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Fikadu T, Gebru Z, Abebe G, Tesfaye S, Zeleke EA. Assessment of mothers' satisfaction towards child vaccination service in South Omo zone, South Ethiopia region: a survey on clients' perspective. BMC Womens Health 2024; 24:272. [PMID: 38724930 PMCID: PMC11080138 DOI: 10.1186/s12905-024-03120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Even though childhood vaccination is a common and cost-effective public health intervention in preventing and reducing childhood disease and death, significant numbers of children do not complete vaccination within the first year of life. Studies indicated that user satisfaction influences service utilization and used as a key indicator of quality care. However, evidence on the level of mothers' satisfaction with immunization service are limited in urban and accessible places and not well investigated among remote and pastoral communities. As such, this study aimed to address this gap and investigated mothers' satisfaction towards child vaccination in a pastoralist and agrarian community of the South Omo zone in Southern region of Ethiopia. METHODS An institution-based cross-sectional study was conducted among 1221 randomly selected mothers with children eligible for childhood vaccination using a structured, pretested, and interviewer-administered questionnaire. Maternal positive evaluations of the overall vaccination service were measured using 5-point Likert scale questions. Data were entered into Epi data version 3.5.1 and analyzed using IBM SPSS statistical package version 25. Exploratory factor analysis was used for Likert scale questions to extract factor scores which facilitate treatment of variables as continuous for further analysis. Bivariate and multivariable logistic regression analysis was employed to identify factors associated with the outcome variable. A P-value < 0.05 and adjusted odds ratio with 95% CI respectively were used to declare statistical significance and degree of association. RESULT A total of 849 (69.53%) study participants were satisfied with the vaccination care provided for their children. Factors associated with mother's satisfaction with child vaccination care include maternal age less than 30 years (AOR = 2.12; 95% CI = 1.61-2.79), infants age between 8 and 12 months (AOR = 1.83; 95% CI = 1.28, 2.62), not having history of adverse events following immunization (AOR = 1.57; 95% CI = 1.01-2.45), having 1 child under the age of 5 years (AOR = 1.34; 95% CI = 1.02-1.76), waiting 30 min or less to get the service (AOR = 1.39; 95% CI = 1.05-1.85), traveling 30 min or less to the vaccination center (AOR = 1.46; 95% CI = 1.08-1.98), having poor knowledge about the importance of vaccination (AOR = 1.51; 95% CI = 1.06-2.16), and having moderate knowledge about the importance of vaccination (AOR = 1.52; 95% CI = 1.06-2.18). CONCLUSION Interestingly, mothers' satisfaction with their children's vaccination service was relatively higher in a predominantly pastoral community compared with most of previous studies conducted in Ethiopia. Maternal and child age, number of children under the age of 5 years, history of adverse events following immunization, distance to the vaccination center, waiting time to get service and maternal knowledge were factors significantly associated with mothers' satisfaction. Proactive measures with focus on increasing access to vaccination service, improving waiting time and raising awareness among mothers were recommended.
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Affiliation(s)
- Teshale Fikadu
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia.
| | - Zeleke Gebru
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Getachew Abebe
- Department of Clinical Anatomy, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | | | - Eshetu Andarge Zeleke
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
- College of Medicine and Public Health, Flinders University, Flinders Health and Medical Research Institute, Adelaide, South Australia
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Kim JH, Bell GA, Bitton A, Desai EV, Hirschhorn LR, Makumbi F, Nabiwemba E, Ratcliffe HL, Wabwire-Mangen F, Kibira SPS, Schwarz D. Health facility management and primary health care performance in Uganda. BMC Health Serv Res 2022; 22:275. [PMID: 35232451 PMCID: PMC8886189 DOI: 10.1186/s12913-022-07674-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background Primary health care is a critical foundation of high-quality health systems. Health facility management has been studied in high-income countries, but there are significant measurement gaps about facility management and primary health care performance in low and middle-income countries. A primary health care facility management evaluation tool (PRIME-Tool) was initially piloted in Ghana where better facility management was associated with higher performance on select primary health care outcomes such as essential drug availability, trust in providers, ease of following a provider’s advice, and overall patient-reported quality rating. In this study, we sought to understand health facility management within Uganda's decentralized primary health care system. Methods We administered and analyzed a cross-sectional household and health facility survey conducted in Uganda in 2019, assessing facility management using the PRIME-Tool. Results Better facility management was associated with better essential drug availability but not better performance on measures of stocking equipment. Facilities with better PRIME-Tool management scores trended towards better performance on a number of experiential quality measures. We found significant disparities in the management performance of primary health care facilities. In particular, patients with greater wealth and education and those living in urban areas sought care at facilities that performed better on management. Private facilities and hospitals performed better on the management index than public facilities and health centers and clinics. Conclusions These results suggest that investments in stronger facility management in Uganda may strengthen key aspects of facility readiness such as essential drug availability and potentially could affect experiential quality of care. Nevertheless, the stark disparities demonstrate that Uganda policymakers need to target investments strategically in order to improve primary health care equitably across socioeconomic status and geography. Moreover, other low and middle-income countries may benefit from the use of the PRIME-Tool to rapidly assess facility management with the goal of understanding and improving primary health care performance.
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Affiliation(s)
- June-Ho Kim
- Ariadne Labs (Harvard T.H. Chan School of Public Health & Brigham and Women's Hospital), 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA. .,Division of General Medicine and Primary Care, Brigham and Women's Hospital, MA, Boston, USA.
| | - Griffith A Bell
- Ariadne Labs (Harvard T.H. Chan School of Public Health & Brigham and Women's Hospital), 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Asaf Bitton
- Ariadne Labs (Harvard T.H. Chan School of Public Health & Brigham and Women's Hospital), 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA.,Division of General Medicine and Primary Care, Brigham and Women's Hospital, MA, Boston, USA
| | - Eesha V Desai
- Ariadne Labs (Harvard T.H. Chan School of Public Health & Brigham and Women's Hospital), 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Hannah L Ratcliffe
- Ariadne Labs (Harvard T.H. Chan School of Public Health & Brigham and Women's Hospital), 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | | | | | - Dan Schwarz
- Ariadne Labs (Harvard T.H. Chan School of Public Health & Brigham and Women's Hospital), 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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Steele V, Patterson K, Berrang-Ford L, King N, Kulkarni M, Lwasa S, Namanya DB, Harper SL. Antenatal Care Research in East Africa During the Millennium Development Goals Initiative: A Scoping Review. Matern Child Health J 2022; 26:469-480. [PMID: 35028892 DOI: 10.1007/s10995-021-03355-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The global burden of maternal mortality remains high and inequitably distributed between countries. Antenatal care (ANC) was identified as critical component in achieving the Millennium Development Goal of improving maternal health. This scoping review aimed to summarize trends and critically explore research about ANC attendance for East African women conducted during the Millennium Development Goals initiative, with a specific focus on barriers to ANC access. METHODS Using a scoping review methodology, aggregator databases were searched for relevant articles. Articles were screened by independent reviewers using a priori inclusion criteria. Eligible articles were retained for data charting and analysis. RESULTS Following screening, 211 articles were analyzed. The number of relevant articles increased over time; utilized primarily quantitative methods; and involved authors with affiliations from various African countries. Many interrelated physical, social, and cultural factors influenced women's seeking, reaching, and receiving of quality ANC. The extent of studies identified suggest that ANC is a priority research area, yet key gaps in the literature exist. Limited qualitative research, and few articles examining ANC experiences of women from vulnerable groups (e.g. adolescents, women with a disability, and Indigenous women) were identified. DISCUSSION These context-specific findings are important considering the Sustainable Development Goals aim to nearly triple the maternal mortality reductions by 2030. In order to achieve this goal, interventions should focus on improving the quality of ANC care and patient-provider interactions. Furthermore, additional qualitative research examining vulnerable populations of women and exploring the inclusion of men in ANC would help inform interventions intended to improve ANC attendance in East Africa.
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Affiliation(s)
- Vivienne Steele
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
| | - Lea Berrang-Ford
- Priestley Centre for Climate Change, Leeds University, Leeds, LS2 9JT, York, UK
| | - Nia King
- School of Medicine, Queen's University, 15 Arch Street, Kingston, ON, K7L 3L4, Canada.
| | - Manisha Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Shuaib Lwasa
- Department of Geography, Makerere University, P.O. Box 7062, Kampala, Uganda
| | | | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada. .,School of Public Health, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 1C9, Canada.
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Kayiga H, Genevive DA, Amuge PM, Ssemata AS, Nanzira RS, Nakimuli A. Lived experiences of frontline healthcare providers offering maternal and newborn services amidst the novel corona virus disease 19 pandemic in Uganda: A qualitative study. PLoS One 2021; 16:e0259835. [PMID: 34890417 PMCID: PMC8664167 DOI: 10.1371/journal.pone.0259835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/27/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has brought many health systems in low resource settings to their knees. The pandemic has had crippling effects on the already strained health systems in provision of maternal and newborn healthcare. With the travel restrictions, social distancing associated with the containment of theCOVID-19 pandemic, healthcare providers could be faced with challenges of accessing their work stations, and risked burnout as they offered maternal and newborn services. This study sought to understand the experiences and perceptions of healthcare providers at the frontline during the first phase of the lockdown as they offered maternal and newborn health care services in both public and private health facilities in Uganda with the aim of streamlining patient care in face of the current COVID-19 pandemic and in future disasters. METHODS Between June 2020 and December 2020, 25 in-depth interviews were conducted among healthcare providers of different cadres in eight Public, Private-Not-for Profit and Private Health facilities in Kampala, Uganda. The interview guide primarily explored the lived experiences of healthcare providers as they offered maternal and newborn healthcare services during the COVID-19 pandemic. All of the in depth interviews were audio recorded and transcribed verbatim. Themes and subthemes were identified using both inductive thematic and phenomenological approaches. RESULTS The content analysis of the in depth interviews revealed that the facilitators of maternal and newborn care service delivery among the healthcare providers during the COVID-19 pandemic included; salary bonuses, the passion to serve their patients, availability of accommodation during the pandemic, transportation to and from the health facilities by the health facilities, teamwork, fear of losing their jobs and fear of litigation if something went wrong with the mothers or their babies. The barriers to their service delivery included; lack of transport means to access their work stations, fear of contracting COVID-19 and transmitting it to their family members, salary cuts, loss of jobs especially in the private health facilities, closure of the non-essential services to combat high patient numbers, inadequate supply of Personal Protective equipment (PPE), being put in isolation or quarantine for two weeks which meant no earning, brutality from the security personnel during curfew hours and burnout from long hours of work and high patient turnovers. CONCLUSION The COVID-19 Pandemic has led to a decline in quality of maternal and newborn service delivery by the healthcare providers as evidenced by shorter consultation time and failure to keep appointments to attend to patients. Challenges with transport, fears of losing jobs and fear of contracting COVID-19 with the limited access to personal protective equipment affected majority of the participants. The healthcare providers in Uganda despite the limitations imposed by the COVID-19 pandemic are driven by the inherent passion to serve their patients. Availability of accommodation and transport at the health facilities, provision of PPE, bonuses and inter professional teamwork are critical motivators that needed to be tapped to drive teams during the current and future pandemics.
