Mobile nutrition assessment and decision support system for village health teams in Uganda.

The government of Uganda through the Ministry of Health and other stakeholders are in efforts of strengthening information systems for nutrition, through data collection, management and dissemination. In these effortshealth centers at the regional level were used to carry-out nutrition assessments and training to village health teams(VHTs) to extend the service to the families. The Ministry of health and other implementing partners are encouraging community based service delivery and this is being done by involving the VHTs in all services provided to the community. The VHTs work as the vocal people for the families in the communities hence are able to idenify the needs of the communities. The main objective of this study is to design and develop a mobile nutrition assessment and decision support systems for VHTs in Uganda to support them in nutrition assessment and giving families feeding recommendations.The study will use the available nutrition assessment data to design and develop a decision support system that supports proper feeding, manage follow-ups and referrals to avoid relapses among children who are enrolled in the nutrition clinic.In this thesis a Design Science Research Methodology (DSRM) was used to help us direction in coming up with an artefact.In addition, the user centered design approach was followed, to allow involvement of users throughout the design of the prototype.The project worked closely with the staff at the health center. Interviews and focus group discussions were applied to get qualitative feedback.Furthermore, a prototype was demonstrated and the questionnaires distributed to get feedback on the designed prototype.A low and high fidelity prototype for nutrition assessment and decision support has been developed to be used by VHTs and health facilities to manage nutrition and make real time decisions

Contraceptive Use among Young People in Uganda: Exploration of obstacles, enablers, and quality of services

Background: Unsafe abortions, a life shortening condition leading to untimely deaths of young women in low income countries, are a public health concern. The bio-social gap, which is the period between menarche and marriage has widened, thus the time young women/men need contraception has increased. High rates of teen pregnancy, unintended birth, unsafely induced abortions and associated mortality among young women, is attributed to low contraceptive use. Paradoxically, awareness about contraception is high. It is not understood why young people are not using contraceptives, hence this study. Aim: To explore and analyze obstacles and enablers to contraceptive use and quality of services provided to young people aged 15-24 in two districts in Uganda, in order to increase knowledge about why contraceptives are not used and identify areas for improvement. Methods: The studies were carried out among young people 15-24 years and health care providers at public, private not for profit (PNFP), and private for profit (PFP) contraceptive delivery points. Quantitative and qualitative approaches were used. Focus group discussions (FGDs) were used to explore young peoples’ views about obstacles and enabling factors to contraceptive use (study I). Semi-structured questionnaires were used to guide face-face interviews with health care providers to determine factors influencing contraceptive use and provision (Study II). Simulated client methodology was used to assess the quality of contraceptive services and clients experiences of contraceptive care (Study III and IV). Descriptive statistics (II, IV), inferential statistics (II, IV) and factor analysis (III) were performed. Qualitative data were analyzed using content analysis (I) and thematic analysis (IV). Results: Young men and women described multiple obstacles to contraceptive use, which were categorized as misconceptions and fears related to contraception, gender power relations, socio-cultural expectations and contradictions, short term planning, and health service barriers (I). Additionally, young people recounted several enabling factors that included female strategies to overcome obstacles, changing perceptions and attitude towards contraceptive use and smaller family size (I). Contraceptive use and provision to young people were constrained by sporadic contraceptive stocks, poor service organization, limited number of trained personnel, high costs, and unfriendly service. Most providers were not competent enough to provide long-acting methods. There were significant differences in providers’ self-rated competence by facility type. Private for-profit providers’ competence was limited for most contraceptives. Providers had misconceptions about contraceptives, they had negative attitudes towards the provision of contraceptives to young people, and they imposed non-evidence-based age restrictions and consent requirements. Thus, most providers were not prepared or were hesitant to give young people contraceptives. Short-acting methods were, however, considered acceptable for young married women and those with children (II). Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessments scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. A minority of providers offered young people their preferred method of choice and a minority showed respect for privacy (III, IV). Both qualitative and quantitative results highlighted favorable reception, provider bias, and low client satisfaction. Two thirds of the providers choose a contraceptive method for the client. The clients reported satisfaction with contraceptive services in 29 percent of the consultations. Privacy was reported to be observed in 42 percent and clients felt respectfully treated in 50 percent of the consultations (IV). Conclusion: Our findings suggest changing perceptions and attitudes in favor of contraceptive use and smaller family size although obstacles still exist (I). Provider, client, and health system factors restricted contraceptive provision and use for young people (II). The quality of contraceptive services provided to young people was low (III). Young people were not able to exercise their rights to choose, obtain and use contraceptives when needed. Overall satisfaction with the services was low and client- provider interactions were often unfavorable (IV). Implications: Reducing obstacles and reinforcing enabling factors through education, culturally sensitive behavior change strategies have the potential to enhance contraceptives use. Alternative models of contraceptive service delivery to young people are needed. Contraceptive use prospects are dependent on provider behavior. Concurrent quality improvements and strengthening of health systems are needed

