Browsing by Author "Santini Stefano"

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Preparedness for Mass Casualities of Road Traffice Crashes in Uganda
(Uganda Martyrs University Press, 2011-04) Bikaitwoha Everd Maniple; Onyachia Nathan W; Santini Stefano
In Uganda, increase in human and vehicular populations against a non-expanding road infrastructure, breakdown in enforcement of traffic regulations and poor vehicle quality contribute to the high rate of casualties from road traffic crashes on highways, with over 2000 deaths per year. Highway hospitals should be the vanguard of preparedness to manage mass surgical casualties, to minimize road crash mortality.
Preparedness for mass casualties of road traffic crashes in Uganda:
(Uganda Martyrs University Press, 2011-04-01) Onyachi Nathan W.; Bakaitwoha Everd Maniple; Santini Stefano
In Uganda, increase in human and vehicular populations against a non-expanding road infrastructure, breakdown in enforcement of traffic regulations and poor vehicle quality contribute to the high rate of casualties from road traffic crashes on highways, with over 2000 deaths per year. Highway hospitals should be the vanguard of preparedness to manage mass surgical casualties, to minimize road crash mortality. Objectives: To determine the capacity of Uganda’s highway hospitals to manage mass surgical casualties. Methods: A descriptive, cross-sectional study of emergency surgical services of ten key highway general hospitals. Results: The hospitals had adequate capacity to manage uncomplicated solitary cases of injury. However, they had severe shortage of essential surgical equipment (9.6% of expected). Staffing was poor (64.3% of the recommended) and the staff lacked the life-saving surgical skills needed in a frontline hospital. There was perennial shortage of essential supplies e.g. blood, surgical gloves, intravenous fluids, oxygen and medicines. There was inadequate space for emergency surgery and only few staff members reside within easy reach for quick mobilization. Overall surge capacity was rated at below 50% of what is required. Conclusion: Ugandan highway hospitals lack the technical and infrastructural capacity to handle mass casualties resulting from road traffic crashes. Surge capacity is below 50% of that required to manage mass casualties. Recommendations: The key recommendations of this paper are: re-organisation of the outpatient departments to cater for mass emergency surgical cases, deployment of qualified surgeons in highway hospitals, training of hospital staff in life-saving surgical skills, targeted supervision of highway hospitals, training of managers in disaster preparedness, and improved funding for highway hospitals.
The quality and use of maternal health care in Oyam district, Uganda:
(Uganda Martyrs University Press, 2009-04-01) Birungi Sixtus; Odaga John; Lochoro John Peter; Santini Stefano; Owiny Vincent; De Vivo Emmanuela
Despite the availability of technically sound approaches, maternal mortality and other reproductive health problems persist in Uganda and other developing countries. Utilisation of maternal health services remains very low, especially delivery attended by skilled birth attendants. In Oyam and other Ugandan districts smarting out of prolonged insurgency, reproductive health services are generally poorly utilised. Doctors with Africa-CUAMM, an Italian NGO, together with other partners and with funding from the EU, initiated a programme intended to improve the uptake and quality of reproductive health services in Oyam District. A baseline study was conducted in 2008 to document the initial pattern of use and quality of the existing maternal healthcare services in order to generate baseline data against which the performance of the programme will be evaluated. Its objectives were to establish the level of utilisation of maternal healthcare; the factors underlying mothers' health-seeking behaviour; the quality of maternal healthcare services; and to describe the outcome of pregnancies carried within the previous 5 years. The study had three major components: a household survey (1472 households); a survey of community resource persons (30 TBAs, and 9 senior women leaders); and a health facilities survey (1 hospital, 1 HC IV, and 5 HC IIIs). Government-owned facilities were the most prevalent and most utilised (by 84.7%). The median age of the mothers at the last pregnancy was 24 years and by that age, most mothers had had 3 pregnancies. At the first onset of labour, most women consulted an untrained friend or relative, and TBAs due to proximity. Overall, 41% of the deliveries in the district take place in health facilities, and 44% at the TBAs but 3.2% are not attended to. PNC services are not well utilised despite high levels of awareness of the presence and utility of the services (by 73%). Most mothers utilize injectable hormonal contraceptives and natural methods. Resistance from spouses and perceived negative effects of FP methods are major hindrances to FP utilisation. Over 90% of the pregnancies had a positive outcome for the mother and child. The study recommends focusing on quality improvement through implementation of the standard package of reproductive health services and support supervision.
