Treatment seeking behaviour among poor urban women in Kampala Uganda

This thesis examines women's treatment seeking behaviour for their own illnesses and that of children underfive in Kamwokya . The focus is on the extent to which women's access to money and time use patterns affect treatment seeking. It has been argued that women's treatment seeking behaviour is influenced more by their time use than their access to and availability of money.The findings obtained through the use of case histories and in-depth interviews indicate that though women in Kamwokya have access to their own money, mainly through participation in income generating activities (business), illness management for children under-five and even more for the women themselves, remains problematic. Women are overworked and manage fragile businesses that require their personal attention and presence. Hence, treatment seeking is done in a manner that will ensure minimal disruption of businesses. Consequently children's health, and even more so, that of women , is compromised for the sake of other family needs.This thesis demonstrates that illness management is not context free, and that no one factor can explain the whole process ; it both affects and is affected by other things happening in the family. Due to the multiple roles women have to fulfil, "time use "is found to be the organising and central factor in illness management for both women and children in Kamwokya, whether from rich or poor households.The thesis concludes by suggesting that policy makers, health care providers and professionals ought to take into account the daily routines of family life in their plans and programmes. Strengthening of private sector health providers, health education programmes and increased awareness raising of male responsibilities towards their families are recommended as a way of improving the health of women and children in Uganda

