Districts In Eastern Uganda Research Articles

Access to subsidized ACT and malaria treatment--evidence from the first year of the AMFm program in six districts in Uganda

To determine the effect of the Affordable Medicines Facility for malaria (AMFm) launched in April 2011 in Uganda on the use of Artemisinin Combination Therapies (ACTs) for malaria treatment. 2398 households across six districts in Eastern Uganda were monitored through monthly survey visits from April 2011 to April 2012. During each visit, health seeking modules were completed for any morbidity episode reported by the household. Additional surveys were conducted with 114 licensed drug shops in the same districts in April 2011 and April 2012. Changes in drug shops' stocking and pricing of ACTs, as well as changes in households' treatment behaviour and drug usage were analysed. The fraction of licensed drug shops reporting that an ACT was one of their top five bestselling antimalarial drugs increased from 32% to 84% (Δ=0.517, 95% Confidence Intervals (CI) [0.407, 0.628], P<0.001). The fraction of children under the age of 5 with fevers getting an ACT increased from 37% to 47% (Δ=0.103, 95% CI [0.070, 0.136], P<0.001), and the fraction of ACT treatments among patients getting any antimalarial increased from 51% to 65% (Δ=0.145, 95% CI [0.121, 0.169], P<0.001). The observed changes were particularly large among poorer households, and were smallest for households from the highest wealth quintile. The study results suggest that, during its first year of implementation in Uganda, the AMFm achieved its main objective of increasing the availability and use of ACTs. Estimates of the impact of the AMFm on ACT use for children under 5 imply that the program should be considered highly cost-effective under current World Health Organization (WHO) guidelines. The overall results look promising, but larger and longer term studies will be needed to assess the health impact and cost-effectiveness of the program.

Stakeholder analysis for a maternal and newborn health project in Eastern Uganda.

BackgroundBased on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders’ interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country.MethodsA stakeholder analysis was carried out in March 2011 at national level and in four districts of Eastern Uganda where the proposed interventions would be conducted. At the national level, four key informant interviews were conducted with the ministry of health representative, Member of Parliament, and development partners. District health team members were interviewed and also engaged in a workshop; and at community level, twelve focus group discussions were conducted among women, men and motorcycle transporters.ResultsThis analysis revealed that district and community level stakeholders were high level supporters of the proposed interventions but not drivers. At community level the mothers, their spouses and transporters were of low influence due to the limited funds they possessed. National level and district stakeholders believed that the intervention is costly and cannot be affordably scaled up. They advised the study team to mobilize and sensitize the communities to contribute financially from the start in order to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions will influence policy through modeling on how to improve the quality of maternal/newborn health services, male involvement, and improved accessibility of services.ConclusionMost of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up.

Use of traditional medicine for the treatment of diabetes in Eastern Uganda: a qualitative exploration of reasons for choice

BackgroundWhile there are biomedical drugs for managing diabetes mellitus, some patients with diabetes use traditional medicine. The aim of the study was to explore why patients with diabetes use traditional medicine for the treatment of diabetes.MethodsThe study was conducted in Iganga and Bugiri districts in Eastern Uganda using four focus group discussions (FGDs) with patients with diabetes; two with female patients and two with male patients, thirteen key informant interviews (KIIs); nine with health workers working with patients with diabetes and four with herbalists. FGDs and KIIs focused on what respondents perceived as reasons for patients with diabetes taking traditional medicine. Analysis was done using content analysis.ResultsReasons for taking traditional medicine included finding difficulties accessing hospitals, diabetic drugs being out of stock, traditional medicine being acceptable and available within community, as well as being supplied in big quantities. Others were traditional medicine being cheaper than biomedical treatment and payment for it being done in installments. Traditional medicine was also more convenient to take and was marketed aggressively by the herbalists. Influence of family and friends as well as traditional healers contributed to use of traditional medicine.ConclusionsPossibilities of putting diabetic drugs at facilities closer to patients need to be considered and health facilities should have a constant supply of diabetic drugs. Community members need to be sensitized on the proper treatment for diabetes mellitus and on the dangers of taking traditional medicine.

