School of Public Health (Public-Health) Collections
Permanent URI for this collection
Browse
Recent Submissions
1 - 5 of 1074
-
ItemEffect of mobile health interventions on enhancing completion of the diagnostic process among peoplr with presumed tuberculosis in Central Uganda(Makerere university, 2026)Background: In 2025, tuberculosis (TB) remained the leading infectious killer despite being preventable. The “WHO End TB” strategy calls for a reduction in TB incidence by 90% and deaths by 95% by 2035. However, progress towards achieving this strategy has been partly hampered by the continued loss to follow-up (LTFU) of patients along the TB care cascade. In the TB care cascade, patients can be lost either before they are screened or before they are diagnosed when presumed with TB or before they initiate treatment after testing positive for the infection or before completing treatment. At the health facility level, the biggest LTFU of patients happens between one being presumed to have TB and getting a diagnosis leading to loss to follow-up (LTFU) before completing the diagnostic process despite having reached the facility. Continuous LTFU of people with presumed TB before they are diagnosed propagates community transmission of mycobacterium tuberculosis (Mtb) and poor patient outcomes. There is therefore an urgent need to come up with interventions to reduce this LTFU of people with presumed TB before they are tested. Objectives: The main objective of this thesis was to assess the magnitude of pre-diagnosis LTFU and the effect of mHealth interventions to enhance completion of the diagnostic process among people with presumed TB in Central Uganda so as to inform the design of interventions. Specific objectives were: i) to determine the proportion of pre-diagnosis LTFU and factors associated in Central Uganda (sub-study 1); ii) to explore the facilitators and barriers to completion of the diagnostic process among people with presumed TB in Central Uganda (sub-study 2); iii) to synthesize evidence on mHealth interventions used to reduce LTFU among people with presumed TB and those diagnosed (sub-study 3); iv) to assess the effect of the SMS or phone call intervention to enhance completion of the diagnostic process among people with presumed TB (sub-study 4) and v) to explore factors that influence use of the SMS or phone call intervention to enhance completion of the diagnostic process among people with presumed TB (sub-study 4). Methods: The study was implemented under four sub-studies based on the Socio-ecological (SEM) model using both quantitative and qualitative methods of data collection. In sub-study 1, a retrospective cohort analysis of secondary data was conducted among people with presumed TB who presented to the study facilities from 1st January 2019 to 31st December 2022 to determine the proportion of pre-diagnosis LTFU and factors associated. Modified Poisson regression modelling was used to estimate adjusted prevalence ratios (adj.PR) and factors associated with TB pre-diagnosis LTFU. In sub-study 2, twenty-five In-depth interviews (IDIs) with purposively selected people with presumed TB who either completed or dropped out of the diagnostic process were conducted to explore facilitators and barriers to completion of the diagnostic process using a qualitative descriptive design. In addition, six focus group discussions (FGDs) with patients who had recently initiated TB treatment and 20 key informant interviews (KIIs) with health workers were also conducted. Thematic analysis was used for analysis. In sub-study 3, a systematic review was conducted to synthesize evidence on what mHealth interventions have been previously used to reduce LTFU in the TB presumption phase. In sub-study 4, a mixed methods study was embedded in an individual randomised controlled trial (RCT) to assess the effect of Short Message Service (SMS) and phone call intervention on completing the TB diagnostic process and explore factors that influence their use. Results: From sub-study 1, overall 28.3% (3,699/13.064) experienced pre-diagnosis LTFU within 30 days from the day they were presumed with TB. Pre-diagnosis LTFU was more likely to occur among patients aged 0-14 years (adj.PR=1.1, 95% CI: 1.06, 1.24), females (adj.PR=1.06, 95% CI: 1.01, 1.12), those with no record of place of residence (adj. PR=2.7, 95% CI: 2.54, 2.93), and those with no record of phone contact (Paper 1). In sub-study 2: the key facilitators for completion of the TB diagnostic process included; persistent symptoms, obtaining same day results, prior TB knowledge, social support and caring health workers. Barriers were; TB and HIV stigma, long turnaround time of results, stock out of supplies, unclear appointment for collection of results, lack of transport to return to the health facility, and poor health worker attitude (Paper 2). From the systematic review in sub-study 3, SMS, phone calls, WhatsApp messages and mobile applications (Apps) were the mHealth interventions utilised in the TB presumption phase. Phone calls and SMS were however the