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Acceptability, perceived reliability and challenges associated with distributing HIV self-test kits to young MSM in Uganda:
(Wiley Online Library, 2019-04-01) Okoboi, Stephen; Twimukye, Adelline; Oucul, Lazarus; Castelnuovo, Barbara; Agaba, Collins; Muloni, Immaculate; Nanfuka, Mastula; Kambugu, Andrew; King, Rachel
Introduction: HIV self-testing is a flexible, accessible and acceptable emerging technology with a particular potential to identify people living with HIV who are reluctant to interact with conventional HIV testing approaches. We assessed the accept- ability, perceived reliability and challenges associated with distributing HIV self-test (HIVST) to young men who have sex with men (MSM) in Uganda. Methods: Between February and May 2018, we enrolled 74 MSM aged ≥18 years purposively sampled and verbally consented to participate in six focus group discussions (FGDs) in The AIDS Support Organization (TASO Masaka and Entebbe). We also conducted two FGDs of 18 health workers. MSM FGD groups included individuals who had; (1) tested greater than one year previously; (2) tested between six months and one year previously; (3) tested three to six months previously; (4) never tested. FGDs examined: (i) the acceptability of HIVST distribution; (iii) preferences for various HIVST distribution channels; (iv) perceptions about the accuracy of HIVST; (v) challenges associated with HIVST distribution. We identified major themes, developed and refined a codebook. We used Nvivo version 11 for data management. Results: MSM participants age ranged between 19 and 30 years. Participants described HIVST as a mechanism that would facilitate HIV testing uptake in a rapid, efficient, confidential, non-painful; and non-stigmatizing manner. Overall, MSM preferred HIVST to the conventional HIV testing approaches. Health workers were in support of distributing HIVST kits through MSM peers. MSM participants were willing to distribute the kits and recommended HIVST to their peers and sexual partners. They suggested HIVST kit distribution model work similarly to the current condom and lubricant peer model being implemented by TASO. Preferred channels were peers, hot spots, drop-in centres, private pharmacies and MSM friendly health facilities. Key concerns regarding use of HIVST were; unreliable HIVST results, social harm due to a positive result, need for a confirmatory test and linking both HIV positive and negative participants for additional HIV services. Conclusions: Distribution of HIVST kits by MSM peers is an acceptable strategy that can promote access to testing. HIVST was perceived by participants as beneficial because it would address many barriers that affect their acceptance of testing. However, a combined approach that includes follow-up, linkage to HIV care and prevention services are needed for effective results.
Adherence to Iron and Folic Acid Supplementation and Its Associated Factors among Pregnant Women Attending Antenatal Care at Bwindi Community Hospital, Western Uganda
(International Journal of Reproductive Medicine, 2021-06-07) Nimwesiga, Christine; Murezi, Mereth; Taremwa, Ivan Mugisha
This study assessed the adherence to iron and folic acid supplementation and the associated factors among pregnant women attending antenatal care at Bwindi Community Hospital, in Western Uganda. Methods. This was a cross- sectional study that used an interviewer-administered questionnaire and reviewed medical records. Binary and multivariable logistic regression analyses were used to identify factors associated with iron and folic acid supplementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to assess for statistical significance. Results. We enrolled 438 pregnant women aged 16 to 41years. Participants’ mean age (±standard deviation (SD)) was 25.9 (±3.17) years. The self- reported adherence to iron and folic acid supplementation (consumed ≥4 tablets a week or 20 tablets in a month daily without missing the prescribed dosage) was 22.37% (N = 98). Among the adherent pregnant women, the reported reasons (and their respective proportionality) for adherence were getting advice and counseling from the healthcare worker about the good effects of iron and folic acid supplementation (N = 34, 34.69%) and knowledge about the health benefits of iron and folic acid supplementation such as preventing anemia (N = 16, 16.33%), among others. On the other hand, the reported reasons (and their respective proportionality) for iron and folic acid nonadherence were forgetfulness (N = 158, 46.47%), taking too many pills (N = 7, 2.06%), not knowing the usefulness of iron and folic acid supplementation (N = 29, 8.53%), fear of the side effects of the medication (N = 119, 35.00%), and not getting the supplement from the hospital (N = 27, 7.94%). Bivariable and multivariable logistic regression analyses indicated that pregnant women who were primigravida (adjusted odds ratio ðAORÞ = 4:5), who have parity of 2 or 3 (AOR = 3:4), who perceived importance of iron and folic acid supplementation to prevent anemia (AOR = 2:9), and who considered it important to take iron and folic acid supplementation (AOR = 2:9) showed a statistically significant association with adherence to iron and folic acid supplementation. Moreover, pregnant women who perceived the risk of not taking iron and folic acid supplementation (AOR = 5:2), those who received sufficient health education regarding the goals of iron and folic acid supplementation as well as the dangers of not taking the supplements (AOR = 4:4) and adequate counseling, and those who obtained an explanation of the effects of iron and folic acid (AOR = 4:8) showed a significant association with adherence to iron and folic acid supplementation. Conclusion. This study found a low adherence of iron and folic acid supplementation and was associated with obstetric and client- and health system-related characteristics. To this end, there is a need for individualized strategies targeting such factors and intensifying health education, guidance, and counseling to optimize adherence to iron and folic acid supplementation.
