Uganda Health Research Articles

Prevalence, regional distribution, and determinants of infertility in Uganda between 2006 and 2016: analysis of three Demographic and Health Surveys

Background Low- and middle-income countries, particularly in the African region in-country distribution and determinants of infertility are understudied. In this study, we aimed to estimate the prevalence, regional distribution, and determinants of infertility in Uganda to inform programming. Methods We estimated the prevalence of primary and secondary infertility among women aged 20-49 years using data from the three rounds of the Uganda Demographic and Health Survey 2006, 2011, and 2016, and compared the differences across geographic regions. We pooled data sets for all three years and conducted logistic regression to identify factors associated with infertility. Results We included 16,537 women aged 20-49 years for analysis of primary infertility and 12,628 for secondary infertility. The overall prevalence of infertility (pooled across the three surveys was 6.4%. The prevalence of primary infertility was 1.4% (95% Confidence interval, CI=1.0-1.8), 0.7% (95% CI=0.5-1.0) and 0.8% (95% CI=0.6-1.0) in 2006, 2011 and 2016, respectively. The prevalence of secondary infertility was 7.4% (95% CI=6.5-8.4), 6.9% (95% CI=5.9-8.0) and 7.1% (95% CI=6.4-7.9) in 2006, 2011, and 2016 respectively. The prevalence of primary infertility was similar across regions. Secondary infertility was highest in the Central (7.9%, 95% CI= 6.1-10.3, in 2016) and Northern regions (7.4%, 95% CI=6.1-8.9, in 2016). In all survey years, women with higher education had lower odds of secondary infertility compared to women with no education (adjusted odds ratio, aOR=0.54, 95% CI=0.35-0.83; P < 0.001). Conclusions Our results suggest that the prevalence of primary infertility is similar across regions, whereas secondary infertility varies by region, with higher prevalence in Central and Northern regions. More research is required to understand the drivers behind the variation of secondary infertility across regions to inform policy and decision making.

Mid-level managers’ perspectives on implementing isoniazid preventive therapy for people living with HIV in Ugandan health districts: a qualitative study

BackgroundIsoniazid preventive therapy (IPT) works to prevent tuberculosis (TB) among people living with HIV (PLHIV), but uptake remains low in Sub-Saharan Africa. In this analysis, we sought to identify barriers mid-level managers face in scaling IPT in Uganda and the mechanisms by which the SEARCH-IPT trial intervention influenced their abilities to increase IPT uptake.MethodsThe SEARCH-IPT study was a cluster randomized trial conducted from 2017–2021. The SEARCH-IPT intervention created collaborative groups of district health managers, facilitated by local HIV and TB experts, and provided leadership and management training over 3-years to increase IPT uptake in Uganda. In this qualitative study we analyzed transcripts of annual Focus Group Discussions and Key Informant Interviews, from a subset of SEARCH-IPT participants from intervention and control groups, and participant observation field notes. We conducted the analysis using inductive and deductive coding (with a priori codes and those derived from analysis) and a framework approach for data synthesis.ResultsWhen discussing factors that enabled positive outcomes, intervention managers described feeling ownership over interventions, supported by the leadership and management training they received in the SEARCH-IPT study, and the importance of collaboration between districts facilitated by the intervention. In contrast, when discussing factors that impeded their ability to make changes, intervention and control managers described external funders setting agendas, lack of collaboration in meetings that operated with more of a ‘top-down’ approach, inadequate supplies and staffing, and lack of motivation among frontline providers. Intervention group managers mentioned redistribution of available stock within districts as well as between districts, reflecting efforts of the SEARCH-IPT intervention to promote between-district collaboration, whereas control group managers mentioned redistribution within their districts to maximize the use of available IPT stock.ConclusionsIn Uganda, mid-level managers’ perceptions of barriers to scaling IPT included limited power to set agendas and control over funding, inadequate resources, lack of motivation of frontline providers, and lack of political prioritization. We found that the SEARCH-IPT intervention supported managers to design and implement strategies to improve IPT uptake and collaborate between districts. This may have contributed to the overall intervention effect in increasing the uptake of IPT among PLHIV compared to standard practice.Trial registrationClinicalTrials.gov, NCT03315962, Registered 20 October 2017.