Question de confiance

À l’image de la nouvelle génération de professionnels de l’information, Jane est ouverte, enthousiaste, engagée, dynamique. Entre deux ateliers du séminaire CTA sur les organisations paysannes, elle a répondu aux questions de Spore sur son travail, son action et ses rêves. Un brin de conversation à l’ombre d’un arbre. ' L’information, c’est le pouvoir. L’information et le savoir vous mettent en confiance et vous permettent de prendre des décisions en connaissance de cause. ' Veut-elle dire par là qu’une personne accomplie ne doute pas d’elle-même et que certaines personnes avec qui elle travaille ne sont pas des agricultrices et agriculteurs accomplis? En un sens, oui. Certains ne sont pas sûrs d’eux, même s’ils sont issus d’une famille qui cultive la terre depuis des siècles. Ils ont l’information pratique, certes, mais ils n’en savent pas assez sur les marchés. Un producteur qui ignore la demande du marché n’aura peut-être pas de débouché, même s’il produit un excellent maïs. Alors, il risque de se désintéresser de son maïs, puisque celui-ci ne lui rapporte rien. Et le pouvoir, demandons-nous? Notre travail, rétorque Jane, consiste à donner aux gens le pouvoir et la confiance en soi en les informant. Beaucoup de gens n’osent pas se lever et prendre la parole, parce qu’ils ont peur de ne pas dire ' ce qu’il faut ', mais s’ils sont informés, s’ils sont sûrs d’eux, ils peuvent faire de bons commentaires ou poser la bonne question au bon moment. Cela les aide à s’engager. Moi-même, ajoute-t-elle, j’ai besoin de confiance pour aller chercher la bonne information, par exemple chez mes collègues — chercheurs, agronomes, vulgarisateurs, commerciaux ou chargés du crédit. J’ai besoin qu’ils apprécient mieux le rôle de l’information et qu’ils ne considèrent pas qu’ils ont d’autres priorités quand je leur demande un article. Mais, insistons-nous, pense-t-on encore vraiment ainsi au XXIe siècle, en pleine ère de l’information ? Pas intentionnellement, nous rassure-t-elle. En fait, la plupart des gens ont du mal à estimer une information à sa juste valeur, car ils ne peuvent ni la toucher ni la sentir. Un vulgarisateur peut montrer des semences ou des espacements à respecter dans la culture du maïs, et les paysans verront et apprécieront directement. Avec l’information, ils ne réagissent pas aussi vite. Jane se penche en avant, comme pour marteler son propos sur une note plus positive. ' Certaines personnes apprécient l’information, d’ailleurs des agriculteurs écrivent dans notre revue Farmers’ Voice. ' Au passage, nous plaisantons avec elle : qu’est-ce qui vaut mieux, publier les lettres de lecteurs en première page comme dans FV ou en dernières pages comme dans Spore ? Jane parle d’un agriculteur de la région du centre qu’elle a rencontré pendant un atelier et qui lui a dit : ' J’ai lu un article sur un agriculteur qui produit, dans une autre région, des oranges et des fruits de la passion et je me suis dit, s’il peut le faire, pourquoi pas moi ? ' Les fruits de la passion sont devenus sa principale source de revenus et la plus sûre. Ce qu’il a bien fait comprendre à ses collègues participant à l’atelier, c’est qu’il faut apprécier la connaissance et toujours chercher à en savoir plus. En fait, le savoir a changé sa vie. J’ai aussi écrit sur un autre paysan, Jane continue, car il ne connaissait pas l’anglais et n’était pas en mesure de lire l’article. Il a été lu jusqu’au Danemark où se trouve le principal bailleur de fonds de l’UNFFE. Une organisation paysanne danoise s’est intéressée à lui et quand son équipe de tournage est venue en Ouganda pour un film, elle lui a rendu visite. En fin de compte, il a obtenu une formation spéciale en vulgarisation, car il était doué pour transmettre des connaissances à ses collègues paysans. Croyez-moi, il est maintenant très sûr de lui, il s’est vraiment épanoui et quand il vient au bureau, il demande ceci et cela, car il sait qu’il connaît exactement les besoins des autres agriculteurs. Et tout le monde est comme lui, demandons-nous? Pas tout le monde : certains liront quelque chose, l’apprécieront et le mettront en pratique ; d’autres n’en feront rien de concret. L’information, suggérons-nous, serait-elle comme les semences qui tombent ici sur un sol fertile ou là sur les cailloux, comme on le dit dans la Bible ? Jane développe l’idée : ce n’est pas une question de terre caillouteuse. La terre peut être très fertile, mais elle a besoin d’eau. L’information peut tomber sur cette terre fertile, mais manquer de pluie. L’énergie des gens peut avoir sur l’information l’effet de la pluie sur une semence. Jane parle avec fierté des émissions de radio de son organisation et de sa collection de cassettes pour les agriculteurs, en six langues. Elle évoque la façon dont chaque exemplaire de FV est lu par quatre personnes et est diffusé dans les écoles, et son projet d’augmenter le tirage au-delà des 2 000 exemplaires actuels en le finançant par la publicité. Qu’est-ce qui l’a déçue ? La maigre couverture des thèmes agricoles par la presse écrite. L’attitude des journalistes, qui demandent un ' coup de pouce ', et des rédacteurs qui dissertent sur la culture du haricot, mais n’abordent pas les grandes questions politiques. Jane s’enflamme et parle d’organiser un atelier pour les journalistes afin de gagner leurs plumes. A-t-elle un rêve, un rêve professionnel ? Ses yeux brillent un peu plus, sa main bat l’air fermement. Je veux être dans un réseau, aider à donner la bonne information aux agriculteurs, créer une boutique où l’on puisse tout trouver, mais elle n’existe pas encore parce que les investisseurs, les agences d’appui n’apprécient pas la circulation de l’information à sa juste valeur. Ah ! Mais ça, c’est parce qu’ils n’ont pas encore rencontré Jane… la confiance personnifiée. [caption] Jane Kyomuhendo Baitwa dirige le service d’information de la Fédération nationale ougandaise des agriculteurs (UNFFE) — anciennement l’UNFA — à Kampala, ainsi que son magazine Farmers’ Voice. Journaliste professionnelle avec une expérience radio, elle est titulaire d’une maîtrise en sciences politiques de l’Université de Makerere. Les opinions exprimées dans ce Point de vue sont celles de l’auteur, et ne reflètent pas nécessairement les idées du CTA.À l’image de la nouvelle génération de professionnels de l’information, Jane est ouverte, enthousiaste, engagée, dynamique. Entre deux ateliers du séminaire CTA sur les organisations paysannes, elle a répondu aux questions de Spore sur son..

Gender focused methods of research

Meeting: Climate Change and Adaptation Workshop, 25-30 January, 2010, Naivasha, KEResearch methodology should include a range of data collection methods to address the gender dimensions of vulnerability. Gender focused research reduces biases such as: treating sex/gender like any other variable and failing to put it into context; assumptions about gender neutrality and the consequent failure to provide gender sensitive research; failing to disaggregate data based on sex; failing to analyze sex-disaggregated data; failing to report the results of disparities. No single method can cover all of the issues hence it is important to combine quantitative and qualitative methods

High Efficacy of Two Artemisinin-Based Combinations (Artesunate + Amodiaquine and Artemether + Lumefantrine) in Caala, Central Angola.

In April 2004, 137 children 6-59 months of age with uncomplicated Plasmodium falciparum (Pf) malaria (Caala, Central Angola) were randomized to receive either artemether-lumefantrine (Coartem) or artesunate + amodiaquine (ASAQ). After 28 days of follow-up, there were 2/61 (3.2%) recurrent parasitemias in the Coartem group and 4/64 (6.2%) in the ASAQ group (P = 0.72), all classified as re-infections after PCR genotyping (cure rate = 100% [95%CI: 94-100] in both groups). Only one patient (ASAQ group) had gametocytes on day 28 versus five (Coartem) and three (ASAQ) at baseline. Compared with baseline, anemia was significantly improved after 28 days of follow-up in both groups (Coartem: from 54.1% to 13.4%; ASAQ: from 53.1% to 15.9%). Our findings are in favor of a high efficacy of both combinations in Caala. Now that Coartem has been chosen as the new first-line anti-malarial, the challenge is to insure that this drug is available and adequately used

Competitive advantage in SMEs: effect of supply chain management practices, logistics capabilities and logistics integration in a developing country

Purpose – The purpose of this paper is to explore the relationship between supply chain management practices, logistics capabilities, logistics integration and competitive advantage of Small and Medium Enterprises (SMEs) in a developing country. Design/methodology/approach – Using a structured questionnaire survey, cross-sectional data collected from 204 SMEs in Kampala – Uganda were analysed using exploratory and confirmatory factor analysis, and Structural Equation Modelling (SEM) using AMOS version 26 to validate the theorised relationships. Findings – The study findings revealed that both supply chain management practices and logistics integration are positively and significantly associated with competitive advantage. Also, both supply chain management practices and logistics capabilities are positively and significantly associated with logistics integration. Additionally, the authors found that logistics integration partially mediates in the relationships between supply chain management practices and competitive advantage, and logistics capabilities and competitive advantage. Conclusively, the three independent variables collectively account for 11% variance in competitive advantage of SMEs. Originality/value – Given the general observation that SMEs are fundamental to socio-economic development, yet resource constrained, this study uses Resource-based and dynamic capabilities theoretical perspectives to provide an empirical understanding of the supply chain and logistics resources and capabilities necessary for building competitive advantage of SMEs in the context of a developing economy

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

Limiting nutrients for bean production on contrasting soil types of Lake Victoria Crescent of Uganda

