Mbale District Research Articles

Child mental illness and the help-seeking process: a qualitative study among parents in a Ugandan community

BackgroundChild mental illness contributes significantly to the burden of disease worldwide, and many are left untreated due to factors on both the provider and user side. Recognising this, the Ugandan Ministry of Health recently released the Child and Adolescent Mental Health (CAMH) Policy Guidelines. However, for implementation to be successful the suggested policy changes must resonate with the service users. To better understand the sociocultural factors influencing parental mental help-seeking, we sought insights from parents in the Mbale district of eastern Uganda.MethodIn this qualitative study, eight focus group discussions were conducted with mothers and fathers in urban and rural communities. Parents of children younger than 10 years were purposively selected to discuss a vignette story about a child with symptoms of depression or ADHD as well as general themes relating to child mental illness. The data were analysed using qualitative content analysis.ResultsDescriptions of severe symptoms and epileptic seizures were emphasised when recognising problem behaviour as mental illness, as opposed to mere ‘stubbornness’ or challenging behaviour. A mixture of supernatural, biomedical, and environmental understandings as underlying causes was reflected in the help-seeking process, and different treatment providers and relevant institutions, such as schools, were contacted simultaneously. A notion of weakened community social support structures hampered access to care.ConclusionAwareness of symptoms closer to normal behaviour must be increased in order to improve the recognition of common mental illnesses in children. Stakeholders should capitalise on the common recognition of the importance of the school when planning the upscaling of and improved access to services. Multifactorial beliefs within the spiritual and biomedical realms about the causes of mental illness lead to multisectoral help-seeking, albeit without collaboration between the various disciplines. The CAMH Policy Guidelines do not address traditional service providers or provide a strategy for better integration of services, which might mean continued fragmentation and ineffective service provision of child mental health care.

A Correlation Analysis of School Plant Management and Curriculum Implementation in Bungokho County Secondary Schools, Mbale District, Uganda

The study examined the correlation between school plant management and curriculum implementation in government aided secondary schools in Bungokho County, Mbale District. It was guided by three hypotheses; Ho1 there is no statistically significant correlation between management of study materials and curriculum implementation; Ho2 there is no statistically significant correlation between management of physical infrastructure and curriculum implementation and Ho3 there is no statistically significant correlation between school location and curriculum implementation. Correlational research design was used as empirical road map with a sample size of 110 respondents who participated in the study. A piloted self-constructed questionnaire tool was used to collect data. It was then analyzed using inferential statistical tool of Pearson product-moment correlation coefficient and also by descriptive statistics of frequencies and percentages. The findings revealed that there was a strong positive correlation between school location management and curriculum implementation (r = .50, n =110, p<.05). The study found that there was a positive moderate correlation between study materials and curriculum implementation (r = .34, n = 110, p<.05). It was also discovered that there was a positive moderate correlation between physical infrastructure and curriculum implementation (r = .40, n =110, p<.05). The study recommended that; the school administrators should ensure that available school equipment is effectively used to facilitate content delivery for effective learning. There should be candid use of available physical infrastructure to enhance innovations and creativity among the teaching staff and students. The Boards of Governors managing secondary schools in Bungokho County and government stakeholders should ensure that any constructed secondary schools in the area should strategically and geographically be well located with ease of access.

Optimising informed consent for participants in a randomised controlled trial in rural Uganda: a comparative prospective cohort mixed-methods study

