Integration of Mental Health into Primary Health Care in a rural district in Uganda

Objective: Mental health has been identified as a major priority in the Ugandan Health Sector Strategic Plan. Efforts are currently underway to integrate mental health services into the Primary Health Care system. In this study, we report aspects of the integration of mental health into primary health care in one rural district in Uganda. Method: Qualitative methods were used for data collection. Semi-structured interviews and focus group discussions were conducted with various stakeholders within the ministry of health as well as line ministries. Data analysis was done using Nvivo 7, specifically adopting framework analysis approach. Results: Attempts to offer organized mental health services were found to be present in only a few health facilities. The district had only a single mental health nurse, and very few General Health Workers adequately equipped with the knowledge and skills to provide mental health services. The vertical referral system was not being followed as planned and there was no evidence of any organized community interventions for those with mental disorders. The mental health nurse and a few PHC nurses however expressed interest and commitment to providing services for persons with mental illness, despite the challenges. Conclusion: Although mental healthis expected to be integrated into primary health care, mental health services in this district have not yet achieved the expected level of integration. This implies that this important policy requirement has not yet been effectively realized in this rural district, which could be the case in many other districts of a similar status. There is thus a need to direct more efforts towards realization of this important policy requirement.Key words: Mental health; Primary Health Care; Integration; Ugand

Media and Mental Health in Uganda

Objective: The media is largely regarded as an important stakeholder in health service delivery, with a great influence on publicattitudes. However, little is known about its interest in mental health and the guiding factors that influence media coverage of mentalhealth issues. This article describes the importance accorded to mental health by the media and the factors that influence mediacoverage of mental health issues in Uganda. Method: Semi-structured interviews were held with representatives from sixprominent media houses as part of the situational analysis of the mental health system in Uganda. Data was analyzed using Nvivo7 qualitative data analysis software. Results: The media was found to be interested and actively involved in health initiatives, butwith little attention devoted to mental health. Coverage and interest in mental health was noted to be mainly dependent on theindividual journalists’ interests, and mostly for personal reasons. Low interest was largely attributed to mental health beingperceived as a non-priority area, and the fact that mental illness is not a major contributor to mortality. Media coverage andreporting is guided by prioritization of the Health Department. Conclusion: The media in Uganda is an important stakeholderin the health care system with a key role of advocacy, publicity and mass education. Media houses however are less interested inmental health as evidenced by low coverage of mental health issues. This calls for advocacy and sensitization as a way ofpersuading media for more involvement in mental health initiatives.Key words: Media; Mental health; Uganda; Publi

Economic justification of non-motorized transport (nmt) in cities of developing countries: case study non-motorized transport scheme for kampala central business district

African cities have waited too long to deal with the existential threat of Climate change and thus have begun to suffer its effects. In most African cities, populations are increasing rapidly and the reliance on Non-motorized transport (NMT) is high, but dedicated NMT infrastructure remains limited. In all cities and towns across Uganda, the use of private vehicles has risen steadily over the years and has congested these cities, poisoned the air and killed NMT users at exceptionally high rates. In view of the above, The Ministry of Works and Transport developed and passed the Non-Motorized transport policy in 2012 and currently this policy is at implementation stage. Kampala Capital City Authority (KCCA) in the bid to implement this policy has undertaken a pilot project to establish Non-Motorized Transit corridors along Namirembe Road and Luwum Street which are be accessible to only pedestrians and cyclists. Further to this KCCA has undertaken designs for an extension of this pilot to cover 4.25 km of CBD streets and 15km along the existing medium gauge railway to from the CBD to Namanve. This paper presents an economic justification of the aforementioned NMT projects using the Non-Motorized Transport Project Assessment Tool (NMT PAT) to quantitatively and qualitatively analyse the expected impacts (benefits and costs). The impacts have been analysed in four categories i.e Social impacts, Economic impacts, Health impacts and Environment impacts. The results of the analysis indicate that considering a design life of 15 years Kampala city will experience reductions in emissions to the tune of 675,000 tons for Carbon dioxide, 13.81 tons of Particulate matter and 2536 tons of Nitrogen dioxide. The health benefits in terms of reduction in accidents valued at Uganda shillings 4,163,611,405,517.35 (USD 1,134,499,020) will also be realized. A general improvement in journey quality, security and liveability will also be achieved as well as a reduction in the noise levels by about 3.75 decibels. To encapsulate by implementing the proposed NMT infrastructure, a Net present Value of 14 trillion shillings (USD 3 Billion) shall be realised thus demonstrating that NMT investment is an attractive venture for developing cities.Papers presented virtually at the 39th International Southern African Transport Conference on 05 -07 July 202

