Community chloroquine distribution for malaria control in Bushenyi district of Uganda.

OBJECTIVE: To document successful community chloroquine distribution for malaria control in Bushenyi district, southwestern Uganda. DESIGN: A cross sectional survey immediately after a four-month community chloroquine distribution exercise. One hundred sixty seven distributors in 140 out of 166 parishes in Bushenyi district did the chloroquine distribution during the 2001 malaria epidemic. PARTICIPANTS: A cluster random sample of 215 heads of households or their spouses were interviewed using a pre-tested questionnaire. MAIN OUTCOME MEASURES: Socio-demographic characteristics, malaria/fever morbidity, health seeking behaviour in the previous four months, knowledge about chloroquine distribution, opinions about the chloroquine distribution exercise and whether the household had used the service of the chloroquine distributors. RESULTS: Thirty per cent of the people surveyed had suffered from malaria in the previous four months. Seventy per cent of the households were aware of the chloroquine distribution and 56% of the patients who had malaria in the previous four months accessed the services of chloroquine distributors. People who were aware of chloroquine distributors were less likely to use services where a fee is levied. The total cost of chloroquine distribution was about 20,000 United States dollars. CONCLUSIONS: Community chloroquine distribution can increase access to treatment and can be done in a short time at an affordable cost

Predictors of compliance with community-directed ivermectin treatment in Uganda: quantitative results.

In order to identify the factors influencing compliance with mass ivermectin treatment for onchocerciasis control, a cross-sectional study was carried out in Bushenyi District, Uganda. Data were collected by interviewing 839 individuals who were randomly selected from 30 clusters where onchocerciasis is endemic. Information was collected on compliance with ivermectin treatment, socio-demographic characteristics, perception of personal susceptibility to onchocerciasis, knowledge about cause/transmission of onchocerciasis, knowledge of signs and symptoms of onchocerciasis, treatment of onchocerciasis, benefits and dangers of taking ivermectin, organization of distribution of ivermectin, work and selections of community drug distributors (CDDs), social influence and support to take ivermectin and on barriers and supports towards compliance with ivermectin treatment. The major factors favouring compliance were: perceiving CDDs as doing their work well, believing that measuring height is the best way to determine one's dose of ivermectin, having social support from one's family, saying that ivermectin treatment costs nothing, perceiving personal risk of onchocerciasis, believing that ivermectin prevents onchocerciasis and perceiving radios as supporting treatment with ivermectin. The strongest predictor of compliance with ivermectin treatment is perceiving CDDs as doing their work well with adjusted odds ratios of 5.54 (95% CI: 3.19-9.62). In order to improve compliance with ivermectin treatment, CDDs need to be well-facilitated and ivermectin distribution should be free. Health education is necessary so that people perceive themselves to be at risk of onchocerciasis and to understand the rationale of using height for dose determination. The health education should target the family and use radios

The Emerging Challenges in Transmission and Detection of Filovirus Infections in Developing Countries

This chapter reviews the emerging challenges in the transmission and detection of Ebola and Marburg filoviruses since their identification in 1967 and 1976, respectively. Five known highly fatal Ebola species are examined. Ebola outbreaks comprising of 14 EBOV, 7 SUDV, and 4 BDBV infections are reviewed, including the largest West African Ebola outbreak. The ecology of filoviruses and the possible interactions with intermediate hosts and reservoirs is also examined. Evidence that bats are the principal reservoirs of these infections is reviewed. Surveys raise the possibility that other nonhuman primates including dogs may be involved. Challenges on the presumed modes of transmission are discussed with a possibility of droplet and aerosol routes. The discovery of Ebola virus in pigs and its potential impact on the food chain are discussed. The WHO Syndrome Case definition guidelines for diagnosis are examined and shortcomings discussed. However, the early case detection is undermined by the many tropical diseases with similar symptoms. The low positive predictive value for diagnosis based on the antibody antigen assays in outbreaks complicates early isolation and action especially in resource constrained settings. The chapter suggests improvements and areas for further research on the ecology, transmission, and management of filovirus infections

