Journal Articles (Health)

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50 Years of Cuamm's Passion: What More Needs to be Done to Tackle Inequity?
(2004-03) Okuonzi, Sam Agatre
Established over fifty years ago, CUAMM, an abbreviation for Collegio Universitario Aspiranti Medici Missionari, or University College for Aspiring Missionary Doctors is a humanitarian non-governmental organization (NGO), which deals with health and health related issues in a unique way. The picture conveyed by the name as a college for doctors aspiring for mission work is lamentably inaccurate. It is much more than a college; it is an NGO, whose members are trained and prepared. Planning for their work is carried out in the field offices and cordnated by the organisation's headquarters in Padua, Italy. Its activities, carried out by visionary and innovative, daring, passion-driven, and selfless individuals span a number of countries in Africa. They work in hospitals and some 30 health projects in the poorest and/or war-torn countries in Africa - Angola, Ethiopia, Rwanda, Mozambique, Tanzania and Uganda. After half a century of missionary work, CUAMM is taking stock of what it has achieved and what needs to be done. That the organization has helped save millions of lives is beyond dispute. Yet, the suffering of most people of sub- Saharan Africa has not reduced. No doubt, the economies of these countries have grown, but disparities and inequities have increased. In other words, unfairness and injustice have increased. CUAMM was created by a group of doctors and priests inspired by the principles of the Christian church, based on equity and justice for all. The organisation is open to all those who share these principles and care for them, irrespective of their religious or political affiliation. But how can CUAMM address such an intractable societal problem of inequity and injustice? To consider this and other related questions, CUAMM organized a conference in Padua, on November 20, 2004 to sensitize the public stakeholders on health equity, and to assess whether indeed CUAMM was meeting equity targets. The theme of this issue of our journal was inspired by this conference and the articles published to discuss it were, also, presented there. CUAMM is determined to tackle health inequity with renewed strength and commitment. This is in keeping with the Holy See's counsel to refrain from a looming culture of indifference to the increasing worldwide inequity. There were no easy solutions to health inequity, the basis of human suffering. But some broad strategies came out of the conference. To tackle inequity CUAMM would have to do more than provide emergency services. It would work to empower communities, through knowledge, skills and resource generation. It would balance between health care and determinants of welfare. This means it would have to work with other partners to influence local and global governments and activities. For example it could lobby Northern Governments to increase aid to the poor and suffering, lobby for a fair trade between South and the North, and lobby for the removal of harsh economic austerity measures imposed by the World Bank through its structural adjustment programmes (or its latest version, the Poverty Reduction Strategy Papers). CUAMM can also work locally with governments to influence policies on more equitable and sustainable financing and provision of health and other social services. Many approaches such as removal, reduction or flattening of user fees discussed at the conference, were found to have had dramatic positive effect on the use and quality of health care. As equity involves redistribution of resources, which in turn are driven by power and politics, CUAMM's involvement in influencing national and international policies will be inevitable. In this issue, we also publish articles debating the export of Ugandan health workers, appropriate staffing levels for district-size hospitals and patient satisfaction with health care. We also publish other articles discussing the subject of corporate responsibility using the Bhopal accident as an example as well as field experience of improving service quality and immunisation coverage in Uganda. Copyright 2004 - Department of Health Sciences of Uganda Martyrs University
Addressing virtual learning challenges in higher institutions of learning: a systematic review and meta-analysis
(Şahin İDİN, 2022-07-01) Omona, Kizito
Many universities across the globe are set to keep lectures online, more especially in this era of COVID-19 and yet there is an increased spotlight on the challenges faced by learners. Some of these challenges include; issues related to communications, assessments and scheduling of lectures. Teaching and learning in an e-learning environment is said to happen differently as opposed to the traditional classroom and this can present new challenges to instructors and learners. The purpose of this study was to review the various ways of addressing virtual challenges in higher institutions of learning. Literature Search of databases of Google Scholar, PubMed, SCOPUS and ResearchGate using the keywords “Addressing virtual learning challenges” was done. Additional inputs were taken from blogs and relevant reports. The results varied; some learners reported that "It's difficult to share our points as online discussions can move swiftly from one topic to another. Engaging a big class in a live forum can be challenging too." Other learners asserted that by regulating who can speak up at one time, the moderator can ensure that no one is left behind. However, it is also reported that there is a growing concern of plagiarism surrounding online examination and thus stringent plagiarism checks must be enhanced to curtail such vice. Conclusively, a lot is still needed to address virtual learning challenges. No single measure is exhaustive enough and more vigilance is required to sustain the adopted measures and improve the quality of virtual learning.
