Nakaseke District Research Articles

Self-care and healthcare seeking practices among patients with hypertension and diabetes in rural Uganda

Background Implementing effective self-care practices for non-communicable diseases (NCD) prevents complications and morbidity. However, scanty evidence exists among patients in rural sub-Saharan Africa (SSA). We sought to describe and compare existing self-care practices among patients with hypertension (HTN) and diabetes (DM) in rural Uganda. Methods Between April and August 2019, we executed a cross-sectional investigation involving 385 adult patients diagnosed with HTN and/or DM. These participants were systematically randomly selected from three outpatient NCD clinics in the Nakaseke district. Data collection was facilitated using a structured survey that inquired about participants’ healthcare-seeking patterns, access to self-care services, education on self-care, medication compliance, and overall health-related quality of life. We utilized Chi-square tests and logistic regression analyses to discern disparities in self-care practices, education, and healthcare-seeking actions based on the patient’s conditions. Results Of the 385 participants, 39.2% had only DM, 36.9% had only HTN, and 23.9% had both conditions (HTN/DM). Participants with DM or both conditions reported more clinic visits in the past year than those with only HTN (P = 0.005). Similarly, most DM-only and HTN/DM participants monitored their weight monthly, unlike those with only HTN (P<0.0001). Participants with DM or HTN/DM were more frequently educated about their health condition(s), dietary habits, and weight management than those with only HTN. Specifically, education about their conditions yielded adjusted odds ratios (aOR) of 5.57 for DM-only and 4.12 for HTN/DM. Similarly, for diet, aORs were 2.77 (DM-only) and 4.21 (HTN/DM), and for weight management, aORs were 3.62 (DM-only) and 4.02 (HTN/DM). Medication adherence was notably higher in DM-only participants (aOR = 2.19). Challenges in self-care were significantly more reported by women (aOR = 2.07) and those above 65 years (aOR = 5.91), regardless of their specific condition(s). Conclusion Compared to rural Ugandans with HTN-only, participants with DM had greater utilization of healthcare services, exposure to self-care education, and adherence to medicine and self-monitoring behaviors. These findings should inform ongoing efforts to improve and integrate NCD service delivery in rural SSA.

Measles outbreak in Semuto Subcounty, Nakaseke District, Uganda, June–August 2021

Semuto Subcounty reported rubella/measles outbreaks in January 2020 and June-August 2021. This study investigated the outbreak in 2021 to determine the scope, and the factors associated with transmission. A probable case was defined as a resident of Semuto Subcounty with acute onset of fever and a generalized maculopapular rash with either cough/cold or red eyes from 1 June to 31 August 2021. A confirmed case was defined as a probable case with a blood sample positive for measles-specific IgM. A village-matched case-control study was conducted with 30 cases and 122 controls (1:4 ratio). A control was defined as an individual aged 6 months-9 years, sampled at random, with no signs or symptoms of measles from 1 June to 31 August 2021, residing in the same village as the matched case. Adjusted Mantel-Haenszel odds ratios (ORMH) and confidence intervals (CIs) were calculated. Of the 30 cases (27 probable and three confirmed), 16 (53%) were male. The subcounty attack rate (AR) was 3.2/1000. Children aged 5-9 years were the most affected (AR 5.0/1000). Twenty-two (79%) cases and 116 (97%) controls had ever received measles vaccine (ORMH 0.13, 95% CI 0.03-0.52). Interaction with symptomatic persons at water collection points (ORMH 4.4, 95% CI 1.6-12) and playing at community playgrounds (ORMH 4.2, 95% CI 1.7-11) increased the odds of infection. Socializing/congregating at water collection points and community playgrounds facilitated the transmission of measles in this outbreak.

Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment

ObjectiveTo explore how respondents with common chronic conditions—hypertension (HTN) and diabetes mellitus (DM)—make healthcare-seeking decisions.SettingThree health facilities in Nakaseke District, Uganda.DesignDiscrete choice experiment (DCE).Participants496 adults with HTN and/or DM.Main outcome...

