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Do Community-based Livelihood Interventions Affect Sexual and Reproductive Health and Rights of Young People in Slum Areas of Uganda: a Difference-in-difference with Kernel Propensity Score Matching Analysis

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Abstract

Slum dwellers across Africa have been targeted in interventions whose impacts remain unclear. We evaluated the impact of a livelihood intervention on the sexual and reproductive health and rights (SRHR) of young people in the slum areas of Kampala, Uganda. We carried out a repeated cross-sectional survey in 2014 and 2017 to examine the impact of community-based livelihood interventions on the SRHR of young people in the slum areas of Kampala, Uganda. Impacts were observed such as reduced sexual activity, reduction in aspects of gender-based violence attitudes and beliefs, increased access to and decision-making about contraceptive and family-planning services, increased availability and affordability of SRHR services, reduced need to seek further knowledge on SRHR, reduced barriers to HIV testing, and increased knowledge of health responsibilities. Unexpected results included: increased proportion of young people who had ever had sex, decreased mean age of sexual debut, unaffordability of contraceptives, and increased culturally shaped attitudes and social norms related to gender-based violence. We observed no impact on condom use, consensual sex and sexual assault, the number of sexual partners, knowledge about HIV/AIDS, stigma and discrimination against people living with HIV/AIDS, affordability of male and female condoms, and uptake of HIV testing services. Rights-based interventions are crucial to how we understand the SRHR of young people in complex sociocultural environments. While the livelihood interventions made significant impacts on the SRHR of young people, there are questions about how such interventions address deeply rooted sociocultural practices to maximise outcomes.

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Data Availability

The commensurate datasets are not publicly available due to ethical and legal restrictions to protect the privacy of intervention beneficiaries. Data may be available from the corresponding author upon request for researchers who meet the criteria for access to confidential data and upon signing a non-disclosure agreement.

References

  1. Fatusi AO. Young people’s sexual and reproductive health interventions in developing countries: making the investments count. J Adolesc Health. 2016;59(3):S1–3. https://doi.org/10.1016/j.jadohealth.2016.06.016.

    Article  PubMed  Google Scholar 

  2. Boldosser-Boesch A, Byrnes D, Cindy Carr, et al. Briefing cards: sexual and reproductive health and rights (SRHR) and the post-2015 development agenda. Washington DC: Universal Access Project, United Nations Foundation; 2015.

  3. Nalukwago J, Crutzen R, van den Borne B, et al. Gender norms associated with adolescent sexual behaviours in Uganda. Int Soc Sci J. 2019;69(231):35–48.

    Article  Google Scholar 

  4. Wado YD, Sully EA, Mumah JN. Pregnancy and early motherhood among adolescents in five East African countries: a multi-level analysis of risk and protective factors. BMC Pregnancy Childbirth. 2019;19(1):1–11.

    Article  Google Scholar 

  5. Ochen AM, Chi PC, Lawoko S. Predictors of teenage pregnancy among girls aged 13–19 years in Uganda: a community based case-control study. BMC Pregnancy Childbirth. 2019;19(1):1–14.

    Article  Google Scholar 

  6. Ministry of Health. Adolescent health policy guidelines and service standards. Kampala, Uganda: Reproductive Health Division, Department of Community Health, Ministry of Health; 2012.

  7. Ministry of Education and Sports. National sexuality education framework. Kampala, Uganda: Ministry of Education and Sports; 2018.

  8. Government of Uganda, UNICEF. The national strategy to end child marriage and teenage pregnancy 2014/2015 – 2019/2020: a society free from child marriage and teenage pregnancy. Kampala, Uganda: Ministry of Gender, Labour and Social Development and UNICEF; 2015.

  9. Kamara JK, Namugambe BM, Egessa R, Kamanga G, Renzaho AM. The socioeconomic and sexual health status of young people living in urban slum areas of Kampala, Uganda. J Urban Health. 2019;96(4):616–31.

    Article  Google Scholar 

  10. Rijsdijk LE, Lie R, Bos AE, Leerlooijer JN, Kok G. Sexual and reproductive health and rights: implications for comprehensive sex education among young people in Uganda. Sex Education. 2013;13(4):409–22. https://doi.org/10.1080/14681811.2012.747432.

