Equity in Access to Care: How about the Socially Vulnerable groups in Northern Uganda

Context: Primary Health Care in Uganda is provided through the Uganda National Minimum Health Care Package. UNMHCP aims to provide essential health care for all. Northern Uganda has been at war for twenty years. Setting: In 1995 Uganda created internally displaced people (IDP) camps to provide security for the population attacked by the rebel group Lord\u27s Resistance Army. Approximately two million people (85% women and children), live in 144 IDP camps. The difficult living conditions in IDP camps may have a direct effect on health. Objectives: 1) To determine whether UNMHCP meets IDPs health needs; and 2) To highlight ways how IDPs health needs can be addressed. Design: Two randomly selected camps were visited. Data were collected through direct observation, key informant discussions, and review of available IDP data. Findings: The findings were 1) Women and others in IDP camps face a multitude of social problems; 2) IDP camps have inadequate supplies of clean safe water and waste disposal systems; 3) Shelters are small, overcrowded huts; 4) The majority of the \u3e 1,000 Northern Uganda deaths per week occur outside a health facility; and 5) The IDP depend on the World Food Program for sustenance. Conclusions: UNMHCP does not fully meet the health needs of Northern Uganda\u27s socially vulnerable people. A more effective response requires ramping up services to address the magnitude of the social problems and unmet IDP health needs. Health professional training could empower health service providers to better address Uganda\u27s socially vulnerable groups

Situational analysis of teaching and learning of medicine and nursing students at Makerere University College of Health Sciences

<p>Abstract</p> <p>Background</p> <p>Makerere University College of Health Sciences (MakCHS) in Uganda is undergoing a major reform to become a more influential force in society. It is important that its medicine and nursing graduates are equipped to best address the priority health needs of the Ugandan population, as outlined in the government’s Health Sector Strategic Plan (HSSP). The assessment identifies critical gaps in the core competencies of the MakCHS medicine and nursing and ways to overcome them in order to achieve HSSP goals.</p> <p>Methods</p> <p>Documents from the Uganda Ministry of Health were reviewed, and medicine and nursing curricula were analyzed. Nineteen key informant interviews (KII) and seven focus group discussions (FGD) with stakeholders were conducted. The data were manually analyzed for emerging themes and sub-themes. The study team subsequently used the checklists to create matrices summarizing the findings from the KIIs, FGDs, and curricula analysis. Validation of findings was done by triangulating information from the different data collection methods.</p> <p>Results</p> <p>The core competencies that medicine and nursing students are expected to achieve by the end of their education were outlined for both programs. The curricula are in the process of reform towards competency-based education, and on the surface, are well aligned with the strategic needs of the country. But implementation is inadequate, and can be changed:</p> <p>• Learning objectives need to be more applicable to achieving competencies.</p> <p>• Learning experiences need to be more relevant for competencies and setting in which students will work after graduation (i.e. not just clinical care in a tertiary care facility).</p> <p>• Student evaluation needs to be better designed for assessing these competencies.</p> <p>Conclusion</p> <p>MakCHS has made a significant attempt to produce relevant, competent nursing and medicine graduates to meet the community needs. Ways to make them more effective though deliberate efforts to apply a competency-based education are possible.</p

An Observational Study of Umbilical Cord Clamping and Care Practices during Home Deliveries in Central Uganda

Delayed umbilical cord clamping and care practices have important implications for infant iron stores and neonatal survival. This is especially important in countries like Uganda, where there is a high prevalence of anemia in women and children coupled with a high newborn mortality rate. This study assesses cord clamping and care practices in home births in a coverage area of 12 health centers in 4 districts near Kampala, Uganda. We interviewed 147 women, most of who had at least primary school education and delivered their babies in the homes of traditional birth attendants. Only 65% of the persons conducting delivery washed hands, and most wore gloves. Most frequent cord ties were threads (86.7%), and glove rims (8.3%). Cords were cut with clean instruments in most (93.1%) deliveries. During cord clamping, newborn was positioned at a higher level than mother in 59%, delayed clamping (≥3mins) was reported in 52%. Combination of delayed clamping and positioning of newborn at mother’s level or lower was reported in only 19%. Substances used for cord care included surgical spirit (42.4%), local herbs (24.5%), powder (22.6%), ash (21.6%), saline water (10.3%), and tea (2.8%). Cord care instructions given most commonly were: cleaning with warm saline water (27%), spirit or antiseptics (25%), and herb application (7%). Awareness regarding cord infections was poor (20%). Mother’s education level, and age were not associated with cord clamping or care practices. Our study indicates scope for interventions to help improve hemoglobin levels in infancy. Education regarding cord care practices may reduce infections

