Health Workers’ Perceptions on Where and How to Integrate Tobacco Use Cessation Services Into Tuberculosis Treatment; A Qualitative Exploratory Study in Uganda

Background: Tobacco use is associated with exacerbation of tuberculosis (TB) and poor TB treatment outcomes. Integrating tobacco use cessation within TB treatment could improve healing among TB patients. The aim was to explore perceptions of health workers on where and how to integrate tobacco use cessation services into TB treatment programs in Uganda. Methods: Between March and April 2019, nine focus group discussions (FGDs) and eight key informant interviews were conducted among health workers attending to patients with tuberculosis on a routine basis in nine facilities from the central, eastern, northern and western parts of Uganda. These facilities were high volume health centres, general hospitals and referral hospitals. The FGD sessions and interviews were tape recorded, transcribed verbatim and analysed using content analysis and the Chronic Care Model as a framework. Results: Respondents highlighted that just like TB prevention starts in the community and TB treatment goes beyond health facility stay, integration of tobacco cessation should be started when people are still healthy and extended to those who have been healed as they go back to communities. There was need to coordinate with different organizations like peers, the media and TB treatment supporters. TB patients needed regular follow up and self-management support for both TB and tobacco cessation. Patients needed to be empowered to know their condition and their caretakers needed to be involved. Effective referral between primary health facilities and specialist facilities was needed. Clinical information systems should identify relevant people for proactive care and follow up. In order to achieve effective integration, the health system needed to be strengthened especially health worker training and provision of more space in some of the facilities. Conclusions: Tobacco cessation activities should be provided in a continuum starting in the community before the TB patients get to hospital, during the patients’ interface with hospital treatment and be given in the community after TB patients have been discharged. This requires collaboration between those who carry out health education in communities, the TB treatment supporters and the health workers who treat patients in health facilities

(Ophtha), H.Dip. Ophtha (Cataract Surgery) (Kenya medical training college

ABSTRACT Sexual dysfunction can impact a person's ability to form or sustain intimate relationships and co morbidity between sexual dysfunction and anxiety as well as depression has been reported. Yet epidemiological, etiological, and health association to sexual dysfunction has only begun to be explored in Kenya. Aim: To determine the prevalence, types of sexual dysfunction and their socio demographic correlate in diabetic patients. Design: Descriptive cross-sectional study Setting: The study was conducted at the outpatient diabetic clinic of Kenyatta National Hospital. This is the main referral hospital in Kenya. Methods: A total of 350 participants were enrolled in the study. The Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) questionnaires were used to evaluate sexual dysfunctions in female and male patients respectively. Results: The participants were composed of 164 females aged between 18-74 years and 186 males aged between 19-100 years. In males, prevalence of sexual dysfunctions were: erectile dysfunction (68.8%); orgasmic dysfunction (48.4%); sexual desire (81.7%); intercourse satisfaction (86.6%) and overall satisfaction (68.4%).The female sexual dysfunction was 36.6% and was categorized as mild (17.1%); moderate (18.3%) and severe (1.2%). Conclusion: Diabetic patients have a high prevalence of sexual dysfunctio

Is sexual abuse a part of war? A 4-year retrospective study on cases of sexual abuse at the Kenyatta National Hospital, Kenya

The harmful effects of sexual abuse are long lasting. Sexual abuse when associated with violence is likely to impact negatively on the life of the victim. Anecdotal reports indicate that there was an increase in the number of cases of sexual violence following the 2007 post election conflict and violence in Kenya. Although such increases in sexual abuse are common during war or conflict periods the above reports have not been confirmed through research evidence. The purpose of the current study is to establish the trend in numbers of reported cases of sexual abuse at Kenyatta National Hospital over a 4-year period (2006-2009). Data on sexually abused persons for the year 2006-2009 was retrieved from the hospitals record. A researcher designed questionnaire was used to collect relevant data from the completed Post Rape Care (PRC) form. The PRC-Ministry of Health no. 363 (MOH363) form is mandatorily completed by the physician attending the sexually abused patient. There was an increase in the number of cases of sexual abuse reported in 2007 election year in Kenya, with a statistically significant increase in the sexually abused male cases. Sexual crime is more prevalent when there is war or conflict

Change in Knowledge of Tobacco Use and Secondhand Smoke Exposure Among Health Workers in Uganda

Background: Tobacco use exacerbates diseases, including tuberculosis (TB) and interferes with recovery from such outcomes. However, there is sparse research on the integration of tobacco cessation into TB programs. Moreover, there is limited evidence on how mHealth solutions for tobacco can enhance cessation among TB patients. This study aimed to assess the impact of a training program to integrate tobacco cessation in TB program on the knowledge of health workers. Methods: In June 2017, a 5-day training about tobacco use and control and the use of mHealth solutions to improve tobacco cessation and enhance adherence to TB treatment was conducted in Uganda. A comparison of percent of participants reporting knowledge on selected health outcomes of tobacco use and secondhand tobacco smoke (SHS) exposure was conducted. Knowledge was assessed on a 21-outcome-item before and after training. A non-parametric test, signrank for comparison of paired observations was conducted. The changes were considered statistically significant if the p-value was less than 5%. Results: Twenty three trainees from across the country attended (13 females, 10 males), with median age of the trainees was 39 years. Pre-training knowledge about tobacco use (66.6%) was higher than SHS exposure (45%). Following the training, both sets of knowledge significantly improved (median 100%). Pre-training knowledge about health effects of tobacco use was particularly low for diabetes (27%), meningitis (9.5%), ear infection (43%), impotence (47.6%), and fibrosis (30%). Except heart attack (76%), lung illness among children (91%), lung cancer (81%), and chronic lung disease (81%), pre-training knowledge about SHS was low for all other disease outcomes. Conclusions: Healthcare providers play critical role in preventing and reducing tobacco use. The low pre-training knowledge of the TB health workers suggests the critical need for training health providers in Uganda and elsewhere in Africa in order to curtail the increasing trend in usage