Patient attitudes towards community-based tuberculosis DOT and adherence to treatment in an urban setting; Kampala, Uganda

Introduction: High Tuberculosis treatment default rate (17%) and sub-optimal treatment completion rates (45%) has burdened Kampala. Nevertheless, there are observable increase in the number of patients on TB DOT; from 6% to 29% in two consecutive annual reports. The main objective was to determine the association of TB patient attitudes towards community-based observers on the TB drug adherence on directly observed treatment for TB in Kampala.Methods: A cross-sectional study was carried out in Lubaga division, Kampala. A total of 201 patients in continuation phase of treatment for Pulmonary TB (i.e. 8 to 20 weeks of TB treatment) were included in the study. Patient attitudes were measured using a 4-point Likert scale aggregated into a binary outcome with ''agree'' and ''disagree'' responses. Poisson regression model using a forward fitting approach in STATA v12 was used to determine the association between patient attitude towards CB-DOTs observers and adherence to TB treatment.Results: Among the 201 patients, 66% reported their treatment was being observed by someone. Relatives were the commonest (82%) treatment observers, 26% were non adherent to their TB treatment. Perceiving ''no need for a treatment observer'' and ''people rejecting TB patients'' were predictors of non-adherence to TB treatment (IRR=1.6,95%CI 1.00-2.57;p=0.048) and (IRR=0.6, 95%CI 0.35-0.95; p=0.019) respectively.Conclusion: Patient's perceived attitude and stigma towards treatment observers contribute to non-adherence on TB treatment. For improved local TB control, more emphasis is needed to build a friendly environment between treatment supporters and patients during the course of TB treatment.Keywords: Tuberculosis, pulmonary tuberculosis, tuberculosis directly observed treatment, community-based, treatment supporter

Missed opportunity for tuberculosis case detection in household contacts in a high burden setting

Contact investigation remains an essential component of tuberculosis (TB) control, yet missed opportunities to trace, medically examine, and treat close contacts of newly diagnosed index TB cases persist. We report a new case of active TB in a 21 year-old woman who was a household contact of a known TB index case in Kampala, Uganda. She was identified during a house-to-house TB case finding survey using chronic cough (≥2 weeks). This case study re-emphasizes two important public health issues in relation to TB control in developing countries; the need to promote active contact investigations by National TB programs and the potential complementary role of active case finding in minimizing delays in TB detection especially in high burden settings like Uganda.Pan African Medical Journal 2012; 12:

Assessment of the Readiness and Availability of Palliative Care Services in Hospitals in Kampala, Uganda

Background: In Uganda, there are approximately 350,000 patients with illnesses needing palliative care (Merriman, Mwebesa & Katabira, 2012) and among whom 210,000 persons in painare in urgent need of Palliative care (American Cancer Society, 2014).Further, palliative care was introduced to improve the quality of life of patients and their families who are facing problems associated with life-threatening illness, whether physical, psychosocial or spiritual (Temel, 2010). More still, palliative care reduces unnecessary hospital admissions and the use of health services. However, the use of morphine and other controlled medicines that are essential for palliative careare overly restricted by regulations thereby hindering access to adequate pain relief and palliative care. Furthermore,palliative care has been incorporated into the Uganda’s Health Sector Strategic and Investment Plans but has been hampered by minimal resources and huge shortages of health workers. Further, Uganda has one of the most rapid growth of palliative care in Africa as well as the only country in sub-Saharan Africa graded as having “Stage 4” comprehensive palliative care according to the Global Atlas of Palliative Care (Worldwide Palliative Care Alliance, 2014). Additionally, Uganda was ranked 35th out of 80 countries for the Quality of death Index (Economist Intelligence Unit, 2015). Despite these accolades, hospital based palliative care is not universally available throughout the country. In 2014 the Ministry of Health provided only 103 million Uganda shillings for development of Palliative care in its national budget. This is a small amount to share, and as most hospitals received very little funding for palliative care, it is likely that hospital medical superintendents used discretionary funds to provide the service (O’Brien et al., 2013). Therefore, the objective of this study was to assess the readiness and availability of palliative Care services in hospitals in Kampala, Uganda from April, 2016 to June, 2016. Methods: A cross sectional study design was used. Results: The study found that 7 of the 27 hospitals (26%) were offering palliative care, 6 (22%) had a specialized staff offering palliative care and only 5 (19%) had a staff designated to coordinate palliative care services. Overall, the level of  readiness to provide palliative care was found to be very low with only 3 of the 27 hospitals (11%) demonstrating readiness as per the set criteria (availability of pain medication in stock, availability of morphine in stock and availability of a healthcare worker to provide palliative care). Conclusion: Readiness and availability of palliative care services is very low among hospitals in Kampala. Keywords: Palliative Care, Morphine, Readiness, Availabilit