Exploring Solar Energy Integration in Ugandan Health Centers: Evaluating the Implementation of Heliophotovoltaic Solutions for Rural Healthcare

This study presents a comprehensive examination of the impact of integrating solar energy into healthcare delivery in rural Uganda. Utilizing an extensive equation encompassing factors such as cost savings, operational efficiency, healthcare outcomes, and environmental impact, the research uncovers a holistic benefit of sustainable energy adoption into Uganda Health Centers. Key findings suggest that beyond serving as a reliable and sustainable power source, solar energy integration has the potential to revolutionize rural healthcare. The equation reveals promising outcomes, including redirected resources for critical healthcare needs, improved operational efficiency, and positive healthcare outcomes. The environmental benefits, coupled with the scalability of solar models, emphasize a sustainable future for rural healthcare. The study concludes with a compelling call to action, urging stakeholders to collaborate in swift implementation, policy development, and research initiatives. Recommendations include targeted policies, funding for solar infrastructure, and ongoing research into region-specific considerations. This work serves as a reagent for a sustainable transformation in healthcare delivery, advocating for a brighter and healthier future for underserved communities in Uganda and other countries with similar challenges. Keywords: Solar Energy Integration, Rural Healthcare, Cost Savings, Operational Efficiency, Sustainable Transformation

Mothers’ education and childhood anaemia in Uganda

ABSTRACT This article employs ordered probit to examine the effect mother’s education and other socio-economic and community factors on the prevalence of childhood anaemia in urban and rural areas and severity of anaemia in Uganda using the Uganda Demographic and Health Survey. In Uganda, 53% of children aged 6–59 months suffered from some degree of anaemia, with 24% being mildly anaemic, 27% moderately anaemic, and 2% severely anaemic (UDHS, 2016). Anaemia has substantial negative effects on the health and economic wellbeing of nations and communities. The study findings indicate that mother’s education attainment and the partner’s schooling and socio-economic factors are important in explaining the prevalence of childhood anaemia in Uganda. The major implication of these results is that raising women’s education improves their economic opportunities, and the behavioural responses and this can greatly improve children’s health outcomes in terms of low prevalence of childhood anaemia.

Individual and community-level factors associated with women’s utilization of postnatal care services in Uganda, 2016: a multilevel and spatial analysis

BackgroundOver time, Uganda has experienced high levels of maternal mortality (435 deaths per 100,000 live births in 2006 to 336 deaths per 100,000 live births in 2016). The persistence of high levels of maternal mortality jeopardizes the achievement of Sustainable Development Goal (SDG) 3.1, which calls for reducing maternal mortality to 70 deaths per 100,000 live births by 2030. Conversely, the utilization of postnatal care (PNC) services in Uganda remained very low and has varied across regions. This study examined the individual and community-level factors influencing women’s utilization of postnatal care services in Uganda.MethodsSecondary data from the 2016 Uganda Demographic and Health Survey (UDHS) were used in this study. The study population consisted of women aged 15 to 49 who reported giving birth in the five years preceding the 2016 UDHS survey. The factors associated with postnatal care services were identified using multilevel binary logistic regression and spatial analysis.ResultsThe result shows that the prevalence of postnatal care service utilization in Uganda was low (58.3%) compared to the World Health Organization (WHO) target of 100%. The univariate analysis shows that 13.7% of women were adolescents, 79% were of higher parity, and 70.4% had primary/no formal education, of which 76.6% resided in rural areas. On the other hand, the multilevel analysis results showed that women aged 20-29 years and 30-39 years were also found to be more likely to use PNC services (AOR = 1.2, 95% CI: 1.01-1.47). Women who received quality ANC (AOR = 2.1, 95% CI: 1.78–2.36) were more likely to use postnatal care services than their counterparts. At the community level, women who lived in media-saturated communities were more likely to use postnatal care services (AOR = 1.3, 95% CI: 1.01–1.65). The spatial analysis found that the Central, Eastern, and Northern regions were the areas of hotspots in the utilization of postnatal care services.ConclusionThis study found that age, parity, level of education, place of residence, employment status, quality of the content of antenatal care, and community media saturation were the predictors of postnatal care service utilization. The spatial analysis showed that the spatial distributions of postnatal care service utilization were significantly varied across Uganda. The government must expand access to various forms of media throughout the country to increase PNC utilization.

