Health system factors influencing traditional herbal medicine use during pregnancy amongst women in Mpigi District, Central Uganda

An estimated 80% of the population in developing countries is dependent on traditional medicine for their health needs, including use during pregnancy despite limited knowledge of potential side effects including teratogenicity. Controlling use of traditional medicines during pregnancy requires understanding the driving factors. This study aimed at determining the health system factors that influence traditional herbal medicine use during pregnancy in a Ugandan setting. A cross-sectional study was conducted among 315 post-partum women obtained by random sampling from post-natal clinics of health facilities in Mpigi District after informed consent. We carried out concurrent triangulation by conducting two focused group discussions of 10 post-natal mothers each, and four Key informant interviews. Quantitative Data analysis involved descriptive statistics and logistic regression analysis. Qualitative data was analyzed by thematic content analysis and presented as narratives. Prevalence of herbal medicine use during pregnancy was 79% (95% Confidence Interval (CI) 68.1% – 86.9%), mainly consumed through oral route (96%). Costly health care adjusted Prevalence Ratio (aPR) 1.61 (95% CI 1.02-2.53), p-value 0.042, and presence and influence of Traditional Birth Attendants aPR 1.21(95% CI 1.05-1.41), p-value 0.011 were significantly associated with use of traditional herbal medicines during pregnancy. Use of traditional herbal medicines is driven by the high costs of quality health care and influence from Traditional Birth Attendants. Innovations in health financing should be promoted and Traditional Birth Attendants should be sensitized and incorporated in the mainstream health care system as community referral agents. (Afr J Reprod Health 2021; 25[6]: 88-98)

Missed Opportunity for Neonates to Live: A Cross-Sectional study on Utilization of Peri-Natal Death Audits to address the Causes of Peri-Natal Mortality in District Hospitals of East–Central Uganda.

Aim:  To assess the utilization of PDAs in addressing the avoidable causes of perinatal mortality in the eastern region of Uganda. Methodology:  A cross-section design using a mixed method was conducted between 2014-2015 at Iganga, Bugiri, and Kamuli general hospitals in the East-Central region of Uganda. The interviews involved 115 health workers who included Doctors, Nurses/Midwives, Clinical officers, and Laboratory and Theatre staff. These were drawn from four departments including the Maternity ward, Outpatient department, Theatre, and pediatric ward. Hospital top and departmental managers formed the key informants for this study. Annual reports for the period 2009/10-2012/13 were reviewed. In addition, monthly reports for the calendar year 2013 together with patients’ clinical case notes and patients’ registers were also reviewed to determine the magnitude and causes of perinatal mortality. Factors contributing to perinatal death were assessed and categorized into fetal, maternal, and health facility factors. Results:  Results revealed a high and rising perinatal mortality rate of 70/1,000 live births and a decreasing maternal mortality ratio of 363/100,000 live births. Most perinatal deaths were fresh stillbirths 48/88 which occurred during the intrapartum period and the majority of early neonatal death was due to birth asphyxia. None of the health facilities was conducting perinatal death audits and the quality of data used for perinatal death audits was inadequate and was scored poorly. Challenges hindering utilization of perinatal death audits included lack of staff sensitization and training, work overload, lack of motivation, fear of blame and litigation, political interference, and lack of support from the community. Conclusion:  There was a high prevalence of perinatal deaths in east-central Uganda yet none of the hospitals was conducting perinatal death reviews. Recommendations: Health workers should be trained on perinatal death audit tools and guidelines. Records departments to revitalize with tools and personnel for effective data management

Adherence to laboratory findings in the management of malaria in the high and low transmission areas of Nakasongola and Kabalore Districts of Uganda

Malaria is one of the leading causes of morbidity and mortality in Africa today. It is estimated that a single bout of malaria in Africa costs a sum equivalent to earning for over ten working days. In Uganda, more than 95% of the malaria cases are due to Plasmodium falciparum , the most virulent parasite species that causes severe forms of disease. It has acquired resistance to the commonly used and cheap antimalarial medicines like Chloroquine and Sulfadoxine/Pyrimethamine (CQ/SP) combination. The Uganda Government changed the malaria treatment policy in 2005 to include Artemisinin Combination Therapies (ACTs) as first line treatment for the uncomplicated malaria. Whereas prompt and accurate laboratory diagnosis of malaria is the key to the effective management malaria, clinical syndromic diagnosis has been the most widely used approach in Uganda. This was widely advocated for in sub-Saharan Africa as a means of increasing antimalarial coverage and reducing the risk of progression to severe disease and death. However, such practice was only tolerated in the era of inexpensive and safe antimalarial therapy of CQ/SP. An adult course of the new recommended first-line ACTs costs more than 10 times the cost of a course of CQ/SP. It is therefore difficult to afford this treatment at individual and national levels. Therefore, presumptive treatment becomes economically and clinically less acceptable and raises a need for a more accurate diagnosis. To make a definitive diagnosis of malaria, demonstration of the parasite in the blood is essential. However, it was not whether health workers have started adopting the reliance on laboratory results before making antimalarial prescriptions. The study was an attempt to understand the practices of health workers in the health facilities with laboratory services in one high and one low malaria transmission areas of Uganda. Nine health facilities in Nakasongola and Kabalore were selected on the basis of possession of functional laboratory services and 487 patients with fever/receiving antimalarial treatment were enrolled for the survey. It was found that access to laboratory services was limited to a small population. Although the majority of patients reporting to these health facilities (over 95% for the two districts) were sent to the laboratory, only 52% and 32% of those that received their results for Nakasongola and Kabarole respectively tested positive for the presence of malaria parasites. However, all patients reporting to the health facilities with fever still received antimalarials despite health worker training and guidelines under the new first-line treatment policy. This meant that health workers have not changed their prescription practices and laboratory findings were not being used in the management of malaria

