College of Health Sciences (CHS)

Permanent URI for this community

http://10.29.1.53:4000/handle/10570/2

Browse

Browsing College of Health Sciences (CHS) by Title

  • Item
    The 14-day incidence and risk factors of gastrointestinal anastomotic leak among adult patients in Mulago Hospital, a prospective cohort study
    (Makerere University, 2025) Omare, Isaac
    Background: Anastomotic leak is one of the most feared complications following gastrointestinal (GI) anastomotic surgery. It increases morbidity and mortality of patients undergoing GI surgery. Globally, the frequency of anastomotic leak varies depending upon the tissue that is being anastomosed. Higher incidences of anastomotic leak up to 36.5% have been reported in Low- and Middle-income countries compared to the lower rates of less than 10% in Higher income countries for small and large bowel anastomoses. Despite the burden, the incidence and risk factors of anastomotic leak following gastrointestinal surgery are not well defined in Uganda. Objective: We aimed to determine the incidence and risk factors of anastomotic leak following gastrointestinal surgery at Mulago National Referral Hospital (MNRH). Methods: In this prospective cohort study, we recruited 85 adult patients admitted to the general surgery wards of MNRH 24 hours following gastrointestinal surgery. Independent variables including preoperative anemia, preoperative albumin level, and ASA status were recorded on entry, while the dependent variable (anastomotic leak) was obtained upon 14 day’s follow- up. Data was analysed using SPSS version 26. Multivariate logistic regression was used to determine the independent risk factors for anastomotic leak, p< 0.05 was considered statistically significant. Results: Out of the 85 participants recruited, 7 (8.2%) developed anastomotic leak during the 14 day follow up. Hemoglobin level less than 10 g/dl (RR, 8.15; 95% C.I, 1.16 - 57.48; p=0.035) was identified as independent risk factor for anastomotic leak after multivariate logistic regression adjusted for confounders. Conclusion: The incidence of anastomotic leak in Mulago National Referral Hospital was low, (8.2%). Low Hb (Hb<10g/dl) was the only statistically significant predictor variable of gastrointestinal anastomotic leak in this study.
  • Item
    30 day in-hospital patient mortality after ICU discharge and associated factors : a retrospective cohort study in selected tertiary hospitals in Kampala
    (Makerere University, 2021-01-25) Nantongo, Betty
    Background: Intensive care medicine is rapidly growing because critical illness is a major component of the global burden of disease especially in LMICs. We retrospectively evaluated the 30 day In-hospital patient mortality after ICU discharge and associated factors. Methods: We conducted a retrospective multicentre Cohort study on all patients that were discharged alive from the ICU at three tertiary hospitals in Kampala- Uganda, patient records discharged between January 2018 to December 2019 were reviewed during their hospital stay to fill the data extraction tool and followed up. In-hospital mortality after ICU discharge as primary outcome. Results: In total 711 patients were included with mean age of 42 years and 56.4% were male. A total of 106/711 patients died after ICU discharge giving a mortality of 14.9% (95% CI: 12.4-17.7). Most (86/711) patients died within the first 20 days with a 0.802 survival probability and were mostly above 40 years. The median number of hospital stay after ICU discharge 7 days (IQR: 5-11). Multivariate analysis identified presence of comorbidities, Respiratory disorder at ICU admission and GIT disorder at ICU admission and inotropic/vasopressor support to be associated with patient mortality after ICU discharge while Tracheostomy placement was found to be protective. Conclusion: The 30-day in hospital patient mortality rate after ICU discharge was high compared to that in high income countries. Most in-hospital patient deaths after ICU discharge occurred during the first 20 days. A prospective study is needed to further explore In-hospital patient mortality after ICU discharge and associated factors.
  • Item
    Abdominal sonographic changes among HIV-TB co-infected adult patients initiating highly active antiretroviral therapy at Mulago Hospital Complex.
    (Makerere University, 2014) Jabo, Christian Roy Thomas
    Human immunodeficiency virus (HIV) infection increases the risk for infection with Mycobacterium tuberculosis (TB). In HIV-TB co-infected patients, abdominal tuberculosis accounts for 11-16% of extra pulmonary cases. Abdominal sonographic changes following initiation of Highly Active Antiretroviral Therapy (HAART) in these patients may be due to the response to anti-Tuberculous drugs and HAART, due to adverse reactions to these treatments or due to other associated co-morbidities. The changes may show improvement of abdominal features during treatment or worsening as a result of paradoxical TB-IRIS. They may also be new findings due to other opportunistic infections. Ultrasound imaging is a useful auxiliary investigative modality in the management of HIV-TB co-infected patients initiating HAART and it can demonstrate these abdominal sonographic changes. However, there is no recent research on its role in the management of HIV-TB co-infection in Uganda. Objective The study aimed at describing the abdominal sonographic findings among HIV-TB co-infected adult patients initiating HAART at Mulago Hospital Complex. Methodology A prospective descriptive study design was used. This study was nested in a prospective observational cohort study whose aim was to determine the incidence and predictors of clinical and immunological outcomes in adult patients co-infected with TB-HIV. It was conducted in the Department of Radiology at Mulago Hospital, the national referral hospital. Adults with HIV-TB co infection eligible for HAART were enrolled in the study. Serial abdominal ultrasound scans using low frequency (2-5MHZ) and high frequency probes (7-12MHZ) were performed. Data were collected on structured questionnaires, entered into a computer using Epi data version 3.1 and analysed using Stata version 11 with the help of a statistician. Results Eighty nine patients were enrolled and had a baseline ultrasound scan, 70 (78.7%) patients had a scheduled follow up scan and 10 (11.2%) had an ultrasound scan during an unscheduled visit. 