ObjectivesDescribe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda.Study designMixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process.SettingThree parishes in Nwoya district in the Gulu region, Northern Uganda.ParticipantsPurposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5–8 participants in each of three parishes.ResultsStakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall.They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient–provider relationships as short-term gains of the codesign.ConclusionParticipatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.

Background Short birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda. Methods Gendered fuzzy cognitive mapping sessions (n = 21), focus group discussions (n = 12), and an administered survey questionnaire (n = 255) generated evidence on short birth intervals. Deliberative dialogues with women, their communities, and service providers suggested locally relevant actions promote culturally safe child spacing. Results Women, men, and youth have clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice as women are disempowered to exercise child spacing. Women who use contraceptives without their husbands’ consent risk losing financial and social assets and are likely to be subject to intra-partner violence. Women were not comfortable with available contraceptive methods and reported experiencing well-recognized side effects. They reported anxiety about the impact of contraception on the health of their future children. This fear was fed by rumors in their communities about the effects of contraceptives on congenital diseases. The women and their communities suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives. Conclusions The economic context, gender power dynamics, inequality, gender bias in land tenure and ownership regulations, and the limited contraceptive supply reduce women’s capacity to practice child spacing.

Introduction: Mother-to-child transmission is the leading cause of HIV infection in children. Without treatment, half of these HIV infected children die before their second birthday.Purpose: To establish the contribution of mother-baby-pair points approach to eMTCT outcomes in Arua District Uganda.Material and Methods: A descriptive and analytical cross sectional study design which employed mixed methods approach was used. 196 HIV positive breast feeding mothers from three government hospitals (Arua Regional Referral Hospital, Adumi Health Center IV and Oli Health Center IV) were interviewed. Data was collected using structured questionnaires, focus group discussions and interviews guides.Results: Majority 168 (85.7%) of the respondents and their babies were enrolled to eMTCT care immediately after delivery and up to 17(8.7%) were enrolled beyond two weeks after delivery. Reasons for enrolment into care included; counseling before, during and after pregnancy on the importance of adherence to ART, early enrolment into care and delivery in a health facility. Most of the babies enrolled in mother-baby-points were HIV sero-negative (75.5%) with only 6.6% of them being sero-positive, thus signifying the contribution of mother-baby-points towards eliminating mother-child-transmission of HIV. Age of mothers was associated with retention on eMTCT care (χ2(5) =11.19, p=0.048). Again, having had any form of education on eMTCT was associated with retention on eMTCT care (p=0.001).Conclusion: The degree of enrollment in to eMTCT care was high but some mothers who still enrolled late. This affects early infant diagnosis, uptake of eMTCT services and retention of mothers and their infants.