Adherence to Iron and Folic Acid Supplementation and Its Associated Factors among Pregnant Women Attending Antenatal Care at Bwindi Community Hospital, Western Uganda
(Hindawi, 2021-06-07) Nimwesiga, Christine; Murezi, Mereth; Taremwa, Ivan Mugisha
Aims/Objectives. This study assessed the adherence to iron and folic acid supplementation and the associated factors among pregnant women attending antenatal care at Bwindi Community Hospital, in Western Uganda. Methods. This was a cross- sectional study that used an interviewer-administered questionnaire and reviewed medical records. Binary and multivariable logistic regression analyses were used to identify factors associated with iron and folic acid supplementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to assess for statistical significance. Results. We enrolled 438 pregnant women aged 16 to 41years. Participants’ mean age (±standard deviation (SD)) was 25.9 (±3.17) years. The self- reported adherence to iron and folic acid supplementation (consumed ≥4 tablets a week or 20 tablets in a month daily without missing the prescribed dosage) was 22.37% (N = 98). Among the adherent pregnant women, the reported reasons (and their respective proportionality) for adherence were getting advice and counseling from the healthcare worker about the good effects of iron and folic acid supplementation (N = 34, 34.69%) and knowledge about the health benefits of iron and folic acid supplementation such as preventing anemia (N = 16, 16.33%), among others. On the other hand, the reported reasons (and their respective proportionality) for iron and folic acid nonadherence were forgetfulness (N = 158, 46.47%), taking too many pills (N = 7, 2.06%), not knowing the usefulness of iron and folic acid supplementation (N = 29, 8.53%), fear of the side effects of the medication (N = 119, 35.00%), and not getting the supplement from the hospital (N = 27, 7.94%). Bivariable and multivariable logistic regression analyses indicated that pregnant women who were primigravida (adjusted odds ratio ðAORÞ = 4:5), who have parity of 2 or 3 (AOR = 3:4), who perceived importance of iron and folic acid supplementation to prevent anemia (AOR = 2:9), and who considered it important to take iron and folic acid supplementation (AOR = 2:9) showed a statistically significant association with adherence to iron and folic acid supplementation. Moreover, pregnant women who perceived the risk of not taking iron and folic acid supplementation (AOR = 5:2), those who received sufficient health education regarding the goals of iron and folic acid supplementation as well as the dangers of not taking the supplements (AOR = 4:4) and adequate counseling, and those who obtained an explanation of the effects of iron and folic acid (AOR = 4:8) showed a significant association with adherence to iron and folic acid supplementation. Conclusion. This study found a low adherence of iron and folic acid supplementation and was associated with obstetric and client- and health system-related characteristics. To this end, there is a need for individualized strategies targeting such factors and intensifying health education, guidance, and counseling to optimize adherence to iron and folic acid supplementation
Agony resulting from cultural practices of canine bud extraction among children under five years in selected slums of Makindye:
(BMC Oral health, 2018) Atim, Fiona; Nagaddya, Teddy; Nakaggwa, Florence; Mboowa, Mary Gorrethy N; Kirabira, Peter; Okiria, John Charles
Background: Canine Bud Extraction (CBE) is a process of removing or gouging children’s healthy canine tooth buds embedded underneath the gum using traditional unsterilized tools. The practice of CBE commonly known as false teeth removal continues to be an adopted cultural intervention of choice, in the prevention of morbidity and mortality from common childhood illnesses. However, it is a practice against the rights of children with serious consequences. While CBE is associated with the perceived myth of curative gains, the agony emanating from the cultural practice exposes children to ill-health conditions such as dehydration, malnutrition, blood-borne diseases like HIV/AIDs, septicemia, fever and death. This research sought to understand the factors underpinning the practice of CBE among urban slum dwellers. Method: A cross-sectional study was conducted from five randomly selected slums in Makindye division; 298 household heads or guardians with children below 5 years, who had ever suffered from false teeth were interviewed. The variables measured included guardians’ socio-demographic profiles, determinants of CBE, common childhood illnesses assumed to be treated with CBE and the reported side-effects associated with the practice. Results: Of the 298 respondents with children who had ever suffered from “false teeth” interviewed, 56.7% had two or more children below 5 years and 31.9% were from the central region. The proportion of households practicing CBE was 90.3%; 69.8% of the caretakers mentioned that it was done by traditional healers and for 12.1% by trained health workers (dentists). Number of children (OR = 2.8, 95% CI: 1.1–7.2) and the belief that CBE is bad (OR = 0.1, 95% CI: < 0.001, p < 0.001) had a statistically significant association with CBE. Additionally, number of children (χ2 = 4.9, p = 0.027) and 2 sets of beliefs (CBE treats diarrhea (χ2 = 12.8, p = 0.0017) and CBE treats fever (χ2 = 15.1, p = 0.0005) were independent predictors of CBE practice. A total of 55.7% respondents knew that there were side effects to CBE and 31% mentioned death as one of them. Conclusion: The high proportion of households practicing CBE from this study ought to awaken the perception that the practice is ancient. CBE in this community as the study suggests was strongly driven by myths. The strong belief that CBE is bad provides an opportunity for concerted effort by primary health care providers, policymakers and the community to demystify the myths associated with false teeth and the gains of CBE.