Adherence to Laboratory Findings in the Management of Malaria in The High and Low Transmission Areas of Nakasongola and Kabalore Districts of Uganda
(2008) Nanyingi, Miisa
Malaria is one of the leading causes of morbidity and mortality in Africa today. It is estimated that a single bout of malaria in Africa costs a sum equivalent to earning for over ten working days. In Uganda, more than 95% of the malaria cases are due to Plasmodium falciparum, the most virulent parasite species that causes severe forms of disease. It has acquired resistance to the commonly used and cheap antimalarial medicines like Chloroquine and Sulfadoxine/Pyrimethamine (CQ/SP) combination. The Uganda Government changed the malaria treatment policy in 2005 to include Artemisinin Combination Therapies (ACTs) as first line treatment for the uncomplicated malaria. Whereas prompt and accurate laboratory diagnosis of malaria is the key to the effective management malaria, clinical syndromic diagnosis has been the most widely used approach in Uganda. This was widely advocated for in sub-Saharan Africa as a means of increasing antimalarial coverage and reducing the risk of progression to severe disease and death. However, such practice was only tolerated in the era of inexpensive and safe antimalarial therapy of CQ/SP. An adult course of the new recommended first-line ACTs costs more than 10 times the cost of a course of CQ/SP. It is therefore difficult to afford this treatment at individual and national levels. Therefore, presumptive treatment becomes economically and clinically less acceptable and raises a need for a more accurate diagnosis. To make a definitive diagnosis of malaria, demonstration of the parasite in the blood is essential. However, it was not whether health workers have started adopting the reliance on laboratory results before making antimalarial prescriptions. The study was an attempt to understand the practices of health workers in the health facilities with laboratory services in one high and one low malaria transmission areas of Uganda. Nine health facilities in Nakasongola and Kabalore were selected on the basis of possession of functional laboratory services and 487 patients with fever/receiving antimalarial treatment were enrolled for the survey. It was found that access to laboratory services was limited to a small population. Although the majority of patients reporting to these health facilities (over 95% for the two districts) were sent to the laboratory, only 52% and 32% of those that received their results for Nakasongola and Kabarole respectively tested positive for the presence of malaria parasites. However, all patients reporting to the health facilities with fever still received antimalarials despite health worker training and guidelines under the new first-line treatment policy. This meant that health workers have not changed their prescription practices and laboratory findings were not being used in the management of malaria.
Agricultural Biotechnology for Developing Countries
(Uganda Martyrs University, Department of Health Sciences, 2004-08) Raney, Terri
The Food and Agriculture Organization of the United Nations, in "The State of Food and Agriculture 2003-04", examines the potential of agricultural biotechnology to address the current and future needs of the world's poor and food insecure. Critics of biotechnology claim that technology is not the answer to the problems of poverty and hunger. They argue - correctly - that the world produces enough food to provide everyone with an adequate diet and that what is required is more equitable access by the poor. They extrapolate from these sensible observations to the mistaken conclusion that technological innovation is unimportant or even counter-productive in the fight against poverty and hunger (GRAIN, 2004). This paper summarizes the findings of The State of Food and Agriculture and argues that technological innovation in agriculture, based on the best of modern science, is a necessary condition for sustainable economic growth and poverty alleviation. Biotechnology is not a panacea, but it is an essential part of the solution. This paper briefly reviews the range of biotechnology applications that can address problems of the poor. It also describes the role of technological innovation in promoting agricultural and economic growth and examines the key differences between the Green Revolution and the Gene Revolution. These differences - private sector dominance and safety and regulatory concerns - influence both the technologies being developed and their capacity to reach the poor. The economic evidence on the experience of developing countries so far with GM crops is reviewed, followed by policy recommendations to enhance the likelihood that the Gene Revolution will meet the needs of the poor.