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Affiliation(s)
- Herbert Kayiga
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | - Annettee Nakimuli
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
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Jones RM, Vesel L, Kimenju G, Ogolla T, Munson M, Little S, Rajasekharan S, Wegner MN, Langer A, Pearson N. Implementation of the INTERGROWTH-21 st gestational dating and fetal and newborn growth standards in Nairobi, Kenya: women's experiences with ultrasound and newborn assessment. Glob Health Action 2021; 13:1770967. [PMID: 32544027 PMCID: PMC7480435 DOI: 10.1080/16549716.2020.1770967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In order to make further gains in preventing newborn deaths, effective interventions are needed. Ultrasounds and newborn anthropometry are proven interventions to identify preterm birth complications, the leading cause of newborn deaths. The INTERGROWTH-21st global gestational dating and fetal and newborn growth standards prescribe optimal growth in any population. Jacaranda Health in Kenya was the first low-resource health facility to implement the standards and evaluate their feasibility and acceptability. Objective To capture patients’ perceptions of ultrasound and newborn care before and during implementation of the INTERGROWTH-21st standards. Methods The study was conducted over two years before and during the introduction of the INTERGROWTH-21st standards. Fifty pregnant and/or newly delivered women were selected for in-depth interviews and focus group discussions using convenience and purposive sampling. Interviews were conducted by research assistants using semi-structured guides once in the pre-implementation phase and twice in the implementation phase. Interviews were transcribed, double-coded by two independent researchers and thematically analyzed together. Demographic information was obtained from hospital records. Results Patients reported being generally satisfied with ultrasound care when providers communicated effectively. Women reported a priority for ultrasound was that it allowed them to feel reassured. However, a clear need for better pre-screening information emerged consistently from patients. Women noted that factors facilitating their choosing to have an ultrasound included ensuring the well-being of the fetus and learning the sex. Barriers included wait times and financial constraints. Patients were generally satisfied with care using the newborn standards. Conclusions As the INTERGROWTH-21st standards are implemented worldwide, understanding ways to facilitate implementation is critical. Increased and standardized communication about ultrasound should be provided before the procedure to increase satisfaction and uptake. Considering patient perspectives when integrating new standards or guidelines into routine clinical care will inform effective strategies in care provision, thus improving maternal and newborn health and survival.
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Affiliation(s)
- Rachel M Jones
- Department of Research & Design, Jacaranda Health , Nairobi, Kenya
| | - Linda Vesel
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , MA, USA
| | - Grace Kimenju
- Department of Research & Design, Jacaranda Health , Nairobi, Kenya
| | - Teresa Ogolla
- Department of Research & Design, Jacaranda Health , Nairobi, Kenya
| | - Meghan Munson
- Department of Research & Design, Jacaranda Health , Nairobi, Kenya
| | - Sarah Little
- Department of Research & Design, Jacaranda Health , Nairobi, Kenya
| | | | - Mary Nell Wegner
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , MA, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , MA, USA
| | - Nicholas Pearson
- Department of Research & Design, Jacaranda Health , Nairobi, Kenya
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A Descriptive-Multivariate Analysis of Community Knowledge, Confidence, and Trust in COVID-19 Clinical Trials among Healthcare Workers in Uganda. Vaccines (Basel) 2021; 9:vaccines9030253. [PMID: 33809269 PMCID: PMC8000597 DOI: 10.3390/vaccines9030253] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background—misinformation and mistrust often undermines community vaccine uptake, yet information in rural communities, especially of developing countries, is scarce. This study aimed to identify major challenges associated with coronavirus disease 2019 (COVID-19) vaccine clinical trials among healthcare workers and staff in Uganda. Methods—a rapid exploratory survey was conducted over 5 weeks among 260 respondents (66% male) from healthcare centers across the country using an online questionnaire. Twenty-seven questions assessed knowledge, confidence, and trust scores on COVID-19 vaccine clinical trials from participants in 46 districts in Uganda. Results—we found low levels of knowledge (i.e., confusing COVID-19 with Ebola) with males being more informed than females (OR = 1.5, 95% CI: 0.7–3.0), and mistrust associated with policy decisions to promote herbal treatments in Uganda and the rushed international clinical trials, highlighting challenges for the upcoming Oxford–AstraZeneca vaccinations. Knowledge, confidence and trust scores were higher among the least educated (certificate vs. bachelor degree holders). We also found a high level of skepticism and possible community resistance to DNA recombinant vaccines, such as the Oxford–AstraZeneca vaccine. Preference for herbal treatments (38/260; 14.6%, 95% CI: 10.7–19.3) currently being promoted by the Ugandan government raises major policy concerns. High fear and mistrust for COVID-19 vaccine clinical trials was more common among wealthier participants and more affluent regions of the country. Conclusion—our study found that knowledge, confidence, and trust in COVID-19 vaccines was low among healthcare workers in Uganda, especially those with higher wealth and educational status. There is a need to increase transparency and inclusive participation to address these issues before new trials of COVID-19 vaccines are initiated.
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Exploring country-wide equitable government health care facility access in Uganda. Int J Equity Health 2021; 20:38. [PMID: 33461568 PMCID: PMC7814723 DOI: 10.1186/s12939-020-01371-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor. Methods An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking, bicycling, and driving scenarios. Statistically significant clusters of high and low travel time to health centers were calculated using spatial statistics. Random Forest analysis was used to explore the relationship between poverty, population density, health center access in minutes, and time saved in travel to health centers using a bicycle instead of walking. Linear Mixed-Effects Models were then used to validate the performance of the random forest models. Results The percentage of Ugandans within a one-hour walking distance of the nearest health center II is 71.73%, increasing to 90.57% through bicycles. Bicycles increased one-hour access to the nearest health center III from 53.05 to 80.57%, increasing access to the tiered integrated national laboratory system by 27.52 percentage points. Significant clusters of low health center access were associated with areas of high poverty and urbanicity. A strong direct relationship between travel time to health center and poverty exists at all health center levels. Strong disparities between urban and rural populations exist, with rural poor residents facing disproportionately long travel time to health center compared to wealthier urban residents. Conclusions The results of this study highlight how the most vulnerable Ugandans, who are the least likely to afford transportation, experience the highest prohibitive travel distances to health centers. Bicycles appear to be a “pro-poor” tool to increase health access equity. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01371-5.
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Bypassing or successful referral? A population-based study of reasons why women travel far for childbirth in Eastern Uganda. BMC Pregnancy Childbirth 2020; 20:497. [PMID: 32854629 PMCID: PMC7457236 DOI: 10.1186/s12884-020-03194-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Delivery in a facility with a skilled health provider is considered the most important intervention to reduce maternal and early newborn deaths. Providing care close to people’s homes is an important strategy to facilitate equitable access, but many women are known to bypass the closest delivery facility for a higher level one. The aim of this study was to investigate to what extent mothers in rural Uganda bypassed their nearest facility for childbirth care and the determinants for their choice. Methods The study used data collected as part of the Expanded Quality Management Using Information power (EQUIP) study in the Mayuge District of Eastern Uganda between 2011 and 2014. In this study, bypassing was defined as delivering in a health facility that was not the nearest childbirth facility to the mother’s home. Multilevel logistic regression was used to model the relationship between bypassing the nearest health facility for childbirth and the different independent factors. Results Of all women delivering in a health facility, 45% (499/1115) did not deliver in the nearest facility regardless of the level of care. Further, after excluding women who delivered in health centre II (which is not formally equipped to provide childbirth care) and excluding those who were referred or had a caesarean section (because their reasons for bypassing may be different), 29% (204/717) of women bypassed their nearest facility to give birth in another facility, 50% going to the only hospital of the district. The odds of bypassing increased if a mother belonged to highest wealth quintile compared to the lowest quintile (AOR 2.24, 95% CI: 1.12–4.46) and decreased with increase of readiness of score of the nearest facility for childbirth (AOR = 0.84, 95% CI: 0.69–0.99). Conclusions The extent of bypassing the nearest childbirth facility in this rural Ugandan setting was 29%, and was associated primarily with the readiness of the nearest facility to provide care as well as the wealth of the household. These results suggest inequalities in bypassing for better quality care that have important implications for improving Uganda’s maternal and newborn health outcomes.
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Kim MK, Arsenault C, Atuyambe LM, Macwan'gi M, Kruk ME. Determinants of healthcare providers' confidence in their clinical skills to deliver quality obstetric and newborn care in Uganda and Zambia. BMC Health Serv Res 2020; 20:539. [PMID: 32539737 PMCID: PMC7296707 DOI: 10.1186/s12913-020-05410-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022] Open
Abstract
Background Poor quality obstetric and newborn care persists in sub-Saharan Africa and weak provider competence is an important contributor. To be competent, providers need to be both knowledgeable and confident in their ability to perform necessary clinical actions. Confidence or self-efficacy has not been extensively studied but may be related to individuals’ knowledge, ability to practice their skills, and other modifiable factors. In this study, we investigated how knowledge and scope of practice are associated with provider confidence in delivering obstetric and newborn health services in Uganda and Zambia. Methods This study was a secondary analysis of data from an obstetric and newborn care program implementation evaluation. Provider knowledge, scope of practice (completion of a series of obstetric tasks in the past 3 months) and confidence in delivering obstetric and newborn care were measured post intervention in intervention and comparison districts in Uganda and Zambia. We used multiple linear regression models to investigate the extent to which exposure to a wider range of clinical tasks associated with confidence, adjusting for facility and provider characteristics. Results Of the 574 providers included in the study, 69% were female, 24% were nurses, and 6% were doctors. The mean confidence score was 71%. Providers’ mean knowledge score was 56% and they reported performing 57% of basic obstetric tasks in the past 3 months. In the adjusted model, providers who completed more than 69% of the obstetric tasks reported a 13-percentage point (95% CI 0.08, 0.17) higher confidence than providers who performed less than 50% of the tasks. Female providers and nurses were considerably less confident than males and doctors. Provider knowledge was moderately associated with provider confidence. Conclusions Our study showed that scope of practice (the range of clinical tasks routinely performed by providers) is an important determinant of confidence. Ensuring that providers are exposed to a variety of services is crucial to support improvement in provider confidence and competence. Policies to improve provider confidence and pre-service training should also address differences by gender and by cadres.
