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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.
Human Papillomavirus Vaccination Uptake and Its Predictors Among Female Adolescents in Gulu Municipality, Northern Uganda
(Dovepress, 2022-09-25) Aruho, Caroline; Mugambe, Samuel; Baluku, Joseph Baruch; Taremwa, Ivan Mugisha
Background: Human papillomavirus (HPV) is the putative case of cervical cancer. However, uptake of HPV vaccination is reportedly low in Uganda. This study explored the predictors of HPV vaccination uptake among female adolescents aged 15–18 years in Gulu Municipality, in northern Uganda. Methods: This was an analytical cross-sectional survey that was conducted among adolescents aged 15–18 years in Gulu Municipality. A structured questionnaire was used. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Descriptive statistics and a log binomial model were used to analyze the factors associated with HPV vaccination uptake. Results: Less than a quarter of the female adolescents (22%) aged 15–18 years in Gulu municipality, Gulu district, had been vaccinated with the human papillomavirus vaccine. HPV vaccination uptake was lower by 23% among adolescents who stayed with their mothers only (aPR = 0.769, CI = 0.595–0.995, P = 0.046), and by 14% among adolescents whose parents were unmarried (aPR0.859, CI = 0.776–0.951, P=0.003). Conclusion: This study reports a low HPV vaccination coverage among adolescents in Gulu Municipality, which is associated with parental perceptions and marital status. Efforts to increase uptake should focus on parents of adolescents.
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.
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.
Unsuppressed viral load after intensive adherence counselling in rural eastern Uganda;
(BMC Health Services Research, 2021-12-18) Ndikabona, Geoffrey; Alege, John Bosco; Kirirabwa, Nicholas Sebuliba; Kimuli, Derrick
Background:The East Central (EC) region of Uganda has the least viral suppression rate despite having a relatively low prevalence of human immunodeficiency virus (HIV ). Although the viral suppression rate in Kamuli district is higher than that observed in some of the districts in the region, the district has one of the largest populations of people living with HIV (PLHIV ). We sought to examine the factors associated with viral suppression after the provision of intensive adherence counselling (IAC) among PLHIV in the district. Methods: We reviewed records of PLHIV and used them to construct a retrospective cohort of patients that started and completed IAC during January – December 2019 at three high volume HIV treatment facilities in Kamuli district. We also conducted key informant interviews of focal persons at the study sites. We summarized the data descriptively, tested differences in the outcome (viral suppression after IAC) using chi-square and t-tests, and established indepen-dently associated factors using log-binomial regression analysis with robust standard errors at 5% statistical signifi-cance level using STATA version 15. Results: We reviewed 283 records of PLHIV. The mean age of the participants was 35.06 (SD 18.36) years. The major-ity of the participants were female (56.89%, 161/283). The viral suppression rate after IAC was 74.20% (210/283). The most frequent barriers to ART adherence reported were forgetfulness 166 (58.66%) and changes in the daily routine 130 (45.94). At multivariable analysis, participants that had a pre-IAC viral load that was greater than 2000 copies/ml [adjusted Prevalence Risk Ratio (aPRR)= 0.81 (0.70 - 0.93), p=0.002] and those that had a previous history of viral load un-suppression [aPRR= 0.79 (0.66 - 0.94), p=0.007] were less likely to achieve a suppressed viral load after IAC. ART drug shortages were rare, ART clinic working hours were convenient for clients and ART clinic staff received training in IAC. Conclusion: Despite the consistency in drug availability, counselling training, flexible and frequent ART clinic days, the viral suppression rate after IAC did not meet recommended targets. A high viral load before IAC and a viral rebound were independently associated with having an unsuppressed viral load after IAC. IAC alone may not be enough to achieve viral suppression among PLHIV. To improve viral suppression rates after IAC, other complementary services should be paired with IAC
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.