Supervised versus unsupervised antimalarial treatment with six-dose artemether-lumefantrine: pharmacokinetic and dosage-related findings from a clinical trial in Uganda.

BACKGROUND: A six-dose antimalarial regimen of artemether-lumefantrine (A/L) may soon become one of the most widely used drug combination in Africa, despite possible constraints with adherence and poor absorption due to inadequate nutrition, and a lack of pharmacokinetic and effectiveness data. METHODS: Within a trial of supervised versus unsupervised A/L treatment in a stable Ugandan Plasmodium falciparum transmission setting, plasma lumefantrine concentrations were measured in a subset of patients on day 3 (C [lum]day3) and day 7 (C [lum]day7) post-inclusion. Predictors of lumefantrine concentrations were analysed to show how both C [lum]day7 and the weight-adjusted lumefantrine dose affect 28-day recrudescence and re-infection risks. The implications of these novel findings are discussed in terms of the emergence of lumefantrine-resistant strains in Africa. RESULTS: C [lum]day3 and C [lum]day7 distributions among 241 supervised and 238 unsupervised patients were positively skewed. Unsupervised treatment and decreasing weight-adjusted lumefantrine dose were negatively associated with C [lum]day3. Unsupervised treatment and decreasing age showed strong negative associations with C [lum]day7. Both models were poorly predictive (R-squared < 0.25). There were no recrudescences in either arm, but decreasing lumefantrine dose per Kg resulted in up to 13-fold higher adjusted risks of re-infection. Re-infections occurred only among patients with C [lum]day7 below 400 ng/mL (p < 0.001). CONCLUSION: Maintaining the present six-dose regimen and ensuring high adherence and intake are essential to maximize the public health benefits of this valuable drug combination

Tuberculosis infection control practices in a high-burden metro in South Africa : a perpetual bane for efficient primary health care service delivery

Background: Tuberculosis (TB) prevention, including infection control, is a key element in the strategy to end the global TB epidemic. While effective infection control requires all health system components to function well, this is an area that has not received sufficient attention in South Africa despite the availability of policy and guidelines. Aim: To describe the state of implementation of TB infection control measures in a high-burden metro in South Africa. Setting: The research was undertaken in a high TB-and HIV-burdened metropolitan area of South Africa. More specifically, the study sites were primary health care facilities (PHC), that among other services also diagnosed TB. Methods: A cross-sectional survey, focusing on the World Health Organization levels of infection control, which included structured interviews with nurses providing TB diagnosis and treatment services as well as observations, at all 41 PHC facilities in a high TB-burdened and HIV-burdened metro of South Africa. Results: Tuberculosis infection control was poorly implemented, with few facilities scoring 80% and above on compliance with infection control measures. Facility controls: 26 facilities (63.4%) had an infection control committee and 12 (29.3%) had a written infection control plan. Administrative controls: 26 facilities (63.4%) reported separating coughing and non-coughing patients, while observations revealed that only 11 facilities (26.8%) had separate waiting areas for (presumptive) TB patients. Environmental controls: most facilities used open windows for ventilation (n = 30; 73.2%); however, on the day of the visit, only 12 facilities (30.3%) had open windows in consulting rooms. Personal protective equipment: 9 facilities (22%) did not have any disposable respirators in stock and only 9 respondents (22%) had undergone fit testing. The most frequently reported barrier to implementing good TB infection control practices was lack of equipment (n = 22; 40%) such as masks and disposable respirators, as well as the structure or layout of the PHC facilities. The main recommendation to improve TB infection control was education for patients and health care workers (n = 18; 33.3%). Conclusion: All levels of the health care system should be engaged to address TB prevention and infection control in PHC facilities. Improved infection control will address the nosocomial spread of TB in health facilities and keep health care workers and patients safe from infection

