Faculty of Science

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Browsing Faculty of Science by Subject "Affecting"

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    Factors Affecting Entry into Care for HIV Positive Clients Tested from Non-Primary Health Care Settings in Lyantonde District.
    (Uganda Martyrs University, 2012) Twinomujuni, Moses
    TWINOMUJUNI MOSES (2012-M121-10031) Factors Affecting Entry into Care for HIV Positive Clients Tested from Non-Primary Health Care Settings in Lyantonde District Background: success of any antiretroviral treatment programme depends on early identification and timely treatment of HIV positive clients. Management of HIV clients takes a wider dimension than just an infected individual and involves a referral and linkage system. Introduction of ART services in Uganda has improved the overall well-being of PLWHAs and their families. However, a number of HIV clients who test positive still do not enrol into care. This study aimed at assessing the factors that influence the time of enrolment into care in Lyantonde district. Methodology: this was a descriptive comparative cross-sectional study of 209 PLHAs. Sample selection was by mixed sampling techniques. Data collection used both qualitative and quantitative methods and analysis was done through the use of the Statistical Package for the Social Sciences (SPSS). Results: sixty six percent of clients tested from non-primary health care settings enrolled into care. The median time between testing and entry into care was one month. Facilitators of early entry into care were: disclosure of sero status, tested as a couple, buddy, start dose of Septrin, VCT approach. Barriers included: stigma, HIV related misconceptions. Both VHTs and inter-facility and community to facility referrals and networking were below desirable level. There were high levels of retesting clients especially when they reached the ART sites. The district health systems lacks a mechanism of tracking HIV positive clients, which results into multiple cases of double or even triple testing. Conclusion: the study shows improved access to ART services; however, there are still barriers related to the individual, the family and the community which the system needs to address. Recommendations: there is need to conduct regular annual service utilisation surveys, dissemination meetings with various implementing partners, operationalisation of the VHT policy and strengthening of the inter-facility referral network by the district health managers. There is also need to start ART outreaches in designated sites such as HC11s. Key Words: Factors, Affecting, Care, HIV Positive Clients, Non-Primary Health Care Lyantonde District
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    Factors Affecting Health System’s Support for HIV Status Disclosure of Clients in Health Facilities of Bundibugyo District
    (Uganda Martyrs University, 2012) Muhindo, Zuura
    MUHINDO ZUURA (2012-M121-10019) Factors Affecting Health System’s Support for HIV Status Disclosure of Clients in Health Facilities of Bundibugyo District Background: disclosure of HIV positive status is an important goal for prevention of HIV/AIDS. People living with the disease are faced with a difficulty in deciding with whom, when and how to disclose their HIV status. Reports of non-disclosure and consequences of disclosure are common. Understanding the health system in place to support HIV status disclosure, demands investigation. Main objective: the study then focused on factors affecting health system’s support for HIV status disclosure of people living with HIV/AIDS so as to establish functional health system support mechanisms to enable clients disclose their HIV positive results with ease. Methodology: a descriptive cross sectional study was conducted in 10 health facilities which offer comprehensive HIV/AIDS care in Bundibugyo district. Data were collected from 317 clients, 55 health workers and 10 health managers. By use of the Statistical Package for the Social Sciences (SPSS), frequency percentages were computed for uni-variate data analysis and odds ratios were computed for multivariate data analysis. Results: overall 94.90% of clients on ART disclosed their HIV status. Majority of the clients (99.50%) had disclosed to their friends. The main reasons for non-disclosure among the clients were; lack of confidentiality among people, fear of discrimination (stigma) in the community, worries of not getting a future partner and financial support. Conclusion: the health system supported clients to disclose their HIV status. Disclosure rate among clients on ART was high but most clients have reported to their friends more than anyone else indicating that clients still experience difficulties in equally revealing their HIV status to spouses, relatives and community members. Recommendation: effectively addressing issues on disclosure was recommended. Formulation of policies and strengthening the capacity of the health system (increase human resource, planning, monitoring and supervision) is of great importance to enhance disclosure. Key Words: Factors, Affecting, Health System’s Support, HIV Status, Disclosure, Clients, Bundibugyo District
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    Factors Affecting Health System’s Support for HIV Status Disclosure of Clients in Health Facilities of Bundibugyo District.