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Affiliation(s)
- Min Kyung Kim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith Street, Boston, MA, 02120, USA.
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith Street, Boston, MA, 02120, USA
| | - Lynn M Atuyambe
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Mubiana Macwan'gi
- Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith Street, Boston, MA, 02120, USA
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Kakongi N, Rukundo GZ, Gelaye B, Wakida EK, Obua C, Okello ES. Exploring pathways to Hospital Care for Patients with Alzheimer's disease and related dementias in rural South Western Uganda. BMC Health Serv Res 2020; 20:498. [PMID: 32493309 PMCID: PMC7268702 DOI: 10.1186/s12913-020-05365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In order to analyze use of health services and identify sources of delays in accessing the right care for patients with Alzheimer's disease and related dementias (AD/ADRD), understanding of care seeking pathways is needed. The objectives of this study were: (i) to explore pathways to hospital care for patients with AD/ADRD and (ii) to describe challenges experienced by the patients and their families while seeking health care. METHODS Using purposive sampling, 30-in-depth, semi-structured interviews were conducted among caregivers of older adults diagnosed with dementia from rural Southwestern, Uganda. Data was analyzed using ATLAS. Ti software. RESULTS There was variability in pathways to care from individual to individual. There was one broader theme captured: points of care choice with four broader categories: hospitals, clinics, places of religious worship and traditional healers' shrines, each with its facilitating factors, outcomes and challenges encountered. Most of the respondents reported use of hospitals at first and second visit to the health care point but places of religious worship became more common from third to sixth health care encounter. Major improvements (58.1%) were observed on hospital use but little or no help with prayers, clinics and traditional healers. The challenges experienced with formal points of care focused on lack and cost of prescribed drugs, weakening effect of the drugs, lack of skills to manage the condition, and lack of improvement in quality of life. These challenges together with knowledge gap about the disease and belief in spiritual healing facilitated the shift from formal to informal health care pathways, more particularly the places of religious worship. CONCLUSIONS Our study findings indicate that caregivers/families of patients with dementia went to different places both formal and informal care settings while seeking health care. However, hospital point of care was more frequent at initial health care visits while places of worship took the lead at subsequent visits. Although no specific pathway reported, most of them begin with hospital (formal) and end with non-formal. We recommend that health systems carry out public awareness on dementia.
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Affiliation(s)
- Nathan Kakongi
- Department of Biochemistry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Edith K. Wakida
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
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Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia. PLoS One 2019; 14:e0214750. [PMID: 30969979 PMCID: PMC6457564 DOI: 10.1371/journal.pone.0214750] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/19/2019] [Indexed: 12/16/2022] Open
Abstract
Despite the removal of user fees on public primary healthcare in Zambia, prior studies suggest that out-of-pocket payments are still significant. However, we have little understanding of the extent to which out-of-pocket payments lead patients to hardship methods of financing out-of-pocket costs. This study analyses the prevalence and determinants of hardship financing arising from out-of-pocket payments in healthcare, using data from a nationally-representative household health expenditure survey conducted in 2014. We employ a sequential logistic regression model to examine the factors associated with the risk of hardship financing conditional on reporting an illness and an out-of-pocket expenditure. The results show that up to 11% of households who reported an illness had borrowed money, or sold items or asked a friend for help, or displaced other household consumption in order to pay for health care. The risk of hardship financing was higher among the poorest households, female headed-households and households who reside further from health facilities. Improvements in physical access and quality of public health services have the potential to reduce the incidence of hardship financing especially among the poorest.
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Munabi-Babigumira S, Glenton C, Willcox M, Nabudere H. Ugandan health workers' and mothers' views and experiences of the quality of maternity care and the use of informal solutions: A qualitative study. PLoS One 2019; 14:e0213511. [PMID: 30856217 PMCID: PMC6411106 DOI: 10.1371/journal.pone.0213511] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 02/22/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Although the coverage of maternity services in some low and middle-income countries (LMIC) has greatly improved, the quality of maternity care remains poor, and maternal mortality rates are high. In this study, we describe the meaning and determinants of maternity care quality from the perspective of health workers and mothers in Uganda, the informal solutions used by health workers to manage their daily challenges, and we suggest ways in which maternal care quality can be improved. METHODS We conducted a qualitative study in the Mpigi and Rukungiri districts of Uganda. Twenty-eight health workers based at selected health centres participated in structured interviews. Thirty-six mothers, half of whom had delivered at health facilities, participated in focus group discussions. Data were analysed thematically, and informed by the WHO framework on quality of care for maternal and newborn health and by Lipsky's street level bureaucracy concept. RESULTS According to health workers, knowledge of clinical standards and processes, timeliness, and women's choice during labour, as well as resources, physical infrastructure; collaboration with mothers, professionals and community health workers; were important aspects of good quality care. Mothers' perceptions of good quality care were largely similar to health workers' views, though mothers were more concerned about health workers' interaction skills. Structural challenges sometimes led health workers to develop informal solutions such as asking mothers to purchase their own supplies with variable implications on the quality of care. While several of these informal solutions were useful in addressing bottlenecks in the health system, they sometimes placed additional burdens and personal costs on health workers, created mistrust, inequity in care and negative experiences among mothers who could not afford the extra costs. CONCLUSIONS Health system structural factors; including technical, interpersonal, resource and infrastructural factors; impede the provision and experience of good quality maternity care at health centres in Uganda. Improving the quality of care will require strategies that address these core problems in the health system structure. Such structural reforms will require political support to commit resources, skilful management and leadership that seek to change organisational behaviour and build trust through good quality, woman-centred maternity care.
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Affiliation(s)
- Susan Munabi-Babigumira
- Global Health Unit, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Claire Glenton
- Global Health Unit, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Mutebi A, Muhumuza Kananura R, Ekirapa-Kiracho E, Bua J, Namusoke Kiwanuka S, Nammazi G, Paina L, Tetui M. Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services. Glob Health Action 2018; 10:1347363. [PMID: 28856988 PMCID: PMC5645720 DOI: 10.1080/16549716.2017.1347363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services. Objective: To understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda. Methods: This was a cross-sectional descriptive study that employed both quantitative and qualitative data collection techniques. Data on the characteristics of community-based savings groups (CBSGs) were collected from 247 CBSG leaders in the districts of Kamuli, Kibukuand Pallisa using self-administered open-ended questionnaires. To triangulate the findings, we conducted in-depth interviews with seven CBSG leaders. Descriptive quantitative and content analysis for qualitative data was undertaken respectively. Results: Almost a quarter of the savings groups had 5–14 members and slightly more than half of the saving groups had 15–30 members. Ninety-three percent of the CBSGs indicated electing their management committees democratically to select the group leaders and held meetings at least once a week. Eighty-nine percent of the CBSGs had used metallic boxes to keep their money, while 10% of the CBSGs kept their money using mobile money and banks,respectively. The main reasons for the formation of CBSGs were to increase household income, developing the community and saving for emergencies. The most common challenges associated with CBSG management included high illiteracy (35%) among the leaders,irregular attendance of meetings (22%), and lack of training on management and leadership(19%). The qualitative findings agreed with the quantitative findings and served to triangulate the main results. Conclusions: Saving groups in Uganda have the basic required structures; however, challenges exist in relation to training and management of the groups and their assets. The government and development partners should work together to provide technical support to the groups.
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Affiliation(s)
- Aloysius Mutebi
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Rornald Muhumuza Kananura
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Elizabeth Ekirapa-Kiracho
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - John Bua
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Suzanne Namusoke Kiwanuka
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Getrude Nammazi
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda.,b Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda
| | - Ligia Paina
- c Department of International Health , Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Moses Tetui
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda.,d Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
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Ekirapa-Kiracho E, Paina L, Muhumuza Kananura R, Mutebi A, Jane P, Tumuhairwe J, Tetui M, Kiwanuka SN. 'Nurture the sprouting bud; do not uproot it'. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda. Glob Health Action 2018; 10:1347311. [PMID: 28820046 PMCID: PMC5645701 DOI: 10.1080/16549716.2017.1347311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. Objectives: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. Methods: This qualitative study was done in three districts in Eastern Uganda. Saving groups were identified and provided with support to enhance members’ access to maternal and newborn health. Fifteen focus group discussions (FGDs) and 18 key informant interviews (KIIs) were conducted to elicit members’ views about saving practices. Document review was undertaken to identify key lessons for supporting saving groups. Qualitative data are presented thematically. Results: Awareness of the importance of saving, safe custody of money saved, flexible saving arrangements and easy access to loans for personal needs including transport during obstetric emergencies increased willingness to save with saving groups. Saving groups therefore provided a safety net for the poor during emergencies. Poor management of saving groups and detrimental economic practices like gambling constrained saving. Efficient running of saving groups requires that they have a clear management structure, which is legally registered with relevant authorities and that it is governed by a constitution. Conclusions: Saving groups were considered a useful form of saving that enabled easy acess to cash for birth preparedness and transportation during emergencies. They are like ‘a sprouting bud that needs to be nurtured rather than uprooted’, as they appear to have the potential to act as a safety net for poor communities that have no health insurance. Local governments should therefore strengthen the management capacity of saving groups so as to ensure their efficient running through partnerships with non-governmental organizations that can provide support to such groups.
