Use of mobile phones to promote hygiene and sanitation in northern Uganda

The paper presents the use of mobile telephones to creating awareness to change the behaviors of people in the selected towns of northern Uganda in water, hygiene, sanitation promotion. It also includes HIV/AIDS as one of the cross cutting issues being mainstreamed by the ministry of Water and Environment. Water and Sanitation Development Facility-North in partnership with German Development Cooperation (GIZ) is piloting Water, Sanitation and Hygiene (WASH) campaign through cell phones in what we term short messaging service (SMS). The objective of this campaign is to relates to the implementation of an SMS-based Knowledge, Attitudes, and Practices (KAP) campaign on Water, Sanitation and HIV/AIDS-related aspects in select urban centers in Northern Uganda to gage communities Knowledge, Attitudes, and Practices (KAP) campaign on Water, Sanitation and HIV/AIDS-related aspects in select urban centres in Northern Uganda. The approach radio talk shows and spots, call center and short messages

Enhancing waterborne toilets to reduce water usage in schools: experience from Kampala, Uganda

Over 620 million children worldwide lacked a basic sanitation service at their school and 12% of schools have facilities that are not usable. In Kampala’s public primary school, the pupil to stance area stands at 57:1 as compared to the required 40:1 by the public health regulation of 2000. A number of waterborne toilets have been constructed in schools to change the pupil to stance ratio from 118:1 to 57:1 in the period 2012- 2018. However, the administrators of schools have denied 07% of the toilets in schools to be accessed by pupils in an effort to control water bills. Administrators prefer pupils to use pit latrines to waterborne toilets because they use less water. This acerbates the inadequacy of access to sanitation in schools in Kampala. The objective of this work was to develop a waterborne sanitation facility that meets the school administrators’ preferences features of VIP latrine with water usage of less than 10 liters of water to flush the toilet. Kampala Capital City Authority (KCCA) has constructed water based toilets referred to as ‘channel flush’ toilets in public schools to reduce water usage. The channel flush toilet uses a channel as a receiving chamber for faecal matter which is flushed intermittently to the septic tank or bio-digester. Each toilet block is flushed four times a day with each flushing time using 60 liters of water. With the channel flush toilet, schools use about 4 liters per child per day on flushing toilets leading to a 90% water usage reduction. Emptying has been reduced from 30 cubic meters to 5 cubic meters per year. The toilet is recommended to be used in schools and public places such as markets and taxi parks

Provider-initiated HIV testing in health care settings: Should it include client-centered counselling?

To increase access to HIV testing, the WHO and CDC have recommended implementing provider-initiated HIV testing (PITC). To address the resource limitations of the PITC setting, WHO and CDC suggest that patient-provider interactions during PITC may need to focus on providing information and referrals, instead of engaging patients in client-centered counselling, as is recommended during client-initiated HIV testing. Providing HIV prevention information has been shown to be less effective than client-centered counselling in reducing HIV-risk behaviour and STI incidence. Therefore, concerns exist about the efficacy of PITC as an HIV prevention approach. However, reductions in HIV incidence may be greater if more people know their HIV status through expanded availability of PITC, even if PITC is a less effective prevention intervention than is client-initiated HIV testing for individual patients. In the absence of an answer to this public health question, adaptation of effective brief client-centered counselling approaches to PITC should be explored along with research assessing the efficacy of PITC

Status of waste management in the East African cities : understanding the drivers of waste generation, collection and disposal and their impacts on Kampala City's sustainability