Alcohol consumption increases non-adherence to ART among people living with HIV enrolled to the community-based care model in rural northern Uganda
(Plos One, 2020-11-24) Adrawa, Norbert; Alege, John Bosco; Izudi, Jonathan
Background Non-adherence to anti-retroviral therapy (ART) is associated with considerable morbidity and mortality among people living with Human Immunodeficiency Virus (PLHIV). Community-based ART delivery model offers a decentralized and patient-centered approach to care for PLHIV, with the advantage of improved adherence to ART hence good treatment outcomes. However, data are limited on the magnitude of non-adherence to ART among PLHIV enrolled to the community-based ART model of care. In this study, we determined the frequency of non-adherence to ART and the associated factors among PLHIV enrolled to the community-based ART delivery model in a large health facility in rural northern Uganda. Methods This analytic cross-sectional study randomly sampled participants from 21 community drug distribution points at the AIDS Support Organization (TASO) in Gulu district, northern Uganda. Data were collected using a standardized and pre-tested questionnaire, entered in Epi-Data and analyzed in Stata at univariate, bivariate, and multivariate analyses levels. Binary logistic regression analysis was used to determine factors independently associated with non-adherence to ART, reported using odds ratio (OR) and 95% confidence level (CI). The level of statistical significance was 5%.. Results Of 381 participants, 25 (6.6%) were non-adherent to ART and this was significantly associated with alcohol consumption (Adjusted (aOR), 3.24; 95% CI, 1.24–8.34). Other factors namely being single/or never married (aOR, 1.97; 95% CI, 0.62–6.25), monthly income exceeding 27 dollars (aOR, 1.36; 95% CI, 0.52–3.55), being on ART for more than 5 years (aOR, 0.60; 95% CI, 0.23–1.59), receipt of health education on ART side effects (aOR, 0.36; 95% CI, 0.12–1.05), and disclosure of HIV status (aOR, 0.37; 95% CI, 0.04–3.20) were not associated with non-adherence in this setting. Conclusion Non-adherence to ART was low among PLHIV enrolled to community-based ART delivery model but increases with alcohol consumption. Accordingly, psychosocial support programs should focus on alcohol consumption.
Anti-Mycobacterial Activity of Medicinal Plant Extracts Used in the Treatment of Tuberculosis by Traditional Medicine Practitioners in Uganda
(Scientific Research Publishing, 2023-02-10) Mpeirwe, Moses; Taremwa, Ivan Mugisha; Orikiriza, Patrick; Ogwang, Patrick Engeu; Ssesazi, Duncan; Bazira, Joel
Tuberculosis (TB) remains a public health challenge and one of the leading causes of death worldwide. TB is preventable and curable. However, treatment of tuberculosis has continued to be difficult as a result of rapid increase of multi drug and extensively drug resistant strains of Mycobacterium tuberculosis. Medicinal plants have for centuries been traditionally used in treatment of tuberculosis and similar ailments. They possess antimicrobial properties which render them a new hope as a source of novel bioactive leads in the development of antimycobacterial agents. In this study, 2 plant species commonly used traditionally in Uganda for treatment of tuberculosis,Zanthoxylum leprieurii and Rubia cordifolia were screened for in vitro antimycobacterial activity against Mycobacterium tuberculosis strains; pan sensitive MTB H37Rv, Rifampicin resistant TMC 331 strain and two wild strains (onerifampicin resistant and another one rifampicin susceptible). Antimycobacterial activity of aqueous, ethanolic and methanolic plant extracts was determined using Resazurin Microtiter Assay (REMA). Both plant extracts exhibited significant in vitro antimycobacterial activity against all strains of My-cobacterium tuberculosis. Minimum inhibitory concentrations (MIC) of methanolic crude extracts of both plants ranged from 23.4 μg/mL to 187.5 μg/mL. Comparatively, methanol extracts of both plants possessed superior antimy-cobacterial activity against all Mycobacterium tuberculosis strains. Our findings indicated that both plants exhibited activity against susceptible and resistant strains of Mycobacterium tuberculosis. While antimycobacterial activity of Z. leprieurii confirms results from previous studies, activity of the extracts of R. cordifolia is reported for the first time in East Africa. Further studies aimed at determining the effects of combination of these plant extracts and standard anti-TB drugs should be carried out.
