Academic submissions (CHS)

Permanent URI for this collection

http://10.29.1.53:4000/handle/10570/4086

Browse

Browsing Academic submissions (CHS) by Title

  • Item
  • Item
    Assessment of factors associated with district health facility preparedness towards cholera epidemics: A case of Namayingo District, Uganda
    (Makerere University, 2018-11) Hyuha, Chrispus Jarmen
    Background: African countries are prone to epidemics due to poor preparedness. Uganda adopted the Integrated Disease Surveillance and Response (IDSR) strategy to effectively respond to epidemics. Despite having an IDSR, Namayingo district has repeatedly experienced annual cholera outbreaks. The outbreaks result into unexpected government expenditure with a negative effect on people‘s health and economic welfare. Objective. To assess the district health facilities preparedness to respond to cholera outbreaks in Namayingo district. Methodology; A cross sectional quantitative study was conducted in all the public health facilities in Namayingo District. A total of 231 health workers were interviewed using a structured questionnaire adopted from the IDSR tool. Data were captured using Microsoft excel and analyzed using Stata 14.0. The median IDSR scores was used to determine preparedness. Logistic regression analysis was carried out to identify factors associated with preparedness. Results: The District preparedness to respond to cholera outbreak was 38.10%. Factors significantly associated with preparedness included; age, educational level, profession, years of service, duration in current facility, being resident within a facility, grade and location of health facility, and presence of hand washing facilities and detergents. Slightly more than half (51.52% 95%CI 45.02-58.01) of the health workers were knowledgeable on cholera. Conclusion and Recommendations: The District preparedness to respond to cholera was poor. Health care services in lower and rural health facilities should be upgraded including provision of washing facilities. Trainings on IDSR should be offered to Staff with lower levels of education should be offered IDSR training.
  • Item
  • Item
    Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda
    (Makerere University, 2020-03-19) Nteziyaremye, Julius
    Background: Asymptomatic bacteriuria in pregnancy (ASBP) is associated with adverse pregnancy outcomes such as pyelonephritis, preterm or low birth weight delivery if untreated. The aim of this study was to determine the prevalence of asymptomatic bacteriuria, the isolated bacterial agents, and their antibiotic sensitivity patterns in pregnant women attending antenatal care at Mbale Hospital. Methods: This was a cross-sectional study in which 587 pregnant women with no symptoms and signs of urinary tract infection were recruited from January to March 2019. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured using standard laboratory methods. The bacterial colonies were identified and antibiotic sensitivity was done using disc diffusion method. Chi-squared tests and logistic regression were done to identify factors associated with asymptomatic bacteriuria. A p-value < 0.05 was considered statistically significant. Results: Out of the 587 pregnant women, 22 (3.75%) tested positive for asymptomatic bacteriuria. Women aged 20-24 years were less likely to have ASBP when compared to women aged less than 20 years (AOR = 0.14, 95%CI 0.02-0.95, P = 0.004). The most common isolates in descending order were E. coli (n = 13, 46.4%) and S.aureus (n = 9, 32.1%). Among the gram-negative isolates, the highest sensitivity was to gentamycin (82.4%) and imipenem (82.4%). The gram-positive isolates were sensitive to gentamycin (90.9%) followed by imipenem (81.8%). All the isolates were resistant to sulphamethoxazole with trimethoprim (100%). Multidrug resistance was 82.4% among gram-negative isolates and 72.4% among the gram-positive isolates. Conclusion: There was high resistance to the most commonly used antibiotics. There is need to do urine culture and sensitivity from women with ASBP so as to reduce the associated complications.
  • Item
    Awareness and practices of preconception care among women attending antenatal care at Rushere community hospital, kiruhura district
    ( 2015-08) Tweheyo, Samuel
    Background: Preconception care (PCC) has been shown to be effective in improving the health of mothers and pregnancy outcomes in developed countries. The aim of this study was therefore to describe the awareness and practices of preconception care among women attending ANC in Kiruhura district. Methods: The study was a cross-sectional descriptive study that used both quantitative and qualitative methods. Sample size was 376 women and study area was Rushere community hospital. Results: Three hundred seventy six pregnant women were interviewed. The mean/median age of respondents was 26 years (range 16–45 years). A total of 106(28.2%) respondents were prime gravid; 164(43.6%) multipara, and 106(28.2%) grandmultipara. 59(15.7%) respondents had no formal education while 225(59.8%) had primary school education, 75(20%) had secondary school education and only 17(4.9%) had tertiary education. Awareness A total of 144(38.3%) respondents had heard of preconception care and were referred to as the ‘aware group’. Out of these, 52(36.11%) could correctly define it. The respondents’ awareness of preconception care and their ability to define the subject correctly increased significantly with their educational status. Practice A total of 84 (22.34%) practiced some form of preconception care. Only 70(83.3%) of those who practiced PCC consulted health staff and of these, 22(31.42%) consulted general practitioners and clinical officers, while 48(68.6%) consulted nurses while the other 14(16.67%) respondents consulted traditional birth attendants and their parents. Conclusion: Generally women were not aware of preconception care, especially the forms of medical assessment and screening procedures that are done although there was some awareness in the simple definition and counseling about healthy life style. This study therefore has pointed out that Rushere hospital staff need to think of innovative ways to improve levels of PCC awareness and practice among the general population that it serves.
