Male circumcision is the “surgical removal all or part of the prepuce (foreskin) of the penis” (Van Dam & Anastasi, 2000, p.3). Circumcision is one of the ancient and most common surgical procedures ever practised (Auvert et al., 2009 as cited by Illiyasu, Abubakar, Jibo & Salihu, 2012).Warner and Stratstrin (1981 as cited by Moses, Bailey and Ronald, 1998) revealed that male circumcision in West Africa dates back over 5000years and for at least 3000years in the Middle East. In the later part of the 19th and 20th century circumcision was performed mainly for medical reasons (Wirth 1978 as cited by Moses et al., 1998). Circumcision has been traditionally conducted for various reasons such as hygiene, medical, religion and ethnicity (Van Dam and Anastasi, 2000 as cited by Atashili, 2006). In most cultures, male circumcision is a symbol of manhood associated with bravery and endurance (Doyle, 2005). Moreover, it is also associated with masculinity, social cohesion, self-identity and spirituality (Niang, 2006 as cited by WHO, 2009).

There is compelling evidence that circumcision reduces men’s risk of becoming infected with HIV through heterosexual intercourse by at least one-half, and possibly as much as twothirds. Three randomized clinical trials have shown that men who are circumcised were less than half as likely to become infected with HIV within the trial periods (Auvert et al. 2005, Bailey et al. 2007, Gray et al. 2007). This finding is supported by over 40 sociological and epidemiological studies which show a strong link between circumcision and reduced HIV prevalence (Nagerkerke NJD 2007, Siegfried et al. 2003, Weiss, Quigley, and Hayes 2000).

Based on the data from the clinical trials, models have estimated that routine circumcision across sub-Saharan Africa could prevent up to six million new HIV infections and three million deaths in the next two decades (Williams et al. 2006). Given this strong evidence, the World Health Organisation (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended that male circumcision should be considered as an important and additional intervention for HIV prevention (WHO 2007). As a result, different countries in the sub-Saharan Africa are at different stages of introducing and scaling-up circumcision services.

In 2007, Voluntary Medical Male circumcision (VMMC) program was launched in Southern and Eastern Africa as a recommended preventive strategy supported by WHO, UNAIDS, and others. VMMC emerged as an effective preventive measure to reduce the transmission of viral sexual infections such as the Human Immune Virus (HIV), (Keetile, 2018); herpes simplex type 2, and human papillomavirus (Bailey, 2018; Gray RH, et al (2018). Some studies have indicated that circumcised men were at low risk of acquiring chancroid and syphilis than uncircumcised men (World Health Organization 2019). Other evidence indicated that 48% of women with circumcised men had reduced vaginal infections, for example, trichomonas vaginalis, while in men it reduced genital ulcer diseases (Morris, et al 2019). Male circumcision is a surgical procedure that involves the removal of the foreskin of the penis by a health worker (UNAIDS, 2019). It is a common practice globally done for many reasons that are medical, cultural, religious, or social (Morris, et al, 2016). According to Klausner (2012), an uncircumcised man is likely to acquire HIV because the inner surface of the foreskin contains Langerhans cells where the Human immune Virus (HIV) receptors can attach hence a primary entry of the virus. WHO, (2018) asserts that by removing the foreskin, the glans become keratinized and creates a barrier to the virus to enter through the penis. Globally, 37-39% of men were circumcised, and half of the results for circumcision based on cultural and religious reasons and the last being medical reasons (Morris., et al, 2016).

In Africa, male circumcision is prevalent in North African countries with 93% compared to sub-Saharan African countries with 62%. The findings indicated that male circumcision was performed due to religious reasons more especially in north and western countries of Africa (UNAIDS 2016)

In Uganda, Mangula (2018) report indicated that the percentage of circumcised men rose in 2006 compared to 2016. In 2011, HIV prevalence stood at 4.5% among CM and 6.7% among uncircumcised men. Voluntary Medical Male circumcision was proven as a preventive intervention-reducing female to male transmission of HIV (WHO/Uganda Ministry of Health 2017).financial support and failure to reach the coverage areas were influencing accessibility of men for circumcision but the statistics of eligible men raised from 26.4% in 2011 to 40% in 2014 (Uganda AIDS Commission, 2016). In 2017, 847633 male circumcisions were performed, falling short of targeted annual coverage of 1 million (Uganda Ministry of Health, WHO, 2017).