Polycyclic aromatic hydrocarbons in breast milk of nursing mothers: Correlates with household fuel and cooking methods used in Uganda, East Africa

Maternal breast milk, which is a complete food for the infant's growth, development, and health, contains fats and lipids making it susceptible to accumulation of lipophilic compounds like polycyclic aromatic hydrocarbons (PAHs). This study aimed at analyzing correlates of measured levels of PAHs in breast milk of nursing mothers to frequently used household fuels and cooking methods in Uganda, and estimate the potential health risks of PAHs to infants through breastfeeding. Sixty breast milk samples were collected from healthy and non-smoking mothers who had lived in Kampala capital city (urban area) and Nakaseke district (rural area) for at least five years. Sample extracts were analyzed for PAHs using a gas chromatograph coupled with a triple quadrupole mass spectrometer. ∑13PAHs in samples from Kampala ranged from 3.44 to 696 ng/g lw while those from Nakaseke ranged from 0.84 to 87.9 ng/g lw. PAHs with 2–3 rings were more abundant in the samples than PAHs with 4–6 rings. At least 33 % of the variance in the levels of ∑13PAHs in the breast milk samples was attributable to the fuel type and cooking methods used. Nursing mothers who used charcoal for cooking accumulated higher levels of ∑13PAHs in their breast milk samples compared to those who used firewood. Levels of ∑13PAHs in breast milk of mothers increased depending on the cooking methods used in the order; boiling< grilling< deep-frying. In all samples, hazard quotients for PAHs were <1 and estimated incremental cancer risks were all between 10−6 and 10−4, indicating that the health risks to infants due to the ingestion of PAHs in breast milk was tolerable. Further studies with large datasets on PAHs and their derivatives and, larger samples sizes are needed to confirm these findings.

Knowledge and attitude of secondary school students in Nakaseke, Uganda towards HIV transmission and treatment.

Background: One of the major health concerns in Nakaseke district, Uganda is the high prevalence of HIV/AIDS. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), as of March 2014, the prevalence rate of the disease in the district was estimated at about 8%, compared to the national average of 6.5%, making Nakaseke district have the sixth-highest prevalence rate of HIV/AIDS in the entire country. We set out to explore the knowledge and attitude of secondary school students in Nakaseke, Uganda on HIV transmission and treatment. Methods: This was a cross sectional survey-based study with data collected during the month of February 2020. Data were analyzed using R programming language version 3.6.2. Results: A total of 163 participants volunteered for the study, 53.37% males and 46.63% females with ages ranging from 12 - 20 years. Participants came from 5 senior classes (S1, S2, S3, S4 and S6). In total, 87.73% participants were aware of HIV/AIDS while 12.27% were not. The major source of information was through teachers/schools. 96.50% knew the mode of transmission of HIV/AIDS and 95.11% were conversant with HIV/AIDS prevention. 63.6% were aware of the terms DNA and genes whereas 36.36% were not. Discussion:Generally, the students in Nakaseke district, Uganda had a high level of awareness of HIV/AIDS based on Bloom's cut-off point. However, with regards to aspects such as the cause and modern prevention methods like taking prep and prevention of mother to child transmission were less known to them. Efforts to find a cure for HIV/AIDS are still in vain. Therefore, strong emphasis on up to date control and prevention methods should be implemented to fight the HIV/AIDS scourge .

Acceptability of patient-centered hypertension education delivered by community health workers among people living with HIV/AIDS in rural Uganda