AIDS, Primary Health Care and Poverty
(Uganda Martyrs University, Department of Health Sciences, 2004-04) Murru, Maurizio
This paper analyzes the complex interrelation between poverty and AIDS. Poverty, in its many and diverse aspects and with its many and diverse consequences, creates a fertile breeding ground for the expansion of HIV/AIDS. In turn, HIV/AIDS, for its mode of transmission and its epidemiological features, badly affects the livelihood of its victims, their families, their entire communities and countries. Sub Saharan Africa bears the brunt of the epidemic. With about 10% of the world population, it has about 66.5 % of the world seropositive cases. In three Southern African countries the HIV prevalence in the adult population reaches or exceeds the level of 30 %. Recent WHO estimates put life expectancy in Sub Saharan Africa at about 47 years and that, without AIDS, it would be at about 62 years. The development achievements of the last decades risk being lost and the future of the continent is at risk. But numbers, alone, don’t tell the whole story. They don’t talk of millions of orphans, dilapidated health services, crumbling educational systems, illiteracy, gender discriminations, harmful cultural practices, uncontrolled urbanization, conflicts and civil wars, refugees and internally displaced people, entire economies on the verge of collapsing. In the rich countries, AIDS is no more a death penalty. It is a chronic disease that, although with problems, can be treated. For years the idea that the poor "had to be" excluded from the benefits of Antiretroviral Treatment (ART), simply because they are poor, has been accepted somehow passively. Things are now changing. The paper briefly touches upon ART and its implications. It is also stated that all deaths due to poverty and deprivation are unacceptable, not just those due to AIDS. The main conclusion is that the fight against HIV/AIDS is the fight against poverty. The resources to win this war are not lacking. What seems to be lacking are vision, political will and genuine interest in all human beings.
All That Glitters is Not “Macroeconomics”
(Uganda Martyrs University, Department of Health Sciences, 2003-12) Cattaneo, Adriano
Despite many problems, the Report on Macroeconomics and Health is an important document. It re-launches the role of the WHO, which in itself is a good thing, as the WHO is an organisation potentially more independent and democratic than the World Bank. “Combating disease will be clearest proof of our capacity to construct an authentic global community. There is no justification in the world today for those millions of individuals suffering and dying every year for lack of the $34 dollars per head necessary to have essential health care services. A world that is just and looks to the future will not allow this tragedy to continue. Governments will follow commitments taken in recent years with what actions are necessary to give dignity, hope and life itself to the poorer and more vulnerable nations of the world. We know that this is possible and we are sure that in the years to come the world will dedicate all its energy to the service of this noble and vital task’. This is the concluding paragraph to the Report “Macroeconomics and Health: Investing in Health for Economic Development”, published by the WHO on 20 December 2001. Full marks go to Gro Harlem the attempt at restoring visibility to the WHO, which has been obscured recently by a colourless of the World Bank. She has started by evening Primary Health Care and gone on with an important, even if controversial, Annual Report on the performance of health care systems which is stimulating new and hopefully productive discussion of international public health care.
Anthelminthic treatment during pregnancy is associated with increased risk of infantile eczema: randomised-controlled trial results
(John Wiley & Sons A/S, 2011) Mpairwe, Harriet; Webb, Emily L; Muhangi, Lawrence; Ndibazza, Juliet; Akishule, Denise; Nampijja, Margaret; Ngom-wegi, Sophy; Tumusime, Josephine; Jones, Frances M; Fitzsimmons, Colin; Dunne, David W.; Muwanga, Moses; Rodrigues, Laura C.; Elliott, Alison M
Background: Allergy is commoner in developed than in developing countries. Chronic worm infections show inverse associations with allergy, and prenatal exposures may be critical to allergy risk. Objective: To determine whether anthelminthic treatment during pregnancy increases the risk of allergy in infancy. Methods: A randomised, double-blind, placebo-controlled trial on treatment in pregnancy with albendazole versus placebo and praziquantel versus placebo was conducted in Uganda, with a 2 · 2 factorial design; 2507 women were enrolled; infants’ allergy events were recorded prospectively. The main outcome was doctor-diagnosed infantile eczema Results: Worms were detected in 68% of women before treatment. Doctor-diagnosed infantile eczema incidence was 10.4/100 infant years. Maternal albendazole treatment was associated with a significantly increased risk of eczema [Cox HR (95% CI), p: 1.82 (1.26–2.64), 0.002]; this effect was slightly stronger among infants whose mothers had no albendazole-susceptible worms than among infants whose mothers had such worms, although this difference was not statistically significant. Praziquantel showed no effect overall but was associated with increased risk among infants of mothers with Schistosoma mansoni [2.65 (1.16–6.08), interaction p = 0.02]. In a sample of infants, skin prick test reactivity and allergen-specific IgE were both associated with doctor-diagnosed eczema, indicating atopic aetiology. Albendazole was also strongly associated with reported recurrent wheeze [1.58 (1.13–2.22), 0.008]; praziquantel showed no effect. Conclusions: The detrimental effects of treatment suggest that exposure to maternal worm infections in utero may protect against eczema and wheeze in infancy. The results for albendazole are also consistent with a direct drug effect. Further studies are required to investigate mechanisms of these effects, possible benefits of worms or worm products in primary prevention of allergy, and the possibility that routine deworming during pregnancy may promote allergic disease in the offspring.