9 patients (10.1%) were lost to follow up of whom 6 patients died (66.7%) while 3 (33.3%) did not return for the scheduled scan. 65.2% were males and 34.8 % were females giving a male to female ratio of 1.9:1. The age range was from 20-62 years and the median age was 32 years. There was no statistically significant difference in the abdominal sonographic findings at base line and 4 weeks after initiating HAART. Clinical features of abdominal pain and abdominal distention were significantly associated with development of abdominal sonographic changes while abdominal pain was the only symptom significantly associated with worsening of the abdominal sonographic changes (a OR=6.0, 95% CI=1.106-13.552 and a p value=0.038) on follow up or on development of symptoms of TB-IRIS. Fourteen patients had normal abdominal scans while 75 had features suggestive of abdominal TB on baseline scan like lymphadenopathy, hepatosplenomegaly and splenic nodules. Fourteen patients had features suggestive of TB-IRIS on the follow up and unscheduled scans. Co-morbidities like nephropathy, splenic candidiasis and carvenous hemangiomas were diagnosed. Sonographic changes observed in the abdomen were resolution of splenic infarction, regression of splenic abscesses, appendicitis, prostatic abscess, ascites, lymphadenopathy, cholecystitis, splenomegaly and hepatomegaly. Conclusions There is an increased incidence of HIV-TB co-infected patients with sonographic features which may be suggestive of abdominal tuberculosis at baseline scan. Worsening abdominal sonographic changes within 4 weeks of initiating HAART tend to be associated with paradoxical TB-IRIS. Abdominal pain and distention are associated with development of abdominal sonographic changes. Abdominal pain is significantly associated with worsening of abdominal sonographic features on follow up visits. There is no statistically significant difference between abdominal sonographic features at baseline and follow up 4 weeks after initiating HAART. Recommendations A study designed to establish the clinico-sonographic-pathological correlation and the schedule for follow up scans is highly recommended. Follow up abdominal sonography should be delayed beyond 4 weeks unless patients develop new symptoms or worsened symptoms. A screening ultrasound examination for TB-IRIS should be performed in all HIV-TB co-infected on treatment who develop abdominal pain.
  • Item
    The abdominal sonographic features of burkitt's lymphoma in patients seen at Uganda Cancer Institute, Mulago Hospital, Kampala
    ( 2009-10) Kwitonda, Pascal
    INTRODUCTION: Burkitt lymohoma is a B-cell lymphoma presenting in three main clinical variants: the endemic, the sporadic and the immunodeficiency-associated variants. In Uganda, Burkitt’s lymphoma represents 50-70% of childhood cancers presenting mainly as facial tumour. Diagnosis depends on tissue examination. Imaging provides very useful diagnostic and staging information. Characteristically abdominal BL sonographically presents as well defined solid hypoechoic mass with mass effect; they lack calcifications and are a vascular on colour Doppler study. Ultrasound therefore plays an important auxiliary role in early detection and diagnosis of this potentially curable tumour and can be used to predict the prognosis. OBJECTIVES: The major objective of the study was to describe the sonographic features of BL and to relate them with the clinical features and laboratory findings in order to determine the prognostic benefit of abdominal ultrasound in patients with BL at the UCI-Mulago hospital. METHODOLOGY: This case series was conducted In UCI and Department of Radiology-Mulago hospital from march 2009 to September 2009. Sixty (60) patients with confirmed BL had abdominal ultrasonography done before initiation of chemotherapy and at one month after initiation of chemotherapy. RESULTS: Sixty (60) patients participated in the study. The age range was 3-18 years with a mean of 7.2 and standard deviation of 2.98. The peak incidence was between 5-9 years. There were 43 (71.7%) males and 17(28.3%) females. Facial bone tumours remained the commonest clinical finding however, the commonest single presenting compalit was palpable abdominal mass with pain in 31(51.7%) patients. Abdominal ultrasound showed that 40 (66.7%) of all patients had intra abdominal masses. Forty four (73.3%) patients had the tumours involving other parts of the body. Mpst patients presented with stage D disease and therefore had poor prognosis. The commonest ultrasound findings were multiple lobulated heterogeneous hypoechoic abdominal masses in 40 (66.7%) patients. Of these masses 20(33.3%) were in the kidneys. Follow-up abdominal ultrasound showed that 32(80%) patients had tumour regression after one month of induction. CONCLUSION: • Abdominal ultrasound was able to demonstrate greater disease extent than clinical evaluation, thus highlighting the value of imaging in tumour staging and follow-up of patients. • This study showed more cases of abdominal BL involvement than previously seen in our patients, possibly due to better imaging facilities now. • Burkitt’s lymphoma should be strongly suspected in a child presenting with large lobulated hypoechoic intra-abdominal mass and histological diagnosis must be established as soon as possible. • Serum LDH levels were very high in patients with large and multiple tumour sites involvement but decreased as the tumour mass regressed. RECOMMENDATIONS: • Follow up abdominal ultrasound should be done after one month of treatment in order to assess early response to chemotherapy. • A bigger study should be done to comprehensively assess the role of ultrasound and serum LDH levels in follow up and determination of prognosis in BL patients.
  • Item
    The academic alliance for AIDS care and prevention in Africa
    (The Johns Hopkins University AIDS Service, 2001-11) Quinn, Thomas C.