Prevalence of Anemia and Its Associated Socio-Demographic Factors Among Pregnant Women Attending an Antenatal Care Clinic at Kisugu Health Center IV, Makindye Division, Kampala, Uganda
(Dovepress, 2020) Mahamoud, Naimo Khalif; Mwambi, Bashir; Oyet, Caesar; Segujja, Farouk; Webbo, Fred; Okiria, John Charles; Taremwa, Ivan Mugisha
Aims/Objectives: This study sought to determine the prevalence, morphological character- ization and associated socio-demographic factors of anemia among pregnant women attend- ing Kisugu Health Centre IV, Makindye Division, Kampala, in Uganda. Methods: This was a cross-sectional study that employed laboratory analysis of blood samples to determine hemoglobin concentration, and a structured questionnaire to obtain socio-demographic factors associated with anemia during pregnancy. Results: We enrolled 345 pregnant women aged 15 to 43 years. The median, interquartile range, and mean Hb levels were 8.1g/dL, 6.4 ± 2.1g/dL and 7.9g/dL, respectively. There were 89 participants whose Hb levels were indicative of anemia, giving anemia prevalence of 25.8% (95% confidence interval: 21.6–29.8). Of these, 25 (28.1%) had mild anemia, 46 (51.7%) had moderate anemia, while 18 (20.2%) had severe anemia. Thin blood film examination showed normocytic-hypochromic (75.3%), then microcytic-hypochromic (21.6%), and macrocytic- hypochromic red blood cells (3.4%). The socio-demographic factors of gestational age, parity, and mother’s occupation were significantly associated with the risk of anemia (p< 0.05). Conclusion: We report a high prevalence of anemia among pregnant women; with a majority of hypochromic-microcytic anemia. This may necessitate more anemia awareness and it requires institution of nutritional interventions to avert fetal-maternal complications
Socio-Demographics and Late Antenatal Care Seeking Behavior: A Cross Sectional Study among Pregnant Women at Kyenjojo General Hospital, Western Uganda
(Scientific Research Publishing, 2020-01-17) Komuhangi, Grace
Background: Late antenatal care attendance among pregnant women at health facilities remains a significant public health problem. Globally, approximately 830 women die every day due to pregnancy-related complications and 99% of these deaths occur in developing countries whereby 86% of pregnant women access Antenatal Care (ANC) services at least once. Objective: The general objective of the study was to determine factors associated with late antenatal care seeking behavior among pregnant women at Kyenjojo general hospital. Methods: This was a descriptive cross sectional study design that considered quantitative data collection methods among pregnant women attending ANC. The sample size was determined using Kish and Leslie (1969) formula using a proportion of 37% (0.37) of women who sought late ANC. A systematic sampling technique was used to sample pregnant women on daily basis. Results: A total of 283 women participated in the study. Spouse’s occupation was significantly associated with late ANC attendance (p = 0.026). On the other hand, education level of respondent (Fisher’s = 8.363, p = 0.028*), religion (Fisher’s = 5.77, p = 0.048*) and parity (Fisher’s 10.312, p = 0.026*) revealed statistically significant association with late ANC attendance. In multivariate logistic regression, on occupation, women with unemployed spouses were significantly associated with 25% increase in attendance of late ANC compared to those in formal employment (AOR = 0.25, CI: 0.073 - 0.855, p = 0.027*). Conclusion: The Majority of pregnant women sought ANC at 90.1% (n = 255). There’s a need for government to strengthen health promotion targeting women in rural communities.
Peer distribution of HIV self-test kits to men who have sex with men to identify un-diagnosed HIV infection in Uganda:
(Plos One, 2020-01-23) Okoboi, Stephen; Oucu, Lazarus; Castelnuovo, Barbara; Nanfuka, Mastula; Kambugu, Andrew; Mujugira, Andrew; King, Rachel
Introduction One-in-three men who have sex with men (MSM) in Uganda have never tested for HIV. Peer-driven HIV testing strategies could increase testing coverage among non-testers. We evaluated the yield of peer distributed HIV self-test kits compared with standard-of-care testing approaches in identifying undiagnosed HIV infection. Methods From June to August 2018, we conducted a pilot study of secondary distribution of HIV self-testing (HIVST) through MSM peer networks at The AIDS Support Organization (TASO) centres in Entebbe and Masaka. Peers were trained in HIVST use and basic HIV counselling. Each peer distributed 10 HIVST kits in one wave to MSM who had not tested in the previous six months. Participants who tested positive were linked by peers to HIV care. The primary outcome was the proportion of undiagnosed HIV infections. Data were analysed descriptively. Results A total of 297 participants were included in the analysis, of whom 150 received HIVST (intervention). The median age of HIVST recipients was 25 years (interquartile range [IQR], 22–28) compared to 28 years IQR (25–35) for 147 MSM tested using standard-of-care (SOC) strategies. One hundred forty-three MSM (95%) completed HIVST, of which 32% had never tested for HIV. A total of 12 participants were newly diagnosed with HIV infection: 8 in the peer HIVST group and 4 in the SOC group [5.6% vs 2.7%, respectively; P = 0.02]. All participants newly diagnosed with HIV infection received confirmatory HIV testing and were initiated on antiretroviral therapy. Conclusion Peer distribution of HIVST through MSM networks is feasible and effective and could diagnose more new HIV infections than SOC approaches. Public health programs should consider scaling up peer-delivered HIVST for MSM.
