Ugandan Experience Research Articles

Support to Radiology Residency Programs in Developing Countries: Our Experience in Uganda With the Mbarara University of Science and Technology

Support to Radiology Residency Programs in Developing Countries: Our Experience in Uganda With the Mbarara University of Science and Technology

Child malnutrition – from Hospital to clinical practice – the experience of Tanzania and Uganda

Child malnutrition – from Hospital to clinical practice – the experience of Tanzania and Uganda

The Role of Apprenticeship in Improving the Livelihood of HIV-Positive Adolescents Who Prematurely Drop Out of School: The Mildmay Uganda Experience

Objective: HIV and AIDS have adverse effects on the livelihood of adolescents especially when parents die or are poor due to ill health. Mildmay Uganda has an apprenticeship programme that helps such adolescents acquire skills in order to improve their quality of life. The aim of this study was to examine the role of apprenticeship in improving the livelihood of HIV-positive adolescents who prematurely dropped out of school. Methods: A retrospective review of data of all adolescents who had been enrolled on the apprenticeship programme from January 2012 to January 2014 was done to document their progress and any lessons learnt. A vulnerability index tool was used to assess vulnerability levels and at same time to measure the progress and improvement of livelihood. Results: A total of twenty (20) adolescents were enrolled on the apprenticeship programme during the stated period. Sixty percent were male and were in the age range of 17-24 years. Sixteen out of the 20 (80%) were able to use the acquired skills through apprenticeship to improve their livelihood. The other four adolescents completed apprenticeship, but did not practice their acquired skills. One male opted to venture into another business and three females abandoned their vocations when they got married. The vulnerability level assessment outcome showed a graduation from extremely poor to poor. Adolescents were able to meet their basic needs, keep clinic appointments and were emotionally stable by end of period of review. Conclusion: Apprenticeship is one way that can be used successfully to improve the livelihood of adolescents who prematurely drop out of school.

Science, Technology and Sustainable Food Production in Africa: An Assessment

This paper examines the impact of science and technology on sustainable food security in Africa, particularly on the contribution of Biodiversity, Biotechnology, and Biosafety. The researchers adopted a descriptive survey of wide range of literature drawn from the experience of South Africa, Zimbabwe, Uganda, Kenya, Cameroon, Tanzania and Nigeria. The centrality of the role of science and technology in sustainable food security in these countries is highlighted. Challenges of achieving sustainable food security is also identified. The study concludes that to achieve sustainable food security Africa must lay a solid foundation for African science and technology by investing more on education, research and development (R&D) as well as initiate public policies aimed at sharing adaptive and practical innovations and breakthroughs in science, technology and sustainability of food in the African continent among African States. Furthermore, African countries as a matter of urgency should invest on agricultural development with a view to achieving sustainable food production. DOI: 10.5901/mjss.2015.v6n6s4p285

Dealing with Relational and Social Challenges After Child Soldiering: Perspectives of Formerly Recruited Youth and Their Communities in Northern Uganda

AbstractThe reintegration of formerly recruited youth typically engenders a range of relational and social challenges, affecting both formerly recruited youth and the communities to which they return. Yet, research rarely studies the perspectives of community members, hampering the design of much‐needed community‐based interventions. This study aimed to understand how communities in northern Uganda experience and deal with relational and social challenges during the reintegration of youths who were formerly recruited into the Lord's resistance army (LRA). The study was undertaken in 2012 in Lira district. Participatory Ranking Methodology (PRM) was conducted with 267 participants, of whom 49 were formerly recruited youths. The results show five themes that give insight into how communities experience and handle relational and social challenges in the reintegration of formerly recruited youth: (i) letting go of fear, (ii) getting used to life after captivity, (iii) resentment and forgiveness, (iv) reducing insults and nicknaming and (v) coping with ongoing relational and social challenges. We discuss how formerly recruited youths and other community members frame relational and social challenges differently, and value similar resources for different reasons. The results of this study suggest that multiple experiences of and perspectives on relational and social challenges following child soldiering should be taken into account to develop interventions that are supported and valued by the community. Furthermore, interventions should draw upon the strategies that communities have already developed in response to relational and social challenges. Copyright © 2015 John Wiley & Sons, Ltd.

