Mathematical Properties of a Class of Four-dimensional Neutral Signature Metrics

While the Lorenzian and Riemanian metrics for which all polynomial scalar curvature invariants vanish (the VSI property) are well-studied, less is known about the four-dimensional neutral signature metrics with the VSI property. Recently it was shown that the neutral signature metrics belong to two distinct subclasses: the Walker and Kundt metrics. In this paper we have chosen an example from each of the two subcases of the Ricci-flat VSI Walker metrics respectively. To investigate the difference between the metrics we determine the existence of a null, geodesic, expansion-free, shear-free and vorticity-free vector, and classify these spaces using their infinitesimal holonomy algebras. The geometric implications of the holonomy algebras are further studied by identifying the recurrent or covariantly constant null vectors, whose existence is required by the holonomy structure in each example. We conclude the paper with a simple example of the equivalence algorithm for these pseudo-Riemannian manifolds, which is the only approach to classification that provides all necessary information to determine equivalence.Comment: 18 page

Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda

Background: The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs.Objectives: To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda.Methods: The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish.Results: While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants’ health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities.Conclusions: There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.Key words: Health seeking behaviour, Rural community, Health facilities, Challenges, Ugand

Knowledge and practices on malaria prevention in two rural communities in Wakiso District, Uganda

Background: Malaria is the leading cause of morbidity and mortality in Uganda particularly among children under 5 years of age.Objectives: The study assessed the knowledge and practices on malaria prevention in 2 rural communities in Wakiso District, Uganda with emphasis on the various prevention methods.Methods: The study was a cross-sectional survey carried out among 376 households using both quantitative and qualitative methods. Log-binomial regression, chi square and Spearman's rank order correlation were used to test for associations.Results: The majority of participants (64.6%) had low knowledge on malaria prevention methods, with untreated mosquito nets (81.7%), mosquito coils (36.9%) and insecticide treated nets (29.6%) being the most known methods. Knowledge on malaria prevention methods was associated with age (χ2 = 32.1; p < 0.01), employment status (χ2 = 18.1; p < 0.01), education (χ2 = 20.3; p = 0.01), income (χ2 = 14.5; p = 0.01) and having heard a malaria message in the previous 12 months (χ2 = 92.3; p < 0.01). Households that had at least one mosquito net were 45.5% and net ownership increased with household income. Only 0.5% of the houses had undergone indoor residual spraying in the previous 12 months, while 2.1% had complete mosquito proofing in windows and ventilators to prevent mosquito entry.Conclusion: There is potential to improve practices on malaria prevention by targeting other methods beyond mosquito nets such as installing proofing in windows and ventilators. The integrated approach to malaria prevention which advocates the use of several malaria prevention methods in a holistic manner should be explored for this purpose.Keywords: Malaria, prevention, knowledge, practices, integrated approach, Ugand

Perceived barriers to early detection of breast cancer in Wakiso District, Uganda using a socioecological approach

Background: Early detection of breast cancer is known to improve its prognosis. However, women in most low and middle income countries, including Uganda, do not detect it early hence present at an advanced stage. This study investigated the perceived barriers to early detection of breast cancer in Wakiso district, Uganda using a multilevel approach focused through a socioecological framework. Methods: Using qualitative methods, participants were purposively selected to take part in the study. 5 semi-structured interviews were conducted among the community members while two focus groups were conducted amongst women’s group and community health workers (CHWs) in Ssisa sub county, Wakiso district. In addition, 7 key informant interviews with health professionals, policy makers and public health researchers were carried out. Results: Findings from the study revealed that barriers to early detection of breast cancer are multifaceted and complex, cutting across individual, interpersonal, organizational, community and policy barriers. The major themes that emerged from the study included: knowledge, attitudes, beliefs and practices (KABP); health system and policy constraints; and structural barriers. Prominent barriers associated with KABP were low knowledge, apathy, fear and poor health seeking behaviours. Barriers within the health systems and policy arenas were mostly centred around competing health care burdens within the country, lack of a cancer policy and weak primary health care capacity in Wakiso district. Distance, poverty and limited access to media were identified as the most prominent structural barriers. Conclusion: Barriers to early detection of breast cancer are complex and go beyond individual behaviours. These barriers interact across multiple levels of influence such as organizational, community and policy. The findings of this study could provide opportunities for investment in multi-level interventions

