Baseline Prevalence of Trachoma in Refugee Settlements in Uganda: Results of 11 Population-based Surveys.

PURPOSE: There are several settlements in the Northern and Western Regions of Uganda serving refugees from South Sudan and Democratic Republic of Congo (DRC), respectively. Trachoma prevalence surveys were conducted in a number of those settlements with the aim of determining whether interventions for trachoma are required. METHODS: An evaluation unit (EU) was defined as all refugee settlements in one district. Cross-sectional population-based trachoma prevalence survey methodologies designed to adhere to World Health Organization recommendations were deployed in 11 EUs to assess prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds. Household-level water, sanitation and hygiene coverage was also assessed in study populations. RESULTS: A total of 40,892 people were examined across 11 EUs between 2018 and 2020. The prevalence of TF in 1-9-year-olds was <5% in all EUs surveyed. The prevalence of trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds was <0.2% in 5 out of 11 EUs surveyed and ≥0.2% in the remaining 6 EUs. A high proportion of households had improved water sources, but a low proportion had improved latrines or quickly (within a 30-minute return journey) accessible water sources. CONCLUSIONS: Implementation of the antibiotic, facial cleanliness and environmental improvement components of the SAFE strategy is not needed for the purposes of trachoma's elimination as a public health problem in these refugee settlements; however, intervention with TT surgery is needed in six EUs. Since instability continues to drive displacement of people from South Sudan and DRC into Uganda, there is likely to be a high rate of new arrivals to the settlements over the coming years. These populations may therefore have trachoma surveillance needs that are distinct from the surrounding non-refugee communities

Completing Baseline Mapping of Trachoma in Uganda: Results of 14 Population-Based Prevalence Surveys Conducted in 2014 and 2018.

PURPOSE: We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years, trichiasis in adults aged ≥15 years, and water and sanitation (WASH) indicators in 12 suspected-endemic districts in Uganda. METHODS: Surveys were undertaken in 14 evaluation units (EUs) covering 12 districts. Districts were selected based on a desk review in 2014 (four districts) and trachoma rapid assessments in 2018 (eight districts). We calculated that 1,019 children aged 1-9 years were needed in each EU to estimate TF prevalence with acceptable precision and used three-stage cluster sampling to select 30 households in each of 28 (2014 surveys) or 24 (2018 surveys) villages. Participants living in selected households aged ≥1 year were examined for trachoma; thus enabling estimation of prevalences of TF in 1-9 year-olds and trichiasis in ≥15 year-olds. Household-level WASH access data were also collected. RESULTS: A total of 11,796 households were surveyed; 22,465 children aged 1-9 years and 24,652 people aged ≥15 years were examined. EU-level prevalence of TF ranged from 0.3% (95% confidence interval [CI] 0.1-0.7) to 3.9% (95% CI 2.1-5.8). EU-level trichiasis prevalence ranged from 0.01% (95% CI 0-0.11) to 0.81% (95% CI 0.35-1.50). Overall proportions of households with improved drinking water source, water source in yard or within 1km, and improved sanitation facilities were 88.1%, 23.0% and 23.9%, respectively. CONCLUSION: TF was not a public health problem in any of the 14 EUs surveyed: antibiotic mass drug administration is not required in these districts. However, in four EUs, trichiasis prevalence was ≥ 0.2%, so public health-level trichiasis surgery interventions are warranted. These findings will facilitate planning for elimination of trachoma in Uganda

Interrogating teachers’ support structures for effective implementation of ICT in Kenya primary schools