    Article  Google Scholar 

  11. Renzaho AM, Kamara JK, Georgeou N, Kamanga G. Sexual, reproductive health needs, and rights of young people in slum areas of Kampala, Uganda: a cross-sectional study. PloS One. 2017;12(1). https://doi.org/10.1371/journal.pone.0169721

  12. Mberu B, Mumah J, Kabiru C, Brinton J. Bringing sexual and reproductive health in the urban contexts to the forefront of the development agenda: the case for prioritizing the urban poor. Matern Child Health J. 2014;18(7):1572–7.

    Article  Google Scholar 

  13. UBOS. Statistical Abstract. Kampala, Uganda: Uganda Bureau of Statistics; 2017.

  14. Magelah P, Ntambirweki-Karugonjo B. Youth unemployment and job creation in Uganda: opportunities and challenges. Report of Proceedings of the 49th Session of the State of the Nation Platform. Advocates Coalition for Development and Environment (ACODE) Info Sheet, 2014.

  15. UN Habitat. Cities of youth: cities of prosperiry. Nairobi, Kenya: United Nations Human Settlements Programme (UN-Habitat); 2013.

  16. McGranahan M, Bruno-McClung E, Nakyeyune J, et al. Realising sexual and reproductive health and rights of adolescent girls and young women living in slums in Uganda: a qualitative study. Reprod Health. 2021;18(1):125. https://doi.org/10.1186/s12978-021-01174-z.

    Article  PubMed  PubMed Central  Google Scholar 

  17. John Paul II Justice and Peace Centre. The plight of the urban poor and yet increased rural-urban migration: a social-economic analysis of informal settelements of Kampala. Kampala, Uganda: John Paul II Justice and Peace Centre; 2009.

  18. UBOS. The national population and housing census 2014 – main report. Kampala, Uganda: Uganda Bureau of Statistics; 2014.

  19. IOM. Strengthening social cohesion and stability in slum populations: baseline study, Kampala- Uganda. Kampala, Uganda: International Organization for Migration; 2017.

  20. Awiti A. The Uganda youth survey report. Kampala, Uganda: Aga Khan University; 2016.

    Google Scholar 

  21. UAC, UNAIDS. Synthesis, consolidation and building consensus on key priority population size estimation in numbers. Kampala: Uganda AIDS Commission; 2019.

  22. Hammer J. Randomized control trials for development? Three problems, 2017. https://www.brookings.edu/blog/future-development/2017/05/11/randomized-control-trials-for-development-three-problems/. Accessed 9 November 2021.

  23. Ravallion M. Should the randomistas (continue to) rule? Working Paper 492. Washington DC: Center for Global Development; 2018.

  24. Clark R, Reed J, Sunderland T. Bridging funding gaps for climate and sustainable development: pitfalls, progress and potential of private finance. Land Use Policy. 2018;71:335–46.

    Article  Google Scholar 

  25. Bakibinga P, Kabaria C, Kyobutungi C, et al. A protocol for a multi-site, spatially-referenced household survey in slum settings: methods for access, sampling frame construction, sampling, and field data collection. BMC Med Res Methodol. 2019;19(1):109. https://doi.org/10.1186/s12874-019-0732-x.

    Article  Google Scholar 

  26. Alves MCGP, Escuder MML, Goldbaum M, Barros MBdA, Cesar CLG, Carandina L. Household sampling in slums in surveys. Rev Saude Publica. 2011;45:1099–109.

    Article  Google Scholar 

  27. Moroto H, Sakamoto M, Ahmed T. Possible factors influencing NGOs’ project locations for disaster management in Bangladesh. Int J Disaster Risk Reduct. 2018;27:248–64.

    Article  Google Scholar 

  28. Kamara JK, Agho K, Renzaho AM. Combating recurrent hazards: evidence from rural Lesotho and Eswatini–a qualitative study. Environ Hazards. 2020;19(5):421–41.

    Article  Google Scholar 

  29. Lawton J, Hallowell N, Snowdon C, Norman J, Carruthers K, Denison F. Written versus verbal consent: a qualitative study of stakeholder views of consent procedures used at the time of recruitment into a peripartum trial conducted in an emergency setting. BMC Med Ethics. 2017;18(1):36. https://doi.org/10.1186/s12910-017-0196-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Renzaho AM, Dhingra N, Georgeou N. Youth as contested sites of culture: the intergenerational acculturation gap amongst new migrant communities—parental and young adult perspectives. PloS One. 2017;12(2). https://doi.org/10.1371/journal.pone.0170700.