Serial marriages and AIDS in Masaka District

In the process of studying the functioning of households under the conditions of the AIDS epidemic in the districts of Masaka, Kabarole and Rukungiri, information was collected on the marital history of persons aged 12 years and above who had ever been involved in a regular union or marriage. That information allows the discussion of the pattern of marital mobility and the exploration of the possible links between serial marriages and the dynamics of the current epidemic. Serial marriages can be defined as the participation in a sequence of regular partnerships or unions. By this definition, males in polygamous unions are involved in the practice of serial marriages in that they go through the formation of regular unions more than once in their lifetime and are often involved in more than one such union at a time. In the case of females, serial marriage takes the form of transition from first to second and subsequent unions within a monogamous or polygamous framework. This paper describes the pattern of these serial marriages, the causes of the dissolution of unions, and the relationship between the observed patterns and selected social and demographic factors such as sex, residence, education and the household-level experience of a previous HIV/AIDS related illness or death. Particular attention is paid to the role of death of spouse and especially of death from AIDS in the dissolution of unions. Apart from the use of basic descriptive statistics, a hierarchical log linear regression is carried out and the tests of partial association between the fact of serial marriage and selected variables are presented

Culture and risk : the role of culture and indigenous knowledge in the interpretation and adaptation to disasters : a case study of landslides in Bududa district, Eastern Uganda

Master's thesis Global development and planning UT505 - University of Agder 2017This study explores the role culture and indigenous knowledge play in people’s ‘interpretation’ and ‘adaption’ to landslides in Uganda. This study is important because globally, natural hazards are becoming more dangerous and destructive than ever before, causing an increasing number of disasters that interfere with a community’s livelihood and set back development efforts. Decades of Disaster Risk Reduction (DRR) strategies notwithstanding, many people are still vulnerable to disasters. It can be argued however, that people are still vulnerable because aspects of their culture and indigenous knowledge have been missing in these strategies. Organisations involved in DRR often assume that with essential information, people would not ‘live’ in ‘risky’ areas, which is not always the case. Culture and indigenous knowledge are important sources of social capital that can be utilised for disaster preparedness, response, recovery and adaptation. Thus, they should be at the centre of the strategies intending to address the problem. From the study, culture and indigenous knowledge influenced the way people interpreted the cause of landslides and ultimately, how responded and adapted to them. Survivors made decisions concerning relocation based on their cultural beliefs and past experiences. Nonetheless, the government and NGOs involved in landslide risk reduction have ignored the important role of people’s culture and indigenous knowledge. The study identified the missing piece of the jigsaw from the activities of these organisations, which is to endeavour, understand and incorporate culture and indigenous knowledge of local people who live in disaster prone areas. This is because, through their exposure to past landslides, people have developed a body of knowledge and beliefs that they use to interpret and ‘live’ with the risks from landslides. This knowledge can be tapped and integrated for sustainable disaster risk reduction. External organisations do not necessarily need to ‘believe’ in what local people ‘believe in’, but they should understand, accept and ‘work with’ the fact that those affected by disasters have considerations and priorities based on their culture and experiences that are likely to impact on disaster management strategies and developmen

Seeking referral care for newborns in eastern Uganda : community health workers' role, caretakers' compliance and provision of care