Teachers cannot do it alone! Teachers hold the inestimable place of linking policy-makers and learners, a role that has become increasingly important in the age of integration of Information and Communication Technologies (ICTs) in education. In Kenya, as is the trend globally, the country has, for many years, been intentional in its efforts to infuse ICTs in education at all levels. In basic education, the National Education Sector Plans (NESPs) of the last two decades incorporated ICT into teaching and learning as one of its priorities. Behind these ICT-in-Education plans is the need to ensure that the teachers can support the agenda. The purpose of this study was therefore to interrogate the existing teachers’ support structures for optimal use of ICTs and identify gaps to be addressed. To achieve this, the study applied a mixed method approach which complementarily fused both qualitative and quantitative research strategies, processes and procedures. Data was collected from teachers and head-teachers drawn from public primary schools in four selected counties of Kajiado, Kilifi, Nairobi and Uasin Gishu in Kenya. The sample size was 352 respondents from a 3,400-population block from whom data was collected through questionnaires and structured interview schedules. A two-phase model was engaged with an initial process of quantitative data collection from teachers, followed by qualitative data collection using structured interviews with head-teachers which provided rich narratives to affirm and expound on teachers’ feedback. Concurrently, publicly available policy documents were considered and reviewed in this study. The various quantitative and qualitative datasets were then analysed in descriptive and inferential statistical methods and subsequently triangulated to enhance the validity and credibility of the findings. The study was anchored in two theories namely: Network Society Theory and Diffusion Innovation Theory. The interpretivist paradigm was adopted since the study was dealing with teachers who occupy a unique place in the society given that they interact with each one of us at one point or another. This research was largely informed by teachers’ perceptions, attitudes and interpretations regarding the support structures provided for integration of ICTs in the teaching and learning process. The findings indicated that in Kenya’s public primary schools, the existing structures were not adequate and not effective in supporting teachers for ICT; teachers and/or head-teachers have no clear understanding of the ICT policies in place; head-teachers appreciate the positive and significant relationship between well-defined teacher support structures and effective integration of ICT in school activities; and that while there is significant ICT infrastructure in most schools, there is insufficient technical support to teachers which leads to a poor appreciation of the power of technology to support teachers’ activities in schools. The study also revealed some barriers that hinder teacher support for ICT integration which included inadequate ICT infrastructure for the teachers; poor ICT skills resulting from a low level of ICT support to teachers; and negative attitudes stemming from lack of confidence in the use of ICT devices. The study concluded that while the barriers that prevent teachers from effectively using ICT are immense, they are not insurmountable and therefore, every effort should be sought to upskill and motivate teachers to transition to a mindset that sees ICT as an integral enabler of teaching and learning in the 21st Century. The study, therefore, recommends that education stakeholders need to re-think the structures of support to teachers by paying special attention to providing the requisite environment of both soft and hardware towards a sustainable and effective ICT-in-Education ecosystem. Some of the tangible recommendations of this study are the deployment of a framework for continuous ICT in teaching Skills and Content on-Demand (SCoD1); and re-designing ways to motivate teachers with continuous in-system incentivisation and recognition of exemplary practice. The apogee of this study is a clarion call to shift the focus from policy to practice by instituting specific activities that will see the teachers appreciate, through practice, the astounding potential presented by ICTs. This will result in significantly reducing teachers’ mundane workload so as to concentrate on their critical role of effectively facilitating teaching and learning, ultimately achieving excellent learning outcomes. It is by empowering the teachers that the education sector will exploit the optimal benefits of ICTs-in-Education, particularly in Primary Schools and Basic Education as a whole.Educational Leadership and ManagementD. Phil. (Education (Education Management)

Factors influencing the sustainability of neglected tropical disease elimination programs: A multi-case study of the Kenya national program for elimination of lymphatic filariasis

© 2020 by The American Society of Tropical Medicine and Hygiene Elimination of a disease is the holy grail in global health. The pathology of several neglected tropical diseases (NTDs) such as lymphatic filariasis (LF) makes elimination a reality. However, successful elimination requires that NTD programs be sustainable-the ability to confirm that the disease has been eliminated and the capacity to ensure that it does not return. The WHO\u27s guidelines on NTDs thoroughly detail how to reach elimination. Notwithstanding, comprehensive guidance regarding contextual and programmatic factors that influence sustainability is lacking. Moreover, a comprehensive NTD sustainability framework that includes these factors is nonexistent. This research aimed to develop a framework that identified the critical programmatic and contextual factors influencing sustainability of NTD elimination programs. The methodology included a literature review and a multiple case study. The literature review had two objectives: the first was to identify unique attributes of NTD elimination programs that should be considered when planning for sustainability and the second was to identify an existing sustainability framework that could be adapted to NTD elimination programs. The literature review resulted in a draft sustainability framework that was then tested, using a multicase study methodology, on the Kenya National Program for Elimination of Lymphatic Filariasis. The result is the first comprehensive NTD sustainability framework that identifies key contextual and programmatic factors that influence NTD sustainability. This framework is an invaluable resource for practitioners and policy makers alike as many countries start to eliminate NTDs

Utilization of digital tools to enhance COVID-19 and tuberculosis testing and linkage to care: A cross-sectional evaluation study among Bodaboda motorbike riders in the Nairobi Metropolis, Kenya.

Kenya has registered over 300,000 cases of COVID-19 and is a high-burden tuberculosis country. Tuberculosis diagnosis was significantly disrupted by the pandemic. Access to timely diagnosis, which is key to effective management of tuberculosis and COVID-19, can be expanded and made more efficient through integrated screening. Decentralized testing at community level further increases access, especially for underserved populations, and requires robust systems for data and process management. This study delivered integrated COVID-19 and tuberculosis testing to commercial motorbike (Bodaboda) riders, a population at increased risk of both diseases with limited access to services, in four counties: Nairobi, Kiambu, Machakos and Kajiado. Testing sheds were established where riders congregate, with demand creation carried out by the Bodaboda association. Integrated symptom screening for tuberculosis and COVID-19 was conducted through a digital questionnaire which automatically flagged participants who should be tested for either, or both, diseases. Rapid antigen-detecting tests (Ag-RDTs) for COVID-19 were conducted onsite, while sputum samples were collected and transported to laboratories for tuberculosis diagnosis. End-to-end patient data were captured using digital tools. 5663 participants enrolled in the study, 4946 of whom were tested for COVID-19. Ag-RDT positivity rate was 1% but fluctuated widely across counties in line with broader regional trends. Among a subset tested by PCR, positivity was greater in individuals flagged as high risk by the digital tool (8% compared with 4% overall). Of 355 participants tested for tuberculosis, 7 were positive, with the resulting prevalence rate higher than the national average. Over 40% of riders had elevated blood pressure or abnormal sugar levels. The digital tool successfully captured complete end-to-end data for 95% of all participants. This study revealed high rates of undetected disease among Bodaboda riders and demonstrated that integrated diagnosis can be delivered effectively in communities, with the support of digital tools, to maximize access