According to Mpigi hospital records, there is a record that 152 surgical operations were done and only 16 bodaboda men participated despite the support from donors like the Rakai health science program (RHSP), WHO, and Centre for Disease Control (CDC) (HMIS report, 2018). Studies done in other regions about the prevalence and factors associated with low uptake of VMMC among men were; economic reasons, social reasons, culture, fear of pain, long healing, level of education and inadequate health workforce to carry out the services (Wambura et al, 2011). Therefore, the need to find out whether they are the same reasons affecting the uptake of VMMC among bodaboda men in Mpigi Town Council.

Purpose of the study

To identify the prevalence and factors influencing uptake of voluntary medical male circumcision among Bodaboda men in the Mpigi town council as one of the measures to curb the spread of HIV/AIDS.

Objectives

To estimate the influence of Cultural factors on voluntary medical male circumcision uptake in the Mpigi town council.
To determine the facilitators and barriers associated with uptake of VMMC among bodaboda men in the Mpigi town council.
To establish the strategies that encourage bodaboda men to take-up the VMMC in the Mpigi town council.

Research questions

What is the influence of Cultura factors on voluntary medical male circumcision uptake in the Mpigi town council?
What are the facilitators and barriers associated with uptake of VMMC among bodaboda men in the Mpigi town council?
What strategies could be taken to encourage bodaboda men to take-up the VMMC in Mpigi town?

Problem statement

Despite the government effort put in place to aid the prevention of HIV infection through voluntary medical male circumcision in the Mpigi Town Council, there is still a low uptake of VMMCs by the bodaboda men. Health workers try their best to see that they implement government-supported programs like VMMC but such activities are associated with an inadequate health workforce. Among studies that have investigated to reasons for poor uptake indicate that men’s fear of pain, the long period taken to heal, and economic issues could be the major reasons for not taking up the intervention (HMIS, 2018). Bodaboda men take up the significant percentage of men in the Mpigi town council and therefore, their low uptake of VMMCs could facilitate an increase in the spread of HIV/AIDS in this area. In this area of Mpigi no study of this kind has been conducted yet there is need to implement the government initiatives of preventive programmes. Therefore the reason for taking up this project is to establish the factors influencing the uptake of Voluntary Medical Male Circumcision among Bodaboda men in the Mpigi Town Council so that implementation programmes can be developed based on evidence.

Justification

Various studies carried out in Uganda indicated that Uganda aimed to circumcise 80% (4.2 million) of all uncircumcised men aged 15-49 years by the end of 2015. This was achieved by only 50% between 2008-2013 (WHO, 2015). Therefore, this is going to provide insight into the prevalence and factors influencing uptake of VMMCs in Mpigi Town Council, so that what . So far, there is no study done on the same. The generated information could be of use to policymakers and interested Non-Government Organizations (NGOs) to design healthy strategies for the district.

Findings from this study will also act as a foundation for future researchers to find out more about voluntary medical male circumcision in different situations.

Significance of the study

Quantitative research incorporates a survey-based approach to gain feedback concerning populations ideas and opinions. Because of this study, the MOHs’ aim of circumcising 80% of men to prevent the spread of HIV/AIDS by 2030 will be reached.

Conceptual framework

Social-Economic factors

· Currently employed

· Unemployed

· Poverty

Male Circumcision uptake among bodaboda clients

Cultural factors

· Tribe

· Religion

Information factors

· Education

· Exposure to media

Fig 1. Showing the conceptual framework of independent and dependent variables.

Description of the Conceptual Framework

The conceptual framework highlights the relationship between the independent and dependent variables of the study. The dependent variable is the uptake of VMMC and the independent variables are the individual factors, social and economic factors affecting uptake of VMMC uptake among bodaboda men in the Mpigi town council. Some of the individual factors influencing uptake may include age, fear of surgery, fear of pain, fear of delayed wound healing while the social and economic factors may be religion, tribe, employment status, and education among others.

