Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda

<p>Abstract</p> <p>Background</p> <p>Uganda has an acute problem of inadequate human resources partly due to health professionals' unwillingness to work in a rural environment. One strategy to address this problem is to arrange health professional training in rural environments through community placements. Makerere University College of Health Sciences changed training of medical students from the traditional curriculum to a problem-based learning (PBL) curriculum in 2003. This curriculum is based on the SPICES model (student-centered, problem-based, integrated, community-based and services oriented). During their first academic year, students undergo orientation on key areas of community-based education, after which they are sent in interdisciplinary teams for community placements. The objective was to assess first year students' perceptions on experiential training through community placements and factors that might influence their willingness to work in rural health facilities after completion of their training.</p> <p>Methods</p> <p>The survey was conducted among 107 newly admitted first year students on the medical, nursing, pharmacy and medical radiography program students, using in-depth interview and open-ended self-administered questionnaires on their first day at the college, from October 28-30, 2008. Data was collected on socio-demographic characteristics, motivation for choosing a medical career, prior exposure to rural health facilities, willingness to have part of their training in rural areas and factors that would influence the decision to work in rural areas.</p> <p>Results</p> <p>Over 75% completed their high school from urban areas. The majority had minimal exposure to rural health facilities, yet this is where most of them will eventually have to work. Over 75% of the newly admitted students were willing to have their training from a rural area. Perceived factors that might influence retention in rural areas include the local context of work environment, support from family and friends, availability of continuing professional training for career development and support of co-workers and the community.</p> <p>Conclusion</p> <p>Many first year students at Makerere University have limited exposure to health facilities in rural areas and have concerns about eventually working there.</p

Reliability of the Luganda version of the Child Behaviour Checklist in measuring behavioural problems after cerebral malaria

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

<p>Abstract</p> <p>Background</p> <p>Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH.</p> <p>Methods</p> <p>Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis.</p> <p>Results</p> <p>Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.</p> <p>Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills.</p> <p>Conclusions</p> <p>Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.</p

One size does not fit all: local determinants of measles vaccination in four districts of Pakistan

Common factors are associated with vaccination. However, despite common factors the pattern of variables related to measles vaccination differs between and within districts. In this study children were more likely to receive measles vaccination if their mother had any formal education, if she knew at least one vaccine preventable disease, and if she had not heard of any bad effects of vaccination. In rural areas, living within 5 km of a vaccination facility or in a community visited by a vaccination team were factors associated with vaccination, as was the mother receiving information about vaccinations

Quality of care and its effects on utilisation of maternity services at health centre level

Objective: To determine antenatal attendance and place of delivery of women in Chilomoni health centre catchment area and how they perceived the quality of health care provided at the health centre.Design: A cross-sectional household survey.Subjects: Women aged between fifteen and forty nine years, who had delivered at least one child, and had stayed in Chilomoni health centre catchment area during the past five years.Results: Of the 1108 women interviewed, 52% reported for antenatal care at the health centre, but only eight per cent used it for delivery. Reasons for not using the health centre were mainly family refusal and poor facilities at the health centre (68%). On the quality of care, 97% were satisfied with the providers’ attitudes, 9l% with communication, 86% with the providers technical competence in general, 97% with working hours, but only 37% were satisfied with privacy. Only four per cent were satisfied with the supply of drugs. Variables independently associated with non use of the health centre were: lack of drugs (OR 2.8, p = 001), poor ambulance service (OR 2.4, p = 0.03), poor laboratory services (OR 1.7, p = 001), long waiting time (OR 1.6, p = 0.02) and lack of privacy (OR l.5, p = 0.01).Conclusion: Few women use Chilomoni health centre for antenatal services and still fewer use it for delivery. Reasons for not using the health centre included refusal by the family members and the poor facilities at the health centre. We recommend that the facilities atChilomoni health centre be improved immediately

Missed opportunities and caretaker constraints to childhood vaccination in rural areas of Uganda

Background: Despite concerted support to vaccination programmes, coverage remains low. While health service reasons for this are known, there is little information on caretaker constraints to vaccination in Africa. Objective: To establish the prevalence of missed vaccination opportunities and caretaker constraints to childhood vaccinations. Design: Cross-sectional descriptive study. Subjects: Caretakers of 408 children aged 12-23 months were interviewed. Setting: Kiyeyi, a rural area in Eastern Uganda. Results: Complete vaccination coverage by card was 26.7% while by history and card it was 44.6%. Of the 215 eligible children who sought treatment in a health facility where vaccination could be offered, 59.6% missed an opportunity to be vaccinated while 24.4% of the children missed an opportunity during routine vaccination sessions. Reasons for non-completion of vaccination included caretaker ‘not bothered', being busy, or illand fear of rude health workers. While most caretakers were aware of vaccination and its benefits, none knew the immunisation schedule. The major caretaker constraints were low level of formal education, fear of vaccine side effects, and perceived contraindications to vaccinations. (East African Medical Journal: 2002 79(7): 347-354) Conclusion: Promotion of formal education for girls and educating mothers and health workers on the timing of vaccinations, their side effects and management might contribute to higher vaccination coverage

What future for banana-based farming systems in Uganda? A participatory scenario analysis