  • Item
  • Item
    Can an educational podcast improve the ability of parents of primary school children to assess the reliability of claims made about the benefits and harms of treatments : study protocol for a randomised controlled trial
    (BioMed Central, 2017) Semakula, Daniel ; Nsangi, Allen ; Oxman, Matt ; Austvoll-Dahlgren, Astrid ; Sarah Rosenbaum, Sarah ; Margaret Kaseje, Margaret ; Nyirazinyoye, Laeticia ; Fretheim, Atle ; Chalmers, Iain ; Oxman, Andrew ; Sewankambo, Nelson K.
    Background: Claims made about the effects of treatments are very common in the media and in the population more generally. The ability of individuals to understand and assess such claims can affect their decisions and health outcomes. Many people in both low- and high-income countries have inadequate aptitude to assess information about the effects of treatments. As part of the Informed Healthcare Choices project, we have prepared a series of podcast episodes to help improve people’s ability to assess claims made about treatment effects. We will evaluate the effect of the Informed Healthcare Choices podcast on people’s ability to assess claims made about the benefits and harms of treatments. Our study population will be parents of primary school children in schools with limited educational and financial resources in Uganda. Methods: This will be a two-arm, parallel-group, individual-randomised trial. We will randomly allocate consenting participants who meet the inclusion criteria for the trial to either listen to nine episodes of the Informed Healthcare Choices podcast (intervention) or to listen to nine typical public service announcements about health issues (control). Each podcast includes a story about a treatment claim, a message about one key concept that we believe is important for people to be able to understand to assess treatment claims, an explanation of how that concept applies to the claim, and a second example illustrating the concept. We designed the Claim Evaluation Tools to measure people’s ability to apply key concepts related to assessing claims made about the effects of treatments and making informed health care choices. The Claim Evaluation Tools that we will use include multiple-choice questions addressing each of the nine concepts covered by the podcast. Using the Claim Evaluation Tools, we will measure two primary outcomes: (1) the proportion that ‘pass’, based on an absolute standard and (2) the average score Discussion: As far as we are aware this is the first randomised trial to assess the use of mass media to promote understanding of the key concepts needed to judge claims made about the effects of treatments.
  • Item
    Caregivers’ attitudes and perceptions towards approval/non-approval of contraceptive use among adolescents in Tororo District, Uganda
    (Makerere University, 2018) Izuegbunam, Eucharia Uchechukwu
    Introduction: In Uganda, adolescent pregnancy remains a key public health concern. The use of contraceptives by adolescents has been controversial. Although the adolescents’ caregivers are key in decision making for adolescents, there is paucity of data about caregivers’ attitudes and perceptions towards approval/non-approval of adolescent use of contraception in Tororo District. This study explored the caregivers’ attitudes and perceptions towards approval/non-approval of contraceptive use among adolescents in Tororo District Uganda. Methods: A qualitative exploratory study purposely selecting about 81 caregivers of adolescents aged 10 to 19 years. Six focus group discussions and nine in-depth interviews were conducted among caregivers of currently or ever been pregnant adolescents or with a male adolescent who has ever impregnated a girl. Analysis: Data were transcribed and subsequently analyzed with ATLAS.ti version 7.0 software program using content analysis. Using this approach, texts were coded into meaningful texts, condensed meaning units, and categories. Sub-themes and themes were developed. Important quotes and patterns were also identified. Results: Nearly all the caregivers had good knowledge of contraception and approved contraceptive use among adolescents. Most of the caregivers had positive attitudes and perceptions towards adolescent’s contraceptive use. Factors associated with caregivers’ attitudes and perceptions were mostly cultural and religious beliefs. Caregivers expressed that they influence their adolescents in all aspects especially when it comes to contraceptive use, nevertheless they start influencing their adolescent’s behavior at the age of eight and still make decisions for them including the married adolescents. Conclusion and recommendation: Caregivers have positive attitudes and perceptions toward contraceptive use among adolescents. However, there is need to improve health education among caregivers’ of adolescent, community and religious leaders on the importance of adolescents using contraceptives and to correct the numerous misconceptions that influence caregivers’ attitudes and perceptions.