The Quality and Use of Maternal Health Care in Oyam District, Uganda: A baseline survey for an intervention
(Department of Health Sciences of Uganda Martyrs University, 2015-11-15) Birungi Sixtus; Odaga John; Santini Stefano
Despite the availability of technically sound approaches, maternal mortality and other reproductive health problems persist in Uganda and other developing countries. Utilisation of maternal health services remains very low, especially delivery attended by skilled birth attendants. In Oyam and other Ugandan districts smarting out of prolonged insurgency, reproductive health services are generally poorly utilised. Doctors with Africa-CUAMM, an Italian NGO, together with other partners and with funding from the EU, initiated a programme intended to improve the uptake and quality of reproductive health services in Oyam District. A baseline study was conducted in 2008 to document the initial pattern of use and quality of the existing maternal healthcare services in order to generate baseline data against which the performance of the programme will be evaluated. Its objectives were to establish the level of utilisation of maternal healthcare; the factors underlying mothers' health-seeking behaviour; the quality of maternal healthcare services; and to describe the outcome of pregnancies carried within the previous 5 years. The study had three major components: a household survey (1472 households); a survey of community resource persons (30 TBAs, and 9 senior women leaders); and a health facilities survey (1 hospital, 1 HC IV, and 5 HC IIIs). Government-owned facilities were the most prevalent and most utilised (by 84.7%). The median age of the mothers at the last pregnancy was 24 years and by that age, most mothers had had 3 pregnancies. At the first onset of labour, most women consulted an untrained friend or relative, and TBAs due to proximity. Overall, 41% of the deliveries in the district take place in health facilities, and 44% at the TBAs but 3.2% are not attended to. PNC services are not well utilised despite high levels of awareness of the presence and utility of the services (by 73%). Most mothers utilize injectable hormonal contraceptives and natural methods. Resistance from spouses and perceived negative effects of FP methods are major hindrances to FP utilisation. Over 90% of the pregnancies had a positive outcome for the mother and child. The study recommends focusing on quality improvement through implementation of the standard package of reproductive health services and support supervision..
User fees in private non-for-profit hospitals in Uganda: a survey and intervention for equity
(BioMed Central Ltd., 2005) Amone Joseph; Asio Salome; Cattaneo Adriano; Kweyatulira Annet Kakinda; Macaluso Anna; Maciocco Gavino; Mukokoma Maurice; Ronfani Luca; Santini Stefano
Background: In developing countries, user fees may represent an important source of revenues for private-non-for-profit hospitals, but they may also affect access, use and equity. Methods: This survey was conducted in ten hospitals of the Uganda Catholic Medical Bureau to assess differences in user fees policies and to propose changes that would better fit with the social concern explicitly pursued by the Bureau. Through a review of relevant hospital documents and reports, and through interviews with key informants, health workers and users, hospital and nonhospital cost was calculated, as well as overall expenditure and revenues. Lower fees were applied in some pilot hospitals after the survey. Results: The percentage of revenues from user fees varied between 6% and 89% (average 40%). Some hospitals were more successful than others in getting external aid and government subsidies. These hospitals were applying lower fees and flat rates, and were offering free essential services to encourage access, as opposed to the fee-for-service policies implemented in less successful hospitals. The wide variation in user fees among hospitals was not justified by differences in case mix. None of the hospitals had a policy for exemption of the poor; the few users that actually got exempted were not really poor. To pay hospital and non-hospital expenses, about one third of users had to borrow money or sell goods and property. The fee system applied after the survey, based on flat and lower rates, brought about an increase in access and use of hospital services. Conclusion: Our results confirm that user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible.