Factors associated with management of pneumonia among children by Community Health Workers in Abim district, Uganda

Introduction: Pneumonia is a leading cause of death among children under five years of age in Uganda. Community Health Workers (CHWs) can prevent pneumonia deaths if they know how to manage the disease correctly. We conducted a study to determine factors associated with management of pneumonia among under-five year children by CHWs in Abim district, Uganda. Methods: This was a cross sectional study. We obtained data from 374 CHWs using a training video, questionnaire, Sick Child Job Aid (SCJA) and case vignettes. We determined the proportion of CHWs that correctly managed pneumonia. Modified Poisson regression established factors associated with management of pneumonia in children by CHWs. We conducted four key informant interviews with CHWs focal persons, and five focus group discussions with community members. Results: We found that 15.5% of CHWs correctly managed pneumonia among children as per the SCJA. In addition, 73.8% of the CHWs respiratory rate counts were close to the respiratory count of the training video with +/- five range. Educational level (Adj. PR 2.06; 95% CI: (1.18-3.61) p-value 0.011), having a CHW register (Adj. PR 0.54; 95% CI (0.30-0.98) p-value 0.041) and drug stock outs (Adj. PR 4.24; 95% CI (1.37-13.13) p-value 0.012) were significantly associated with CHW management of pneumonia. Refresher training, availability of equipment and supplies, and support supervision were the main health facility factors influencing management of pneumonia. Perceptions that CHWs could not manage pneumonia among children, drug stock outs, and lack of trust were community factors influencing CHW management of pneumonia. Conclusion: A low proportion of CHWs correctly managed pneumonia among children. Strategies to improve provision of CHW registers, drugs, support supervision, refresher trainings, as well as recruiting CHWs with a minimum of secondary level of education are necessary to improve management of pneumonia among children. Communities also need to be sensitised on roles and responsibilities of CHWs in management of pneumonia

Implementation of intensified tuberculosis case finding among people living with HIV in Kampala, Uganda: a cross sectional study

Introduction: Intensified Case Finding (ICF) is a cost-effective strategy for tuberculosis (TB) control and improving quality of life however, its implementation by health workers is generally reported as low in Uganda. There is limited information on the level of ICF implementation and the barriers or facilitators to its implementation among public health facilities in Kampala Capital City Authority (KCCA). In this study we determined the level of ICF implementation, facilitators and its barriers in KCCA public health facilities. Methods: We conducted a cross-sectional study between May-July 2015. We purposively selected six KCCA public health facilities and conducted exit interviews with patients attending Anti-Retroviral Therapy (ART) clinics to assess whether they were screened for TB. In-depth and key informant interviews with health workers were conducted to explore their experiences in implementing ICF. Results: Overall, ICF implementation was sub optimal. Less than 10% (30/321) clients reported being screened for current cough, fever, weight loss or night sweats. Conversely, 90.0% (289/321) clients screened for at least one TB symptom with cough being the most frequently asked symptom 87.5% (281/321). Of 131 clients who were screened and reported having at least one TB symptom, 36.6% (48/131) were sent to the laboratory, 2.3% (3/131) for X-Ray and 61.1% (80/131) to pharmacy. Training, support supervision, proper coordination, and support from implementing partners were facilitators of ICF implementation. Poor staff attitude, irregular supply of ICF related inputs/materials, high workload, transport and stigma were key barriers to ICF policy implementation. Conclusion: ICF implementation at ART clinics in KCCA public health facilities was sub optimal. Health workers’ attitude, training, support supervision and stigma of TB clients should be addressed for better ICF implementation

Cost of care for preterm babies to Clients and influence of costs on care in resource limited settings - Societal perspective: A case of Jinja Regional Referral Hospital in East central Uganda

Introduction: The costs of care for preterm birth to clients and the influence of costs on preterm care remain a significant issue to the health system and families globally especially in the low-middle income countries particularly, in Asia and sub-Saharan Africa with already constrained economies. However, this has not received worthwhile attention. We estimated the costs of care for preterm babies to families (clients) and the influence of costs on the care for preterm babies from a societal perspective in Jinja Regional Referral Hospital. Methods: This was a one-month survey from August 2016 — September 2016 through which we had exit interviews with 100 mothers to determine the costs on admission and followed up 82 mothers to determine follow up costs of all babies that were born preterm and weighed less than 2.5 kg either at discharge or follow up. A micro costing approach was used to compute client costs for preterm care. Mothers were asked to identify absolute costs incurred. We also reviewed medical records of patients and receipts that were available from clients. A likert scale was used to assess influence of costs on preterm care to mothers. This ranged from -5 to 5, where (+5 to +1) was high influence, (0) was neutral, (-5 to -1) was low influence. Respondents were also asked to give reasons for their answers. From the provider perspective, we conducted key informant interviews with health care workers to ascertain the influence of costs on preterm care from the provider perspective. Analysis of findings was done using the Microsoft excel sheet. Statistical analysis was done using Stata Version 13 to determine the influence of costs on the care of preterm babies from the client's perspective. Thematic analysis was used to analyze the influence of costs on care from the provider perspective. Costs were converted to US$for the annual exchange average rate of 2016. One-way sensitivity analysis was done to establish the impact of cost drivers on the total cost. Results: The total annual cost of preterm care from the client perspective was US$ 10,520.36 and the unit cost of care per preterm baby was US$ 105.2 at Jinja Regional Referral Hospital. Cost drivers included opportunity costs (i.e., potential benefits foregone by clients to take care of preterm babies), drug costs on follow up, supplies and feeding costs to the mothers/caregivers during admission. Drugs, supplies thermal care and feeding costs during admission were found to have a high influence on preterm care from a societal perspective. Conclusion: The cost of preterm care is high from the client perspective and is characterized by longer stay in hospital because of missed treatment due to stock outs and affordability constraints to clients, but also discharge against medical advice leading to poor survival of preterm babies. Improving funding for preterm care and welfare for caregivers during hospitalization may lead to better outcomes for preterm babies

Cost of care for preterm babies in Jinja Regional Referral Hospital, East-central Uganda: A provider perspective

Introduction: Preterm birth and its complications are a major global health burden and significantly contribute to the under-five mortality in Uganda. This study aimed at identifying the morbidities suffered by preterm babies and the cost of preterm care to the provider in Jinja Referral Hospital. Methods: This was a one-year cost analysis of preterm care from August 2015 – July 2016. The study took on a micro-costing approach, through which medical and accounting records, were reviewed for 507 preterm babies that were seen over the year to determine morbidities of preterm infants and costs from the provider perspective. Analysis of findings was done using a Microsoft excel sheet. Costs were converted to US$for the annual exchange average rate of 2016. One-way sensitivity analysis was done to establish the impact of cost drivers on the total cost. Results: We found that the most prevalent morbidities among preterm babies were; neonatal hyperbilirubinemia, respiratory distress and neonatal septicaemia. The total annual cost of preterm care from the provider perspective was US$ 54,108 and the unit cost of care per preterm baby was US$ 107 at Jinja Regional Referral Hospital. Cost drivers included; equipment, personnel and utility costs (water and electricity). Conclusion: The cost of preterm care is high and sub-optimal from a provider perspective. It is characterized by stockouts of drugs and supplies which are critical in the care that is required to boost the survival of preterm babies. Improving funding for preterm care may be helpful in enhancing preterm survival

A case-control study of factors associated with caesarean sections at health facilities in Kabarole District, Western Uganda, 2016.

INTRODUCTION: World Health Organization estimates that the appropriate caesarean section rates should range from 10% to 15% at the population level. There is limited access and utilisation of caesarean section services in Uganda. This case-control study explored factors associated with caesarean section delivery, focusing on service-related and individual level factors. METHODS: we interviewed 134 cases that had a caesarean section and 134 controls that had a "normal" vaginal delivery. The study was conducted at health facilities in Kabarole district during March to May 2016. Multivariable logistic regression was used to determine individual factors associated with caesarean sections, at a significance level of p 35 years) compared to the controls. The factors associated with caesarean section delivery were: having a previous caesarean section delivery (adjusted odds ratio (AOR): 4.5 CI: 2.22-9.0), attendance of four or more ANC visits (AOR: 2.0 CI: 1.04-3.83). Inadequate human resource, medicines and supplies affected access to the service. Misconceptions such as negative branding of women that have caesarean section deliveries as "lazy" reduced its acceptance thus low utilisation of the service. CONCLUSION: health system inadequacies and misconceptions about caesarean section delivery contributed to the low access and utilisation of the service

Predictors of recovery from complicated severe acute malnutrition among children 6-59 months admitted at Mbale Hospital, Uganda

Introduction: In Uganda, 300,000 children under 5 years are acutely malnourished with 1.3% suffering from Severe Acute Malnutrition (SAM). Mbale Regional Referral hospital (MRRH) nutrition unit admits SAM children with comorbidities into inpatient care striving to ensure recovery, reduce morbidity and mortality. We assessed the incidence and predictors of time to recovery among SAM children admitted as inpatients in MRRH nutrition unit. Methods: We reviewed records of children 6-59 months old managed at the inpatient unit for SAM at MRRH from 2013 to 2016. Data on patient demographics, comorbidities, medications administered, and treatment outcomes were collected from the integrated nutrition register and patient charts. Recovery incidence was determined using Kaplan Meier survival analysis. Cox proportional hazards regression competing risks model with death, default and transfer as competing risks was fit to identify predictors of time to recovery. Results: Overall, 322 patient records were reviewed of which 183 (56.8%) were males with median age of 19 months (IQR; 14-26 months). Of these, 246 (76.4%) recovered with recovery incidence of 31.3 per 1000 person days and a median recovery time of 27 days (IQR; 16-38 days). Children with SAM who were dewormed during treatment were 33% more likely to recover faster compared to their counterparts who were not dewormed (AHR= 1.33; C.I = 1.01-1.74). Conclusion: Recovery was in acceptable range of Sphere standards and deworming was a predictor of time to recovery. The Uganda Ministry of health should ensure nutritional rehabilitation units follow the stipulated guidelines for management of SAM. Findings were limited by missing data