Antiretrovirals are Coming to Africa: Are you Ready?
(Uganda Martyrs University, Department of Health Sciences, 2004-04) Blyth, Mike
International agencies are beginning a rapid scaling up of antiretroviral distribution programs in Africa. Some are particularly looking for "faith-based organizations" (FBOs) as partners. The new initiatives may offer both unprecedented opportunities and some dangers for FBOs who wish to join in. The opportunities include increasing our capacity to provide not only HIV/AIDS care but other aspects of health care, and a potential for increased communication and cooperation between Christian organizations. The dangers include the likely widespread appearance of antiretroviral resistance; long term sustainability; negative impact on other aspects of HIV care and prevention; indirect costs to FBOs; corruption; encouragement of a culture of money and power, drawing FBOs away from their perceived missions; overextension; and harmful competition among FBOs. Organizations should be aware of the opportunities and dangers, and review their own calling and mission, before embarking on large-scale, externally-funded programs of ARV distribution.
Antiviral use among hepatitis B infected patients in a low resource setting in Africa: a case study of West Nile, Uganda
(PubMed, 2023-06) Seremba, Emmanuel; Wandera, Claude; Ssekitoleko, Richard; Nankya-Mutyoba, Joan; Nyeko, Filbert; Amandua, Jacinto; Ejalu, David; Omale, William; Ocama, Ponsiano
Failure to access antiviral medications is a leading cause of hepatitis B (HBV)-associated morbidity and mortality in sub-Saharan Africa (SSA). Despite guideline availability, SSA is not on course to meet its elimination targets. We characterized factors associated with antiviral medication use and challenges to offering chronic care in a large Ugandan institution. We abstracted HBV care data. 2,175/2,209 (98.5%) had HBV-infection. Most participants were men [1,197 (55%)]; median (IQR) age 27 years (19-35); 388/1689 (23.0%) had cirrhosis by sonography and 141/2175 (6.5%) by the aspartate aminotransferase to platelet ratio index (APRI) score ≥2. Of the eligible, 20/141 (14.2%) with APRI score ≥2 and 24/388 (6.2%) with sonographic evidence of liver cirrhosis were not on antiviral medications. Overall, 1,106 (51%) were on medications though 65.8% had not been fully investigated. In multivariate analysis, age ≥35 years [OR (95% CI) = 1.52 (1.01-2.28), p=0.043], APRI ≥2 [OR (95% CI) =1.79 (1.48- 2.16), p<0.001], hepatitis B viral load >2,000IU/mL [OR (95% CI) = 6.22 (5.08-7.62), p<0.001] were associated with antiviral medications use. Over half of participants in care had not been fully evaluated although on treatment and many eligible patients did not access medications. There is need to bridge these gaps for SSA to realise its HBV elimination goals.