BackgroundPoor participant understanding of research information can be a problem in community interventional studies with rural African women, whose levels of illiteracy are high. This study aimed to improve the informed consent process for women living in rural eastern Uganda. We assessed the impact of alternative consent models on participants’ understanding of clinical trial information and their contribution to the informed consent process in rural Uganda.MethodsThe study applied a parallel mixed-methods design for a prospective comparative cohort, nested within a pilot study on the community distribution of an alcohol-based hand rub to prevent neonatal sepsis (BabyGel pilot trial). Women of at least 34 weeks’ pregnancy, suitable for inclusion in the BabyGel pilot trial, were recruited into this study from their homes in 13 villages in Mbale District. As part of the informed consent process, information about the trial was presented using one of three consent methods: standard researcher-read information, a slide show using illustrated text on a flip chart or a video showing the patient information being read as if by a newsreader in either English or the local language. In addition, all women received the patient information sheet in their preferred language. Each information-giving method was used in recruitment for 1 week. Two days after recruitment, women’s understanding of the clinical trial was evaluated using the modified Quality of Informed Consent (QuIC) tool. They were also shown the other two methods and their preference assessed using a 5-point Likert scale. Semi-structured interviews were administered to each participant. The interviews were audio-recorded, transcribed and translated verbatim, and thematically analysed.ResultsA total of 30 pregnant women in their homes participated in this study. Their recall of the trial information within the planned 48 h was assessed for the majority (90%, 27/30). For all three consent models, women demonstrated a high understanding of the study. There was no statistically significant difference between the slide-show message (mean 4.7; standard deviation, SD 0.47; range 4–5), video message (mean 4.9; SD 0.33; range 4–5) and standard method (mean 4.5; SD 0.53; range 4–5; all one-way ANOVA, p = 0.190). The slide-show message resulted in the most objective understanding of question items with the highest average QuIC score of 100 points. For women who had been recruited using any of the three models, the slide show was the most popular method, with a mean score for all items of not less than 4.2 (mean 4.8; SD 0.6; range 4–5). Most women (63%, 19/30) preferred the slide-show message, compared with 17% (5/30) and 20% (6/30) for the standard and video messages, respectively. The reasons given included the benefits of having pictures to aid understanding and the logical progression of the information.ConclusionOur results from this small study suggest that slide-show messages may be an effective and popular alternative way of presenting trial information to women in rural Uganda, many of whom have little or no literacy.Trial registrationISRCTN, ISRCTN67852437. Registered on 18 March 2018.

Potato market access, marketing efficiency and on-farm value addition in Uganda

Abstract Understanding barriers to market access for smallholder farmers and their marketing efficiency when they participate in agricultural value chains is key to unlocking the market potential and overcoming market failures. This study aimed at determining factors limiting farmers’ market access, the break-even point for undertaking postharvest value addition activities by the farmers, and the market efficiency of the Uganda potato market chains in which the smallholder farmers are participating. Our study was based on the hypothesis that market access and efficiency are higher where farmers have contract arrangements with buyers, and where they are directly linked with the buyers at the end of the value chain. The study was carried out in the popular potato growing districts of Kabale and Mbale in Uganda. The survey involved purposive selection of the study areas and random selection of potato farmers and traders. We used an Ordinary Least Square model to determine factors that influence potato smallholder farmers’ market access. We also used break-even analysis to determine the break-even point for potato farmers to take up postharvest value addition activities, and a value addition approach to determine market efficiency. Results indicate that having a contract with buyers, size of land owned, number of forked hoes owned and variety grown positively and significantly influenced farmer market access. We found that adding value to potato on farm earns farmers relatively more income. A farmer would earn 25% higher than when no value addition was done. Market chains where farmers sell to local rural traders were more efficient than selling to other alternatives. We recommend farmer involvement in value addition, collective and/or contractual marketing, and selling directly to the nearest actor in the value chain.

REINVENTINGIMBALUAND FORCIBLE CIRCUMCISION: GISU POLITICAL IDENTITY AND THE FIGHT FOR MBALE IN LATE COLONIAL UGANDA

ABSTRACTUgandan colonial authorities carved Bugisu and Bukedi districts out of Mbale district in 1954, isolating Mbale town as a separate entity. With ethnic tensions escalating as independence approached, Gisu and Gwere fought for Mbale's ownership. Empowered by decentralisation, Bugisu District Council pressed the colonial state to declare Mbale part of Bugisu, viewing the town as key to the region's wealth, and providing a symbolic status similar to that enjoyed by Uganda's leading ethnic groups. Gisu activists reinvented tradition as a tool of political advocacy, exerting hyper-masculine power over Mbale's non-circumcising Gwere residents through forcible circumcision. Gisu reformulation of a cultural practice within an urban struggle challenges previous categorisations of the Mbale case as merely another local obstacle to Uganda's peaceful decolonisation. Evidence analysed in this article contributes to a new understanding of East Africa's uneasy transition to self-government, and to the role of ethnic competition within late-colonial mobilisations more broadly.