BackgroundThe prevalence of hypertension is increasing among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). However, knowledge of the complications and management of hypertension among PLWHA in Uganda remains low. We explored the acceptability of implementing hypertension (HTN) specific health education by community health workers (CHWs) among PLWHA in rural Uganda.MethodsWe conducted a qualitative study consisting of 22 in-depth interviews (14 PLWHA/HTN and 8 CHWs), 3 focus group discussions (FGDs), 2 with PLWHA/HTN and 1 with CHWs from Nakaseke district, Uganda. Participants were interviewed after a single session interaction with the CHW. Data were transcribed from luganda (local language) into English and analyzed using thematic analysis. We used Sekhon’s model of acceptability of health Interventions to explore participants’ perceptions.ResultsParticipants believed CHWs utilized easy-to-understand, colloquial, non-technical language during education delivery, had a pre-existing rapport with the CHWs that aided faster communication, and had more time to explain illness than medical doctors had. Participants found the educational material (PocketDoktor™) to be simple and easy to understand, and perceived that the education would lead to improved health outcomes. Participants stated their health was a priority and sought further disease-specific information. We also found that CHWs were highly motivated to carry out the patient-centered education. While delivering the education, CHWs experienced difficulties in keeping up with the technical details regarding hypertension in the PocketDoktor™, financial stress and patient questions beyond their self-perceived skill level and experience. PLWHA/HTN had challenges accessing the health facility where the intervention was delivered and preferred a household setting.ConclusionsHypertension patient-centered education delivered by CHWs using the PocketDoktor™ was acceptable to PLWHA and hypertension in Nakaseke area in rural, Uganda. There is need for further studies to determine the cost implications of delivering this intervention among PLWHA across LMIC settings.

Knowledge and attitude of secondary school students in Nakaseke, Uganda towards HIV transmission and treatment

Background: One of the major health concerns in Nakaseke district, Uganda is the high prevalence of HIV/AIDS. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), as of March 2014, the prevalence rate of the disease in the district was estimated at about 8%, compared to the national average of 6.5%, making Nakaseke district have the sixth-highest prevalence rate of HIV/AIDS in the entire country. We set out to explore the knowledge and attitude of secondary school students in Nakaseke, Uganda on HIV transmission and treatment.Methods: This was a cross sectional survey-based study with data collected during the month of February 2020. Data were analyzed using R programming language version 3.6.2.Results: A total of 163 participants volunteered for the study, 53.37% males and 46.63% females with ages ranging from 12 – 20 years. Participants came from 5 senior classes (S1, S2, S3, S4 and S6). In total, 87.73% participants were aware of HIV/AIDS while 12.27% were not. The major source of information was through teachers/schools. 96.50% knew the mode of transmission of HIV/AIDS and 95.11% were conversant with HIV/AIDS prevention. 63.6% were aware of the terms DNA and genes whereas 36.36% were not.Discussion: Generally, the students in Nakaseke district, Uganda had a high level of awareness of HIV/AIDS based on Bloom’s cut-off point. However, with regards to aspects such as the cause and modern prevention methods like taking prep and prevention of mother to child transmission were less known to them. Efforts to find a cure for HIV/AIDS are still in vain. Therefore, strong emphasis on up to date control and prevention methods should be implemented to fight the HIV/AIDS scourge .

Knowledge and attitude of secondary school students in Nakaseke, Uganda towards HIV transmission and treatment

Background: One of the major health concerns in Nakaseke district, Uganda is the high prevalence of HIV/AIDS. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), as of March 2014, the prevalence rate of the disease in the district was estimated at about 8%, compared to the national average of 6.5%, making Nakaseke district have the sixth-highest prevalence rate of HIV/AIDS in the entire country. We set out to explore the knowledge and attitude of secondary school students in Nakaseke, Uganda on HIV transmission and treatment. Methods: This was a cross sectional survey-based study with data collected during the month of February 2020. Data were analyzed using R programming language version 3.6.2. Results: A total of 163 participants volunteered for the study, 53.37% males and 46.63% females with ages ranging from 12 – 20 years. Participants came from 5 senior classes (S1, S2, S3, S4 and S6). In total, 87.73% participants were aware of HIV/AIDS while 12.27% were not. The major source of information was through teachers/schools. 96.50% knew the mode of transmission of HIV/AIDS and 95.11% were conversant with HIV/AIDS prevention. 63.6% were aware of the terms DNA and genes whereas 36.36% were not. Discussion: Generally, the students in Nakaseke district, Uganda had a high level of awareness of HIV/AIDS. However, with regards to aspects such as the cause and modern prevention methods like taking prep and prevention of mother to child transmission were less known to them. Efforts to find a cure for HIV/AIDS are still in vain. Therefore, strong emphasis on up to date control and prevention methods should be implemented to fight the HIV/AIDS scourge.

