Predictors of recovery from complicated severe acute malnutrition among children 6-59 months admitted at Mbale Hospital, Uganda

Introduction: In Uganda, 300,000 children under 5 years are acutely malnourished with 1.3% suffering from Severe Acute Malnutrition (SAM). Mbale Regional Referral hospital (MRRH) nutrition unit admits SAM children with comorbidities into inpatient care striving to ensure recovery, reduce morbidity and mortality. We assessed the incidence and predictors of time to recovery among SAM children admitted as inpatients in MRRH nutrition unit. Methods: We reviewed records of children 6-59 months old managed at the inpatient unit for SAM at MRRH from 2013 to 2016. Data on patient demographics, comorbidities, medications administered, and treatment outcomes were collected from the integrated nutrition register and patient charts. Recovery incidence was determined using Kaplan Meier survival analysis. Cox proportional hazards regression competing risks model with death, default and transfer as competing risks was fit to identify predictors of time to recovery. Results: Overall, 322 patient records were reviewed of which 183 (56.8%) were males with median age of 19 months (IQR; 14-26 months). Of these, 246 (76.4%) recovered with recovery incidence of 31.3 per 1000 person days and a median recovery time of 27 days (IQR; 16-38 days). Children with SAM who were dewormed during treatment were 33% more likely to recover faster compared to their counterparts who were not dewormed (AHR= 1.33; C.I = 1.01-1.74). Conclusion: Recovery was in acceptable range of Sphere standards and deworming was a predictor of time to recovery. The Uganda Ministry of health should ensure nutritional rehabilitation units follow the stipulated guidelines for management of SAM. Findings were limited by missing data

Community willingness to pay for maternal transport in Kabarole District, Western Uganda: A cross-sectional study

Introduction: Saving Mothers Giving Life project in Kabarole district has supported maternal transportation to health facilities since 2012. There is need to sustain project outcomes when it winds up. We assessed community willingness to pay (WTP) for the maternal transport services and associated factors. Methods: We conducted a crosssectional study among household heads in Kabarole district. We used simple random sampling to select the villages and households and purposively selected household heads. We administered structured questionnaires to household heads. A household ead who reported that he/she was willing to contribute financially to the maternal transport services in the district was categorized as willing to pay. We obtained preferred entity to coordinate and manage the funds, preferred transport means, payment mode and amount of money through structured interviews. We used modified Poisson regression models to determine associations between WTP and the various characteristics of participants. Results: A total of 646 household heads were interviewed. The mean age was 33.8 years (SD±8.85). Most, 68% (442/646) were willing to pay for maternal transport. Of the 442 willing to pay, 65.38% preferred monthly payment with an average of UGX 2,207.6/= (<1.00 USD). Education was positively associated with WTP at all levels. Being married, participating in a saving scheme and staying more than five kilometers away from a heath facility were also associated with WTP: (APR 1.15, 95% CI 1.02-1.30), (APR 1.12, 95% CI 1.01-1.25), (APR 1.32, 95% CI 1.15-1.50) respectively. Conclusion: Households need to be mobilized, educated about the outcomes of accessing maternal services, and the need to pay for maternal transport. Payment modalities can be agreed upon by all stakeholders in a participatory and iterative proces

Early infant male circumcision for HIV prevention in Uganda: determinants of uptake and future intention; and exploration of health workers’ perspectives