Role of the health system in influencing uptake of human papillomavirus vaccine among adolescent girls in Mbale District, eastern Uganda: a cross-sectional, mixed-methods study

Abstract Background Cervical cancer ranks as the most common cancer among women in Uganda, and prevalence has increased by 1·8% per annum over the past 20 years. Human papillomavirus (HPV) is responsible for more than 90% of cases of cervical cancer. The availability of an HPV vaccine presents an opportunity to prevent cervical cancer; however, national coverage stands at 17% against target coverage of 80% since the vaccine's introduction in 2015. This study assessed the role of the health system in influencing uptake of the HPV vaccine so as to inform vaccine implementation in Uganda. Methods We did a cross-sectional study that employed qualitative and quantitative methods. We did structured interviews among 407 adolescents aged 9–15 years systematically selected using Bennet's cluster survey method from five subcounties in Mbale district and six key informants (district health officials) in May 2017. Adolescents were involved in decision making about where to receive the vaccine. We used the WHO six building blocks framework to assess health system factors. Nine health facilities were assessed using a WHO checklist for vaccine service delivery. Quantitative data were analysed using Stata version 13. Qualitative data were analysed using MAXQDA version 12. Uptake was defined as receiving two doses of the vaccine. Findings 56 (14%) of 407 adolescents self-reported vaccine uptake. 182 (52·3%) of 348 reported lack of awareness about the HPV vaccine as the major reason for not having received it. Receiving vaccines from outreach clinics (p=0·02), having many options from which to receive the vaccine (p=0·002), getting an explanation on possible side-effects (p=0·024), and receiving the vaccine alongside other services (p=0·024) were positively associated with uptake. Key informants reported inconsistency in vaccine supply, inadequate training on HPV vaccine, and the lack of a clear target for HPV vaccine coverage as the health system factors that contribute to low uptake. Interpretation Uptake was well below the Ministry of Health target of 80%. We recommend training of health workers to provide adequate information on HPV vaccine, raising awareness of the vaccine in markets, schools, and radio talk shows, and communicating the target to health workers. Funding None.

Prevalence of Waterborne Diseases in Relation to Age and Gender in Nakoloke Sub County Mbale District, Uganda

Prevalence of Waterborne Diseases in Relation to Age and Gender in Nakoloke Sub County Mbale District, Uganda

PREVALENCE AND DETERMINANTS OF POSTPARTUM MORBIDITIES AMONG WOMEN IN MBALE DISTRICT, EASTERN UGANDA

Introduction: maternal-ill-health is common after delivery, and yet there is scanty information on postpartum morbidity. This problem is more prevalent in developing countries but, its importance has not been extensively recognized. Maternal morbidity increases the risk of death among affected women and also have the potential to cause long-term disabilities with consequences of poor quality of life of the mother and child. This study determined the magnitude and determinants of postpartum maternal morbidity among women in Mbale district.

Cross-Sectional Serological Survey for Leptospira spp. in Beef and Dairy Cattle in Two Districts in Uganda.

Seroprevalence of Leptospira spp. in cattle is unknown in Uganda. The aim of this study was to estimate the seroprevalence of L. interrogans Icterohaemorrhagiae, Pomona, L. kirschneri Butembo, Grippotyphosa, L. borgpetersenii Nigeria, Hardjo, Wolfii, and Kenya and an overall seroprevalence in cattle from Kole and Mbale districts. Two hundred-seventy five bovine sera from 130 small holder farms from Kole (n = 159) and Mbale (n = 116), collected between January and July 2015, were tested for antibodies against eight Leptospira strains by Microscopic Agglutination Test. A titer of ≥100 was considered seropositive, indicating past exposure. Overall, the seroprevalence was 19.27% (95% CI 14.9–24.5%). Pomona seroprevalence was highest with 9.45% (6.4–13.7%), followed by Kenya 5.09% (2.9–8.6%), Nigeria 4.00% (2.1–7.2%), Wolfii 3.27% (1.6–6.3%), Butembo 1.86% (0.7–4.4%), Hardjo 1.45% (0.5–3.9%), and Icterohaemorragiae and Grippotyphosa with less than 1% positive. Seroprevalence did not differ between districts and gender (p ≥ 0.05). Seven animals had titers ≥400. Cross-reactions or exposure to ≥1 serovar was measured in 43% of serum samples. Seroprevalence of 19% implies exposure of cattle to leptospires.

