KNOWLEDGE, ATTITUDES AND INTENDING PRACTICES TOWARDS EXCLUSIVE BREASTFEEDING AMONG FEMALE UNDERGRADUATES: A CROSS-SECTIONAL CASE STUDY OF MILDMAY INSTITUTE OF HEALTH SCIENCES .

Background:   Breastfeeding is a basic human activity that is vital to a baby‟s growth and development. Excellent breastfeeding advice from health professionals can influence a mother‟s decision to initiate and maintain breastfeeding positively. The study was aimed at assessing the knowledge, attitudes, and intended practices toward exclusive breastfeeding among female undergraduates at the Mildmay Institute of Health Sciences. Method:   A mixed method cross-sectional study was performed among165full time undergraduate female students at MIHS, using convenience sampling by a structured self-administered questionnaire composed of 16 items to evaluate the students' knowledge, 18 items to assess attitudes towards exclusive breastfeeding, 12 items to assess the intending practices and socio-demographics characteristics questions. Results:  Overall, the majority (55%) of study participants had inadequate knowledge, 54.5%of the participants had positive attitudes, 44.4% were neutral and 0.6% of the respondents were less  positive towards breastfeeding, a statistically significant association (p=0.019) was found between the knowledge score and the score of intending practices.  Conclusions:   The conducted study illustrated inadequate knowledge, positive attitudes, and inappropriate intending practices toward exclusive breastfeeding among full-time female undergraduate students at the Mildmay Institute of health sciences. Recommendations:  Curricular changes aimed at promoting, supporting, protecting, and correcting the misconceptions about exclusive breastfeeding should be put in place across all levels of female undergraduates in health professions. Smart advocacy about exclusive breastfeeding should be carried out within the institute to improve the level of knowledge about exclusive breastfeeding

Effect of different organic substrates on reproductive biology, growth and offtake of the African night crawler earthworm (Eudrilus eugeniae)

Rapid growth and high fecundity of E. eugeniae makes it a commercial vermicomposting agent. The worm is also a rich protein source (50-70%CP) in livestock diets. The major question, however, is how do we promote earthworm production as a strategy for ecological livestock intensification and integration with crops through earthworm domestication as a source of protein and vermicompost. Reproduction characteristics, growth and offtake of E. eugeniae were studied using four organic substrates including abattoir waste (AW), cattle manure (CM), soya bean crop residue (SBCR) and a mixture of cattle manure and soya bean crop residue (CM+SBCR) aged for 15 days. Irrespective of the substrate, length and biomass of earthworms increased at a decreasing rate between the 1st and 8th weeks. Clitellum appearance was initiated at 31.5±2.4, 32.8±3.2, 33.7±3.3 and 35.5±2.4 days for AW, CM, CM+SBCR and SBCR, respectively, while cocoon initiation was at 69.0±1.4 (AW), 54.9±2.3 (CM), 51.7±1.7 (CM+SBCR) and 60.0±2.4 (SBCR) days. Organic substrate used affected reproductive biology, growth and offtake of E. eugeniae. Higher survivability, total earthworm biomass accumulation and offtake when cultured on CM and a binary combination of CM + SBCR is an indication that a strategy for sustainable crops-livestock integration can be sparked off by earthworm domestication. Earthworm domestication can be promoted using CM or a combination of (CM+SBCR) as substrate

