Village Health Teams Research Articles

Adolescent and Youth Experiences With Contraceptive Self-Injection in Uganda: Results From the Uganda Self-Injection Best Practices Project

PurposeWe used qualitative and quantitative data to evaluate the differing experiences of adolescents and adult women in the contraceptive self-injection program in primary care settings in Uganda. From these results, we assessed barriers to adolescent DMPA-SC self-injection access and continuation and provide recommendations to address them. MethodsThe Self-Injection Best Practices (2017–2019) project in four districts trained clinic-based providers and Village Health Teams to provide self-injection training in clinics, community settings, and small group meetings for adolescent girls and young women. More than 12,000 women of reproductive age received self-injection services through the program, including 2,215 under 20 years. Structured surveys (n = 1,060) and in-depth interviews (n = 36) were conducted with randomly selected adolescent participants between July and November 2018. Mixed-effects logistic regression was used to assess quantitative differences in outcomes of interest between age groups. ResultsThe study found no significant difference in self-injection proficiency or continuation between adolescents and adult women; 86.1% of adolescents self-injected independently when due for reinjection. Adolescents were significantly less likely than adults to report first hearing about self-injection from a community health worker. More adolescents expressed concern over discovery when seeking contraception at a clinic and fear of their DMPA-SC units being discovered at home. Adolescents were significantly less likely than adult women to mention convenience as a rationale for self-injecting, and more likely to mention wanting to learn a new skill and/or that friends recommended self-injection. DiscussionSelf-injection is a promising method of contraception for adolescents in Uganda, given comparable proficiency and continuation relative to adult women. Policies and programs should ensure rights-based access to a range of methods, including self-injection for this age group.

Perinatal Depression and Breastfeeding: A Mixed Methods Study Among South Sudanese Refugees in the West Nile Region in Uganda

Abstract Objectives The specific study objectives were: 1) to identify perceived common stressors among parents in refugee settlements, 2) to analyze the associations of perinatal depression and early initiation of breastfeeding and 3) to analyze the associations between perinatal depression and exclusive breastfeeding. Methods Qualitative study participants were mothers (n = 66) and fathers (n = 49) who compromised eight focus group discussions (FGDs): four mothers FGDs, two fathers FGDs, two mothers and fathers FGDs. Two FGDs with Village Health Team and six individual interviews with key informants also were conducted. Thematic analysis was used in NVivo, v. 12. Quantitative study participants (n = 390) were pregnant mothers who were enrolled in a community-based randomized control study. Perinatal depression was measured using Patient Health Questionnaire-9 during 3rd trimester and postpartum. Early initiation and exclusive breastfeeding were assessed using WHO guidelines. SAS, v. 9.4, was used to conduct logistic regressions to analyze perinatal depression and breastfeeding and models were adjusted for confounders. Results Five themes related to common stressors among refugees included: marital conflict and violence, other violence and conflict, lack of basic needs, inadequate health care, issues involving childbirth, and issues involving children. Over two-thirds (66.3%) of mothers breastfed within one hour after birth and 55.5% exclusively breastfed. Antenatal depression occurred in 19.9% of participants and 23.5% had postpartum depression. Antenatal depression was not significantly associated with early initiation of breastfeeding or exclusive breastfeeding. Postpartum depression was associated with significantly lower odds of breastfeeding within an hour after birth [AOR 0.35 (0.21- 0.61), p-value < 0.001] and of exclusive breastfeeding [AOR 0.44 (0.26–0.74), p-value < 0.01]. Conclusions Screening and treatment for perinatal depression during antenatal and postnatal care is important for refugee mothers. Interventions aiming to improve breastfeeding among refugees may also consider addressing postpartum depression. Funding Sources Supported by a grant from the Nestlé Foundation for the study of problems of nutrition in the world, Lausanne, Switzerland and Oklahoma State University Foundation Marilynn Thoma Chair and Humphreys Grant.

Factors Associated with Treatment Adherence of Patients on Anti-Tuberculosis Drugs Following Covid-19 Pandemic at Health Facilities of Masaka City, Uganda

Purpose: To examine factors associated with adherence of patients on Anti-tuberculosis treatment in Health facilities at Masaka City. Specifically the study was guided by four objectives; to establish the current level of adherence, to explore the patient knowledge, to find out socio-economic factors, and to identify Health facility factors contributing to adherence of patient on tuberculosis treatment.
 Methodology: A cross-sectional research design with both quantitative and qualitative approaches of data collection and analysis was used. At least 110 patients on tuberculosis drug were selected and 15 health workers working in tuberculosis clinics to give expert views on the problem under investigation. Interview guide and questionnaires were used and data were analyzed using Stata version 13. Descriptive statistics, percentages were presented in the findings on frequency distribution tables. Qualitative data obtained using interviews was analyzed using thematic content analysis and narrative reasoning.
 Results: Prevalence of adherence to TB treatment was at 86% from the patients the study was conducted. In the study most patients had adequate knowledge on Tuberculosis treatment and it had attributed a majority 86% with good adherence on Tuberculosis Drug. On health facility factors there was limited medical supplies of drug to improve care, most patients were youth. Statistically, there was significant relationship between frequent counseling and patient adherence at multivariate levels. (OR=15.5073; [95% Cl: 3.73553 to 27.27917]; p=0.010). There was no relationship between patients’ adherence and employment status and good conduct of health workers was significally associated with patient adherence. (OR=7.0566; [95%Cl: 2.77620 to 11.3371]; P=0.001). In this study factors affecting adherence included stigma, discrimination and suspension of transport as COVID-19 prevention guideline by Ministry of health Uganda negatively contributed to poor adherence of patients. This was attributed to by isolation and neglect by family members, relatives, health workers and the community for fear of COVID-19 suspicion at each respective health facility. Involvement of TB survivor in TB treatment would increase adherence and retention in care.
 Recommendations: In the study there was suboptimal adherence of 86% as opposed to MOH Uganda of 95%, due to stigma and discrimination. The study recommended each TB patient be assigned a family member and a village health team as treatment supporters. Intensified health education and pre TB treatment counselling on adherence increases patients ability to take medication consistently leading to good TB treatment outcomes. Not involving and supporting private clinics to provide TB services is a very big missed opportunity by the health sector. Most patients first visit private clinics before coming to public health centers. Involvement of TB survivor in TB treatment would increase adherence and retention in care.