  • Item
    Characteristics and survival of patients with lung cancer at Uganda Cancer Institute
    (Makerere University, 2020) Bogere, Naghib
    Background: Lung cancer incidence is increasing and is the 7th leading cause of cancer-related deaths in Uganda. However, the characteristics, survival, and prognostic factors among lung cancer patients in Uganda are not well described, resulting in the use of extrapolated data from developed countries with different demographic and logistical challenges. We describe the baseline characteristics, survival, and prognostic factors among lung cancer patients at Uganda Cancer Institute (UCI). Methodology: This was a retrospective chart review of 207 lung cancer patients at UCI between January 2008 and August 2018. Data on demographic, clinical, laboratory, and treatment characteristics, and vital status were abstracted and analyzed. We determined survival as the time from histological diagnosis to death. The Kaplan Meier survival function was used to calculate the yearly event probabilities and median survival time and the 5-year overall survival rate. The factors associated with survival were analyzed using bivariate (log-rank) and then multivariate analysis through the Cox-proportional hazards regression model. Results: Majority were mostly female (56.5%) with a median age of 60 years (range 20-94 years) and never-smokers (78.7%). Difficulty in breathing (83.6%), cough (80.7%) and history of pleural effusion (66.2%) were the commonest symptoms. Presumptive anti-tuberculosis treatment was given to 23.2% for a median duration of 12 weeks (range 2-32 weeks) before a lung cancer diagnosis was made. Majority had NSCLC (96.6%) of which 74.5% was adenocarcinoma and 19% squamous cell carcinoma. All had advanced (stage 3 or 4) lung cancer with 96.1% having stage 4 disease. Chemotherapy (44.9%) and biological therapy (34.8%) were the commonest treatments used. Median survival was 4.4 months while 5-year survival was 1.7%. Duration since first symptom (HR 0.993), ECOG performance status, ALP (1.003), Total bilirubin (HR 1.068), Squamous cell carcinoma (HR 2.132) and biological therapy (HR .502) were associated with survival on multivariate cox regression analysis. Conclusion: Lung cancer in Uganda occurred predominantly among middle aged female never smokers with adenocarcinoma histology, stage 4 disease, and poor survival. Survival was low and treatment with biological agents was associated with longer survival. This is in contrast with patients in the western world. Recommendations: We recommend the development of an algorithm for lung cancer screening and early diagnosis in our population, training of health workers on lung cancer screening and further research on lung cancer in Uganda.
  • Item
    Characterization of T-Cell specific immune responses among alcohol consumers in a fisher folk community of Lake Victoria
    (Makerere University, 2018-11-22) Muwanda, Fahad
    Background: Alcohol is an immunosuppressant which acts directly through T cell apoptosis, mitochondrial damage, and inhibition of T cell responses. Alcohol abuse and its social and behavioral consequences have been associated with increased incidence and severity of HIV infection, though with insignificant success towards HIV prevention strategies. Hypotheses from animal studies which suggest that alcohol may increase biological susceptibility to HIV through effects on T-cell responses are yet to be proven in humans. This study sought to characterize T-cell specific responses among alcohol consumers in a fisherfolk community of Lake Victoria. Methods: This study was cross-sectional, and nested into a larger study titled “A stimulated Vaccine Efficacy Trial (SiVET) Among Adults in Fishing Communities in Entebbe, Uganda.” The SiVET Study recruited 250 HIV-negative, male and female (not pregnant) study participants aged 18 to 49 years. The WHO AUDIT questionnaire was administered to 60 alcohol sub-study participants who were classified as alcohol consumers or non-consumers based on the tool’s scores. We employed flow cytometry in immunophenotyping and intracellular cytokine staining to determine and compare median peripheral T- cell subset frequency and percentage T-cell cytokine production among alcohol and non-alcohol consumers respectively. Results: This study analyzed 52 samples including 19, 20 and 13 for mild, moderate and nonconsumers respectively. The study revealed that alcohol consumers had reduced median frequencies of peripheral CD4+ and CD8+ T-cells in comparison with non-consumers. The study indicated that alcohol consumers exhibited lower median percentage of IL-2 producing CD4+ cells than nonconsumers. In contrast, alcohol consumers had higher median percentages of IL-13 producing CD4+ cells than non-consumers. Conclusion: This study revealed that mild/moderate alcohol consumption can potentially suppress and potentiate T cell specific responses through a reduction of peripheral CD4+, CD8+ frequencies, and IL-2 production by Th1 cells while enhancing IL-13 production by Th2 cells respectively. Recommendations: More in-vitro human studies characterizing T-cell specific responses in alcohol consumers need to be done to augment the design of biological mechanisms for integration into HIV prevention strategies.
