PATIENT’S PERCEPTIONS OF ANTI-CANCER CHEMOTHERAPY SIDE EFFECTS AND ADHERENCE ON TREATMENT AT MBARARA REGIONAL REFERRAL HOSPITAL.

Background: Chemotherapy is one of the most common treatment modalities for cancer. However, despite the benefits of indicated chemotherapy, the side effects and toxicities of the treatment frequently affect the patient’s quality of life (QOL) and hence adherence to the treatment.  The aim of the study was to examine the patient’s perception of the anti-cancer chemotherapy side effects and adherence to treatment at MRRH Methodology: The study utilized a descriptive qualitative design. It involved 40-60 minute in-depth interviews with 10 participants who had undergone chemotherapy treatment to understand their perceptions and their adherence to treatment. Inductive thematic data analysis was used to generate themes and categories. Results: The following themes and categories emerged:  Benefits [helpful, feeling good, believed getting better], and perceived severity [chemotherapy side effects, frustration, pain and fear of death]. Conclusion: The perceived severity of the chemotherapy had a considerable impact on patients' quality of life. Despite these side effects experienced by most of the participants, the benefits of chemotherapy and considerable support from staff influenced the participants to adhere to treatment. Recommendations: There is a need for health workers to continue providing the necessary information about the disease, the drugs, the course of treatment, and the prognosis to improve patient acceptance of the chemotherapy

Factors Influencing Annual Procurement Planning of Medicines and Medical Supplies in Public Health Facilities in Kampala District

BackgroundDespite significant progress made by many countries towards meeting the millennium development goals and now sustainable development goals, there has been little improvement in access to essential medicines in developing countries.ObjectivesThe main aim of this study is to assess the factors influencing annual procurement planning of medicines and medical supplies in the public health facilities in Kampala district.MethodsThis study targeted respondents from government Health facilities in Kampala with a total population of 424 employees and applied simple random sampling to select 206 health workers. The researcher adopted mixed research approach with application of descriptive statistics, correlational and explanatory research designs that were used to maximize reliability and validity of findings. While the qualitative data was gathered through reviewing logistics tools, a physical count of the 30% purposively selected stock cards and interview of the staffs was carried out in health facilities in Kampala district, a Statistical Package for Social Science (SPSS) version 20 was used to analyze the quantitative data. Accordingly, a chi-square was used to determine the association between independent and dependent variables.ResultsThe findings indicated that 37.8% of the staff responded positively about the availability of annual procurement plan while the rest were from various health facilities. A significant association was observed between knowledge and availability of annual Procurement planning (X2 = 34.7; p value =.0001), as well as management support and Annual Procurement Planning (X2 = 9.87; P value = .008).ConclusionIn conclusion, the finding generated from analysis of quantitative and qualitative data revealed that a majority of the factors influencing annual procurement planning had a positive effect on medical supplies in public health facilities in Uganda although the capacity and capability of health workers, quality of logistics management information systems, and management support desires improvement. Rwanda J Med Health Sci 2021;4(2): 292-30

An evaluation of the implementation of decentralization of the World Bank's operations of poverty reduction in Uganda

Continued debates on economic development, poverty eradication and the growing skeptism concerning the paradigms proposed through many decades, has led to a continued search for a paradigm that would, finally, resolve the issue of pervasive poverty in the Sub-Saharan Africa. Having implemented decentralization within government entities without any significant contribution to poverty eradication, the focus has now turned to the development agencies themselves. What are the inefficiencies in these agencies which if addressed might enable them deliver development aid more efficiently thus, providing more resources for development from being lost in the attrition of overheads? It is, therefore, argued that decentralization of development agencies will improve the efficiency and effectiveness of IFIs in delivering development aid. At the same time, decentralization reforms have been proposed as a response to the failures of highly centralized states (or organizations in this case). Empirical evidence, strongly, suggests that physical proximity and more "face-time", promotes better results-on-the-ground, delivered by staff who are better attuned to local conditions and have a better understanding of the client and their development agenda. But, will decentralization alone solve the issue of pervasive poverty? This research recognises that the factors affecting poverty are diverse and intricate and isolating just one part of the puzzle is not enough. Nevertheless, it is argues that decentralization, has a positive impact on poverty reduction thus, this study presents both practical and theoretical considerations from which policy measures can be derived. This thesis focused on establishing how the World Bank, changed its strategies through the implementation of decentralization of its operations as proposed in the ‗Strategic Compact‘, renewed the way it worked in order to maintain its relevance in the development world. The World Bank President, James Wolfensohn, proposed the Compact as a solution to the organization‘s self diagnosis that it was in distress, in a state of possible decline and was not fulfilling its mission of poverty eradication. This research, using Uganda Country Office as a case study, undertook, mainly, a qualitative review of the overall strategy of decentralization and its implementation organization wide and specifically, in Uganda. The research examined how the implementation of the strategy impacted on poverty trends in Uganda. This research found that the decentralization strategy was, fundamentally, the right one to deliver better results of the Bank‘s mission of ‗fighting poverty for lasting results‘ and its vision of ‗A World Free of Poverty‘. Contrary to the popular notion that the World Bank has been, largely ineffective in the delivery of its mission and its decentralization strategy just another one of its 'shams‘, this research established that the implementation of the strategy, although not having a direct or causal relationship, did have positive impact on poverty alleviation in Uganda. This study, therefore, makes a case for decentralization of donor organizations as a means of better delivery of the poverty eradication agenda in the developing world. The benefits though hard to measure in monetary terms are, nevertheless, real in terms of faster and better quality engagement with the clients which in turn, result into better delivery of services and programmes