Managing Ebola in Low-resource Settings: Experiences from Uganda

Five outbreaks of Ebola virus disease of the Sudan Ebola virus and the Bundibugyo Ebola virus occurred in Uganda from 2000 to 2012. The attack rates and the case fatality rates were much higher for the former than the later. Fever and bleeding manifestations associated with the clustering of cases were typical clinical features. Close contact with infected person was probably the major route of spread. Apparent asymptomatic and atypical Ebola infection was demonstrated in some close contacts, suggesting past unrecognised exposure or cross-reacting antibodies. A zoonotic connection was apparent in monkeys and asymptomatic villagers. The Ministry of Health together with its partners contained the outbreaks, sometimes with delays, but at least once promptly. Early detection and communication yielded the best ideal outcomes. A community-based response ensured timely case search and contact tracing for the isolation and management of patients. The syndrome-based EVD case definition and the laboratory screening tests for Ebola were used to detect cases. However, their unknown specificity and sensitivity and their low positive predictive values were a major weakness in the screening process. Validation of the criteria and the tests at the local level was essential. There were gaps in isolation procedures as 64% of the health care workers were infected after the isolation units were established. Palliative treatment was an important part of management as it improved survival and public confidence. Therefore, survival and not just quarantine must be emphasized and be a critical component of EVD management. Substantial investment in human resource for health is needed to attract, reward, retain and compensate health workers. Collaboration and partnerships at national and international level is vital in building health systems for early surveillance and management of emerging infections. The Uganda experience provides opportunities for further research on some of these strategies that could improve the management and control of Ebola in low resource countries

Towards a National AIDS-Control Program in Uganda

This is an article published in special Issue: AIDS-Global perspective in the Western Journal of Medicine. 1987 Dec; 147:726-729. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1025994/A national AIDS-control program was developed in Uganda to deal with a potentially serious epidemic of the acquired immunodeficiency syndrome (AIDS). A cumulative total of 1, 138 cases of AIDS has been reported in Uganda between 1983-since AIDS was introduced into the country and March 1987. More than 80% of the victims are sexually active persons whereas less than 10% are infants and children younger than 5 years. Virtually no cases or seropositivity is reported in persons between the ages of 5 and 14 years or after the age of 60 years. Most transmission has been through the heterosexual route, and, unlike in the United States, the male-female ratio is 1:1. Heterosexual high-risk behavior is cited as an important mode of transmission. A survey of household contacts showed that despite the closeness, only the sexual partners were seropositive. A five-year plan of action has been developed, and health education is the main thrust. It also includes blood screening, improved sterile procedures, improved surveillance and notification, research and terminal patient care. The plan stresses integration based on primary health care. There are unresolved moral issues of whether or not to tell the truth to an AIDS victim or any healthy seropositive person in developing countries, especially unstable persons. The best approach is to sensitize everyone so that they become guardians of their lives because sexual behavior is an issue of individual responsibility

Factors impacting performance of training institutions in Uganda

The purpose of this study was to develop and empirically test a hypothetical model of factors impacting performance of training institutions in Uganda in order to establish their statistical significance. The liberalisation of the education sector in Uganda, which has led to the rapid growth in the establishment of private sector higher education institutions in the country, now necessitates empirical and theoretical research into the factors impacting performance of these training institutions. The mission of higher education training institutions is to constantly create a critical academic community to debate national issues and to generate relevant knowledge for the country’s economic growth and development. The study investigated and analysed how the independent variables (individual-, institutional- and external) impact institutional performance (dependent variable). The study reviewed literature in the areas of individual-, institutional- and external factors supported by Wei’s (2006), Mackenzie-Phillips (2008), Burke-Litwin (1994), Lusthaus, Adrien, Anderson and Carden (1999) and The Jain (2005) models as presented in section 6 of chapter one. The hypothetical model developed was based on the models mentioned. The study sought the perceptions of managers and utilised the quantitative research paradigm. A survey was conducted using a self-administered questionnaire distributed to managers in both public and private training institutions in Uganda. The final sample comprised 488 respondents. Data was collected in 2012 over a period of four months. The returned questionnaires were subjected to several statistical analyses. The validity of the measuring instrument was ascertained using exploratory factor analysis. The Cronbach’s alpha values for reliability were calculated for each of the factors identified during the exploratory factor analysis. In this study, correlation and exploratory factor analysis, the KMO measure of sample adequacy and Bartlett’s test of sphericity and regressions were the main statistical procedures used to test the appropriateness of data, correlation and significance of the relationships hypothesised between the various independent and dependent variables. The study identified nine independent variables as significantly impacting the performance (dependent variable) of training institutions in Uganda. Three statistical significant relationships were found between the individual factors: knowledge acquisition, role identity, employee empowerment and performance of training institutions in Uganda. Four statistical significant relationships were found between the institutional factors: strategic intent, management capabilities, organisational resources, organisational culture and performance of training institutions in Uganda. Two statistical significant relationships were found between the external factors: political/legal, stakeholders and performance of training institutions in Uganda. The study also found five statistically insignificant variables. It was found that managers in training institutions in Uganda should encourage employees to assess their own performance. Managers should formulate a policy on transparency and practice open communication using the right communication channels. Training institutions in Uganda should consider having organic and flatter organisational structures with a wider span of control. Managers should regard economic variables such as inflation rates and tax obligations when planning and drawing up budgets as this will impact their profitability. There is a need in Uganda to collaborate with and forge close relationships with international training institutions and global partners to become more globally competitive. The study has provided general guidelines at individual level how to best utilize employees to improve performance of training institutions in Uganda. Furthermore, general operational guidelines at institutional level for improving performance of training institutions have been given for such institutions to become and remain competitive in the global market place. The study has also highlighted general guidelines regarding managing external environmental factors to assist in improving performance of training institutions in Uganda