Abstract of the dissertationEarly infant male circumcision for HIV prevention in Uganda: determinants of uptake and future intentions; and exploration of health workers’ perspectivesbyMichael EdiauDoctor of Philosophy in Public Health (Global Health) San Diego State University 2022 University of California San Diego 2022Professor Susan M. KieneBackground: World Health Organization (WHO) recommends early infant male circumcision (EIMC) for HIV prevention in countries with high HIV prevalence and low male circumcision (MC) coverage, like Uganda. This dissertation assessed the; effect of MC knowledge on EIMC (chapter 1) and theorized determinants of intention to circumcise male infants and associated moderators in central Uganda (chapter 2). It also explored health workers’ perspectives on EIMC in a traditionally non-circumcising community in northeastern Uganda (chapter 3). Methods: This was a cross-sectional survey of parents of male children aged 0–5 years from central Uganda (chapters 2 and 3). Multivariable logistic regression analysis was performed to determine correlates of male infant circumcision (chapter 2, n=1,831). The theory of planned behavior (TPB) predictors of intention to circumcise male children and potential moderators were assessed using PATH analyses (chapter 3, n=2,134). To explore health workers’ perspectives on EIMC (chapter 4), a qualitative descriptive study was conducted using in-depth interviews with health workers (n=26) in Soroti and Katakwi districts. Qualitative data were analyzed using thematic analysis. Results: The odds of having a circumcised male child were higher among parents who knew MC prevents HIV infection (aOR 1.77, 95% CI 1.57-1.98, p<0.001), circumcised fathers (aOR 1.87, 95% CI 1.68-2.08, p<0.001). TPB predictors of intention included attitude (Coeff=0.58, p=0.002) and PBC (Coeff=0.26, p=0.002). Gender and father’s circumcision status did not moderate any TPB relationship. Health workers who participated in EIMC welcomed it for its benefits and advantages, including being a simple procedure, fast wound health, and future HIV prevention. However, some health workers who had not participated in EIMC expressed concerns about EIMC, including the risk of injury and pain. EIMC facilitators included the provision of funding and health workers’ training on EIMC. Reported barriers included lack of funding and supplies as EIMC barriers since the provided support ended. Conclusion: Having knowledge of MC predicted male infant circumcision. Attitude and PBC towards EIMC predicted intention to circumcise male children. Donor funding availability facilitated EIMC, while its cessation was a barrier to EIMC delivery. EIMC programs should target knowledge, attitude, and behavioral control and ensure funding

Knowledge, attitudes and practices of Shisha smoking among youths in Kampala, Uganda

Background Globally tobacco use kills nearly 6 million people annually; a figure expected to increase to 8 million deaths every year by 2030. Though perceived to be safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking. Yet, this practice has gained popularity especially among youths in Kampala. The extent to which this form of tobacco consumption is practiced by the youths, their attitudes and knowledge regarding the health risks in Uganda is unknown. This study therefore aimed to establish knowledge, attitudes, practices and factors associated with shisha smoking among youths. Methods A cross-sectional study was conducted among 530 systematically selected youths aged between 18-30 years found in bars in the two divisions of Kampala between April and May 2014. Youths who are incapacitated were excluded. Three outcome variables; knowledge, attitudes and practice were assessed. Data was collected using a semi structured interviewer administered questionnaire. Descriptive statistics of key variables were generated at univariate analysis. Multivariable logistic regression analysis with Odds Ratios and corresponding 95% Confidence Intervals were used to measure associations. STATA version 12.0 was used for analysis. Results Of 530 participants, 86.4% had low knowledge, 69.2% had negative attitudes and 36.4% smoked Shisha. 75.7% smoked flavored and sweetened tobacco, 37.6% smoked on weekly basis, 92.8% smoked in the company of friends, 91.2% shared shisha pipes and 93.8% smoked in bars. A further 62.7% smoked shisha with cigarettes. Factors associated with shisha smoking included; smoking cigarettes (Adjusted Odds Ratio (AOR): 6.33, 95% CI: 4.13-9.58); positive attitude (AOR: 4.13, 95% CI: 2.65-6.44); Age (25-30 years) (AOR: 1.72, 95% CI: 1.13-2.62) and no knowledge (AOR: 0.50, 95% CI: 0.29-0.88). Conclusions Shisha smoking among youths attending bars is high with three in every ten youths smoking shisha. Targeted social mobilization would increase awareness regarding adverse health effects of shisha smoking