  • Item
    Chest tube thoracotomy indications and early complications among patients with chest pathology at Mulago National Referral Hospital: a cohort study.
    (Makerere University, 2020-03) Opero, Alfred
    Introduction: Chest tube thoracostomy (CTT) is defined as the insertion of a chest tube into the pleural cavity to drain air, blood, bile, pus, or other fluids. CTT is the most commonly performed lifesaving surgical procedure in thoracic surgery with the indication in the management of traumatic and non-traumatic chest pathologies. However, being invasive it has potential complications which could make it fatal and life-threatening. The objective of the study: To determine the indications of CTT, early chest tube thoracostomy complications, and associated risk factors among chest pathology patients in MNRH. Methods of study: The study was a prospective cohort study that reviewed 90 participants in a period of three months. It was conducted at MNRH focusing on patients with chest pathology and with chest tube thoracostomy. The main ward of focus was CTS ward and wards; 16c, TB, casualty, and acute care as other sub-units. Results; 90 participants were evaluated, the prevalence of CTT complications was 41.1% at MNRH, male to female ratio was 2:1 and the mean age of the participants was 28 years. 63.3% of chest pathology was due to trauma while 36.7 % was none traumatic. The commonest indication of CTT was hemothorax (31.1%), pneumo-hemothorax 15%, and pleural effusion, and lastly pneumothorax. 32.4% of the complications were due to infection, 29.7% were due to blocked drain, 21.6% were due to residual pneumothorax/effusion. Participants who had symptoms for 7 days and more were 5 times more likely to get complications following CTT. Conclusion; Hemothorax and pleural effusion were the leading indications of CTT. Infection complications and blocked drains on the other hand were the most common early complications of CTT, with symptoms of over seven days causing five-time risk of developing complications.
  • Item
    Childhood severe pneumonia in Mulago Hospital: Associated factors and bacterial etiology in the era of universal access to HIV drugs
    ( 2018) Shema, Christine
    Background: Pneumonia is the leading cause of mortality among children below 5 years. Several factors including not being breastfed, lack of immunisation and HIV exposure have played a role. HIV exposed children have been found to have a weak immunity with increased susceptibility to infections especially lower respiratory tract infections and mortality compared to their unexposed counterparts. The introduction of pneumococcal vaccine, improved access to ART and universal treatment of HIV has led to a decline in the prevalence of pneumonia and the trend of bacteriology may have changed current causative organisms. It was important to study the prevalence, factors associated and bacterial aetiology in children with severe pneumonia in order to modify their inpatient management. Objective: To determine the prevalence of severe pneumonia, factors associated, bacterial aetiology, anti-microbial resistance and outcome among children aged 2 to 59 months admitted to Mulago Hospital Methods: A cross-sectional study was carried out in Acute Care unit and the main paediatric wards of Mulago Hospital. The History, physical exam and investigations such as complete blood count, blood smear for malaria, HIV testing (DNA PCR for HIV exposed children below 18 months) and antibody testing for children above 18 months were done. Sputum induction for culture and sensitivity, DNA PCR and chest X-ray were carried out for children with severe pneumonia. Data was entered using EPI data version 3.1 and analysed using STATA version 14.0 Results; Five hundred and three patients were recruited, 58.5% were male with 50% of the patients being less than 15 months. The prevalence of severe pneumonia was 27% and the factors significantly associated were being HIV positive (OR 3.6, C.I 1.4-9.2), immunisation status that was not up to date (OR 4.4, C.I 1.6-12.3) and having a mother with a low level of education (OR 0.3, C.1 0.2-0.7). Fifty-two percent (52%) of the children had bacteria isolated from sputum and the commonest organisms were Klebsiella pneumoniae (23.2%), Hemophilus influenzae (21.4%) and Streptococcus pneumoniae (16.1%). Klebsiella pneumoniae species were resistant to ampicillin (54%), gentamycin (69%) and ceftriaxone (69%), Hemophilus influenzae was resistant to ceftriaxone (42%) while Streptococcus pneumoniae was sensitive to chloramphenicol (67%). The duration of hospitalisation of children with severe pneumonia was longer than that of children with other diagnoses (M.D -1.4, C.I -2.68,-0.09). The mortality of severe pneumonia was 5.8% and the factors associated with and prolonged duration of hospitalisation were being HIV positive (OR 3.1, C.I 1.1-8.9) and wasting (OR 6.1, C.I 3.5-10.6). The factors that were associated with mortality were being HIV positive (OR 10.9, C.I 3.5-34.4) and wasting (OR 4.85, C.I 1.58-14.82). Conclusion: The prevalence of severe pneumonia among children aged 2-59 months was 27%. The factors associated were being HIV positive, immunisation status and low level of education. The commonest organisms isolated were Klebsiella pneumoniae, Hemophilus influenzae and Streptococcus pneumoniae at 23.2%, 21.4% and 16.1%, respectively. Klebsiella pneumoniae species were sensitive to imipenem and amikacin and resistant to the recommended antibiotics for treatment of severe pneumonia (ampicillin, gentamycin and ceftriaxone) while Hemophilus influenzae and Streptococcus pneumoniae species were sensitive to ceftriaxone and chloramphenicol respectively. The high antibiotic resistance pattern is worrying especially with the current WHO recommendation. Recommendations: Health education should encourage mothers to complete immunisation and carry their immunisation cards at every visit. A study to determine the most efficacious antibiotic in treating severe pneumonia should be carried out.