Prevalence of Sexual Experience and Initiation of Sexual Intercourse Among Adolescents, Rakai District, Uganda, 1994–2011

PurposeThe purpose of the study was to identify risk factors and time trends for sexual experience and sexual debut in rural Uganda. MethodsUsing population-based, longitudinal data from 15- to 19-year olds in Rakai, Uganda, we examined temporal trends in the prevalence of sexual experience and potential risk factors for sexual experience (n = 31,517 person-round observations) using logistic regression. We then identified factors associated with initiation of sex between survey rounds, using Poisson regression to estimate incidence rate ratios (IRR; n = 5,126 person-year observations). ResultsSexual experience was more common among adolescent women than men. The prevalence of sexual experience rose for most age-gender groups after 1994 and then declined after 2002. Factors associated with higher prevalence of sexual experience (without adjustment for other factors) included age, not enrolled in school, orphanhood, lower socioeconomic status, and drinking alcohol in the past 30 days; similar factors were associated with initiation of sex. Factors independently associated with initiation of sex included older age, nonenrollment in school (IRR = 1.7 for women and 1.8 for men), alcohol use (IRR = 1.3 for women and men), and being a double orphan among men (IRR = 1.2). Sexual experience began to decline around 2000, whereas increases in school enrollment began as early as 1994 and declines in orphanhood occurred after 2004 (as antiretroviral therapy became available). ConclusionsSexual experience among youth in Rakai was associated with social factors particularly school enrollment. Changes in these social factors also appear to influence change over time in sexual experience.

Ebola in the context of conflict affected states and health systems: case studies of Northern Uganda and Sierra Leone.

Ebola seems to be a particular risk in conflict affected contexts. All three of the countries most affected by the 2014-15 outbreak have a complex conflict-affected recent history. Other major outbreaks in the recent past, in Northern Uganda and in the Democratic Republic of Congo are similarly afflicted although outbreaks have also occurred in stable settings. Although the 2014-15 outbreak in West Africa has received more attention than almost any other public health issue in recent months, very little of that attention has focused on the complex interaction between conflict and its aftermath and its implications for health systems, the emergence of the disease and the success or failure in controlling it.The health systems of conflict-affected states are characterized by a series of weaknesses, some common to other low and even middle income countries, others specifically conflict-related. Added to this is the burden placed on health systems by the aggravated health problems associated with conflict. Other features of post conflict health systems are a consequence of the global institutional response.Comparing the experience of Northern Uganda and Sierra Leone in the emergence and management of Ebola outbreaks in 2000-1 and in 2014-15 respectively highlights how the various elements of these conflict affected societies came together with international agencies responses to permit the outbreak of the disease and then to successfully contain it (in Northern Uganda) or to fail to do so before a catastrophic cost had been incurred (in Sierra Leone).These case studies have implications for the types of investments in health systems that are needed to enable effective response to Ebola and other zoonotic diseases where they arise in conflict- affected settings.

Transitional justice and democracy in Uganda: between impetus and instrumentalisation

While claims abound regarding transitional justice's importance for democracy building in transitioning countries, empirical investigations of these remain limited or have produced contradictory findings. This article seeks to contribute to these debates by investigating the relationship between transitional justice and democratic institution building in Uganda – looking in particular at the rule of law, the security forces and participation. It does so by exploring the causal mechanisms linking transitional justice to democracy, that is, the means through which transitional justice exerts its impact. Transitional justice is widely expected to impact democratic institution building through three mechanisms: (de)legitimation, reform, and empowerment. However, this article finds that in Uganda, transitional justice's impact through these is more circumscribed than has so far been assumed, and that it sometimes impacts democratic institution building negatively. The Ugandan experience furthermore suggests that in contexts of armed conflict and a hybrid regime, expectations about the extent to which transitional justice can support democratic institution building should be lowered.