High acceptance of home-based HIV counseling and testing in an urban community setting in Uganda

<p>Abstract</p> <p>Background</p> <p>HIV testing is a key component of prevention and an entry point into HIV/AIDS treatment and care however, coverage and access to testing remains low in Uganda. Home-Based HIV Counseling and Testing (HBHCT) has potential to increase access and early identification of unknown HIV/AIDS disease. This study investigated the level of acceptance of Home-Based HIV Counseling and Testing (HBHCT), the HIV sero-prevalence and the factors associated with acceptance of HBHCT in an urban setting.</p> <p>Methods</p> <p>A cross-sectional house-to-house survey was conducted in Rubaga division of Kampala from January-June 2009. Residents aged ≥ 15 years were interviewed and tested for HIV by trained nurse-counselors using the national standard guidelines. Acceptance of HBHCT was defined as consenting, taking the HIV test and receipt of results offered during the home visit. Multivariable logistic regression analysis was performed to determine significant factors associated with acceptance of HBHCT.</p> <p>Results</p> <p>We enrolled 588 participants, 408 (69%, 95% CI: 66%-73%) accepted testing. After adjusting for confounding, being male (adj. OR 1.65; 95%CI 1.03, 2.73), age 25-34 (adj. OR 0.63; 95% CI 0.40, 0.94) and ≥35 years (adj. OR 0.30; 95%CI 0.17, 0.56), being previously married (adj. OR 3.22; 95%CI 1.49, 6.98) and previous HIV testing (adj. OR 0.50; 95%CI 0.30, 0.74) were significantly associated with HBHCT acceptance. Of 408 who took the test, 30 (7.4%, 95% CI: 4.8%- 9.9%) previously unknown HIV positive individuals were identified and linked to HIV care.</p> <p>Conclusions</p> <p>Acceptance of home-based counseling and testing was relatively high in this urban setting. This strategy provided access to HIV testing for previously untested and unknown HIV-infected individuals in the community. Age, sex, marital status and previous HIV test history are important factors that may be considered when designing programs for home-based HIV testing in urban settings in Uganda.</p

High parity predicts use of long-acting reversible contraceptives in the extended postpartum period among women in rural Uganda

Abstract Background The use of implants and Intra-uterine devices (IUD) during the post-partum period is very low in Uganda especially in rural settings. Long-acting reversible contraceptives (LARC) are known to be the most cost-effective for prevention of unintended pregnancy and unsafe abortions. This study aimed at determining the factors associated with long-acting reversible contraceptive use among women in the extended postpartum period in rural Uganda. Methods We conducted a household-based, cross-sectional study among 400 women in two rural communities in Mityana district, central Uganda. Eligible women were aged 15 to 45 years who had childbirth within 12 months of study enrollment in September 2014. The outcome variable was self-reported use of a LARC method, either IUD or implants in the extended postpartum period. The main independent variables were previous childbirths (parity), fertility desire, willingness to use modern contraception, duration of postpartum period and previous pregnancies (gravidity). A logistic regression model was run in STATA v12.0 to compute adjusted odds ratios (AOR) for factors that predicted LARC use statistically significant at p < 0.05. Results Four hundred respondents had a mean age of 27 years (SD = 12) and only 8.5% reported using a LARC method. Use of IUD and implant was 1.8% and 10.4% respectively. Most women using LARC (44.1%) had five or more childbirths (p = 0.01), 70.8% of non-LARC users were willing to use modern contraceptives (p = 0.07) and 2.5% ever had an induced abortion. Having five or more childbirths was independently associated with LARC use in the extended postpartum period (AOR = 4.07, 95%CI 1.08–15.4). Willingness to use modern contraception, desire for more children and postpartum duration had no significant association with LARC use in the extended postpartum period. Conclusion This study revealed low use of LARC within twelve months of child birth despite women’s willingness to use them. High parity (≥5 childbirths) predicted LARC use. The next logical step is to identify barriers to using LARC in the extended postpartum period and design appropriate interventions to increase access and use especially in multi-parous women