Assessing Providers’ Approach to Hypertension Management at a Large, Private Hospital in Kampala, Uganda
(Annals of Global Health, 2020) Green, Aliza S.; Lynch, Hayley M.; Nanyonga, Rose Clarke; Squires, Allison P.; Gadikota-Klumpers, Darinka D.; Schwartz, Jeremy I.; Heller, David J
Background: Hypertension is increasingly prevalent in Uganda and its clinical management remains suboptimal across the country. Prior research has elucidated some of the factors contributing to poor control, but little is known about providers’ approaches to hypertension management and perceptions of barriers to care. This is particularly true in private health care settings – despite the fact that the private sector provides a substantial and growing portion of health care in Uganda. Objective: Our exploratory, pragmatic qualitative study aimed to examine the factors affecting the quality of hypertension care from the perspective of providers working in an urban, private hospital in Uganda. We focused on the organizational and system-level factors influencing providers’ approaches to management in the outpatient setting. Methods: We conducted interviews with 19 health care providers working in the outpatient setting of a 110-bed, private urban hospital in Kampala, Uganda. We then coded the interviews for thematic analysis, using an inductive approach to generate the study’s findings. Findings: Several themes emerged around perceived barriers and facilitators to care. Providers cited patient beliefs and behaviors, driven in part by cultural norms, as key challenges to hypertension control; however, most felt their own approach to hypertension treatment aligned with international guidelines. Providers struggled to collaborate with colleagues in coordinating the joint management of patients. Furthermore, they cited the high cost and limited availability of medication as barriers. Conclusions: These findings offer important strategic direction for intervention development specific to this Ugandan context: for example, regarding culturally-adapted patient education initiatives, or programs to improve access to essential medications. Other settings facing similar challenges scaling up management of hypertension may find the results useful for informing intervention development as well.
Assessment of Pneumococcal Conjugate Vaccination on Nasopharyngeal Pneumococcal Carriage:
(SCIENCEDOMAIN international (SDI), 2018-03-21) Onyango, Bournventure; Angurini, Kabaka; Taremwa, Ivan Mugisha
Aims: To determine the nasopharyngeal carriage of Streptococcus pnuemoniae among children under-5 years of age who have been vaccinated with Pneumococcal Conjugate Vaccine (PCV-10) and those unvaccinated in Mbale Municipality, Eastern Uganda. Study Design: This was a cross-sectional study. Place and Duration of Study: The study was conducted in Mbale Municipality Health Centres, Eastern Uganda during the period of September 2015 and June 2016.Methodology: We enrolled 280 children (140 vaccinated with PCV 10 and 140 unvaccinated). Demographic data were obtained from the caregivers and vaccination status from the caregiver and the vaccination card. Nasopharyngeal swabs were tested for Streptococcus pneumonia at least four weeks post-immunization. Pneumococcal carriage was defined by a positive culture, with identification of Streptococcus pnuemoniae. Results: The overall prevalence of Streptococcus pnuemoniae carriage was 123 of280 (43.93%; 95% Confidence interval: 39.88-47.69) with the rate among the immunized of 14.29% (95%% CI: 11.33-16.73), compared to the 78.57% (95%CI: 81.34-88.61) among the unvaccinated children. The odds ratio of pneumococcal carriage was 7.4 among the unvaccinated children compared to the PCV immunized children. Conclusion: Vaccination with PCV offers protection to the risk of pneumococcal carriage. This study emphasizes the value of monitoring for the impact of PCV vaccination program in order to reassure health care workers and families.
Assessment of the accuracy of malaria microscopy in private health facilities in Entebbe Municipality, Uganda: a cross-sectional study
(BMC, 2021) Mutabazi, Tobius; Arinaitwe, Emmanuel; Ndyabakira, Alex; Sendaula, Emmanuel; Kakeeto, Alex; Okimat, Paul; Orishaba, Philip; Katongole, Simon Peter; Mpimbaza, Arthur; Byakika‑Kibwika, Pauline; Karamagi, Charles; Kalyango, Joan Nakayaga; Kamya, Moses R.; Dorsey, Grant; Nankabirwa, Joaniter I.