Background: Newborn deaths contribute 44% of all under-five deaths. Community health worker (CHW) during home-visits may identify and refer newborns to health facilities for postnatal care and treatment of danger signs. However, little is known on the care seeking practices and health system capacity to care for healthy and sick newborns in sub Saharan Africa. Objective: The overall objective of the studies was to assess newborn referral care seeking practices, compliance, and associated community and health systems factors in order to inform scale up of newborn care programs in Uganda and other low income countries with high newborn mortality. Methods: Four studies (I-IV) nested within a cluster randomized trial were conducted between 2011 and 2013 at the Iganga-Mayuge Health Demographic Surveillance Site in eastern Uganda. In Study I, focus group discussions (n=12) with men and women and in-depth interviews (n=11) with mothers and traditional birth attendants were used to obtain a deeper understanding of the social and cultural factors that affect caretakers’ compliance with community newborn referrals. Case vignettes, observations through role plays and record reviews were used in a cross sectional study to assess the ability of 57 trained community health workers to identify and refer sick newborns to health facilities (Study II). Study (III) was retrospective cohort of all referred newborns, during which interviews were held with 700 caretakers to determine compliance rate to seek health facility based care within 24-hours of a referral. In a cross sectional study, capacity to provide newborn care was assessed in all the 20 health facilities within the cluster randomized trial, using observations and interviews with of health workers (Study IV). Results: Community members understood the newborn period differently from health workers. A seclusion period observed immediately after birth restricted movement of the mother and newborn until the umbilical cord dropped off, but was not binding in case of illness (Study I). Of the 57 CHWs assessed, 68% were considered knowledgeable with a median knowledge score of 100% (IQR 94%-100%), and 36 (63%) considered skilled in identifying sick newborns (Study II). A total of 724 newborns were referred, of which 700 were successfully traced. Fifty three percent (373/700) were referred for postnatal care/immunization and 47% because they had at least one danger sign (Study III). Overall, 63% of the caretakers of referred newborns complied within less than24 hours, but more caretakers of sick newborns (243/327, 74%) complied, compared with 196/373 (53%) of those referred for immunization and postnatal care (p<0.001). A majority, (493, 77%) sought care from lower level health facilities. The determinants of compliance were: referred for danger signs Adjusted Odds Ratio (AOR) = 2.3, (95% CI: 1.6-3.5); CHW making a reminder visit to the referred newborn shortly after referral (AOR =1.7; 95% CI: 1.2 –2.7); and age of mother being 25-29 or 30-34 years, (AOR =0.4; 95% CI: 0.2 - 0.8) and (AOR = 0.4; 95% CI: 0.2 - 0.8) respectively; compared to the age group of less than 20 years (Study III). Fifteen of the 20 health facilities offered newborn care but level II facilities had the lowest availability score for resuscitation equipment (31%,) or newborn sepsis drugs (8%), and none offered kangaroo mother care. Two-thirds (33/50, 66%) of the health facility workers were considered knowledgeable in newborn care, but less than a half (17/42, 41%) skilled in newborn resuscitation (Study IV). Conclusion: Trained community health workers when engaged in maternal-newborn programs can assist caretakers to recognize sick newborns, change long held norms like the ‘seclusion’ and achieve good referral care seeking for newborns. There was high compliance with referrals, and caretakers mainly sought care from first level facilities which lacked capacity to care for sick newborns. Health workers had good knowledge about newborn care but unsatisfactory skills for resuscitation of newborns. Wherever deliveries are conducted there must also be health service readiness to care for newborn asphyxia and low-birth weight/prematurity. Policy and practice needs to change to enable lowest level health centres (HCII) to care for newborns with possible septicemia

Social context of HIV infection in Uganda

Some of the important policy and research implications of accumulating HIV/AIDS data are being ignored because of the attraction of social science research focused on the ‘multiple sexual mechanism’ of infection and transmission. Attention is drawn to the other policy and research issues relating to information on the timing of infection through a reanalysis of existing data on cumulative AIDS cases. The most urgent need is to supplement the mainstream research on risk groups with studies of the timing and circumstances of entry into sexual activity in the pre-teen years

Two decades of post-graduate training in Applied Public Health: The experience and challenges of the Uganda Public Health School Without Walls

The objective of this work is to describe the experience of the Uganda Public Health School Without Walls (PHSWOW) in training public health professionals at post-graduate level to offer leadership in planning, delivery of health services and research within a decentralized health system. As one of the constituents of the Makerere University College of Health Sciences, the Uganda PHSWOW has the vision of becoming a Centre of Excellence, providing leadership in public health and the mission of promoting the attainment of better health of the people in Uganda and beyond through public health training, research and community service. Key to the successes of the program are the 238 program graduates, most of whom have remained in-country to serve at district and national levels of service delivery. Collaborations have been established with government, private, non-governmental and international institutions leading to increased health service provision and research for the improvement of health status of populations and influence on public policy. There is still a lot to do in diversifying the skills mix of graduates and contributing to an ambitious increment from 0.4 to 4.7 public health professionals per 10,000 population; as is currently the case in high-middle income countries. Currently, the Uganda PHSWOW has exceeded the proposed output for FETPs of training 3 to 5 graduates per 1 million population suggested by some authors, however the output is still inadequate. More also needs to be done to promote a culture of publication in an effort to translate public health evidence into policy and practice

SMART Vaccines 2.0 decision-support platform : A tool to facilitate and promote priority setting for sustainable vaccination in resource-limited settings