Pathogenic Variation of Colletotrichum lindemuthianum causing Anthracnose of Beans (Phaseolus vulgaris) in Uganda

Colletotrichum lindemuthianum is a highly variable pathogen of common beans that easily overcomes resistance in cultivars bred with single-gene resistance. To determine pathogenic variability of the pathogen in Uganda, samples of common bean tissues with anthracnose symptoms were collected in eight districts of Uganda, namely Kabarole, Sironko, Mbale, Oyam, Lira, Kapchorwa, Maracha and Kisoro. 51 isolates sporulated successfully on Potato Dextrose Agar and Mathur’s media and were used to inoculate 12 differential cultivars under controlled conditions. Five plants per cultivar were inoculated with each isolate and then evaluated for their reaction using the 1 – 9 severity scale. Races were classified using the binary nomenclature system proposed by Pastor Corrales (1991). Variation due to cultivar and isolate effects was significant (P≤0.001) for severity. The 51 isolates from eight districts grouped into 27 different races. Sironko district had the highest number of races followed by Mbale and Kabarole. Races 2047 and 4095 were the most frequently found, each with 10 isolates grouped under them. Race 4095 was the most virulent since it caused a susceptible (S) reaction on all 12 differential cultivars and the susceptible check. This was followed by races 2479, 2047 and 2045 respectively. Two races, 4094 and 2479, caused a susceptible reaction on the differential cultivar G2333, which nevertheless, showed the most broad spectrum resistance followed by cultivars Cornell 49-242, TU, and AB136 respectively. These cultivars are recommended for use in breeding programs aiming at breeding for broad spectrum resistance to bean anthracnose in Uganda.

Potential determinants of profits and market efficiency of potato market chains in Uganda

PurposeThe study aimed at understanding the level of inefficiencies in the potato market chain. Farmers sell potato to traders but continue to complain of limited market access and low profits. The purpose of this paper is to determine market efficiency and profits of the potato market chain, and factors that influence the profits.Design/methodology/approachThe study focussed on potato farmers, traders and small-scale processors. It was conducted in Kabale and Mbale districts being the major potato producing areas in Uganda, and Kampala being a major potato market. Data were collected from 180 farmers, 60 traders and 32 small-scale processors. Descriptive and regression methods were used to analyse the data.FindingsThere were three major potato market chains and all were profitable and efficient. The farmer-buyer node was the most efficient (efficiencies of 128-159 per cent). The trader node efficiency ranged between 56 and 81 per cent. Sex of chain actor, group marketing, contract duration and distance to market were among the factors that affected profits.Research limitations/implicationsProcessors considered were those operating on very small scale, hence results do not apply to large-scale processing. Consumers were not included but the data and results are adequate for the study objective.Originality/valueThis paper provides empirical information that serves as a basis to adopt market options for increased benefits to various chain actors.

English

Common impromptu observations between 2010 and 2012 of apparent virus-like disease symptoms in watermelons and pumpkins in Uganda prompted this study. However, there was no recorded evidence of virus infection in these crops anywhere in Uganda or eastern Africa as a region. Thus, 374 and 522 watermelon and pumpkin plants, respectively, growing in 13 fields were surveyed to record virus-like disease symptoms in Uganda’s four districts of Mbale and Kamuli (eastern region), Mpigi and Masaka (central region) during August to November 2013, and January to March 2014. Leaf samples were also collected and tested for four viruses known to commonly infect watermelons and pumpkins worldwide. Symptom severity was assessed using a scale of 0 to 5, while virus incidence was determined by serological methods. The four viruses tested were Cucumber mosaic virus (CMV), Watermelon mosaic virus (WMV), Zucchini yellow mosaic virus (ZYMV) and Cucurbit aphid borne-yellows virus (CABYV). In both crops, there was a higher incidence of virus-like diseases in central than in eastern region (P = 0.000). All the four viruses were detected with CMV as the most common, followed by WMV, ZYMV, and CABYV. Differences in virus incidences between the districts were not always significant. Single CMV, dual CMV+WMV and triple CMV+WMV+ZYMV were the most common single, and multiple infections in both crops. Watermelons contained more single virus infections than mixed infections (P < 0.001), but this difference was not significant in pumpkins (P = 0.468). In all, single virus infections were significantly higher in watermelons than pumpkins (P < 0.001). This is the first study to report incidence of viruses and virus-like diseases in watermelons and pumpkins in Uganda, and in eastern Africa as a region. The importance of these results with respect to crop production and next steps in virus disease management are discussed. Key words: Cucurbits, DAS-ELISA, multiple virus infection, TAS-ELISA, virus incidence, Uganda.

The university of sydneySocial-Economic Impacts of Sports Betting on Ugandan Youth. The case of Mbale Youth .