Background: Although microscopy remains the gold standard for malaria diagnosis, little is known about its accu‑ racy in the private health facilities in Uganda. This study evaluated the accuracy of malaria microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda. Methods: Between April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility‑based smear results were recorded from the participant’s consultation notes, and a research slide was obtained for expert microscopy during exit interview. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant’s clinic visit. Results: The test positivity rate of malaria parasitaemia was 15.0% by expert microscopy. The sensitivity, specific‑ ity and negative predictive value of the facility‑based microscopy were high (95.8%, 90.1 and 99.2%, respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; (1) who had less than 5 years’ experience in reading malaria smears (adjusted Odds Ratio [aOR] = 9.74, 95% confidence interval [CI] (1.06–89.5), p‑value = 0.04), and (2) who was examining less than 5 smears a day (aOR = 38.8, 95% CI 9.65–156, p‑value < 0.001). Conclusions: The accuracy of malaria microscopy in this setting was high, although one third of the patients diag‑ nosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In‑service training may be sufficient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector where accuracy is still poor.
Assessment of the diagnostic performance of TrueHb ® point-of-care hemometer compared with Sysmex i3 analyzer among patients at International Hospital Kampala, Uganda
(Dove Press, 2019-04-01) Taremwa, Ivan Mugisha; Ndeze, Ivan; Mwambi, Bashir; Atuhairwe, Christine; Achieng, Diana Inda; Natukunda, Bernard
Aim/Objective: To assess the diagnostic performance of TrueHb ® point-of-care (POC) hemometer compared with Sysmex i3 analyzer at International Hospital Kampala, Uganda. Materials and methods: We analyzed ethylenediaminetetraacetic acid blood samples to estimate hemoglobin (Hb) levels using parallel testing with TrueHb ® hemometer and Sysmex i3 analyzer. Data were analyzed to ascertain the diagnostic performance of the test assays using the Bland and Altman method. Sensitivity, specificity, positive and negative predictive values were calculated. Results: The study enrolled 402 patients; of these, 156 (38.8%) were males. The average Hb levels were 8.7±1.8 and 13.3±2.6 g/dL for the anemic and nonanemic patients, respectively. One hundred and fifty-five participants were anemic, giving anemia prevalence of 38.56% (95% CI: 35.17–40.38). The mean difference of the TrueHb ® and Sysmex i3 assays was 2.2219 (SD 1.07915), and the two devices did not show a difference in their measurements (t=−2.407, p-value 0.017, 95% CI: −0.095–0.010). Further, they showed a significant level of agreement (t=41.281; 95% CI: 2.1161–2.3277) and intraclass correlation coefficients (ICC=0.793). The sensitivity, specificity, positive and negative predictive values were 100.00%, 51.01%, 55.16% and 100.00%, respectively. The average performance turnaround time (TAT) for the TrueHb ® hemometer was 2.46 mins (95% CI: 2.37–2.55). Conclusion: TrueHb ® POC hemometer is an accurate POC for Hb estimation with a good performance agreement with the Sysmex i3 analyzer. This, coupled with its utility aspects, makes it a good diagnostic tool in a high anemia burden and low-resource setting.
Barriers Associated With Evidence-Based Practice Among Nurses in Low and Middle- Income Countries:
(sigma, 2019-01-03) Shayan, Shah Jahan; Kiwanuka, Frank; Nakaye, Zainah
Background: Evidence‐based practice (EBP) is both a goal and an approach that requires a combination of clinical experience with the most credible recent research evidence when making decisions in healthcare practice. The approach has been widely embraced; however, an evidence‐to‐practice gap still exists. Aim: To assess barriers to EBP among nurses in low‐ and middle‐income countries. Methods: This review conforms to the PRISMA statement. Databases PubMed, Scopus, EMBASE, and Web of Science/Knowledge were searched using a combination of keywords that included “barriers,” “evidence‐based practice,” and “nurses.” The references of the selected articles were also hand‐searched to obtain additional relevant articles. Studies published in peer‐reviewed journals in English between 2000 and 2018 were included in the review. Results: Sixteen articles were included in the analysis, with a total number of 8,409 participants. Both qualitative and quantitative studies were included in the review. Three main themes emerged from eight categories found. The three main themes were institutional‐related barriers, interdisciplinary barriers, and nurse‐related barriers. The theme of institutional‐related barriers emerged from four categories, which included scant resources, limited access to information, inadequate staffing, and lack of institutional support. The theme of interdisciplinary barriers emerged from subcategories that included lack of communication between academic and clinical practice environments, inconsistency between education and practice in the nursing discipline, lack of teamwork, and the public's negative image about the nursing profession. Finally, the theme of nurse‐related barriers emerged from categories including perceived limitations in the scope of nurses’ practice, time, knowledge of EBP, and individual‐related barriers. Linking Evidence to Action: These findings may guide the design of future interventions aimed at fostering EBP. Implementing EBP in practice should be systematic and requires institutional will and interdisciplinary and individual commitment. It should be a collective goal and a win‐win situation for nurses, clinicians, and healthcare organizations.