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Affiliation(s)
- Elizabeth Ekirapa-Kiracho
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Ligia Paina
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Rornald Muhumuza Kananura
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Aloysius Mutebi
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Pacuto Jane
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | | | - Moses Tetui
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda.,d Department of Public Health and Clinical Medicine Sweden , Umeå University, Epidemiology and Global Health Unit , Umeå , Sweden
| | - Suzanne N Kiwanuka
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
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Can Urban-Rural Patterns of Hospital Selection Be Changed Using a Report Card Program? A Nationwide Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091827. [PMID: 30149514 PMCID: PMC6164887 DOI: 10.3390/ijerph15091827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/13/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022]
Abstract
Background: Guiding patients to choose high-quality healthcare providers helps ensure that patients receive excellent care and helps reduce health disparities among patients of different socioeconomic backgrounds. The purpose of this study was to examine and compare the effect of implementing a report-card program on the patterns of hospital selection in patients from different socioeconomic subgroups. Patients undergoing total knee replacement (TKR) surgery were used as the sample population. Methods: A patient-level, retrospective, observational and cross-sectional study design was conducted. Taiwan National Health Insurance claims data were used and all patients in this database who had received TKR between April 2007–March 2008 (prior to report-card program implementation) and between April 2009–March 2010 (after program implementation) were included. Those patients who were under 18 years of age or who lacked area-of-residence or National Health Insurance premium information were excluded. Travelling distance to the hospital and level of hospital performance were used to evaluate the effect of the report-card program. Results: A total of 32,821 patients were included in this study. The results showed that patterns of hospital selection varied based on the socioeconomic characteristics of patients. In terms of travelling distance and hospital selection, the performance of urban and higher income patients was shorter and better, respectively, than their rural and lower-income peers both before and after report-card-program implementation. Moreover, although the results of multivariate analysis showed that the urban-rural difference in travelling distance enlarged (by 4.75 km) after implementation of the report-card program, this increase was shown to not be significantly related to this program. Furthermore, the results revealed that implementation of the report-card program did not significantly affect the urban-rural difference in terms of level of hospital performance. Conclusions: A successful report-card program should ensure that patients in all socioeconomic groups obtain comprehensive information. However, the results of this study indicate that those in higher socioeconomic subgroups attained more benefits from the program than their lower-subgroup peers. Ensuring that all have equal opportunity to access high-quality healthcare providers may therefore be the next issue that needs to be addressed and resolved.
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Birhanu TM, Birarra MK, Mekonnen FA. Compliance to iron and folic acid supplementation in pregnancy, Northwest Ethiopia. BMC Res Notes 2018; 11:345. [PMID: 29848380 PMCID: PMC5977755 DOI: 10.1186/s13104-018-3433-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/11/2018] [Indexed: 11/20/2022] Open
Abstract
Objective Strict compliance to iron and folic acid supplementation is vital for prevention of anemia in pregnancy. However, data are scarce in Ethiopia. So, we conducted this study to assess the level of compliance to iron and folic acid supplementation during pregnancy and its associated factors. Results Of 418 women, over half, 231 (55.3%), adhered to the recommended iron and folic acid supplementation. Women who started antenatal care (ANC) follow up early [AOR; 95% CI 2.43 (1.12–5.26)], had more frequent number of ANC visit [AOR; 95% CI 2.73 (1.32–5.61)], took small number of tablets per visit [AOR; 95% CI 3.0 (1.21–7.43)], had history of anemia [AOR; 95% CI 1.9 (1.17–3.12)], and were from urban areas [AOR; 95% CI 2.2 (1.29–3.77)], were more likely to conform to recommended iron and folic acid supplementation. Therefore, there need to be prescription of the lowest possible number of tablets per visit. Furthermore, education targeting on increasing maternal health service utilization need to be in place. There need to also be further research aimed at determining the number of tablets to be prescribed per visit specific to individuals’ background characteristics.
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Affiliation(s)
- Tesfaye Molla Birhanu
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mequanent Kassa Birarra
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Ayenew Mekonnen
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Robert E, Samb OM, Marchal B, Ridde V. Building a middle-range theory of free public healthcare seeking in sub-Saharan Africa: a realist review. Health Policy Plan 2018; 32:1002-1014. [PMID: 28520961 PMCID: PMC5886156 DOI: 10.1093/heapol/czx035] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 11/16/2022] Open
Abstract
Realist reviews are a new form of knowledge synthesis aimed at providing middle-range theories (MRTs) that specify how interventions work, for which populations, and under what circumstances. This approach opens the ‘black box’ of an intervention by showing how it triggers mechanisms in specific contexts to produce outcomes. We conducted a realist review of health user fee exemption policies (UFEPs) in sub-Saharan Africa (SSA). This article presents how we developed both the intervention theory (IT) of UFEPs and a MRT of free public healthcare seeking in SSA, building on Sen’s capability approach. Over the course of this iterative process, we explored theoretical writings on healthcare access, services use, and healthcare seeking behaviour. We also analysed empirical studies on UFEPs and healthcare access in free care contexts. According to the IT, free care at the point of delivery is a resource allowing users to make choices about their use of public healthcare services, choices previously not generally available to them. Users’ ability to choose to seek free care is influenced by structural, local, and individual conversion factors. We tested this IT on 69 empirical studies selected on the basis of their scientific rigor and relevance to the theory. From that analysis, we formulated a MRT on seeking free public healthcare in SSA. It highlights three key mechanisms in users’ choice to seek free public healthcare: trust, risk awareness and acceptability. Contextual elements that influence both users’ ability and choice to seek free care include: availability of and control over resources at the individual level; characteristics of users’ and providers’ communities at the local level; and health system organization, governance and policies at the structural level.
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Affiliation(s)
- Emilie Robert
- Research Institute of the McGill University Health Centre (RI-MUHC), Montréal, QC, Canada.,Division of Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada.,Equipe de recherche et d'intervention transculturelles (ERIT), CSSS de la Montagne, Montréal, QC
| | - Oumar Mallé Samb
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada.,Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, QC, Canada
| | - Bruno Marchal
- Institute of Tropical Medicine of Antwerp, Health Services Management Unit, Antwerp, Belgium
| | - Valéry Ridde
- School of public health (ESPUM), Montreal University, Montréal, QC, Canada.,University of Montreal Public Health Research Institute (IRSPUM), Montréal, QC, Canada
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Ekirapa-Kiracho E, Ghosh U, Brahmachari R, Paina L. Engaging stakeholders: lessons from the use of participatory tools for improving maternal and child care health services. Health Res Policy Syst 2017; 15:106. [PMID: 29297336 PMCID: PMC5751791 DOI: 10.1186/s12961-017-0271-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Effective stakeholder engagement in research and implementation is important for improving the development and implementation of policies and programmes. A varied number of tools have been employed for stakeholder engagement. In this paper, we discuss two participatory methods for engaging with stakeholders – participatory social network analysis (PSNA) and participatory impact pathways analysis (PIPA). Based on our experience, we derive lessons about when and how to apply these tools. Methods This paper was informed by a review of project reports and documents in addition to reflection meetings with the researchers who applied the tools. These reports were synthesised and used to make thick descriptions of the applications of the methods while highlighting key lessons. Results PSNA and PIPA both allowed a deep understanding of how the system actors are interconnected and how they influence maternal health and maternal healthcare services. The findings from the PSNA provided guidance on how stakeholders of a health system are interconnected and how they can stimulate more positive interaction between the stakeholders by exposing existing gaps. The PIPA meeting enabled the participants to envision how they could expand their networks and resources by mentally thinking about the contributions that they could make to the project. The processes that were considered critical for successful application of the tools and achievement of outcomes included training of facilitators, language used during the facilitation, the number of times the tool is applied, length of the tools, pretesting of the tools, and use of quantitative and qualitative methods. Conclusions Whereas both tools allowed the identification of stakeholders and provided a deeper understanding of the type of networks and dynamics within the network, PIPA had a higher potential for promoting collaboration between stakeholders, likely due to allowing interaction between them. Additionally, it was implemented within a participatory action research project. PIPA also allowed participatory evaluation of the project from the perspective of the community. This paper provides lessons about the use of these participatory tools. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0271-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
| | - Upasona Ghosh
- IIHMR University, 1 Prabhu Dayal Marg, Sanganer, Jaipur, 302029, India
| | | | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States of America
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Kabwama SN, Mafigiri R, Balinandi S, Kagirita A, Riolexus AA, Zhu BP. Risk factors for hematemesis in Hoima and Buliisa Districts, Western Uganda, September-October 2015. Pan Afr Med J 2017; 28:215. [PMID: 29610653 PMCID: PMC5878846 DOI: 10.11604/pamj.2017.28.215.12395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 10/28/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction On 17 September 2015, Buliisa District Health Office reported multiple deaths due to haemorrhage to the Uganda Ministry of Health. We conducted an investigation to verify the existence of an outbreak and to identify the disease nature, mode of transmission and risk factors. Methods We defined a suspected case as onset of hematemesis between 1 June 2015 and 15 October 2015 in a resident of Hoima, Buliisa or neighbouring districts. We identified cases by reviewing medical records and actively searching in the community. We interviewed case-patients and health-care workers and performed descriptive epidemiology to generate hypotheses on possible exposures. In a case-control study we compared exposures between 21 cases and 81 controls, matched by age (± 10 years), sex and village of residence. We collected 22 biological specimens from 19 case-patients to test for Viral Haemorrhagic Fevers (VHF). We analysed the data using the Mantel-Haenszel method to account for the matched study design. Results We identified 56 cases with onset from June to October (attack rate 15/100,000 in Buliisa District and 5.2/100,000 in Hoima District). The age-specific attack rate was highest in persons aged 31-60 years (15/100,000 in Hoima and 47/100,000 in Buliisa); no persons below 15 years of age had the illness. In the case-control study, 42% (5/12) of cases vs. 0.0% (0/77) of controls had liver disease (ORM-H = ∞; 95%CI = 3.7-∞); 71% (10/14) of cases vs. 35% (28/81) of controls had ulcer disease (ORM-H = 13; 95% CI = 1.6-98); 27% (3/11) of cases vs. 14% (11/81) of controls used indomethacin prior to disease onset (ORM-H = 6.0; 95% CI = 1.0-36). None of the blood samples were positive for any of the VHFs. Conclusion This reported cluster of hematemesis illness was due to predisposing conditions and use of Non-Steroidal Anti-inflammatory Drugs (NSAID). Health education should be conducted on the danger of NSAIDs misuse, especially in persons with pre-disposing conditions.
