The constitution and the economy: new options for African states

Presented at Conference On Constitutionalism And Rights: United States African Dialogue. August 12th - 15th, 1991

Integrated community case management of malaria and pneumonia in eastern Uganda : care-seeking, adherence, and community health worker performance

Background: Despite being easily preventable and treatable, malaria and pneumonia are major killers of children aged less than five years. Integrated community based interventions through which lay persons called community health workers (CHWs) can manage malaria, pneumonia, diarrhea and neonatal conditions are recommended by WHO and UNICEF. However, there is limited information on care-seeking and performance of CHWs in the context of integrated illness management. Main aim: To assess care-seeking and quality of care in integrated community case management of malaria and pneumonia in children aged less than five years in Uganda so as to inform the implementation of integrated community case management of childhood illness strategy (ICCM). Methods: Four studies (I-IV) were nested in a cluster randomized trial in Iganga-Mayuge demographic surveillance site in eastern Uganda. In this trial CHWs treated malaria and pneumonia (intervention arm) or malaria alone (control arm) in children aged 4-59 months. Performance of CHWs (I) was assessed using: questionnaires (with knowledge tests, case scenarios) and record reviews for 125 CHWs; observations among 57 CHWs in the intervention arm; and four focus group discussions with CHWs. Adherence to treatment was assessed using pill counts and caregiver reports among 1256 children treated by CHWs (II). Receipt of prompt and appropriate antibiotics for pneumonia symptoms and treatment outcomes were assessed among 1276 children treated by CHWs (III). Care-seeking and management of malaria and pneumonia were assessed among 1095 children and from 13 key informant interviews (IV). Results: Care-seeking from CHWs was higher in the intervention than the control arm (31% vs 22%, p=0.01) (IV). CHWs’ performance on malaria symptoms was similar in the intervention and control arms on: overall knowledge, eliciting signs and symptoms, and prescribing (I). More children treated by CHWs received prompt and appropriate malaria treatment compared to other health providers (37% vs 9%, p<0.001) (IV). CHWs had high scores in prescribing for pneumonia but had lower: overall knowledge of pneumonia (40%), and scores on eliciting pneumonia signs and symptoms (25%). Only 35% of CHWs counted respiratory rates within two breaths of rates counted by the physician, and 12% of children without fast breathing received antibiotics while 82% with fast breathing received antibiotics (I). Children treated by CHWs in the intervention arm were more likely to receive prompt and appropriate antibiotics for pneumonia symptoms compared to the control arm (RR=3.51, 95% CI = 1.75-7.03) (III). There was also a higher reduction in the proportion of children with fast breathing from day one to day four in the intervention compared to the control arm (9.2% vs 4.2%, p=0.01); and a lower proportion of febrile children on day four (1% vs 4%; RR=0.29, 95% CI = 0.11-0.78) (III). Adherence to combined antimalarials and antibiotics was similar to adherence to antimalarials alone in the intervention arm (mean 99% both groups) (II). Conclusions: CHWs’ performance on malaria was not affected by additional roles of pneumonia management, but they had challenges in assessment of pneumonia symptoms. CHWs should be supported with continued training, adequate supervision and provision of drugs, diagnostics and other supplies

Facebook use and negative body image among U.S. college women

Young women increasingly spend time with social media, but the relationship of this exposure to body image is still in the initial stages of exploration. This study used social comparison theory to examine the relationship between time spent on Facebook and body image. A survey of 881 U.S. college women was conducted in April-May 2013. Findings showed that 10.1% had posted about weight, body image, exercise or dieting, and 27.4% had commented on friends’ posts or photos. More time on Facebook related to more frequent body and weight comparisons, more attention to the physical appearance of others, and more negative feelings about their bodies for all women. For women who wanted to lose weight, more time on Facebook also related to more disordered eating symptoms

Appointment keeping for medical review among patients with selected chronic diseases in an urban area of Uganda