Sports betting activities, particularly among youth, is increasing rapidly in Ugandan. The aim of this study was to determine the motivation for sports betting among Ugandan youth, and the social economic impact of this form of gambling. In a cross sectional quantitative research design, a questionnaire data was obtained from a sample of 181 youth attending betting houses in the Mbale district. Results indicated that that most youths were motivated by the desire to win money. Findings also revealed that Ugandan youth socially and economically benefited from sports betting. The study concludes by recommending that even if findings do not show the negative impacts of gambling on youth, there is need for stricter laws to avert any future negative implications.

Participation of Youth in Community Development Programs in Uganda. A Comparative Study of Naads and HPI Programs in Bungokho Subcounty, Mbale District, Uganda

The youth, especially in developing countries have not been successfully integrated into civil society, decision-making frameworks and the general development process, which affect their present and future livelihoods. Youth in Uganda continue to dominate ranks of most vulnerable and most powerless groups in the labour market and decision making spheres. It is therefore imperative to explore the dynamics of youth’s involvement in the development process. The study evaluated participation of the youth aged 15-30 years in community development programs in Uganda by comparing NAADS and HPI programs in Mbale district. The study used sample survey design to collect data from 165 individual households and 20 key informant interviews and 4 Focus Group Discussions (FGDs) with female and male youth were conducted. Quantitative data was analysed using Statistical Package for social Scientist (SPSS) version 18. Qualitative data was analysed according to themes and sub themes of the study. The information gathered was utilized in identifying the level of youth involvement, benefits that accrue to youth through participation and the challenges associated with participation of youth in community development programs. Findings indicated limited involvement of youth in development process at all stages, save for implementation stage where 83% confirmed that they are involved. Through participation in community development programs, youth benefit from direct and indirect employment, acquisition of knowledge and skills, increased incomes, increased ownership of household assets/resources and improved family nutrition. The challenges for youth participation in community development (both NAADS and HPI) programs included lack of leadership and management skills among the youth, group regulatory barriers and impediments, development programs not targeting youth, irregular involvement of the youth, lack of information about development programs, youth holding negative attitude about the development programs, design and implementation challenges. There is a weakness in the lack of a comprehensive and consistence framework by both NAADS and HPI to ensure effective participation of youth at various levels of development process. It is therefore important for development actors to design youth engagement approaches and strategies to integrate youth in the development process right from program design stage. Also NAADS and HPI need to design special packages i.e. consider youth development needs and interests separate from the general community development needs and interests to attract youth to effectively participate in the process.

Prevalence of child injuries in Mbale region, Eastern Uganda

Background: The rate of unintentional child injuries in sub-Saharan Africa is at 53.1 per 100,000, The highest for low income regions, data on these injuries and associated factors among children in Uganda is very scanty. Most child injuries are related to the way of life in rural communities typically burns from charcoal stoves, candle light , hot fluids, chemicals , falls, and animal bites .Methods: This was a cross sectional community survey among the Promise EBF participants in Mbale district of east Uganda.Objective; to establish the prevalence, causes and associated factors of un intentional child injuries in Mbale District .Results: The commonest unintentional injuries were, falls, and burns 11% of the children. The main causes were hot water (43%) and burning charcoal stoves/firewood. Predisposing factors to burns were residence in rural areas (OR 2.0; 95% CI: 1.1, 3.5) and having three or more siblings (OR 1.6; 95% CI: 0.9, 2.8) .. 40% of the well off mothers and those with at least 8 years of education were more likely to report their child injuries. ((OR: 1.7; 95% CI 1.0, 2.9) and (OR 1.5; 95% CI 1.0, 2.2) respectively).Conclusion: The prevalence of unintentional injuries among children of this cohort of mothers was high, caused by burns, falls, poisoning and animal bites .

Building agricultural networks of farmers and scientists via mobile phones: case study of banana disease surveillance in Uganda