Exploring the association between unintended pregnancies and unmet contraceptive needs among Ugandan women of reproductive age: an analysis of the 2016 Uganda demographic and health survey

BackgroundUnintended pregnancy and unmet contraceptive needs pose significant public health challenges, particularly in developing nations, where they contribute to maternal health risks. While previous research has explored determinants of unintended pregnancies, there remains a gap in understanding the association between unplanned pregnancies and unmet contraceptive needs among Ugandan women of reproductive age. This study aimed to assess unmet contraceptive needs and their correlation with unintended pregnancies and other factors in Uganda, utilizing a nationally representative sample.MethodsData was extracted from the 2016 Uganda Demographic Health Survey (UDHS), a cross-sectional survey conducted in the latter half of 2016. The study encompassed 18,506 women aged 15–49 with a history of at least one prior pregnancy. The primary outcome variable was the planning status of the most recent pregnancy, while the principal independent variable was unmet contraceptive need. Additional variables were controlled in the analysis. Data analysis was performed using STATA version 17, involving descriptive analysis, cross-tabulation, chi-square testing, and logistic regression. Statistical significance was set at p < 0.05.ResultsA substantial proportion of women reported unintended pregnancies (44.5%), with approximately 21.09% experiencing an unmet need for contraception. In the adjusted model, women with unmet contraceptive needs had 3.97 times higher odds of unintended pregnancy (95% CI = 3.61–4.37) compared to those with met contraceptive needs. Significant factors linked to unintended pregnancies included women's age, place of residence, household wealth status, decision-making authority regarding contraceptive use, educational attainment, husband's occupation, and educational level.ConclusionThis study revealed that both the rate of unintended pregnancies and unmet contraceptive needs in Uganda exceeded the global average, warranting urgent policy attention. Addressing unmet contraceptive needs emerges as a potential strategy to curtail unintended pregnancies. Further qualitative research may be necessary to elucidate the sociocultural and behavioral determinants of unwanted pregnancies, facilitating context-specific interventions.

Spatial distribution and determinants of unmet need for family planning among all reproductive‑age women in Uganda: a multi‑level logistic regression modeling approach and spatial analysis

IntroductionUnmet need for family planning is defined as the percentage of sexually active and fecund women who want to delay the next birth (birth spacing) or who want to stop childbirth (birth limiting) beyond two years but who are not using any modern or traditional method of contraception. Despite the provision of family planning services, the unmet need of family planning remains a challenge in low- and middle-income countries (LMICs). Thus, this study aimed to assess the spatial distribution and determinant factors of unmet need for family planning among all reproductive‑age women in Uganda.MethodsA secondary data analysis was done based on 2016 Ugandan Demographic and Health Surveys (UDHS). Total weighted samples of 18,506 women were included. Data processing and analysis were performed using SPSS Version 26, STATA 14.2, ArcGIS 10.8, and SaTScan 10.1.2 software. Spatial autocorrelation and hotspot analysis was made using Global Moran’s index (Moran’s I) and Gettis-OrdGi*statistics, respectively. Determinants of unmet needs for family planning were identified by multi-level logistic regression analysis. Variables with a p-value < 0.05 were declared statistically significant predictors.ResultsThe spatial distribution of unmet need for family planning among women of reproductive age in Uganda was found to be clustered (Global Moran’s I = 0.27, Z-score of 12.71, and p-value < 0.0001). In the multivariable multilevel logistic regression analysis; women in West Nile (AOR = 1.86, 95% CI: 1.39, 2.47), aged 25–49 years old (AOR = .84; 95% CI .72, .99), highly educated (AOR = .69; 95% CI .54, .88), Muslim (AOR = 1.20, 95% CI: 1.03, 1.39), high wealth status (AOR = .73, 95% CI: .64, .82), and had five or more living child (AOR = 1.69, 95% CI: 1.51, 1.88) were significant predictors of unmet need for family planning. Significant hotspot areas were identified in West Nile, Acholi, Teso, and Busoga regions.ConclusionA significant clustering of unmet need for family planning were found in Uganda. Moreover, age, educational status, religion, wealth status, number of alive children, and region were significant predictors of unmet need for family planning. Therefore, in order to minimize the burdens associated with unmet need, an interventions focusing on promotion of sexual and reproductive health service should be addressed to the identified hotspot areas.