Patient- and delivery-level factors related to acceptance of HIV counseling and testing services among tuberculosis patients in South Africa: a qualitative study with community health workers and program managers

<p>Abstract</p> <p>Background</p> <p>South Africa has a high tuberculosis (TB)-human immunodeficiency virus (HIV) coinfection rate of 73%, yet only 46% of TB patients are tested for HIV. To date, relatively little work has focused on understanding why TB patients may not accept effective services or participate in programs that are readily available in healthcare delivery systems. The objective of the study was to explore barriers to and facilitators of participation in HIV counseling and testing (HCT) among TB patients in the Free State Province, from the perspective of community health workers and program managers who offer services to patients on a daily basis. These two provider groups are positioned to alter the delivery of HCT services in order to improve patient participation and, ultimately, health outcomes.</p> <p>Methods</p> <p>Group discussions and semistructured interviews were conducted with 40 lay counselors, 57 directly observed therapy (DOT) supporters, and 13 TB and HIV/acquired immune deficiency syndrome (AIDS) program managers in the Free State Province between September 2007 and March 2008. Sessions were audio-recorded, transcribed, and thematically analyzed.</p> <p>Results</p> <p>The themes emerging from the focus group discussions and interviews included four main suggested barrier factors: (1) fears of HIV/AIDS, TB-HIV coinfection, death, and stigma; (2) perceived lack of confidentiality of HIV test results; (3) staff shortages and high workload; and (4) poor infrastructure to encourage, monitor, and deliver HCT. The four main facilitating factors emerging from the group and individual interviews were (1) encouragement and motivation by health workers, (2) alleviation of health worker shortages, (3) improved HCT training of professional and lay health workers, and (4) community outreach activities.</p> <p>Conclusions</p> <p>Our findings provide insight into the relatively low acceptance rate of HCT services among TB patients from the perspective of two healthcare workforce groups that play an integral role in the delivery of effective health services and programs. Community health workers and program managers emphasized several patient- and delivery-level factors influencing acceptance of HCT services.</p

Stakeholder's perceptions of help-seeking behaviour among people with mental health problems in Uganda

<p>Abstract</p> <p>Introduction</p> <p>Mental health facilities in Uganda remain underutilized, despite efforts to decentralize the services. One of the possible explanations for this is the help-seeking behaviours of people with mental health problems. Unfortunately little is known about the factors that influence the help-seeking behaviours. Delays in seeking proper treatment are known to compromise the outcome of the care.</p> <p>Aim</p> <p>To examine the help-seeking behaviours of individuals with mental health problems, and the factors that may influence such behaviours in Uganda.</p> <p>Method</p> <p>Sixty-two interviews and six focus groups were conducted with stakeholders drawn from national and district levels. Thematic analysis of the data was conducted using a framework analysis approach.</p> <p>Results</p> <p>The findings revealed that in some Ugandan communities, help is mostly sought from traditional healers initially, whereas western form of care is usually considered as a last resort. The factors found to influence help-seeking behaviour within the community include: beliefs about the causes of mental illness, the nature of service delivery, accessibility and cost, stigma.</p> <p>Conclusion</p> <p>Increasing the uptake of mental health services requires dedicating more human and financial resources to conventional mental health services. Better understanding of socio-cultural factors that may influence accessibility, engagement and collaboration with traditional healers and conventional practitioners is also urgently required.</p