  • Item
    Clinical and cranial computed tomography scan findings in adults following road traffic accidents in Kampala, Uganda.
    (African Health Sciences, 2017) Erem, Geoffrey ; Bugeza, Samuel ; Kiguli, Elsie Malwadde
    Background: Globally, road traffic accidents are a major cause of death and disability. The developing countries bear a disproportionately large share of the RTAs which account for about 85% of the deaths. Most of these RTAs result in head injury, which globally, most scholars and medical practitioners consider a significant economic, social and medical problem. In Mulago National referral hospital, RTA is the leading cause of surgical admission. Objective: To describe the cranial computed tomography (CT) scan findings in adults following RTA in Mulago hospital. Methods: Using CT, detailed analysis of 178 adult patients with head injury following RTA was performed. Data was analyzed using SPSS version 16 and presented in tables and graphs. Data recorded included socio-demographic characteristics, clinical and CT variables. Results: Seventy seven percent of the respondents were between 18- 39 years. 52.6% of patients had open head injury. Headache was the most common clinical variable followed by dizziness and aphasia. The most common CT characteristic was extracerebral haemorrhage followed by brain oedema and raised Intra-cranial pressure (ICP). Intra-cerebral haemorrhage was commonest in the frontal lobe followed by parietal lobe. Conclusion: Public health interventions like advocacy and education of the population on safe and responsible road usage should be emphasized to reduce on RTAs
  • Item
    Clinical presentation and in-hospital outcome of patients with myocardial infarction admitted in Mulago hospital
    (MAKERERE UNIVERSITY, 2014-05) Achan, Josephine
    Background Myocardial infarction is one of the leading causes of mortality worldwide with decreasing incidence in developed countries and increasing incidences in developing countries, Uganda inclusive. This increasing trend has been attributed to urbanization and changing life styles in developing countries. There is high burden of risk factors like hypertension and diabetes mellitus in our setting Objectives To describe the clinical presentation and in-hospital outcome among patients admitted with myocardial infarction in Mulago hospital. Methods This was a prospective cohort study that was conducted in Mulago Hospital complex and Uganda Heart Institute. 54 subjects were recruited during the eight months study period. Data on clinical presentations, associated risk factors, laboratory and imaging findings, and complications were collected through standardized questionnaire. Blood samples were obtained for laboratory investigations. Participants were followed for minimum of two weeks and maximum of one month. Results A total of 54 patients were recruited, 29/54 (63%) had ST segment elevation myocardial infarction (STEMI) and 17/54(37%) had non-ST segment elevation myocardial infarction. Chest pain (66.7%) was the common presentation. Most patients in this study came to the hospital more than 72hours with median time of presentation to the hospital from onset of symptoms 93.5hours (SD 57.09, OR=1.002 95%CI 0.9-1.0). The mean age for the study participants was 58.7(SD=+/-10) with more males 38/54 (70.4%) than females 16/54(29.6%). Common associated symptoms were breathlessness 39/54(54.7%), palpitations 21/54(38.9%). Symptoms occurred at rest, with exercise and emotional stress. Only 7/59(13%) of the participants had low systolic and 11/54(20.4%) low diastolic blood pressure. 18/54(33.3%) had high systolic and 20/54(37%) diastolic pressure at admission. 19/54(35.2%) of participants had significant pulmonary rales at admission. 34/54(63%) had New York Heart Association class I and 40/54(74.1%) were in Killip class I. Risk factors include past medical history of hypertension 35/54 (OR=1.53, 95% CI=0.48-4.90), diabetes mellitus (OR=1.52, 95% CI=0.46-4.95), dyslipidaemia 7/54 (OR=1.73, 955CI=0.29-10.10), high LDL Cholesterol were higher risk for myocardial infarction. Low HDL (OR=1.9, 95% CI=0.55-6.58) confers higher risk for myocardial infarction compared to normal and high HDL cholesterol levels. Also similar patterns are seen in family history as positive for hypertension (59.3%) (OR=1.1, 955CI=0.35-3.88) and diabetes mellitus (37%). 