    In the continent of Africa, AIDS is the leading cause of death, responsible for over 20% of all fatalities. To date, over 16 million people in Africa have died from AIDS, and approximately 26 million or 70% of the world’s total of HIV infected people reside in sub-Saharan Africa. Howe ve r, little or no treatment, either for HIV infection itself or for its complications, is available to HIV infected Africans. This inequity in care between Africa and western countries has been attributed to lack of infrastructure, poverty, lack of financial support from developed countries, insufficient health care delivery systems, lack of knowledge by African physicians on the use of these drugs, insufficient laboratory support,political inaction, and many other factors. Although increasing attention has been focused on the problem, particularly in the lay press, and although pharmaceutical companies have reduced the cost of their drugs, most Africans still cannot afford these medicines, and little has been done to bring good clinical care to the millions of HIV infected Africans. To address this problem, a new organization was formed in June 2001 called "The Academic Alliance for AIDS Care and Prevention in Africa," led by a group of Ugandan physicians from Makerere University and the Infectious Diseases Society of America with HIV/AIDS care experts from North America.
  • Item
    Acceptability and perceptions of contraceptives among young HIV positive women in KCCA Art Clinics
    ( 2019-09) Muzeyi, Wani
    Introduction There are about 7000 new HIV infections among young women in Sub Saharan Africa. Forty- three percent of pregnancies among young HIV positive women in Uganda are either unwanted or mistimed and this accounts for 21.3% of neonatal HIV infections. The prevention of unwanted pregnancy among young HIV positive women through the use of effective modern contraceptives is a key component of the WHO’s four-pronged HIV prevention and control strategy. Study objective. To determine the acceptability of contraceptives, its associated factors and perceptions of contraceptives among young HIV positive women in KCCA ART Clinics. Methods We conducted a convergent parallel mixed-methods study from February to May 2019 among 450 participants in three Public Kampala city HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III). For quantitative data, participants were systematically recruited into the study and were interviewed using a structured questionnaire. Data was analysed using STATA 13. Acceptability of contraceptives was measured by the proportion of participants that reported contraceptives to be very acceptable or acceptable. Prevalence ratios were determined using modified Poisson regression reporting clustered robust standard errors with a 95% confidence interval (CI) and P values. For qualitative data, six to eight participants were purposively selected from each facility for in-depth interviews. A total of 20 in-depth interviews were conducted from the three facilities. Thematic analysis was used to describe the data. Results The acceptability of contraceptives among young HIV positive women was low at 40.4 %( 95% CI: 26.0-54.9). Age greater than19 years (PR; 6.88, 95%CI; 1.09-46.91, P =0.04), having a friend who uses contraceptive (PR; 1.89, 95CI; 1.12-3.19; P=0.018) and being divorced/separated (PR; 1.31, 95%CI; 1.03-1.67, P=0,027) were found to be significantly associated with acceptability of contraceptives. Regarding perceptions themes that emerged misconceptions on contraceptive use, lived experiences and perceived negative interaction between ARVs and contraceptive. Conclusion Acceptability of contraceptives among young HIV positive in KCCA ART clinics was low and this could have been due to perceptions young women have about contraceptive usage. Young HIV positive women should be given more information on the safety of contraceptives use.
  • Item
    Acceptability and satisfaction of male partners with antenatal clinic-based HIV testing for PMTCT at Old-Mulago Hospital, Uganda
    (Makerere University, 2010-12) Drasiku, Amos
    Introduction: Despite benefits of and strategies to increase male partner participation in AHCT at Old-Mulago ANC, their attendance has remained very low (15.8% tested). It is not clear whether they accept AHCT and how satisfied those who have undergone it are. Methodology: A cross-sectional study of 214 male partners of antenatal mothers at Old- Mulago ANC selected by simple random sampling was done. Quantitative data was collected using semi-structured interviewer administered questionnaires. Multivariable logistic regression analysis were performed in Stata 10SE to obtain Odds ratios of satisfaction and their 95% CI so as to identify factors which influence satisfaction with AHCT services. Qualitative data was obtained through four FGDs and analyzed by thematic content analysis method. Results: AHCT acceptance was 99.8%, most respondents (81%) were satisfied with their overall AHCT experience and 71% were satisfied with service setting. FGD participants reported that AHCT for male partners is good but some men do not want to be tested together with their wives. The FGD participants too reported satisfaction with AHCT services. Factors with statistically significant association towards overall satisfaction were cleanliness/hygiene (AOR 2.53, 95% CI 1.12-5.70) and service duration (AOR 13.05, 95% CI 2.97-57.44). Conclusion/Recommendation: Men who escort their wives to the antenatal clinic tend to accept AHCT and tend to be satisfied with the testing experience. However, service duration should be reduced by minimizing delays and commencing work early. More staffs should be allocated to the antenatal clinic especially for antenatal examinations and laboratory.