Factors associated with adherence to antiretroviral therapy among HIV infected children in Kabale district, Uganda: a cross sectional study

Abstract Objectives This study was set out to assess the level of adherence to antiretroviral therapy (ART) and its determinants among children receiving HIV treatment in Kabale district, south western Uganda, in order to inform interventions for improving pediatric ART adherence. Results Overall, 79% (121/153) of the children did not miss ART doses over the 7 days. Caregiver forgetfulness was the major reason for missing ART doses, 37% (13/35). Other reasons included transportation costs to the health facilities, 17%, (6/35) and children sitting for examinations in schools. Older children (11–14 years) were more likely to adhere to ART than the younger ones (0–10 years) (AOR = 6.41, 95% CI 1.31–31.42). Caregivers, who knew their HIV status, had their children more adherent to ART than the caregivers of unknown HIV status (AOR = 21.64: 95% CI 1.09–428.28). A significant proportion of children in two facilities 21.5% (32/153) missed ART doses within the previous week. Support for providers to identify clues or reminders to take drugs, extending HIV testing to caregivers and innovative models of ART delivery that alleviate transport costs to caregivers and allow sufficient drugs for children in school could enhance drug adherence among children

Risk factors for HIV infection among circumcised men in Uganda: a case-control study

The study discusses male circumcision how it reduces the risk of HIV infectionIntroduction: Male circumcision (MC) reduces the risk of HIV infection. However, the risk reduction effect of MC can be modified by type of circumcision (medical, traditional and religious) and sexual risk behaviours post-circumcision. Understanding the risk behaviours associated with HIV infection among circumcised men (regardless of form of circumcision) is critical to the design of comprehensive risk reduction interventions. This study assessed risk factors for HIV infection among men circumcised through various circumcision approaches. Methods: This was a case-control study which enrolled 155 cases (HIV-infected) and 155 controls (HIV-uninfected), all of whom were men aged 18-35 years presenting at the AIDS Information Center for HIV testing and care. The outcome variable was HIV sero-status. Using SPSS version 17, multivariable logistic regression was performed to identify factors independently associated with HIV infection. Results: Overall, 83.9% among cases and 56.8% among controls were traditionally circumcised; 7.7% of cases and 21.3% of controls were religiously circumcised while 8.4% of cases and 21.9% of controls were medically circumcised. A higher proportion of cases than controls reported resuming sexual intercourse before complete wound healing (36.9% vs. 14.1%; p18 years (AOR: 5.0, CI: 2.4–10.2); resuming sexual intercourse before wound healing (AOR: 3.4, CI: 1.6–7.3); inconsistent use of condoms (AOR: 2.7, CI: 1.5–5.1); and having sexual intercourse under the influence of peers (AOR: 2.9, CI: 1.5–5.5). Men who had religious circumcision were less likely to have HIV infection (AOR: 0.4, 95% CI: 0.2–0.9) than the traditionally circumcised but there was no statistically significant difference between those who were traditionally circumcised and those who were medically circumcised (AOR: 0.40, 95% CI: 0.1–1.1). Conclusions: Being circumcised at adulthood, resumption of sexual intercourse before wound healing, inconsistent condom use and having sex under the influence of peers were significant risk factors for HIV infection. Risk reduction messages should address these risk factors, especially among traditionally circumcised men

The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda – a mixed methods cross-sectional study