Uganda's Experience with Real Time Monitoring: mTrac and U-Report

This report reviews two real time monitoring initiatives in Uganda that utilize Rapid Short Message Service (RapidSMS) technology: mTrac and U-report. mTrac is a routine data system that uses RapidSMS to accelerate the submission of community and health facility data from local to district to national levels, including disease surveillance, malaria treatment and drug stock indicators. This new system replaced the older paper-based reporting system and makes it possible for staff at health facilities to use their own mobile phones to report on stock levels and usage rates for anti-malarial medicines, with data made instantly available on a web-based dashboard to government managers. To improve response and strengthen accountability, the system also incorporates crowd-sourcing reports of service delivery complaints through an anonymous SMS hotline. In addition to providing information in a timelier manner and making information more accessible, mTrac has found widespread acceptance across local and national levels, and Uganda’s Ministry of Health has taken full ownership of its operation. Although mTrac was initially piloted in a few selected districts in late 2011, it is expected to cover all 5,000 health facilities across the country in 2013.The early experiences of mTrac offer a number of important lessons for RTM. First, the success of the rolling out of mTrac in Uganda suggests that such this type of routine data system could be adapted in many countries to achieve both cost-savings and more efficient and accurate monitoring of key supply and demand health indicators in vulnerable areas. Second, adapting multiple reporting mechanisms can maximize the quality of information received by a RTM initiative. In the case of mTrac, this is achieved by cross-checking the SMS data submitted by the health facilities with information received from the anonymous SMS hotline as well as independent reports sent by volunteer health teams at the community level. Third, RapidSMS reporting holds vast potential to enhance the inclusivity and effectiveness of service delivery systems that are tracked by integrated RTM initiatives. Not only has the electronic reporting system reduced leakage of drugs from the public health system, but mTrac has also introduced more transparency and accountability into the health system, empowered district and national managers with actionable information and helped to ensure the availability of antimalarial treatment for all Ugandan citizens. Lastly, mTrac demonstrates that systematic RTM initiatives can also serve as effective sub-national service delivery tools and support decentralization objectives.U-report, in contrast, was conceived as a social and community-based monitoring system that uses RapidSMS. It offers young Ugandans a chance to voice their opinions on issues that they care about by giving them access to a free SMS service through which they can send in text messages, respond to polls, and receive factual information and results. UNICEF developed the software application and built a web platform for managing communications between the social monitors, called U-reporters, and the central managers. Although the overall objective is to empower youth in general, specific issues tackled by U-reporters often address the needs of vulnerable children, and U-report further possesses the capability of soliciting information from specific areas as well as age groups that are vulnerable. Regarding uses, U-report raises awareness on different issues, supports community-led development, fosters information sharing, including with parliamentarians, and serves as a tool for local and national policy advocacy. At the end of 2012, there were more than 170,000 U-reporters across Uganda (average of 24) and over 200 polls posted on the website..

Filtered meaning: appreciating linguistic skill, social position and subjectivity of interpreters in cross-language research

Arriving in a foreign country with little knowledge of local languages presents the researcher with significant linguistic challenges. Our in-country contacts may suggest potential interpreters for us to hire, but how do we know if these interpreters can fluently speak the languages of our participants? Can we, lacking fluency in local languages, understand when the social position and lived experiences of our interpreter modify the discourses we seek to analyse? Drawing from my human geography research experience in Uganda, this article aims to share strategies to assess the linguistic skills of the interpreter and to understand his or her social position and subjectivity. Uniquely, this paper highlights differences in interpretation and links these differences to the assistants’ social position and subjectivity, highlighting the need to acknowledge that meaning can be filtered by interpretation and requiring that critical reflection be broadened to encompass interpreters in cross-language research.

Teaching by teleconference: The Massachusetts General Hospital — Ugandan experience

Teaching by teleconference: The Massachusetts General Hospital — Ugandan experience

Ebola a reality of modern Public Health; need for Surveillance, Preparedness and Response Training for Health Workers and other multidisciplinary teams: a case for Uganda.

IntroductionWest Africa is experiencing the largest ever reported Ebola outbreak. Over 20,000 people have been infected of which about 9000 have died. It is possible that lack of community understanding of the epidemic and lack of institutional memory and inexperienced health workers could have led to the rapid spread of the disease. In this paper, we share Uganda's experiences on how the capacity of health workers and other multidisciplinary teams can be improved in preparing and responding to Ebola outbreaks.MethodsMakerere University School of Public Health in collaboration with the Ministry of Health and the African Field Epidemiology Network (AFENET), trained health care workers and other multidisciplinary teams from six border districts of Uganda so as to increase their alertness and response capabilities towards Ebola. We used participatory training methods to impart knowledge and skills and guided participants to develop district epidemic response plans. Communities were sensitized about Ebola through mass media, IEC materials, and infection control and prevention materials were distributed in districts.ResultsWe trained 210 health workers and 120 other multidisciplinary team members on Ebola surveillance, preparedness and response. Evaluation results demonstrated a gain in knowledge and skills. Communities were sensitized about Ebola and Districts received person protective equipments and items for infection prevention. Epidemic Preparedness and Response plans were also developed.ConclusionTraining of multidisciplinary teams improves the country's preparedness, alertness and response capabilities in controlling Ebola. West African countries experiencing Ebola outbreaks could draw lessons from the Uganda experience to contain the outbreak.

Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data.