ENTERAL NUTRITION AND BURN WOUND RECOVERY OF PAEDIATRIC PATIENTS: A CASE OF KIRUDDU NATIONAL REFERRAL HOSPITAL

Background:  The study aimed at finding the relationship between normal oral nutrition, use of liquid supplements, tube feeding and burn wound recovery of pediatric patients at Kiruddu National Referral Hospital. Methodology: A descriptive  cross-sectional study  design  conducted  among  caretakers  of pediatric  burn  patients  using  the  prospective  sampling  method.  Socio- demographic factors, medical history, dietary history, 24 hr. recall and biochemical analysis were assessed. Results: 45 caretakers of pediatric burn patients (mean age = 4.08) were studied. The patients sustained between 02-55% TBSA burns. Majority burns occurred for children aged between 0-5. With (71.1%) largest burns caused by scalds, (20%) flames and (8.9%) chemicals. Overall, 73.3% of pediatric patients placed on normal oral nutrition while 26.7% tube feeding. None of the pediatric patients under study received a liquid supplement. Data analysis of enteral nutrition feeding routes and nutrition outcomes was conducted using the chi square. The results showed that there is a significant and positive relationship between normal oral nutrition, tube feeding and white blood cells (p= 0.005), red blood cells (p= 0.001), hemoglobin (p= 0.000), platelets (p= 0.000), creatinine (p= 0.000), urea (p= 0.000), sodium (p= 0.000), potassium (p= 0.000), chloride (p= 0.000) and albumin (p= 0.002,). The blood cells, protein and biochemical parameters are indicative of wound healing. With linear regression the relationship between normal oral nutrition, tube feeding and albumin was found to be of no significance (p=0.553). Conclusions: The study illustrated a significant relationship between normal oral nutrition, burn wound recovery and a positive relationship between tube feeding and burn wound recovery of pediatric burn patients at Kiruddu National Referral Hospital. Recommendations: There is need to carry out a biochemical analysis test that includes transferrin, transthyretin, magnesium, zinc and copper as these tests can help in determining the nutrition status of the patients.    

Does biological relatedness affect child survival?

Objective: We studied child survival in Rakai, Uganda where many children are fostered out or orphaned. Methods: Biological relatedness is measured as the average of the Wright’s coefficients between each household member and the child. Instrumental variables for fostering include proportion of adult males in household, age and gender of household head. Control variables include SES, religion, polygyny, household size, child age, child birth size, and child HIV status. Results: Presence of both parents in the household increased the odds of survival by 28%. After controlling for the endogeneity of child placement decisions in a multivariate model we found that lower biological relatedness of a child was associated with statistically significant reductions in child survival. The effects of biological relatedness on child survival tend to be stronger for both HIV- and HIV+ children of HIV+ mothers. Conclusions: Reductions in the numbers of close relatives caring for children of HIV+ mothers reduce child survival.AIDS/HIV, child survival, fostering, orphans, Uganda

Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda:an intervention cohort study

Background: Perinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda. Methods: Pregnant women in the second and third trimester were consecutively screened using the Luganda version of the 9-item Patient Health Questionnaire (PHQ-9). Women who scored ≥5 on the PHQ-9 and who were confirmed to have depression by a midwife were recruited into a treatment cohort and offered a psychological intervention in a stepped care fashion. Women were assessed with PHQ-9 and WHODAS-2.0 at baseline and again at 3 and 6 months after the intervention. Negative regression analysis was done to examine change in PHQ-9 and WHODAS-2.0 scores from baseline to end line. Data were analysed using STATA version 14. Results: A total of 2652 pregnant women (98.3%) consented to participate in the study and 153 (5.8%) were diagnosed as depressed. Over a quarter (28.8%) reported having experienced physical interpersonal violence (IPV) while (25.5%) reported sexual IPV in the past year. A third (34.7%) of women diagnosed with depression received 4 or more group PST sessions. There was a mean reduction in PHQ-9 score of 5.13 (95%CI − 6.79 to − 3.47, p &lt; 0.001) and 7.13 (95%CI − 8.68 to − 5.59, p &lt; 0.001) at midline and endline, respectively. WHODAS scores reduced significantly by − 11.78 points (CI 17.64 to − 5.92, p &lt; 0.001) at midline and − 22.92 points (CI 17.64 to − 5.92, p &lt; 0.001) at endline. Clinical response was noted among 69.1% (95%CI 60.4–76.6%) and 93.7% (95%CI 87.8–96.8%) of respondents at midline and endline, respectively. Conclusion: An evidence based psychological intervention implemented in primary antenatal care by trained and supervised midwives in a real-world setting may lead to improved outcomes for women with perinatal depression. Future randomised studies are needed to confirm the efficacy of this intervention and possibility for scale up.</p

The experience of mental health service users in health system strengthening: lessons from Uganda.