  31. Examining security and privacy research in developing regions. Proceedings of the 1st ACM SIGCAS Conference on Computing and Sustainable Societies; 2018.

  32. Spriggs M. Understanding consent in research involving communities: the ethical issues. A handbook for human research ethics committees and researchers. Melbourne, Australia: Royal Children’s Hospital; 2010.

  33. Bukenya JN, Nakafeero M, Ssekamatte T, Isabirye N, Guwatudde D, Fawzi WW. Sexual behaviours among adolescents in a rural setting in eastern Uganda: a cross-sectional study. Tropical Med Int Health. 2020;25(1):81–8. https://doi.org/10.1111/tmi.13329.

    Article  Google Scholar 

  34. WHO. Measuring sexual health: conceptual and practical considerations and related indicators. Geneva, Switzerland: World Health Organization; 2010.

  35. Starks H, Garrido MM. Observational & quasi-experimental research methods. Paper presented at the 8th Annual Kathleen Foley Palliative Care Retreat Method Workshop, Park City, Utah; 2014.

  36. Nejad FN, Ghamari MR, Kamal SHM, Tabatabaee SS, Ganjali R. The most important social determinants of slumdwellers’ health: a scoping review. J Prev Med Public Health. 2021;54(4):265–74.

    Article  Google Scholar 

  37. Lunt M, Solomon D, Rothman K, et al. Different methods of balancing covariates leading to different effect estimates in the presence of effect modification. Am J Epidemiol. 2009;169(7):909–17.

    Article  Google Scholar 

  38. Hu Y, Hu F. Balancing treatment allocation over continuous covariates: a new imbalance measure for minimization. J Probability Stat. 2012. https://doi.org/10.1155/2012/842369.

  39. Mayne SL, Lee BK, Auchincloss AH. Evaluating propensity score methods in a quasi-experimental study of the impact of menu-labeling. PloS One. 2015;10(12). https://doi.org/10.1371/journal.pone.0144962.

  40. Caliendo M, Kopeinig S. Some practical guidance for the implementation of propensity score matching. J Econ Surv. 2008;22(1):31–72. https://doi.org/10.1111/j.467-6419.2007.00527.x.

    Article  Google Scholar 

  41. Villa JM. diff: simplifying the estimation of difference-in-differences treatment effects. Stand Genomic Sci. 2016;16(1):52–71.

    Google Scholar 

  42. Austin PC, Small DS. The use of bootstrapping when using propensity-score matching without replacement: a simulation study. Stat Med. 2014;33(24):4306–19. https://doi.org/10.1002/sim.6276.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wali N, Chen W, Rawal LB, Amanullah A, Renzaho A. Integrating human rights approaches into public health practices and policies to address health needs amongst Rohingya refugees in Bangladesh: a systematic review and meta-ethnographic analysis. Arch Public Health. 2018;76(1):1–14. https://doi.org/10.1186/s13690-018-0305-1.

    Article  Google Scholar 

  44. Fuhrimann S, Winkler MS, Kabatereine NB, et al. Risk of intestinal parasitic infections in people with different exposures to wastewater and fecal sludge in Kampala, Uganda: a cross-sectional study. PloS Negl Trop Dis. 2016;10(3). https://doi.org/10.1371/journal.pntd.0004469.

  45. Ezedunukwe IR, Okwundu CI. Economic interventions for prevention of HIV risk and HIV infection. Cochrane Database Syst Rev. 2016;2016(10). https://doi.org/10.1002/14651858.CD008330.

  46. Cislaghi B, Shakya H. Social norms and adolescents’ sexual health: an introduction for practitioners working in low and mid-income African countries. Afr J Reprod Health. 2018;22(1):38–46.

    PubMed  Google Scholar 

  47. Naranbhai V, Karim QA, Meyer-Weitz A. Interventions to modify sexual risk behaviours for preventing HIV in homeless youth. Cochrane Database Syst Rev. 2011(1). https://doi.org/10.1002/14651858.CD007501.pub2.

  48. Jenner E, Jenner LW, Walsh S, Demby H, Gregory A, Davis E. Impact of an intervention designed to reduce sexual health risk behaviors of African American adolescents: results of a randomized controlled trial. Am J Public Health. 2016;106(S1):S78–84. https://doi.org/10.2105/ajph.016.303291.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Abramsky T, Devries K, Kiss L, et al. Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Med. 2014;12(1):1–17.