The factors that influence waste generation and management vary with country but there is a gap in the availability of waste data in Africa limiting the assessment of these factors for sustainability. Hence, this study was aimed at evaluating the drivers of waste generation, collection and disposal, and their impact on sustainability of Kampala as compared to the East African Community (EAC). Waste generation in Kampala was calculated using recorded waste collection efficiencies while data for Nairobi and Dar es Salaam was obtained from existing literature. Waste quantities for disposal were recorded daily at Kiteezi landfill from 2011 to 2017. Results showed that the major drivers of waste generation, collection and disposal in the EAC are population growth, vehicle capacity and the need for disposal respectively. Waste generation rate in Kampala increased from 0.26 to 0.47 kg/capita/day and the annual waste quantity increased significantly (p < 0.5) by 48% from 227,916 to 481,081 tons corresponding to a 54% population increase. Waste collection efficiency increased from 30% to 64% and hence waste for disposal increased significantly (p < 0.5), with a mean of 15,823 tons/month; but varied significantly (p < 0.5) with the city division. The most (5120 tons) and least (3472 tons) waste per month was collected from the Central and Nakawa divisions respectively. Additionally, Kampala Capital City Authority collected significantly more waste than private collectors for all study years. Waste is disposed of at the Kiteezi landfill despite exhausted capacity. Future projections showed that by 2030, annual waste would increase by approximately 60% for Kampala and Nairobi and by 74% for Dar es Salaam. Dar es Salaam generated the highest amount of waste, five times more than Kampala. More investment needs to be made towards the reduction of waste disposal and strategies developed for the reuse and recycling of waste

Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy

CITATION: Kredo, T. et al. 2014. Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy. Cochrane Database of Systematic Reviews, 7:CD007331, doi:10.1002/14651858.CD007331.pub3.The original publication is available at https://www.cochranelibrary.comBackground: The high levels of healthcare worker shortage is recognised as a severe impediment to increasing patients’ access to antiretroviral therapy. This is particularly of concern where the burden of disease is greatest and the access to trained doctors is limited.This review aims to better inform HIV care programmes that are currently underway, and those planned, by assessing if task-shifting care from doctors to non-doctors provides both high quality and safe care for all patients requiring antiretroviral treatment. Objectives: To evaluate the quality of initiation and maintenance of HIV/AIDS care in models that task shift care from doctors to non-doctors.Publisher's versio

Qualitative exploration of perceived benefits of care and barriers influencing HIV care in trans Nzoia, Kenya

Background: Substantial efforts have been made to ensure people living with HIV (PLHIV) are linked to and retained in care but many challenges deter care utilization. We report perceived benefits of seeking HIV care and barriers to HIV care that were identified through a formative assessment conducted to advise the development of an alternative care model to deliver antiretroviral treatment therapy (ART) in Trans Nzoia County, Kenya. Methods: Data were collected in 2015 through key informant interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). The study involved 55 participants of whom 53% were female. Ten KIIs provided community contextual information and viewpoints on the HIV epidemic in Trans Nzoia County while 20 PLHIV (10 male and 10 female) participated in IDIs. Twenty-five individuals living with HIV participated in four FGDs - two groups for men and two for women. Key informants were purposively selected, while every third patient above 18 years at the Kitale HIV Clinic was invited to share their HIV care experience through IDIs or FGDs. Trained research assistants moderated all sessions and audio recordings were transcribed and analyzed thematically. Results: Findings showed that PLHIV in Trans Nzoia County used both conventional and complementary alternative care for HIV; however, public health facilities were preferred. Popular perceived benefits of adopting care were relief from symptoms and the chance to live longer. Benefits of care uptake included weight gain, renewed energy, and positive behavior change. Individual-level barriers to HIV care included lack of money and food, use of alternative care, negative side effects of ART, denial, and disclosure difficulties. At the community level, stigma, limited social support for conventional HIV treatment, and poor means of transport were reported. The health system barriers were limited supplies and staff, long distance to conventional HIV care, and unprofessional providers. Conclusions: Diverse individual, community and health system barriers continue to affect HIV care-seeking efforts in Kenya. Appreciation of context and lived experiences allows for development of realistic care models

Loss to follow-up before and after initiation of antiretroviral therapy in HIV facilities in Lilongwe, Malawi

Although several studies have explored factors associated with loss to follow-up (LTFU) from HIV care, there remains a gap in understanding how these factors vary by setting, volume of patient and patients’ demographic and clinical characteristics. We determined rates and factors associated with LTFU in HIV care Lilongwe, Malawi

Effectiveness of artemisinin-based combination therapy used in the context of home management of malaria: A report from three study sites in sub-Saharan Africa