Introduction: proper management of chronic diseases is important for prevention of disease   complications and yet some patients miss appointments for medical review thereby missing the   opportunity for proper monitoring of their disease conditions. There is limited information on missed  appointments among chronic disease patients in resource limited settings. This study aimed to   determine the prevalence of missed appointments for medical review and associated factors among  chronic disease patients in an urban area of Uganda.Methods: patients or caregivers of children with chronic diseases were identified as they bought  medicines from a community pharmacy. They were visited at home to access their medical documents  and those whose chronic disease status was ascertained were enrolled. The data was collected using: questionnaires, review of medical documents, and in-depth interviews with chronic disease patients. Results: the prevalence of missed appointments was 42% (95%CI=35-49%). The factors associated with missed appointments were: monthly income ?30US Dollars (OR=2.56, CI=1.25–5.26), affording less than half of prescribed drugs (OR=3.92, CI=1.64–9.40), not experiencing adverse events (OR=2.66, CI=1.26–5.61), not sure if treatment helps (OR=2.84, CI=1.047.77), not having a medicines   administration schedule (OR=6.77, CI=2.11–21.68), and increasing number of drugs (OR=0.72,  CI=0.53–0.98).Conclusion: patients missed appointments mainly due to: financial and health system barriers,  conflicting commitments with appointments, and perceptions of the disease condition. Patients should be supported with accessible and affordable health servicesKey words: Chronic disease, medical review appointments, missed appointment

Household preferences and willingness to pay for health insurance in Kampala City: a discrete choice experiment

Introduction: Uganda is in discussions to introduce a national health insurance scheme. However, there is a paucity of information on household preferences and willingness to pay for health insurance attributes that may guide the design of an acceptable health insurance scheme. Our study sought to assess household preferences and willingness to pay for health insurance in Kampala city using a discrete choice experiment. Methods: This study was conducted from 16th February 2020 to 10th April 2020 on 240 households in the Kawempe division of Kampala city stratified into slum and non-slum communities in order to get a representative sample of the area. We purposively selected the communities that represented slum and non-slum communities and thereafter applied systematic sampling in the selection of the households that participated in the study from each of the communities. Four household and policy-relevant attributes were used in the experimental design of the study. Each respondent attended to 9 binary choice sets of health insurance plans that included one fixed choice set. Data were analyzed using mixed logit models. Results: Households in both the non-slum and slum communities had a high preference for health insurance plans that included both private and public health care providers as compared to plans that included public health care providers only (non-slum coefficient β = 0.81, P < 0.05; slum β = 0.87, p < 0.05) and; health insurance plans that covered extended family members as compared to plans that had limitations on the number of family members allowed (non-slum β = 0.44, P < 0.05; slum β = 0.36, p < 0.05). Households in non-slum communities, in particular, had a high preference for health insurance plans that covered chronic illnesses and major surgeries to other plans (0.97 β, P < 0.05). Our findings suggest that location of the household influences willingness to pay with households from non-slum communities willing to pay more for the preferred attributes. Conclusion: Potential health insurance schemes should consider including both private and public health care providers and allow more household members to be enrolled in both slum and non-slum communities. However, the inclusion of more HH members should be weighed against the possible depletion of resources and other attributes. Potential health insurance schemes should also prioritize coverage for chronic illnesses and major surgeries in non-slum communities, in particular, to make the scheme attractive and acceptable for these communities

TRENDS OF RURAL-URBAN MIGRATION IN NIGERIA

Given the tremendous explosions of urban settlements and the decadence of rural areas during the past two or three decades, the myth, reality and hope of a sustainable human settlement pattern seem to have been unraveled by the two UN Habitat Conferences of 1976 and 1996. Even though the wide range, tempting and unresolved human settlement issues have for long been grappled with by the public policies, solutions to the problems have continued to remain a mystery in Nigeria.Migration is not a recent human phenomenon. Over time however, human beings have moved and established settlements in dual albeit with stratified socio-economic and geo-political compositions called either ‘rural’ or ‘urban’. This paper attempts to examine and analyze the general problems of development of urban and rural settlements in Nigeria as well as various shifts in policies and strategies contained therein. However, it shows how and why efforts are concentrated more explicitly on urban settlements. These top-down manifestations of the growth centre strategies with a ‘trickle-down’ pattern, either in a spontaneous or induced manner, have evoked a reminiscence of other development paradigms and the futility of the approaches adopted, which are urban and industrial in nature, externally oriented and characterized by a highly advanced and capital intensive technology. Thus, artificially created Nigerian urbanized settlements are therefore not free from the intricacies of international dependency position, masterminded by MNCs, sanctioned by the Nigerian State and collaborated by the political and economic elites