50.9% of male and 92.9% of female participants had abdominal circumference greater than 102cm and 88cm respectively. Higher body mass index of 24.5-29.5(OR=2.0, 95%CI 0.3-13.1) and 29.5-39(OR=2.2, 95%CI=0.38-13.5) though the p value is not statistically significant was also a risk for myocardial infarction. Positive history of current or former h/o alcohol consumption constituted more than half of the participants (29/54). In contrast only approximately 13/54(24.1%) were current or previous smokers. Over all 10/54(24.1%) developed shock, 10/54(18.5%) had pulmonary oedema and congestive heart failure, 6/54(11.1%) developed arrhythmia, 6/54(11.1%) died in the hospital, and 2/54(3.7%) had ventricular wall aneurysm formation. 1/54(1.9%) had stroke, re infarction and thrombus formation. No patient developed pericarditis and LV dysfunction. Conclusion Majority of patients admitted with myocardial infarction had STEMI and present with chest pain. Most patients are males. Hypertension, Diabetes Mellitus and dyslipidaemia were high risk factors. There was delayed time to presentation to hospital from the time of onset of symptoms. Almost half of the patients with STEMI developed pulmonary edema, shock, congestive heart failure and arrhythmia.
  • Item
  • Item
    Comparison of routine versus selective screening strategies for depression among PLHIV attending Princess Diana Memorial Health Centre iv Soroti.
    (Makerere University, 2018-11) Okimat, Paul
    Abstract Introduction: Depression is not usually screened for among PLHIV in Uganda in spite of the fact that depression is more common among PLHIV than in the general population. The study’s aim was to determine whether selective and routine screening strategies for depression differed in case detection, and performance (sensitivity and specificity); and to describe the perceptions of stake holders on the screening strategies. Methods: The study employed a mixed methods study design with quantitative (a randomized control trial) and qualitative data collection methods. It was conducted in Princess Diana Memorial Health Centre IV HIV clinic. Ethical approval was sought from School of Medicine Research Ethics Committee (REC 2018-041) while registration was done with the Pan African Clinical Trial Registry (PACTR201802003141213). 291 PLHIV and 6 stake holders participated in the study. Participants allocated to selective screening were screened for depression if they had or were at “crisis points” while those allocated to routine screening were screened regardless of whether they had or were at “crisis points” or not. The screening was done at every clinic visit. The PHQ-2 and PHQ-9 were used in sequence for screening while the MINI was used as the reference tool. Audio recorded Key informant interviews were carried out to identify the perceptions of the stake holders. Results: Routine screening detected 8.4% more cases P-value =0.073, 95% confidence interval (-0.8%, 17.6%) (two sided). Sensitivity was significantly higher for routine screening as compared to selective screening strategy (difference =23.7%) P -value = 0.034, 95% confidence interval (2.6%, 44.9%). The stake holders thought it was important to screen for depression among PLHIV with preference to routine screening strategy. Conclusion: The findings indicated that PLHIV should be screened for depression regardless of whether they present with risk factors (“crisis points”) or not given the difference in sensitivity of the strategies, and the stake holders’ concerns. This should be supported with trainings, public sensitization on depression and improvement of the Health information Management System to capture data on depression among PLHIV
  • Item
    Complementary feeding practices and associated factors among infants and young children aged 6-23 months in fort portal municipality Kabarole district.