False teeth "ebiino" and millet disease "oburo" in Bushenyi district of Uganda

Background:\"False teeth\" (Ebiino) and \"Millet disease\" (Oburo, Tea-tea) have been reported in Uganda and other countries in Sub-Saharan Africa. These two perceived diseases are commonly reported in children under-five years of age. Anecdotal and published evidence suggests that these conditions are associated with moderate to severe childhood diseases such as malaria, pneumonia and diarrhoea and that most health seeking behaviour for the conditions is from traditional healers. Objectives:To estimate how common the 2 perceived diseases (false teeth and millet disease) are and describe health seeking behaviour for the two diseases. Methods:We did a cross-sectional survey using an interviewer administered questionnaire with closed and open questions in Bushenyi district, Uganda. The participants included 215 heads of households or their spouses obtained by cluster random sampling of 30 villages. Participants answered questions regarding occurrence of false teeth and millet disease disease in the household, treatment sought for false teeth and millet disease, perceived causes of false teeth and millet disease and about social economic situation of the household. Results: More than one in two of the households had a child less than five years who suffered from false teeth or millet disease in the last five years. More than 80% of the respondents used traditional medicine alone or in combination with modern medicine to treat false teeth and or millet disease. Occurrence of false teeth and millet disease disease were favoured by low education status and not living in a house with cemented floor or having a brick wall. Use of traditional medicine was not associated with social economic conditions. Conclusions:The frequency of the perceived diseases false teeth and millet disease disease is high and may be attributed to low access to preventive and curative health services. Keywords: Malaria; Pneumonia; Diarrhoea; health seeking behaviour; access to health facilities; traditional medicine; health beliefs. African Health Sciences Vol. 7(1) 2007: pp. 25-3

Review of Social Challenges of Heterosexual Transmission of HIV/AIDS in Uganda

This Chapter reviews and discusses the experiences of Uganda and the lessons learnt during the successful implementation of its HIV/AIDS Control Program. The major mode of transmission was by the heterosexual route. Control measures thus emphasized behavior change and sexual discipline that promoted faithfulness and monogamous sexual relationships. This chapter examines the factors responsible for the positive outcomes in the implementation of the national AIDS control strategy. The review is based on literature, reports and personal experience. The Uganda Program AIDS in the Ministry of Health (MOH) was one of the earliest AIDS Control Programs in the world. A cumulative total of nearly 2 million people have been infected since the onset of the outbreak in 1982. Some one million HIV related deaths also occurred. When the National AIDS Control Program was initially rolled out in the country there was no cure and the disease was like a death sentence. The available evidence then demonstrated heterosexual transmission as the major mode of spread. Interventions based on the promotion of Abstinence, Being faithful, and Condom use (ABC strategy) were the main components of the strategy in the public campaigns. This complex disease also impacted society and the social fabric deeply. The activities were expanded to include the socio and economic dimensions of HIV/AIDS. Later on the combination strategy integrating biomedical and social behavior change strategies offered new and more encompassing opportunities. The introduction of the antiretroviral therapy (ART) and availability of simplified tests for detection of the viral load status improved treatment and restored hope. Social support and programs for reduction of stigma opened up participation by people living with HIV/AIDS. A community based intersectoral and decentralized strategy reached every village and assured community engagement and involvement. Drastic and steady declines in prevalence and incidence followed. Cases have been declining steadily and prevalence and incidence rates continue to drop and reverse the HIV status in the country. Community Engagement strategy to promote monogamous sexual behavior and the introduction of the highly active retroviral treatment significantly consolidated to the successful outcomes