  • Item
    ACCEPTABILITY AND WILLINGNESS TO PAY FOR UGANDA’S PROPOSED NATIONAL HEALTH INSURANCE SCHEME AMONG INFORMAL SECTOR WORKERS IN IGANGA AND MAYUGE DISTRICTS
    (Makerere University, 2019) Namuhani, Noel
    Introduction: Access to health care remains a challenge especially among the informal sector in most of the low-income countries due to out of pocket (OOP) expenditures, with Uganda spending over 40.0% out of pocket on health care. To solve this, Uganda has proposed a National health insurance scheme (NHI). However, the acceptability, willingness and ability to pay for the proposed NHI scheme within the informal sector has not been explored. Objective: To assess the willingness to pay for the proposed NHI scheme and its determinants among the informal sector workers in Iganga and Mayuge districts Methodology: This was a cross sectional study. It was conducted in Iganga and Mayuge districts in June 2019. A contingent valuation method using the bidding game technique was used to elicit the willingness to pay. A total of 853/781,948 informal sector workers were randomly selected to participate in the study. Six key informant interviews with health workers and 7 FGDs with informal sector workers were also conducted. Logistic regression was done to identify the determinants for willingness to pay for the proposed NHI scheme. Results: The majority (85.2%) of the respondents would accept the proposed scheme. Most respondents (81.5%) were willing to pay for NHI, the median WTP was UGX 25,000 (USD 6.8) and 74.2% of the respondents believed that they were able to pay for health insurance. The factors that were significantly associated with WTP included; Occupation. Wealth, hearing about health insurance, use of traditional medicine and having saving group membership. Conclusion and Recommendation: The level of acceptability and willingness to pay was high. Therefore, it is viable for MOH to introduce and extend NHI to the informal sector but with affordable premiums while ensuring that the quality of services is enhanced.
  • Item
    Acceptability of cervical cancer screening using visual inspection with acetic acid and lugol's iodine among women attending the family planning clinic in mulago hospital.
    ( 2008-05) Busingye, Priscilla
    BACKGROUND: Cervical cancer is the commonest malignancy among women in Uganda. Over 80% of patients diagnosed with cervical cancer in Mulago hospital present with advanced disease. Cytology based screening services are not feasible for low resource settings like Uganda. It is proposed that visual inspection with acetic acid and Lugol’s iodine is an alternative method to cytology. There are already programs going on with VIA/VILI but since they are new methods we need to know the acceptability of cervical cancer screening using these methods in Ugandan women. OBJECTIVES: The main objective of the study was to determine acceptability of cervical cancer screening using VIA/VILI among women attending the family planning clinics at mulago hospital. METHODS: It was a cross-sectional study with both quantitative and qualitative approaches. A total of 384 participants were recruited in the study RESULTS: Participants who accepted cervical cancer screening using VIA/VILI were 229. Of these, 209 that is, 91.3% were willing to recommend others for the same service while 223 participants that is 98.7% would return for the same screening if the need arose. 155 participants out of 384 did not accept screening. The reasons for refusal included; fear of undressing, fear of the speculum and fear of results. Findings were similar in the FGD. CONCLUSIONS: Acceptability of cervical cancer screening using VIA/VILI was found to be very high among women attending family planning in Mulago hospital. Some women refuse screening because of fear of instruments, undressing and fear of knowing that they might have cancer.
  • Item
    Acceptability of healthy lifestyle recommendations for blood pressure reduction, and its associated factors, among hypertensive people living with HIV in a tertiary HIV clinic in Kampala, Uganda
    (Makerere University, 2023-11) Nalugga, Esther Alice
    Introduction: Hypertension is a significant public health problem with a prevalence ranging between 11% and 29% among people living with HIV (PLWH) in Uganda. Healthy lifestyle recommendations are essential in the prevention and management of hypertension, although determinants of their uptake may differ by regional/cultural context. I aimed to assess the acceptability of healthy lifestyle recommendations for blood pressure reduction among PLWH and hypertension at the Infectious Diseases Institute (IDI), Kampala Uganda, guided by the health belief model (HBM). Methods: A facility-based cross-sectional study was conducted among PLWH aged ≥ 18 years with hypertension receiving care at IDI. I collected data on socio-demographics, clinical history and patients’ ratings on the HBM. Healthy lifestyle recommendations assessed included dietary intake, physical activity, alcohol reduction and smoking cessation. Summary statistics were used to describe the data while logistic regression was used to determine the factors associated with acceptability of the interventions. Results: The study enrolled 427 participants with a mean age of 53 years (SD± 9.4), 57% of them females and 26% obese. Overall, 26.5% of the participants had good knowledge on healthy lifestyle recommendations, 86.9% considered healthy lifestyle recommendations acceptable while 24.4% engaged in healthy lifestyle practices. Urban residents [AOR: 0.35, 95% CI (0.14-0.90)] and participants with high self-efficacy [AOR: 162, 95% CI (37.1-704.4)] were significantly associated with acceptability. Conclusion: This study showed that acceptability of healthy lifestyle recommendations was high, however, knowledge and healthy lifestyle recommendations were low among PLWH and hypertension. Behaviour change programs, including intensive health education, targeting PLWH should be advocated for and integrated into routine HIV care to manage hypertension among PLWH in Uganda.
