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Predictors Of Enrollment Into Community Based Health Insurance Schemes Among Patients with Diabetes Mellitus in Wakiso District – Central Uganda
(Clarke International University, 2023-02) Komugisha, Sarah
Background: This study was done to assess predictors of enrollment into community based health insurance schemes and patients with type II diabetes mellitus in Wakiso district – central Uganda. Diabetes is linked with 1.5 million deaths annually, with all deaths related to poorly controlled diabetes that arise, in part due to non-adherence to medication. Such non-adherence in most cases arises from financial limitations and so, diabetic patients need to have health insurance cover. Currently, CBHI schemes are the most common in developing countries and some have been customized for diabetes patients, as is the case in Wakiso district. However, enrollment into those schemes remains a challenge. Method: The study was cross sectional, targeting 291 diabetic patients in Wakiso district, in which all the three facilities with the CBHI scheme were purposively sampled and patients randomly sampled, following which structured interviews were used to collect data. Data was analyzed in SPSS 25 using the log-binomial model. Results: The proportion of patients with diabetes mellitus in Wakiso district that is enrolled into community based health insurance schemes is 81.4% (237). The prevalence of CBHI enrollment was higher among patients who were Catholics (aPR = 3.982 [CI = 1.190 - 13.318], P = 0.025), who had been educated to secondary school (aPR =12.749 [CI = 3.716 - 43.735], P = 0.000), who rated their health status as being somehow okay had 16 times the odds of being enrolled (aPR = 16.526 [CI = 5.001 - 54.611], P = 0.000). It was however less among patients who had lived with diabetes for less than 5 years (aPR = 0.269 [CI= 0.127 - 0.568], P = 0.001), although it was higher among patients who reported that diabetes medication was always available at their respective health facilities (aPR = 1.979 [CI = 1.066 -3.671], P = 0.030). No bivariate analysis could be conducted because of the null integers in the cells of all cross tabulations between the independent variables and the dependent variable. The null integers notwithstanding, it is evident that there could have been significantly higher proportions of enrolled patients who agreed to the institutional assertions than, those who disagreed. Conclusion: Enrollment into the CBHI among diabetic patients in Wakiso district is high, but not universal, contrary to ideal standards. It is mainly predicted by intrapersonal characteristics and to some extent by institutional characteristics, although it was possible that scheme characteristics are also been of conceivable importance. Behavior change communication will go a long way in increasing enrollment among the patients
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Assessment Of Anticoagulation Control Among Adult Patients On Warfarin Therapy Attending Uganda Heart Institute.
(Clarke International University., 2022-02) Bamwange, Beatrice
Background: Warfarin is an oral anticoagulant prescribed worldwide with a narrow therapeutic index and wide interindividual variability in dose requirement. Due to its difficult in predicting an accurate dose for an individual, it predisposes patients to risks of thromboembolism or even hemorrhagic events associated with underdoing or overdosing respectively. Thus, Time in Therapeutic Range (TTR) is recommended to monitor warfarin anticoagulation control with TTR >60% considered as well controlled. This study assessed the performance of warfarin and associated patients’ and institutional factors on anticoagulation control among adult at UHI, Mulago Hospital from July to October 2021. Methodology: In this study, 157 patients were enrolled, aged 18 to 80 years on warfarin as an anticoagulant control for not less than six months and had a minimum of three INR results. Consecutive and convenient sampling of all patients was done. Patients’ previous three INR results were retrieved from their respective files plus the INR test done on the review date and these were used to calculate the TTR using the Rosendaal’s method of linear interpolation. Quantitative data was entered into MS excel and later exported to the STATA SE13 for analysis while qualitative data was coded manually to generate themes. A TTR >60% was considered good control. Results: The average TTR among the study participants as 45.97% (95% CI=41.51-50.44) and a median of 43% (IQR=24-67). Only 31.21% had a TTR >60. The association between controlled TTR was assessed with; gender, education, comorbidity, comorbidity medication, missed taking warfarin, vitamin K food substance use, use of non–prescribed substances, indication for warfarin, accessing warfarin, paying for warfarin and knowledge regarding warfarin use. Using chi square test and a p value of 0.05, none of the factors was associated with the poor warfarin anticoagulation control. Participants had their views about the services offered at UHI including; appreciation of the cheaper services and quality time with health workers. There were reports on inadequate doctors and long clinic distance. Conclusion and recommendation: There was inadequate anticoagulation control among adult patients on warfarin therapy attending Uganda Heart Institute, Mulago Hospital with a TTR of 45.97 %.The anticoagulation performance of Warfarin was thought to be intrinsic, not affected by the external factors. Therefore, a need to change individuals who are not responding on warfarin to a superior anticoagulant.
