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Background Globally, teenage pregnancy is a public health problem. Low- and middle-income countries in the Sub-Saharan region are more affected with teenage pregnancy. It is worse with teenage girls who have other vulnerabilities like living in refugee camps. However, there is little information about teenage pregnancy in refugee camps especially in resource limited areas like Northern Uganda. Objective To determine the prevalence and the factors associated with teenage pregnancy among refugees in Palabek refugee settlement, Northern Uganda. Methods This was a cross-sectional study conducted among teenage girls in Palabek refugee settlement in Northern Uganda. The study estimated a total sample size of 316 teenage girls and they were sampled using systematic random sampling. Data was collected using researcher administered questionnaire. Conditional logistics regression was employed to identify the associated factors for teenage pregnancy. Results A total of 306 teenagers participated in the study with a response rate of 98.6%. The study showed that the prevalence of teenage pregnancy among teenage girls in Palabek refugee settlement, Northern Uganda was 41.2%. The factors associated with teenage pregnancy among teenage girls in Palabek refugee settlement included: being in the 15–19 years age group (AOR = 6.3, 95%CI: 1.8–22.8), not being in school (AOR = 5, 95%CI: 2.3–10.9), not being married (AOR = 0.2, 95%CI: 0.1–0.5), delayed sexual debut (AOR = 2.4, 95%CI: 1.1–5.5), having multiple sexual partners (AOR = 0.3, 95% CI: 0.1–0.7), alcohol use (AOR = 6.7, 95%CI: 2.2–18.4), being aware of sexual reproductive health services (AOR = 0.4, 95%CI: 0.2–0.9), and having divorced families (AOR = 2.4, 95% CI: 1.2–4.9). Conclusion Study results reveal that 4 in 10 teenage girls in Palabek, Northern Uganda, are pregnant, influenced by individual, community, and health system factors. This highlights vulnerabilities in refugee camps, urging prioritization of sexual and reproductive health for adolescent girls in refugee camps.

Background The prevalence of Plasmodium falciparum and Intestinal Parasitic Infections (IPIs) - with the corresponding pathogenesis among children remain uncertain. This study aimed at determining the prevalence and the outcomes (including anaemia) of the respective infections and co-infections. Anaemia is a condition in which the number of red blood cells transporting oxygen to the various body parts is not sufficient to meet the needs of the body. Methods This was a cross sectional study conducted among 476-refugee camp school children. Kato-Katz technique was used to screen stool samples for intestinal parasites. Microscopy was used for malaria testing while the portable Haemoglobin (Hb) calorimeter was used to measure haemoglobin concentration. Results The overall prevalence of the mixed infections was 63.03%. Plasmodium falciparum was most prevalent of the single infections 262(55.04%) followed by Taenia spp. 14 (2.9%), Schistosoma mansoni 12(2.5%), Giardia lamblia 7 (2.9%), Trichuris trichiura 2(0.4%), Hookworm 2(0.4%) and Strongyloides stercoralis 1(0.2%). The odds of developing simple or uncomplicated malaria infection or anaemia was 14 times higher in individuals with dual co-infection with Plasmodium falciparum + Taenia sp. compared to single parasitic infection (Odds = 14.13, P  = 0.019). Co-infection with Plasmodium falciparum + Taenia spp, was a strong predictor of Malaria and anaemia. Conclusion This study shows that Plasmodium falciparum and Taenia spp. co-infections is a stronger predictor of malaria and anaemia. The prevalence of malaria and anaemia remains higher than the other regions in Uganda outside restricted settlements. The findings of this study underline the need for pragmatic intervention programmes to reduce burden of the co-infections in the study area and similar settlements.