Application of workload indicators of staffing needs (WISN) in determining health workers' requirements for Mityana general hospital, Uganda
(International Journal of Public Health Research, 2015-08-30) Govule, Philip; Mugisha, John Francis; Katongole, Simon Peter; Bikaitwoha, Maniple Evard; Nanyingi, Miisa; Anguyo, Robert; Onzima, DDM
With reducing number of health workers amidst increasing disease burden, ever increasing population and limited resources, health systems are faced with challenges of providing adequate and quality health care globally. The application of provider-population ratio or fixed staff establishments have overtime, not matched the changing human resource needs of health care organizations. This study aimed to estimate human resource requirements of Mityana hospital basing on workload as an alternative to the existing approaches. Methodology: We employed descriptive cross-sectional design and the Workload Indicator of Staffing Needs (WISN) methodology. We utilized focus group discussion, observation and document review to obtain information from key informants; generated annual service statistics from the hospital’s records. The quantitative data were analyzed using the WISN software and spread sheet. Results: All the cadres studied had the same hours of work in a year (1,664), except nursing assistants whose annual available working time was1,696 hours. All the cadres were experiencing additional workload due to use of their time for activities other than their primary duties. Medical officers used more than 50% of their time for such (non-primary) activities compared to the laboratory staff (15%). As a result, the calculated WISN staff requirements were very high compared to the existing staff levels. Mityana hospital had 44% of the posts filled for the studied cadres. The nurses and midwives had the highest calculated requirements (72 and 45 respectively) and the highest staff positions filled (57% and 84% respectively) making them experience the lowest work pressure (49% each). The highest work pressure was experienced by medical officers and medical clinical officers (82% each). Conclusion: The study reveals shortages in health workforce in Mityana hospital. Non-primary activities contributed to work pressure in different units of the hospital, resulting into long hours of shifts which could have compromised quality of health care. This method (WISN) estimates staffing requirements based on actual service provision. Stakeholders facing human resource challenges and scarcity can employ it in prioritizing health cadres for recruitment and deployment based on existing work pressure.
ART in Uganda Catholic Church health facilities: opportunities and challenges.
(Uganda Martyrs University Press, 2005-04) Orach, Sam Orochi
Uganda Government plans to scale up access to antiretroviral therapy (ART) through the involvement of all stakeholders including public, private, Non-governmental organizations, Private-not-for-profit providers etc. based on the use of the existing institutional framework. Like other stakeholders, health facilities of the Catholic Church stand some opportunities to participate in this process. However, it is already clear that the rollout process is overstretching both the implementing health facilities and the Ministry of Health. The human and infrastructure resource demand is fast proving overwhelming. This is worse for the private-not-for-profit facilities. Salary enhancement for government staff alone will further weaken the PNFP partners from contributing effectively in the rollout. Integration of the ART programme into the comprehensive function of the hospitals faces difficulty from its "project" or vertical nature. There is concern over the visible drain of resources from other activities of health facilities providing ART and possible weakening of these facilities. The future sustainability is progressively being questioned. It is proposed that government assists the Church and other implementing partners in strengthening the existing framework as a composite part of the rollout package. It is also suggested that strengthening of the Public Health approach that Uganda is already partially practicing could offer some relief. Strengthening of the community-based approach is particularly advocated for.
ARV Treatment in Poor Settings: the State of the Art
(Uganda Martyrs University, Department of Health Sciences, 2004-04) Cicciò, Luigi
Universal access to antiretroviral drugs (ARVs) has created enormous debate and controversy in developing countries. But it seems to be a more feasible prospect by the day. Prices of ARVs have dramatically come down, and there is an unprecedented commitment by the international community to make universal access to ARVs happen, under WHO’s initiative of 3 by 5. However there are a number of issues to address. First, the criteria for selection of those to be on treatment have not been agreed upon, especially using clinical methods. Second, the compliance to ARVs has been found to be problematic in Africa. It would require a Directly Observed Treatment Strategy (DOTS) approach to improve on compliance. Third, universal access to ARVs will require integration into national health systems, and strengthening these systems. Fourth, monitoring ARV treatment for safety, effectiveness and acceptability will be critical. This will require investment in laboratory services as well as in information management systems. Fifth, sustainable financing of ARVs will require Governments to commit, for a long time to come, substantial funding for ARVs, and to the health systems into which ARVs are to be integrated. Lastly, there are risks that need to be expected and prepared for up front. These include increasing the infectitious periods of people on ARVs by prolonging their lives; leakage and misuse of ARVs and the consequent drug resistance that may occur; and a possible disabling or even collapse of health systems because resources are shunted to universal ARV provision. Nevertheless, the treatment of AIDS that was denied to poor countries on grounds of cost, lack of infrastructure, and other excuses is now more than ever possible to the people of these countries.