  • Item
    Acceptability of integration of cervical cancer screening into routine HIV care, associated factors and perceptions among HIV-infected women: a mixed methods study at Mbarara regional referral hospital
    (Makerere University, 2021-05-07) Ninsiima, Mackline
    Background: Integrating Cervical Cancer Screening (CCS) into routine HIV care has been endorsed as an effective strategy for increasing uptake of CCS, and facilitating early detection and treatment of pre-cancerous lesions among HIV-infected women in Sub Saharan Africa. In Uganda, this strategy has not been implemented yet in most HIV clinics. Assessing the acceptability of this intervention among HIV-infected women is of great relevance to inform its implementation. Objective: To assess the acceptability of integration of Cervical Cancer Screening (CCS) into routine HIV care, associated factors and perceptions among HIV-infected women enrolled in the Immune Suppression Syndrome clinic at Mbarara Regional Referral Hospital (MRRH). Methodology: A mixed methods study utilizing the explanatory sequential approach was conducted among 327 eligible HIV-infected women. Acceptability of integration of CCS into routine HIV care was measured using the Theoretical Framework of acceptability (TFA). A pre-tested questionnaire was used to collect quantitative data. Focus group discussions to explore perceptions regarding the intervention were conducted among purposively selected HIV-infected women. Descriptive analyses for all categorical dependent and independent variables were done. Modified poisson regression with robust variance analysis was utilized to determine factors associated with the acceptability of the intervention. Statistical significance was determined at p-value <0.05. The analysis was performed using STATA Version 14.0. Thematic analysis utilizing inductive coding was used to analyze qualitative data in Atlas.ti 6.0. Results: Majority of the HIV-infected women (64.5%) accepted the integration of CCS into routine HIV care. Religion, perceived risk of developing CC and ever screened for CC were statistically significantly associated with the acceptability of integration of CCS into routine HIV care. Perceived benefits of the proposed intervention were: convenience to seek for CCS, motivation to undergo CCS, improved archiving of CCS results, the confidentiality of HIV patient information, and preference to interact with ISS clinic health workers. Shame to expose their privacy to the ISS clinic health workers and increased waiting time were the only perceived challenges of the integration of CCS into routine HIV care. Conclusion: Study findings highlight the need to take advantage of this acceptability to prioritize implementation of the integration of CCS into routine HIV care, conduct intensified health education and awareness about the increased risk of developing CC among HIV-infected women. HIV-infected women should be reassured of confidentiality and reduced waiting time to increase the uptake of the integrated CCS and HIV services among HIV-infected women along the continuum of HIV care and treatment services.
  • Item
    Acceptability of male infant medical circumcision as an HIV prevention strategy among patients attending a Health Centre IV in Kampala District
    (Makerere University, 2011) Nsereko, Mary N.
    Background: Medical Male Circumcision (MMC) has been shown to reduce the risk of HIV infection by 50-60%. UNAIDS has recommended that MMC be integrated into prevention strategies in countries of high prevalence. Circumcision in infancy has the added advantages of being easier to perform and cheaper through faster healing and less complications. Objectives: The general objective was to establish the factors that influence acceptability of Male Infant Medical Circumcision (MIMC) as an HIV prevention strategy. The specific objectives were to determine knowledge of Male Medical Circumcision (MMC) and identify factors influencing acceptability of MIMC. Methods: A descriptive cross sectional design was used. Participants were selected randomly from people attending a health centre. Data from consenting adults aged 18 years and above was collected using interviewer administered questionnaires. Bivariate analysis to determine factors associated with acceptability and logistic regression was done to remove confounders. Odds ratios (ORs), 95% confidence intervals and p values are reported. Results: A total of 323 participants were interviewed. The mean age was 28.6 with a SD of 9 years. One hundred ninety three of them had 1 or more male children. At bivariate analysis, positive associations with acceptability were prior knowledge of Male Medical Circumcision (MMC) and a belief that MMC improved personal hygiene and prevented STDS/HIV. More than 80% of the respondents preferred circumcision in infancy because of a belief that it healed faster. Significant predictors of acceptability at multivariate analysis were found with being female (AOR 3.36; 95%CI 1.14-9.8), having knowledge about the preventive effect of MMC (AOR 5.61 95%CI 1.17-26.92), perceived family approval for MMC (AOR 23.59; 95%CI 6.43-86.50), and if the service were to be provided safely at affordable prices (AOR 3.27 95%CI1.17-917). Conclusion: MIMC appears to be highly acceptable in Kampala. The option for safe and affordable MIMC should be made available to all parents.
  • Item
    Acceptability of masking and patient separation to control nosocomial Tuberculosis in Uganda: a qualitative study
    (J Public Health, 2011) Buregyeya, Esther ; Mitchell, Ellen M. H. ; Rutebemberwa, Elizeus ; Colebunders, Robert ; Criel, Bart ; Kiguli, Juliet ; Nuwaha, Fred
    Objectives: This study explored the acceptability of cough etiquette, wearing masks and separation by tuberculosis (TB) suspects and TB patients in two districts in Uganda. Design: The study was conducted in Mukono and Wakiso districts in central Uganda. Eighteen in-depth interviews with patients and eight focus group discussions with health workers were conducted. Patients were asked for their opinions on cough etiquette, patient separation and wearing of masks. Results: Patients and health workers felt that physical separation was ideal, yet separation and masking were regarded as embarrassing to patients, emphasizing their potential infectiousness. Patients reported greater willingness to cover their mouth with a handkerchief than to wear a mask. Good counseling and health education were suggested to improve patients’ adoption of separation and masking. However patients expressed concerns about equity, coercive and stigmatizing approaches. Universal precautions were more acceptable than targeted ones, with the exception of separating TB patients. Lack of community awareness about airborne transmission of TB was identified as a barrier to accepting and adopting TB infection control measures. Conclusion: Scaling up effective TB infection control norms and behaviors requires a patient-centered, rights-based, and evidence-based approach. Socially acceptable measures like covering the mouth and nose with a handkerchief should be promoted. We recommend that further studies are needed to explore how community advocacy impacts on acceptability of masking. Furthermore, the efficacy of covering the mouth using a handkerchief or piece of cloth compared to wearing a mask in TB prevention needs to be evaluated.