Psychiatric disorders and psychosocial correlates of high HIV risk sexual behaviour in war-affected Eastern Uganda

This article sets out to investigate the psychiatric and psychosocial risk factors for high risk sexual behaviour in a war-affected population in Eastern Uganda. A cross-sectional survey was carried out in four sub-counties in two districts in Eastern Uganda where 1560 randomly selected respondents (15 years and above) were interviewed. The primary outcome was a derived variable “high risk sexual behaviour” defined as reporting at least one of eight sexual practices that have been associated with HIV transmission in Uganda and which were hypothesised could arise as a consequence of psychiatric disorder or psychosocial problems. Multivariable logistic regression was used to assess factors associated with high risk sexual behaviour in this population. Males were more likely to have at least one “high risk sexual behaviour” than females (11.8% vs. 9.1% in the last year). Sex outside marriage was the most commonly reported high risk sexual behaviour. Among males, the factors independently associated with high risk sexual behaviour were: being married, belonging to non-Catholic/non-Protestant religions, poverty, being a victim of intimate partner violence and having a major depressive disorder (MDD). Among females, the factors that were independently associated with high risk sexual behaviour were: being in the reproductive age groups of 25–34 and 35–44 years, not seeing a close relative killed and having experienced war-related sexual torture. Holistic HIV/AIDS prevention programming in conflict and post-conflict settings should address the psychiatric and psychosocial well-being of these communities as a risk factor for HIV acquisition.

Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda

Background: The WHO estimates that more than 80% of African populations attend traditional healers for health reasons and that 40%–60% of these have some kind of mental illness. However, little is known about the profiles and outcome of this traditional approach to treatment.Objective: The purpose of this study was to describe the profiles and outcome of traditional healing practices for severe mental illnesses in Jinja and Iganga districts in the Busoga region of Eastern Uganda.Methods: Four studies were conducted. Study I used focus group discussions (FGDs) with case vignettes with local community members and traditional healers to explore the lay concepts of psychosis. Studies II and III concerned a cross-sectional survey of patients above 18 years at the traditional healer's shrines and study IV was made on a prospective cohort of patients diagnosed with psychosis in study III. Manual content analysis was used in study I; quantitative data in studies II, III, and IV were analyzed at univariate, bivariate, and multivariate levels to determine the association between psychological distress and socio-demographic factors; for study IV, factors associated with outcome were analyzed. One-way ANOVA for independent samples was the analysis used in Study IV.Results: The community gave indigenous names to psychoses (mania, schizophrenia, and psychotic depression) and had multiple explanatory models for them. Thus multiple solutions for these problems were sought. Of the 387 respondents, the prevalence of psychological distress was 65.1%, where 60.2% had diagnosable current mental illness, and 16.3% had had one disorder in their lifetime. Over 80% of patients with psychosis used both biomedical and traditional healing systems. Those who combined these two systems seemed to have a better outcome. All the symptom scales showed a percentage reduction of more than 20% at the 3- and 6-month follow-ups.Conclusion: Traditional healers shoulder a large burden of care of patients with mental health problems. This calls for all those who share the goal of improving the mental health of individuals to engage with traditional healers.

Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

BackgroundGeographical 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.MethodsThis 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.ResultsMotorcyclists 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.ConclusionsTransport 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.

Economic Valuation of a Tamarind (Tamarindus indica L.) Production System: Green Money from Drylands of Eastern Uganda

Tamarind (Tamarindus indica) is a valuable tree species Uganda and elsewhere in semi-arid Africa—for fruit, timber, leaves and shade—but like other indigenous species has been subject to decline in recent years. The success of steps to assist natural regeneration and rehabilitation will depend on the net financial benefits to the rural households, hence there is a need for improved financial information on the costs and returns of growing tamarind trees. This paper compares the financial performance of T. indica production in the open woodland and cropland areas in Uganda. Household surveys were carried out in Kamuli and Kaliro districts in eastern Uganda from July 2004 to February 2005. The estimated mean production of T. indica was 127 and 84 kg/ha/year from open woodland and cropland areas, respectively, a statistically significant difference. The net present value from T. indica products was US$ 893/ha in woodland and US$ 684/ha in cropland. In terms of foreign export earnings, T. indica juice from woodland and cropland was estimated to generate US$ 0.03/ha and US$ 0.02/ha, respectively. Returns from alternative land-use activities of agricultural cropping were highest for maize and lowest for finger millet in both open woodland and cropland sites. Sensitivity analysis revealed that an increase in the real discount rate from 9.86% (base case) to 15% decreases the financial NPVs of both the open woodland and cropland areas by 24%.

Psychological distress and associated factors among the attendees of traditional healing practices in Jinja and Iganga districts, Eastern Uganda: a cross-sectional study.