Practice, perceived barriers and motivatingfactors to medical-incident reporting:
(BMC Health Services Research, 2020) Naome, Turyahabwe; Mwesigwa, James; Atuhairwe, Christine; Taremwa, Ivan Mugisha
Background:Medical-incident reporting (MIR) ensures patient safety and delivery of quality of care by minimizingunintentional harm among health care providers. We explored medical-incident reporting practices, perceivedbarriers and motivating factors among health care providers at Mbarara Regional Referral Hospital (MRRH). Methods:We conducted a cross-sectional descriptive study on 158 health provider at Mbarara Regional ReferralHospital (MRRH), Western Uganda. Data was gathered using a structured questionnaire and analyzed with SPSS. Thechi-square was used to determine factors associated with MIR at MRRH. Results:The results showed that there was no formal incident reporting structure. However the medical-incidencesidentified were: medication errors (89.9%), diagnostic errors (71.5%), surgical errors (52.5%) and preventive error(47.7%). The motivating factors of MIR were: establishment of a good communication system, instituting correctiveaction on the reported incidents and reinforcing health workers knowledge on MIR (p-value 0.004); presence ofeffective organizational systems like: written guidelines, practices of open door policy, no blame approach, andteam work were significantly associated with MIR (p-value 0.000). On the other hand, perceived barriers to MIRwere: lack of knowledge on incidents and their reporting, non-existence of an incident reporting team and fear ofbeing punished (p- value 0.669). Conclusion:Medical Incident Reporting at MRRH was sub-optimal. Therefore setting up an incident managementteam and conducting routine training MIR among health care workers will increase patient safety.
Quality of Life among Obstetric Fistula Patients at KitovuMissionHospital:
(Hindawi, 2020-05-20) Kakembo, Samuel; Atuhairwe, Christine; Taremwa, Ivan Mugisha
Background. Obstetric fistula (OF) remains a silent neglected maternal challenge associated with devastating life consequences. Living with OF presents far-reaching physical, social, psychosocial, and emotional concerns, which negatively impact a woman’s quality of life. This study evaluated the quality of life among obstetric fistula patients in Masaka district, Uganda. Method. A cross-sectional study was conducted among 63 women diagnosed with OF at Kitovu Mission Hospital. Data were collected using a questionnaire, observation, in-depth interviews, and focus group discussions. Data were analyzed at univariate, bivariate, and multivariate levels, where the ordinal logistic regression model was applied. The qualitative data was transcribed and analyzed using qualitative content analysis. Results. Majority (87%) of the women diagnosed with OF reportedly had a poor quality of life. Bivariate analysis indicated that level of education (), employment status (), energy for everyday life (), capacity to work (), satisfaction with personal relationships (), feelings of loneliness (), negative feelings (), and self-confidence () were significantly associated with good QoL. Multivariate analysis showed increased odds of good QoL increased among women with self-confidence (OR = 32.320; CI = 2.019–517.467), formal education (OR = 9.9497; CI = 1.075–92.048), women who did not experience difficulties in mobility (OR = 19.144; CI = 0.149–2456.770), and women who were satisfied with their personal relationships (OR = 5.785; CI = 0.447–74.824). Conclusion. A holistic fistula treatment approach is required that takes into consideration all aspects of life to address the consequences of obstetric fistula to realize improved quality of life among patients.