    (Uganda Martyrs University, 2012) Muhindo, Zuura
    MUHINDO ZUURA (2012-M121-10019) Factors Affecting Health System’s Support for HIV Status Disclosure of Clients in Health Facilities of Bundibugyo District Background: disclosure of HIV positive status is an important goal for prevention of HIV/AIDS. People living with the disease are faced with a difficulty in deciding with whom, when and how to disclose their HIV status. Reports of non-disclosure and consequences of disclosure are common. Understanding the health system in place to support HIV status disclosure, demands investigation. Main objective: the study then focused on factors affecting health system’s support for HIV status disclosure of people living with HIV/AIDS so as to establish functional health system support mechanisms to enable clients disclose their HIV positive results with ease. Methodology: a descriptive cross sectional study was conducted in 10 health facilities which offer comprehensive HIV/AIDS care in Bundibugyo district. Data were collected from 317 clients, 55 health workers and 10 health managers. By use of the Statistical Package for the Social Sciences (SPSS), frequency percentages were computed for uni-variate data analysis and odds ratios were computed for multivariate data analysis. Results: overall 94.90% of clients on ART disclosed their HIV status. Majority of the clients (99.50%) had disclosed to their friends. The main reasons for non-disclosure among the clients were; lack of confidentiality among people, fear of discrimination (stigma) in the community, worries of not getting a future partner and financial support. Conclusion: the health system supported clients to disclose their HIV status. Disclosure rate among clients on ART was high but most clients have reported to their friends more than anyone else indicating that clients still experience difficulties in equally revealing their HIV status to spouses, relatives and community members. Recommendation: effectively addressing issues on disclosure was recommended. Formulation of policies and strengthening the capacity of the health system (increase human resource, planning, monitoring and supervision) is of great importance to enhance disclosure. Key Words: Factors, Affecting, Health System’s Support, HIV Status, Disclosure, Clients, Bundibugyo District
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    Factors Affecting Patient Flow in Outpatient Departments of two Regional Referral Hospitals in Uganda (Jinja and Gulu Regional Referral Hospitals)
    (Uganda Martyrs University, 2012) Gihembo, Bridget
    GIHEMBO BRIDGET (2012-M191-10010) Factors Affecting Patient Flow in Outpatient Departments of two Regional Referral Hospitals in Uganda (Jinja and Gulu Regional Referral Hospitals) Patient flow is a concept reflecting the movement of patients through a sequence of processes as part of their care pathway. It involves processes that dictate what happens to the patient during his visit to the Out Patient department (OPD). Patient flow begins when the patient steps foot into the OPD facility and ends when she/he is out of the door. Lately OPDs are becoming more congested and struggling to meet the demand of the high volume of patients that has led patients having to wait longer to access OPD services. The goal of this study was to generate information about the factors affecting patient flow that if used will contribute to the improvement of the OPD work processes for quality healthcare to patients. This is in line with the National Health Policy II goal of attaining a good standard health for all people in Uganda in order to promote a healthy and productive life. The objectives of the study were: to describe the general layout of OPDs and how this affects patient flow, to identify the physical facilities available in OPDs, to describe the process a patient goes through in OPD during their care, to determine the average waiting time for patients in OPDs, to identify the challenges faced by medical staff in managing patient flow in OPDs and to identify the efforts employed to improve patient flow in OPDs. The research design was a cross-sectional descriptive study in which quantitative and qualitative data collection methods were used. Data collection was by observation, interviewing OPD clinic managers and exit interviews to patients. Two regional referral hospitals of Gulu and Jinja were selected purposively to represent regional referral hospitals in Uganda. OPD clinic managers and heads of departments were key informants and other respondents were patients of the studied hospitals. The results showed that general layout of most OPDs affected patient flow. Some service points were located outside OPDs that required patients to move out. Physical facilities in most of the 20 OPDs were adequate compared to the standard list of equipment for regional referral hospitals; however, the number of patients had increased and was not adequate for the increased population. Patients go through a series of processes which involves registration, taking of vital observations and weight, health education, counselling and HIV testing, consultation, physical examination, investigations, treatment, discharge or admission. However these varied depending on the needs of the patient. Waiting time varied; in Gulu, mean waiting time varied from 88.7-300.7 while in Jinja it was between 75.7 and 241.6. Challenges in managing patient flow include: poor infrastructure, lack of resources including human resources, location of service points in different places and lack of an appointments system. Patient related factors include: patients coming for primary care and large number of patient visiting OPD. The strategies that were in place to manage patient flow were: multitasking, allocation of duties, team work, monitoring performance, provision of adequate resources, completion of tasks in a timely manner, information graphics, scheduling appointments and task shifting. Patient flow in OPDs is poor and it is affected by a number of factors that are both facility and patient related. Based on the findings above, it is recommended that the government should increase on the funding of lower health facilities so that patients with uncomplicated conditions can be managed there without the need of going to referral hospitals, the government should consider on improving on the infrastructure to cater for the growing demand for health care, there is need to revise the staffing levels of health facilities to match the growing population of patients. Key Words: Factors, Affecting, Patient, Flow, Outpatient Departments, Regional Referral Hospitals, Jinja, Gulu.
