The effects of COVID-19 lockdown measures on health and healthcare services in Uganda

Many countries across the world instituted lockdowns as a measure to prevent the spread of COVID-19. However, these lockdowns had consequences on health systems. This study explored effects of the COVID-19 lockdown measures on health and healthcare services in Uganda. The qualitative study employed focus group discussions (FGDs), household interviews, and key informant interviews (KIIs) in both an urban (Kampala district) and rural (Wakiso district) setting in central Uganda. Fourteen FGDs were conducted among community members, local leaders, community health workers, and health practitioners. Interviews were conducted among 40 households, while 31 KIIs were held among various stakeholders including policy makers, non-governmental organisations, and the private sector. Data was analysed by thematic analysis with the support of NVivo 2020 (QSR International). Findings from the study are presented under four themes: maternal and reproductive health; child health; chronic disease services; and mental health. Maternal and reproductive health services were negatively affected by the lockdown measures which resulted in reduced utilisation of antenatal, postnatal and family planning services. These effects were mainly due to travel restrictions including curfew, and fear of contracting COVID-19. The effects on child health included reduced utilisation of services which was a result of difficulties faced in accessing health facilities because of the travel restrictions. Patients with chronic conditions could not access health facilities for their routine visits particularly due to suspension of public transport. Depression, stress and anxiety were common due to social isolation from relatives and friends, loss of jobs, and fear of law enforcement personnel. There was also increased anxiety among health workers due to fear of contracting COVID-19. The COVID-19 lockdown measures negatively affected health, and reduced access to maternal, reproductive and child health services. Future interventions in pandemic response should ensure that their effects on health and access to health services are minimised

Antimicrobial resistance among farming communities in Wakiso District, Central Uganda: A knowledge, awareness and practice study

Background Antibiotics are increasingly becoming ineffective as antimicrobial resistance (AMR) continues to develop and spread globally—leading to more difficult to treat infections. Countries such as Uganda are still challenged with implementation of AMR related strategies due to data paucity. This includes a lack of data on the prevailing knowledge and awareness of antimicrobial resistance and antibiotic use among farming communities, both commercial and subsistence, which are instrumental in the implementation of targeted interventions. The aim of our study was to assess the knowledge, attitudes and practices on AMR among subsistence and commercial farmers in Wakiso district, central Uganda. Methods A cross-sectional study was conducted using a semi-structured questionnaire in Wakiso district, Central Uganda in between June and September 2021. Polytomous latent class analyses were performed to group participants based on their responses. Multivariable regression and conditional inference trees were used to determine the association between demographic factors and knowledge on antibiotics and AMR. Results A total of 652 respondents participated in the study among whom 84% were able to correctly describe what antibiotics are. Subsistence farmers (OR = 6.89, 95% CI [3.20; 14.83]), and to a lesser extent, farming community members which obtained their main income by another business (OR = 2.25, 95% CI [1.345; 3.75]) were more likely to be able to describe antibiotics correctly than individuals involved in commercial farming. Based on the latent class analysis, three latent classes indicating different levels of knowledge on AMR, were found. Subsistence farming, higher educational level and younger age were found to be associated with belonging to a class of better knowledge. Conclusion The majority of participants were able to correctly describe antibiotics and aware of AMR, however there was some degree of misunderstanding of several AMR concepts. Targeted AMR interventions should improve awareness and also ensure that not only subsistence farmers, but commercial farmers, are included

HIV genotypic resistance among pregnant women initiating ART in Uganda: a baseline evaluation of participants in the Option B+ clinical trial

Background: Pre-treatment HIV drug resistance is a threat to elimination of mother to child HIV transmission and could lead to virological failure among HIV-positive pregnant women. We analysed genotypic HIV drug resistance (HIVDR) of baseline samples of participants enrolled in the Option B+ clinical trial in Uganda.Methods: HIV-infected pregnant women attending antenatal care were enrolled from Uganda’s National Referral Hospital (Mulago) and Mityana District general hospital and surrounding health centers (HCs). Genotypic HIV testing was performed on blood samples from the first 135 enrolled women out of a subset of 136 participants (25%) who had a baseline VL>1000 copies/mL as one sample failed to amplify.Results: 159/540 (29.4%) had a VL < 1000 copies/ml and 381/540 (70.6%) had a VL >1,000 copies/ml. Of the women with VL>1000 copies/ml, 32 (23.7%) had resistance mutations including 29/135 (21.5%) NNRTI mutations, 6/135 (4.4%) NRTI mutations and 3/135 (2.2%) had both NNRTI and NRTI mutations. The most common NNRTI resistance mutations were: K103KN (5), K103N (5), V179T (4) and E138A (4).Conclusions: One quarter of the HIV-infected pregnant women in this trial at baseline had NNRTI genotypic resistance mutations. Our findings support new WHO guidelines for first-line ART that were changed to dolutegravir-based regimens

The role of environmental health in preventing antimicrobial resistance in low- and middle-income countries

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particularly in LMICs and reduce the AMR threat to global public health. The key Environmental Health practices in the prevention of AMR include: (1) adequate WASH through access and consumption of safe water; suitable containment, treatment and disposal of human excreta and other wastewater including from health facilities; good personal hygiene practices such as washing hands with soap at critical times to prevent the spread of resistant microorganisms, and contraction of illnesses which may require antimicrobial treatment; (2) proper disposal of solid waste, including the disposal of unused and expired antimicrobials to prevent their unnecessary exposure to microorganisms in the environment; and (3) ensuring proper food hygiene and safety practices, such as sale and consumption of animal products in which adequate antimicrobial withdrawal periods have been observed, and growing vegetables on unpolluted soil. Environmental Health is therefore crucial in the prevention of infectious diseases that would require antimicrobials, reducing the spread of resistant organisms, and exposure to antimicrobial residues in LMICs. Working with other professionals in One Health, Environmental Health Practitioners have a key role in reducing the spread of AMR including health education and promotion, surveillance, enforcement of legislation, and research