The demographic and nutritional transitions taking place in Uganda, just as in other low- and middle-income countries (LMIC), are leading to accelerating growth of chronic, non-communicable diseases (NCDs). Though still sparse, locally derived data on NCDs in Uganda has increased greatly over the past five years and will soon be bolstered by the first nationally representative data set on NCDs. Using these available local data, we describe the landscape of the globally recognized major NCDs- cardiovascular disease, diabetes, cancer, and chronic respiratory disease- and closely examine what is known about other locally important chronic conditions. For example, mental health disorders, spawned by an extended civil war, and highly prevalent NCD risk factors such as excessive alcohol intake and road traffic accidents, warrant special attention in Uganda. Additionally, we explore public sector capacity to tackle NCDs, including Ministry of Health NCD financing and health facility and healthcare worker preparedness. Finally, we describe a number of promising initiatives that are addressing the Ugandan NCD epidemic. These include multi-sector partnerships focused on capacity building and health systems strengthening; a model civil society collaboration leading a regional coalition; and a novel alliance of parliamentarians lobbying for NCD policy. Lessons learned from the ongoing Ugandan experience will inform other LMIC, especially in sub-Saharan Africa, as they restructure their health systems to address the growing NCD epidemic.

Implementing plant clinics in the maelstrom of policy reform in Uganda

Pests and diseases are key production constraints for Ugandan small-scale farmers. In 2010, the Ugandan Gov- ernment, as part of its agricultural development strategy, adopted plant clinics to improve plant health extension for farmers and to contribute to strengthening disease surveil- lance. Despite government commitment and a growing de- mand for this new type of farmer service, effective implemen- tationofplantclinicsturnedouttobeachallenge.Weexamine how agricultural policies and institutional setups, and their political context, influenced the implementation of plant clinics from 2010 to 2011. We argue that the political agenda surrounding the decentralization and agricultural extension reforms, initiated in 1997, substantially weakened the Minis- try of Agriculture, Animal Industry and Fisheries and undermined institutional stability and the effectiveness of delivery of public extension services. Implementation of plant clinics was further affected by a new district reform and the national elections taking place during the study period. The dual purpose of the plant clinics created uncertainty about their organisational belonging. They fell through the cracks of extension and disease control. This was exacerbated by the unclear roles and authority of the Ministry vs. local govern- ments. For plant clinics to succeed the fundamental issues of governance, resources and implementation structure need to be addressed. The Ugandan experience shows the importance of understanding not only the policy and institutional frame- works in which plant clinics operate, but also the effects of political imperatives and donors on policy implementation. This study provides a basis for institutional and policy analy- sis related to the implementation of plant clinics elsewhere.

Inclusive innovation processes – experiences from Uganda and Tanzania

It has been well known since the 1960s that developing countries need to improve their capacity to use science and technology and that more efforts must be put into R&D that would benefit poor countries and people. Serious efforts to accomplish this exist but they are still too few and small in relation to the size of the problem. Whilst the supply of knowledge and competent people slowly has been growing, there is still a continued lack of demand for domestic knowledge. Foreign consultants dominate knowledge supply to government, industry and aid donors. Small firms and farms are not used to articulate their demand for knowledge. Such weak demand and timid articulation are typical signs of emerging innovations systems. Despite this, there are signs of a fragmented domestic creative potential that could be mobilised to increase innovation for inclusive development. In this article, practical experiences in Uganda and Tanzania illuminate possibilities to articulate and address the knowledge demand from firms and farms through cluster formation. In this type of cluster formations, universities have key roles as knowledge providers and as intermediaries that assist in building the ties and linkages necessary to move the innovation system to a higher state.

Ebola viral hemorrhagic disease outbreak in West Africa- lessons from Uganda.

There has been a rapid spread of Ebola Viral Hemorrhagic disease in Guinea, Liberia and Sierra Leone since March 2014. Since this is the first time of a major Ebola outbreak in West Africa; it is possible there is lack of understanding of the epidemic in the communities, lack of experience among the health workers to manage the cases and limited capacities for rapid response. The main objective of this article is to share Uganda's experience in controlling similar Ebola outbreaks and to suggest some lessons that could inform the control of the Ebola outbreak in West Africa. The article is based on published papers, reports of previous Ebola outbreaks, response plans and experiences of individuals who have participated in the control of Ebola epidemics in Uganda. Lessons learnt: The success in the control of Ebola epidemics in Uganda has been due to high political support, effective coordination through national and district task forces. In addition there has been active surveillance, strong community mobilization using village health teams and other community resources persons, an efficient laboratory system that has capacity to provide timely results. These have coupled with effective case management and infection control and the involvement of development partners who commit resources with shared responsibility. Several factors have contributed to the successful quick containment of Ebola outbreaks in Uganda. West African countries experiencing Ebola outbreaks could draw some lessons from the Uganda experience and adapt them to contain the Ebola epidemic.

