A Retrospective Cross Sectional Study of the Effectiveness of a Project in Improving Infant Health in Bwindi, South Western Uganda.

From Europe PMC via Jisc Publications Router.Publication status: PublishedIntroduction: Low-cost community-based interventions to improve infant health potentially offer an exciting means of progressing toward the Sustainable Development Goals (SDGs). However, the feasibility of such interventions in low-income settings remains unclear. Bwindi Community Hospital (BCH), Uganda implemented a 3-year nurse-led community project to address child-health issues. Nurses supported Community Health Volunteers (CHVs) and visited mothers pre- and/or postnatally to assess and educate mothers and infants. CHVs gathered data and gave basic advice on health and hygiene to mothers. We hypothesized that increased interventions by nurses and CHVs and increased contact with households, would improve health and reduce infant mortality. Methods: This was a retrospective cohort study analyzing routine data of all children born between January 2015 and December 2016. There were three interventions: antenatal nurse visit, postnatal nurse visit and CHV participation. Children received different numbers of interventions. We defined four diverse outcomes: facility-based delivery, immunization completeness, nutritional status, and infant mortality. Odds ratios, adjusted odds ratios, and multivariate logistic regression were used to assess associations between interventions and outcomes. Results: Of the 4,442 children born in 2015 and 2016, 91% were visited by a nurse (81% antenatally and 10% postnatally); 7% lived in villages with a high participating CHV. Households receiving a postnatal visit were more likely to complete immunization (aOR: 1.55, p = 0.016) and have the infant survive (aOR: 1.90, p = 0.05). Children from a hard-to-reach village (no road access) were less likely to be delivered in a health facility (aOR: 0.55, p < 0.001) and less likely to survive in their first year (aOR: 0.69, p = 0.03). Having two or more interventions was associated with a child having all four positive outcomes (aOR 0.78, p = 0.03). Lack of baseline data, a control area, or integrated assessment data limited more detailed evaluation. Conclusion: Visits to mothers after birth, by a nurse to educate and identify child illness, were associated with lower infant mortality and improved infant health as measured by completion of immunizations. Community health interventions could potentially have a greater impact if focused on hard-to-reach areas. Building evaluation into all project designs, whether local or internationally funded, would enable greater learning, and hence better use of resources

Preventing zoonotic and zooanthroponotic disease transmission at wild great ape sites: Recommendations from qualitative research at Bwindi Impenetrable National Park

Employees at wild great ape sites are at high risk of transmitting infectious diseases to endangered great apes. Because of the significant amount of time employees spend near great apes, they are a priority population for the prevention and treatment of zoonotic and zooanthroponotic spillover and need adequate preventive and curative healthcare. Qualitative, semi-structured interviews with 46 staff (rangers and porters) at Bwindi Impenetrable National Park, Uganda (BINP) and key informants from five other wild great ape sites around the world were performed. The objectives of the study were to 1) evaluate health-seeking behavior and health resources used by staff in contact with great apes at Bwindi Impenetrable National Park; 2) evaluate existing occupational health programs for employees working with great apes in other parts of the world; and 3) make recommendations for improvement of occupational health at BINP. Results show that BINP employees do not frequently access preventive healthcare measures, nor do they have easy access to diagnostic testing for infectious diseases of spillover concern. Recommendations include assigning a dedicated healthcare provider for great ape site staff, providing free annual physical exams, and stocking rapid malaria tests and deworming medication in first aid kits at each site

Themes from interviews with staff at Bwindi Impenetrable National Park.

Themes from interviews with staff at Bwindi Impenetrable National Park.</p

Data collection sites at BINP.

Red dots indicate sectors of the park where ranger stations are located, which is where data collection took place. Not pictured is Rushaga station, south of Nkuringo, as data collection did not take place there. © OpenStreetMap contributors.</p

Batwa Indigenous Peoples forced eviction for "Conservation": A qualitative examination on community impacts.

In 1991, the Ugandan government formally established National Parks within the ancestral homelands of the Batwa Peoples. No consultation was carried out with local Batwa communities, and they were consequently forcibly evicted from their Forest home. With this, we sought to better understand the impacts of forced Land eviction through the lens of solastalgia. Nineteen semi-structured interviews were carried out with adult Batwa Peoples of varying age and gender in Uganda from August to November 2022. Interviews were transcribed verbatim, and thematic analysis was carried out on the interview transcripts to identify themes from the initial codes. Four overarching themes were identified, including: 1) Our love and connection with the Forest; 2) What was left in the Forest when we were evicted; 3) What eviction from the Forest did to us as Batwa Peoples; and 4) Batwa People's Landback and returning to the Forest ('Indigenous Lands back into Indigenous hands'). As movement towards the global "30 by 30" conservation agenda occurs, we urge researchers, policy makers, and leaders to listen to the voices of Indigenous Peoples like the Batwa with a key focus on Landback and movement towards a clearer understanding and appreciation of the impacts of Western conservation agendas on Indigenous Peoples globally

Type of site, region, governance of the site, and occupation of each KI is detailed in this table.

Site 00 refers to BINP, which was discussed in the previous section of the results.</p

Participant demographics from Bwindi Impenetrable National Park.

‘Rangers’ refers to staff who simply described themselves as rangers, and did not mention a specialized role such as tracker, guide, or security personnel.</p

Interview guide for Bwindi impenetrable National Park Staff.

This is the guide used for conducting semi-structured interviews with staff at BNP. (DOCX)</p

Types of health facilities used by park staff at BINP and their pros and cons according to the majority of participants.

Types of health facilities used by park staff at BINP and their pros and cons according to the majority of participants.</p

Reporting guidelines.

This paper used the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to ensure all necessary components have been included. (DOCX)</p