ABSTRACTAn important challenge threatening agriculture in Africa is the difficulty in collecting timely data on disease spread and effectiveness of on-farm control methods. This study served as a case study for assessing the viability of a participatory GIS (Geographic Information System) to enable a plant diagnostics network with fieldworkers. The use of mobile phone applications and a centralized database were integrated to provide a blueprint for how a range of agriculture-focused field organizations can collect data, explain events, predict outcomes and adapt and refine strategies with more accurate, cost-efficient and timely information. Over the course of 2 months, 38 Community Knowledge Workers (CKWs) using mobile phones, MTN Mobile Internet and GPS devices collected 3018 surveys documenting the presence/absence of three banana diseases: Banana Xanthomonas Wilt (BXW), Fusarium Wilt (FW) and Banana Bunchy Top disease (BBTD) in Bushenyi and Mbale districts in Uganda. Costs were saved by only mobilizing CKWs who then trained the communities on methods of banana disease detection, preventative measures and disease control procedures; only when doubts over identification or control occurred did the IITA and NARO technical team then prioritize visits. Although the CKWs provided an efficient and cost-effective information channel that can be leveraged to integrate the efforts of scientists with the needs of rural communities, there were significant gaps in prior farmer knowledge on the three targeted diseases, including how to identify or control them, despite extensive awareness campaigns preceding this initiative. Factsheets used for reference following training greatly improved CKW prior knowledge of disease recognition and control methods; hence, 90% of the surveys conducted during the second month met the data quality standards based on survey completeness, GPS accuracy and quality of symptomatic plant photos. There was significant and consistent demand by farmers for CKW services throughout the pilot period. In-depth training and continuous support of CKWs is thus essential. The technology infrastructure is scalable, and further integration of technology components promises a customizable web-based tool for data collection, GIS analysis, information dissemination and management of agriculture extension operations.

English

Access to information and new technologies avails smallholder farmers an opportunity to improve their production decisions. However, access to information on technologies per se may not be relevant if the technologies are not adopted. This study was aimed at determining the factors that enable participants to access information on integrated soil fertility management (ISFM) technologies and to apply these technologies in groundnut production. It was conducted in the major groundnut producing districts of Tororo, Mbale, and Bukedea; where 155 Producers were surveyed. Probit and Multinomial Logit (MNL) models were fitted to the data using STATA analytical package. The results reveal that on average, producers in production groups were more likely to access information and to use new groundnut production technologies compared to their counterparts without groups. In addition, group membership, sex of farmer, and education also pre-disposed producers and processors to access and use new groundnut technologies. Smallholder farmers should be encouraged to form and work in groups as they facilitate knowledge sharing and technology adoption. Key words: Groundnut, capacity building, knowledge access, multinomial logit, Uganda.

Spatial and Temporal distribution of Waterborne Diseases in Namanyonyi Sub-County, Mbale District, Uganda

Spatial and Temporal distribution of Waterborne Diseases in Namanyonyi Sub-County, Mbale District, Uganda

Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study.

BackgroundEvidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda.MethodsThis was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool.ResultsOf the 391 women, 189 (48.3 %) reported that they had ever utilized motorcycle ambulances. Of these, 94.7 % were currently married or living together with a partner while 50.8 % earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95 % CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95 % CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95 % CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95 % CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances were meant for and appreciated their role in taking pregnant women to health facilities.ConclusionThe use of motorcycle ambulances was associated with older age of the mother, male participation in birth preparedness, and consultations with TBAs. These findings suggest a need for interventions to involve men in reproductive health as well as efforts to reach women younger than 35 years of age.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0808-0) contains supplementary material, which is available to authorized users.

Health managers' views on the status of national and decentralized health systems for child and adolescent mental health in Uganda: a qualitative study.

BackgroundRobust health systems are required for the promotion of child and adolescent mental health (CAMH). In low and middle income countries such as Uganda neuropsychiatric illness in childhood and adolescence represent 15–30 % of all loss in disability-adjusted life years. In spite of this burden, service systems in these countries are weak. The objective of our assessment was to explore strengths and weaknesses of CAMH systems at national and district level in Uganda from a management perspective.MethodsSeven key informant interviews were conducted during July to October 2014 in Kampala and Mbale district, Eastern Uganda representing the national and district level, respectively. The key informants selected were all public officials responsible for supervision of CAMH services at the two levels. The interview guide included the following CAMH domains based on the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS): policy and legislation, financing, service delivery, health workforce, medicines and health information management. Inductive thematic analysis was applied in which the text in data transcripts was reduced to thematic codes. Patterns were then identified in the relations among the codes.ResultsEleven themes emerged from the six domains of enquiry in the WHO-AIMS. A CAMH policy has been drafted to complement the national mental health policy, however district managers did not know about it. All managers at the district level cited inadequate national mental health policies. The existing laws were considered sufficient for the promotion of CAMH, however CAMH financing and services were noted by all as inadequate. CAMH services were noted to be absent at lower health centers and lacked integration with other health sector services. Insufficient CAMH workforce was widely reported, and was noted to affect medicines availability. Lastly, unlike national level managers, lower level managers considered the health management information system as being insufficient for service planning.ConclusionManagers at national and district level agree that most components of the CAMH system in Uganda are weak; but perceptions about CAMH policy and health information systems were divergent.