Youths\u2019 perceptions of community health workers\u2019 delivery of family planning services: a cross-sectional, mixed-methods study in Nakaseke District, Uganda

BackgroundHigh rates of unintended adolescent pregnancy are a significant health problem in Uganda. To improve access to family planning (FP) services, community-based Village Health Teams (VHTs) are widely employed in Uganda to deliver education and services. However, evaluations of FP programs suggest that mainly older, married women use VHT FP services.MethodsTo better understand youth reluctance to use VHTs, we collected quantitative FP and contraceptive-seeking behavior data from a survey of 250 youths aged 15–25 in randomly selected households in Nakaseke District, which we triangulated with data from 3 focus group discussions (FGDs) (n = 15).ResultsMost respondents received FP services from the formal health sector, not VHTs. Only half had talked to a VHT, but 65% knew that VHTs provide free FP services, and most (82%) felt comfortable talking to VHTs about FP. The main reasons for discomfort were fear that VHTs would violate privacy (mentioned by 60% of those not comfortable), that VHTs would talk to parents (33%), shyness (mentioned by 42% of those ≤18), and fear of being judged (14%). Concern about side effects was the most common reason for not using FP methods. Survey respondents said having VHTs of the same sex was important, particularly those in the youngest age group (OR = 4.45; 95%CI: 1.24, 16.00) and those who were unmarried (OR = 5.02; 95%CI: 2.42, 10.39). However, FGD participants (who were older than survey respondents on average) often preferred older VHTs of the opposite sex, whom they viewed as more professional and trustworthy. Respondents said the primary deciding factors for using VHTs were whether privacy would be respected, the proximity of care, and the respectfulness of care.ConclusionsVHTs are a known source of FP services but not widely used by youth due to privacy and quality of care concerns. VHT messaging and training should increase focus on ensuring privacy, protecting confidentiality, providing respectful care, and addressing concerns about contraceptive side effects. Preferences for VHTs of similar age and sex may be more important for younger adolescents than older youths for whom quality concerns predominate.

Chronic Obstructive Pulmonary Disease Prevalence and Associated Factors in a Setting of Well-Controlled HIV, A Cross-Sectional Study

In Sub-Saharan Africa, COPD remains prevalent but its association with HIV is not well characterized especially in rural settings. We assessed for COPD prevalence, associated factors and lung function profile among HIV-infected individuals attending ART clinics in rural Nakaseke district of Uganda. We enrolled HIV-positive participants from four HIV treatment centers in rural Uganda. Participants underwent spirometry testing following standard guidelines. We defined COPD as a post-bronchodilator FEV1/FVC ratio less than the fifth percentile of the NHANES III African-American reference. We assessed for factors associated with COPD and lung function profiles using multivariable logistic and linear regression analyses. We analyzed data from 722 HIV-positive participants (mean age 48.0 years, 59.7% women). Over 90% of participants were on ART for a median duration of 4 years (IQR 2–7 years), with a median viral load of 0 copies/mL (IQR 0–0 copies/mL), current and baseline CD4 + T cell count of 478 cells/mm3 (IQR 346–663 cells/mm3) and 335 cells/mm3 (IQR 187–523 cells/mm3) respectively. The prevalence of COPD was 6.22%. COPD was associated with worse respiratory symptoms and health status. History of pulmonary tuberculosis was strongly associated with COPD (adjusted OR = 4.92, 95% CI 1.71 to 14.15, p = 0.003) and reduced lung function. Use of ART, CD4+T cell count and viral load were not associated with COPD or reduced lung function. In conclusion, we report a COPD prevalence of 6.22% in HIV-infected individuals in rural Uganda. Pulmonary tuberculosis remains the strongest predictor of COPD risk and reduced lung function in well-controlled HIV.