Agony resulting from cultural practices of canine bud extraction among children under five years in selected slums of Makindye : a cross sectional study

Background: Canine Bud Extraction (CBE) is a process of removing or gouging children's healthy canine tooth buds embedded underneath the gum using traditional unsterilized tools. The practice of CBE commonly known as false teeth removal continues to be an adopted cultural intervention of choice, in the prevention of morbidity and mortality from common childhood illnesses. However, it is a practice against the rights of the children with serious consequences. While CBE is associated with the perceived myth of curative gains, the agony emanating from the cultural practice exposes children to ill-health conditions such as dehydration, malnutrition, blood-borne diseases like HIV/AIDs, septicemia, fever and death. This research sought to understand the factors underpinning the practice of CBE among urban slum dwellers. Method: A cross-sectional study was conducted from five randomly selected slums in Makindye division; 298 household heads or guardians with children below 5 years, who had ever suffered from false teeth were interviewed. The variables measured included guardians' socio-demographic profiles, determinants of CBE, common childhood illnesses assumed to be treated with CBE and the reported side-effects associated with the practice. Results: Of the 298 respondents with children who had ever suffered from "false teeth" interviewed, 56.7% had two or more children below 5years and 31.9% were from the central region. The proportion of households practicing CBE was 90.3%; 69.8% of the caretakers mentioned that it was done by traditional healers and for 12.1% by trained health workers (dentists). Number of children (OR=2.8, 95% CI: 1.1-7.2) and the belief that CBE is bad (OR=0.1, 95% CI: <0.001, p<0.001) had a statistically significant association with CBE. Additionally, number of children (χ2=4.9, p=0.027) and 2 sets of beliefs (CBE treats diarrhea (χ2=12.8, p=0.0017) and CBE treats fever (χ2=15.1, p=0.0005) were independent predictors of CBE practice. A total of 55.7% respondents knew that there were side effects to CBE and 31% mentioned death as one of them. Conclusion: The high proportion of households practicing CBE from this study ought to awaken the perception that the practice is ancient. CBE in this community as the study suggests was strongly driven by myths. The strong belief that CBE is bad provides an opportunity for concerted effort by primary health care providers, policy makers and the community to demystify the myths associated with false teeth and the gains of CBE

Protective efficacy of isometamidium chloride and diminazene aceturate against natural <i>Trypanosoma brucei<i/>, <i>Trypanosoma congolense<i/> and <i>Trypanosoma vivax<i/> infections in cattle under a suppressed tsetse population in Uganda

The protective efficacy of isometamidium chloride (ISMM) and diminazene aceturate (DIM) against Trypanosoma brucei, Trypanosoma congolense and Trypanosoma vivax infections in cattle under a suppressed tsetse population was assessed in southeast Uganda. A total of 66 and 57 trypanosome-infected cattle were treated with ISMM and DIM, respectively together with 177 trypanosomefree animals not treated were followed for 12 months, checked every 4 weeks. There was no statistical difference in the mean time to infection with any trypanosome species in animals treated with ISMM or DIM. However, the mean time to trypanosome infection was significantly longer for treated animals than controls. The mean time to infection with each of the three trypanosome species differed significantly, with the average time to T. vivax infection the lowest, followed by T. congolense and then T. brucei. The protective efficacy of DIM was as good as that of ISMM; implying curative treatments against trypanosomosis are sufficient for combination with tsetse control. Isometamidium chloride or DIM had the highest impact on T. brucei and T. congolense infections in cattle

Determinants of Uptake of Mass Drug Administration for Schistosomiasis Control in Butiaba Sub-county, Uganda

