Perceived opportunities and challenges of family and community members in supporting teen mothers in rural Eastern Uganda

Josephine Nabugoomu, Gloria K Seruwagi, Kitty Corbett, Susan Horton, Rhona Hanning


There is tremendous need for feasible and acceptable community-based interventions to address poor nutrition and health among teen mothers in rural Eastern Uganda. To inform such interventions, we identified facilitators/opportunities and challenges for maternal/child nutrition and health at community level, as perceived by those closest to the problem.  In-depth interviews were conducted among 101 teens, family and community members in Budondo sub-county using questions based on social cognitive theory constructs related to nutrition/health. Data were analyzed thematically using Atlas-ti7.5.4. Facilitators included family support for positive teen decision-making regarding healthcare and practices and opportunities included income generation training and availability of healthcare services. Challenges included poor attitude of parents towards community workers, harsh treatment, inability to obtain income generation materials, insufficient land, food or medical supplies and medical understaffing. To exploit opportunities for improved maternal/child health and progress towards global sustainable development goals, this study points to needs for local action. (Afr J Reprod Health 2020; 24[3]: 88-100).

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WHO. Adolescent pregnancy: issues in adolescent

health and development. WHO discussion papers on adolescence. Geneva, World Health Organization, 2004. Accessed 10 Oct 2017.

UNFPA. The state of world population 2013.

Motherhood in childhood: facing the challenge of adolescent pregnancy, 2013, 132. Accessed 09 Oct 2017.

UBOS (Uganda Bureau of Statistics) and ICF

International Inc. Uganda demographic and health survey 2016. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc, 2016.

Nabugoomu J, Seruwagi GK, Corbett K, Kanyesigye E,

Horton S and Hanning R. Needs and barriers of teen mothers in rural eastern Uganda: stakeholders’ perceptions regarding maternal/child nutrition and health. Int. J. Environ. Res. Public Health 2018; 15(12): 2776. Doi: 10.3390/ijerph15122776.

Glanz K, Rimer BK and Viswanath K. Health behavior

and health education: Theory, research, and practice. Jossey-Bass. Fourth Edition, 2008, 42, 169, 170, 273, 274. _1483_0.pdf. Accessed 07 Dec 2017.

McKenzie JF and Smeltzer JL. Planning, implementing,

and evaluating health promotion programs. Allyn and Bacon. Second Edition, 1997, 96-114.

Bandura A. Health promotion by social cognitive means.

Health Educ Behav 2004; 31(2): 143-64.

Glanz K. Behavioural and social sciences research:

social and behavioral theories, 2017, 40. Accessed 07 Dec 2017.

Creswell JW. Research design: qualitative, quantitative, and mixed approaches. Thousand Oaks, CA: SAGE

Publications, Inc. Forth Edition, 2014, 6-8.

Ritchie L and Lewis L. Qualitative research practice: A

guide for social science students and researchers. SAGE Publications, Inc. First Edition, 2003, 336. Accessed 18 Sep 2017.

Bisman J. Postpositivism and accounting research. A

(personal) primer on critical realism. AAFBJ 2010; 4(4): 1-25.

Hutton E. An examination of postpositivism and

postmodernism, 2009. Accessed 18 Sep 2017.

Crossan F. Research philosophy: towards an

understanding. Nurse Res 2003;11(1):46-55.

Racher FE and Robin S. Are phenomenology

and postpositivism strange bedfellows? West J Nurs Res 2003; 25(5): 464-81.

Clark AM. The qualitative-quantitative debate: moving

from positivism and confrontation to post-positivism and reconciliation. J Adv Nurs 1998; 27(6) :1242-9.

Swift JA and Tischler V. Qualitative research in

nutrition and dietetics: getting started. J Hum Nutr Diet 2010; 23(6): 559-66.

UBOS (Uganda Bureau of Statistics). Republic of

Uganda: national population and housing census 2014, 2014, 105. Accessed 18 Sep 2017.

UNDP. Republic of Uganda poverty status report 2014:

structural change and poverty reduction in Uganda, 2014, 156. Accessed 29 Oct 2017.

World Bank Group. The Uganda poverty assessment

report 2016. Farms cities and good fortune: assessing poverty reduction in Uganda form 2006 to 2013. Report No ACS18391, 2016, 178. Accessed 16 Oct 2017

UBOS (Uganda Bureau of Statistics)-Jinja district.