Funding Information: Supported by Gavi and the Bill and Melinda Gates Foundation, a number of international organisations have offered capacity-building support to establish NITAGs. While greater emphasis was initially placed on fulfilling process indicators for establishing NITAGs, more recent efforts have sought to advance functional capabilities associated with EIDM, most notably by Agence de Médecine Préventive (AMP), the International Vaccine Institute and The Sabin Vaccine Institute.13 14 These programmes have additionally leveraged technical assistance from WHO and its regional offices, PATH and the US Centers for Disease Control and Prevention.15 16 Funding Information: The UNITAG sought technical assistance from AMP’s Supporting Independent Vaccine Advisory Committees (SIVAC) Initiative,14and engaged in piloting the SMART Vaccines 2.0 platform supported by the Fogarty International Center at the US National Institutes of Health (NIH). A description of the NITAG process is given elsewhere.24 33 Funding Information: Funding This work was supported by the Fogarty International Center, National Institutes of Health, USA. Publisher Copyright: © 2020 Author(s). Published by BMJ.Peer reviewedPublisher PD

A systematic review of community-to-facility neonatal referral completion rates in Africa and Asia

Background An estimated 2.8 million neonatal deaths occur annually worldwide. The vulnerability of newborns makes the timeliness of seeking and receiving care critical for neonatal survival and prevention of long-term sequelae. To better understand the role active referrals by community health workers play in neonatal careseeking, we synthesize data on referral completion rates for neonates with danger signs predictive of mortality or major morbidity in low- and middle-income countries. Methods A systematic review was conducted in May 2014 of the following databases: Medline-PubMed, Embase, and WHO databases. We also searched grey literature. In addition, an investigator group was established to identify unpublished data on newborn referral and completion rates. Inquiries were made to the network of research groups supported by Save the Children’s Saving Newborn Lives project and other relevant research groups. Results Three Sub-Saharan African and five South Asian studies reported data on community-to-facility referral completion rates. The studies varied on factors such as referral rates, the assessed danger signs, frequency of home visits in the neonatal period, and what was done to facilitate referrals. Neonatal referral completion rates ranged from 34 to 97 %, with the median rate of 74 %. Four studies reported data on the early neonatal period; early neonatal completion rates ranged from 46 to 97 %, with a median of 70 %. The definition of referral completion differed by studies, in aspects such as where the newborns were referred to and what was considered timely completion. Conclusions Existing literature reports a wide range of neonatal referral completion rates in Sub-Saharan Africa and South Asia following active illness surveillance. Interpreting these referral completion rates is challenging due to the great variation in study design and context. Often, what qualifies as referral and/or referral completion is poorly defined, which makes it difficult to aggregate existing data to draw appropriate conclusions that can inform programs. Further research is necessary to continue highlighting ways for programs, governments, and policymakers to best aid families in low-resource settings in protecting their newborns from major health consequences

Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda:an intervention cohort study

Background: Perinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda. Methods: Pregnant women in the second and third trimester were consecutively screened using the Luganda version of the 9-item Patient Health Questionnaire (PHQ-9). Women who scored ≥5 on the PHQ-9 and who were confirmed to have depression by a midwife were recruited into a treatment cohort and offered a psychological intervention in a stepped care fashion. Women were assessed with PHQ-9 and WHODAS-2.0 at baseline and again at 3 and 6 months after the intervention. Negative regression analysis was done to examine change in PHQ-9 and WHODAS-2.0 scores from baseline to end line. Data were analysed using STATA version 14. Results: A total of 2652 pregnant women (98.3%) consented to participate in the study and 153 (5.8%) were diagnosed as depressed. Over a quarter (28.8%) reported having experienced physical interpersonal violence (IPV) while (25.5%) reported sexual IPV in the past year. A third (34.7%) of women diagnosed with depression received 4 or more group PST sessions. There was a mean reduction in PHQ-9 score of 5.13 (95%CI − 6.79 to − 3.47, p &lt; 0.001) and 7.13 (95%CI − 8.68 to − 5.59, p &lt; 0.001) at midline and endline, respectively. WHODAS scores reduced significantly by − 11.78 points (CI 17.64 to − 5.92, p &lt; 0.001) at midline and − 22.92 points (CI 17.64 to − 5.92, p &lt; 0.001) at endline. Clinical response was noted among 69.1% (95%CI 60.4–76.6%) and 93.7% (95%CI 87.8–96.8%) of respondents at midline and endline, respectively. Conclusion: An evidence based psychological intervention implemented in primary antenatal care by trained and supervised midwives in a real-world setting may lead to improved outcomes for women with perinatal depression. Future randomised studies are needed to confirm the efficacy of this intervention and possibility for scale up