AOR = 0.02, 95% CI = 0.0-0.6, p = 0.02), receiving PNC information from health workers during ANC/childbirth (AOR = 0.002, 95% CI = 0.0-0.0, p < 0.001), and being advised at discharge to turn up PNC follow-up (AOR = 0.1, 95% CI = 0.0-0.8, p = 0.03) were associated with increased odds of using EPNC.ConclusionsOnly about one-third of postpartum mothers utilized EPNC services three times, as recommended by the WHO. Key factors influencing EPNC were highlighted.

IntroductionImmediate postpartum modern contraceptive uptake among postpartum women gives over 95% assurance of contraception and reduced chances of short interval pregnancies resulting in improved maternal and child health outcomes. The drivers of its uptake among women are vital in designing interventions aimed at improving and scaling up its uptake. The study therefore explored the drivers of uptake of immediate postpartum modern contraceptives by postpartum women in Lira City, northern Uganda.MethodsA descriptive qualitative approach was used. A face-to-face key informant interview was used to collect data from 15 key informants (healthcare providers) working in the department of Obstetrics and Gynecology of Lira Regional Referral Hospital. Data were analyzed using Atlas.Ti and thematic analysis was done. The approach enabled an in-depth understanding of the phenomenon from service providers.ResultsThe barriers to uptake of immediate postpartum modern contraceptives were health system constraints like commodity unavailability, lack of staff training, and inadequate staffing, knowledge and skills gaps of providers. Limited knowledge, religious and cultural beliefs, male partners objection, inadequate access to information, peer influence and fear of side effects were key barriers from recipients of care. The major facilitators include availability of commodities, improved staffing level, staff training, and timely education and counselling.ConclusionThis study highlights that the uptake of immediate postpartum modern contraceptives is hindered by both health system and client-related barriers. Presence of trained staff, availability of contraceptive commodities, improved staffing levels, and timely counselling and education were identified as key facilitators. Addressing both health system and individual barriers through strengthening health systems, targeted provider training, male involvement, and enhanced community education may improve the uptake of immediate postpartum modern contraceptives.

Abstract Background: Hepatitis B virus (HBV) infections are a significant public health concern globally, affecting about 3.2 % of the global population. Few studies have focused on expectant mothers, particularly in urban settings in Uganda. This study assessed the prevalence, knowledge of, and factors associated with HBV infection among expectant mothers attending antenatal care at China-Uganda Friendship Hospital, Naguru, a large urban tertiary hospital in Kampala, Uganda. Methods: We conducted a cross-sectional study among 384 expectant mothers attending antenatal care from July 2024 to August 2024. Data on socio-demographics, HBV knowledge, maternal and behavioural factors were collected using semi-structured questionnaires. HBV status was also determined through serological testing using hepatitis B surface antigen kits. Associations between HBV infection and various factors were analysed using multivariable logistic regression with adjusted odds ratios (AOR) as the measure of association. Results: Among the 384 participants, the median age was 27 years, 336 (87.5%) were married, and their median gravidity was 2. The HBV prevalence was 2.6%, while most respondents (56.3%) had poor knowledge. Factors significantly associated with HBV infection included a positive family history of HBV (AOR 5.63; 95% CI: 1.26-25.06) and a history of body piercing (AOR 5.03; 95% CI: 1.24-20.33). Conclusion: HBV prevalence among expectant mothers at CUFHN was intermediate, and most participants had poor knowledge. Family history and body piercing were significant factors associated with HBV infections. We recommend awareness campaigns, risk-based education, and vaccination for women of reproductive age.

BackgroundBreastfeeding initiation within the first hour of birth is beneficial in reducing the risk of maternal and neonatal mortality. However, a significant proportion of mothers delay initiating breastfeeding within an hour of birth, but the association with age has not been rigorously studied. We examined the association between maternal age and delayed initiation of breastfeeding in a large urban referral hospital in central Uganda.MethodsThis analytic cross-sectional study was conducted at the Entebbe Regional Referral Hospital in Central Uganda. Data were collected using a researcher-administered questionnaire between October 1, 2019, and December 20, 2019. Delayed initiation of breastfeeding was the primary outcome, defined as putting the newborn to the breast after one hour of birth. The primary exposure was maternal age categorized as 15–24, 25–34, and 35–45 years. We performed a modified Poisson regression analysis to determine the independent association between maternal age and delayed initiation of breastfeeding, adjusting for other confounders. We stated the findings as an adjusted prevalence ratio (aPR) and 95% confidence interval (CI).ResultsWe studied 384 participants with a mean age of 27.5 ± 5.5 years. Of the 384 participants studied, 275 (71.6%) had delayed initiating breastfeeding, with the majority aged 15–24 years. In a multivariable analysis, delayed initiation of breastfeeding was significantly associated with maternal age groups of 15–24 years (aPR 1.28, 95% CI 1.01,1.63) and 25–34 years (aPR 1.28, 95% CI 1.01–1.60) compared to the reference group of 35–45 years. Additionally, delivery through cesarean section compared to spontaneous vaginal delivery was associated with delayed initiation of breastfeeding (aPR 1.93, 95% CI 1.49–2.49).ConclusionDelayed initiation of breastfeeding is common and is associated with maternal age (15–24 and 25–34 years) as well as delivery through cesarean section. Routine health education and staff mentoring are needed to enhance early initiation of breastfeeding to prevent maternal and neonatal morbidity and mortality.

Intestinal nematodes affect children in impoverished populations. Conventional anthelminthic drugs have been frequently utilized to manage these infections. However, limitations such as cost, toxic effects, and resistance have shifted towards herbal medicines in low-to middle-income countries. There is a lack of evidence supporting the effectiveness of Cassia occidentalis plant leaf extract in managing helminth infections in Uganda. This study, therefore, sought to determine the phytochemical composition of Cassia occidentalis aqueous leaf extract, its acute toxicity profile, and its in-vitro anthelmintic activity against Ascaris lumbricoides. Leaves of Cassia occidentalis were collected from Bushenyi-Ishaka Municipality, dried to obtain a powder, and macerated with distilledwater to create an aqueous extract. This extract underwent phytochemical screening and acute toxicity testing following established guidelines. The anthelmintic activity was evaluated using an adult worm mortality assay. The study found that the aqueous leaf extract of Cassia occidentalis had significant anthelmintic activity at a concentration of 40 mg/ml (p&lt;0.041). Phytochemical analysis revealed the presence of alkaloids, flavonoids, tannins, saponins, and glycosides, but no steroids were found. The extract had an LD50 of over 5000 mg/kg body weight, as it caused no mortality. The study concluded that Cassia occidentalis has significant anthelmintic activity and a high LD50, supporting its traditional use in managing helminth infections.