Self-care practices and needs in patients with hypertension, diabetes, or both in rural Uganda: a mixed-methods study

BackgroundThe prevalence of non-communicable diseases (NCDs) is increasing in rural sub-Saharan Africa. Implementation and adaptation of recommended self-care practices is crucial for successful management of NCDs to prevent complications. However, little is known about self-care practices in patients living in rural sub-Saharan Africa. In this study, we aimed to understand patients' adherence to self-care practices for hypertension, diabetes, or both, in rural Uganda and their reasons for non-adherence. MethodsWe conducted a mixed-methods study in adult patients previously diagnosed with diabetes or hypertension, or both, who attended outpatient NCD clinics at three health facilities in Nakaseke district. We concurrently collected quantitative data from a random sample of patients using pretested, structured questionnaires and held focus group discussions and in-depth interviews with a purposive sample of patients. Descriptive statistics were calculated for the quantitative data. Qualitative analysis was conducted using a thematic approach. FindingsBetween April and August, 2019, we administered questionnaires and carried out six focus group discussions and 19 in-depth interviews with 385 participants. Mean age was 54·0 years (SD 14·57) and most respondents, 257 (66·8%), were female. Of the 385 participants, 39·2% (151) had diabetes; 36·9% (142) had hypertension, and 23·9% (92) had both conditions. Most respondents reported daily adherence to medication for hypertension (79·5% [186/234]) and diabetes (84·8% [206/243]). Few participants (15·6% [60/385]) reported daily vigorous physical activity, but 63·1% (243/385) reported moderate physical activity at least once per week. Most respondents reported adherence to recommendations for dietary changes (75·6% [291/385]), non-smoking (98·7% [380/385]), alcohol abstinence (90·1% [347/385]), and weight management (75·6% [291/385]). From the interviews and discussions, patients reported that they tried to adhere to recommended medications but were limited by the inability to obtain them. Most patients reported irregular self-monitoring and many reported confusion about recommended practices due to mixed messages, mainly from their peers. Respondents also reported use of herbal remedies, soaking swollen feet in salt water, and coping with stress through prolonged sleep, social isolation, and alcohol use. InterpretationVaried self-care practices exist among rural Ugandan NCD patients. Patients inconsistently engage in recommended practices because of uncertain access to medicines, structural barriers, and inconsistent messaging. Locally adapted educational self-care programmes and consistent access to medicines could help improve self-care in these patients. As low-income countries like Uganda continue to advance their NCD policies, specific attention should be focused on strategies to ensure equitable access to essential NCD medicines. Additionally, the unique circumstances of people living in rural settings should be taken into account when developing programmes for management of NCDs. FundingYale Institute of Global Health Hecht Global Health Faculty Network Award

Development of a discrete choice experiment to understand patient preferences for diabetes and hypertension management in rural Uganda

BackgroundIn 2020, non-communicable diseases (NCDs) currently account for 40% of deaths in east Africa and are expected to surpass communicable diseases as the leading causes of death in sub-Saharan Africa by 2030. However, there remain many gaps in the provision of high quality, patient-centred NCD service delivery in low-income countries such as Uganda, especially in rural settings. We developed a discrete choice experiment (DCE) to understand how patients with common NCDs, such as hypertension and diabetes, make health-care-seeking decisions. A DCE is a quantitative tool that measures the weight of different factors that affect a decision. Participants are presented with two hypothetical scenarios to choose between. Here we report on the formative, qualitative phase of DCE development. MethodsFor this DCE, choice sets consist of two health facilities described in terms of various attributes (factors) that affect decision-making. To develop a locally relevant DCE, we conducted formative qualitative research consisting of 18 in-depth interviews with patients seeking care for hypertension or diabetes, or both, at three health facilities in rural Nakaseke District, Uganda. We purposively selected participants so that each disease and facility were represented. Interviews explored how participants choose which facility to visit and challenges that she or he faces in accessing care or medicines, or both. A team of three researchers coded the interviews using a directed approach to reveal 11 potential attributes on which patients make decisions. After review of the data and analysis with local and international content experts, we narrowed this list to six attributes to be included in the DCE. FindingsThe six selected attributes included: provision of education; availability of medicines; transport to the facility; costs associated with treatment; interactions with health-care providers; and presence of peer support groups. Attribute levels encompassed the range of experiences for each attribute as emerged from qualitative analysis. We then developed a full profile, fractional factorial DCE with three surveys. InterpretationThe process of developing this NCD-focused DCE relied on reference to the literature, primary qualitative data collection, and expert consensus to create a tool that would yield actionable data to improve NCD health service delivery in rural Uganda. Little is known about how rural patients in low-income and middle-income countries navigate the health-care system, nor is there much description of how to develop DCEs to investigate patient preferences in these countries. This work will guide public health officials in developing NCD service delivery options and inform investigators on DCE development. FundingYale Institute of Global Health Hecht Global Health Faculty Network Award Downs International Health Student Travel Fellowship