Breastfeeding cessation in the era of Elimination of Mother to Child Transmission of HIV in Uganda:
(Research Square, 2020-06-08) Okoboi, Stephen; Izudi, Jonathan; Ngbapai, Jackslina Gaaniri
Background: Among human immunodeficiency (HIV) infected mothers, the World Health Organization (WHO) recommends cessation of breastfeeding at one year to prevent HIV transmission but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at one year among HIV infected postpartum mothers at Ndejje Health Center IV, a large Peri-urban health facility in Uganda. Methods: This retrospective cohort study involved all HIV infected postpartum mothers enrolled in HIV care for at least 12 months between June 2014 and June 2018. We abstracted data from registers, held focused group discussions with HIV infected postpartum mothers, and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of HIV infected postpartum mothers who had stopped breastfeeding at one year. We summarized quantitative data descriptively, tested differences in outcome with the Chi-square and t-tests, and established independently associated factors using the modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results: Of 235 HIV infected postpartum mothers, 150 (63.8%) ceased breastfeeding at one year and this was independently associated with the HIV exposed infant (HEI) being female than male (Adjusted risk ratio (aRR): 1.25, 95% confidence interval (CI), 1.04, 1.50), the mother being multiparous than primparous (aRR, 1.26; 95% CI, 1.04-1.53), and breastfeeding initiation on same-day as birth (aRR, 0.06; 95% CI, 0.01- 0.41). Qualitative results showed that partner reminders about breastfeeding adequacy of BF knowledge and maternal literacy facilitated continued breastfeeding until one year. Inadequate breastfeeding knowledge, casual and formal work demands, in addition to increased breastfeeding demand among boys led to cessation of breastfeeding before one year. Conclusion. Cessation of breastfeeding at one year among HIV infected postpartum mothers was sub optimal and this might increase risk of mother to child transmissions of HIV. Cessation of breastfeeding was more likely among female HEIs and multifarious mothers, and less likely when breastfeeding is initiated on same-day as birth. Interventions to enhance cessation of breastfeeding at one year should target groups of women with lower rates.
Circumstances of child deaths in Mali and Uganda:
(Elsevier Ltd, 2018-06) Willcox, Merlin L; Kumbakumba, Elias; Diallo, Drissa; Mubangizi, Vincent; Kirabira, Peter; Nakaggwa, Florence; Mutahunga, Birungi; Diakité, Chiaka; Dembélé, Eugene; Traoré, Mamadou; Daou, Pierre; Bamba, Drissa; Traoré, Amadou; Berthé, Diafara; Wooding, Nick; Dinwoodie, Kieran; Capewell, Sarah; Foster, Hamish; Rowena, Neville; Ngonzi, Joseph; Kabakyenga, Jerome; Mant, David; Harnden, Anthony
Background Interventions to reduce child deaths in Africa have often underachieved, causing the Millennium Development Goal targets to be missed. We assessed whether a community enquiry into the circumstances of death could improve intervention effectiveness by identifying local avoidable factors and explaining implementation failures. Methods Deaths of children younger than 5 years were ascertained by community informants in two districts in Mali (762 deaths) and three districts in Uganda (442 deaths) in 2011–15. Deaths were investigated by interviewing parents and health workers. Investigation findings were reviewed by a panel of local health-care workers and community representatives, who formulated recommendations to address avoidable factors and, subsequently, oversaw their implementation. Findings At least one avoidable factor was identified in 97% (95% CI 96–98, 737 of 756) of deaths in children younger than 5 years in Mali and 95% (93–97, 389 of 409) in Uganda. Suboptimal newborn care was a factor in 76% (146 of 194) of neonatal deaths in Mali and 64% (134 of 194) in Uganda. The most frequent avoidable factor in postneonatal deaths was inadequate child protection (mainly child neglect) in Uganda (29%, 63 of 215) and malnutrition in Mali (22%, 124 of 562). 84% (618 of 736 in Mali, 328 of 391 in Uganda) of families had consulted a health-care provider for the fatal illness, but the quality of care was often inadequate. Even in official primary care clinics, danger signs were often missed (43% of cases in Mali [135 of 396], 39% in Uganda [30 of 78]), essential treatment was not given (39% in Mali [154 of 396], 35% in Uganda [27 of 78]), and patients who were seriously ill were not referred to a hospital in time (51% in Mali [202 of 396], 45% in Uganda [35 of 78]). Local recommendations focused on quality of care in health-care facilities and on community issues influencing treatment-seeking behaviour. Interpretation Local investigation and review of circumstances of death of children in sub-Saharan Africa is likely to lead to more effective interventions than simple consideration of the biomedical causes of death. This approach discerned local public health priorities and implementable solutions to address the avoidable factors identified.