BACKGROUND: Mental, neurological and substance use disorders are a public health burden in Uganda. Mental health service user involvement could be an important strategy for advocacy and improving service delivery, particularly as Uganda redoubles its efforts to integrate mental health into primary health care (PHC). However, little is known on the most effective way to involve service users in mental health system strengthening. METHODS: This was a qualitative key informant interview study. At national level, 4 interviews were conducted with national level health workers and 3 service user organization representatives. At the district level, 2 interviews were conducted with district level health workers and 5 service user organization representatives. Data were analyzed using content thematic analysis. FINDINGS: Overall, there was low mental service user participation in health system strengthening at both national and district levels. Health system strengthening activities included policy development, implementation of programs and research. Informants mentioned several barriers to service user involvement in mental health system strengthening. These were grouped into three categories: institutional, community and individual level factors. Institutional level barriers included: limited funding to form, train and develop mental health service user groups, institutional stigma and patronage by founder members of user organizations. Community level barriers included: abject poverty and community stigma. Individual level barriers included: low levels of awareness and presence of self-stigma. Informants also recommended some strategies to enhance service user involvement. CONCLUSION: The Uganda Ministry of Health should develop a strategy to improve service user participation in mental health system strengthening. This requires an appreciation of the importance of service users in improving service delivery. To address the barriers to service user involvement identified in this study requires concerted efforts by the Uganda Ministry of Health and the district health services, specifically with regard to attitudes of health workers, dealing with stigma at all levels, raising awareness about the rights of service users to participate in health systems strengthening activities, building capacity and financial empowerment of service user organizations

Development of a district mental healthcare plan in Uganda.

BACKGROUND: Evidence is needed for the integration of mental health into primary care advocated by the national health sector strategic investment plan in Uganda. AIMS: To describe the processes of developing a district mental healthcare plan (MHCP) in rural Uganda that facilitates integration of mental health into primary care. METHOD: Mixed methods using a situational analysis, qualitative studies, theory of change workshops and partial piloting of the plan at two levels informed the MHCP. RESULTS: A MHCP was developed with packages of care to facilitate integration at the organisational, facility and community levels of the district health system, including a specified human resource mix. The partial embedding period supports its practical application. Key barriers to scaling up the plan were identified. CONCLUSIONS: A real-world plan for the district was developed with involvement of stakeholders. Pilot testing demonstrated its feasibility and implications for future scaling up

An overview of Uganda's mental health care system: results from an assessment using the world health organization's assessment instrument for mental health systems (WHO-AIMS)

BACKGROUND: The Ugandan government recognizes mental health as a serious public health and development concern, and has of recent implemented a number of reforms aimed at strengthening the country's mental health system. The aim of this study was to provide a profile of the current mental health policy, legislation and services in Uganda. METHODS: A survey was conducted of public sector mental health policy and legislation, and service resources and utilisation in Uganda, in the year 2005, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2. RESULTS: Uganda's draft mental health policy encompasses many positive reforms, including decentralization and integration of mental health services into Primary Health Care (PHC). The mental health legislation is however outdated and offensive. Services are still significantly underfunded (with only 1% of the health expenditure going to mental health), and skewed towards urban areas. Per 100,000 population, there were 1.83 beds in mental hospitals, 1.4 beds in community based psychiatric inpatient units, and 0.42 beds in forensic facilities. The total personnel working in mental health facilities were 310 (1.13 per 100,000 population). Only 0.8% of the medical doctors and 4% of the nurses had specialized in psychiatry. CONCLUSION: Although there have been important developments in Uganda's mental health policy and services, there remains a number of shortcomings, especially in terms of resources and service delivery. There is an urgent need for more research on the current burden of mental disorders and the functioning of mental health programs and services in Uganda

Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs

Abstract Background Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda. Methods Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach. Results Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training. Conclusion This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries

"The Bottle Is My Wife": Exploring Reasons Why Men Drink Alcohol in Ugandan Fishing Communities.

Fishing communities in Uganda have high rates of excessive alcohol consumption and negative health outcomes related to alcohol consumption, such as HIV acquisition and transmission and intimate partner violence victimization and perpetration. Research lacks understanding of alcohol use in Ugandan fishing communities, underlying reasons for excessive drinking among fishermen or how their community perceives negative health outcomes linked to excessive alcohol consumption. This qualitative study was conducted among Ugandan fisherfolk to determine why excessive alcohol consumption has overtaken their communities. Through analyzing in-depth interviews and focus group discussions, reasons for drinking and community perceptions of drinking were explored using the Socio Ecological Model and the Time Perspective Theory. Interviews were coded into two content themes: social influences on drinking and using alcohol to cope with stress. Participants acknowledged links between excessive alcohol consumption and negative health outcomes within their families and communities. These findings highlight the need for alcohol-related reduction interventions that are sensitive to contextual factors and self-identified contributors to problematic alcohol use within individuals and their communities. Such interventions must consider the social, ecological and economic conditions within fishing sites, focusing not only on individual-level behavioral change but also challenging the underlying structures that foster excessive alcohol consumption