Higher local government statistical abstract, 2009, 98. Accessed 18 Sep 2017.

Tongco MDC. Purposive sampling as a tool for

informant selection. Ethnobotany Research & Applications 2007; 5: 147-58.

Draper A and Swift JA. Qualitative research in nutrition

and dietetics: data collection issues. J Hum Nutr Diet 2011; 24(1): 3-12.

Attride-Stirling J. Thematic networks: an analytic tool

for qualitative research. Commission for health improvement, England. Qualitative Research. SAGE Publications 2001; 1(3): 385-405.

Smith J and Firth J. Qualitative data analysis:

application of the framework approach. Nurse Researcher 2011; 18(2): 52-62.

Braun V and Clarke V. Using thematic analysis in

psychology. Qualitative Research in Psychology 2006; 3(2): 77-101.

Atuyambe L, Mirembe F, Annika J, Kirumira EK and

Faxelid E. Seeking safety and empathy: adolescent health seeking behavior during pregnancy and early motherhood in central Uganda. J Adolesc 2009; 32(4): 781-96.

Kwagala B. Birthing choices among the Sabiny of

Uganda. Cult Health Sex 2013; 15 Suppl 3: S401-14.

Keri L, Kaye D and Sibylle K. Referral practices and

perceived barriers to timely obstetric care among Ugandan traditional birth attendants (TBA). Afr Health Sci 2010; 10(1): 75-81.

Kanabahita C. A lifetime as TBA in Uganda. Safe

Mother 1993; (12): 10.

Lutwama GW, Roos JH and Dolamo BL. A descriptive

study on health workforce performance after decentralisation of health services in Uganda. Hum Resour Health 2012; 7(10): 41.

Chi PC, Bulage P, Urdal H and Sundby J. A qualitative

study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda. BMC Pregnancy Childbirth 2015; 15: 18.

Ricks N. The strengths perspective: providing

opportunities for teen parents and their families to succeed. J Fam Strengths 2016; 15(11): 1-20.

McKenna AN. The role of Ugandan women in rural

agriculture and food security, 2014. Accessed 09 Oct 2017.

FAO and ADB. Gender equality and food security:

women’s empowerment as a tool against hunger, 2013, 114. Accessed 09 Oct 2017.

Flax VL, Yourkavitch J, Okello ES, Kadzandira J,

Katahoire AR and Munthali AC. "If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing": The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda. PLoS One. 2017: 12(6): e0178298.

Singh D, Lample M and Earnest J. The involvement of

men in maternal health care: cross-sectional, pilot case studies from Maligita and Kibibi, Uganda. Reprod Health 2014; 11: 68.

Obermeyer CM, Schulein M, Hardon A, Sievert LL,

Price K, Santiago AC, Lazcano O, Kirumira EK and Neuman M.. Gender and medication use: an exploratory, multi-site study. World Health 2004; 39(4): 57-73.

Museveni KY. President launches initiative on skilling

the girl child, 2016. Accessed 17 Aug 2018.

The State House of Uganda. "Fight poverty,

unemployment" says President as he graduates skilled girls, 2017. Accessed 17 Aug 2018.

Kwesiga P. New Vision News Paper: Museveni cautions

ghetto youth to listen to NRM, 2018. Accessed Aug 19 2018.

SOUL Foundation, 2017.

Accessed Oct 6, 2017.

PEFO (Phoebe Education Fund for Orphans &

vulnerable children), 2017. Accessed 06 Oct 2017.

Tylleskär T, Jackson D, Meda N, Engebretsen IM,

Chopra M, Diallo AH, Doherty T, Ekström EC, Fadnes LT, Goga A, Kankasa C, Klungsøyr JI, Lombard C, Nankabirwa V, Nankunda JK, Van de Perre P, Sanders D, Shanmugam R, Sommerfelt H, Wamani H, Tumwine JK and PROMISE-EBF Study Group. Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. Lancet 2011; 378(9789): 420-27.

Kirkwood BR, Manu A, ten Asbroek AH, Soremekun S,

Weobong B, Gyan T, Danso S, Amenga-Etego S, Tawiah-Agyemang C, Owusu-Agyei S and Hill Z. Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: a cluster randomised controlled trial. Lancet 2013; 381(9884): 2184-92.