Common uropathogens among diabetic patients with urinary tract infection at Jinja Regional Referral Hospital, Uganda
(Afr J Lab Med, 2018-02-09) Nabaigwa, Barbara I; Mwambi, Bashir; Okiria, John; Oyet, Caesar
Between June 2015 and October 2015, 159 mid-stream urine samples from diabetic patients were cultured. The prevalence of urinary tract infection was high at 22% and women were more affected compared with men (P = 0.017). Factors associated with urinary tract infection in these patients were age, sex and high blood glucose levels. Diabetic patients should be screened periodically for urinary tract infection.
Couples’ decision-making on post-partum family planning and antenatal counselling in Uganda: A qualitative study
(Plos One, 2021-05-05) Willcox, Merlin L.; Mubangizi, Vincent; Natukunda, Silvia; Owokuhaisa, Judith; Nahabwe, Haeven; Nakaggwa, Florence; Laughton, Matthew; Chambers, Isabella; Coates, Sabine; King, Emma; Fall, Emma; Muller, Ingrid; Goodhart, Clare; Graffy, Jonathan
Background Although health workers have been trained to provide post-partum family planning (PPFP), uptake remains low in Uganda. An important reason is that women want the agreement of their partner, who is often absent at the time of delivery. In order to address this, we aimed to understand the views of couples and explore barriers and facilitators to implementation of antenatal couples’ counselling on PPFP in Uganda. Methods We conducted individual interviews with a purposive sample of 12 postpartum and 3 antenatal couples; and 34 focus groups with a total of 323 participants (68 adolescent women, 83 women aged 20–49, 79 men, 93 health workers) in four contrasting communities (urban and rural) in South-West and Central Uganda. These were recorded, transcribed, translated, and analysed thematically. Results Although most participants felt that it is important for partners to discuss family planning, half of the couples were unaware of each other’s views on contraception. Most had similar views on motivation to use family planning but not on preferred contraceptive methods. Most liked the idea of antenatal couples’ counselling on PPFP. The main barrier was the reluctance of men to attend antenatal clinics (ANC) in health facilities. Respondents felt that Village Health Teams (VHTs) could provide initial counselling on PPFP in couples’ homes (with telephone support from health workers, if needed) and encourage men to attend ANC. Suggested facilitators for men to attend ANC included health workers being more welcoming, holding ANC clinics at weekends and “outreach” clinics (in rural villages far from health facilities). Conclusion Antenatal couples’ counselling has the potential to facilitate agreement PPFP, but some men are reluctant to attend antenatal clinics. Counselling at home by VHTs as well as simple changes to the organisation of antenatal clinics, could make it possible to deliver antenatal couples’ counselling on PPFP.
Cross‐sectional study on the adherence to malaria guidelines in lakeshore facilities of Buyende and Kaliro districts, Uganda
(Bio Med Central, 2018-11-19) Kaula, Henry; Kiconco, Sylvia; Luigi, Nunez
Background: Uganda adopted the Integrated Management of Malaria (IMM) guidelines, which require testing all suspected cases of malaria prior to treatment and which have been implemented throughout the country. However, adherence to IMM guidelines has not been explicitly investigated, especially in lakeshore areas such as Buyende and Kaliro, two districts that remain highly burdened by malaria. This study assesses the level of adherence to IMM guidelines and pinpoints factors that influence IMM adherence by health providers in Buyende and Kaliro. A cross-sectional study among 197 patients and 26 healthcare providers was conducted. The algorithm for adherence to IMM guidelines was constructed to include physical examination, medical history, laboratory diagnosis, and anti-malarial drug prescription. Adherence was measured as a binary variable, and binary regression was used to identify factors associated with adherence to IMM guidelines. Results: Only 16 (8.1%) of the 197 patients had their medical history and physical examinations taken, while the majority (65.5%) of the patients were recommended for malaria (laboratory) testing. Regarding adherence to prescription guidelines, 127 (64.5%) of the patients received artemisinin combination therapy (ACT) drug prescription. On the other hand, 18.6% of those who tested negative received an ACT drug/prescription and 10.1% tested positive but did not receive an ACT drug or prescription. Overall adherence to IMM guidelines was only 3.1%. The only factor that significantly influenced adherence to IMM guidelines was training; healthcare providers who had attended recent training on these guidelines were almost three times more likely to adhere to the IMM guidelines compared to those who had not attended recent training (OR = 2.858, 95% CI 1.754–4.659). Conclusions: The findings indicate very low levels of adherence to IMM guidelines among healthcare workers in the lakeshore areas of Kaliro and Buyende districts. Since adherence was independently influenced, majorly by training healthcare workers on these guidelines, recommendations include facilitating training on IMM guidelines throughout Uganda.
Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study
(BMC, 2021) Kibirige, Leonard; Izudi, Jonathan; Okoboi, Stephen
Introduction: Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. Methods: We conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. Results: Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76–17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34–11.38). Conclusion: Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.