Sanitation and hygiene status of butcheries in Kampala district, Uganda

There is a growing trend in the consumption of animal products such as meat in the developing world especially due to a growing population, urbanization and rising incomes. This poses a risk of food borne illnesses from meat consumption due to poor sanitation and hygiene. The purpose of this study was to assess the sanitation and hygiene status of butcheries in Kampala district, Uganda. The study was cross-sectional in design and involved quantitative data collection methods. The study units were butcheries from which one respondent was randomly selected to answer the questionnaire. An observational checklist was used to assess the status of sanitation and hygiene of the butcheries. Data were entered and analysed in Epi Info 3.5.1 statistical software. A total of 73 butcheries were visited, 51 (69.9%) of which were permanent structures, 7 (9.6%) semi-permanent and 15 (20.5%) temporary. Observations revealed that 24 (32.9%) butcheries had cracked walls and 66 (90.4%) had damaged floors. The main water source used by the butcheries was tap 67 (91.8%) with the rest collecting water from nearby protected springs. Hand washing facilities were present in 56 (76.7%) of the butcheries of which only 5 (6.8%) had soap for hand washing. Only 19 (26.0%) of the butcheries had receptacles for waste storage. Cleaning practices varied among butchers with 55 (75.3%) cleaning their butcheries daily. Most of the equipment (pangas and knives) found in the butcheries 66 (90.4%) were clean. Regarding personal hygiene, 57 (78.1%) of the respondents wore clean clothes, 65 (89.0%) had short finger nails and only 23 (31.5%) had personal protective wear. From the study, it was observed that the sanitation and hygiene status of butcheries in Kampala district was poor. There is, thus, need for the local authority to put in place stringent measures to ensure proper hygiene and sanitation which will reduce on the risks of meat contamination.Key words: butcheries, hygiene, knowledge, sanitation, Ugand

Do private health providers help achieve Universal Health Coverage? A scoping review of the evidence from low-income countries.

Universal Health Coverage (UHC) is the dominant paradigm in health systems research, positing that everyone should have access to a range of affordable health services. Although private providers are an integral part of world health systems, their contribution to achieving UHC is unclear, particularly in low-income countries (LICs). We scoped the literature to map out the evidence on private providers' contribution to UHC progress in LICs. Literature searches of PubMed, Scopus and Web of Science were conducted in 2022. A total of 1049 documents published between 2002 and 2022 were screened for eligibility using predefined inclusion criteria, focusing on formal as well as informal private health sectors in 27 LICs. Primary qualitative, quantitative and mixed-methods evidence was included, as well as original analysis of secondary data. The Joanna Briggs Institute's critical appraisal tool was used to assess the quality of the studies. Relevant evidence was extracted and analysed using an adapted UHC framework. We identified 34 papers documenting how most basic health care services are already provided through the private sector in countries such as Uganda, Afghanistan and Somalia. A substantial proportion of primary care, mother, child and malaria services are available through non-public providers across all 27 LICs. Evidence exists that while formal private providers mostly operate in well-served urban settings, informal and not-for-profit ones cater for underserved rural and urban areas. Nonetheless, there is evidence that the quality of the services by informal providers is suboptimal. A few studies suggested that the private sector fails to advance financial protection against ill-health, as costs are higher than in public facilities and services are paid out of pocket. We conclude that despite their shortcomings, working with informal private providers to increase quality and financing of their services may be key to realizing UHC in LICs