Annet Nanvubya

Project summary

Fishing communities make a great contribution to food security, foreign exchange and local government revenue. In Uganda, they have been reported to contribute close to 30% of the country’s Gross Domestic Product (GDP). Nevertheless, these communities, hitherto which are considered “hard to reach areas”, are typically characterized by a high presence of bars, lodges and entertainment halls, commercial sex activities, high alcohol consumption, multiple and concurrent sexual partnerships. Close to one third of the population comprises of teenagers who tend to be emancipated minors. These communities have very limited access to basic health care services including reproductive health services; conditions which are believed to make them highly vulnerable to unwanted or unintended pregnancies, sexually transmitted diseases including HIV and related complications. In order for people in fishing communities to lead healthier lives, their reproductive health services particularly family planning need to be improved. Fisher folk especially fishermen and fish traders, are known to be very mobile moving between islands and landing sites in a predictable manner according to seasonal variations in fish yield. This mobile lifestyle is believed to be contributing to their risk taking behaviors partly due to absence from their spouses and lack of constant social and spousal audit. So they tend to have extra marital  partnerships with a relatively low level of condom use which predisposes them to fathering unwanted children and leads them to acquiring HIV and other sexually transmitted infections in the process. The HIV incidence and prevalence rates for fishing communities in Uganda are 4-5 times higher than the national averages. In order to help control the HIV epidemic in this population, an effective, safe, efficacious and affordable preventive HIV vaccine alongside other HIV preventive measures is urgently needed as part of a broader prevention effort. Getting a vaccine however, requires different candidate vaccines to be tested for efficacy in high risk populations which testing requires that research participants of reproductive age use family planning and receive related counselling since little or no human data exist regarding vaccine safety in pregnancy. The high HIV infection rates in fishing communities make them an ideal study population for future HIV vaccine efficacy trials. As preparations to conduct HIV vaccine efficacy trials in these communities proceed, it is crucial that sexual and reproductive health needs in these communities are prioritized. Uganda has a population of approximately 35 million people, almost 10 million of which are women of reproductive age (15-49 years). The annual growth rate is approximately 3.03 percent and the total fertility rate (TFR) remains high at 6.2 children per woman. Family planning remains one of the most cost-effective public health measures available for controlling population growth. It allows individuals and couples to anticipate and attain their desired number of children by spacing and timing of their births. On the other hand, family planning is associated with lower rates of maternal and infant mortality and leads to economic growth. In Uganda, the unmet need for family planning is high previously estimated to be 41%. Fishing communities however, are presumed to have a much higher unmet need with a high fertility rate of more than 7 children for a woman of reproductive age as compared to the national 6.2. Improving FP services in fishing communities remains critical because of their rapid population growth, high HIV infection rates, and high numbers of teenage/adolescent mothers. Expanding access to and improving the quality of family planning programs in resource limited settings like fishing communities is central to improving and maintaining the health of individuals and societies in order to help them reach their full potential. I set out to conduct a study where baseline information about knowledge, uptake and unmet need of family planning will be collected. Thereafter, a randomized control trial will be conducted among 1004 randomly selected participants. Half of them will be health educated about family planning using a standardized WHO family planning tool and the other half (control arm) will be counselled on FP following the Ministry of health guidelines. All participants will be offered family planning methods of their choice and will be followed up for 12 months. Afterwards, knowledge, uptake and unmet need levels in the control and active arms will be compared. Study participants will be recruited from two fish landing sites in Uganda.