  • Item
    Acceptability of modified directly observed therapy for Antiretroviral Therapy (ART) and associated factors among HIV patients in Arua Hospital
    (Makerere University, 2010-10) Afayo, Robert
    Introduction: Combination ART has led to dramatic reductions in morbidity and mortality among patients with HIV/AIDS in Uganda. Successful treatment with ART requires the patient to maintain consistent adherence to the prescribed regimen on a long term basis. However, only 68% of the Ugandan urban patients interviewed reported an adherence rate of 95% to HAART. Modified directly observed therapy for ART has been suggested as an intervention for non-adherence. This study has shed light on acceptability of modified DOT and associated factors before its adoption. Objective: To assess acceptability of modified DOT-ART and associated factors among HIV-infected patients attending Arua hospital HIV clinic in 2010 Methods: Cross–sectional design using both qualitative and quantitative methods was conducted between February and March, 2010 among HIV-infected patients attending Arua hospital. Data were collected on acceptability of a modified DOT-ART, preference of different forms of modified DOT-ART, and associated factors. The proportion of patients who were willing to accept modified DOT-ART and proportion of patients who preferred different forms modified DOT-ART were determined. Using bivariate and multivariate analysis, factors associated with acceptability of modified DOT-ART were assessed. Statistical significance was determined using 95% confidence Interval and p-value (<0.05) of Odds Ratios as the measure of effect. Qualitative data was analyzed into themes. Results: A total of 358 participants were enrolled. Of these, 55.9% (200/358) were willing to accept modified DOT. The proportion of patients on ART who accepted modified DOT was 61.5% (110/179) and those not on ART was 50.3% (90/179). The majority, (58.5%, 117/200) of participants preferred home/family-based DOT among different forms of modified DOT-ART. Male patients (OR= 0.463, 95%CI= 0.68-0.799, P= 0.006), married patients (OR= 0.354, 95%CI= 0.129-0.973, P= 0.044), patients with low social support (OR= 0.616, 95%CI= 0.384-0.990, P= 0.045), and patients not receiving co-trimoxazole prophylaxis (OR=0.324, 95%CI= 0.151-0.696, P=0.004), were less likely to accept modified DOT for ART. While patients on ART (OR= 2.431, 95%CI= 1.357-4.353, P=0.003) and those who never ever missed ARV dose (OR= 2.192, 95%CI= 1.134-4.234, P=0.020) were more likely to accept modified DOT-ART. Conclusion: The study showed that over half of the participants were willing to accept modified DOT- ART. Home/Family-based approach was the most preferred form of modified DOT-ART. Acceptability of modified DOT was higher among patients on ART compared to those not on ART. Non-acceptance of modified DOT-ART was more common particularly among the males, the married; patients with low social support, non-adherent patients and patients not taking co-trimoxazole prophylaxis. Recommendations: There is need to further explore into the acceptability and feasibility of modified DOT to other populations before MOH can consider the use of mDOT as a strategy to strengthen adherence to ART particularly to highly non-adherent patients. As MOH considers use of mDOT, education of patients on what mDOT-ART entails will be key to the success of this program.
  • Item
    Acceptability of SMS reminders as an HIV PREP adherence support tool and associated factors among adolescent girls and young women in Mukono District
    (Makerere University, 2022-12) Muteebwa, Laban
    Background: Young Women in Uganda contributed 29% of new HIV infections despite representing only 10% of the total population and are priority beneficiaries of PrEP, yet they have been found to have low adherence. SMS reminders have been found to improve adherence to PrEP in AGYW. There is paucity of literature about their acceptability among AGYW in Mukono district. Objective: To estimate the level of acceptability, the associated factors and explore the perceptions toward use of SMS reminders as a PrEP adherence support tool and among AGYW in Mukono district. Methods: This parallel convergent mixed-methods study enrolled 142 AGYW using PrEP. A structured questionnaire and In-depth interview guide were used to collect quantitative and qualitative data respectively. Quantitative data were analyzed in STATA 17.0 Continuous variables were summarized using median (IQR) and factors associated with acceptability of SMS reminders were analyzed using a modified Poisson regression. Qualitative data were analyzed by inductive thematic analysis in open code version 4.03. Results: The acceptability of SMS reminders was 90.9% (95% CI (84.9, 95.0)). Being from rural residence and not believing that SMS can breach individual’s privacy were significantly associated with acceptability of SMS reminders with adjusted prevalence ratios of 0.92 (95% CI (0.84, 0.99)) and 1.4 (95% CI (1.07, 1.84)) respectively. AGYW perceived that SMS reminders are highly acceptable to support adherence. However, they felt that the success of this intervention hinges on whether it ensures confidentiality about their PrEP use. Conclusions: SMS reminders are highly acceptable to AGYW provided they ensure confidentiality is maintained however, AGYW living in rural areas may need additional support to use this intervention.