commonly used interventions mainly used as reminders to collect or deliver TB result, and for linkages and referrals to diagnostic centres. The evaluation of the SMS and phone call interventions revealed that completion of the TB diagnostic process was highest among participants randomised to the phone call arm compared to those in the standard of care 74.3% (434/584). There was no statistically significant effect for those in the SMS arm (adj RR 0.99, 95% CI: 0.91,1.08). Individual factors, social influences, technological factors, intervention design factors, health system factors and participant experiences influenced the use of the SMS and phone call intervention (sub-study 4). Conclusion: From the study findings in this thesis, more than a quarter of the people with presumed TB got lost before getting tested or before receiving their test results. Completion of the TB diagnostic process was facilitated by obtaining same day results, prior TB knowledge, social support, while TB and HIV stigma, long turnaround time of results and lack of transport to return to the health facility were barriers. SMS and phone calls were the commonly used mHealth interventions in the TB presumption phase. From the evaluation of the intervention, completion of the TB diagnostic process was highest among participants in the phone call reminders arm compared to the standard of care. Implementation of SMS or phone call interventions is influenced by social influences, technological factors and intervention design factors. To enhance completion of the TB diagnostic process, there is need for empowering laboratories with resources to avail same day results, short of which mHealth interventions that incorporate phone calls should be considered to communicate readiness of results to the patients. Design of SMS and phone call interventions should take into consideration individual factors, social, technological factors, user experiences and localised design strategies. Social support and stigma reduction interventions should be embraced both in the community and at the health facility to support people with presumed TB to complete the diagnostic process.
-
ItemPrevalence of home births assisted by traditional birth attendants and associated factors among mothers 15- 49 years in Lira district, Uganda.(Makerere University., 2026-08-18)Home births, which occur outside formal health facilities and are often attended by traditional birth attendants (TBAs), remain a major public health concern, particularly in rural areas. They are associated with poor maternal and neonatal outcomes and continue to contribute to Uganda’s high maternal mortality. Despite ongoing efforts to promote facility-based deliveries, a considerable proportion of women still give birth at home. This study aimed to determine the prevalence and identify factors associated with home births among mothers in Lira District, northern Uganda. Methods:A cross-sectional study was conducted among women aged 15–49 years who had delivered within the six months preceding the survey. A multistage sampling approach was used to select 267 participants. Quantitative data were collected using semi-structured questionnaires, and qualitative insights were obtained through interviews with nine key informants. Quantitative data were analyzed using STATA software, employing modified Poisson regression to identify factors associated with home births.Results:Of the 267 respondents, the mean age was 28.3 years (SD±7.2), most were married (81.2%), and the majority had attained primary education (70.6%). The prevalence of home births assisted by TBAs was 23.3%. Education level was strongly associated with delivery location: women with primary education had a 30% lower prevalence of home birth compared to those with no education (APR = 0.70; 95% CI: 0.61,0.80), while those with secondary education had a 32% lower prevalence (APR = 0.68; 95% CI: 0.59, 0.79). Single mothers had a 32% higher prevalence of home birth compared to married women (APR = 1.32; 95% CI: 1.19, 1.51), and widowed mothers had a 21% higher prevalence. (APR = 1.21; 95% CI: 1.03, 1.42). Higher parity was associated with a lower prevalence of home birth compared to primiparous women (two births: APR = 0.88; 95% CI: 0.79, 0.99; three births: APR = 0.83; 95% CI: 0.74-0.92; four or more births: APR = 0.85; 95% CI: 0.76, 0.95). Fewer antenatal care visits were associated with a higher prevalence of home birth. Women who attended one ANC visit had a 26% higher prevalence of home births compared to those who attended four or more visits (APR = 1.26; 95% CI: 1.09, 1.46).Conclusion: More than two in ten women in Lira district delivered at home with the assistance of TBAs. Lower education, limited availability of health workers, and inadequate ANC attendance were key drivers of home births, while higher parity appeared protective. Strengthening maternal health education and improving ANC quality and accessibility remain essential to reduce TBA-assisted home births and enhance health facility utilization in similar rural settings.