Studies on the utilization and proximate composition of wild Aframomum anguistifolium (sonn.) K. Schum fruits in Nakaseke district, Uganda

Nakaseke district is located in the central region of Uganda and has high abundance of edible Aframomum anguistifolium (wild cardamom) fruit, locally known as “Amatuunguru’’. The fruit is consumed by only few people who access it from the wild and there is limited information on the nutritional benefits of the fruit. This study determined the utilization and consumptive benefits of A. anguistifolium fruits among the local communities of Nakaseke district as well as the proximate composition of the fruit. A cross-sectional survey using an interview guide was conducted to establish the utilization and consumptive benefits of the fruit while the proximate composition (crude protein, fat, carbohydrate, fiber and ash, moisture) was determined using standard methods of Association of Official Analytical Chemists (AOAC). The results revealed that fruits are collected and consumed by the local communities because of their nutritional and medicinal values. A. anguistifolium plant is not domesticated despite the different consumptive benefits accrued from it. The results revealed that children are the major collectors (consumers) of the fruit (48%) compared to women and men and they collect the fruit from the wild as they go about their chores like collecting firewood, tending grazing animals and fetching water. The fruit’s availability is highest in the rainy season and maturity indicators include the fruit exocarp turning red in colour. The exocarp is removed and thrown away during consumption leaving the inside part which is edible. The fruit was found to contain moisture (72.98%). The content of the dry matter was ash (13.97%), crude fat (4.35%), crude protein (6.82%), crude fiber (12.55%) and nitrogenfree extracts/NFE (62.30%). Hence the fruit is a suitable supplement for moisture, fats, proteins and crude fiber needed in human diet. The plant is still collected from the wild and grows mainly in swampy areas (wetlands) which are being cleared for agriculture, settlement and road construction. This plant could be endangered if its conservation is not prioritized.

Polybrominated diphenyl ethers in mothers' breast milk and associated health risk to nursing infants in Uganda.

The aim of this study was to investigate levels of polybrominated diphenyl ethers (PBDEs) in breast milk samples from healthy primiparous mothers who had lived in Kampala capital city (urban area) and Nakaseke district (a rural area) for the last five years. Fifty samples were collected between March and June 2018 and were extracted by dispersive solid-phase extraction (SPE). Clean-up was performed on an SPE column and analysis was done using gas chromatography-mass spectrometry. Total (∑) PBDEs (BDE 28, 47, 49, 66, 77, 99, 100,138,153, 154, 183 and 209) ranged from 0.59 to 8.11 ng/g lipid weight (lw). The levels of PBDEs in samples from Kampala capital city were significantly higher than those from Nakaseke (p < 0.01, Mann-Whitney U test). The most dominant congeners were BDE-209 and -47 (contributed 37.1% and 20.2%, respectively to ∑PBDEs), suggesting recent exposure of mothers to deca-and penta-BDE formulations. Fish and egg consumption, plastics/e-waste recycling and paint fumes were associated with higher levels of BDE-47, -153 and -99, respectively, implying that diet and occupation were possible sources of the pollutants. Estimated dietary intakes (ng kg-1 body weight day-1) for BDE-47, -99 and -153 were below the US EPA reference doses for neurodevelopmental toxicity, suggesting minimal health risks to nursing infants who feed on the milk. Generally, the risk quotients for BDE-47, -99 and -153 were <1 in majority (96%) samples, indicating that the breast milk of mothers in Uganda was fit for human consumption.