The workplace as a learning environment: Perceptions and experiences of undergraduate medical students at a contemporary medical training university in Uganda

Background. One of the most effective ways of translating medical theory into clinical practice is through workplace learning, because practice is learnt by practising. Undergraduate medical students at Makerere University College of Health Sciences, Kampala, Uganda, have workplace rotations at Mulago National Referral and Teaching Hospital (MNRTH), Kampala, for the purpose of learning clinical medicine. Objectives. To explore undergraduate medical students’ perceptions and experiences regarding the suitability of MNRTH as a learning environment to produce competent health professionals who are ready to meet the demands of contemporary medical practice, research and training. Methods. This was a cross-sectional study with a mixed-methods approach. Students’ perceptions and experiences were assessed using the Dundee Ready Educational Environment Measure (DREEM), as well as focus group discussions (FGDs). Data from DREEM were analysed as frequencies and means of scores of perceptions of the learning environment. FGD data were analysed using thematic analysis. Results. The majority of students perceived the learning environment as having more positives than negatives. Among the positive aspects were unrestricted access to large numbers of patients and a wide case mix. Negative aspects included overcrowding due to too many students, and inadequate workplace affordances. Conclusions. The large numbers of patients, unrestricted access to patients and the wide case mix created authentic learning opportunities for students – they were exposed to a range of conditions that they are likely to encounter often once they qualify. The areas of concern identified in the study need to be addressed to optimise learning at the workplace for undergraduate medical students

Competency-based medical education in two Sub-Saharan African medical schools.

Background Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME). Institutional reviews This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes are highlighted. Both schools used similar processes in developing their CBME curricula, with early and significant stakeholder involvement. Competencies were determined taking into consideration each country’s health and education systems. Final competency domains were similar between the two schools. Both schools established medical education departments to support their new curricula. New teaching methodologies and assessment methods were needed to support CBME, requiring investments in faculty training. Both schools received external funding to support CBME development and implementation. Conclusion CBME has emerged as an important change in medical education in Sub-Saharan Africa with schools adopting it as an approach to transformative medical education. Makerere University and the University of Ibadan have successfully adopted CBME and show that CBME can be implemented even for the low-resourced countries in Africa, supported by external investments to address the human resources gap

Newborn Care Practices among Mother-Infant Dyads in Urban Uganda.

Background. Most information on newborn care practices in Uganda is from rural communities which may not be generalized to urban settings. Methods. A community based cross-sectional descriptive study was conducted in the capital city of Uganda from February to May 2012. Quantitative and qualitative data on the newborn care practices of eligible mothers were collected. Results. Over 99% of the mothers attended antenatal care at least once and the majority delivered in a health facility. Over 50% of the mothers applied various substances to the cord of their babies to quicken the healing. Although most of the mothers did not bathe their babies within the first 24 hours of birth, the majority had no knowledge of skin to skin care as a thermoprotective method. The practice of bathing babies in herbal medicine was common (65%). Most of the mothers breastfed exclusively (93.2%) but only 60.7% initiated breastfeeding within the first hour of life, while a significant number (29%) used prelacteal feeds. Conclusion. The inadequate newborn care practices in this urban community point to the need to intensify the promotion of universal coverage of the newborn care practices irrespective of rural or urban communities and irrespective of health care seeking indicators

Perceptions of orthopaedic medicine students and their supervisors about practice-based learning: an exploratory qualitative study