Background Anaemia is a major cause of morbidity among children under five years in Uganda. However, its magnitude among refugee populations is marginally documented. In this study, the prevalence and contributors to anaemia among children 6 to 59 months in Kyangwali refugee settlement in Western Uganda was determined. Methods This was a cross-sectional study that was carried out among 415 mother- child dyads at Kwangwali refugee settlement. Anaemia was determined by measuring haemoglobin concentration using the HaemoCue method, while nutritional status was examined using standard World Health Organisation (WHO) nutritional indices. Data abstraction forms, pretested questionnaires and face to face interviews were used to collect patient data. Associations between the independent variables and anaemia were examined using modified Poisson regression with robust standard errors. In all statistical tests, a P- value of < 0.05 was considered as significant. Results The proportion of children with anaemia was 49.2% (95% CI: 44.4–53.9). Anaemia was 1.4 times (95% CI = 1.13–1.82; p  = 0.003) more prevalent among wasted children than the normal children. The prevalence of anaemia was also higher among underweight children than those with normal weight (aPR = 1.37, 95% CI = 1.11–1.70; p  = 0.004). Additionally, the prevalence of anaemia was higher among children of birth order of 6 or above (aPR = 2.00, 95% CI = 1.22–3.29; p  = 0.006), while anaemia prevalence was lower among children whose mothers’ had attained secondary level of education (aPR = 0.19, CI = 0.04–0.98; p  = 0.048) and those who fed on fish (aPR = 0.75, 95% CI = 0.57–0.99; p  = 0.039) and meals prepared with oils and fats (aPR = 0.70, 95% CI = 0.51–0.97; p  = 0.029). There was no significant relationship between anaemia occurrence and the household dietary diversity score. Conclusions About half of the study children were found to be anaemic. The most significant contributors to anaemia in the study population were malnutrition, maternal education, feeding practices and birth order. The study findings suggest need of screening of children for anaemia at all nutritional clinics, promotion of education, addressing barriers to sustainable food supply and accessibility of nutrient-dense foods, treating anaemia in children alongside other micronutrient deficiencies and addressing the nutritional needs of multiparous mothers in refugee communities.

Background Suicide is a leading cause of death among young people globally. Although suicidality has been studied in various populations, limited research has focused on refugee youth in low and middle-income countries. This study aimed to assess the prevalence of suicidal ideation, suicide attempts, and methods of attempted suicide among refugee children and adolescents in southwestern Uganda. We also examined risk factors associated with suicidal ideation in this population. Methods We conducted a cross-sectional study of 325 refugee children and adolescents selected through simple random sampling in Nakivale Refugee Settlement, southwestern Uganda. Suicidal behavior and post-traumatic stress disorder (PTSD) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, version 7.02 (MINI-KID). Additional variables—including war-related trauma and post-migration experiences were measured using structured checklists administered through KoboCollect. The data were then exported to STATA 17 for analysis. Descriptive statistics were used to calculate the prevalence of suicidal ideation, attempts, and means, while bivariate and multivariate logistic regression analyses were conducted to identify factors associated with suicidal ideation. Results Of 325 participants, 129 (40%) reported suicidal ideation, and among these, 70 (54%) had formulated a suicide plan. Of those with a plan, 13 (19%; (4.3% of the total sample)) had attempted suicide. The most common method of attempted suicide was self-poisoning (4/13, 31%), followed by hanging or drowning (3/13, 23%), self-stabbing (2/13, 15%), and self-imposed accidents (1/13, 8%). In multivariate analyses, suicidal ideation was significantly associated with exposure to war-related trauma (OR = 2.30, 95% CI: 1.35–3.94, p  = 0.002), PTSD (OR = 5.47, 95% CI: 2.15–13.94, p  < 0.001), and being an unaccompanied minor (OR = 6.14, 95% CI: 2.13–17.68, p  = 0.001). Conclusion Suicidal ideation is highly prevalent among refugee children and adolescents in Nakivale Refugee Settlement. Prevention efforts should prioritize trauma-related factors, PTSD, and the specific needs of unaccompanied minors. Clinical trial number Not applicable.