Challenges to hypertension and diabetes management in rural Uganda: a qualitative study with patients, village health team members, and health care professionals

BackgroundThe prevalence of hypertension and diabetes are expected to increase in sub-Saharan Africa over the next decade. Some studies have documented that lifestyle factors and lack of awareness are directly influencing the control of these diseases. Yet, few studies have attempted to understand the barriers to control of these conditions in rural settings. The main objective of this study was to understand the challenges to hypertension and diabetes care in rural Uganda.MethodsWe conducted semi-structured interviews with 24 patients with hypertension and/or diabetes, 11 health care professionals (HCPs), and 12 community health workers (known as village health team members [VHTs]) in Nakaseke District, Uganda. Data were coded using NVivo software and analyzed using a thematic approach.ResultsThe results replicated several findings from other settings, and identified some previously undocumented challenges including patients’ knowledge gaps regarding the preventable aspects of HTN and DM, patients’ mistrust in the Ugandan health care system rather than in individual HCPs, and skepticism from both HCPs and patients regarding a potential role for VHTs in HTN and DM management.ConclusionsIn order to improve hypertension and diabetes management in this setting, we recommend taking actions to help patients to understand NCDs as preventable, for HCPs and patients to advocate together for health system reform regarding medication accessibility, and for promoting education, screening, and monitoring activities to be conducted on a community level in collaboration with village health team members.

Knowledge, Attitudes, and Use of Family Planning in Rural Uganda: Comparing the Female and Male Perspectives [6H

INTRODUCTION: Unintended pregnancy is a significant modifiable factor contributing to the high maternal mortality rate in Uganda. This study compares women and men’s knowledge of and attitudes toward family planning (FP) in rural Uganda to understand potential barriers to its use. METHODS: Data were collected from villagers through surveys in rural Nakaseke District, Uganda (N=362). Participants’ socio-demographics, indicators of unmet need, and knowledge/accessibility of FP services were queried and analyzed. RESULTS: 183 women and 179 men (average age 32.5, range 15-71) participated. All women and 98% of men reported some knowledge of FP. Most women (62%) obtained FP information from health workers; most men (73%) obtained information via radio. 64% of women and 53% of men reported ever using FP; 40% of respondents reported current use. Of these, 35% of women involved their partners in their decision, compared to 23% of men. Of participants reporting barriers to FP (n=46), women cited partner opposition as the most common obstacle (23%), whereas men reported inability to access their chosen method (39%). Women and men identified common contraceptive side-effects, e.g. vaginal bleeding (47% vs 31%), but men were more likely to report myths, e.g. increased infertility (9% vs 1%). CONCLUSION: Men and women in rural Uganda reported limited access to FP as a significant barrier to use. For women, partner opposition contributed significantly to limiting access. Men relied on incomplete/inaccurate sources of information, furthering their reluctance to use FP. Our study demonstrates the importance of targeting education for men and women to increase acceptance/success of FP programs.

Typhoid over diagnosis and reporting in Nakaseke District, Uganda, 2016

Introduction : typhoid is a disease of public health importance in Uganda. A data audit conducted among 12 public health facilities for week 15 to week 21 in Nakaseke District recorded a high number of typhoid cases (342). Likewise, analysis of records in the MOH weekly surveillance system for week 18 to 21 estimated about 134 typhoid cases per 50,000 which are higher than the recommended threshold (20 persons per 50,000 populations) in the community.

