Predictors of cervical cancer screening uptake in two districts of Central Uganda.

Uganda's cervical cancer age standardized incidence rate is four times the global estimate. Although Uganda's ministry of health recommends screening for women aged 25-49 years, the screening remains low even in the most developed region (Central Uganda) of the country. This study examined the demographic, social, and economic predictors of cervical cancer screening in Central Uganda with the aim of informing targeted interventions to improve screening. The cross-sectional survey was conducted in Wakiso and Nakasongola districts in Central Uganda. A total of 845 women age 25-49 years participated in the study. Data were analyzed at bivariate and multivariate levels to examine the predictors of CC (cervical cancer) screening. Only 1 in 5 women (20.6%) had ever screened for cervical cancer. Our multivariate logistic regression model indicated that wealth index, source of information, and knowledge about CC and CC screening were significantly associated with cervical cancer screening. The odds of cervical cancer screening were higher among rich women compared with poor women [AOR = 1.93 (95%CI: 1.06-3.42), p = 0.031)], receiving information from health providers compared with radios [AOR = 4.14 (95%CI: 2.65-6.48), p<0.001, and being more knowledgeable compared with being less knowledgeable about CC and CC screening [AOR = 2.46 (95%CI: 1.49-3.37), p<0.001)]. Overall cervical cancer screening uptake in central Uganda was found to be low. The findings of the study indicate that women from a wealthy background, who had been sensitized by health workers and with high knowledge about CC and CC screening had higher odds of having ever screened compared with their counterparts. Efforts to increase uptake of screening must address disparities in access to resources and knowledge

Malaria parasitemia positivity rate by month for infants aged less than six months in Ugandan Primary Health centers, October 2010 – September 2011.

<p>Malaria parasitemia positivity rate by month for infants aged less than six months in Ugandan Primary Health centers, October 2010 – September 2011.</p

Malaria suspicion, testing and parasitemia positivity rates by age group in infants aged less than six months in Ugandan Primary Health centers, October 2010 – September 2011.

<p>Malaria suspicion, testing and parasitemia positivity rates by age group in infants aged less than six months in Ugandan Primary Health centers, October 2010 – September 2011.</p

Flow chart for malaria diagnosis in young infants in 36 Ugandan Primary Health centers, October 2010 – September 2011.

<p>Flow chart for malaria diagnosis in young infants in 36 Ugandan Primary Health centers, October 2010 – September 2011.</p

Characteristics of the infant patients under the age of six years Ugandan Primary Health centers.

<p>*Weight for age was based on WHO z-scores for child growth standards and it was therefore calculated for patients with sex & weight data.</p><p>^£ Commonly diagnosed illnesses associated with fever.</p><p>Characteristics of the infant patients under the age of six years Ugandan Primary Health centers.</p

Predictors of being prescribed an antimalarial when the diagnostic test result for malaria was negative among infants tested in Ugandan Primary Health centers.

<p>* Statistically significant at 0.05 level.</p><p>Predictors of being prescribed an antimalarial when the diagnostic test result for malaria was negative among infants tested in Ugandan Primary Health centers.</p

Effect of integrated capacity-building interventions on malaria case management by health professionals in Uganda: a mixed design study with pre/post and cluster randomized trial components.

BACKGROUND: The Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) designed two interventions: Integrated Management of Infectious Disease (IMID) training program and On-Site Support (OSS). We evaluated their effects on 23 facility performance indicators, including malaria case management. METHODOLOGY: IMID, a three-week training with two follow-up booster courses, was for two mid- level practitioners, primarily clinical officers and registered nurses, from 36 primary care facilities. OSS was two days of training and continuous quality improvement activities for nine months at 18 facilities, to which all health workers were invited to participate. Facilities were randomized as clusters 1∶1 to parallel OSS "arm A" or control "arm B". Outpatient data on four malaria case management indicators were collected for 14 months. Analysis compared changes before and during the interventions within arms (relative risk = RR). The effect of OSS was measured with the difference in changes across arms (ratio of RR = RRR). FINDINGS: The proportion of patients with suspected malaria for whom a diagnostic test result for malaria was recorded decreased in arm B (adjusted RR (aRR) = 0.97; 99%CI: 0.82,1.14) during IMID, but increased 25% in arm A (aRR = 1.25; 99%CI:0.94, 1.65) during IMID and OSS relative to baseline; (aRRR = 1.28; 99%CI:0.93, 1.78). The estimated proportion of patients that received an appropriate antimalarial among those prescribed any antimalarial increased in arm B (aRR = 1.09; 99%CI: 0.87, 1.36) and arm A (aRR = 1.50; 99%CI: 1.04, 2.17); (aRRR = 1.38; 99%CI: 0.89, 2.13). The proportion of patients with a negative diagnostic test result for malaria prescribed an antimalarial decreased in arm B (aRR = 0.96; 99%CI: 0.84, 1.10) and arm A (aRR = 0.67; 99%CI: 0.46, 0.97); (aRRR = 0.70; 99%CI: 0.48, 1.00). The proportion of patients with a positive diagnostic test result for malaria prescribed an antibiotic did not change significantly in either arm. INTERPRETATION: The combination of IMID and OSS was associated with statistically significant improvements in malaria case management

Estimated percentage of patients who received an appropriate antimalarial, dispersion by facility and arm.

<p>Estimated percentage of patients who received an appropriate antimalarial, dispersion by facility and arm.</p

Exploratory analysis.

<p>p<0.01.</p