Nutritional Recovery Outcome among Moderately Malnourished Under-five Children in Communities Implementing Positive Deviance - Hearth or Community Health Workers’ Nutrition Promotion Approaches in Karusi and Kirundo Provinces, Burundi

The Positive Deviance - Hearth (PD-H) approach is important in controlling malnutrition; however, there is limited data on its effect in improving nutrition status. Objective: To assess the effect of PD-H and community health worker nutrition promotion (CHWNP) in improving nutrition status and recovery among the moderately malnourished under-five (MMU5) children in Burundi. Methodology: PD-H and CHWNP approaches were used in Karusi and Kirundo provinces, respectively. MMU5 children were enrolled at baseline for the intervention (PD-H, (358) and usual care (CHWNP, (310). Haemoglobin level and anthropometric indicators (MUAC, wasting, underweight and stunting) were taken at baseline for 12, 60 and 120 days. Changes in nutritional recovery were compared within groups exposed to each approach using ANOVA for continuous outcomes and chi-square for categorical outcomes. Further analysis compared changes between the two groups exposed to the two approaches using random effects logistic models for binary outcomes and mixed effect models for continuous outcomes. Results: The MMU5 children discharged cured after 60 days and at 120 days follow-up. When compared with the baseline, this was statistically significant in both CHWNP and PDH groups on anthropometric indicators (wasting, underweight, stunting, MUAC and weight) but not anaemia. After controlling for socio-demographic factors, MMU5 enrolled in CHWNP were more likely to be discharged cured than those in PD-H with respect to moderate wasting (AOR=2.74, 95% CI= 1.19-6.29), underweight (AOR=1.56, 95% CI= 1.01-2.43) as well as MUAC (AOR=1.21, 95% CI= 0.49-3.00). Conclusion: Both CHWNP and PD-H significantly improved nutrition status and recovery. However, the proportion of those who recovered was significantly larger in CHWNP compared to PD-H.Keywords · Recovery rate · Community-based nutrition program · Nutrition status · Positive deviance · Under-fiv

Building capacity for HIV/AIDS program leadership and management in Uganda through mentored Fellowships

Background: Around the world, health professionals and program managers are leading and managing public and private health organizations with little or no formal management and leadership training and experience. Objective: To describe an innovative 2-year, long-term apprenticeship Fellowship training program implemented by Makerere University School of Public Health (MakSPH) to strengthen capacity for leadership and management of HIV/AIDS programs in Uganda. Implementation process: The program, which began in 2002, is a 2-year, full-time, non-degree Fellowship. It is open to Ugandan nationals with postgraduate training in health-related disciplines. Enrolled Fellows are attached to host institutions implementing HIV/AIDS programs and placed under the supervision of host institution and academic mentors. Fellows spend 75% of their apprenticeship at the host institutions while the remaining 25% is dedicated to didactic short courses conducted at MakSPH to enhance their knowledge base. Achievements: Overall, 77 Fellows have been enrolled since 2002. Of the 57 Fellows who were admitted between 2002 and 2008, 94.7% (54) completed the Fellowship successfully and 50 (92.3%) are employed in senior leadership and management positions in Uganda and internationally. Eighty-eight percent of those employed (44/54) work in institutions registered in Uganda, indicating a high level of in-country retention. Nineteen of the 20 Fellows who were admitted between 2009 and 2010 are still undergoing training. A total of 67 institutions have hosted Fellows since 2002. The host institutions have benefited through staff training and technical expertise from the Fellows as well as through grant support to Fellows to develop and implement innovative pilot projects. The success of the program hinges on support from mentors, stakeholder involvement, and the hands-on approach employed in training. Conclusion: The Fellowship Program offers a unique opportunity for hands-on training in HIV/AIDS program leadership and management for both Fellows and host institutions

Sustainable community based interventions for improving environment and health for communities in slums of Banda, Kampala City, Uganda : final technical report (2007-2011)

Fast declining health status parallels degradation of ecosystems, as seen in slums, evidenced by epidemics of cholera and diarrheal diseases. Urban authorities lack financial, human and infrastructural resources to satisfactorily provide required services to respond to theses inadequacies, which contribute to increases in infant mortality rates. The goal of the three-phase project titled ‘Sustainable Community Based Interventions for Improving Environment and Health’ in the Banda slums in Kampala, Uganda was to improve people's understanding of links between environment and health, with a focus on diarrheal diseases and malnutrition