  • Item
    Acceptability of TeleMental Health and its influencing factors among adolescent patients, caretakers, and mental health professionals at Butabika Hospital
    (Makerere University, 2023-11) Segawa, Enock Suubi
    Background: Mental disorders are a significant cause of disability worldwide, Uganda inclusive. In 2019, they accounted for 4.92% and 3.94% of the disease burden in the world and Uganda, respectively. Adolescents are at a relatively higher risk of these disorders due to developmental biological and psychological vulnerabilities to environmental stressors. Telemental health (TMH) can be used to increase access to mental health services for adolescents. However, its effectiveness will depend on its acceptability by adolescent patients, their caretakers, and mental health professionals (MHPs). Main objective: To assess the acceptability of TMH for adolescent patients at Butabika Hospital among adolescent patients, their caretakers, and MHPs, and determine the associated factors among the patients and their caretakers. Methods: A concurrent mixed-methods design was used. The quantitative research component was a cross-sectional design among 63 patients and 188 caretakers. Quota sampling was used. Data were collected using a researcher-administered questionnaire. It was managed in EpiData Manager and analysed using Stata software. The qualitative research component was with four mental health professionals, six patients, and eight caretakers. An exploratory descriptive qualitative approach was used. Data were collected through in-depth and key-informant interviews. It was managed in OpenCode and analysed by thematic analysis. Results from the qualitative were triangulated with those from the quantitative research component at the interpretation phase. Results: Most patients were female (61.9%), did not own phones (59.7%), and had no experience with any TMH service (77.4%), while most caretakers were female (72.3%), owned phones (97.9%), and had no experience with any TMH service (81.4%). The prevalence of high acceptability among patients was 77.8% (95% CI: 67.2% - 88.3%), and among caretakers was 93.1% (95% CI: 89.4% - 96.7%). None of the candidate factors was associated with high acceptability among patients, while caretaker acceptability was associated with phone ownership (aPR 0.940, 95% CI: 0.900 - 0.982). There were no confounding or interaction effects in the data. Most participants favoured using or providing the TMH service at Butabika Hospital. Furthermore, while using or providing the service was ethical, it presented difficulties in the case of providing it to minors who were non-emancipated patients. The mental health professionals also anticipated minimal opportunity costs, except if they had to provide it outside working hours. Finally, most participants believed that physical limits hampered the efficiency of the service. Conclusion: Most patients and caretakers expressed high acceptability of the TMH service for adolescent patients at Butabika Hospital. Among caretakers, not owning a phone was associated with a high acceptability of TMH. However, the study was underpowered to detect associations between any candidate predictor and high acceptability. Most participants had favourable opinions about the service. However, they also expressed concerns about its limitations. The management of Butabika Hospital could consider conducting formative research about the TMH service. All TMH providers should endeavour to innovate within prevailing constraints to mitigate the limitations of TMH. Finally, future researchers should use large homogeneous samples from study populations to ensure adequate study power.
  • Item
    Acceptance of routine counselling and testing for HIV among medical patients at Mulago Hospital casuality unit.
    ( 2005-07) Nakanjako, Damalie K
    Introduction: HIV counseling and testing is an entry point to comprehensive HIVIAIDS prevention and care. In Uganda, VCT is available in ambulatory settings where clients present by self-selection. Routine Counseling and Testing for HIV (RCT) is not widely offered as part of medical care at Mulago hospital. Data on patient acceptability of RCT in an acute care setting is still limited in Sub-Saharan Africa and Uganda in particular. This study determined the acceptability of RCT and the patient factors influencing uptake of the service in a hospital Methods: This was a cross-sectional study. Participants were selected by systematic sampling of patients attending the medical casualty unit at Mulago Hospital; Interviews were conducted to determine whether patients knew their HIV serostatus. HIV counseling and testing was offered to all eligible patients and results were delivered within 30minutes. WHO clinical staging was performed for the HIV positive patients. Acceptability of RCT was measured by the proportion of patients that agreed to be tested for HIV. Bivariate analysis was done to determine the sociodemographic, socio-economic and medical factors affecting the acceptability of RCT. Results: One hundred ninety three out of 233 patients that came to the Mulago casualty unit between October and December 2004 (83%) were not aware of their HIV serostatus. One hundred seventy one out of the 193 (88%) had sought treatment at a health unit in the previous six months where HIV testing had not been offered. Seventy out of 17 1 (5 1%) who had sought medical care in the previous six months had been to both private and public health units. One hundred ninety eight out of 208 (95%) that were offered HIV testing accepted to test for HIV. The very high acceptability precluded analysis of the factors associated with decline to test for HIV. One hundred and eleven out of 223 (50%) study participants were infected with HIV and 86 of the 111 HIV infections (77%) were diagnosed during the study period. Seventy eight out of 111 HIV infected participants (70%) were in WHO clinical stage 3 and 4. No immediate psychological breakdown was observed following delivery of HIV positive results. Conclusions: Acceptability of routine HIV testing was high at the medical casualty unit at Mulago Hospital. RCT in this setting identified a significant number of HIV infected patients. RCT has a potential public health impact of increasing the number of HIV infections diagnosed and hence the number of persons with access to HIV/AIDS prevention and treatment services. We recommend that RCT should be adopted as standard of care for patients at the medical casualty unit at Mulago hospital and other private and public health units in Uganda in order to meet patients at their earliest contact with the health care system.
  • Item
    Acceptance of routine testing for HIV among adult patients at the medical emergency unit at a national referral hospital in Kampala, Uganda
    ( 2006) Nakanjako, Damalie ; Kamya, Moses ; Kyabayinze, Daniel ; Mayanja-Kizza, Harriet ; Freers, Jurgen ; Whalen, Christopher ; Katabira, Elly
    HIV testing is an entry point to comprehensive HIV/AIDS prevention and care. In Uganda, Routine Testing and Counseling for HIV (RTC) is not widely offered as part of standard medical care in acute care settings. This study determined the acceptance of RTC in a medical emergency setting at Mulago national referral hospital. We interviewed 233 adult patients who were offered HIV testing. Overall, 83% were unaware of their HIV serostatus and 88% of these had been to a health unit in the previous six months. Of the 208 eligible for HIV testing, 95% accepted to test. Half the patients were HIV infected and 77% of these were diagnosed during the study. HIV testing was highly acceptable and detected a significant number of undiagnosed HIV infections. We recommend adoption of RTC as standard of care in the medical emergency unit in order to scale HIV diagnosis and linkage to HIV/AIDS care.