Background: Community health workers (CHWs) have the potential to reduce child mortality by improving access to care, especially in remote areas. Uganda has one of the highest child mortality rates globally. Moreover, rural areas bear the highest proportion of this burden. The optimal performance of CHWs is critical. In this study, we assess the performance of CHWs in managing malaria, pneumonia, and diarrhea in the rural district of Lira, in northern Uganda. Designs: A cross-sectional mixed methods study was undertaken to investigate the performance of 393 eligible CHWs in the Lira district of Uganda. Case scenarios were conducted with a medical officer observing CHWs in their management of children suspected of having malaria, pneumonia, or diarrhea. Performance data were collected using a pretested questionnaire with a checklist used by the medical officer to score the CHWs. The primary outcome, CHW performance, is defined as the ability to diagnose and treat malaria, diarrhea, and pneumonia appropriately. Participants were described using a three group performance score (good vs. moderate vs. poor). A binary measure of performance (good vs. poor) was used in multivariable logistic regression to show an association between good performance and a range of independent variables. The qualitative component comprised seven key informant interviews with experts who had informed knowledge with regard to the functionality of CHWs in Lira district. Results: Overall, 347 CHWs (88.3%) had poor scores in managing malaria, diarrhea, and pneumonia, 26 (6.6%) had moderate scores, and 20 (5.1%) had good scores. The factors that were positively associated with performance were secondary-level education (adjusted odds ratio [AOR] 2.72; 95% confidence interval [CI] 1.50–4.92) and meeting with supervisors in the previous month (AOR 2.52; 95% CI 1.12–5.70). Those factors negatively associated with CHW performance included: serving 100–200 households (AOR 0.24; 95% CI 0.12–0.50), serving more than 200 households (AOR 0.22; 95% CI 0.10–0.48), and an initial training duration lasting 2–3 days (AOR 0.13; 95% CI 0.04–0.41). The qualitative findings reinforced the quantitative results by indicating that refresher training, workload, and in-kind incentives were important determinants of performance. Conclusions: The performance of CHWs in Lira was inadequate. There is a need to consider pre-qualification testing before CHWs are appointed. Providing ongoing support and supervision, and ensuring that CHWs have at least secondary education can be helpful in improving their performance. Health system managers also need to ensure that the CHWs’ workload is moderated as work overload will reduce performance. Finally, although short training programs are beneficial to some degree, they are not sufficient and should be followed up with regular refresher training

Factors associated with willingness to take up indoor residual spraying to prevent malaria in Tororo district, Uganda: a cross-sectional study

Abstract Background Indoor residual spraying (IRS) is an efficient method of preventing malaria in homes, and community willingness to take up IRS is critical to its success. The first phase of IRS was conducted in Tororo district, Uganda between December 2014 and January 2015. High coverage rates (90%) were attained in the district. However, Mulanda sub-county had the lowest coverage of 78%, in the first round. This study assessed willingness and associated factors of IRS uptake among household heads for the next IRS campaign in Mulanda sub-county, Tororo district. Methods A household survey was conducted in all three parishes of Mulanda sub-county. A multistage sampling technique involving the village and household as the first and second sampling levels, respectively, was used to identify 640 households Household heads were interviewed using standard questionnaire. Seven key informants were also conducted to explore the impact of community IRS-perceptions on uptake. Bi-variable and multi-variable logistic regression analyses were used to identify factors associated with willingness to take up IRS. Qualitative data was analysed by thematic content analysis method. Results Most (79.9%) respondents were willing to take up repeat IRS. However this was below the target of 85%. Fear of insecticide adverse effects (62%) was the most common reason mentioned by 134 (21%) household heads who were not willing to take up IRS. Factors associated with to take up IRS were; age ≥ 35 years (AOR 1.9; 95% CI 1.08–3.51), higher socio-economic status (AOR 0.4; 95% CI 0.27–0.98), not taking IRS in previous round (AOR 0.1; 95% CI 0.06–0.23), not knowing reason for conducting IRS (AOR 0.4; 95% CI 0.24–0.78) and having an iron sheet roof (AOR 2.2; 95% CI 1.03–4.73). Community and religious leaders were the preferred sources of IRS information. Conclusions The level of willingness to take up IRS was low (79%) compared to the targeted 85%. Involvement of community and religious leaders in community sensitization on the efficacy and safety of the chemicals could increase uptake of IRS