Assessing Risk of HIV and Hepatitis C among People who Inject Drugs in East Africa: Findings From a Rapid Assessment
(Journal of Viral Hepatitis, 2019) Platt, Lucy; Stengel, Camille; Nkurunziza, Menus; Muhangi, Denis; Byansi, Peter; Wandiembe, Peter; Busago, Andre; Bitira, David; Mundia, Bernard; Onesmus, Mlewa; Rhodes, Tim
Rapid assessment cross-sectional surveys and qualitative interviews were conducted among people who inject drugs (PWID) in Burundi and Uganda, as well as key informants working with drug users, to assess risk associated with HIV and hepatitis C (HCV). A total of 127 PWID were recruited in Burundi and 125 in Uganda of which the majority were male and aged between 24 and 26 years. Blood samples were collected in Burundi to test for antibodies to HIV, HCV and B Surface Antigen (HBsAg). Heroin was mainly injected in Uganda and Burundi with a small minority injecting crack/cocaine. Half of participants in Burundi, and 86% in Uganda had been HIV tested. The minority had been tested for HCV in any site (5-7%). HIV prevalence from the serological testing in Burundi indicated that 10% tested positive for antibodies to HIV, 6% to HCV and 9% to HBsAg. Qualitative data suggested that structural factors including costs of needle/syringes as well policies prohibiting pharmacies selling injecting equipment to PWID were related to reuse and sharing of needles/syringes among PWID, despite awareness HIV transmission risk. Police arrest was common in Burundi and Uganda and the use of bribes by police compounded existing high levels of poverty. Findings accentuate the need for policy shifts to enable easier access to clean injecting equipment, increased availability of HIV and HCV testing and increased access to affordable drug treatment and introduction of opioid substitution therapy. Specific attention is needed to the potential for sexual transmission of HIV among this population.
Assessing the external validity of a randomized controlled trial of anthelminthics in mothers and their children in Entebbe, Uganda
(BioMed Central, 2014) Millard, James D; Muhangi, Lawrence; Sewankambo, Moses; Ndibazza, Juliet; Elliott, Alison M; Webb, Emily L
The ‘external validity’ of randomized controlled trials is an important measure of quality, but is often not formally assessed. Trials concerning mass drug administration for helminth control are likely to guide public health policy and careful interpretation of their context is needed. We aimed to determine how representative participants in one such trial were of their community. We explore implications for trial interpretation and resulting public health recommendations. Methods: The trial assessed was the Entebbe Mother and Baby Study (EMaBS), a trial of anthelminthic treatment during pregnancy and early childhood. In a novel approach for assessing external validity, we conducted a two-stage cluster sample community survey within the trial catchment area and compared characteristics of potentially-eligible community children with characteristics of children participating in the trial. Results: A total of 173 children aged three to five-years-old were surveyed from 480 households. Of children surveyed, we estimated that mothers of 60% would have been eligible for recruitment, and of these, 31% had actually been enrolled. Children surveyed were compared to 199 trial children in the same age group reviewed at annual trial visits during the same time period. There were significant differences in ethnicity between the trial participants and the community children, and in socioeconomic status, with those in the trial having, on average, more educated parents and higher maternal employment. Trial children were less likely to have barefoot exposure and more likely to use insecticide-treated bed nets. There were no significant differences in numbers of reported illness events over the last year. Conclusions: The trial had not enrolled all eligible participants, and those enrolled were of higher socioeconomic status, and had lower risk of exposure to the parasitic infections targeted by the trial interventions. It is possible the trial may have underestimated the absolute effects of anthelminthic treatment during pregnancy and early childhood, although the fact that there were no differences in reported incidence of common infectious diseases (one of the primary outcomes of EMaBS) between the two groups provides reassurance. Concurrent community surveys may be an effective way to test the external validity of trials. EMaBS Trial registration: ISRCTN32849447, registered 22 July 2005
Assessing the Roles of Internet of Things in Combating the Global Spread of COVID-19 Virus: A Systematic Review and Meta-analysis
(Science and Education Publishing, 2022-03-22) Omona, Kizito
Internet of things (IoT), as the name sounds, refers to a network of physical objects called ‘things’, that are implanted with sensors, software and other technologies to connect and exchange data with other devices and other systems over the Internet. Connecting these objects and then adding sensors to them contribute some digital intelligence to the devices which eventually enables them to communicate real-time data without the need for physical human involvement. This revolution improves modern healthcare systems. The purpose of this study was to examine the healthcare roles of internet of things (IoT) in combating the global spread of COVID-19 virus. Literature Search of Google Scholar databases, PubMed, SCOPUS and ResearchGate using the keywords “Internet of things” or “IoT” and “COVID-19” was made. Further inputs were taken from blogs and relevant reports. Adoption of IoT technology was found to be rapid and is expected to impact on reducing healthcare-associated costs and improvement of treatment outcomes of COVID-19 infected patients or any other. This is achieved through early patient diagnosis, remote patient monitoring, and cold-chain supply monitoring, among others. Conclusively, from a grey look, IoT proves to be cost-effective, efficient and provides timely and significant care to critical patients in case of pandemics.
