Browsing by Author "Garimoi, Orach Christopher"

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Cancer Care in Countries in Transition in Africa: The Case of Uganda
(Springer, Cham, 2016) Mwaka, Amos Deogratius; Wabinga, Henry; Garimoi, Orach Christopher
Uganda is a low-income country experiencing epidemiological transition with a double burden of communicable diseases including malaria, tuberculosis, and HIV as well as a rising incidence of noncommunicable diseases including cancers, hypertension, and heart diseases and diabetes. The country has a high population growth rate of 3.5 %. The population of the older people who are more prone to cancers is increasing exponentially and cancers related to lifestyles and old age are on the increase. This is in addition to the high rates of infection-related cancers including cervical cancer (most common cancer among women in Uganda), Kaposi sarcoma, and hepatocellular carcinoma. These infection-related cancers predominantly affect the young economically productive age groups and hence contribute negatively to economic production and poverty eradication. Majority of cancer patients in Uganda are diagnosed with advanced stage cancers and experience poor survival. There are few specialized cancer care facilities and cancer specialists in Uganda. Hospice Africa Uganda contributes immensely to the care of the terminally ill cancer patients while the Kampala Cancer registry provides high quality data on cancer exposures, incidences, and mortality to guide planning, research, and policy on care for cancer.
Integration of Traditional and Complementary Medicine into Medical School Curricula: A Survey Among Medical Students in Makerere University, Uganda
(BMJ Publishing Group Ltd., 2019-08-14) Mwaka, Amos Deogratius; Tusabe, Gersave; Garimoi, Orach Christopher; Vohra, Sunita; Ibingira, Charles
Objective To describe the disposition and sociodemographic characteristics of medical students associated with inclusion of traditional and complementary medicine in medical school curricula in Uganda. Design A cross-sectional study conducted during May 2017. A pretested questionnaire was used to collect data. Disposition to include principles of traditional and complementary medicine into medical school curricula was determined as proportion and associated factors determined through multivariate logistic regression. Participants and setting Medical students in their second to fifth years at the College of Health Sciences, Makerere University, Uganda. Makerere University is the oldest public university in the East African region. Results 393 of 395 participants responded. About 60% (192/325) of participants recommended inclusion of traditional and complementary medicine principles into medical school curricula in Uganda. The disposition to include traditional and complementary medicine into medical school curricula was not associated with sex, age group or region of origin of the students. However, compared with the second year students, the third (OR 0.34; 95% CI 0.17 to 0.66) and fifth (OR 0.39; 95% CI 0.16 to 0.93) year students were significantly less likely to recommend inclusion of traditional and complementary medicine into the medical school curricula. Participants who hold positive attributes and believe in effectiveness of traditional and complementary medicine were statistically significantly more likely to recommend inclusion into the medical school curricula in Uganda. Conclusions Inclusion of principles of traditional and complementary medicine into medical school curricula to increase knowledge, inform practice and research, and moderate attitudes of physicians towards traditional medicine practice is acceptable by medical students at Makerere University. These findings can inform review of medical schools’ curricula in Uganda.
Knowledge of Cervical Cancer Risk Factors and Symptoms Among Women in a Refugee Settlement: A Cross-Sectional Study in Northern Uganda
(BioMed Central Ltd, 2020-12-03) Adoch, Winnie; Garimoi, Orach Christopher; Scott, E.Suzanne; Okeny, Goddie Geoffrey; Moodley, Jennifer; Komakech, Henry; Walter, M. Fiona; Mwaka, Amos Deogratius
Background: There are limited data on awareness of cervical cancer risk factors and symptoms among refugee populations living in Uganda. In this study, we sought to determine the awareness and knowledge of cervical cancer risk factors and symptoms among women in Palabek refugee settlement, northern Uganda. Methods: We conducted a cross-sectional study. 815 women (aged 18–60 years) were randomly selected using multistage sampling in Palabek refugee settlement. Data were collected using pre-tested, structured questionnaires. Logistic regression models were used to determine magnitudes of association between socio-demographic and health system factors, and knowledge on cervical cancer risk factors and symptoms. Results: The majority of participants (53%, n = 433) were young (18–29 years), married (68%, n = 553), and did not have formal employment (93%, n = 759). Less than half (40%, n = 325) had heard of cervical cancer. Of those who had heard, most recognized multiple male sexual partners, early onset of sexual intercourse and HPV infections as risk factors for cervical cancer (93%, n = 295; 89%, n = 283; and 86%, n = 271 respectively). Median knowledge score for risk factor recognition = 7 (IQR: 3–9). Median knowledge score for symptoms recognition = 7 (IQR: 1–10). Half of women (50%, n = 409) correctly recognized 7 to 11 symptoms of cervical cancer, with vaginal bleeding between menstrual periods, pelvic pain, and vaginal bleeding during/after sexual intercourse recognized by 58, 52 and 54% respectively. Single women (OR = 0.59 (95%CI: 0.38–0.94), and women that lived farther than 1 kilo meter from nearest health facility in South Sudan (OR = 0.36–0.49 (95%CI: 0.26–0.84) were less likely to be knowledgeable of symptoms of cervical cancer. Conclusion: A significant proportion of women in Palabek refugee settlement had not heard about cervical cancer. Refugee health services providers could increase awareness of cervical cancer risk factors and symptoms through health education in order to promote risk reduction behaviours and guide women during symptoms appraisal. Single women and those who lived more than one kilo metre from nearest health facility in home country could be a priority group for awareness intervention in the settlement.