Individual, health facility-related, and psychosocial determinants of retention in chronic HIV care among HIV-positive young people in Mukono Municipality, Uganda
(Research Gate, 2020-06) Kasibante, Phillip; Kyeyune, Jemimah Kiboss; Atuhairwe, Christine; Taremwa, Ivan Mugisha
Introduction: Retention in care is a known determinant of successful treatment outcome and serves as a measure of abating the emergence of resistant strains of human immunodeficiency virus (HIV). We report on the individual, health facility-related, and psychosocial determinants of retention in chronic HIV care among young HIV-infected patients in Mukono Municipality, in Uganda. Material and methods: A cross sectional study included 118 participants, aged 15 to 24 years and health workers, and it was conducted between May and September 2017. Data were obtained using a questionnaire, an abstraction tool, and key informant interviews. Logistic regression analysis was used to establish predictor variables, with a p ≤ 0.05. Results: Slightly half, 53.4% of the HIV patients were retained in care for 24 months. Participants with CD4 cell counts above 500 cells/μl at the initiation of treatment were 3 times more likely to be lost to follow-up (odd, 3 : 1). The availability of peer support services (p = 0.026), no extra support from parents/ friends (p = 0.02), stigma and associated blame on others (p = 0.04) showed statistical correlation to the retention in HIV chronic care. On the other hand, peer support services attendance (p = 0.091) and attitude of health providers (p = 0.762) did not show statistical significance in the retention of care of HIV patients. Conclusions: The study reports a low retention in HIV care among people aged 15 to 24 years, and this was positively associated with individual, health facility-related, and psychosocial factors, which require intensive efforts to abate such barriers.
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.
Mind the gap: scaling up the utilization of insecticide treated mosquito nets using a knowledge translation model in Isingiro district, rural south western Uganda
(Open Access Journal, 2020-09-01) Taremwa, Ivan Mugisha; Ashaba, Scholastic; Ayebazibwe, Carlrona; Kemeza, Imelda; Adrama, Harriet Ochokoru; Omoding, Daniel
Background: The phenomenon of Knowledge Translation (KT) is a key intervention towards bridging the ‘know–do’ gap. We conducted a KT initiative in Isingiro district to positively change attitude and improve on the uptake of Insecticide Treated Mosquito Nets (ITNs) as a malaria prevention strategy. Methods: This was a community based interactive initiative that was carried out within the seventeen administrative units of Isingiro district using varied dissemination activities, namely: health talks; drama activities, and the sharing of ITNs success stories. Results: We reached out to 34 dissemination groups, comprising communal gathering, religious crusades, open markets, secondary schools, and district administration. In addition, we spot-visited 46 households to ascertain the physical presence of ITNs, and their appropriate use. The major intervention was improved knowledge base of malaria causation and prevention strategies. The indicators for improved knowledge were hinged on the five-interventions, namely: (a) communal sensitization on malaria to provide, (b) monitoring and support of selected households, (c) emphasis of ITN use as a malaria prevention strategy, (d) promotion of care for ITNs, and (e) promotion of ITN use. In all, the major output was improved knowledge base of malaria causation and prevention strategies by providing accurate information to redress the myths and misconceptions related to malaria and ITNs use. Conclusion: This undertaking describes a consolidated community intervention to promote ITN utilization. It is plausible that this intervention positively enhances and promotes uptake and utilization of ITNs.
Predictors of nursing leadership in Uganda: a cross-sectional study
(PMC, 2020-11) Nanyonga, Rose Clarke; Bosire, Edna N; Heller, David J; Bradley, Elizabeth; Reynolds, Nancy R
Evidence regarding the role of nurses-in-leadership and how to engage nurses in policy decisions is minimal in sub-Saharan Africa. The purpose of this study was: (1) to assess the leadership practices of nurses-in-leadership in Uganda (by self-report) and from the perspective of 'followers' (direct-report, peers, co-workers, other); and (2) to determine factors (positively) associated with leadership practices. We surveyed 480 nurses, 120 in leadership roles (Response Rate 57%) and 360 'followers' (Response Rate 60%), who were recruited from five hospitals in Kampala, Uganda. We used the Leadership Practice Inventory (Self and Observer), a project-specific demographic questionnaire and Denison's Organizational Culture Survey (DOCS). Sixty-three per cent of the respondents held a registered nursing certificate; 79% had received formal leadership training; 47% were based in private for-profit (PFP) hospitals, 28% in private not-for-profit (PNFP) and 25% in public hospitals. Among the five leadership practices, nurses-in-leadership used the practice of Model the Way (M = 8.27, SD = 1.30), Challenge the Process (M = 8.12, SD = 1.30) and Encourage the Heart (M = 8.04, SD = 1.51) more frequently (on a 10-point Likert Scale). Inspire a Shared Vision (M = 7.82, SD = 1.57) and Enable Others to Act (M = 7.62, SD = 1.66) practices were used less frequently. The same rank order was true for leadership scores from the perception of followers. However, leadership scores by followers were significantly lower (P < 0.01) than the nurse leader self-reported scores across all sub-scales. Leadership practice scores were higher in public than private hospitals (P < 0.0001). Organizational culture (OC) was associated (P < 0.001) with leadership practices. Although overall leadership practice scores were generally high, the less frequent use of Inspire and Enable practices suggests opportunities for targeted improvement. Moreover, differences between self-reported and leadership scores by followers suggest perception gaps between leaders and their followers. The positive relationship between public hospital settings and self-reported leadership practices among nurses-in-leadership suggests that important nursing leadership practices are possible even in a low-resource clinical setting.