Effect of disclosure of HIV status on patient representation and adherence to clinic visits in eastern Uganda:
(Plos One, 2021-10-19) Izudi, Jonathan; Okoboi, Stephen; Lwevola, Paul; Kadengye, Damazo; Bajunirwe, Francis
Background: Disclosure of human immunodeficiency virus (HIV) status improves adherence to antiretroviral therapy (ART) and increases the chance of virological suppression and retention in care. However, information on the effect of disclosure of HIV status on adherence to clinic visits and patient representation is limited. We evaluated the effects of disclosure of HIV status on adherence to clinic visits and patient representation among people living with HIV in eastern Uganda. Methods: In this quasi-randomized study, we performed a propensity-score-matched analysis on observational data collected between October 2018 and September 2019 from a large ART clinic in eastern Uganda. We matched participants with disclosed HIV status to those with undisclosed HIV status based on similar propensity scores in a 1:1 ratio using the nearest neighbor caliper matching technique. The primary outcomes were patient representation (the tendency for patients to have other people pick-up their medications) and adherence to clinic visits. We fitted a logistic regression to estimate the effects of disclosure of HIV status, reported using the odds ratio (OR) and 95% confidence interval (CI). Results: Of 957 participants, 500 were matched. In propensity-score matched analysis, disclosure of HIV status significantly impacts adherence to clinic visits (OR = 1.63; 95% CI, 1.13–2.36) and reduced patient representation (OR = O.49; 95% CI, 0.32–0.76). Sensitivity analysis showed robustness to unmeasured confounders (Gamma value = 2.2, p = 0.04). Conclusions: Disclosure of HIV status is associated with increased adherence to clinic visits and lower representation to collect medicines at the clinic. Disclosure of HIV status should be encouraged to enhance continuity of care among people living with HIV.
The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda
(NCBI, 2018) Atuhairwe, Christine; Amongin, Dinah; Agaba, Elly; Mugarura, Steven; Taremwa, Ivan Mugisha
Background: Breast cancer, the third most frequent cancer of women is preventable through knowledge of breast self-examination. Of the 44% of women diagnosed with breast cancer at the Uganda Cancer Institute, only 22% go for a check-up in less than three months. This study explored the effect of breast cancer knowledge on the uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda. Methods: A household survey of women in Kyadondo County was conducted from June 2014 to August 2015. This involved studying in-depth using a questionnaire the level of breast cancer knowledge of the respondents. Data was analyzed using logistic regression model. Chi-square test was used to establish relationships between knowledge base factors and the uptake of breast cancer prevention modalities. Results: This study has established an empirical relationship between uptake of breast cancer prevention modalities and source of information especially radio (OR 1.94 95% CI: 1.16–3.24), television (OR 1.82 95%CI: 1.14–2.93), awareness of breast cancer (OR 4.03 95%CI: 1.01–15.98), knowledge on how to reduce the risk of breast cancer (OR 1.98 95% CI: 1.20–3.27), what reduces breast cancer acquisition (OR 2.75 95% CI: 1.42–5.35), how to check for signs of breast cancer especially through breast self-examination (OR 3.09 95% CI: 1.62–5.88), and other methods of breast cancer diagnosis in a health care set up. Conclusion: The women’s level of breast cancer awareness as a primary prevention strategy was found wanting, and requires a boost through community health education.
Factors Influencing Annual Procurement Planning of Medicines and Medical Supplies in Public Health Facilities in Kampala District
(AFRICAN JOURNALS ONLINE, 2021-09-10) Ajulong, Martha Grace; Okiria, John Charles; Owako, Martin
Background: Despite significant progress made by many countries towards meeting the millennium development goals and now sustainable development goals, there has been little improvement in access to essential medicines in developing countries. Objectives The main aim of this study is to assess the factors influencing annual procurement planning of medicines and medical supplies in the public health facilities in Kampala district. Methods: This study targeted respondents from government Health facilities in Kampala with a total population of 424 employees and applied simple random sampling to select 206 health workers. The researcher adopted mixed research approach with application of descriptive statistics, correlational and explanatory research designs that were used to maximize reliability and validity of findings. While the qualitative data was gathered through reviewing logistics tools, a physical count of the 30% purposively selected stock cards and interview of the staffs was carried out in health facilities in Kampala district, a Statistical Package for Social Science (SPSS) version 20 was used to analyze the quantitative data. Accordingly, a chi-square was used to determine the association between independent and dependent variables. Results: The findings indicated that 37.8% of the staff responded positively about the availability of annual procurement plan while the rest were from various health facilities. A significant association was observed between knowledge and availability of annual Procurement planning (X2 = 34.7; p value =.0001), as well as management support and Annual Procurement Planning (X2 = 9.87; P value = .008). Conclusion: In conclusion, the finding generated from analysis of quantitative and qualitative data revealed that a majority of the factors influencing annual procurement planning had a positive effect on medical supplies in public health facilities in Uganda although the capacity and capability of health workers, quality of logistics management information systems, and management support desires improvement.

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