An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study

Introduction: gobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015. Methods: we obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics. Results: a total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected. Conclusion: road traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions

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

Lived experiences of stressors and problems of higher education students on teacher education course in the Eastern Highlands of Zimbabwe, 2019

Introduction: there is increasing levels of stressors and hardship among higher education students especially in low and middle income countries. Higher education institutions have an important role to play in the provision of robust and comprehensive support for students who experience stressors and hardship. Research and action in this area has however not been prioritized by the institutions in Zimbabwe. This study examined students´ expression of their experience with stressors and problems of studying in higher education in the Eastern Highlands of Zimbabwe. Methods: the study employed a qualitative approach using the phenomenology approach. Three institutions of higher education in the eastern border highlands of Zimbabwe were considered. Four focus group discussions were conducted with eight participants in each group. A one-to-one semi-structured interview with eight individual participants was also conducted to further examine the issues raised in the focus groups. Data were analyzed thematically using the Silences Framework theoretical model. Results: five overarching themes emerged from the analysis: (i) the stress of completing assessments without adequate learning materials. (ii) Unfair placement workload results into poor assessment outcomes. (iii) College-life is more difficult due to financial constraints. (iv) Marital problems interfering with college work: there is no mental health service available. (v) Enduring pains of bereavement with no emotional support or helpline. Conclusion: the study recommends the need to develop an inter-ministerial mental health strategy for institutions of higher learning with the view of implementing policies that address students suffering in Zimbabwean HE institutions

Knowledge, Perceptions, and Practices of Electronic Waste Management among Consumers in Kampala, Uganda

Background. Although proper management of electronic waste (e-waste) is key to preventing disease and protecting the environment, there is no clear mechanism for its management in Uganda. This study assessed knowledge, perceptions, and practices of e-waste management among consumers in Kampala city, Uganda. Methods. We conducted a cross-sectional study among people who used, repaired, or sold electronics (consumers). Both quantitative and qualitative methods of data collection using a sequential explanatory strategy were utilized. The quantitative survey involved 640 study participants, while qualitative interviews included 18 key informant interviews with stakeholders and six focus group discussions with 57 consumers. Modified Poisson regression was used to establish associations with corresponding 95% confidence intervals, and qualitative data analysed thematically. Results. Two-thirds (67.7%; 433/640) of electronics consumers had poor knowledge on the management of e-waste. More than three-quarters 79.1% (506) of the consumers had positive perceptions towards e-waste management. Consumers perceived e-waste as harmful to human health and the environment. Participants in informal employment were 0.96 times less likely to have positive perceptions towards e-waste management compared to those in formal employment (adjusted PR = 0.96, 95% CI: 0.93–0.99). Mobile phones and televisions were the most owned e-waste with only 7.96% (18/226) and 13.2% (7/53) disposed off, respectively. Selling e-waste to repair shops and donation were the common disposal options. Conclusion. Knowledge on proper e-waste management is poor among electronic consumers in Kampala, Uganda, though most have positive perceptions. There is need for increased awareness on e-waste management to prevent its effects on health and the environment. Special attention should be towards sensitisation on e-waste handling practices before disposal and final disposal options available

Geospatial distribution of pedestrian injuries and associated factors in the greater Kampala Metropolitan Area, Uganda

Background: Road traffic injuries (RTIs) are the leading cause of death among 15-29-year olds, of which 22% are pedestrians. In Uganda, pedestrians constitute 43% of RTIs. Over 52% of these injuries occur in Greater Kampala Metropolitan Area (GKMA). However, information on geospatial distribution of RTIs involving pedestrians and associated factors is scanty. We established the geospatial distribution of pedestrian injuries and associated factors in GKMA, Uganda. Methods: We conducted a mixed methods cross sectional study in three districts of GKMA. We used a structured questionnaire to interview 332 injured pedestrians at ten purposively selected health facilities from May to July 2017. We used a modified Australian Walkability Audit Tool to assess road characteristics and videography to capture road user behaviour at reported injury sites. Injury location (outcome) was categorized into three locations according to primary land use: residential areas, commercial/business areas and bar & entertainment areas. The injury hotspots were then mapped out using Quantum Geographic Information System (QGIS). Multinomial logistic regression was used to identify factors associated with injury location and adjusted prevalence ratios (APR) reported at 95% confidence interval. Results: Males represented 66.5% (221/332) of the sample. Pedestrian injuries were most prevalent among 15-29-year olds (45.5%, 151/332). Most (47.2%, 157/332) injuries occurred in commercial and business areas. Namasuba-Zana (13%, 43/332) followed by Nakawa-Kireka on Jinja road (9.7%, 32/332) had the highest number of injuries. Presence of speed humps was protective (APR=0.13, 95%CI 0.01-0.93). However, zebra crossings (APR=6.41, 95% CI: 1.14-36.08) and clear traffic (APR=6.39, 95%CI: 2.75-14.82) were associated with high prevalence of pedestrian injuries. Conclusion: Presence of speed humps was safer for pedestrians but zebra crossings and clear traffic had more than 6-fold risk for injuries. Findings suggest that constructing speed humps on the roads in busy areas and sensitizing motorists to respect zebra crossings could reduce pedestrian injuries

Prevalence of non-fatal injuries and associated factors in Mbarara Municipality, Western Uganda, December 2016-June 2017