Ghee-making in the cattle corridor of Uganda

In sub-Saharan Africa, women in smallholder dairy operations carry a disproportionate labor burden, especially in making traditional fermented milk products like ghee. There is a clear need to improve the production processes, not only to decrease the labor burden, but also to increase quantity and enhance quality. The objective of this study was to document the current butter/ghee-making practice and to identify priority areas that need attention. Women groups engaged in traditional butter/ghee production were identified from the cattle corridor of Uganda. The five study locations were: Ngoma village/town in Nakaseke district, Nyamilinga and Kabuye villages in Kiboga district, Kanyaryeru village in Kiruhura district and Kotido in Kotido district. The women demonstrated the processes and were engaged in focus groups to better understand details that were not adequately covered during the demonstrations. The demonstrations were video-taped for future reference. Butter is made from the milk of a cow that has been lactating for at least one month. Milk and/or cream are allowed to ferment for up to 12 hours and butter is separated by churning in a gourd. The butter/ghee-making practices in the cattle corridor of Uganda differ in how the milk is handled before churning to separate the butterfat. The study revealed that butter/ghee-making is an effective way to reduce losses when farmers cannot sell their milk. However, churning to separate butter fat is the most labor-intensive component of the overall ghee-making process; it is the bottle neck to increasing quantity without proportionately increasing the labor burden. Also, women handling large volumes complained of fatigue due to high energy required for manual churning. Women reported chest pains, especially those churning 10 liters of milk in 20-liter gourds. This posture of placing the gourd on their laps or between the legs on a cushion followed by shaking reportedly causes knee and elbow pains and as a result some women have given up churning. The study concluded that a hand-operated high capacity churning device, if developed and adopted, will not only increase farmer productivity in terms of reduced labor and/or increased incomes, but will also enhance quality and reduce churning-related health problems. Key words : Smallholder, poverty, ghee, traditional processing, labor, fermentation, churning, productivity, Uganda

Redesigning dental education curricula delivary strstigy at the newly established University of Rwanda School of Dentistry

purpose of this study was to assess the impact of the ACCESS nursing assistant training program and the current role of its graduates in rural health care work. Structure/Method/Design: Working with local stakeholders, a team of three student volunteers developed a survey to evaluate the training outcomes of theACCESSnursing assistant program.The survey focused on demographics, pre-training status, the ACCESS training program, post-training employment, and community impact and career development goals. Survey participants were contacted using telephone numbers stored in a pre-existing database containing 109 graduates. A short-form survey was administered via telephone to those living outside Nakaseke district while a long-form survey was administered in-person to graduates residingwithin a 10mile-radius of the training school. The data generated by the survey was analyzed and presented using thematic areas outlined above. The results support a sustainable collaborative educational model by providing student feedback regarding the training received. Outcomes & Evaluation: The mean age of the participants was 24 years, with the majority female (86.5%). All participants reported an overall positive impact of the training program. A large majority of graduates reported current employment in health care (91.9%) with place of employment primarily in health clinics (37.1%) and pharmacies (34.3%). Participants are predominantly working in rural areas (80.0%). Graduates also reported a desire to pursue more training for degree advancement (77.8%) and to return for further training at the ACCESS school (67.6%). Going Forward: Overall, the ACCESS training program has provided a stepping-stone for many trainees and has impacted the community through increased health service provision. There is a great need for creating opportunities for students to access further studies for deg Funding: Funding Provided by Western Connecticut Health Network. Abstract #: 02ETC071

Financial Performance and Technical Efficiency Differentials for Apicultural Technologies in Nakaseke District, Uganda

Despite apiculture being potentially a large income earner, the financial performance of various apicultural technologies at farm-level is still poor yet very few studies have delved in this sub sector. Using a representative sample of 69 respondents from Nakaseke District, the Ordered Probit analysis revealed that farming experience, apiary plot size, shortness of distance of water source and hive colonization levels were the major positive determinants of apicultural financial performance. A Stochastic Frontier Analysis (SFA) suggested that 62% and 76% of the total variation in honey output in traditional and improved technologies was due to technical inefficiency. The high efficiency levels in traditional technology seemed to suggest that more honey output would only be realized through introduction of improved technologies rather than focusing on technical skills while the low efficiency in improved technology would be improved using technical training. The study recommended policy incentives ranging from specific commodity-targeting extension messages, provision of low interest rate credit products and baiting materials to enhance efficiency.