Community willingness to pay for maternal transport in Kabarole District, Western Uganda: A cross-sectional study

Introduction: Saving Mothers Giving Life project in Kabarole district has supported maternal transportation to health facilities since 2012. There is need to sustain project outcomes when it winds up. We assessed community willingness to pay (WTP) for the maternal transport services and associated factors. Methods: We conducted a crosssectional study among household heads in Kabarole district. We used simple random sampling to select the villages and households and purposively selected household heads. We administered structured questionnaires to household heads. A household ead who reported that he/she was willing to contribute financially to the maternal transport services in the district was categorized as willing to pay. We obtained preferred entity to coordinate and manage the funds, preferred transport means, payment mode and amount of money through structured interviews. We used modified Poisson regression models to determine associations between WTP and the various characteristics of participants. Results: A total of 646 household heads were interviewed. The mean age was 33.8 years (SD±8.85). Most, 68% (442/646) were willing to pay for maternal transport. Of the 442 willing to pay, 65.38% preferred monthly payment with an average of UGX 2,207.6/= (<1.00 USD). Education was positively associated with WTP at all levels. Being married, participating in a saving scheme and staying more than five kilometers away from a heath facility were also associated with WTP: (APR 1.15, 95% CI 1.02-1.30), (APR 1.12, 95% CI 1.01-1.25), (APR 1.32, 95% CI 1.15-1.50) respectively. Conclusion: Households need to be mobilized, educated about the outcomes of accessing maternal services, and the need to pay for maternal transport. Payment modalities can be agreed upon by all stakeholders in a participatory and iterative proces

The state of COVID-19 contact tracing following relaxation of the national lockdown: A qualitative study among surveillance response teams in Kampala, Uganda

Introduction: The surge in COVID-19 cases triggered a need for surveillance systems to implement new strategies that augment and accelerate manual contact tracing. In Uganda, COVID-19 cases increased exponentially following the relaxation of the national lockdown. However, little is known about how the surveillance system mitigated COVID-19 transmission during this period. We sought to understand how contact tracing was being conducted in Kampala district following relaxation of the national lockdown. Methods: We conducted a cross-sectional qualitative study, between November and December 2020, among surveillance response officials in the five Divisions of Kampala-Uganda. We purposively selected and interviewed 14 key informants from the Division health offices who included five Division surveillance focal persons, four data analysts and five laboratory personnel. Interviews were audio recorded and transcribed verbatim. We used a conventional approach for content analysis to identify emergent themes. Results: We found that adjustments were made in the contact tracing system to cope with the increasing number of COVID-19 cases. Online and mobile application technology systems including Go-data, WhatsApp, Open Data Kit and City Health Information System were adopted for collection, storage, analysis and reporting of contact tracing data. In one Division, community health workers were trained and engaged. Phone calls were adopted to supplement physical follow-up of contacts. We found managerial barriers such as delays in communication, limited skilled-workforce and insufficient laboratory supplies. Behavioral barriers including lack of cooperation from cases and contacts triggered by perceived stigma affected effective implementation and sustainability of the adjustments in contact tracing. Conclusion: Online systems and engagement of community health workers were adopted to optimize contact tracing coverage in Kampala. There is need to assess the effectiveness and outcomes of digital solutions to contact tracing in resource-limited settings. Besides, clear strategies should be designed to ensure the attainment of gains from community health workers when engaged in surveillance response activities

An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study

Introduction: gobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015. Methods: we obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics. Results: a total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected. Conclusion: road traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions

Adherence to complementary feeding guidelines among caregivers of children aged 6-23 months in Lamwo district, rural Uganda

Introduction: malnutrition contributes to half of all deaths among children under-five years in developing countries such as Uganda. Optimal complementary feeding is one of the crucial interventions that could prevent these deaths. This study measured adherence to complementary feeding guidelines and its associated factors among caregivers of children aged 6-23 months in Lamwo district, rural Uganda. Methods: a household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software. Results: a household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software.nearly all (97.7%, 341/349) children had ever been breastfed. Complementary feeding was initiated at six months for 47.0% (164/349) of the children. The number of complementary meals ranged from 1-4 meals per day with a mean of 3 meals per day (SD = 0.8). About half (55.8%, 195/349) of the children were given less than the recommended amount of food. Overall only 40.1% (140/349) of all study respondents were adherent to complementary feeding guidelines. The odds of adherence to complementary feeding were higher among caregivers with children aged 6-8 months (AOR = 4.68, 95% CI: 1.91-11.48), children whose fathers had attained 8 or more years of formal education (AOR = 2.27, 95% CI: 1.22-4.19), caregivers with two children under five years (AOR = 5.46, 95% CI: 1.46-20.36), those living in the poorest households (AOR = 3.00, 95% CI: 1.37-6.57) and those who showed willingness to recommend initiation of complementary feeding at six months to another mother (AOR = 1.34 95% CI: 1.06-1.70). Conclusion: adherence to complementary feeding guidelines was very low in this rural African setting indicating an urgent need for interventions such as health education to improve adherence with consequent reduction in rates of under nutrition. These interventions should target caregivers with older children, fathers with less than 8 years of formal education and those living in the wealthiest households