    Article  Google Scholar 

  50. Sewpaul V, Kreitzer L, Raniga T. The tensions between culture and human rights: emancipatory social work and Afrocentricity in a global world. Calgary, Canada: University of Calgary Press; 2021.

  51. Analogbei T, Dear N, Reed D, et al. Predictors and barriers to condom use in the African cohort study. AIDS Patient Care STDS. 2020;34(5):228–36. https://doi.org/10.1089/apc.2019.0302.

    Article  PubMed  Google Scholar 

  52. Okiror S. Faulty condoms leave charity facing court case in Uganda. London: The Gaurdian 2020. https://www.theguardian.com/globaldevelopment/2020/mar/02/faulty-condoms-leave-charity-facing-court-case-in-uganda. Accessed 9 November 2021.

  53. De Coninck Z, Marrone G. Trends and determinants of condom use in Uganda. East Afr J Public Health. 2012;9(3):105–11.

    PubMed  Google Scholar 

  54. UAC. The Uganda HIV/AIDS country progress report, July 2016–June 2017. Kampala, Uganda: Uganda AIDS Commission; 2017.

  55. Musheke M, Ntalasha H, Gari S, et al. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health. 2013;13(1):220. https://doi.org/10.1186/471-2458-13-220.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Sam-Agudu NA, Folayan MO, Ezeanolue EE. Seeking wider access to HIV testing for adolescents in Sub-Saharan Africa. Pediatr Res. 2016;79(6):838–45. https://doi.org/10.1038/pr.2016.28.

    Article  PubMed  Google Scholar 

  57. Kwesiga B, Aliti T, Nabukhonzo P, et al. What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments. BMC Health Serv Res. 2020;20(1):1–8.

    Article  Google Scholar 

  58. Dehne KL, Dallabetta G, Wilson D, et al. HIV Prevention 2020: a framework for delivery and a call for action. The Lancet HIV. 2016;3(7):e323–32.

    Article  Google Scholar 

  59. Muhanguzi FK, Bennett J, Muhanguzi HR. The construction and mediation of sexuality and gender relations: experiences of girls and boys in secondary schools in Uganda. Fem Form. 2011;23(3):135–52.

    Google Scholar 

  60. Macia M, Maharaj P, Gresh A. Masculinity and male sexual behaviour in Mozambique. Cult Health Sex. 2011;13(10):1181–92.

    Article  Google Scholar 

  61. Hladik W, Sande E, Berry M, et al. Men who have sex with men in Kampala, Uganda: results from a bio-behavioral respondent driven sampling survey. AIDS Behav. 2017;21(5):1478–90. https://doi.org/10.1007/s10461-016-1535-2.

    Article  PubMed  Google Scholar 

  62. Ministry of Health. Addendum to HIV testing services policy and implementation guidlines: HIV self-testing and assisted parner notification services. Kampala, Uganda: Ministry of Health; 2018.

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Acknowledgements

The intervention on which the study is based was funded by the Australian Department of Foreign Affairs and Trade through World Vision. The funders had no role in study design, analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. School of Social Sciences, Western Sydney University, Penrith, NSW, 2751, Australia

    Andre M. N. Renzaho & Daniel Doh

  2. Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia

    Andre M. N. Renzaho

  3. Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, 3004, Australia

    Andre M. N. Renzaho

  4. School of Humanities and Social Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3151, Australia

    Joseph K. Kamara

  5. World Vision International, East Africa Regional Office, Karen, Nairobi, Kenya

    Joseph K. Kamara

  6. Department of Social World and Social Administration, School of Social Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda

    Paul Bukuluki

  7. NHMRC Clinical Trial Center, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia

    Rashidul A. Mahumud

  8. College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda

    Moses Galukande

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  1. Andre M. N. Renzaho
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Correspondence to Joseph K. Kamara.

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Ethics Approval

The study protocol was approved by the School of Health Sciences Research Ethics Committee, Makerere University (Approval number: #Rec Ref 2017-079) and recognised by the Western Sydney University Research Ethics Committee (Approval number: REDI Reference: RH12259).

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Table 6 Description of the intervention
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Renzaho, A.M.N., Kamara, J.K., Doh, D. et al. Do Community-based Livelihood Interventions Affect Sexual and Reproductive Health and Rights of Young People in Slum Areas of Uganda: a Difference-in-difference with Kernel Propensity Score Matching Analysis. J Urban Health 99, 164–189 (2022). https://doi.org/10.1007/s11524-021-00596-1

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