Process evaluation of a parent-child communication intervention for adolescent sexual and reproductive health in Uganda

BackgroundPrevious initiatives concerning adolescent sexual and reproductive health (SRH) education in Low-or-Middle Income Countries (LMICs) have been limited by cultural norms and misinformation perpetuated within families. Responding to the paucity of research on the implementation of SRH interventions in LMICs and limited knowledge regarding their mechanisms, this study undertakes a process evaluation of a parent-focused intervention to promote parent-adolescent communication about SRH in Uganda.MethodsThis paper explores the implementation, contextual factors and mechanisms of impact of the intervention, using the Medical Research Council (MRC) guidelines for process evaluations. Implementation was evaluated through indicators of dose, fidelity and adaptations, acceptability and feasibility. The contextual factors and mechanisms of impact were evaluated to refine the intervention’s causal assumptions. Data was collected during April - October 2021 in South-Western Uganda using a mixed-methods approach, including document analysis, intervention observations, interviews, focus group discussions and most significant change stories.ResultsThe acceptability of the intervention was related to its community engagement, the strong rapport with delivery agents, and individual characteristics of participants. Five contextual factors influencing implementation were highlighted; (i) cultural norms, (ii) perceptions about youth SRH, (iii) poverty, (iv) Covid-19 pandemic, and (v) prior research projects in the community. When considering the intervention’s mechanisms of impact, four causal pathways were identified; (i) Awareness of SRH needs helped parents overcome stigma, (ii) Parenting skills training improved SRH communication, (iii) Group learning stimulated shared parenting, and (iv) Group learning improved co-parenting.ConclusionThe paper presented three key learnings and corresponding recommendations for future research. Firstly, implementation success was credited to meaningful community engagement which improved acceptability and uptake. Secondly, the complex influences of contextual factors highlighted the need for contextual analysis in research studies to inform intervention design. Finally, this evaluation recognised the interplay between mechanisms of impact and suggested further research consider such combined impacts when designing intervention content.

Prevalence of probable substance use disorders among children in Ugandan health facilities

BackgroundGlobally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda.MethodsWe conducted a health facility cross-sectional study, involving 854 children aged 6–17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software.ResultsThe overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24–1.31) while that of probable AUD alone was 25.3% (95% CI 1.22–1.28). Peer substance use (APR = 1.24, 95% CI 1.10–1.32), sibling substance use (APR = 1.14, 95% CI 1.06–1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01–1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82–0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01–1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01–1.12) were found to be significantly associated with probable AUD/SUD.ConclusionsOur findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities.