Assessment of risk factors associated with multi-drug resistant tuberculosis (MDR-TB) in Gulu regional referral hospital
(African Journals Online (AJOL), 2023-10-11) Omona, Kizito; Opiyo, Mucha Albert
Multi-drug resistant tuberculosis (MDR-TB) is increasingly recognized as emerging infectious disease of public health concern. Globally, 206030 people were diagnosed with MDR-TB in 2019, representing a 10% increase from 186883 people who had it in 2018. In Uganda, the prevalence of MDR among new TB cases is 4.4% and 17.7% among previously treated TB cases. To determine the risk factors associated with MDR-TB among tuberculosis patients in Gulu regional referral hospital. Material and Methods: A cross-sectional analytical study using both quantitative and qualitative methods of data collection and analysis was used. Data was collected from 384 TB patients using data extraction form and 6 Key informant interviews conducted. Analysis using Pearson chi-square test was run. HIV positive patients were 2.6 times more likely to be infected with MDR-TB than HIV negative patients [AOR=2.6: 95% CI 1.34– 5.85: P=0.006]. Previously treated TB patients were 2.8 times more likely to be infected with MDR-TB than newly diagnosed TB patients [AOR=2.8: 95% CI 1.33– 5.85: P=0.006]. Defaulting TB patients were 3.1 times more likely to be infected with MDR-TB than the non-defaulting TB patients [AOR=3.1]. There is high prevalence of drug resistance among patients attending TB treatment at the facility.
Assessment of safe motherhood health service coverage, birth defects detection and child disability prevention using lot quality assurance sampling in Central Uganda
(East African Health Research Commission, 2023) Akankwasa, Edith; Kamya, Willy; Sendijja, Moses; Mudoola, Janet; Lwenge, Mathias; Anguyo DDM Onzima, Robert; Kasozi, Daniel; Byansi, Peter; Katongole, Simon Peter
It is crucial to have satisfactory coverage of safe motherhood services in order to prevent birth defects and child disabilities. Mildmay Uganda Institute of Health Sciences (MIHS) implemented a safe motherhood project aimed at preventing birth defects and child disabilities. Three years after the project’s implementation, a rapid cross-sectional health facility survey was conducted in 4 districts of central Uganda to assess the coverage of key safe motherhood and early childhood services. The Lot Quality Assurance Sampling approach was used to assess coverage of 16 indicators in the areas of ANC, skilled birth attendance, early childhood care, postnatal care, and knowledge about child disability prevention. A Decision Rule was set at 80% upper threshold to classify the performance of health facilities at the district level. The survey found that there was variation in performance across indicators and districts. All districts achieved the 80% coverage target in ANC first visit, mothers who received at least two doses of Fansidar for intermittent preventive treatment of malaria in pregnancy, and mothers with knowledge of the action to take in case they suspect childhood disability. Folic acid supplementation during pregnancy and screening for birth defects using the Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score had overall coverage above the target, but one district each had coverage below target in each of these 2 indicators. The coverage target was not reached in the rest of the survey indicators in each of the districts. Well-performing districts, especially in indicators with inconsistent performance, offer valuable insights for learning and adapting interventions in districts that do not meet the desired coverage of those particular indicators. Considering the disparities in performance among different indicators and districts, project planners should adopt, modify and implement successful strategies in districts and indicators that perform well. By doing so, they can enhance the performance of under performing districts or indicators.