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Affiliation(s)
- Steven Ndugwa Kabwama
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Richardson Mafigiri
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | | | - Atek Kagirita
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Alex Ario Riolexus
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Kampala, Uganda
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Shumba CS, Kabali K, Miyonga J, Mugadu J, Lakidi L, Kerchan P, Tumwesigye T. Client satisfaction in a faith-based health network: findings from a survey in Uganda. Afr Health Sci 2017; 17:942-953. [PMID: 29085423 PMCID: PMC5656196 DOI: 10.4314/ahs.v17i3.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Client satisfaction surveys are important in evaluating quality of the healthcare processes and contribute to health service improvements by assisting health program managers to develop appropriate strategies. The goal of this study was to assess clients' level of satisfaction with services provided by private-not-for-profit member health facilities affiliated to Uganda Protestant Medical Bureau. Methods This was a cross-sectional descriptive study using an interviewer-administered questionnaire conducted in 254/278 (91%) of UPMB member health facilities between 27th April and 14th July 2014 among 927 clients. The tool measured ten dimensions of the care-seeking experience namely; health facility access; waiting time; health providers; support staff; rights; payments; facilities and environment; consent; confidentiality; and the overall care seeking experience. Logistic regression was utilised for multivariate analysis. Results Overall client satisfaction was found to be high within the UPMB network (84.2%). Most of the client satisfaction dimensions were rated above 70% except payments and rights. There was evidence of association with marital status; single/never married were 3.05 times more likely to be dissatisfied compared to widowed. Clients attending HCIII were less likely to be dissatisfied compared to those attending HCII (OR=0.51, 95% CI: 0.25–1.05). Post-secondary education (OR=1.79; 95% CI 1.01–3.17), being formally employed (OR=2.78, 95% CI: 0.91–8.48) or unemployed (OR=3.34, 95% CI: 1.00–11.17), attendance at a hospital (OR=2.15, 95% CI: 1.36– 3.41) were also associated with high dissatisfaction levels with payments. Conclusion This study found a high level of satisfaction with services in the UPMB network but recorded low client satisfaction with the dimensions of rights and payments. Health workers should take time to explain rights and entitlement as well as charges levied to clients.
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Affiliation(s)
| | - Kenneth Kabali
- Uganda Protestant Medical Bureau, 877 Balintuma Road, Mengo, Kampala, Uganda
| | - Jonathan Miyonga
- Uganda Protestant Medical Bureau, 877 Balintuma Road, Mengo, Kampala, Uganda
| | - Jairus Mugadu
- Uganda Protestant Medical Bureau, 877 Balintuma Road, Mengo, Kampala, Uganda
| | - Luke Lakidi
- Uganda Protestant Medical Bureau, 877 Balintuma Road, Mengo, Kampala, Uganda
| | - Patrick Kerchan
- Uganda Protestant Medical Bureau, 877 Balintuma Road, Mengo, Kampala, Uganda
| | - Tonny Tumwesigye
- Uganda Protestant Medical Bureau, 877 Balintuma Road, Mengo, Kampala, Uganda
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Kambala C, Lohmann J, Mazalale J, Brenner S, Sarker M, Muula AS, De Allegri M. Perceptions of quality across the maternal care continuum in the context of a health financing intervention: Evidence from a mixed methods study in rural Malawi. BMC Health Serv Res 2017; 17:392. [PMID: 28595576 PMCID: PMC5465597 DOI: 10.1186/s12913-017-2329-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/22/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2013, Malawi with its development partners introduced a Results-Based Financing for Maternal and Newborn Health (RBF4MNH) intervention to improve the quality of maternal and newborn health-care services. Financial incentives are awarded to health facilities conditional on their performance and to women for delivering in the health facility. We assessed the effect of the RBF4MNH on quality of care from women's perspectives. METHODS We used a mixed-method prospective sequential controlled pre- and post-test design. We conducted 3060 structured client exit interviews, 36 in-depth interviews and 29 focus group discussions (FGDs) with women and 24 in-depth interviews with health service providers between 2013 and 2015. We used difference-in-differences regression models to measure the effect of the RBF4MNH on experiences and perceived quality of care. We used qualitative data to explore the matter more in depth. RESULTS We did not observe a statistically significant effect of the intervention on women's perceptions of technical care, quality of amenities and interpersonal relations. However, in the qualitative interviews, most women reported improved health service provision as a result of the intervention. RBF4MNH increased the proportion of women reporting to have received medications/treatment during childbirth. Participants in interviews expressed that drugs, equipment and supplies were readily available due to the RBF4MNH. However, women also reported instances of neglect, disrespect and verbal abuse during the process of care. Providers attributed these negative instances to an increased workload resulting from an increased number of women seeking services at RBF4MNH facilities. CONCLUSION Our qualitative findings suggest improvements in the availability of drugs and supplies due to RBF4MNH. Despite the intervention, challenges in the provision of quality care persisted, especially with regard to interpersonal relations. RBF interventions may need to consider including indicators that specifically target the provision of respectful maternity care as a means to foster providers' positive attitudes towards women in labour. In parallel, governments should consider enhancing staff and infrastructural capacity before implementing RBF.
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Affiliation(s)
- Christabel Kambala
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
- Environmental Health Department, The Malawi Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - Julia Lohmann
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
| | - Jacob Mazalale
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Stephan Brenner
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
| | - Malabika Sarker
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
- James P. Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka, 1212 Bangladesh
| | - Adamson S. Muula
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Manuela De Allegri
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
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Scheel JR, Molina Y, Patrick DL, Anderson BO, Nakigudde G, Lehman CD, Thompson B. Breast Cancer Downstaging Practices and Breast Health Messaging Preferences Among a Community Sample of Urban and Rural Ugandan Women. J Glob Oncol 2017; 3:105-113. [PMID: 28503660 PMCID: PMC5424549 DOI: 10.1200/jgo.2015.001198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Among a community sample of Ugandan women, we provide information about breast cancer downstaging practices (breast self-examination, clinical breast examination [CBE]) and breast health messaging preferences across sociodemographic, health care access, and prior breast cancer exposure factors. METHODS Convenience-based sampling was conducted to recruit Ugandan women age 25 years and older to assess breast cancer downstaging practices as well as breast health messaging preferences to present early for a CBE in the theoretical scenario of self-detection of a palpable lump (breast health messaging preferences). RESULTS The 401 Ugandan women who participated in this survey were mostly poor with less than a primary school education. Of these women, 27% had engaged in breast self-examination, and 15% had undergone a CBE. Greater breast cancer downstaging practices were associated with an urban location, higher education, having a health center as a regular source of care, and receiving breast cancer education (P < .05). Women indicated a greater breast health messaging preference from their provider (66%). This preference was associated with a rural location, having a health center as a regular source of care, and receiving breast cancer education (P < .05). CONCLUSION Most Ugandan women do not participate in breast cancer downstaging practices despite receipt of breast cancer education. However, such education increases downstaging practices and preference for messaging from their providers. Therefore, efforts to downstage breast cancer in Uganda should simultaneously raise awareness in providers and support improved education efforts in the community.
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Affiliation(s)
- John R Scheel
- University of Washington; Seattle Cancer Care Alliance
| | | | | | - Benjamin O Anderson
- University of Washington; Fred Hutchinson Cancer Research Center, Seattle, WA
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Ssali A, Poland F, Seeley J. Exploring informed consent in HIV clinical trials: A case study in Uganda. Heliyon 2016; 2:e00196. [PMID: 27872904 PMCID: PMC5110465 DOI: 10.1016/j.heliyon.2016.e00196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/29/2016] [Accepted: 11/09/2016] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In settings with low literacy levels ensuring that participants are fully-informed before they consent to participate in clinical trials is a challenge. We explored the experiences and concerns of key actors in the informed consent process in two HIV clinical trials. METHOD Semi-structured interviews were conducted with 46 respondents including trial participants, research study team and research ethics committee members about their experiences during the informed consent process. Three focus group discussions were conducted with 14 Community Advisory Board (CAB) members and 17 trial participants. Data were analysed to identify key themes. FINDINGS The consent process was highlighted as an important procedure by all the key actors however each group had a particular area of emphasis. Signing a consent form was given importance by research team and ethics committee members, because it provided documented evidence of a participant's willingness to join a clinical trial. Participants did not welcome the presence of a witness for a non-literate participant because understanding study information was not closely related to an ability to read and write. CONCLUSION This study's findings indicated that obtaining a volunteer's signature or thumbprint on a consent form did not necessarily mean that the participant was fully-informed about the information relevant to their taking part nor that they understood all the information shared with them. Informed consent requires sufficient time in the research process to have staff trained well enough before research begins. Ensuring and gaining informed consent should be understood and treated as a relation-centred, dynamic supportive process throughout the duration of a research study.
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Affiliation(s)
- Agnes Ssali
- Medical Research Council/UVRI Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda
| | | | - Janet Seeley
- Medical Research Council/UVRI Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Gage AJ, Ilombu O, Akinyemi AI. Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis. BMC Pregnancy Childbirth 2016; 16:297. [PMID: 27716208 PMCID: PMC5054586 DOI: 10.1186/s12884-016-1097-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Existing studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services. Methods Using linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15–49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs. Results The health facility delivery rate increased from 25.4 % in 2005 to 44.1 % in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery. Conclusion Supply-side factors appeared to play a role in health facility delivery after controlling for socio-demographic factors. Improving uptake of delivery care would require greater attention to rural–urban inequities and health facility management practices, and to increasing the number of health facilities with fundamental elements for delivery of basic emergency obstetric and neonatal care. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1097-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anastasia J Gage
- Department of Global Community Health and Behavioral Sciences, Tulane University, 1440 Canal Street, Suite 2200-22 Mail code: 8319, New Orleans, LA, 70112-2824, USA
| | - Onyebuchi Ilombu
- Independent Researcher, 212 Loyola Avenue, Apartment 1105, New Orleans, LA, 70112, USA
| | - Akanni Ibukun Akinyemi
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, Nigeria.
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Atuyambe LM, Baingana RK, Kibira SPS, Katahoire A, Okello E, Mafigiri DK, Ayebare F, Oboke H, Acio C, Muggaga K, Mbalinda S, Nabaggala R, Ruzaaza G, Arubaku W, Mary S, Akera P, Tumwine JK, Peters DH, Sewankambo NK. Undergraduate students' contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda. BMC MEDICAL EDUCATION 2016; 16:123. [PMID: 27114073 PMCID: PMC4843200 DOI: 10.1186/s12909-016-0626-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/05/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND It has been realised that there is need to have medical training closer to communities where the majority of the population lives in order to orient the trainees' attitudes towards future practice in such communities. Although community based education (CBE) has increasingly been integrated into health professions curricula since the 1990s, the contribution students make to service delivery during CBE remains largely undocumented. In this study, we examined undergraduate health professions students' contribution to primary health care during their CBE placements. METHODS This was a qualitative study involving the Medical Education for Equitable Services to All Ugandans consortium (MESAU). Overall, we conducted 36 Focus Group Discussions (FGDs): one each with youth, men and women at each of 12 CBE sites. Additionally, we interviewed 64 community key-informants. All data were audio-recorded, transcribed and analysed using qualitative data analysis software Atlas.ti Ver7. RESULTS Two themes emerged: students' contribution at health facility level and students' contribution at community level. Under theme one, we established that students were not only learning; they also contributed to delivery of health services at the facilities. Their contribution was highly appreciated especially by community members. Students were described as caring and compassionate, available on time and anytime, and as participating in patient care. They were willing to share their knowledge and skills, and stimulated discussion on work ethics. Under the second theme, students were reported to have participated in water, sanitation, and hygiene education in the community. Students contributed to maintenance of safe water sources, educated communities on drinking safe water and on good sanitation practices (hand washing and proper waste disposal). Hygiene promotion was done at household level (food hygiene, hand washing, cleanliness) and to the public. Public health education was extended to institutions. School pupils were sensitised on various health-related issues including sexuality and sexual health. CONCLUSION Health professions students at the MESAU institutions contribute meaningfully to primary health care delivery. We recommend CBE to all health training programs in sub-Saharan Africa.