-
ItemImplementation of the World health organization infection prevention and control core components in the provision of care to cancer patients at the Uganda Cancer institute; a mixed methods study.(Makerere University, 2026-06)Background: Effective implementation of infection prevention and control (IPC) is imperative for prevention and reduction of healthcare-associated infections (HAIs) especially in the cancer patient. HAIs are of significant public health concern with a considerable impact on morbidity, mortality, and quality of life especially in cancer patients. Cancer patients are at a greater risk of acquiring HAIs due to their weakened immune system arising from cancerous conditions and medications, as well as prolonged hospital stays. While there has been a study on bacteraemia in febrile cancer patients at UCI, there is scanty literature to describe the level of implementation of the World Health Organization (WHO)Infection Prevention and Control (IPC) core components (CCs) at the Uganda Cancer Institute (UCI). The aim of this study was to assess the level of implementation of WHO IPC CCs at UCI. Methods: The study was a cross sectional three-part mixed methods study, utilising the convergent parallel approach. It consisted of a (1) a hospital-based cross-sectional component (utilizing the WHO infection prevention and control assessment framework (IPCAF) tool, (2) observational checklist, (3) key informant interviews (KIIs). Findings from both the quantitative and qualitative data were collected and triangulated. Based on the overall score obtained from the IPCAF tool, UCI was assigned to one of the 4 levels of IPC promotion and practice. The results from the observational checklist were used to validate the results from the WHO IPCAF too while the findings from the KIIs provided further explanation to level of implementation of the WHO IPC CCs at UCI.Results: The overall IPC compliance score for UCI was 33.2% (265.9/800), interpreted as a basic level of compliance. IPC scores ranged from the lowest, 173/800 in Paediatric OPD to highest 432.5/800 for Lymphoma Tumor Centre (LTC). Adult units had higher IPC scores (mean = 309.3) than paediatric units (mean = 178.8) while outpatient units had higher IPC scores (mean = 276.9) than inpatient units (mean = 260.25). These differences were however not statistically significant, p=0.133 and p=0.800 respectively. Facilitators for IPC implementation included existence of an IPC committee, UCI leadership commitment, availability of PPE, skilled staff, segregation of patients and access controls. Barriers against IPC implementation included insufficient IPC staff, limited space and equipment, delayed PPE replenishment, inadequate training, lack of HAI surveillance, poor monitoring and feedback, and infrastructure limitations. Conclusion: This study revealed a lower level of implementation of WHO IPC CC at UCI 33.2% (265.9/800), which shows that there is still significant room for improvement especially for HAI surveillance (CC4), monitoring/audit and feedback (CC6), and workload, staffing and bed occupancy (CC7).
-
ItemPrevalence and factors associated with depression, anxiety and stress among minibus taxi drivers in Kampala City, Uganda(Makerere University, 2025)Introduction: Minibus taxi drivers in Kampala city have increased risk of developing depression, anxiety and stress because of their occupation. The prevalence and factors associated with depression, anxiety and stress among minibus taxi drivers in Kampala are not well documented yet their significance in the transport industry has impacts on individual lives, society and the population health. General objective: To determine the prevalence and factors associated with depression, anxiety and stress among taxi drivers in Kampala city. Methods: This cross-sectional study was conducted among 422 minibus taxi drivers whose taxi stages/ routes were in Old, New, Kisenyi, Usafi, Namirembe, Nakawa and Nateete minibus taxi parks in Kampala. A validated Depression Anxiety Stress Scale (DASS-21) questionnaire was used to assess the levels of depression, anxiety and stress among the minibus taxi drivers. A semi-structured questionnaire was also used to collect data on factors associated with depression, anxiety and stress. STATA software version 15 was used for descriptive and Robust Poisson regression model statistical analyses. Results: The prevalence of depression, anxiety and stress was high at 65.64%, 70.85% and 81.99% respectively. Minibus taxi drivers who were using Internet had 17% (aPR= 0.83, 95% CI: 0.72-0.97) less prevalence of depression. The prevalence of depression was less by 21% (aPR= 