Equity in vaccine coverage in Uganda from 2000 to 2016: revealing the multifaceted nature of inequity

BackgroundThis study analyses vaccine coverage and equity among children under five years of age in Uganda based on the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Understanding equity in vaccine access and the determinants is crucial for the redress of emerging as well as persistent inequities.MethodsApplied to the UDHS for 2000, 2006, 2011, and 2016, the Vaccine Economics Research for Sustainability and Equity (VERSE) Equity Toolkit provides a multivariate assessment of immunization coverage and equity by (1) ranking the sample population with a composite direct unfairness index, (2) generating quantitative measure of efficiency (coverage) and equity, and (3) decomposing inequity into its contributing factors. The direct unfairness ranking variable is the predicted vaccination coverage from a logistic model based upon fair and unfair sources of variation in vaccination coverage. Our fair source of variation is defined as the child’s age – children too young to receive routine immunization are not expected to be vaccinated. Unfair sources of variation are the child’s region of residence, and whether they live in an urban or rural area, the mother’s education level, the household’s socioeconomic status, the child’s sex, and their insurance coverage status. For each unfair source of variation, we identify a “more privileged” situation.ResultsThe coverage and equity of the Diphtheria-Pertussis-Tetanus vaccine, 3rd dose (DPT3) and the Measles-Containing Vaccine, 1st dose (MCV1) – two vaccines indicative of the health system’s performance – improved significantly since 2000, from 49.7% to 76.8% and 67.8% to 82.7%, respectively, and there are fewer zero-dose children: from 8.4% to 2.2%. Improvements in retaining children in the program so that they complete the immunization schedule are more modest (from 38.1% to 40.8%). Progress in coverage was pro-poor, with concentration indices (wealth only) moving from 0.127 (DPT3) and 0.123 (MCV1) in 2000 to -0.042 and -0.029 in 2016. Gains in overall equity (composite) were more modest, albeit significant for most vaccines except for MCV1: concentration indices of 0.150 (DPT3) and 0.087 (MCV1) in 2000 and 0.054 and 0.055 in 2016. The influence of the region and settings (urban/rural) of residence significantly decreased since 2000.ConclusionThe past two decades have seen significant improvements in vaccine coverage and equity, thanks to the efforts to strengthen routine immunization and ongoing supplemental immunization activities such as the Family Health Days. While maintaining the regular provision of vaccines to all regions, efforts should be made to alleviate the impact of low maternal education and literacy on vaccination uptake.

Prevalence of Diarrhea and Associated Risk Factors among Children Aged Under Five Years Presenting at Hoima Regional Referral Hospital

Diarrhea is among the top ten killers worldwide and in 2015, it accounted for 11% of child deaths globally. Many of these cases are from low and middle-income countries including Uganda. The last Uganda Demographic and Health Survey (UDHS) report in 2015 showed that the prevalence of childhood diarrhea was 19.5%. The local prevalence in Hoima was not known as no study had been done concerning the subject. The purpose of this study therefore was to identify the prevalence of diarrhea and its associated risk factors among children aged under five years presenting at Hoima Regional Referral Hospital. A cross-sectional descriptive study design was adopted for this study. Data was collected from 241 mother-child pairs using a pretested semi structured questionnaire. Collected data was entered in the computer after cleaning and analyzed using IBM SPSS version 25. Descriptive statistics were one to get the prevalence of diarrhea while Chi square and binary logistic regression analysis was done to find the independent variables associated with diarrhea among children under 5 years. The prevalence of diarrhea among under 5 years old in this study was 12.4%. The risk of diarrhea was increased in non-working mothers (OR=8.571; CI=2.889-25.426; p&lt;0.001), child’s age between 6 and 24 months (OR=9.098; CI= 3.282-25.220; p&lt;0.001) and unprotected water sources (OR=12.100; CI=3.559-41.133; p&lt;0.001). Christian religion (OR=0.263; CI=0.090- 0.768; p=0.015), and not using bottle feeding (OR=0.229; CI=0.104-0.507; p&lt;0.001) showed a reduced risk of diarrhea. The present study showed a high prevalence of diarrhea among children under five years of age. The independent variables that were found to be associated with diarrhea were mother’s working status, child’s age, source of drinking water, religion and bottle feeding. The results of this study have serious policy implications for health intervention programs and the researcher recommends that promoting women income generating programs may have a significant importance on child health and survival in the study area and Uganda in general. The longterm solution for decreasing morbidity from diarrhea may include the delivery of improved sanitation and hygiene through efficient health educational programs that concentrate on personal hygiene which lead to full sanitation. This should be reinforced in combination with health workers educating households on sanitation and child feeding practices. Keywords: Diarrhea, Children under 5 years, Mothers, Women, Child deaths.