Assessment of solid waste management at source in compliance with guidelines
(Şahin İDİN, 2023-01-01) Omona, Kizito; Maderu, Paul
Solid waste management poses a big challenge for many urban households, especially in developing countries. Overcrowding and informal settlements have emerged with illegal and indiscriminate waste disposal. Guidelines for proper management of solid waste are least observed at household level in such settings. The study was to assess solid waste management at source in compliance with guidelines among residents of Kawempe municipality, Kampala district. It was descriptive and analytical cross-sectional study design, where 385 household heads and local leaders were interviewed using questionnaires and interview guides. Only 37.9% of households complied with guidelines for solid waste management at source. Factors of waste management practices were waste reduction (p<.005), separation (p<.001), reuse (p<.001) and composting (p<.027). Determinants such as gender (p<.007), marital status (p<.016), educational level (p<.00), occupation (p<.007), household size (p<.025), medium of community sensitization (p<.00), enforcement of bi-laws (p<.005), type of waste generated (p<0.00) and waste storage method (p < .009) were implicated. Conclusively, compliance with guidelines in the management of household solid waste at source was still very low within the city.
Assessment of the accuracy of malaria microscopy in private health facilities in Entebbe Municipality, Uganda: a cross-sectional study
(BMC Springer Nature, 2021-06-06) Mutabazi, Tobius; Arinaitwe, Emmanuel; Ndyabakira, Alex; Sendaula, Emmanuel; Kakeeto, Alex; Okimat, Paul; Orishaba, Philip; Katongole, Simon Peter; Mpimbaza, Arthur; Byakika‑Kibwika, Pauline; Karamagi, Charles; Nakayaga Kalyango, Joan; Kamya, Moses R.; Dorsey, Grant; Nankabirwa, Joaniter I.
Although microscopy remains the gold standard for malaria diagnosis, little is known about its accu‑ racy in the private health facilities in Uganda. This study evaluated the accuracy of malaria microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda. Between April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility-based smear results were recorded from the participant’s consultation notes, and a research slide was obtained for expert microscopy during exit interview. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant’s clinic visit. The test positivity rate of malaria parasitaemia was 15.0% by expert microscopy. The sensitivity, specifc‑ ity and negative predictive value of the facility-based microscopy were high (95.8%, 90.1 and 99.2%, respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; (1) who had less than 5 years’ experience in reading malaria smears (adjusted Odds Ratio [aOR]=9.74, 95% confdence interval [CI] (1.06–89.5), p-value=0.04), and (2) who was examining less than 5 smears a day (aOR=38.8, 95% CI 9.65–156, p-value<0.001). The accuracy of malaria microscopy in this setting was high, although one third of the patients diag‑ nosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In-service training may be sufcient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector where accuracy is still poor
Association between malaria exposure and Kaposi’s sarcoma-associated herpes virus seropositivity in Uganda
(John Wiley & Sons Ltd., 2015) Nalwoga, Angela; Cose, Stephen; Wakeham, Katie; Miley, Wendell; Ndibazza, Juliet; Drakeley, Christopher; Elliott, Alison M; Whitby, Denise; Newton, Robert
Objective: Unlike other herpes viruses, Kaposi’s sarcoma-associated herpes virus (KSHV) is not ubiquitous worldwide and is most prevalent in sub-Saharan Africa. The reasons for this are unclear. As part of a wider investigation of factors that facilitate transmission in Uganda, a high prevalence country, we examined the association between antimalaria antibodies and seropositivity against KSHV. methods Antibodies against P. falciparum merozoite surface protein (PfMSP)-1, P. falciparum apical membrane antigen (PfAMA)-1 and KSHV antigens (ORF73 and K8.1) were measured in samples from 1164 mothers and 1227 children. results Kaposi’s sarcoma-associated herpes virus seroprevalence was 69% among mothers and 15% children. Among mothers, KSHV seroprevalence increased with malaria antibody titres: from 60% to 82% and from 54% to 77%, comparing those with the lowest and highest titres for PfMSP-1 and PfAMA-1, respectively (P < 0.0001). Among children, only antibodies to PfAMA-1 were significantly associated with KSHV seropositivity, (P < 0.0001). In both mothers and children, anti-ORF73 antibodies were more strongly associated with malaria antibodies than anti-K8.1 antibodies. Conclusion: The association between malaria exposure and KSHV seropositivity suggests that malaria is a cofactor for KSHV infection or reactivation.

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