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.
Health Facilities’ Readiness to Manage Hypertension and Diabetes Casesat Primary Health Facilities in Bidibidi Refugee Settlement,Yumbe District, Uganda
(Hindawi, 2021-01-23) Isadru, Vuchiri Ray; Nanyonga, Rose Clarke; Alege, John Bosco
Background. NCDs are the greatest global contributors to morbidity and mortality and are a major health challenge in the 21stcentury. .e global burden of NCDs remains unacceptably high. Access to care remains a challenge for the majority of persons living with NCDs in sub-Saharan Africa. In Uganda, 55% of refugee households, including those with chronic illnesses, lack access to health services. Of these, 56% are in the West-Nile region where the Bidibidi settlement is located, with 61% of its refugee households in need of health services especially for NCDs (UNHCR, 2019). Data on NCDs in Bidibidi are scarce. Unpublished health facilities’ (HFs) data indicate that cardiovascular diseases (CVDs) (54.3%) and metabolic disorders (20.6%) were the leading causes of consultation for major NCDs (IRC, 2019). No readiness assessment has ever been conducted to inform strategies for the efficient management of NCDs to avert more morbidity, mortality, and the economic burden associated with NCD managementor complications among refugees. .is study sought to determine the readiness of HFs in managing hypertension (HTN) and diabetes cases at primary health facilities in the Bidibidi refugee settlement, Yumbe district, Uganda. Methods. .e study used facility-based, cross-sectional design and quantitative approach to assess readiness for the management of HTN and diabetes. Allthe 16 HFs at the Health Centre III (HCIII) level in Bidibidi were studied, and a sample size of 148 healthcare workers (HCWs) was determined using Yamane’s formula (1967). Proportionate sample sizes were determined at each HF and the simple randomsampling technique was used. HF data were collected using the Service Availability and Readiness Assessment (SARA) checklist and a structured questionnaire used among HCWs. Data were analyzed using SPSS version 20. Univariate analysis involved descriptive statistics; bivariate analysis used chi-square, Fisher’s exact test, and multivariable regression analysis for readiness of HCWs. Results. 16 HCIIIs were studied in five zones and involved 148 HCWs with a mean age of 28 (std±4) years. .e majority71.6% (106) were aged 20–29 years, 52.7% were females, and 37.8% (56/148) were nurses. Among the 16 HFs, readiness average score was 71.7%. .e highest readiness score was 89.5% while the lowest was 52.6%. .e 16 HFs had 100% diagnostic equipment,96% had diagnostics, and 58.8% had essential drugs (low for nifedipine, 37.5%, and metformin, 31.2%). Availability of guidelines for the management of HTN and diabetes was 94%, but only low scores were observed for job aid (12.5%), trained staff (50%), and supervision visits (19%). Only 6.25% of the HFs had all the clinical readiness parameters. On the other hand, only 24% (36) of theHCWs were found to be ready to manage HTN and diabetes cases. Chi-square tests on sex (p<0.001), education level (p�0.002),and Fisher’s tests on profession (p<0.001) established that HCWs with bachelor’s degree (AOR�3.15, 95% CI: 0.569–17.480) and diploma (AOR�2.93, 95% CI: 1.22–7.032) were more likely to be ready compared to the reference group (certificate holders). Medical officers (AOR�4.85, 95% CI: 0.108–217.142) and clinical officers (AOR�3.79, 95 CI: 0.673–21.336) were more likely to be ready compared to the reference group, and midwives (AOR�0.12, 95% CI: 0.013–1.097) were less likely to be ready compared to the reference group. In addition, female HCWs were significantly less likely to be ready compared to male HCWs (AOR�0.19,95% CI: 0.073–474). Conclusion. HFs readiness was high, but readiness among HCWs was low. HFs had high scores in equipment,diagnostics, and guidelines, but essential drugs, trained staff, and supervision visits as well HCWs had low scores in trainings and supervisions received. Being male, bachelor’s degree holders, diploma holders, medical officers, and clinical officers increased the readiness of the HCWs.