Common bean (Phaseolus vulgaris L.) is one of the most important grain legumes in East Africa, but its yield has remained below the genetic potential. Declining soil fertility is among the primary constraints to bean production in most East African bean producing regions. Often existing recommendations are generic and inept to guide farm level decision making on nutrient replenishment. A greenhouse nutrient omission study was conducted to determine the limiting nutrients in three soils of Masaka District, commonly cropped to beans: “Liddugavu” a Phaeozem, “Limyufumyufu” a Cambisol and “Luyinjayinga” an Umbrisol soil. Nine treatments; (i) complete nutrient treatment, (ii) N omitted, (iii) P omitted, (iv) K omitted, (v) Mg omitted, (vi) S omitted, (vii) Ca omitted, (viii) Micronutrients omitted and (ix) control without nutrients. Each treatment was randomly assigned to the three soils and replicated three times using a completely randomised design. Nitrogen, phosphorus and potassium were limiting nutrients for bean production in Umbrisol (Luyinjayinja) while in Cambisol (‘Limyufumyufu), common bean production was most limited by soil acidity. The performance varied with soil types, with beans grown on the Phaeozem registering greater leaf number and growth, confirming both scientist’s and local farmer’s knowledge that this soil has greater potential than the other two soils

The pathway of obstructed labour as perceived by communities in south-western Uganda: a grounded theory study

BACKGROUND: Obstructed labour is still a major cause of maternal and perinatal morbidity and mortality in Uganda, where many women give birth at home alone or assisted by non-skilled birth attendants. Little is known of how the community view obstructed labour, and what actions they take in cases where this complication occurs. OBJECTIVE: The objective of the study was to explore community members' understanding of and actions taken in cases of obstructed labour in south-western Uganda. DESIGN: Grounded theory (GT) was used to analyse data from 20 focus group discussions (FGDs), 10 with women and 10 with men, which were conducted in eight rural and two urban communities. RESULTS: A conceptual model based on the community members' understanding of obstructed labour and actions taken in response is presented as a pathway initiated by women's desire to 'protecting own integrity' (core category). The pathway consisted of six other categories closely linked to the core category, namely: (1) 'taking control of own birth process'; (2) 'reaching the limit - failing to give birth' (individual level); (3) 'exhausting traditional options'; (4) 'partner taking charge'; (5) 'facing challenging referral conditions' (community level); and finally (6) 'enduring a non-responsive healthcare system' (healthcare system level). CONCLUSIONS: There is a need to understand and acknowledge women's reluctance to involve others during childbirth. However, the healthcare system should provide acceptable care and a functional referral system closer to the community, thus supporting the community's ability to seek timely care as a response to obstructed labour. Easy access to mobile phones may improve referral systems. Upgrading of infrastructure in the region requires a multi-sectoral approach. Testing of the conceptual model through a quantitative questionnaire is recommended

Varying efficacy of artesunate+amodiaquine and artesunate+sulphadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in the Democratic Republic of Congo: a report of two in-vivo studies

BACKGROUND: Very few data on anti-malarial efficacy are available from the Democratic Republic of Congo (DRC). DRC changed its anti-malarial treatment policy to amodiaquine (AQ) and artesunate (AS) in 2005. METHODS: The results of two in vivo efficacy studies, which tested AQ and sulphadoxine-pyrimethamine (SP) monotherapies and AS+SP and AS+AQ combinations in Boende (Equatorial province), and AS+SP, AS+AQ and SP in Kabalo (Katanga province), between 2003 and 2004 are presented. The methodology followed the WHO 2003 protocol for assessing the efficacy of anti-malarials in areas of high transmission. RESULTS: Out of 394 included patients in Boende, the failure rates on day 28 after PCR-genotyping adjustment of AS+SP and AS+AQ were estimated as 24.6% [95% CI: 16.6-35.5] and 15.1% [95% CI: 8.6-25.7], respectively. For the monotherapies, failure rates were 35.9% [95% CI: 27.0-46.7] for SP and 18.3% [95% CI: 11.6-28.1] for AQ. Out of 207 patients enrolled in Kabalo, the failure rate on day 28 after PCR-genotyping adjustment was 0 [1-sided 95% CI: 5.8] for AS+SP and AS+AQ [1-sided 95% CI: 6.2]. It was 19.6% [95% CI: 11.4-32.7] for SP monotherapy. CONCLUSION: The finding of varying efficacy of the same combinations at two sites in one country highlights one difficulty of implementing a uniform national treatment policy in a large country. The poor efficacy of AS+AQ in Boende should alert the national programme to foci of resistance and emphasizes the need for systems for the prospective monitoring of treatment efficacy at sentinel sites in the country