BackgroundMental health problems are a major public health concern worldwide. Evidence shows that African communities, including Uganda, use both modern and traditional healing systems. There is limited literature about the magnitude of psychological distress and associated factors among attendees of traditional healing practices. This study aimed to determine the prevalence and associated factors of psychological distress among attendees of traditional healing practices in two districts in Uganda.MethodsFace-to-face interviews with the Lusoga version of the Self Reporting Questionnaire (SRQ-20) were carried out with 400 patients over the age of 18 years attending traditional healing in Iganga and Jinja districts in Eastern Uganda. Patients were recruited consecutively in all the traditional healers' shrines that could be visited in the area. Persons with 6 or more positive responses to the SRQ were identified as having psychological distress. Prevalence was estimated and odds ratios of having psychological distress were obtained with multiple logistic regression analysis.Results387 questionnaire responses were analyzed. The prevalence of psychological distress in connection with attendance at the traditional healers' shrines was 65.1%. Having a co-wife and having more than four children were significantly associated with psyclogical distress. Among the socioeconomic indicators, lack of food and having debts were significantly associated with psychological distress. The distressed group was more likely to need explanations for ill health. Those who visited both the healer and a health unit were less likely to be distressed.ConclusionThis study provides evidence that a substantial proportion of attendees of traditional healing practices suffer from psychological distress. Associated factors include poverty, number of children, polygamy, reason for visiting the healer and use of both traditional healing and biomedical health units. These findings may be useful for policy makers and biomedical health workers for the engagement with traditional healers.

Factors Associated with the Use of Pesticides in Uganda: Strategic Options for Targeting Integrated Pest Management (IPM) Programs

Targeting particular groups who share similar production practices and problems has proven to be a cost-effective, efficient way to design and disseminate agricultural technologies. The accumulated evidence indicates that where successful, Integrated Pest Management (IPM) programs have been goaloriented and targeted. Since one of the primary goals of IPM is to control pests while reducing the use of synthetic pesticides, knowledge of social, economic and institutional factors that influence farm-level decisions to adopt pesticides may suggest different targets and strategies for disseminating IPM. Using a multi-staged sampling procedure, two hundred farmers from two districts in Eastern Uganda were interviewed regarding their socioeconomic background and pest management practices. Regression results indicate the most important predictor of pesticide use was growing tomatoes, followed in order by owning a backpack sprayer, farming in Kumi district, a higher level of education and more contact with extension. These results suggest targeting specific crops and cropping environments associated with high pesticide use for IPM programs. Farmers owning backpack sprayers could be targeted for programs that integrate pesticide safety and information about IPM. Extension agents also need to be provided information about and trained in IPM. Alternative IPM approaches are recommended for farmers who are not using pesticides.

Cereal stemborer species complex and establishment of Cotesia flavipes Cameron in eastern Uganda

Studies were conducted in two districts of eastern Uganda from 1997 to 1999 to introduce and monitor the establishment of an exotic parasitoid, Cotesia flavipes Cameron (Hymenoptera: Braconidae), for the control of the stemborer Chilo Partellus (Swinhoe) (Lepidoptera: Pyralidae), and also to determine the stemborer species complex in maize and sorghum. The study confirmed the presence of four important stemborers, two pyralids Ch. partellus and Eldana saccharina Walker and two noctuids, Busseola fusca Fuller and Sesamia calamistis Hampson. Chilo Partellus was dominant, constituting 53-88% of stemborers fourd followed by B. fusca at 8–37 %. The most abundant local parasitoid was the larval parasitoid Cotesia sesamiae (Cameron) (Hymenoptera: Braconidae). The pupal parasitoids Pediobius furvus Gahan (Hymenoptera: Eulophidae) and Dentichasmias busseolae Heinrich (Hymenoptera: Ichneumonidae) were also recorded. Parasitism of Co. sesamiae on Ch. partellus ranged between 0 and 13.1 %. The introduced Co. flavipes was recovered from all sites in four consecutive seasons (between 1998 and 1999) causing parasitism of between 4 and 32.9 % on Ch. partellus. Cotesia flavipes was also recovered from the indigenous stemborers B. fusca and S. calamistis. This study indicates that Co. flavipes has established in eastern Uganda.

Haemorrhagic Trypanosoma vivax Outbreak in Cattle in Mbale and Tororo Districts in Eastern Uganda

Haemorrhagic <i>Trypanosoma vivax</i> Outbreak in Cattle in Mbale and Tororo Districts in Eastern Uganda