CHAPTER TWO

REVIEW OF LITERATURE

2.0 Introduction

This chapter presents the literature review cited by other scholars about factors affecting the acceptability of voluntary medical male circumcision by men in other areas. The literature will be presented according to the study objectives; a. The prevalence of VMMC in Mpigi town council

2.1 Cultura factors on voluntary medical male circumcision uptake

Several strategies have been implemented in order to curb the spread of HIV including Voluntary Medical Male Circumcision (VMMC). VMMC is defined as the surgical removal of the foreskin by a trained health worker. It is a strategy to prevent the spread of HIV that was recommended by the World Health Organization (WHO) in 2007. It was specifically recommended in countries with high HIV prevalence and low prevalence of male circumcision such as Zimbabwe. This followed results of Randomized Control Trials (RCTs) done in South Africa, Uganda and Kenya which demonstrated that VMMC reduces HIV transmission by up to 60%. It has also been demonstrated that circumcising 80% of men could prevent 45% of new HIV infections between the years 2011 and 2015. However, it is worth noting that VMMC offers partial protection to HIV. This calls for use of other HIV prevention methods in conjunction with the strategy. Moreover, concerns have been raised about possibility of compensatory disinhibition after the procedure.

Apart from the partial prevention of HIV transmission, VMMC has been found to have other medical benefits. These include improvement of personal hygiene, reduction of sexually transmitted infections such as genital herpes, syphilis and Chlamydia, prevention of penile cancer, prevention of ballanitis, prevention of paraphymosis, reduction in risk of urinary tract infections and reduction of cervical cancer risk in partners of circumcised men.

VMMC was seen to be cost effective. An initial investment of US1, 5billion dollars between 2011 and 2015 to achieve 80% coverage of VMMC services in 14 priority countries in Southern and Eastern Africa countries and a further investment of US0, 5billion dollars from 2016 to 2025 to maintain that coverage of 80% would result in net savings of US16, 5 billion dollars between 2011 and 2025

Though being an ancient practise, WHO (2009) estimated that worldwide, only 30% of the males aged 15years and above are circumcised. Around 69% are Muslim, 0.8% are Jewish and 13% are non Muslim and Jewish men living in the United States of America (WHO, 2009). In the Jewish and Muslim religion, male circumcision is chiefly informed by religious beliefs and is mostly carried-out in the eighth and seventh day respectively (WHO, 2009). According to WHO (2009), Buddhism, Christianity and Hinduism have a neutral stance on male circumcision. Various ethnic groups practice MC in Sub-Saharan Africa and in Aboriginal Australasians (Dunsmuir & Gordon, 1999; Beidelman, 1987 as cited by WHO, 2009), the Aztecs and Mayans in the Americas (Tierney, 2003; Remondino, 1891; Schendel, Stellenbosch University http://scholar.sun.ac.za 6

Alvaraz Amezquita, Bustamante Vasconcelos, 1968 as cited by WHO, 2009) and the Philippines and Eastern Indonesia (Hull & Budiharsana, 2001 as cited by WHO, 2009) circumcision has been practised for non religious reasons.

The practise of male circumcision within countries varies. For instance, in Kenya 84% of the men are circumcised, yet, the percentage is much lower for the Luo and Turkana ethnic tribes with 17% and 40 % respectively (DHS, 2006 as cited by WHO, 2009). Similarly, in Uganda and South Sudan male circumcision is not practised among the Jopadhola, Acholi and other Luo-speaking River-Lake Nilotic who are the descendants of the Luo tribe (Bailey et al., 2002 as cited by WHO, 2009). In Tanzania, male circumcision is mainly conducted as a cultural and religious practice (Mujinja et al., 2009). Like in Kenya, the prevalence of the practise among other ethnic groups is low. The Demographic Health Survey data in Tanzania confirmed that 96.8% of Muslim, 60-70% Christians and 25% of men with indigenous beliefs were circumcised (Wambura et al., 2009). On the other hand, Mwanza Region comprise of the customarily non-circumcising population. Seventy-four percent of the Muslim Sukuma men were not circumcised signifying the influence of the non-circumcising tradition among Muslims in this locale (Nnko, Washija, Urassa, & Boerma, 2001).

According to Kripke et al, & Morris et al (2016), it is documented that voluntary medical male circumcision (VMMC) status and sexually transmitted infections (STI’s) risk are associated and VMMC is now part of the HIV prevention programs worldwide.

Since VMMC is a practice done worldwide to treat adverse medical conditions such as phimosis, paraphimosis, balanoposthitis, and penile cancer (Clark et al., 2011; Morris et al., 2014),

No country is likely to have a VMMC prevalence of zero and hence the lowest estimate set for any country is 0.1 %. Approximately, 38% of the world’s males aged 15 -59 years are reported to be circumcised. Of these, 62.1% are circumcised for religious reasons and include the Jews or Muslims. The remaining 37.9% of all the circumcised men embraced safe medical circumcision(SMC), while others got circumcised due to cultural reasons and other aspects (Morris et al., 2016).

In developed countries like Denmark, where non-medical circumcision is rare, a large survey found 4.5 % of Lutheran and non-religious men were circumcised (Frisch et al., 2011). Most of these Medical Circumcisions (MCs) took place after infancy and given the historical opposition to MC in Denmark, the few men circumcised probably for treatment of an adverse medical condition caused by the presence of the foreskin (Frisch et al., 2011). In Australia where MC has been common in infancy for many years, only 11.5 % of men were circumcised after infancy mainly to treat medical conditions such as phimosis; while others were fulfilling parental wishes (Mao et al., 2008).

In Sub Saharan Africa, the prevalence of male circumcision tends to vary due to ethnic and religious differences in the different geographical settings. Within North Africa and West 8

Africa countries which are majorly Islamic, MC is almost universal (WHO and UNAIDS, 2012). In some West African countries such as Burkina Faso and Ghana, the prevalence of circumcision is lower among the traditionalists and highest among the Muslims and Christians. In Cameroon, circumcision is almost universal among all religions except the Animists, among whom there is one particular ethnic group, the Mboum who embrace circumcision as part of their culture (Reed et al, 2012).

The uptake of VMMC in Mutare rural district in Zimbabwe among men aged 15-29 was quite low and was estimated to be at 17% while 83% were not circumcised (Chiringa et al., 2016). In Kenya the proportion of men who reported being circumcised increased significantly from 85.0% in 2007 to 91.2% in 2012. While in Nyanza Province, 66% of males were reported to be circumcised, compared to 91% in the rest of the country (Mwandi et al., 2011). In Tanzania, 70% of the sexually active males are voluntarily circumcised. However, some regions have as high as over 95% circumcision rate, while others are as low as 24% with such differences in the uptake of VMMC attributable to culture, traditions and religions (WHO, 2011).

The 2011 modeling for Uganda revealed that in order to attain 80% MC prevalence by 2025, it needed to perform 4.25 million MCs and an additional 2.1 millionin the years 2016 to 2025 (Hankins et al., 2011). Obama supported a target of having 4.7 million MCs by end of 2014 on World AIDS Day 2011 (Kripke et al., 2016). In 2014, the Uganda Aids Commission reported the national SMC prevalence in Uganda of about 40% (UAC, 2014). Between April 2013 and August 2017, only 188,512 males were circumcised at the national level (, 2017). The prevalence of VMMC uptake has been documented only in few regions of Uganda. According to a study that was carried out by TASO in Masaka district, prevalence of VMMC among the population was found to be 34% (UNAIDS, 2015). In general, the prevalence of uptake of SMC varies considerably according to geographical location, with figures ranging from 2% in the Mid Northern region to 53% in the Mid-Eastern region of Uganda (Reeds et al., 2012).

2.2 Facilitators and Barriers associated with the uptake of Voluntary Medical Male Circumcision (VMMC) referring.

The findings among the students at Midlands State University (MSU) by Mtemeri et al., (2013) revealed that a few were willing to go for circumcision because they were not aware of the importance of being circumcised and but had the opinion that some men do not opt for this method of prevention because the surgery is painful. ‘‘I was afraid because those who had gone for the circumcision were saying that it was very painful when the foreskin is cut, during suturing, and then after that you were unable to perform your normal duties as usual.” (FGD, respondent).

In a study it was revealed that the main source of information about male circumcision was through media especially radio was the major source of information, followed by newspapers. Significant number of the male had also discussed the issue with friends and a few had read about male circumcision from posters and flyers (Naidoo et al., 2012).

“For me I heard from the radio that to do circumcision is good because it protects a person from getting HIV and other sexually transmitted diseases so that is what encouraged me to go for cicumcision.” (focused group discussion, respondent).

“For me I heard from the health care providers that male circumcision is very good because it protects an individual from contracting HIV and other sexually transmitted diseases therefore that is what encouraged me to go for male circumcision.” (FGD, respondent).

The findings from another study also showed that some people were not aware of the importance of male circumcision. A few identified it for reduction of STI/HIV transmission, while some felt that it was just a religious practice or just to keep clean. This showed the inadequate knowledge about male circumcision (Bailey et al, 2014). “For me in our family we were born Christians, no one who is circumcised and we were told that if anyone gets circumcised, it will be easy for that person to convert to Muslim region so that is why am not circumcised.” (FGD, respondent).

