Background: Uganda has one of the highest maternal deaths at a ratio of 336 per 100,000 live births. As Uganda strives to achieve sustainable development goals, appropriate antenatal care is key to reduction of maternal mortality. We explored women’s reported receipt of seven of the Uganda guidelines components of antenatal care, and associated factors in hard to reach Lake Victoria island fishing communities of Kalangala district. Methods: A cross sectional survey among 486 consenting women aged 15–49 years, who were pregnant at any time in the past 6 months was conducted in 6 island fishing communities of Kalangala district, Uganda, during January–May 2018. Interviewer administered questionnaires, were used to collect data on socio-demographics and receipt of seven of the Uganda guidelines components of antenatal care. Regression modeling was used to determine factors associated with receipt of all seven components. Results: Over three fifths (65.0%) had at least one ANC visit during current or most recent pregnancy. Fewer than a quarter of women who reported attending care at least four times received all seven ANC components [(23.6%), P < 0.05]. Women who reported receipt of ANC from the mainland were twice as likely to have received all seven components as those who received care from islands (aOR = 1.8; 95% CI:0.9–3.7). Receipt of care from a doctor was associated with thrice likelihood of receiving all components relative to ANC by a midwife or nurse (aOR = 3.2; 95% CI:1.1–9.1). Conclusions: We observed that the delivery of antenatal care components per Ugandan guidelines is poor in these communities. Cost effective endeavors to improve components of antenatal care received by women are urgently needed. Task shifting some components of ANC to community health workers may improve care in these island communities. Trial registration: PACTR201903906459874 (Retrospectively registered).

This study sought to determine the level of concordance between self-reported alcohol use and the presence of its urinary ethyl glucuronide (EtG) metabolite in women living in urban Kampala. In 2023, we recruited 300 young women, ages 18 to 24 years, to participate in a prospective cohort study across three sites in urban Kampala (i.e., Banda, Bwaise, and Makindye) to examine the mechanistic pathways of mental illness. As part of the baseline assessment, participants were asked to complete a research assistant-administered survey and to provide a urine sample to screen for 16 different substances and/or their metabolites, including EtG. Overall, 58% (n = 174) reported to have ever consumed alcohol and 23% (n = 68) to have used it in the past month. Among the 300 women, 10% (n = 30) had EtG levels in their urine sample and of these, 40% (n = 12) reported to have never consumed alcohol, using a self-reported survey (p = 0.035). Recent alcohol use was relatively low among the women in this study. However, the discordance between self-reported alcohol use and the presence of EtG presents concerns about the accuracy of self-reported alcohol use. Additional research is needed to contextualize self-reported alcohol use, social desirability, and the implications for alcohol prevention and intervention strategies for young women in urban Kampala.

Introduction: Climate change is an emerging global health crisis, particularly in low-resource settings like Uganda’s urban slums. These areas face significant challenges in mitigating climate risks, exacerbating the vulnerability of residents. This study aims to assess the prevalence of climate change anxiety and its association with generalised anxiety among young women living in urban slums. Understanding this relationship is crucial for developing community-based mental health strategies and resilience-building initiatives to address the psychological impact of climate change. Methods: This study utilises baseline data from ‘The Onward Project On Wellbeing and Adversity’ (TOPOWA), a prospective cohort study focused on mental illness and social determinants of health among young women aged 18–24 years living in Kampala’s urban slums. A total of 300 women were recruited from three sites: Banda, Bwaise and Makindye. At baseline, interviewer-administered surveys measured climate change anxiety using the 13-item Climate Anxiety Scale and generalised anxiety using a 7-item scale. Bivariate and multivariate analyses were conducted to determine the associations between climate anxiety, generalised anxiety and demographic factors. Results: Of the 249 women included in the analysis, 21% reported moderate to severe levels of climate change anxiety, while the remaining 79% experienced mild to minimal levels. Multivariate analysis revealed a strong association between higher levels of generalised anxiety and increased climate change anxiety. Additionally, older age was linked to higher climate anxiety, whereas higher education levels and living in multigenerational households were associated with lower levels of climate anxiety. Conclusion: One in five young women in Kampala’s urban slums experiences moderate to severe climate change anxiety, closely linked to generalised anxiety. These findings highlight the urgent need for targeted mental health interventions and community-based resilience programmes. Leveraging family support in multigenerational households may also play a role in reducing climate-related anxiety and fostering adaptive coping mechanisms.

Unintended pregnancies among adolescent and young women in low- and middle-income countries pose major public health challenges, underscoring the need for improved access to modern contraceptives. This study examined prevalence, preferences, and correlates of modern contraceptive use among young women living in urban slums of Kampala, Uganda, to inform targeted interventions. We analyzed baseline data from The Onward Project On Wellbeing and Adversity (TOPOWA), an NIH-funded, multi-component prospective cohort study on mental health among women aged 18–24 years. In 2023, 300 participants were recruited from three sites (Banda, Bwaise, Makindye). Interviewer-administered surveys assessed contraceptive choices, lifestyle, and demographic factors. Modified Poisson regression was used to examine correlates of contraceptive use. Among participants, 66.0% had ever used contraception, 40.0% were current users, and 38.0% reported modern contraceptive use. Multivariable analyses showed that having a consistent partner (PR = 3.28; 95% CI: 1.90–5.67), engaging in sex work (PR = 2.10; 95% CI: 1.46–3.02), older age (PR = 1.08; 95% CI: 1.01–1.16), and having children (PR = 1.72; 95% CI: 1.12–2.66) were associated with higher modern contraceptive use. Findings highlight important gaps in sustained contraceptive use and the need for tailored interventions addressing economic, social, and educational barriers to improve reproductive health in this low-resource setting.

The purpose of this study was to use the Columbia Suicide Severity Rating Scale (C-SSRS) to assess the prevalence and patterns of suicidality among young women living in poverty to guide effective, targeted interventions for vulnerable populations. Data were drawn from ‘The Onward Project On Wellbeing and Adversity’ (TOPOWA) study, a prospective cohort examining mental health in the context of social determinants of young women aged 18 to 24 years in Kampala’s urban slums. A cohort of 300 women, recruited from three study sites, participated in baseline assessments. Suicidality was assessed using the C-SSRS. Demographic and psychosocial factors and their associations with suicidality are presented. Of the 300 women participants, 66.0% had some secondary education and 62.0% had children, with most of them living with their children (81.7%). Suicidal thoughts were reported by 46.0%, and 17.3% had attempted suicide, with poisoning (23.1%) and hanging (21.2%) being the most common methods. The prevalence of suicidality in this population was very high, indicating significant unmet mental health needs. Since not all suicide attempts are associated with preceding thoughts or plans, it is crucial to consider a broader range of risk factors and warning signs. Social support systems and socioeconomic strengthening may be fruitful strategies for the prevention of suicidality in this population.