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    Factors Affecting the Provision of Medico-Legal Services by Health Facilities of Lango Sub-Region.
    (Uganda Martyrs University, 2012) Sabiiti, Fanuel Abwoli
    SABIITI FANUEL ABWOLI (2012-M191-10022) Factors Affecting the Provision of Medico-Legal Services by Health Facilities of Lango Sub-Region Introduction: Medico-Legal Services (MLS) are vital health services worldwide, developed to improve the collection of medico-legal evidence and provide better care to victims/survivors. These services document and collect available evidence for corroboration in courts of law. There are factors that may affect their provision, which may vary from country to country, and even from region to region. The Lango sub-region was deeply affected by the LRA war and violence is known to be high. At the same time, the main highways to the northern region and beyond pass through Lango sub-region (Kampala-Gulu-Juba, Soroti-Lira-Juba, and Lira-Kitgum-Juba). With poor regulation and enforcement of driving standards and the Highway Code, the region is very prone to road traffic accident injuries. Other factors include land disputes due to displacement during the war that eventually results into acts of violence. Unemployment and excessive consumption of alcohol (Lira-Lira) are predisposing factors to violence. In view of the above, it prompted the need for a study to provide some data on which informed decisions can be made for appropriate planning. Among medico-legal cases, sexual violence has received more attention in the study. Objectives: the objectives of the study were: (i) to identify factors affecting the provision of MLS, (ii) to assess the level of knowledge, attitude and practices of health workers with regard to medico-legal issues and, (iii) to establish the most common medico-legal cases in Lango sub-region. Methods: this study was of a descriptive cross-sectional design, and employed both qualitative and quantitative data collection methods. The study sample consisted of 5 health facilities (one regional referral hospital, two general hospitals and two HCIVs) purposively selected. Self-administered questionnaires for key informants (DHOs, Hospital directors/Medical superintendents, DPCs, OC Stations) and respondents (Health workers and Police officers) were used. Observations of examination rooms at places of work, review of relevant records were conducted and check lists used. Results/Findings: the major findings are that most of the health facilities studied lacked some equipment for proper investigations and experienced occasional stock outs of some reagents. All health facilities did not have special rooms for examining victims of sexual violence. The hospitals are having inadequate numbers of medical doctors. The region has never had a Police xvi surgeon. Health workers have limited knowledge on MLS. Duty rosters for MLS do not exist in the facilities. MLS records are not electronically handled. Other findings included late reporting of survivors and interference during investigations. Over a period of 5 years, the most prevalent medico-legal cases in 32 the studied facilities were Road Traffic Accidents: 6681 (46.9%), Assault: 3928 (27.10%) followed by Defilement: 2574 (17.76%). Lira Regional Referral Hospital alone recorded/registered 6,421cases of Road Traffic Accidents and 1,309 cases of assault and battery in five years. The regional referral hospital’s staffing status for medical doctors was at 47.8 %( out of 4 senior consultants only 1 was available, out of 12 consultants supposed to be at the facility only one was available , as for medical officers only 6 were available out of 10 and as for clinical officers they were 14 available out of 20. Conclusions: the study revealed that there are a number of factors affecting the provision of MLS, consequently compromising the quality of service. These factors range from inadequate human resources, infrastructure design, insufficient transport and poor records management. Recommendations: in view of the above findings it is, therefore, recommended that the various district health authorities in the region, together with their local governments recruit and retain medical doctors. As for hospitals, improvising special examination rooms can be worked out with the districts works department. At policy level, the Department of Clinical Services consider setting up training programmes on MLS for health workers already in service and those in the training institutions. The directorate of training in the Police should consider recruiting more police surgeons. Key Words: Factors, Affecting, Provision, Medico-Legal Services, Health Facilities, Lango Sub-Region