Mbabazi (2011) agree with the results of this study in that the major reason for men refusing to be circumcised is fear of pain, some men felt that they were too old for the surgery. This fear of pain and opinion about when to get circumcised indicates that information that gets to people about male circumcision is not fully addressing their concerns hence the inadequate knowledge and low turn up from communities.

In a study by Rapfute et al., (2014) about factors associated with uptake of VMMC, Mazowe district, Zimbabwe it was revealed that voluntary medical male circumcision was deterrent that most men wanted to keep it private and personal but the facility was exposed.

A research carried out in Machinga District Malawi (2017), showed that fear of complications associated with VMMC kept away some men from undergoing the procedure. They also stated that after operation they may fail to put on under wears and puts on women clothes and eventually you can die of severe bleeding. Fear of pain associated with undergoing the procedure, post-operative healing process and bleeding prevented them from accessing the VMMC services. (Albert et al., 2011)

A study done on male circumcision and penile sensitivity reported that circumcision after puberty reduces sexual pleasure and lower orgasm intensity due to much effort needed to achieve orgasm in clients. Some clients feared the complained issues stated by circumcised men like numbness, unusual sensations such as burning, prinking, itching or tingling. (Bronselar et al., 2013).

“I really tell you that I was told that men who are circumcised some time their sexual performance reduces even ending up not producing children.” (FGD, respondent).

A study by Gasarira et al (2013), found out that old age was the main reason for the failure to attend voluntary medical Male Circumcision.

A study carried out by Plotkin et al (2013), showed that lack of special rooms to keep circumcised old men out of sight by their relatives and other villagers who visited hospital was perceived shameful. Such an environment compromises the status of adult men who enjoy a privilege place in society.

According to Kighoma (2011), when a follow up on the clients was made to ascertain the reasons for not turning up, the following were elicited; too busy to attend, refused by spouse, no longer interested, had health problems, refused by parents and was at school

A study carried out in Tanzania by Wambura et al., (2011), men and women said that cultural values did not support safe voluntary medical male circumcision after adolescence stage. Therefore, whoever above adolescent stage could not go for circumcision, which showed inadequate knowledge about the relationship.

“Tell you what most of my friends are not circumcised and even in our family so I do not see the reason why I go for male circumcision (FGD, respondent)

A research carried out by Adams (2012) on the low utilization of male circumcision services in Kwaluseni, Swaziland showed that loss of income as they miss to go work during healing period prohibited them from getting circumcised.

In a study to find on male circumcision; willingness to undergo male circumcision and HIV risk behaviours among Men in Botswana, it was revealed that some individual couldn’t attend circumcision services because of high transport money to health centres (Keetile and Rakgoasi, 2014).

Herman-Roloff et al., (2011) in their study on acceptability of medical male circumcision among uncircumcised men in Kenya one year after the National Male Circumcision Program revealed that delayed wound healing and prolonged time away from work are common barriers of male circumcision uptake amongst men. It is therefore paramount that the authorities responsible improve the quality of VMMC services focusing on reducing delayed wound healing time so that this does not stand as a barrier towards VMMC. ‘‘It will be difficult for my people to have what to eat because of staying at home not working in the process of healing.’’ (FGD, respondent)

A research conducted in Machinga District in Malawi, many participants stated that costs incurred in form of transport to access free VMMC services, payments for the procedure in private health facilities as in Zambia made them not to go for circumcised. (Masase et al, 2017)

A research carried out in Nyaza, Kenya (2012), stated that occupation also appeared to be a factor in men’s hesitation to seek VMMC services. Men working in the transport sector e.g. Bodaboda cyclists and those engaged in jobs involving manual labor or being in water (fisher men) said that they were reluctant to seek for VMMC services due to physical demand of their job. Other men’s financial concerns seemed to stem from misinformation. They confused the period they would need to be away from work (1-3 days is recommended) following VMMC with the prescribed 6-weeks period of abstinence time (Ssekubugu et al., 2013)

Plotkin et al.2013 in their study on the social and individual factors affecting adult attendance at VMMC services in Tanzania revealed that participants in the study had concerns about income loss during the post-surgical recovery period where they claimed it took long for them to heal and resume work

In another study on factors, contributing to the low uptake of VMMC in Mutare rural district, Zimbabwe found out that circumcision was likely to take their time from work hence where hesitant to attend (Chiring et al, 2016).