Introduction: Schistosomiasis is one of the Neglected Tropical Diseases (NTDs) targeted for elimination in Uganda by 2025 through Mass Drug Administration (MDA) using praziquantel.  To achieve this, WHO estimates indicate that MDA coverage and uptake of 75% is required. However, coverage remains suboptimal with insufficient knowledge and inadequate drug supply often cited as key reasons. There is a need to add to the body of knowledge in various settings to enable more robust mitigation measures. This study aimed to assess the uptake of praziquantel for MDA and associated factors in Butiaba sub-county along the shores of Lake Albert in Uganda. Methods: A cross-sectional study was conducted in five randomly selected villages within Butiaba sub-county between July and September 2021 using quantitative and qualitative approaches. Semi-structured questionnaires were administered to 450 adults, with additional two Focus Group Discussions and Key Informant interviews held with implementation structures from the village to district level. Results: Self-reported uptake of praziquantel within twelve months of the most recent MDA exercise was 71.56% (95% CI: 67.14 – 75.68). Of all the participants, 5.78% reported have never swallowed praziquantel in their lifetime, and 75% (96/128) of participants who didn’t swallow praziquantel in the last twelve months reported having at least swallowed the drug in the last ten years. Respondents were less likely to have swallowed praziquantel if they had no knowledge about schistosomiasis signs (AOR= 0.18, 95% CI: 0.08–0.39) and more likely if they were between the ages 30-39years (AOR= 2.31, 95% CI: 1.35–3.95) or 40 years and above (AOR= 2.86, 95% CI: 1.45 – 4.95). Operational  challenges such as the inadequate supply of praziquantel and financial constraints also influence the uptake of praziquantel during MDA in Butiaba sub-county. Conclusion: The uptake of praziquantel during MDA in Butiaba sub-county was high but still below the WHO target of 75%. People with limited knowledge of schistosomiasis symptoms and those aged 18 – 29 years were less likely to take Praziquantel. Irregular drug supply was also a key challenge. Recommendation: Rigorous health education and ensuring a continuous supply of Praziquantel are key to improving MDA uptake

Spatial Analysis of Sleeping Sickness, Southeastern Uganda, 1970–2003

Disease will likely spread into central Uganda

The Dispersal Ecology of Rhodesian Sleeping Sickness Following Its Introduction to a New Area

Tsetse-transmitted human and animal trypanosomiasis are constraints to both human and animal health in sub-Saharan Africa, and although these diseases have been known for over a century, there is little recent evidence demonstrating how the parasites circulate in natural hosts and ecosystems. The spread of Rhodesian sleeping sickness (caused by Trypanosoma brucei rhodesiense) within Uganda over the past 15 years has been linked to the movement of infected, untreated livestock (the predominant reservoir) from endemic areas. However, despite an understanding of the environmental dependencies of sleeping sickness, little research has focused on the environmental factors controlling transmission establishment or the spatially heterogeneous dispersal of disease following a new introduction. In the current study, an annually stratified case-control study of Rhodesian sleeping sickness cases from Serere District, Uganda was used to allow the temporal assessment of correlations between the spatial distribution of sleeping sickness and landscape factors. Significant relationships were detected between Rhodesian sleeping sickness and selected factors, including elevation and the proportion of land which was “seasonally flooding grassland” or “woodlands and dense savannah.” Temporal trends in these relationships were detected, illustrating the dispersal of Rhodesian sleeping sickness into more ‘suitable’ areas over time, with diminishing dependence on the point of introduction in concurrence with an increasing dependence on environmental and landscape factors. These results provide a novel insight into the ecology of Rhodesian sleeping sickness dispersal and may contribute towards the implementation of evidence-based control measures to prevent its further spread

Restricted Application of Insecticides: A Promising Tsetse Control Technique, but What Do the Farmers Think of It?

Restricted application of insecticides to cattle is a cheap and safe farmer-based method to control tsetse and the diseases they transmit, i.e. human and animal African trypanosomoses. The efficiency of this new control method has been demonstrated earlier but no data is available on its perception and adoption intensity by farmers. We studied these two features in Burkina Faso, where the method has diffused thanks to two development projects. The study allowed identifying three groups of farmers with various adoption intensities, of which one was modern and two traditional. The economic benefit and the farmers' knowledge of the epidemiological system appeared to have a low impact on the early adoption process whereas some modern practices, as well as social factors appeared critical. The quality of technical support provided to the farmers had also a great influence on the adoption rate. The study highlighted individual variations in risk perceptions and benefits, as well as the prominent role of the socio-technical network of cattle farmers. The results of the study are discussed to highlight the factors that should be taken into consideration, to move discoveries from bench to field for an improved control of trypanosomoses vectors