Penfold S, Manzi F, Mkumbo E, Temu S, Jaribu J,

Shamba DD, Mshinda H, Cousens S, Marchant T, Tanner M, Schellenberg D and Schellenberg JA. Effect of home-based counselling on newborn care practices in southern Tanzania one year after implementation: a cluster-randomised controlled trial. BMC Pediatr. 2014; 14: 187.

Flax VL , Negerie M, Ibrahim AU, Leatherman S, Daza

EJ and Bentley ME. Integrating group counseling, cell phone messaging, and participant-generated songs and dramas into a microcredit program increases Nigerian women's adherence to international breastfeeding recommendations. J Nutr 2014; 144(7): 1120-4.

Nyqvist BM, Guariso A, Svensson J and Yanagizawa-

Drott D. Reducing child mortality in the last mile: a randomized social entrepreneurship intervention in Uganda, 2017, 45. Accessed 30 Oct 2017.

Nyqvist BM, Svensson J and Yanagizawa-Drott D. Can

good products drive out bad? Evidence from local markets for antimalarial medicine in Uganda, 2016, 49. Accessed 30 Oct 2017.

BRAC Health. Health, nutrition and population, 2017. Accessed 30 Oct 2017.

WHO. Monitoring the building blocks of health systems.

A handbook of indicators and their measurement strategies, 2010, 110. Accessed 16 Oct 2017.

Turinawe EB, Rwemisisi JT, Musinguzi LK, de Groot

M, Muhangi D, de Vries DH, Mafigiri DK, Katamba A, Parker N and Pool R. Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda. Reprod Health 2016; 13: 24.

Anastasi E, Borchert M, Campbell OM, Sondorp E,

Kaducu F, Hill O, Okeng D, Odong VN and Lange IL. Losing women along the path to safe motherhood: why is there such a gap between women's use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda. BMC Pregnancy Childbirth 2015; 15: 287.

Ononge S, Okello SE and Mirembe F. Excessive

bleeding is a normal cleansing process: a qualitative study of postpartum haemorrhage among rural Uganda women. BMC Pregnancy Childbirth 2016; 16: 211.

Rudrum S. Traditional birth attendants in rural northern

Uganda: policy, practice, and ethics. health care for women Int 2016; 37(2): 250-69.

Izudi J, Epidu C, Katawera A and Kekitiinwa A. Quality

Improvement interventions for nutritional assessment among pregnant mothers in northeastern Uganda Biom Res Int. 2017: 8036535.

Maternal and Child Nutrition Study Group, Group

members, Black RE, Alderman H, Bhutta ZA, Gillespie S, Haddad L, Horton S, Lartey A, Mannar V, Ruel M, Victora CG, Walker SP and Webb P. Maternal and child nutrition: building momentum for impact. Lancet 2013; 382(9890): 372-5.

Clifton A, Repper J, Banks D and Remnant J. Co-

producing social inclusion: the structure/agency conundrum. J Psychiatr Ment Health Nurs. Sci Med. 2013; 20(6): 514-24.

Abel T and Frohlich KL. Capitals and capabilities:

linking structure and agency to reduce health inequalities Soc Sci Med 2012; 74(2): 236-44.

Anaf J, Baum F, Newman L, Ziersch A and Jolley G.

The interplay between structure and agency in shaping the mental health consequences of job loss. BMC Public Health 2013; 13: 110.

Bungay V, Halpin M, Atchison C and Johnston C.

Structure and agency: reflections from an exploratory study of Vancouver indoor sex workers. Cult Health Sex 2011; 13(1): 15-29.

Uganda. Ministry of Gender, Labour and Social

Development: The Uganda gender policy, 2007, 20. Accessed 18 Jan 2018.

UNDP/Uganda. Gender equality strategy, 2014-2017:

investing in gender equality for Uganda’s socio-economic transformation, 2016, 14. file:///C:/Users/jnabugoo/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/UNDPUg2016%20-UNDP%20Uganda%20Gender%20Equality%20Strategy.pdf. Accessed 18 Jan 2018.

UN/Uganda. Report on government of Uganda’s

implementation of the Beijing platform for action (1995) and the outcome of the twenty-third special session of the general assembly, 2000, 13. Accessed 18 Jan 2018.


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