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Affiliation(s)
- Lynn M. Atuyambe
- />Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences, New Mulago Hospital Complex-School of Public Health Building Suite nr 307, P.O. Box 7072, Kampala, Uganda
| | - Rhona K. Baingana
- />School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon P. S. Kibira
- />Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences, New Mulago Hospital Complex-School of Public Health Building Suite nr 307, P.O. Box 7072, Kampala, Uganda
| | - Anne Katahoire
- />School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elialilia Okello
- />School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David K. Mafigiri
- />School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Florence Ayebare
- />Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Henry Oboke
- />Faculty of Medicine, Gulu University, Kampala, Uganda
| | - Christine Acio
- />Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- />School of Health Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Kintu Muggaga
- />Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- />School of Health Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Scovia Mbalinda
- />School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ruth Nabaggala
- />Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gad Ruzaaza
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Wilfred Arubaku
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Samantha Mary
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Peter Akera
- />Faculty of Medicine, Gulu University, Kampala, Uganda
| | - James K. Tumwine
- />School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David H. Peters
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nelson K. Sewankambo
- />Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
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Yu TH, Chung KP, Wei CJ, Chien KL, Hou YC. Do the Preferences of Healthcare Provider Selection Vary among Rural and Urban Patients with Different Income and Cause Different Outcome? PLoS One 2016; 11:e0152776. [PMID: 27054711 PMCID: PMC4824465 DOI: 10.1371/journal.pone.0152776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/19/2016] [Indexed: 11/18/2022] Open
Abstract
Background Equal access to healthcare facilities and high-level quality of care are important strategies to eliminate the disparity in outcome of care. However, the existing literature regarding how urban or rural dwelling patients with different income level select healthcare providers is insufficient. The purposes of this study were to examine whether differences of healthcare provider selection exist among urban and rural coronary artery bypass surgery (CABG) patients with different income level. If so, we further investigated the associated impact on mortality. Methods A retrospective, multilevel study design was conducted using claims data from 2007–2011 Taiwan’s Universal Health Insurance Scheme. Healthcare providers’ performance and patients’ travelling distance to hospitals were used to define the patterns of healthcare provider selection. Baron and Kenny’s procedures for mediation effect were conducted. Results There were 10,108 CABG surgeries included in this study. The results showed that urban dwelling and higher income patients were prone to receive care from better-performance providers. The travelling distances of urban dwelling patients was 15 KM shorter, especially when they received better-performance provider’s care. The results also showed that the difference of healthcare provider selection and mortality rate existed between rural and urban dwelling patients with different income levels. After the procedure of mediation effect testing, the results showed that the healthcare provider selection partially mediated the relationships between patients’ residential areas with different income levels and 30-day mortality. Conclusion Preferences of healthcare provider selection vary among rural and urban patients with different income, and such differences partially mediated the outcome of care. Health authorities should pay attention to this issue, and propose appropriate solutions to eliminate the disparity in outcome of CABG care.
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Affiliation(s)
- Tsung-Hsien Yu
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Chung-Jen Wei
- Department of Public Health, Fu-Jen Catholic University, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Chang Hou
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
- Department of Chinese Medicine, Tao-Yuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Department of Bioscience Technology, Chuan-Yuan Christian University, Taoyuan, Taiwan
- * E-mail:
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Dewana Z, Fikadu T, G/Mariam A, Abdulahi M. Client perspective assessment of women's satisfaction towards labour and delivery care service in public health facilities at Arba Minch town and the surrounding district, Gamo Gofa zone, south Ethiopia. Reprod Health 2016; 13:11. [PMID: 26867797 PMCID: PMC4750206 DOI: 10.1186/s12978-016-0125-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 02/02/2016] [Indexed: 11/26/2022] Open
Abstract
Background A woman’s satisfaction with labour and delivery care service has a good effect on her health and subsequent utilization of the services. Thus knowledge about women’s satisfaction on labour and delivery care used to enhances the services utilization. The objective of this study was to assess the satisfaction of women’s towards labour and delivery care service and identify factors associated it at public health facilities in Arba Minch town and the surrounding district, Gamo Gofa zone, southern Ethiopia. Methods Facility based cross sectional study was conducted among women who gave birth at public health facility. A total 256 women who gave birth during the study period were included in the study. Data was collected using a structured questionnaire. Satisfaction level was measured using a 5 point- likert scale questions. Data were entered using Epi data version 3.5.1 and analyzed using SPSS 20.0 statistical software. Factor analysis was employed for likert scale questions to extract factor represented each of the scale which facilitate treatment of variable as continuous for further analysis. Bi-variate and multivariable logistic regression analysis was employed to identify association between women’s satisfaction and predicator variables. Statistical significance was declared at P value <0.05 on final model. The strength of association was interpreted using the adjusted odds ratio and 95 % CI. Result This study revealed that 90.2 % of women who gave birth in public health facilities were satisfied with labour and delivery care. Factors associated with women’s satisfaction with labour and delivery care services include: not attending formal education [AOR = 8.00, 95 % CI = (1.52, 12.27)] attending antenatal care four times and more [AOR = 5.00, 95 % CI = (1.76, 14.20)] waiting below 15 minutes to be seen by health professional [AOR = 3.37, 95 % CI = (1.14, 9.97)] and not paying for drugs and supplies [AOR = 6.19, 95 % CI = (1.34, 18.59)]. Conclusion Although majority of women were satisfied with the labour and delivery service they got, their level of satisfaction was influenced by educational status, number of ANC visits, waiting time, and payment for drug and supplies. Thus, public health intervention working on improving delivery care should consider these factors.
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Affiliation(s)
- Zeritu Dewana
- Arba Minch Health Science College, Arba Minch P.O.Box # 55, Arba Minch, Ethiopia
| | - Teshale Fikadu
- Arba Minch Health Science College, Arba Minch P.O.Box # 55, Arba Minch, Ethiopia.
| | - Abebe G/Mariam
- College of Public Health and Medical Sciences, Department of population and family health, Jimma University, Jimma P.O.Box # 230, Jimma, Ethiopia
| | - Misra Abdulahi
- College of Public Health and Medical Sciences, Department of population and family health, Jimma University, Jimma P.O.Box # 230, Jimma, Ethiopia
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Tancred T, Schellenberg J, Marchant T. Using mixed methods to evaluate perceived quality of care in southern Tanzania. Int J Qual Health Care 2016; 28:233-9. [PMID: 26823050 PMCID: PMC4833203 DOI: 10.1093/intqhc/mzw002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 11/09/2022] Open
Abstract
Objective To compare perceived quality of maternal and newborn care using quantitative and qualitative methods. Design A continuous household survey (April 2011 to November 2013) and in-depth interviews and birth narratives. Setting Tandahimba district, Tanzania. Participants Women aged 13–49 years who had a birth in the previous 2 years were interviewed in a household survey. Recently delivered mothers and their partners participated in in-depth interviews and birth narratives. Intervention None. Main Outcome Measures Perceived quality of care. Results Quantitative: 1138 women were surveyed and 93% were confident in staff availability and 61% felt that required drugs and equipment would be available. Drinking water was easily accessed by only 60% of respondents using hospitals. Measures of interaction with staff were very positive, but only 51% reported being given time to ask questions. Unexpected out-of-pocket payments were higher in hospitals (49%) and health centres (53%) than in dispensaries (31%). Qualitative data echoed the lack of confidence in facility readiness, out-of-pocket payments and difficulty accessing water, but was divergent in responses about interactions with health staff. More than half described staff interactions that were disrespectful, not polite, or not helpful. Conclusion Both methods produced broadly aligned results on perceived readiness, but divergent results on perceptions about client–staff interactions. Benefits and limitations to both quantitative and qualitative approaches were observed. Using mixed methodologies may prove particularly valuable in capturing the user experience of maternal and newborn health services, where they appear to be little used together.
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Affiliation(s)
- Tara Tancred
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, London, UK
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Kambala C, Lohmann J, Mazalale J, Brenner S, De Allegri M, Muula AS, Sarker M. How do Malawian women rate the quality of maternal and newborn care? Experiences and perceptions of women in the central and southern regions. BMC Pregnancy Childbirth 2015; 15:169. [PMID: 26275999 PMCID: PMC4537589 DOI: 10.1186/s12884-015-0560-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While perceived quality of care is now widely recognized to influence health service utilization, limited research has been conducted to explore and measure perceived quality of care using quantitative tools. Our objective was to measure women's perceived quality of maternal and newborn care using a composite scale and to identify individual and service delivery factors associated with such perceptions in Malawi. METHODS We conducted a cross-sectional survey in selected health facilities from March to May 2013. Exit interviews were conducted with 821 women convenience sampled at antenatal, delivery, and postnatal clinics using structured questionnaires. Experiences and the corresponding perceived quality of care were measured using a composite perception scale based on 27 items, clustered around three dimensions of care: interpersonal relations, conditions of the consultation and delivery rooms, and nursing care services. Statements reflecting the 27 items were read aloud and the women were asked to rate the quality of care received on a visual scale of 1 to 10 (10 being the highest score). For each dimension, an aggregate score was calculated using the un-weighted item means, representing three outcome variables. Descriptive statistics were used to display distribution of explanatory variables and one-way analysis of variance was used to analyse bivariate associations between the explanatory and the outcome variables. RESULTS A high perceived quality of care rating was observed on interpersonal relations, conditions of the examination rooms and nursing care services with an overall mean score of 9/10. Self-introduction by the health worker, explanation of examination procedures, consent seeking, encouragement to ask questions, confidentiality protection and being offered to have a guardian during delivery were associated with a high quality rating of interpersonal relations for antenatal and delivery care services. Being literate, never experienced a still birth and, first ANC visit were associated with a high quality rating of room conditions for antenatal care service. CONCLUSIONS The study highlights some of the multiple factors associated with perceived quality of care. We conclude that proper interventions or practices and policies should consider these factors when making quality improvements.