Determinants of late antenatal care attendance among high parity women in Uganda: analysis of the 2016 Uganda demographic and health survey

BackgroundTimely and adequate Antenatal Care (ANC) effectively prevents adverse pregnancy outcomes and is crucial for decreasing maternal and neonatal mortality. High-parity women (5 + children) are at higher risk of maternal mortality. Limited information on the late timing of ANC among this risky group continues to hamper Uganda’s efforts to reduce maternal mortality ratios and improve infant and child survival. This study aimed to determine factors associated with attendance of the first ANC after 12 weeks of gestation among high-parity women in Uganda.MethodsThis study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey. The study sample comprised 5,266 women (aged 15–49) with five or more children. A complementary log-log regression model was used to identify factors associated with late ANC attendance among high-parity women in Uganda.ResultsOur findings showed that 73% of high parity women delayed seeking their first ANC visit. Late ANC attendance among high-parity women was associated with distance to the health facility, living with a partner, partner’s education, delivery in a health facility, and Desire for more children. Women who did not find the distance to the health facility when going for medical help to be a big problem had increased odds of attending ANC late compared to women who found distance a big problem (AOR = 1.113, CI: 1.004–1.234), women not living with partners (AOR = 1.196, 95% CI = 1.045–1.370) having had last delivery in a health facility (AOR = 0.812, 95% CI = 0.709–0.931), and women who desired to have another child (AOR = 0.887, 95% CI = 0.793–0.993) had increased odds compared to their counterparts.ConclusionsTo increase mothers’ timely attendance and improve maternal survival among high-parity women in Uganda, programs could promote and strengthen health facility delivery and integrate family planning with other services such as ANC and postnatal care education to enable women to seek antenatal care within the recommended first trimester. This study calls for increased support for programs for education, sensitization, and advocacy for health facility-based deliveries. This could be done through strengthened support for VHT and community engagement activities.

A scoping review of qualitative studies on sexual and reproductive health and rights in Uganda: Exploring factors at multiple levels.

Uganda is burdened by high unintended and teen pregnancies, high sexually transmitted infections, and harm caused by unsafe abortion. Explore factors influencing sexual and reproductive health and rights (SRHR) in Uganda by synthesizing evidence from qualitative studies using a scoping review. Original qualitative peer-reviewed research studies published between 2002 and 2023 in any language exploring factors influencing SRHR in Uganda. Eight databases searched using qualitative/mixed methods search filters and no language limits. Information extracted included author, article title, publication year, study aims, participant description, data collection type, sample size, main findings, factors at the individual, interpersonal, community, and policy levels, implications for SRHR in Uganda, and study limitations. Quality of the selected articles was assessed using the Critical Appraisal Skills Programme tool. One hundred seventy-three studies met inclusion criteria. At the individual level, knowledge and attitudes toward SRHR, risky sexual behavior, and access to maternal SRHR services were identified as critical factors influencing health outcomes. Interpersonal factors included communication with sexual partners and relationships with family, school, and community members. Healthcare organization factors included adolescent access to education, SRHR services, and HIV prevention. Cultural and social factors included gendered norms and male involvement in SRHR. Policy-level factors included the importance of aligning policy and practice. Multiple factors at individual, interpersonal, community, healthcare, cultural, and policy levels were found to influence SRHR in Uganda. The findings suggest that interventions targeting multiple levels of the socio-ecological system may be necessary to improve SRHR outcomes. This review highlights the need for a holistic approach that considers the broader socio-ecological context. Reducing identified gaps in the literature, particularly between policy and practice related to SRHR, is urgently needed in Uganda. We hope this review will inform the development of policies and interventions to improve SRHR outcomes.