    ( 2018-11-26) Bagaaya, Sharon
    Background:Evidence has shown that promotion of appropriate complementary feeding practices reduces the incidence of stunting and leads to better growth outcome, Inappropriate complementary feeding leads to nutrient inadequacy. Over the years infants and young child feeding policy implementaion focussed mainly on promotion of breast feeding practices while complementary feeding practices were neglected. Appropriate complementary feeding among infants and young children 6-23 months has been assesed for 21 countries, however there is missing data on subpopulation data on complemnetary feeding with in each country. Rural settings that have high prevalences of stunting need their complementary feeding practices assessed. This study there fore aims to determine the factors associated with complementary feeding practices of children 6-23months in Fortportal Kabarole District. Objective :The main objective of the study was to determine the prevalence of appropriate complementary feeding practices and associated factors among infants and young children 623 months in fort portal Municipality. Methods:A community based cross-sectional study was conducted among 206 mothers/caretakers of infants and young children 6-23months using both quantitative and qualitative methods. Probability proportionate to population size sampling technique was used to select the study subjects. A pretested standard WHO questionnaire for assessing infant and young child feeding indicators was adopted for assessing complementary feeding indicators. Appropriate complementary feeding was assessed using a composite index. Prevalence ratios and there 95% confidence intervals were generated. Modified poisson regression model was used to generate factors associated with appropriate complementary feeding. For qualitative data, Focus Group Discussions were employed to capture participants’ perceptions on complementary feeding practices. Results: The prevalence of appropriate complementary feeding was found at 21.4%. Results showed that cohabiting (PR: 2.15; CI:1.10 – 4.18), having a formal employment (PR:7.05: CI:1.69-29.36) and having no child illness (PR: 1.85; CI:0.88 – 4.35) were associated with appropriate complementary feeding. Qualitative results showed inadequate information on appropriate complementary feeding and low income as major challenges faced by Mothers / Care takers. Conclusion: Low appropriate complementary feeding practices of infants and young children 6-23 months was observed. Interventions to address complementary feeding practices such as health access, and community based income generating enterprises to enable access to resources for acquiring food for infants and young children 6-23months.
  • Item
    Compliance with standard precautions of infection control in the management of labour by healthcare workers at Mulago National Referral Hospital
    (Makerere University, 2018-08-23) Komuhangi, Grace
    Background: Infections acquired during labour are the leading cause of maternal mortality globally. Compliance with Standard Precautions of Infection Control (SPIC) on the side of healthcare workers is crucial in preventing infection transmission during labour. However, lack of training on SPIC in the management of labour and work overload may be associated with non-compliance with SPIC the management of labour. Aim: The purpose of this study was to determine compliance with standard precautions of infection control and associated factors in the management of labour and child birth by healthcare workers in Mulago Hospital to generate information, which may be, used in infection control and prevention practices. Methodology: A cross-sectional study utilizing a quantitative approach was conducted among 115 healthcare workers. Consecutive sampling was done to include respondents in the study. Data were collected by direct observation and researcher administered questionnaires. Data was coded and entered into the computer using SPSS version 20 with programmed quality control checks. Descriptive data analyses, frequencies, cross tabulations and logistic regression analysis were the major statistical methods used. Results: Data from103 healthcare workers who were involved in the study were analysed. , 74% were females. Overall compliance was at 52%, although it varied across domains. The majority of the healthcare workers (95.1%) did not comply with hand hygiene. Being a male was associated with low compliance scores across most domains. One of the hospital factors which was significantly associated with compliance to hand hygiene was having had an in-service training with p =0.008 and p=0.012 at multivariate analysis. Conclusion: Overall compliance to standard precautions of infection control was low compared to the Centre for Disease Control (CDC) recommendation. The findings in this study provide insight into individual and hospital related factors associated with compliance with standard precautions of infection control in the management of labour. There is an urgent need to put up interventions to improve on compliance with SPIC in management of labour among all healthcare workers.
  • Item
    Consumer health information literacy promotion program in public and community libraries in Africa : experience from Kenya, Nigeria, Uganda, and Zimbabwe
    (Taylor & Francis Group, 2017) Ajuwon, Grace A. ; Kamau, Nancy ; Kinengyere, Alison ; Masimba, Muziringa
    The aim of this project was to enhance the capacity of public and community librarians in four African countries (Kenya, Nigeria, Uganda, and Zimbabwe) in meeting the consumer health information (CHI) needs of their patrons. A total of 65 librarians from 34 public and community libraries were trained on how to access and use consumer health information resources by health sciences librarians in the selected countries. A needs assessment preceded the training that focused on health literacy, health information literacy, sources of health information, online information searching tools and search techniques, and how to search CHI resources, including Kidshealth.org, Womenshealth.gov, MedlinePlus, and CancerNet, among others. Each team of participating libraries received a seed grant to design and implement a consumer health activity. The trained public and community librarians in both Nigeria and Uganda conducted training on use of CHI resources to different categories of patrons. In Nigeria, high school students were trained on how to use their mobile phone to access CHI resources. Adolescents and other categories of library patrons were trained on information and communication technology (ICT) skills and accessing CHI resources in Uganda. In Kenya, the public librarian created a Consumer Health Information Corner and purchased CHI books for patrons to consult, while in Zimbabwe, the public library partnered with other non-governmental organizations to provide consumer health information materials to the library for patron use. It is possible for academic health sciences librarians to partner with public and community librarians in Africa to carry out a successful CHI project.