Health Risks in Our Environment: Urban Slum Youth’ Perspectives Using Photovoice in Kampala, Uganda

Due to increasing urbanization, many people find themselves living in slums that expose them to several health risks. We explored urban health risks that fall short of the planetary boundaries in an urban slum in Kampala, Uganda using photovoice. We selected, trained, and assigned ten youth (five females and five males) to take photos on urban health risks. The photographs were discussed, and transcripts were analyzed based on the doughnut economics model using content analysis in NVivo 12. Environments and actions of slum dwellers expose them to health risks, and cause them to live at the edge of planetary boundaries. Environmental sanitation challenges, including solid and liquid waste management, excreta management, and food hygiene and safety expose slum dwellers to risks at the edge of the lower boundary of the planet. Urban conditions expose slum dwellers to poor physical infrastructure, undesirable work conditions, pollution, and health and safety challenges. Crime, violence, and substance use were also viewed as vices that make slum environments dangerous habitats. On the other hand, practices like inhabiting wetlands and using biomass fuels in addition to traffic fumes expose slum dwellers to effects associated with living above the planetary boundaries. Urban youth reflected on health risks that have immediate effects on their health and day-to-day living. Urbanization, especially in low resource settings, needs to be cognizant of the ensuing risks to health and thus ensure sustainable growth

Status of Household Solid Waste Management and Associated Factors in a Slum Community in Kampala, Uganda

Background. Only a third of the total waste generated in slum communities in Kampala is collected and disposed of to the landfill every month. This study assessed the status of household solid waste management and associated factors in a slum community in Kampala, Uganda. Methods. We conducted a community-based cross-sectional study involving 395 households using a semistructured questionnaire and an observational checklist. Proper solid waste management was determined based on possession of waste collection and storage receptacle; collection receptacle ability to minimise nuisances (covered); segregation of waste; presence of flies and other vectors; and collection receptacle fill status. Prevalence rate ratios and their 95% confidence intervals were used as a measure of association. Results. Only, 41.3% (163/395) of the households exhibited proper waste management practices. The majority of the households 85.8% (339/395) owned solid waste storage receptacles, most of which were sacs 61.7% (209/339) and would minimise nuisances 72.9% (245/339). The main type of waste collected was biodegradable materials 56.7% (224/395). The majority of the households 78.7% (311/395) did not segregate their waste. Solid waste was mainly transported to the collection point by pulling the collecting sac 54.4% (215/395). The city authority 73.9% (292/395) and private companies 12.9% (51/395) were the major entities collecting waste. Factors associated with proper waste management were collecting waste in plastic containers (adjusted PR = 1.27, 95% CI (1.04–1.55)), polythene bags (adjusted PR = 0.26, 95% CI (0.14–0.47)), and paper bags or metallic bins (adjusted PR = 0.13, 95% CI (0.03–0.44)) as well as awareness of solid waste management laws (adjusted PR = 1.49, 95% CI (1.20–1.85)) and the dangers of improper solid waste management (adjusted PR = 2.15, 95% CI (1.51–3.06)). Conclusion. Solid waste management was generally poor. As such, a cascade of interventions that address knowledge, physical, and behavioural aspects of solid waste management is required to improve its management in slum communities

Adherence to malaria treatment guidelines among health care workers in private health facilities in Kampala's informal settlements, Uganda.

Poor adherence to malaria treatment guidelines among healthcare workers (HCWs) is a major contribution to diagnostic challenges, treatment failure, and non-rational use of antimalarial medicines. However, there is limited information about adherence to malaria treatment guidelines among HCWs in private health facilities in informal settlements in Uganda. This study therefore assessed the level of adherence to malaria treatment guidelines and associated factors among HCWs in private health facilities in Kampala's informal settlements. A cross-sectional study was conducted among 339 HCWs from private health facilities in slums of 4 selected divisions in Kampala, Uganda. Quantitative data was collected using a semi-structured questionnaire, cleaned in MS Excel 2016 and analyzed using STATA 15.0 statistical software. Bivariate and multivariate analysis were conducted using a generalized linear model of modified Poisson regression to obtain factors associated with adherence to malaria treatment guidelines. The study revealed that majority of respondents 71.1%(241/339) were aged 30 years and below, and 50.1%(170/339) of the were female. Almost all of the respondents 98.8%(335/339) reported that they had malaria diagnostic equipment (microscopy or rapid diagnostic tests) at their facilities, 47.5%(161/339) had non-recommended anti-malarial drugs present in stock and 36.0% reported that they did not refer severely ill patients to higher health facilities in the previous 3 months. Although 92.6%(314/339) of the respondents had heard about the national malaria treatment guidelines, 63.1%(214/339) of them adhered to these guidelines. Having a bachelors degree (APR 1.54, (CI: 1.13-2.10)P 0.006), and having high levels of knowledge (APR 1.44, (CI: 1.13-1.60)P 0.001) were positively associated with high adherence to malaria treatment guidelines. In conclusion, adherence to malaria treatment guidelines was suboptimal and less than the national target of 90%. Enforcement, supervision, trainings, and continuous medical education should be enhanced in private healthcare facilities to improve adherence to malaria treatment guidelines in informal settlements