A research carried out in Mutare rural district in Zimbabwe, 95% reported absence from work during healing period, 49% reported persistent pain may result in job loss and others stated lack of money for transport to seek health services in case of any complication after surgery. (chiring,2016)

Despite all that cited literature above, no literature was found from the study area hence the need for this study.

3.3 Strategies to encourage bodaboda men to uptake VMMC in Mpigi town council

There have been many reasons given by bodaboda men hindering them from attaining the VMMC services and these included; Individual, Social and Economic factors. There are a number of strategies done in different areas according to the literature

A study done in Tanzania by Wambura et al (2017) highlighted that there was need to improve the communication skills in order to empower the men with knowledge about the benefits of VMMC and train their partners.

According to Kennedy et al (2020) a systematic review and a meta-analysis to increase the uptake of VMMC for HIV prevention in the sub Saharan African countries done and it stated that when the clients were supported economically with transport and food vouchers selected carefully, it improved the uptake of VMMC by the potential clients.

Wambura et al (2017) pointed out that proper timing for the athletes, anglers and school going children as well as telling the clients the benefits of VMMC increased the uptake of by men in that area.

circumcision leads to a decrease in STIs and a possible reduction in micro tears and trauma to the foreskin during sex (Rasool, Sameer &Saddiqi, 2011). Based on the epidemiological and experimental substantiation, MC could have a considerable impact on the HIV epidemic especially among the most highly affected countries (Westercamp and Bailey, 2007). In fact, models have estimated that routine MC in Sub-Saharan Africa could highly avert about 6 million new infections and 3 million deaths in the next two decades (Williams et al., 2006 as cited by Wambura et al., 2009).

CHAPTER THREE

METHODOLOGY

3.1 Introduction.

This chapter presents the research methodology, including the study setting, study design, study variables, sample size and sampling procedure. It also describes quality control, how data was processed and presented, tools and methods of data collection, ethical consideration of study results.

3.2 Study Design

The study will be descriptive cross sectional design using quantitative method of data collection. This descriptive and cross sectional design will provide information on which further studies will be carried out on factors affecting acceptability of VMMC. Quantitative method will be used in order to provide numerical values to be presented descriptively. The choice of this technique is also guided by the fact that the study aims at generating findings, which would facilitate a general understanding and interpretation of the problem.

3.3 Study Setting

The study will be conducted in Mpigi Town Council, Mpigi District. The Town Council has 20 bodaboda stages. Mpigi district is 150 km South West of Kampala Uganda’s capital city with an urban population of approximately 13464 people (UBOS, 2014). It inhabits people of different economic status and economic activities. For example, bodaboda riding, social centers like bars and lodges where people drink and smokes a lot after work. The commonest tribe in the area are Baganda whose stable foods are Matooke, cassava, maize, and coffee being their cash crops. The political setting is the town council.

3.4 Study Population

The study population involved bodaboda members operating in Mpigi Town Council. This was because they are the ones with low turn up for VMMC in the town council; this population was targeted for the study aimed at finding out factors affecting the acceptability of VMMC in Mpigi Town Council.

3.4.1 Sample Size Determination

Mugenda and Mugenda (2003), argue that it is impossible to study the whole targeted population and therefore the researcher shall take a sample of the population. A sample is a subset of the population that comprises members selected from the population. Using Krejcie and Morgan’s (1970) table for sample size determination approach, a sample size of 52 Boda Boda riders will be selected from the total population of 60 Boda Boda riders in Mpigi townn council.

3.4.1 Sampling Procedure

Simple random sampling employed. First the different bodaboda stages were randomly selected then the respondents also selected by simple random sampling method, whereby those at stage were considered. The names then coded. The codes of all the boda men were placed on pieces of paper of the same size, color or texture (one code per paper). These then were placed in a box. The box was shaken, and the research assistant asked to pick one piece of paper. Then shaken again, and another piece of paper picked. This procedure continued until 50 pieces of paper are picked, corresponding to the number of bodaboda men needed. The boda men of the codes on the picked papers were selected to participate in the study.

I then the men selected were briefed about the purpose of the study, and then requested them to offer the information needed for the study. In case the man declined to participate in the study, another was selected to replace him in the manner described above.