Background: Practice-based learning is crucial in forming appropriate strategies for improving learning among the medical students that support the country’s understaffed health sector. Unsatisfactory learning consequently results in poor performance of students and poor quality of health care workforce in the long run. Exploring the perceptions about the current practice-based learning system and how to improve is thus vital. This study set out to explore the perceptions of Orthopaedic medicine students and their supervisors about practice-based learning at a tertiary training hospital. Methods: This was an exploratory phenomenological qualitative study that involved in-depth interviews among 10 Orthopedic students during their rotation in the emergency ward of Mulago hospital and 6 of their supervisors. Interviews were audio-recorded, transcribed, and then imported into Atlas ti 8.3 for analysis. The data were coded and grouped into themes relating to perceptions of practice-based learning, general inductive analysis was used. The general inductive approach involved condensing the raw textual data into a brief and summary format. The summarized format was then analyzed to establish clear links between the perceptions of practice-based learning and the summary findings derived from the raw data. Results: The mean age of the students was 23±1.5 years. Four out of the six supervisors were Orthopaedic officers while the remaining two were principal Orthopaedic officers, four out of the six had a university degree while the other two were diploma holders. The main themes arising were hands-on skills, an unconducive learning environment, the best form of learning, and having an undefined training structure. Particularly, the perceptions included the presence of too many students on the wards during the rotation, frequent stock-outs of supplies for learning, and supervisors being overwhelmed caring for a large number of patients. Conclusion: Barriers to satisfactory practice-based learning were overcrowding on the wards and insufficient training materials. To improve practice-based learning, adequate learning materials are required and the number of students enrolled needs to be appropriate for the student – supervisor ratio

It is not always Tuberculosis! A case of pulmonary cryptococcosis in an immunocompetent child in Uganda

Pulmonary cryptococcosis is rare in immunocompetent individuals. Limited data exist regarding its occurrence in children, especially in developing countries. This case report describes an 8-year-old HIV-negative child with pulmonary cryptococcosis, previously diagnosed and treated for tuberculosis twice without improvement. Fine needle aspiration biopsy confirmed the diagnosis of pulmonary cryptococcosis and serum cryptococcal antigen test was positive. The child improved on amphotericin and fluconazole treatment. Despite the limited diagnostic capacity in many resource-constrained settings like Uganda, this case report highlights the need to investigate other causes of pneumonia in immunocompetent children that are not improving on conventional antimicrobial treatments

Standardizing assessment practices of undergraduate medical competencies across medical schools: challenges, opportunities and lessons learned from a consortium of medical schools in Uganda

Introduction:&nbsp;health professions education is gradually moving away from the more traditional approaches to new innovative ways of training aimed at producing professionals with the necessary competencies to address the community health needs. In response to these emerging trends, Medical Education for Equitable Services to All Ugandans (MESAU), a consortium of Ugandan medical schools developed key competencies desirable of graduates and successfully implemented Competency Based Education (CBE) for undergraduate medical students.&nbsp;Objectives:&nbsp;to examine the current situation and establish whether assessment methods of the competencies are standardized across MESAU schools as well as establish the challenges, opportunities and lessons learned from the MESAU consortium. Methods:&nbsp;it was a cross-sectional descriptive study involving faculty of the medical schools in Uganda. Data was collected using focus group discussions and document reviews. Findings were presented in form of themes. Results:&nbsp;although the MESAU schools have implemented the developed competencies within their curricular, the assessment methods are still not standardized with each institution having its own assessment procedures. Lack of knowledge and skills regarding assessment of the competencies was evident amongst the faculty. The fear for change amongst lecturers was also noted as a major challenge. However, the institutional collaboration created while developing competencies was identified as key strength. Conclusion:&nbsp;findings demonstrated that despite having common competencies, there is no standardized assessment blue print applicable to all MESAU schools. Continued collaboration and faculty development in assessment is strongly recommended

Near-peer mentorship for undergraduate training in Ugandan medical schools: views of undergraduate students

Introduction: Masters Students are major stakeholders in undergraduate medical education but their contribution has not been documented in Uganda. The aim of the study was to explore and document views and experiences of undergraduate students regarding the role of masters students as educators in four Ugandan medical schools. Methods: This was a cross-sectional descriptive study using qualitative data collection methods. Eight Focus Group Discussions were conducted among eighty one selected preclinical and clinical students in the consortium of four Ugandan medical schools: Mbarara University of Science and Technology, Makerere College of Health Sciences, Gulu University and Kampala International University, Western Campus. Data analysis was done using thematic analysis. Participants' privacy and confidentiality were respected and participant identifiers were not included in data analysis. Results: Undergraduate students from all the medical schools viewed the involvement of master's students as very important. Frequent contact between masters and undergraduate students was reported as an important factor in undergraduate students' motivation and learning. Despite the useful contribution, master' students face numerous challenges like heavy workload and conflicting priorities. Conclusion: According to undergraduate students in Ugandan medical schools, involvement of master's students in the teaching and learning of undergraduate students is both useful and challenging to masters and undergraduate students. Masters students provide peer mentorship to the undergraduate students. The senior educators are still needed to do their work and also to support the master's students in their teaching role.Pan African Medical Journal 2016; 2