Healthcare professionals' knowledge of and compliance with the ASCO/ESMO/GLIM guidelines for the diagnosis and management of cancer cachexia (CC): the ASSIST-CC baseline findings in Uganda.

More than 50% of people with advanced cancer suffer from cancer-related cachexia (CC) - a major contributor to morbidity and mortality. Despite the lack of local guidelines on CC diagnosis and management in Uganda, the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO) and the Global Leadership Initiative on Malnutrition (GLIM) developed guidelines on CC screening and management. However, the level of knowledge on CC and compliance with the available guidelines among Ugandan oncology health professionals is unknown. This study aimed to assess the level of awareness and knowledge of CC diagnosis and management and compliance with the ASCO/ESMO/GLIM guidelines on CC among healthcare professionals (HCPs) involved in the care of cancer patients. In this phase one, a self-administered structured questionnaire developed using the ASCO/ESMO and GLIM guidelines on diagnosis and management of CC was used to assess the level of awareness, and knowledge of 200 health professionals from three hospital settings on CC, and compliance with the ASCO/ESMO/GLIM guidelines on CC related core communication, barriers to communication, clinician training in communication, discussing goals of care, treatment options and meeting the needs of the underserved populations. The data were entered into Research Electronic Data Capture software analysed using STATA version 18.0 software. The overall objectively correct knowledge score of CC diagnosis criteria was 67.5% (n = 135), yet there was a much lower level of awareness about ASCO/ESMO/GLIM guidelines on CC at 30% (n = 60) and only 21% (n = 42) of the HCPs have ever assessed Quality of life of CC patients. The compliance with ASCO/ESMO/GLIM guidelines on nutritional interventions for patients with CC varied across the variables markedly, ranging from 25.1% (n = 50) to 81% (n = 162) for the specific ASCO/ESMO/GLIM guidelines' recommendations. Whereas compliance with the guidelines on discussing goals of care, prognosis, treatment options and end-of-life care scored the highest in most variables, most HCPs exhibited low compliance with the discussion about patients' end-of-life preferences early in the course of incurable illness (49.8%, n = 99). There were statistically significant differences between the mean scores of only two variables among the three hospitals in compliance with ASCO/ESMO/GLIM guidelines on the provision. This study indicated that the overall objectively correct knowledge of CC diagnosis criteria was inadequate, with a much lower level of awareness about the ASCO/ESMO/GLIM guidelines on CC and a handful of the HCPs have ever assessed the quality of life of CC patients. Quality improvement interventions on CC diagnosis and management should prioritize improving the level of knowledge on CC, diagnostic criteria and patient-clinician communication, including discussion about patients' end-of-life care using standardised tools such as ASCO/ESMO or GLIM guidelines on CC using a multidisciplinary team approach.

The impact of integrating finance information systems within reproductive health Uganda operations

The impact of integrating finance information systems within reproductive health Uganda operations

Adoption of Artificial Intelligence in the Ugandan Health Sector: a review of literature

Adoption of Artificial Intelligence in the Ugandan Health Sector: a review of literature

The Paradox of the Ugandan Health Insurance System: Challenges and Opportunities for Health Reform.

For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda's health sector.

Modeling the Risk Factors of Undernutrition among Children below Five Years of Age in Uganda Using Generalized Structural Equation Models.