Background: Injuries are a significant public health problem but poorly quantified especially in low and middle-income countries. In Uganda, the burden of injuries is poorly quantified with most of the data reported being facility and mortality based. Many non-fatal injuries, therefore, remain unreported in communities. We conducted a household survey in Mbarara Municipality to identify and describe all non-fatal injury events and the associated factors. Methods: We conducted a cross-sectional study of non-fatal injuries among 966 household members in Mbarara Municipality, from May to June 2017. The most recent non-fatal injury (within a six-month recall period; December 2016 to June 2017) resulting in loss of at least one day of usual daily operating activity was considered. We conducted a descriptive statistical analysis to estimate the counts and frequencies of non-fatal injuries. We identified factors associated with non-fatal injuries using a modified Poisson regression model. Results: The prevalence of non-fatal injuries was 18.2% (176/966) with 92% (162/176) of the non-fatal injuries being unintentional. Falls 27.3% (48/176) were the most common cause of injury followed by road traffic injuries (RTI), 26.7% (47/176), burns 16.5% (29/176) and the least being poisoning 2.8% (5/176). Occupation as casual laborer (Adjusted PR=2.1, 95% CI: 1.2 - 3.7), urban residency (Adjusted PR=1.5, 95% CI: 1.1 - 1.9) and being a non-native of the study area (Adjusted PR=1.7, 95% CI: 1.3 - 2.3) were independently associated with non-fatal injuries. Conclusion: Almost one out of five people had suffered a non-fatal injury in the past six months in Mbarara Municipality. Majority of the non-fatal injuries were unintentional, caused by falls and RTIs, and were amongst casual labourers and urban residents. These findings reveal a gap in injury prevention in Uganda that needs to be addressed to improve the quality of life

Geospatial Distribution of Pedestrian Injuries and Associated Factors in the Greater Kampala Metropolitan Area, Uganda

Background: Road traffic injuries (RTIs) are the leading cause of death among 15-29-year olds, of which 22% are pedestrians. In Uganda, pedestrians constitute 43% of RTIs. Over 52% of these injuries occur in Greater Kampala Metropolitan Area (GKMA). However, information on geospatial distribution of RTIs involving pedestrians and associated factors is scanty. We established the geospatial distribution of pedestrian injuries and associated factors in GKMA, Uganda. Methods: We conducted a mixed methods cross sectional study in three districts of GKMA. We used a structured questionnaire to interview 332 injured pedestrians at ten purposively selected health facilities from May to July 2017. We used a modified Australian Walkability Audit Tool to assess road characteristics and videography to capture road user behaviour at reported injury sites. Injury location (outcome) was categorized into three locations according to primary land use: residential areas, commercial/business areas and bar & entertainment areas. The injury hotspots were then mapped out using Quantum Geographic Information System (QGIS). Multinomial logistic regression was used to identify factors associated with injury location and adjusted prevalence ratios (APR) reported at 95% confidence interval. Results: Males represented 66.5% (221/332) of the sample. Pedestrian injuries were most prevalent among 15-29-year olds (45.5%, 151/332). Most (47.2%, 157/332) injuries occurred in commercial and business areas. Namasuba-Zana (13%, 43/332) followed by Nakawa-Kireka on Jinja road (9.7%, 32/332) had the highest number of injuries. Presence of speed humps was protective (APR=0.13, 95%CI 0.01-0.93). However, zebra crossings (APR=6.41, 95% CI: 1.14-36.08) and clear traffic (APR=6.39, 95%CI: 2.75-14.82) were associated with high prevalence of pedestrian injuries. Conclusion: Presence of speed humps was safer for pedestrians but zebra crossings and clear traffic had more than 6-fold risk for injuries. Findings suggest that constructing speed humps on the roads in busy areas and sensitizing motorists to respect zebra crossings could reduce pedestrian injuries

A heat map showing clustering of healthcare facilities in Wakiso district.

A heat map showing clustering of healthcare facilities in Wakiso district.</p

Dataset.

Hepatitis B Virus (HBV) infection remains a significant global public health challenge especially in low-and-middle income countries. Although there are significant global and national efforts to control Hepatitis B, equitable distribution and access to prevention services such as testing and vaccination remains a challenge. Efforts to increase access are hindered by inadequate evidence on the availability and distribution of HBV services. This cross-sectional study aimed at generating evidence of the distribution of HBV prevention services in Wakiso District, Uganda. A total of 55 healthcare facilities (HCFs) including 4 hospitals, and 51 primary care facilities were surveyed. Data were collected using an electronic structured questionnaire and analysed using STATA 14.0. A chi-square test was performed to establish the relationship between HCF characteristics and the availability of hepatitis B services. ArcGIS (version 10.1) was used to generate maps to illustrate the distribution of hepatitis B prevention services. We found out that the hepatitis B vaccine was available in only 27.3% (15) of the HCF, and 60% (33) had testing services. Receipt of the hepatitis B vaccine doses in the last 12 months was associated with the level (p = ≤0.001) and location (p = 0.030) of HCF. Availability of the hepatitis B vaccine at the time of the survey was associated with the level (p = 0.002) and location (p = 0.010) of HCF. The availability of hepatitis B testing services was associated with the level (p = 0.031), ownership (p≤0.001) and location (p = 0.010) of HCF. HCFs offering vaccination and testing services were mostly in urban areas, and close to Kampala, Uganda’s capital. Based on this study, hepatitis B prevention services were sub-optimal across all HCF levels, locations, and ownership. There is a need to extend hepatitis B prevention services to rural, public and private-not-for-profit HCFs.</div