0.79, 95% CI: 0.64-0.98) among minibus drivers who worked six days of in a week compared to those who worked ≤5 days. The prevalence of depression was 24% (aPR=1.24, 95% CI: 1.00-1.53) higher among minibus taxi drivers who were involved in a major road accident in the last 1 year compared to those who had not been involved in an accident. Having a chronic medical condition (aPR=1.22, 95% CI: 1.06-1.41) and having Family history of mental disorders (aPR=1.29, 95% CI: 1.10-1.51) were found to be significant risk factors for depression. The prevalence of anxiety was less by 28% and 21% among minibus taxi drivers who owned the taxi (aPR=0.72, 95% CI: 0.55-0.94) and those who worked 6 days in a week (aPR=0.79, 95% CI: 0.66-0.95), respectively. Having an average of 7 or more hours of sleep per day (aPR=1.49, 95% CI: 1.02-2.17), Sometimes (aPR=1.94, 95% CI: 1.27-2.96) and never (aPR=1.70, 95% CI: 1.10-2.61) getting 7 to 9 hours of sleep per day and having a chronic medical condition (aPR=1.20, 95% CI: 1.05-1.36) were found to be risk factors for anxiety. There was 12% and 39% increased prevalence of stress among minibus taxi drivers who had been involved in a major road accident in the last 1year (aPR=1.12, 95% CI: 1.00-1.26) and those who got an average of 7 or more hours of sleep per day (aPR=1.39, 95% CI: 1.02-1.91), respectively. Minibus taxi drivers who sometimes and never got 7 to 9 hours of sleep per day had a 68% (aPR=1.68, 95% CI: 1.19-2.35) and 62% (aPR=1.62, 95% CI: 1.15-2.29) higher prevalence of stress respectively compared to those got 7 to 9 hours of sleep daily. Having a chronic medical condition (aPR=1.13, 95% CI: 1.04-1.23) and having a family history of mental disorders (aPR=1.16, 95% CI: 1.06-1.27) were also found to be significant risk factors for stress. Conclusion and recommendation: Depression, anxiety and stress among minibus taxi drivers in Kampala are public health issues. There is need for routine screening for depression, anxiety and stress. The Ministry of Health in collaboration with the Ministry of Works and Transport should hold campaigns to raise awareness on mental health and coping mechanisms plus enforce good occupational health practices among minibus taxi drivers.
-
ItemPreparedness of health facilities to respond to effects of flooding on community health in Kasese District, Western Uganda(Makerere University, 2024)Introduction: Climate change presents a profound threat to public health. Uganda is vulnerable to the health effects of climate change. Kasese district has experienced several recurrent floods and landslides during 2013 – 2015, 2020 and 2021 impacting on communities. Objective: To assess the current state of preparedness of health facilities to respond to the effects of flooding on community health in Kasese District, Western Uganda. Methods: We conducted a cross-sectional study during April 2024 in Kasese district. A total of 43 health facilities (96% Response) were purposively selected and surveyed. They comprised all health centre levels – HC II, III, IV, and Hospital – from the eight flood-prone sub-counties in the district. At each health facility, the In-charge and health personnel responsible for disaster/ emergency response were interviewed. A total of 15 key informants including district health workers and stakeholders were interviewed. Quantitative data were analyzed using Stata Version 15. Univariate and bivariate analyses were performed. Qualitative data were exported to ATLAS.ti Version 6.0 and thematic analysis performed. Findings: The study found that more than a third (35%) of the health facilities had experienced flooding during the last five years. None of the health facilities was completely prepared to respond to major flooding events. The majority (86%) of the health facilities neither had emergency plans nor did 81% have disaster management committees. Most (95%) health personnel in charge of emergencies were aware of climate change and its health effects, yet only 14% had been trained on disaster management and climate change. The main barriers to preparedness included shortages of human resources, lack of training and capacity building among health workers, shortage of medical supplies, inadequate infrastructure, and poor coordination. Conclusion: There is a low level of preparedness of health facilities to respond to the effects of flooding characterized by lack of emergency plans, low number of personnel trained on disaster, shortage of personnel and poor coordination. There is a need for a multifaceted approach to improve training of health workers in disaster management, infrastructure, and increase funding for emergency preparedness.