The prevalence of undernutrition among children below five years of age, in Uganda and the world over, remains very high. About 45% of all global deaths among children below five years of age are attributed to undernutrition. A number of studies using different statistical approaches affirm this effect, yet some factors indicate the influence of other factors within the system. This study, therefore, uses a method that demonstrates how different variables feed into each other. The aim of this study was to establish the major factors associated with an increased likelihood of undernutrition and the paths showing how these risk factors influence undernutrition. Data from the Uganda Demographic and Health Survey (UDHS, 2016) were used for this study. A sample of 4530 children, whose age, height, and weight measurements were recorded, was considered for this study. Additionally, the study used generalized structural equation models to identify the multifaceted natures and paths of the risk factors that influence undernutrition among children below five years of age. The study relied on the UNICEF 2020 conceptual framework to identify and analyze the direct and indirect effects of these risk factors of undernutrition. From the perspective of a male child, having a perceived small size at birth, a low birth weight, being breastfed for less than 6 months, having no formal education from mothers, limited income-generating opportunities, a low wealth status, and notable episodes of diarrhea were among the key factors associated with an increased likelihood of undernutrition. The identified paths were as follows: (i) Having no education, as this was associated with limited working opportunities and a low income, which increases the likelihood of low household wealth status, hence increasing the chances of undernutrition. (ii) Exposure to a rural setting was associated with an increased likelihood of undernutrition through association with poor and or low employment levels within the rural areas. (iii) A shorter duration of breastfeeding was associated with children in urban areas, resulting in an increased likelihood of undernutrition. (iv) Children aged between 6 and 47 months had a higher likelihood of undernutrition. An approach that addresses and recognizes all these factors at different levels, along the established paths, should be implemented to effectively reduce undernutrition among children below five years of age.

ENHANCING HEALTHCARE QUALITY AMONG COMMUNITY HEALTH FACILITIES WITH RESULTS-BASED FUNDING IN EASTERN UGANDA

This study examines the effects of Result-Based Funding (RBF) on the healthcare quality in Health Centre (HC) III in Jinja District concerning patient waiting time, drug stockout, choice of healthcare, and availability of essential medicines in Uganda's community health facilities. The research used a cross-sectional survey design and found that results-based funding like timely funding, and funding size had a significant relationship with healthcare quality. Management practices also had a strong positive correlation with healthcare quality, but most importantly management practices moderated the relationship between results-based funding and healthcare quality among Health Centre IIIs in Jinja District. The study recommends increasing the size of RBF, sending or providing timely funds, improving the fund size, and building and maintaining results-based incentives for staff that implement activities at the health facilities. Health Centre management to continue activity planning, improve staffing levels, carry out regular monitoring of all activities supported by the RBF programme, and ensure that storage capacity is enabled for the safety of essential medicines and other stores.

Family planning uptake and its associated factors among women of reproductive age in Uganda: An insight from the Uganda Demographic and Health Survey 2016.

Despite the government efforts to reduce the high fertility levels and increase the uptake of family planning services in Uganda, family planning use was still low at 30% in 2020 which was the lowest in the East African region. This study was undertaken to determine the prevalence and factors associated with the uptake of family planning methods among women of reproductive age in Uganda. This community-based cross-sectional study utilized secondary data from the Uganda Demographic and Health Survey (UDHS) of 2016. The survey data was downloaded from the Measure Demographic Health Survey website after data use permission was granted. Data was collected from a representative sample of women of the reproductive age group (15-49 years) from all 15 regions in Uganda. A total of 19,088 eligible women were interviewed but interviews were completed with 18,506 women. Data analysis was performed using SPSS statistical software version 32.0 where univariable, bivariable, and multivariable analyses were conducted. The prevalence of family planning use was found to be 29.3% and that of modern contraceptive use was found to be 26.6%. Multivariable analysis showed higher odds of current family planning use among older women (40-44 years) (aOR = 2.09, 95% CI: 1.40-3.12); women who had attained the secondary level of education (aOR = 1.91, 95% CI: 1.32-2.76); those living in households with the highest wealth index (aOR = 1.87, 95% CI: 1.29-2.72); and awareness of the availability of family planning methods (aOR = 1.41, 95% CI: 1.17-1.72). In conclusion, the study suggests improving women's education attainment, socio-economic position, and awareness may help increase use in the population.