Determinants of Adolescent and Youth Sexual and Reproductive Health Service Utilization in Hard-To-Reach Communities of Amudat District, Uganda

Introduction:Uganda has one of the largest adolescent and youth populations globally and yet access and utilization of sexual and reproductive health services (SRH) among this population remains inadequate, especially in hard-to-reach communities. This study sought to establish the contextual determinants of service utilization in Amudat District, a hard-to-reach community in Karamoja, Uganda.Materials and Methods:A community based descriptive cross-sectional study was conducted using random sampling of 503 respondents recruited after informed consent. Data were collected using interviewer administered questionnaires, entered into epidata 3.1 and analysed using STATA version 12. For quantitative data, logistic regression analysis was used to determine factors associated with services utilization. Qualitative data were analysed by content analysis, for themes.Results:Older adolescents and youth out-of-school were more likely to utilise services, with religion and socially accepted norms additionally determining utilisation of services.Conclusion:Strengthening social services that keep adolescents in school; supporting community engagement through youth gatekeepers particularly youth champions, religious and cultural leaders; while fostering family values that favour SRH discussions will increase access to and use of SRH services in hard-to-reach communities.Recommendations:Promote culturally adapted sexuality education; prevent child marriage, and provide youth friendly SRH services aligned to need in Amudat and similar settings Key Words: Adolescents and Youths, Sexual and Reproductive Health, Hard-To-Reach Communities, Youth Friendly Service

Awareness on safety of obtaining dental radiograph during pregnancy.

Awareness on safety of obtaining dental radiograph during pregnancy.</p

Issues to be included in oral health promotion guideline during ANC.

Issues to be included in oral health promotion guideline during ANC.</p

Demographic characteristics of respondents.

BackgroundOral health promotion (OHP) during pregnancy is an important global public health and basic human right issue related to quality of life. Several statements and guidelines have been published emphasizing the need for improved oral health care of pregnant mothers, prenatal care providers have missed this critical opportunity. In this study, we assessed factors influencing adoption of oral health promotion by antenatal care providers.Materials and methodsA descriptive cross-sectional study design that employed both quantitative and qualitative data collection methods and analysis. 152 samples determined using Yamane’s 1967 and stratified sampling technique was used. Three FGDs and six KI interviews were held. Univariate, bivariate and multivariate analyses were done using SPSS (20.0) and ATLAS Ti for qualitative analysis.ResultsAdoption of OHP was low 28% (42). Factors influencing adoption were age of respondents (OR = 0.066, 95%CI = 0.009–0.465, p = 0.006*), level of care of health facility (OR = 0.050, 95%CI = 0.008–0.322, p = 0.002*), good understanding between dentists and ANC providers (OR = 0.283, 95%CI = 0.084–0.958, p = 0.042*), availability of practice guideline for OHP in ANC (OR = 0.323, 95%CI = 0.108–0.958, p = 0.043*), number of years at work (p = 0.084), being knowledgeable (OR = 2.143, 95%CI = 0.864–5.311, p = 0.100), having skills to advance OHP(OR = 0.734, 95%CI = 0.272–1.984, p = 0.542), Management being good at influencing new practices (OR = 00.477.734, 95%CI = 0.227–2.000, p = 0.477). More emphasis on national and local of oral health issues, continuous staff training on oral health, dissemination of National oral health policy (NOHP) were some of key issues that emerged from the qualitative results.ConclusionAdoption of OHP was low. This was attributed to age, number of years spent at work, level of health facility, having good understanding between dentists and ANC providers, availability of practice guidelines, dissemination of National oral health policy, continuous staff training. We recommend the current NOHP to be reviewed, develop prenatal OHC guidelines, enhance the capacity of ANC providers through training, collaboration with dentists and launch official adoption of OHP.</div

Knowledge on type of preventive oral care pregnant women should receive.

Knowledge on type of preventive oral care pregnant women should receive.</p

Factors influencing adoption of oral health promotion by ANC providers in Moyo district, North-Western Uganda.

Factors influencing adoption of oral health promotion by ANC providers in Moyo district, North-Western Uganda.</p

Adoption of oral health promotion by ANC providers.

Adoption of oral health promotion by ANC providers.</p