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Affiliation(s)
- Christabel Kambala
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, INF 324, Heidelberg, Germany.
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Private Bag 360, Chichiri, Blantyre 3, Malawi.
- Environmental Health Department, The Malawi Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Blantyre, Malawi.
| | - Julia Lohmann
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, INF 324, Heidelberg, Germany.
| | - Jacob Mazalale
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, INF 324, Heidelberg, Germany.
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Stephan Brenner
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, INF 324, Heidelberg, Germany.
| | - Manuela De Allegri
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, INF 324, Heidelberg, Germany.
| | - Adamson S Muula
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Malabika Sarker
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, INF 324, Heidelberg, Germany.
- James P. Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka, 1212, Bangladesh.
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Bua J, Paina L, Kiracho EE. Lessons learnt during the process of setup and implementation of the voucher scheme in Eastern Uganda: a mixed methods study. Implement Sci 2015; 10:108. [PMID: 26245345 PMCID: PMC4527126 DOI: 10.1186/s13012-015-0292-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 07/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background In spite of the investments made by the Ugandan Government, the utilisation of maternal health services has remained low, resulting in a high maternal mortality (438 maternal deaths per 100,000 live births). Aiming to reduce poor women’s constraints to the utilisation of services, an intervention consisting of a voucher scheme and health system strengthening was implemented. This paper presents the lessons learnt during the setup and implementation of the intervention in Eastern Uganda, in order to inform the design and scale up of similar future interventions. Methods The key lessons were synthesised from a variety of project reports, as well as qualitative data drawn from six focus group discussions and four in-depth interviews conducted in the Buyende and Pallisa districts during the implementation phase of the voucher scheme. Results and Conclusions To promote the successful implementation of interventions with demand and supply side initiatives, such as voucher schemes, the health system should be able to respond to the demand created by providing the additional required resources such as health workers, essential supplies and equipment. Involving a diverse, multi-sectoral group of stakeholders is important for addressing the different barriers experienced by women when seeking maternal health services. Voucher schemes should have a mechanism of detecting unintended consequences and mitigating them. Sustainability plans should be built into such interventions to maintain the gains achieved. Lastly, health policy planners can use this information to develop follow-up programmes to test modified versions that are more sustainable. Such programmes could use locally existing community structures for management and resource mobilisation for self-sustainment.
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Affiliation(s)
- John Bua
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Ligia Paina
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Elizabeth Ekirapa Kiracho
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
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Yu TH, Hou YC, Tung YC, Chung KP. Why do outcomes of CABG care vary between urban and rural areas in Taiwan? A perspective from quality of care. Int J Qual Health Care 2015; 27:361-8. [PMID: 26239475 DOI: 10.1093/intqhc/mzv050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study explores the association between coronary artery bypass surgery (CABG) patients' residence and quality of care in terms of 30-day mortality. DESIGN A retrospective, multilevel study design was conducted using claims data from Taiwan's Universal Health Insurance Scheme. Hospital and surgeon's CABG operation volume, risk-adjusted surgical site infection rate and risk-adjusted 30-day mortality rate in the previous year were adopted as performance indicators, and the level of quality was evaluated via K-means clustering algorithm. Baron and Kenny's procedures for mediation effect were conducted. SETTING Hospitals in Taiwan. PARTICIPANTS Patients who underwent CABG surgeries from 1 January 2008 to 30 September 2011 were identified in this study. However, patients who were under the age of 18 years or above the age of 85(n = 164), with missing data for gender (n = 3) or received surgeries from surgeons who never performed any CABG surgeries (n = 27), were excluded. INTERVENTIONS None. MAIN OUTCOME MEASURES Thirty-day mortality. RESULTS There were 9973 CABG surgeries included in this study. Patients who lived in urban areas received better quality of care (28.90 vs. 21.57%) and enjoyed better outcome (4.33 vs. 6.84%). After the procedure of mediation effect testing, the results showed that the relationship between patient residence's urbanization level and 30-day mortality was partially mediated by patterns of quality of care. CONCLUSIONS The rural-dwelling CABG patients are less likely to approach the better performing healthcare providers, and this tendency indirectly affects their treatment outcomes. Policymakers still need to develop strategies to ensure better equity in access to quality health care.
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Affiliation(s)
- Tsung-Hsien Yu
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Yu-Chang Hou
- Department of Chinese Medicine, Tao Yuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
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Musoke D, Karani G, Ssempebwa JC, Etajak S, Guwatudde D, Musoke MB. Knowledge and practices on malaria prevention in two rural communities in Wakiso District, Uganda. Afr Health Sci 2015; 15:401-12. [PMID: 26124785 DOI: 10.4314/ahs.v15i2.13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Malaria is the leading cause of morbidity and mortality in Uganda particularly among children under 5 years of age. OBJECTIVES The study assessed the knowledge and practices on malaria prevention in 2 rural communities in Wakiso District, Uganda with emphasis on the various prevention methods. METHODS The study was a cross-sectional survey carried out among 376 households using both quantitative and qualitative methods. Log-binomial regression, chi square and Spearman's rank order correlation were used to test for associations. RESULTS The majority of participants (64.6%) had low knowledge on malaria prevention methods, with untreated mosquito nets (81.7%), mosquito coils (36.9%) and insecticide treated nets (29.6%) being the most known methods. Knowledge on malaria prevention methods was associated with age (χ2 = 32.1; p < 0.01), employment status (χ2 = 18.1; p < 0.01), education (χ2 = 20.3; p = 0.01), income (χ2 = 14.5; p = 0.01) and having heard a malaria message in the previous 12 months (χ2 = 92.3; p < 0.01). Households that had at least one mosquito net were 45.5% and net ownership increased with household income. Only 0.5% of the houses had undergone indoor residual spraying in the previous 12 months, while 2.1% had complete mosquito proofing in windows and ventilators to prevent mosquito entry. CONCLUSION There is potential to improve practices on malaria prevention by targeting other methods beyond mosquito nets such as installing proofing in windows and ventilators. The integrated approach to malaria prevention which advocates the use of several malaria prevention methods in a holistic manner should be explored for this purpose.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - George Karani
- Cardiff School of Health Sciences, Cardiff Metropolitan University, UK
| | - John C Ssempebwa
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Samuel Etajak
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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Musoke D, Boynton P, Butler C, Musoke MB. Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda. Afr Health Sci 2014; 14:1046-55. [PMID: 25834516 DOI: 10.4314/ahs.v14i4.36] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs. OBJECTIVES To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda. METHODS The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish. RESULTS While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities. CONCLUSIONS There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Ceri Butler
- University College London Medical School, UK
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Gilmore B, Vallières F, McAuliffe E, Tumwesigye NM, Muyambi G. The last one heard: the importance of an early-stage participatory evaluation for programme implementation. Implement Sci 2014; 9:137. [PMID: 25253191 PMCID: PMC4190461 DOI: 10.1186/s13012-014-0137-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The systematic involvement of project beneficiaries in community maternal and child health programmes remains low and limited, especially during the formative stages of the project cycle. Understanding how positive and negative feedbacks obtained from communities can subsequently be used to inform and iterate existing programmes is an important step towards ensuring the success of community health workers for maternal and child health programming and, ultimately, for improving health outcomes. METHODS The study took place over a period of 4 weeks in North Rukiga, Kabale District of southwestern Uganda. Using a cross-sectional qualitative study that employed an epistemological approach of phenomenology, nine focus group discussions and eight in-depth interviews were conducted with a total of 76 female participants across six different sites. Women were identified as either users or non-users of the maternal and child health programme. Purposeful sampling was employed to recruit women from six different locations within the programme catchment area. Translated and transcribed transcripts were subjected to a bottom-up thematic analysis using NVivo 10 Software, whereby themes were arrived at inductively. RESULTS Predominant themes emerging from the focus groups and key informant interviews identified early trends in programme strengths. Beneficiaries reported confidence in both the programme and the relationships they had forged with community health workers, exhibited pride in the knowledge they had received, and described improved spousal involvement. Beneficiaries also identified a number of programme challenges including barriers to adopting the behaviours promoted by the programme, and highlighted issues with programme dependency and perceived ownership. It also emerged that community health workers were not reaching the entire population of intended programme beneficiaries. CONCLUSIONS This research provides support for the importance of an early-stage participatory evaluation of beneficiaries' perceptions of newly initiated health programmes. Our results support how evaluations conducted in the early phases of programme implementation can provide valuable, timely feedback as well as yield recommendations for programme adjustment or re-alignment, and in turn, better meet end-user expectations. Potential reasons for the observed lack of community participation in early stages of programme implementation are considered.
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Affiliation(s)
- Brynne Gilmore
- />Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Frédérique Vallières
- />Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Eilish McAuliffe
- />Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Nazarius Mbona Tumwesigye
- />School of Public Health, College of Health Science, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Gilbert Muyambi
- />World Vision Uganda, Kisozi Complex, P.O. Box 8759, Kampala, Uganda
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Malangu N. Contribution of plants and traditional medicines to the disparities and similarities in acute poisoning incidents in Botswana, South Africa and Uganda. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2014; 11:425-38. [PMID: 25435629 DOI: 10.4314/ajtcam.v11i2.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute poisoning incidents are one of the leading causes of morbidity and hospitalization in several countries. The purpose of this analysis was to compare the patterns of acute poisoning in three countries namely, Botswana, South Africa and Uganda; and examine the similarities and disparities in the patterns of occurrence of acute poisoning based on the sociodemographic factors of the victims, the toxic agents involved, the circumstances surrounding the incidents and their outcomes. MATERIALS AND METHODS This paper is based on the re-analysis of data that were collected from January to June 2005 by some Master of Public Health students using a similar data collection tool. A single dataset made of the original individual datasheets was constituted and analysed. RESULTS Overall, it was found that the mean age of victims of acute poisoning was 20.9 ± 14.5 years; the youngest victim was a 3 months old boy from South Africa; and the oldest was a 75 years old man from Uganda. In descending order, the most common toxic agents involved in poisoning incidents were household products (46.1%), agrochemicals (18.8%), pharmaceuticals (14.0%), animal and insect bites (13.0%), food poisoning (4.5%), as well as plants and traditional medicines (3.6%). Across the three countries, acute poisoning occurred mainly by accident, but the contextual factors of each country led to a pattern of acute poisoning that showed some similarities with regard to the distribution of deliberate self-poisoning among females, teenagers, and young adult victims. There were disparities related to the differential access to toxic agents, based on the age and gender of the victims. Of the 17 deaths reported, 2 (11.7%) were due to traditional medicines; household products were implicated in fatal outcomes in all three countries, though the extent of their involvement varied from country to country. CONCLUSION Although plant and traditional medicines caused fewer cases of acute poisoning incidents, they contributed considerably to fatal outcomes.