3.4.3 Inclusion Criteria.

All bodaboda cyclists who were willingly consented and operated in Mpigi Town Council were considered for the study.

3.4.4 Exclusion criteria

The study will not include people who are not boda riders and also it will be strictly for men above 18 years. The reason for choosing only Boda Boda riders is because this is the study topic.

The people below 18 years will also not be included in the study becaue at that age the children are not expected to be incolved into sexual activity and minor donot have the priviledge to determine their choices.

3.5 Definition of Variables

Variables were characters or ideas that vary from person to person or place to place. This study used both dependent and independent variable.

3.5.1 Dependent variables

These were outcomes or effects of the independent variables. The dependent variables were;

The low turn up for VMMC by bodaboda men in Mpigi Town Council Mpigi district.

3.5.2 Independent variables

These were the presumed cause underlying a phenomenon or the predictors. The independent variables included;

Cultural factors

Social-economic factors

Information factors

3.6 Research instruments

For this study, data will be collected from primary and secondary sources. As such the following data collection methods will be used; Questionnaire survey method, Interview method of data collection and Documentary Review method. The Questionnaire method will be selected for its ability to gather information faster and best for large population.

3.6.1 Questionnaire Method

This involves the use of questionnaire instrument that consists of a number of questions and prompts used to elicit responses from respondents to generate raw data (Abawi, 2017). My major method of data collection in this study will be the questionnaire method. this will invove desighning the questionnaire and handing it over to the respodents. The choice is made based on its being best for sensitive and more personal information, less costly and can offer consistent and objective views of respondents (Abawi, 2017) and (Kabir, 2016).

3.7 Data Collection Procedure

The researcher will seekst for an introduction letter from the Agakhan university to help introduce me to Mpingi health centre IV will grant e permissions and in turn introduced me to the respondents. The researcher will then seek an informed consent of the respondents and administer the questionnaires to the Boda Boda riders around Mpigi Health centre IV and give them time to fill in the information and after three days collecte the completed questionnaires.

3.7.1 Data Management

The data collection tool was carefully designed and edited before it was issued out to the respondents. This was to ensure that data was of quality, accuracy, and complete. Respondents were coded to facilitate analysis.

3.7.2 Data processing and Analysis

Data processing shall be done by entering the data into a statistics package for social sciences (SPSS) in line with the research questions. Data analysis shall be done by also using this statistics package for social sciences (SPSS) to formulate frequency tables where the mean, variance and standard deviation will be obtained.

3.7.3 Pre-visiting

Prior to the study, the study setting was visited; this will help the researcher to acquaint herself within the study area. This also helped the researcher in contacting the relevant authorities for necessary consent and there after a data collection plan to be established.

3.7.4 Pre-testing

The tools for data collection were tested before their actual use to ensure relevancy and smooth flow of questions. The tools were pre-tested from 10 bodaboda members in Mpigi town of Mpigi District. Pre-testing helped in verifying the reliability and validity of the tools. After the pre-test, unnecessary questions was deleted and ambiguous questions made clear.

3.7.5 Editing and storage

This was done at the end of each data collection to identify omissions and errors in the research tools to ascertain consistency, completeness and accuracy of information obtained. This was done by the researcher by reading through the scripts and ensuring that answers given were recorded correctly against each question and then kept well in a locker for safety.

3.8 Ethical Consideration.

The research proposal was submitted to the research committee of Agha Khan University were it was approved. A written and verbal consent was sought from the respondents prior to the administration of the research tool. For confidentiality purpose, names and titles of the participants’ were not put in the research. The purpose of the study was explained to the respondents, confidentiality of the information obtained and their will to participate and withdrawal was granted. And at the end of each interview, the respondents were thanked or appreciated for their time and willingness to participate.

3.9 Limitation of the Study

Some of the respondents were not very free to reveal some information for fear of victimization. This was alleviated by assuring confidentiality of the results.

Inadequate resources in terms of funds, this was managed through employing high level of financial discipline by following the budget.

Some respondents expected financial payment but this was addressed by explaining the purpose of the study.

Majority of respondents did not understand English but this was addressed by interpreting the questionnaire to them in order to acquire desired results.

3.10 Dissemination of the Study Results

Completed copies of the research report were distributed to the following offices;

Uganda Nurses and Midwives Examination Board (UNMEB)

Aga Khan University

Research supervisor

REFERENCES

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CHAPTER ONE: INTRODUCTION

Background