CONTEXT: Population pressure, land scarcity and encroachment of nature reserves are challenging sustainable intensification of agriculture in Uganda. One of the main staple crops in Uganda is East African Highland banana. Area expansion and improved management have enhanced the economic performance of banana, yet at the expense of food security, environmental and social sustainability. While a transition of banana-based farming systems to a more sustainable future seems necessary, the desired future state and pathways of getting there may differ among actors involved. OBJECTIVES: Our study aimed to co-design potential transition pathways with stakeholders along the banana value chain in Uganda, and to assess the effects of these pathways on sustainability indicators at the household level. METHODS: We conducted a participatory scenario analysis consisting of: 1) stakeholders envisioning and backcasting a sustainable future for two banana-based farming systems in Uganda; 2) researchers developing and quantifying plausible future scenarios to assess their effects on locally-relevant sustainability indicators at the household level; 3) stakeholders reflecting on the results, including synergies and trade-offs between sustainability indicators. RESULTS AND CONCLUSIONS: Stakeholders' envisioned future combined with main trends influencing banana-based farming systems resulted in four contrasting scenarios: Marginalisation (stagnation compared with the reference baseline); Business as usual (extrapolation of historic trends); Intensification (including Integrated Soil Fertility Management and collective marketing of banana); and Transformation (irrigation in banana, balanced crop nutrient management, cooperatives, and increased farm sizes for some as other households leave agriculture). Compared with the current baseline situation, selected sustainability indicators food self-sufficiency and farm gross margins decreased in Marginalisation, but improved in all other scenarios. Soil nutrient balances were unfavourable in all scenarios, except with balanced crop nutrition in Transformation. Stakeholders recognised labour as a main trade-off for desired improvements in other sustainability domains. Stakeholders also reflected on benefits and risks of a continued specialisation in banana, and fiercely debated the desirability of mineral fertilizer use. The active involvement of stakeholders in providing the building blocks for the scenarios, identifying relevant indicators and reflecting on the results, aimed to guide stakeholders on concrete entry points for improving sustainability of the system. SIGNFICANCE: Indications of stakeholder commitment towards a more sustainable future included a convergence of ideas on the need for Integrated Soil Fertility Management, collaboration in cooperatives and the need for savings to overcome risks of specialising in banana. Meanwhile, higher-level advocacy and support is required in decision-making on more complex, long-term challenges

Poverty, life events and the risk for depression in Uganda.

BACKGROUND: Understanding the determinants of major depression in sub-Saharan Africa is important for planning effective intervention strategies. OBJECTIVE: To investigate the social and life-event determinants of major depressive disorder in the African sociocultural context of rural Uganda. METHODS: A cross-section survey was carried out in 14 districts in Uganda from 1 June 2003 to 30 October 2004. 4,660 randomly selected respondents (15 years and above) were interviewed. The primary outcome was the presence of 'probable major depressive disorder' (PMDD) as assessed by the Hopkins symptom checklist. RESULTS: The prevalence of PMDD was 29.3% (95% confidence interval, 28.0-30.6%). Factors independently associated with depression in both genders included: the ecological factor, district; age (increase with each age category after 35 years); indices of poverty and deprivation (no formal education, having no employment, broken family, and socioeconomic classes III-V). Only a few adverse life events, notably those suggestive of a disrupted family background (death of a father in females and death of a mother in males) were associated with increased risk. CONCLUSION: Socioeconomic and sociodemographic factors, operating at both ecological and the individual level are the strongest independent determinants of depression. Adverse life events were less strongly associated with depression in this sample

Trend of case notification and treatment outcome in tb management units in refugee settlements in Uganda. A fouryear retrospective analysis, 2014-2017

Background: Tuberculosis (TB) is a major health challenge in refugee populations. Monitoring the key indicators of TB program performance is essential to improve the effectiveness of TB control in refugee camps.Objective: To investigate trends of TB case notifications and treatment outcomes in refugee settlements in Uganda, 2014-2017.Design: Retrospective descriptive cohort studySettings: Thirty-three health facilities located in 12 refugee settlementsSubjects: All TB cases registered from January 1 2014 to December 31 2017Results: A total of 794 TB cases of whom 63.4% were of age 15-44 years and 2.9% Extrapulmonary TB (EPTB) were registered. TB case notification increased from 89 in 2014 to 452 cases in 2017. From 2014 to 2017: male to female ratio for notification was ≥ 2.1:1; percentage of bacteriologically confirmed new and relapse pulmonary was 73.5% to 90.5%; and TB treatment success rate remained lower at 56.2% to 70.8%. On average 32.2% had unfavorable outcomes, including 22% lost to followup (LTFU), 4.5% not evaluated, 3.8% died, and 1.5% had treatment failure. Unsuccessful treatment was significantly associated with EPTB (AOR 11.4 95% CI (1.9-66.5).Conclusion: During the study period: TB case notification continuously increased; TB cases were predominately by male and age 15-44 years; frequency of EPTB remained lower than the national data (7.3%); and TB treatment success was far below the global target (≥ 90%) which need to be improved. There was higher LTFU, not evaluated and death. Patients with EPTB who are at higher risk for unsuccessful treatment need special support