Background The COVID-19 pandemic has been characterized by multiple waves with varying rates of transmission affecting countries at different times and magnitudes. Forced displacement settings were considered particularly at risk due to pre-existing vulnerabilities. Yet, the effects of COVID-19 in refugee settings are not well understood. In this study, we report on the epidemiology of COVID-19 cases in Uganda’s refugee settlement regions of West Nile, Center and South, and evaluate how health service utilization changed during the first year of the pandemic. Methods We calculate descriptive statistics, testing rates, and incidence rates of COVID-19 cases in UNHCR’s line list and adjusted odds ratios for selected outcomes. We evaluate the changes in health services using monthly routine data from UNHCR’s health information system (January 2017 to March 2021) and apply interrupted time series analysis with a generalized additive model and negative binomial distribution, accounting for long-term trends and seasonality, reporting results as incidence rate ratios. Findings The first COVID-19 case was registered in Uganda on March 20, 2020, and among refugees two months later on May 22, 2020 in Adjumani settlement. Incidence rates were higher at national level for the general population compared to refugees by region and overall. Testing capacity in the settlements was lower compared to the national level. Characteristics of COVID-19 cases among refugees in Uganda seem to align with the global epidemiology of COVID-19. Only hospitalization rate was higher than globally reported. The indirect effects of COVID-19 on routine health services and outcomes appear quite consistent across regions. Maternal and child routine and preventative health services seem to have been less affected by COVID-19 than consultations for acute conditions. All regions reported a decrease in consultations for respiratory tract infections. Interpretation COVID-19 transmission seemed lower in settlement regions than the national average, but so was testing capacity. Disruptions to health services were limited, and mainly affected consultations for acute conditions. This study, focusing on the first year of the pandemic, warrants follow-up research to investigate how susceptibility evolved over time, and how and whether health services could be maintained.

Background While 5% of 247 million global malaria cases are reported in Uganda, it is also a top refugee hosting country in Africa, with over 1.36 million refugees. Despite malaria being an emerging challenge for humanitarian response in refugee settlements, little is known about its risk factors. This study aimed to investigate the risk factors for malaria infections among children under 5 years of age in refugee settlements in Uganda. Methods We utilized data from Uganda’s Malaria Indicator Survey which was conducted between December 2018 and February 2019 at the peak of malaria season. In this national survey, household level information was obtained using standardized questionnaires and a total of 7787 children under 5 years of age were tested for malaria using mainly the rapid diagnostic test. We focused on 675 malaria tested children under five in refugee settlements located in Yumbe, Arua, Adjumani, Moyo, Lamwo, Kiryadongo, Kyegegwa, Kamwenge and Isingiro districts. The extracted variables included prevalence of malaria, demographic, social-economic and environmental information. Multivariable logistic regression was used to identify and define the malaria associated risk factors. Results Overall, malaria prevalence in all refugee settlements across the nine hosting districts was 36.6%. Malaria infections were higher in refugee settlements located in Isingiro (98.7%), Kyegegwa (58.6%) and Arua (57.4%) districts. Several risk factors were significantly associated with acquisition of malaria including fetching water from open water sources [adjusted odds ratio (a OR ) = 1.22, 95% CI : 0.08–0.59, P  = 0.002], boreholes (a OR  = 2.11, 95% CI : 0.91–4.89, P  = 0.018) and water tanks (a OR  = 4.47, 95% CI : 1.67–11.9, P  = 0.002). Other factors included pit-latrines (a OR  = 1.48, 95% CI : 1.03–2.13, P  = 0.033), open defecation (a OR  = 3.29, 95% CI : 1.54–7.05, P  = 0.002), lack of insecticide treated bed nets (a OR  = 1.15, 95% CI : 0.43–3.13, P  = 0.003) and knowledge on the causes of malaria (a OR  = 1.09, 95% CI : 0.79–1.51, P  = 0.005). Conclusions The persistence of the malaria infections were mainly due to open water sources, poor hygiene, and lack of preventive measures that enhanced mosquito survival and infection. Malaria elimination in refugee settlements requires an integrated control approach that combines environmental management with other complementary measures like insecticide treated bed nets, indoor residual spraying and awareness. Graphical Abstract

