Using Action Research to Address Poor Waste Management at Kijjabwemi C/U Primary School in Kijjabwemi Suburb, Masaka City.

Background: This action research (AR) project was carried out at Kijjabwemi C/U Primary school at Kijjabwemi suburb of Kimaanya-Kabonera division of the newly formed Masaka City to identify, analyze, prioritize and identify solutions to address a health problem of priority at this setting using the locally accessible and available resources. Methodology: A participatory rural appraisal approach (PRA) guided how this research achieved its objectives right from the collection of information about the health challenges faced by this school. Data was collected using Focus group discussions, interviewing, and transect walk methods. Although the majority of data is qualitative, quantitative data is as well used especially where voting on an issue took place. At prioritization, a two-phase approach conceptualized by 1) multi-level voting techniques and 2) the Hanlon method of specifying criteria, PEARL testing, and Priority scoring was adopted to priorities the most urgent, serious, and feasible problem. The five Why/What for the root cause analysis was used to analyze the problem. Results: Out of the twelve health problems enlisted as urgent and serious by over 50% of stakeholders in the first phase, Poor waste management was identified as a major and priority problem caused by the excessive distance between generation and final disposal point, lack of designated collection points as well as containers, time and irregularity of disposal, shallow waste disposal pit and lack of well develop enforceable guidelines. Conclusion and recommendation: Stakeholder-centered- learning about excellent waste management practices, utilizing transferable plastic bins of 40ml capacity, increasing the depth of the disposal pit as well as fencing it, and developing settings-oriented guidelines to increase vigilance for waste generation reduction, frequency of disposal, and burning of waste was implemented as interventions

Healthcare delivery for paediatric and adolescent diabetes in low resource settings: Type 1 diabetes clinics in Uganda

The management of type 1 diabetes (T1DM) includes setting up organised follow-up clinics. A programme for establishing such clinics in Uganda commenced in 2009. The clinics were established along the chronic care model and were integrated into the health structure of other chronic diseases. Web-based electronic medical records were utilised to establish a centralised registry. All children with diabetes below 18 years of age were encouraged to enrol into the programme by attending the nearest established T1DM clinic. At the commencement of the programme, there were 178 patients with T1DM receiving care in various health facilities but without organised follow-up T1DM clinics. These patients were subsequently enrolled into the programme and as of June 30, 2018, the programme had a total of 32 clinics with 1187 children; 3 with neonatal diabetes. Challenges encountered included difficulties in timely diagnosis, failure to provide adequate care in the remote rural areas and failure to achieve pre-defined glycated haemoglobin (HbA1c) goals. Despite these challenges, this observational study demonstrates that healthcare delivery for T1DM organised along the chronic care model and supported by web-based electronic medical records is achievable and provides care that is sustainable. Addressing the encountered challenges should result in improved outcomes for T1DM