BACKGROUND: The use of artemisinin-based combination therapy (ACT) at the community level has been advocated as a means to increase access to effective antimalarial medicines by high risk groups living in underserved areas, mainly in sub-Saharan Africa. This strategy has been shown to be feasible and acceptable to the community. However, the parasitological effectiveness of ACT when dispensed by community medicine distributors (CMDs) within the context of home management of malaria (HMM) and used unsupervised by caregivers at home has not been evaluated. METHODS: In a sub-set of villages participating in a large-scale study on feasibility and acceptability of ACT use in areas of high malaria transmission in Ghana, Nigeria and Uganda, thick blood smears and blood spotted filter paper were prepared from finger prick blood samples collected from febrile children between six and 59 months of age reporting to trained CMDs for microscopy and PCR analysis. Presumptive antimalarial treatment with ACT (artesunate-amodiaquine in Ghana, artemether-lumefantrine in Nigeria and Uganda) was then initiated. Repeat finger prick blood samples were obtained 28 days later for children who were parasitaemic at baseline. For children who were parasitaemic at follow-up, PCR analyses were undertaken to distinguish recrudescence from re-infection. The extent to which ACTs had been correctly administered was assessed through separate household interviews with caregivers having had a child with fever in the previous two weeks. RESULTS: Over a period of 12 months, a total of 1,740 children presenting with fever were enrolled across the study sites. Patent parasitaemia at baseline was present in 1,189 children (68.3%) and varied from 60.1% in Uganda to 71.1% in Ghana. A total of 606 children (51% of infected children) reported for a repeat test 28 days after treatment. The crude parasitological failure rate varied from 3.7% in Uganda (C.I. 1.2%-6.2%) to 41.8% in Nigeria (C.I. 35%-49%). The PCR adjusted parasitological cure rate was greater than 90% in all sites, varying from 90.9% in Nigeria (C.I. 86%-95%) to 97.2% in Uganda (C.I. 95%-99%). Reported adherence to correct treatment in terms of dose and duration varied from 81% in Uganda (C.I. 67%-95%) to 97% in Ghana (C.I. 95%-99%) with an average of 94% (C.I. 91%-97%). CONCLUSION: While follow-up rates were low, this study provides encouraging data on parasitological outcomes of children treated with ACT in the context of HMM and adds to the evidence base for HMM as a public health strategy as well as for scaling-up implementation of HMM with ACTs

Quality of home-based rapid HIV testing by community lay counsellors in a rural district of South Africa

INTRODUCTION: Lack of universal, annual testing for human immunodeficiency virus (HIV) in health facilities suggests that expansion of HIV testing and counselling (HTC) to non-clinical settings is critical to the achievement of national goals for prevention, care and treatment. Consideration should be given to the ability of lay counsellors to perform home-based HTC in community settings. METHODS: We implemented a community cluster randomized controlled trial of home-based HTC in Sisonke District, South Africa. Trained lay counsellors conducted door-to-door HIV testing using the same rapid tests used by the local health department at the time of the study (SD Bioline and Sensa). To monitor testing quality and counsellor skill, additional dry blood spots were taken and sent for laboratory-based enzyme-linked immunosorbent assay (ELISA) testing. Sensitivity and specificity were calculated using the laboratory result as the gold standard. RESULTS AND DISCUSSION: From 3986 samples, the counsellor and laboratory results matched in all but 23 cases. In 18 cases, the counsellor judged the result as indeterminate, whereas the laboratory judged 10 positive, eight negative and three indeterminate, indicating that the counsellor may have erred on the side of caution. Sensitivity was 98.0% (95% CI: 96.3 98.9%), and specificity 99.6% (95% CI: 99.4 99.7%), for the lay counsellor field-based rapid tests. Both measures are high, and the lower confidence bound for specificity meets the international standard for assessing HIV rapid tests. CONCLUSIONS: These findings indicate that adequately trained lay counsellors are capable of safely conducting high-quality rapid HIV tests and interpreting the results as per the kit guidelines. These findings are important given the likely expansion of community and home-based testing models and the shortage of clinically trained professional staff.Department of HE and Training approved lis