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Prevalence OF Cryptosporidium Parvum And Associated Risk Factors Among People Living With HIV Attending ART Clinic AT Wakiso Health Centre IV, Wakiso Town Council
(Clarke International University., 2022-02) Nanziri, Antonie
Introduction: Cryptosporidiosis caused by a coccidian parasite is a common cause of chronic diarrhoea among people living with HIV.It is associated with devastating complications like severe acute malnutrition, severe dehydration, significant weight loss and inflammation of the gall bladder, liver or pancreas. The purpose of the study was to determine the prevalence of cryptosporidium infection and the risk factors associated with cryptosporidiosis among PLWHIV at Wakiso H/CIV. Methods: We enrolled 231 HIV/AIDS patients on ART from July to September 2021. Stool samples were collected from study participants, wet saline preparations made and examined, stool samples concentrated using formal ether concentration, and smears stained using the modified Zeihls-Neilsen technique. Structured questionnaires were used to collect demographic data, patient-related factors and the common signs and symptoms that predisposed the study participants to cryptosporidiosis. Results: Out of 231, 155 (67.09%) were females and 76 (23.67%) males. The age range was 5–67 years and mean age 34.16 years and the CD4 cell count distribution ranged from 100- 800 cells /μl.ART was accessible for 206/231(89.18%). The overall prevalence of cryptosporidiosis was 21.21%. Cryptosporidium infection was found to be associated with animal rearing (p=0.020), duration on ART (p=0.008) with those who had been on ART for .>4 years mostly affected, low CD4 category (P=0.044) and dehydration (p=0.000). There was no significant association between cryptosporidiosis and educational background (P=0.149), marital status (P=0.125), religion (P=0.688), occupation (p=0.125, source of water (p=0.615), ART regimen(p=0.702), ART status(p=0.241), adherence level(p=0.681), diarrhoea(p=0.075), abdominal pain(p=0.596), vomitingp=0.171), nausea(p=0.439) and fever(P=0.940). Conclusion:The prevalence got in this study was high compared to what was observed by other studies done in other parts of Uganda. There is a need for early diagnosis in order to fight the infection, a need to develop more sensitive and specific diagnostic techniques like molecular methods and a need to adopt cryptosporidium screening among the advanced HIV disease priority opportunistic infections Key words: Cryptosporidiosis, HIV, ART, risk factors and prevalence
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Prevalence Of Malaria Among Pregnant Women Attending Kitebi Health Centre III, Kampala District.
(Clarke International University., 2021-11) AFaayo, Jeremiah Morrison
ABSTRACT Background: Malaria is a major public health problem affecting between 250 million people globally every year. In endemic areas, approximately 25 million pregnancies are at risk of Plasmodium falciparum infection every year, and 25% of these women have evidence of placental infection at the time of delivery Objective: The main objective of this study was to determine the prevalence of malaria among pregnant women attending Kitebi Health Centre III Kampala district, Uganda. Methods: A descriptive cross-sectional study was carried out among consenting pregnant women attending antenatal from Kitebi health centre III in November 2021. Self- administered questionnaires were used to obtain socio-demographic and knowledge assessment data . Blood was examined for malaria parasites using Malaria RDTs. Data was entered in Excel and analyzed using Stata ver.13 using univariate and bi variate analysis. Results: The overall prevalence of malaria among pregnant women attending Kitebi Health Center was 19.8% (16/81). None of the socio-demographic factors was associated with malaria prevalence except Tribe where malaria prevalence was high among the Basoga 68.75%(11/16) (p<0.001). Majority of the study participants knew use of intermittent preventive treatment (IPT) 87.65% (71 /81) and mosquito net use 75% (61/81) as the most effective ways of malaria prevention among pregnant women. Recommendations: Mothers should be encouraged to start antenatal as early as first trimester and they should be educated about the importance and proper use of mosquito bed- nets and IPT. Conclusion: The prevalence of malaria among pregnant women was high. Majority of the social demographics were not associated with Malaria prevalence. Participants knew that Intermittent preventive treatment (IPT) and mosquito net use as the most effective ways of malaria prevention among pregnant women.
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Prevalence OF HIV Among HIV Exposed Infants And Associated Factors, AT Art Clinic Bukomero Health Centre IV Kiboga District.
(Clarke International University., 2021-11) Bazanye, Edward
BACKGROUND The sub-Saharan Africa accounts for 80% of all the new mother to child transmission of HIV globally. There has been a decrease in the number MTCT cases in the past years due to an increase in utilization of PMTCT services however there are still gaps in developing countries Objective To determine the prevalence of HIV among HIV exposed infants and associated factors, at ART clinic Bukomero health Centre IV Kiboga district. Methodology It was a descriptive cross-section study among women living with HIV and their infants attending EID department at Bukomero health centre IV. Data was collected using self- administered questionnaires and Laboratory results were obtained by using results obtained from EID department for infants below 18month and determines HIV 1&2 strips with positives confirmed with start Pak for infants at 18month. Results A total of 102 HIV positive women and their infants attending EID department at Bukomero health Centre IV were enrolled. Out of these, more than half 54 (52.9%) of the children were female whereas the males were 48 (57.1%). Majority 70 (68.6%) of the mothers were staying with their husbands, 31 (30.4%) of the mothers were single mothers and only 1% of the respondents were divorced. a prevalence rate of 2% was obtained among the study population. The study also revealed that majority 98 (96.1%) of the mothers received ARVs during their pregnancy, only 4 (3.9%) did not receive the ARVs during the pregnancy period. Similarly, majority 96 94.1%) of the mothers delivered from a health facility. Only 6 (5.9%) of the respondents did not deliver from a health facility and hospital delivery and imitation on ART were significantly associated with prevalence of HIV. Statistical analysis revealed that level of education was significantly associated with the vertical transmission of HIV among exposed children (P<0.05) in the study population. Conclusion and recommendation Generally, the observed prevalence of vertical transmission of HIV is still high in the study area compared to the WHO goal of elimination of vertical transmission of HIV (< 50case in, the utilization of MCH is high and I recommend initiation of mothers on ART and hospital delivery in order to bridge the