Opt-out cervical cancer screening increases coverage of cervical cancer screening in HIV clinical care settings: Experiences from Mildmay, Uganda

Background Cervical cancer is highly prevalent in developing countries. In Uganda, overall incidence rate is estimated at 44 per 100,000 women and 60 per 100,000 among HIV infected women. However, only 30% of women have ever been screened for cervical cancer and linkage to treatment after diagnosis is suboptimal. For HIV infected women, who are at highest risk of cervical cancer, the HIV care delivery system provides an opportunity for cervical cancer services. In this paper we share the Mildmay Uganda (MUg) experiences in integrating cervical cancer services into HIV care.

Strengthening district-based health reporting through the district health management information software system: the Ugandan experience.

BackgroundUntimely, incomplete and inaccurate data are common challenges in planning, monitoring and evaluation of health sector performance, and health service delivery in many sub-Saharan African settings. We document Uganda’s experience in strengthening routine health data reporting through the roll-out of the District Health Management Information Software System version 2 (DHIS2).MethodsDHIS2 was adopted at the national level in January 2011. The system was initially piloted in 4 districts, before it was rolled out to all the 112 districts by July 2012. As part of the roll-out process, 35 training workshops targeting 972 users were conducted throughout the country. Those trained included Records Assistants (168, 17.3%), District Health Officers (112, 11.5%), Health Management Information System Focal Persons (HMIS-FPs) (112, 11.5%), District Biostatisticians (107, 11%) and other health workers (473, 48.7%). To assess improvements in health reporting, we compared data on completeness and timeliness of outpatient and inpatient reporting for the period before (2011/12) and after (2012/13) the introduction of DHIS2. We reviewed data on the reporting of selected health service coverage indicators as a proxy for improved health reporting, and documented implementation challenges and lessons learned during the DHIS2 roll-out process.ResultsCompleteness of outpatient reporting increased from 36.3% in 2011/12 to 85.3% in 2012/13 while timeliness of outpatient reporting increased from 22.4% to 77.6%. Similarly, completeness of inpatient reporting increased from 20.6% to 57.9% while timeliness of inpatient reporting increased from 22.5% to 75.6%. There was increased reporting on selected health coverage indicators (e.g. the reporting of one-year old children who were immunized with three doses of pentavelent vaccine increased from 57% in 2011/12 to 87% in 2012/13). Implementation challenges included limited access to computers and internet (34%), inadequate technical support (23%) and limited worker force (18%).ConclusionImplementation of DHIS2 resulted in improved timeliness and completeness in reporting of routine outpatient, inpatient and health service usage data from the district to the national level. Continued onsite support supervision and mentorship and additional system/infrastructure enhancements, including internet connectivity, are needed to further enhance the performance of DHIS2.

A scoping study on task shifting; the case of Uganda.

BackgroundTask shifting has been implemented in Uganda for decades with little documentation. This study’s objectives were to; gather evidence on task-shifting experiences in Uganda, establish its acceptability and perceptions among health managers and policymakers, and make recommendations.MethodsThis was a qualitative study. Data collection involved; review of published and gray literature, and key informant interviews of stakeholders in health policy and decision making in Uganda. Data was analyzed by thematic content analysis.ResultsTask shifting was the mainstay of health service delivery in Uganda. Lower cadre of health workers performed duties of specialized health workers. However, Uganda has no task shifting policy and guidelines, and task shifting was practiced informally.Lower cadre of health workers were deemed to be incompetent to handle shifted roles and already overworked, and support supervision was poor.Advocates of task shifting argued that lower cadre of health workers already performed the roles of highly trained health workers. They needed a supporting policy and support supervision.Opponents argued that lower cadre of health workers were; incompetent, overworked, and task shifting was more expensive than recruiting appropriately trained health workers.ConclusionsTask shifting was unacceptable to most health managers and policy makers because lower cadres of health workers were; incompetent, overworked and support supervision was poor. Recruitment of existing unemployed well trained health workers, implementation of human resource motivation and retention strategies, and government sponsored graduates to work for a defined mandatory period of time were recommended.

Targeted HIV testing of children in the care of HIV positive adults, a gateway to the HIV positive child: The Mildmay, Uganda experience

Targeted HIV testing of children in the care of HIV positive adults, a gateway to the HIV positive child: The Mildmay, Uganda experience