Endemic, Emerging and Re-emerging Communicable Diseases in Uganda

Fred Wabwire-Mangen and Gakenia Wamuyu Maina review the environmental, social and political factors that explain the inequitable distribution of communicable disease burden in Uganda. Development (1999) 42, 134–137. doi:10.1057/palgrave.development.1110101

Effect of nutrition assessment, counselling and support integration on mother-infant nutritional status, practices and health in Tororo and Butaleja districts, Uganda: A comparative non-equivalent quasi-experimental study

Abstract Background Malnutrition remains a health challenge for women aged 15 to 49 years and their infants. While Nutrition Assessment Counselling and Support (NACS) is considered a promising strategy, evidence of its effectiveness remains scanty. This study assessed the effect of the comprehensive NACS package on the mother-infant practices, health and nutrition outcomes in two districts in Eastern Uganda. Methods A comparative non-equivalent quasi-experimental design was employed with two groups; Comprehensive NACS (Tororo) and Routine NACS (Butaleja). Pregnant mothers were enrolled spanning various trimesters and followed through the antenatal periods and post-delivery to monitor their health and nutrition status. Infants were followed for feeding practices, health and nutritional status at birth and weeks 6, 10, 14 and at months 6, 9 and 12 post-delivery. Propensity score matching ensured study group comparability. The NACS effect was estimated by nearest neighbour matching and the logistic regression methods. Statistical analysis utilised STATA version 15 and R version 4.1.1. Results A total of 666/784 (85%) with complete data were analysed (routine: 412, comprehensive: 254). Both groups were comparable by mothers’ age, Mid Upper Arm Circumference, prior antenatal visits, meal frequency, micronutrient supplementation and instances of maternal headache, depression and diarrhoea. However, differences existed in gestation age, income, family size, education and other living conditions. Comprehensive NACS infants exhibited higher infant birth weights, weight-for-age z-scores at the 3rd -6th visits (p < 0.001), length-for-age z scores at the 4th -7th visits (p < 0.001) and weight-for-length z-scores at the 3rd − 5th (p < = 0.001) visits. Despite fewer episodes of diarrhoea and fever, upper respiration infections were higher. Conclusions The comprehensive NACS demonstrated improved mother-infant nutritional and other health outcomes suggesting the need for integrated and holistic care for better maternal, infant and child health

The effects of enhanced access to antiretroviral therapy: a qualitative study of community perceptions in Kampala city, Uganda

Introduction: Since 2001, Antiretroviral Therapy (ART) has been integrated as part of the Uganda National Program for Comprehensive HIV/AIDS Care and Support. If patients take Antiretroviral drugs (ARVs) as prescribed, quality of life is expected to improve and patients become healthier. It is, however, postulated that scale up of ARVs could erode the previous achievement in behaviour change interventions. This study examined community perceptions and beliefs on whether enhanced access to ARVs increases risk behaviour. It also examined people&apos;s fears regarding HIV/AIDS infection and the use of ARVs. Methods: This was a qualitative study that utilized Focus Group Discussions (FGDs) and Key Informant (KI) interviews. Participants were purposefully sampled. Twenty FGDs comprising of 190 participants and 12 KI interviews were conducted. FGDs were conducted with adult men and women (above 25 years), and youth (male and female) while KI interviews were held with Kampala City Council officials, Kawempe Division Local Council officials, health workers and religious leaders. All data was tape recorded with consent from participants and transcribed thereafter. Typed data was analyzed manually using qualitative latent content analysis technique. Results: Most participants felt that enhanced access to ART would increase risky sexual behaviour; namely promiscuity, lack of faithfulness among couples, multiple partners, prostitution, unprotected sexual practices, rape and lack of abstinence as the risky sexual behaviours. A few FGDs, however, indicated that increased ART access and counselling that HIV-positive people receive promoted positive health behaviour. Some of the participants expressed fears that the increased use of ARVs would promote HIV transmission because it would be difficult to differentiate between HIV-positive and HIV-negative persons since they all looked healthy. Furthermore, respondents expressed uncertainty about ARVs with regard to adherence, sustainable supply, and capacity to ensure quality of ARVs on the market. Conclusions: There are fears and misconceptions that enhanced access to ART will increase risky sexual behaviour and HIV transmission. Information Education and Communication (IEC) on ART use and availability should be enhanced among all people. Prevention programs which are modified and specific to the needs of the people living with HIV should be developed and implemented, and should include information on the ability of individuals to transmit HIV even when they are on ART