Background Implementation of community-based Maternal and Perinatal Death Surveillance and Response (CB-MPDSR) in crisis-affected settings offers an opportunity to adapt humanitarian programming and mount solutions to directly improve maternal and neonatal health among those most in need. This study aimed to understand factors that influence implementation of CB-MPDSR approaches across diverse humanitarian contexts. Methods A comparative qualitative case study was conducted in December 2021-July 2022 to assess CB-MPDSR implementation in 4 diverse humanitarian settings: Cox’s Bazar (CXB) refugee camps, Ugandan refugee settlements, South Sudan, and Yemen. A scoping review and 39 individual or group semi-structured key informant interviews were conducted. Thematic content analysis was employed to understand the adoption, penetration, and fidelity of CB-MPDSR approaches and elucidate cross-setting learning. Findings Adoption of CB-MPDSR varied: refugee contexts in CXB and Uganda had well-established systems involving active pregnancy and mortality surveillance and verbal autopsy. In Yemen, implementation was reliant upon passive reporting mechanisms, while implementing partners in South Sudan employed a mix of strategies. Financial, human resources, and socio-cultural dynamics significantly limited implementation, especially the notification and review of perinatal deaths. Strategic engagement of community stakeholders was employed to improve participation and transparency between communities and health systems; however, community trust in the humanitarian health system remains an unresolved issue. Conclusions CB-MPDSR offers insights into important systemic and cultural factors contributing to mortality within crisis-affected settings. Our results call for more research investment in understanding how to effectively adapt CB-MPDSR and development of operational guidance to assist humanitarian actors in introducing or bolstering CB-MPDSR approaches, so as to support a system reflective of complex realities faced by these diverse and mobile communities.

The prevalence of post-traumatic stress disorder (PTSD) and its risk factors among adult refugees in the context of war-related forced migration is well established. However, reliable data are lacking on war-related trauma among refugee children and adolescents residing in refugee settlements. This study estimated the magnitude of PTSD and its associated factors among children and adolescents in Nakivale refugee settlement, south-western Uganda. We conducted a cross-sectional quantitative study among 325 adolescent (10-19-year-old) refugees, who were selected using a simple random sampling approach. The presence of PTSD was assessed by the Mini-International Neuropsychiatric Interview for Children and Adolescents. The main predictor variables were assessed by structured checklists for war trauma and post-migration using Kobol collect software. Data were exported to Stata 23 for analysis. The prevalence of PTSD was computed using descriptive statistics. Bivariate and multivariate logistic regression analyses were used to determine factors associated with PTSD. The prevalence of PTSD in our study was 83% (269/325, 95% CI 0.782-0.867). Factors associated with PTSD included post-migration difficulties (OR = 4.11, 95% CI 2.52-8.43,  < .001) and exposure to war-related trauma (OR = 2.23, 95% CI 1.16-4.261,  = .016). The high prevalence of PTSD in our sample of refugee children and adolescents is associated with both war trauma and post-migration difficulties. This information is important for the psychological assessment and treatment of the children and adolescents living in the refugee settlement. Identification of potentially modifiable factors in post-migration conditions and acknowledgement of the effects of conflicts on health are of high priority from both societal and global perspectives.

Background In 2014, Uganda launched the National Male Involvement Strategy in Maternal and Child Health. In 2020, the District Health Management Information System report for Lamwo district, where Palabek Refugee Settlement is located, indicated a 10% male involvement in antenatal care (ANC) at the settlement. We investigated determinants of male involvement in ANC in Palabek Refugee Settlement to inform programs on improvement of male involvement in ANC in a refugee setting. Methodology We conducted a community-based cross-sectional analytical study among a proportionate sample of mothers in Palabek Refugee Settlement from October-December 2021. Using a standardized questionnaire, we collected information on demographics and the constructs of the socio-ecological model where consent was given. We summarized data in tables and figures. We used Pearson chi-square test to determine significance of independent variables at bivariate level. A multivariable logistic regression model was run for all variables found significant at bivariate analysis to determine association between the different independent variables and male involvement in ANC. Results We interviewed 423 mothers. The mean age of their male partners was 31 years, SD 7. 81% (343/423) of male partners had formal education, with 13% (55/423) having a source of income and 61% (257/423) having access to ANC information during their pregnancy. The level of male involvement in ANC in Palabek Refugee Settlement was 39% (164/423). Male involvement in ANC was positively associated with access to information on ANC (AOR 3.0; 95%Cl: 1.7–5.4) and frequent couple discussion on ANC (AOR 10.1; 95%Cl: 5.6–18.0). However, it was negatively associated with distance ≥ 3 km to the health facility (AOR 0.6 ;95%Cl: 0.4-1.0). Conclusions Approximately one in three male partners in Palabek Refugee Settlement were involved in ANC. Male partners who had access to information during ANC and those who had frequent discussions were more likely to get involved in ANC. Men who lived ≥ 3 km from the health facility were less likely to be involved in ANC. We recommend intensified awareness creation on importance of male involvement in ANC and implementation of integrated community outreaches to reduce distance to the health facility.