  • Item
    Continuous labor support from a companion of choice in Uganda: Practices, role orientation, experiences and effect on birth outcomes
    (Makerere University, 2024) Wanyenze, Eva Wodeya
    Background: With the current pace of progress in meeting the goal to end preventable maternal deaths by 2030, the world will likely fall short of this target by more than 1 million lives. Globally, up to 2.5 million lives can be saved using evidence-based care practices including utilization of the birth companion in the intrapartum care. Uganda grapples with challenges of health human resources especially midwifery care providers. Such shortages jeopardize midwives’ ability, availability, and motivation to offer support to women during childbirth. A birth companion of choice is recommended by WHO to promote non-clinical care for all women for a positive childbirth experience and improved birth outcomes. Birth companions could be leveraged to a great degree to mitigate the current health human resource crisis. Empirical evidence on the effect of labor support, and specific support practices with regards to women's care needs is weak in low-income settings. This study aimed to explore labor support practices and to evaluate the effect of role orientation of birth companions on birth outcomes, maternal satisfaction, and care experiences in Eastern Uganda. Methods Sub-study I: Exploratory descriptive qualitative design was used. Ten non-participant direct observations of normal laboring women admitted in early labor with a full-time birth companion were conducted. In-depth interviews with the women observed were conducted pre-discharge. Latent content analysis was done. Sub-study II: A stepped wedge cluster randomized trial; a pilot study among 475 participants (control n=240), intervention n= 235) from 4 clusters. Midwives in the intervention period provided an orientation session for the birth companions on supportive labor techniques. Women with a birth companion, and expecting a vaginal delivery were included. The primary outcome was the mode of delivery. Secondary outcomes were coping, anxiety, length of labor, Apgar score, need for augmentation, and maternal satisfaction. Analysis was undertaken on an “intention to treat basis”. Statistical tests, including Chi-squared tests, t-tests, and confidence intervals, were two-sided. The statistical significance was set at 5%. Sub-study III. A phenomenological descriptive study design among 12 women supported by birth companions who had received a role orientation session on admission. Follow up home based in-depth interviews were conducted within a week during the postpartum period. Colaizzi method of phenomenological analysis was used. Results Birth companion practices identified were “support actions aiding a good childbirth experience” and “support actions hindering coping with labor”. Support actions aiding a good experience reported were emotional presence, motivation, providing nourishments, messenger activities, body massage for pain relief, assisting in ambulation, and coaching. Companion fearful behaviors, disrespectful care in the form of unacknowledged needs, and hostility from birth companions were cited to hinder coping. Women’s care needs identified included: thoughtful communication, trust, anticipatory care, and birth companions to recognize non-perceptive phases of labor to allow them focus on themselves. Following orientation of birth companions on labor support techniques, anxiety scores were lower in the intervention group (p = 0.001). The proportion of women able to cope during early active labor was higher during the intervention period (P = 0.031). Women in the intervention period had 80 percent higher odds of coping (P=0.032) compared to the control period. Notable differences were observed in anxiety and coping with labor among first-time mothers, younger women (15-24), and women who received support from siblings. There were no statistically significant differences in the mode of delivery, need to augment labor, length of labor, and Apgar scores. The mean maternal satisfaction score was significantly higher in the intervention period compared to the control period (P>0.001). Maternal satisfaction scores were lowest with pain management and highest with humaneness across the study periods. Qualitative evaluation of orientation showed that women that received support from birth companions who had an orientation had higher self efficacy to give birth even in moments when they had given up on having a normal birth. Women were contented with their experience with birth companions who had received an orientation. They reported feeling loved, esteemed, respected due to birth companions’ profound care. Trust between birth companion and woman was critical and influenced response to instructions to relaxation, mobility, nutrition, and hydration. Kindness was a driver for obedience to instructions. Conclusion: Birth companions provide emotional, physical support, and advocate for women’s needs during labor. Companion fearful behaviors and insensitiveness hinders coping with labor. Midwife-provided orientation of birth companions on labor support lowered maternal anxiety and improves coping with labor and maternal satisfaction with care. Birth companion orientation enhanced women’s self-efficacy, promoted respectful, compassionate intrapartum care and a positive birth experience. Midwife-provided orientation of birth companion is a low-cost intervention pivotal in improving women's care experience, as well as contributing to ending preventable maternal and newborn mortality in Uganda.