  • Item
    Access to anti-hypertensive and anti-diabetic medications amongst people living with HIV in Soroti District, Eastern Uganda
    (Makerere University, 2022-12) Mwawule, Wadulo Fredrick
    Background: Access to anti-diabetic and anti-hypertensive medicines is one of the factors that needs to be addressed so as to ensure continuous availability of affordable quality of care to HIV clients living with hypertension and diabetes. Inability to bridge the gap of anti-hypertensive and anti-diabetic medicine access will offset the tremendous gains associated with the use of antiretroviral therapy. Objective: To determine access to anti-hypertensive and anti-diabetic medicines amongst HIV clients. Methods: This was a cross-sectional study that collected both qualitative and quantitative data. A semi-structured questionnaire was used to collect quantitative data from 215 HIV positive hypertension and diabetic clients. The collected data was entered into SPSS version 24, and analyzed using descriptive statistics and logistic regression to assess access to anti-hypertensive and anti-diabetic medicines. An interview guide was used to collect qualitative data from 16 key-informants (pharmacist, prescribing clinicians, dispensers, stores attendants and nurse in-charges). Collected data was transcribed, exported into Atlas.ti 22 software, and analyzed thematically. Results: The six anti-hypertensive and anti-diabetic medicines observed were stocked-out for an average of 26.02% (16/60 days) of the days. The anti-hypertensive medicines had more stock-out days (20/60 days) compared to anti-diabetic medicines which had a stock-out duration of (12/60) days. Losartan-hydrochlorothiazide, anti-hypertensive medicine had the highest number of stock-out days (32/60) days. Accessibility was poor, with the majority 193 (89.8%) of the clients travelling more than 5Km for their medicine refills and only 86 (40%) of the clients receiving all their prescribed medicines. Medicine affordability was also poor, with majority 183 (85.1%) of the clients at risk of catastrophic health expenditure. Education level (AOR=0.245; 95% CI: 0.092-0.655; p=0.005˂0.05) was significantly associated with accessibility to non-communicable disease medicines. Supply chain practices affecting access to anti-hypertensive and anti-diabetic medicines included; inadequate technical personnel, and limited funds. Conclusion: Access to non-communicable disease medicines is generally poor as illustrated by poor accessibility, affordability, persistent stock-outs, limited funds, inadequate technical personnel, and delayed delivery of medicines by the central medical store. Recommendation: Government needs to strengthen health facilities in the management of non-communicable diseases by increasing access to medicines. Key words: Access, availability, accessibility, affordability, HIV/AIDS, NCDs, HIV and NCDs.
  • Item
    Access to health care for febrile children in Uganda: symptom recognition, care seeking practices and provider choice
    (Karolinska Institutet and Makerere University, 2009) Rutebemberwa, Elizeus Kabareebe
    Background: Febrile illnesses including malaria and pneumonia are leading causes of death among children under five in Uganda. Despite government efforts to increase health care access by offering free services at government facilities, the majority of the sick children receive care after 24 hours, often with less efficacious drugs. one of the strategies suggested for increasing access is the distribution of antimalarials and antibiotics at community level. However, determinants on access to health care for febrile children are not sufficiently understood. Main aim: The aim of this study was to assess the factors associated with access to treatment for febrile children under five in order to inform the implementation of child survival interventions at community level. Methods: Four studies were conducted in Iganga-Mayuge Demographic Surveillance Site in Eastern Uganda (I-IV). Study used key informant interviews (KIIs) with eight health workers and eight traditional healers and five focus group discussions (FGDs) with mothers of children under five. Study II was a cross sectional survey of 9,176 children under five. Study III was a survey of a random sample of 1078 households with children under five. Study IV used four FGDs with fathers and mothers of children under five and eight KIIs with health workers in government and Non-Governmental Organization facilities, community medicine distributors (CMDs), and attendant in drug shops and private clinics. Content analysis was used for qualitative data. Quantitative data was analysed at univariate, bivariate and multivariate levels to determine the independent predictors of delayed care or choice of provider. Results: There is general lack of knowledge on antibiotics as first treatment for fever with pneumonia symptoms (I) and use of less efficacious drugs for malaria acquired from the open market (IV). Caretakers prefer health care providers with a variety of drugs and able to do diagnostic investigations (IV). Two thirds of the caretakers consult the private sector and 27% of them among other things because they can get treatment on credit (III). There are diverse perceptions on drug efficacy among caretakers (IV). Being of low socio-economic status (OR 1.45; 95% CI 1.06┤1.97) and presenting with pallor (OR 1.58; 95% CI 1.10-2.25) are associated with delay in care seeking >24 hours after onset. Children seeking care outside the home <24 hours had fast breathing (OR 0.75; 95% CI 0.60-0.87), had had tepid sponging (OR 0.43; 95% CI 0.27-0.68), had provider proximity (OR 0.72; 95% CI 0.60-0.87) and went to drug shops (OR 0.70; 95% CI 0.59-0.84) or CMDs (OR 0.33; 95% CI 0.15-0.74) (II). Caretakers more likely went to government facilities when children had vomiting (OR 2.07; 95% CI 1.10-3.89), or when expecting qualified (OR 10.32; 95% CI 5.84-18.26) or experienced workers (OR 1.93; 95% CI 1.07-3.48). Caretakers went to private providers when seeking treatment as "first aid" (OR 0.20; 95% CI 0.08-0.52) (III). Discussion: Caretakers should be sensitized on recognition of symptoms for pneumonia, prompt care seeking and use efficacious drugs. CMDs should be able to do some diagnostic investigations and have constant drug supply. Using drug shops and private clinics in community interventions could complement government efforts to deliver timely treatment. Keywords: fever, malaria, pneumonia, community health worker, drug shop, child