Virologic response of treatmentexperienced HIV-infected Ugandan childrenand adolescents on NNRTI based first-lineregimen, previously monitored withoutviral load
(BMC Pediatrics, 2021) Kibalama, Ssemambo Phionah; Nalubega-Mboowa, Mary Gorrethy; Owora, Arthur; Serunjogi, Robert; Kironde, Susan; Nakabuye, Sarah; Ssozi, Francis; Nannyonga, Maria; Musoke, Philippa; Barlow-Mosha, Linda
Background:Many HIV-infected African children gained access to antiretroviral treatment (ART) through expansionof PEPFAR programs since 2004 and introduction of“Test and Treat”WHO guidelines in 2015. As ART accessincreases and children transition from adolescence to adulthood, treatment failure is inevitable. Viral load (VL)monitoring in Uganda was introduced in 2016 replacing clinical monitoring. However, there’s limited data on thecomparative effectiveness of these two strategies among HIV-infected children in resource-limited settings (RLS). Methods:HIV-infected Ugandan children aged 1–12 years from HIV-care programs with> 1 year of first-line ARTusing only immunologic and clinical criteria to monitor response to treatment were screened in 2010. Eligiblechildren were stratified by VL≤400 and > 400 copies/ml randomized to clinical and immunological (control) versusclinical, immunological and VL monitoring to determine treatment failure with follow-up at 12, 24, 36, and 48weeks. Plasma VL was analyzed retrospectively for controls. Mixed-effects logistic regression models were used tocompare the prevalence of viral suppression between study arms and identify factors associated with viralsuppression. Results:At baseline all children (n= 142) were on NNRTI based ART (75% Nevirapine, 25% efavirenz). One third ofART-experienced children had detectable VL at baseline despite high CD4%. Median age was 6 years (interquartilerange [IQR]: 5–9) and 43% were female. Overall, the odds of viral suppression were not different between studyarms: (arm by week interaction,p= 0.63), adjusted odds ratio [aOR]: 1.07; 95%CI: 0.53, 2.17,p= 0.57) and did notchange over time (aOR: 0 vs 24 week: 1.15; 95% CI: 0.91, 1.46,p= 0.24 and 0 vs 48 weeks: 1.26; 95%CI: 0.92, 1.74,p= 0.15). Longer duration of a child’s ART exposure was associated with lower odds of viral suppression (aOR: 0.61;95% CI: 0.42, 0.87,p< .01). Only 13% (9/71) of children with virologic failure were switched to second-line ART, in spite of access to real-time VL. Conclusion:With increasing ART exposure, viral load monitoring is critical for early detection of treatment failure inRLS. Clinicians need to make timely informed decisions to switch failing children to second-line ART. Trial registration:ClinicalTrials.govNCT04489953, 28 Jul 2020. Retrospectively registered. (https://register.clinicaltrials.gov).
Prevalence of tobacco use and associated risk factors among pregnant women in Maracha District, Uganda
(Academic Journals, 2021-06) Alege, John Bosco; Jurua, Russall Okudra; Drazidio, Judith
Globally, tobacco use has become the largest public health threat that kills around 7 million people annually, of which about 6 million deaths are due to direct tobacco use, and 890,000 are attributed to passive smoking. This study assessed prevalence and associated risk factors of tobacco use among pregnant women, 15 to 49 years. Health facility-based analytical cross-sectional study was conducted among 199 pregnant women using purposive sampling technique and convenient sampling technique for the respondents. Chi-square test and binary logistic regression were used to compare quantitative data at a 95% CI. Prevalence of tobacco use among respondents was 39.2%. The results gives those who starting to smoke at more than 30 years (p≤0.001), agreeing that smoking makes pregnant women feel they have total control over their health and life (p≤0.008); the likelihood of tobacco use reduced among pregnant women aged 20-29 years (p≤0.032), those disagreeing that tobacco use as a sign of maturity (p≤0.003) and disagreeing that smoking can help calm nerves, control moods, and alleviates stress (p≤0.002). However, cultural factors that reduced the chances of smoking in pregnancy include smoking more than five times a day (p≤0.01) and smoking cigarettes (p≤0.017), were statistically associated with smoking. High prevalence of tobacco use among pregnant women in Kijomoro and Eliofe health center III was recorded. Thus, there is need to sensitize pregnant women about tobacco-related health problems on them and their unborn children.
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.

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