Limiting nutrients for bean production on contrasting soil types of Lake Victoria Crescent of Uganda

Common bean (Phaseolus vulgaris L.) is one of the most important grain legumes in East Africa, but its yield has remained below the genetic potential. Declining soil fertility is among the primary constraints to bean production in most East African bean producing regions. Often existing recommendations are generic and inept to guide farm level decision making on nutrient replenishment. A greenhouse nutrient omission study was conducted to determine the limiting nutrients in three soils of Masaka District, commonly cropped to beans: \u201cLiddugavu\u201d a Phaeozem, \u201cLimyufumyufu\u201d a Cambisol and \u201cLuyinjayinga\u201d an Umbrisol soil. Nine treatments; (i) complete nutrient treatment, (ii) N omitted, (iii) P omitted, (iv) K omitted, (v) Mg omitted, (vi) S omitted, (vii) Ca omitted, (viii) Micronutrients omitted and (ix) control without nutrients. Each treatment was randomly assigned to the three soils and replicated three times using a completely randomised design. Nitrogen, phosphorus and potassium were limiting nutrients for bean production in Umbrisol (Luyinjayinja) while in Cambisol (\u2018Limyufumyufu), common bean production was most limited by soil acidity. The performance varied with soil types, with beans grown on the Phaeozem registering greater leaf number and growth, confirming both scientist\u2019s and local farmer\u2019s knowledge that this soil has greater potential than the other two soils.Le haricot commun (Phaseolus vulgaris L.) est un des l\ue9gumes \ue0 grains les plus importants en Afrique de l\u2019Est, mais son rendement reste toujours en dessous de son potentiel g\ue9n\ue9tique. La baisse de la fertilit\ue9 du sol est parmi les contraintes primaires \ue0 la production du haricot dans la plupart des r\ue9gions productrices de l\u2019Afrique de l\u2019Est. Le plus souvent, les recommandations sont g\ue9n\ue9riques et inad\ue9quates pour guider la prise de d\ue9cision au niveau champ sur le r\ue9approvisionnement en nutriment. Une \ue9tude sous serre sur l\u2019omission de nutriment a \ue9t\ue9 conduite pour d\ue9terminer les nutriments limitants dans les trois sols du district de Masaka, commun\ue9ment utilis\ue9s pour produire du haricot\ua0: \u201cLiddugavu\u201d un sol du Phaeozem, \u201cLimyufumyufu\u201d un sol du Cambisol et \u201cLuyinjayinga\u201d un sol du Umbrisol. Neuf traitements, (i) traitement complet de nutriments, (ii) N omis, (iii) P omis, (iv) K omis, (v) Mg omis, (iv) S omis, (vii) Ca omis, (viii) micronutriments omis et (ix) control sans nutriments. Chacun des traitements a \ue9t\ue9 al\ue9atoirement distribu\ue9 aux trois types de sols et r\ue9pliqu\ue9 trois fois dans un dispositif compl\ue8tement al\ue9atoire. Azote, phosphore, et potassium ont \ue9t\ue9 les nutriments limitants pour la production du haricot dans Umbrisol (Luyinjayinja) tandis que dans Cambisol (\u2018Limyufumyufu), la production du haricoct commun a \ue9t\ue9 limit\ue9e par l\u2019acidit\ue9 du sol. Les performances varient en fonction des types de sols, avec le haricot produit sur le Phaeozem comptant plus de feuilles et de croissance, confirmant \ue0 la fois les connaissances des scientifiques et des populations locales qui stipulent que le sol a un potentiel plus \ue9lev\ue9 que les deux autres sols