Social, Demographic and Healthcare Factors Associated With Stage at Diagnosis of Cervical Cancer: Cross-Sectional Study in a Tertiary Hospital in Northern Uganda
(BMJ Publishing Group Ltd, 2015-11-23) Mwaka, Amos Deogratius; Garimoi, Orach Christopher; Were, Maloba Edward; Roland, Martin; Wabinga, Henry; Lyratzopoulos, Georgios
Objective To examine patient and primary healthcare factors and stage at diagnosis in women with cervical cancer in Northern Uganda with the intention to identify factors that are associated with advanced stages in order to inform policies to improve survival from cervical cancer in low income and middle income countries. Design Cross-sectional hospital-based study. Setting Tertiary, not-for-profit private hospital in postconflict region. Participants Consecutive tissue-diagnosed symptomatic patients with cervical attending care. Of 166 patients, 149 were enrolled and analysed. Primary outcome Cervical cancer stage at diagnosis. Results Most women were diagnosed at stages III (45%) or IV (21%). After controlling for age, marital status, educational attainment and number of biological children, there was evidence for association between advanced stage at diagnosis and pre-referral diagnosis of cancer by primary healthcare professionals (adjusted OR (AOR)=13.04:95% CI 3.59 to 47.3), and financial difficulties precluding prompt help seeking (AOR=5.5:95% CI 1.58 to 20.64). After adjusting for age, marital status and educational attainment, women with 5–9 biological children (AOR=0.27:95% CI 0.08 to 0.96) were less likely to be diagnosed with advanced stage (defined as stages III/IV) cancer. In this pilot study, there was no statistical evidence for associations between stage at diagnosis, and factors such as age at diagnosis and marital status. Conclusions This study is a first attempt to understand the descriptive epidemiology of cervical cancer in rural Ugandan settings. Understanding individual patient factors, patients’ behavioural characteristics and healthcare factors associated with advanced stage at diagnosis is essential for targeted effective public health interventions to promote prompt health seeking, diagnosis at early stage and improved survival from cervical cancer.
Turning a Blind Eye and a Deaf Ear to Traditional and Complementary Medicine Practice Does not Make it go Away: A Qualitative Study Exploring Perceptions and Attitudes of Stakeholders Towards the Integration of Traditional and Complementary Medicine into Medical School Curriculum in Uganda
(BioMed Central Ltd, 2018-12-18) Mwaka, Amos Deogratius; Tusabe, Gervase; Garimoi, Orach Christopher; Vohra, Sunita
Background: A substantial proportion of healthcare professionals have inadequate understanding of traditional and complementary medicine and often consider their use inappropriate. Methods: We conducted a qualitative study to understand the perceptions and attitudes of medical students, medical school faculty and traditional and complementary medicine practitioners. In-depth interviews and focus group discussions were used to collect data. Thematic approach was used in data analysis to identify emerging themes and sub themes. Data analysis was supported with use of Atlas.ti v6.1.1. Results: The majority of participants commended the inclusion of traditional and complementary medicine principles into medical school curricula. The main reasons advanced were that: patients are already using these medicines and doctors need to understand them; doctors would be more accommodating to use and not rebuke patients, thereby minimizing delays in care due to pursuit of alternative therapies; promote patient safety; foster therapeutic alliance and adherence to therapy; uphold patients' right to self-determination; lead to discovery of new drugs from traditional medicines; and set ground for regulation of practices and quality control. However, participants anticipated operational and ethical challenges that include inadequate number of faculty to teach the subject, congested curricula, increased costs in research and development to produce evidence-base data, obstruction by pharmaceutical companies, inaccessibility to and depletion of medicinal plants, and potential conflicts due to diversity in culture and values. A substantial minority of participants thought traditional medicine need not be taught in medical schools because there is lack of scientific evidence on efficacy, safety, and side effects profiles. These shortfalls could make the determination of benefits (beneficence) and harm (maleficence) difficult, as well as compromise the ability of physicians to adequately disclose benefits and harms to patients and family, thereby undermining the process of informed consent and patient autonomy. Conclusions: Training medical students in principles of traditional and complementary medicine is considered reasonable, feasible, and acceptable; and could lead to improvement in health outcomes. There are anticipated challenges to implementing a hybrid medical school curricula, but these are surmountable and need not delay introducing traditional and complementary medicine principles into medical school curricula in Uganda