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Affiliation(s)
- N Malangu
- School of Public Health, Medunsa Campus, University of Limpopo, Pretoria, South Africa
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Callaghan-Koru JA, Nonyane BAS, Guenther T, Sitrin D, Ligowe R, Chimbalanga E, Zimba E, Kachale F, Shah R, Baqui AH. Contribution of community-based newborn health promotion to reducing inequities in healthy newborn care practices and knowledge: evidence of improvement from a three-district pilot program in Malawi. BMC Public Health 2013; 13:1052. [PMID: 24199832 PMCID: PMC3833651 DOI: 10.1186/1471-2458-13-1052] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022] Open
Abstract
Background Inequities in both health status and coverage of health services are considered important barriers to achieving Millennium Development Goal 4. Community-based health promotion is a strategy that is believed to reduce inequities in rural low-income settings. This paper examines the contributions of community-based programming to improving the equity of newborn health in three districts in Malawi. Methods This study is a before-and-after evaluation of Malawi’s Community-Based Maternal and Newborn Care (CBMNC) program, a package of facility and community-based interventions to improve newborn health. Health Surveillance Assistants (HSAs) within the catchment area of 14 health facilities were trained to make pregnancy and postnatal home visits to promote healthy behaviors and assess women and newborns for danger signs requiring referral to a facility. “Core groups” of community volunteers were also trained to raise awareness about recommended newborn care practices. Baseline and endline household surveys measured the coverage of the intervention and targeted health behaviors for this before-and-after evaluation. Wealth indices were constructed using household asset data and concentration indices were compared between baseline and endline for each indicator. Results The HSAs trained in the intervention reached 36.7% of women with a pregnancy home visit and 10.9% of women with a postnatal home visit within three days of delivery. Coverage of the intervention was slightly inequitable, with richer households more likely to receive one or two pregnancy home visits (concentration indices (CI) of 0.0786 and 0.0960), but not significantly more likely to receive a postnatal visit or know of a core group. Despite modest coverage levels for the intervention, health equity improved significantly over the study period for several indicators. Greater improvements in inequities were observed for knowledge indicators than for coverage of routine health services. At endline, a greater proportion of women from the poorest quintile knew three or more danger signs for pregnancy, delivery, and postpartum mothers than did women from the least poor quintile (change in CI: -0.1704, -0.2464, and -0.4166, respectively; p < 0.05). Equity also significantly improved for coverage of some health behaviors, including delivery at a health facility (change in CI: -0.0591), breastfeeding within the first hour (-0.0379), and delayed bathing (-0.0405). Conclusions Although these results indicate promising improvements for newborn health in Malawi, the extent to which the CBMNC program contributed to these improvements in coverage and equity are not known. The strategies through which community-based programs are implemented likely play an important role in their ability to improve equity, and further research and program monitoring are needed to ensure that the poorest households are reached by community-based health programs.
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Affiliation(s)
- Jennifer A Callaghan-Koru
- International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Chandler CIR, Kizito J, Taaka L, Nabirye C, Kayendeke M, DiLiberto D, Staedke SG. Aspirations for quality health care in Uganda: How do we get there? HUMAN RESOURCES FOR HEALTH 2013; 11:13. [PMID: 23521859 PMCID: PMC3610284 DOI: 10.1186/1478-4491-11-13] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 02/28/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND Despite significant investments and reforms, health care remains poor for many in Africa. To design an intervention to improve access and quality of health care at health facilities in eastern Uganda, we aimed to understand local priorities for qualities in health care, and factors that enable or prevent these qualities from being enacted. METHODS In 2009 to 2010, we carried out 69 in-depth interviews and 6 focus group discussions with 65 health workers at 17 health facilities, and 10 focus group discussions with 113 community members in Tororo District, Uganda. RESULTS Health-care workers and seekers valued technical, interpersonal and resource qualities in their aspirations for health care. However, such qualities were frequently not enacted, and our analysis suggests that meeting aspirations required social and financial resources to negotiate various power structures. CONCLUSIONS We argue that achieving aspirations for qualities valued in health care will require a genuine reorientation of focus by health workers and their managers toward patients, through renewed respect and support for these providers as professionals.
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Affiliation(s)
- Clare I R Chandler
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - James Kizito
- Infectious Diseases Research Collaboration, Mulago Hospital Complex, PO Box 7475, Kampala, Uganda
| | - Lilian Taaka
- Infectious Diseases Research Collaboration, Mulago Hospital Complex, PO Box 7475, Kampala, Uganda
| | - Christine Nabirye
- Infectious Diseases Research Collaboration, Mulago Hospital Complex, PO Box 7475, Kampala, Uganda
| | - Miriam Kayendeke
- Infectious Diseases Research Collaboration, Mulago Hospital Complex, PO Box 7475, Kampala, Uganda
| | - Deborah DiLiberto
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel St, London, WCIE 7HT, UK
| | - Sarah G Staedke
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel St, London, WCIE 7HT, UK
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Graffy J, Goodhart C, Sennett K, Kamusiime G, Tukamushaba H. Young people's perspectives on the adoption of preventive measures for HIV/AIDS, malaria and family planning in South-West Uganda: focus group study. BMC Public Health 2012; 12:1022. [PMID: 23173993 PMCID: PMC3567985 DOI: 10.1186/1471-2458-12-1022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 10/31/2012] [Indexed: 11/29/2022] Open
Abstract
Background Despite the possibility of preventing many cases of HIV, malaria and unplanned pregnancy, protective measures are often not taken by those at risk in Uganda. The study aim was to explore young people’s perspectives on the reasons why this is so. Methods Focus groups were conducted with 100 secondary school and college students in Kanungu, Uganda in 2011. Three parallel groups considered HIV, malaria and family planning, and common messages were then explored jointly in a workshop based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). Results Participants identified various reasons why preventive action was not always taken. They worried about the effectiveness and side effects of several key interventions: condoms, antiretroviral treatment, various contraceptives and impregnated mosquito nets. Cost, rural isolation and the quality and availability of health services also limited the extent to which people were able to follow health advice. Although there was respect for policy supporting abstinence and fidelity, it was seen as hard to follow and offering inadequate protection when gender imbalance put pressure on women to have sex. Conclusions There is an opportunity to improve the uptake of preventive measures by tackling the misconceptions and fears that participants reported with clear, evidence-based messages. This should be done in a way that encourages more open communication about reproductive health between men and women, that reaches out to isolated communities, that draws on both voluntary and government services and enlists young people so that they can shape their future.
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Affiliation(s)
- Jonathan Graffy
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK.
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Kizito J, Kayendeke M, Nabirye C, Staedke SG, Chandler CIR. Improving access to health care for malaria in Africa: a review of literature on what attracts patients. Malar J 2012; 11:55. [PMID: 22360770 DOI: 10.1186/1475-2875-11-55] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/23/2012] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Increasing access to health care services is considered central to improving the health of populations. Existing reviews to understand factors affecting access to health care have focused on attributes of patients and their communities that act as 'barriers' to access, such as education level, financial and cultural factors. This review addresses the need to learn about provider characteristics that encourage patients to attend their health services. METHODS This literature review aims to describe research that has identified characteristics that clients are looking for in the providers they approach for their health care needs, specifically for malaria in Africa. Keywords of 'malaria' and 'treatment seek*' or 'health seek*' and 'Africa' were searched for in the following databases: Web of Science, IBSS and Medline. Reviews of each paper were undertaken by two members of the team. Factors attracting patients according to each paper were listed and the strength of evidence was assessed by evaluating the methods used and the richness of descriptions of findings. RESULTS A total of 97 papers fulfilled the inclusion criteria and were included in the review. The review of these papers identified several characteristics that were reported to attract patients to providers of all types, including lower cost of services, close proximity to patients, positive manner of providers, medicines that patients believe will cure them, and timeliness of services. Additional categories of factors were noted to attract patients to either higher or lower-level providers. The strength of evidence reviewed varied, with limitations observed in the use of methods utilizing pre-defined questions and the uncritical use of concepts such as 'quality', 'costs' and 'access'. Although most papers (90%) were published since the year 2000, most categories of attributes had been described in earlier papers. CONCLUSION This paper argues that improving access to services requires attention to factors that will attract patients, and recommends that public services are improved in the specific aspects identified in this review. It also argues that research into access should expand its lens to consider provider characteristics more broadly, especially using methods that enable open responses. Access must be reconceptualized beyond the notion of barriers to consider attributes of attraction if patients are to receive quality care quickly.
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Ekirapa-Kiracho E, Waiswa P, Rahman MH, Makumbi F, Kiwanuka N, Okui O, Rutebemberwa E, Bua J, Mutebi A, Nalwadda G, Serwadda D, Pariyo GW, Peters DH. Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2011; 11 Suppl 1:S11. [PMID: 21410998 PMCID: PMC3059470 DOI: 10.1186/1472-698x-11-s1-s11] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders. Methods This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented. Results Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing. Conclusions Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.
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Affiliation(s)
- Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences P,O,Box 7072, Kampala, Uganda.
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Baingana RK, Nakasujja N, Galukande M, Omona K, Mafigiri DK, Sewankambo NK. Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students. BMC MEDICAL EDUCATION 2010; 10:76. [PMID: 21050457 PMCID: PMC2987936 DOI: 10.1186/1472-6920-10-76] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 11/04/2010] [Indexed: 05/10/2023]
Abstract
BACKGROUND Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda. METHODS Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding. RESULTS The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism. CONCLUSIONS The findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.
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Affiliation(s)
- Rhona K Baingana
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Noeline Nakasujja
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Moses Galukande
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Kenneth Omona
- Lira Regional Referral Hospital, P. O. Box 2, Lira, Uganda
| | - David K Mafigiri
- Faculty of Social Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Nelson K Sewankambo
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
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