Disruption in Essential Health Service Delivery: A Qualitative Study on Access to Family Planning Information and Service Utilization During the First Wave of COVID-19 Pandemic in Uganda.

BackgroundCoronavirus disease 2019 (COVID-19) remains a challenge to public health with profound impact on people’s lives. With several mitigation measures implemented to curb the spread of COVID-19, these impacted on access and utilization of general health services including family planning (FP) services. The objective of the study was to understand the extent to which COVID-19 interrupted access and utilization of FP services as well as highlight the challenges faced during the lockdown in Uganda.MethodsA qualitative study was carried out in August and September 2020 across the country. A total of 21 key informant interviews among researchers, policy makers, funding agencies, district family planning focal persons, district health officers and service providers with implementing partners were conducted. These were conducted using face to face (7), phone calls (11) and zoom (3) meetings. All interviews were audio recorded and transcribed verbatim. Transcripts were used to identify and generate codes, sub themes and themes. Analysis was done using the thematic framework analysis and results presented in themes.ResultsFive themes were identified in this study which included; (i) financial and psychosocial needs, (ii) mobility hindrances, (iii) disrupted service delivery, (iv) responsive reproductive health services. The financial and psychosocial needs themes included: household and individual financial constraints, unpredictable future and community acceptance, loss of employment and unemployment, misconceptions and unintended pregnancies; while mobility hindrances included; restricted movement, high transport costs, and difficulty in finding transport.ConclusionResults showed that the pandemic had immediate and significant long-term effects on family planning service accessibility, utilization and delivery. The study recommends implementation of telehealth services, country-wide sensitization on use of long-term contraceptive methods, empowering village health teams and making family planning services mandatory and free to all private facilities in order to lower any disruptions during pandemics.

Antenatal couples\u2019 counselling in Uganda (ACCU): study protocol for a randomised controlled feasibility trial

BackgroundCommon avoidable factors leading to maternal, perinatal and neonatal deaths include lack of birth planning (and delivery in an inappropriate place) and unmet need for contraception. Progress has been slow because routine antenatal care has focused only on women. Yet, in Uganda, many women first want the approval of their husbands. The World Health Organization recommends postpartum family planning (PPFP) as a critical component of health care. The aim of this trial is to test the feasibility of recruiting and retaining participants in a trial of a complex community-based intervention to provide counselling to antenatal couples in Uganda.MethodsThis is a two-group, non-blinded cluster-randomised controlled feasibility trial of a complex intervention. Primary health centres in Uganda will be randomised to receive the intervention or usual care provided by the Ministry of Health. The intervention consists of training village health teams to provide basic counselling to couples at home, encouraging men to accompany their wives to an antenatal clinic, and secondly of training health workers to provide information and counselling to couples at antenatal clinics, to facilitate shared decision-making on the most appropriate place of delivery, and postpartum contraception. We aim to recruit 2 health centres in each arm, each with 10 village health teams, each of whom will aim to recruit 35 pregnant women (a total of 700 women per arm). The village health teams will follow up and collect data on pregnant women in the community up to 12 months after delivery and will directly enter the data using the COSMOS software on a smartphone.DiscussionThis intervention addresses two key avoidable factors in maternal, perinatal and neonatal deaths (lack of family planning and inappropriate place of delivery). Determining the acceptability and feasibility of antenatal couples’ counselling in this study will inform the design of a fully randomised controlled clinical trial. If this trial demonstrates the feasibility of recruitment and delivery, we will seek funding to conduct a fully powered trial of the complex intervention for improving uptake of birth planning and postpartum family planning in Uganda.Trial registrationPan African Clinical Trials Registry PACTR202102794681952. Approved on 10 February 2021. ISRCTN Registry ISRCTN97229911. Registered on 23 September 2021

Evaluation of public health surveillance systems in refugee settlements in Uganda, 2016\u20132019: lessons learned

BackgroundCivil wars in the Great Lakes region resulted in massive displacement of people to neighboring countries including Uganda. With associated disease epidemics related to this conflict, a disease surveillance system was established aiming for timely detection of diseases and rapid response to outbreaks. We describe the evaluation of and lessons learned from the public health surveillance system set up in refugee settlements in Uganda.MethodsWe conducted a cross-sectional survey using the US Centers for Disease Control and Prevention Updated Guidelines for Evaluating Public Health Surveillance Systems and the Uganda National Technical Guidelines for Integrated Disease Surveillance and Response in four refugee settlements in Uganda—Bidibidi, Adjumani, Kiryandongo and Rhino Camp. Using semi-structured questionnaires, key informant and focus group discussion guides, we interviewed 53 health facility leaders, 12 key personnel and 224 village health team members from 53 health facilities and 112 villages and assessed key surveillance functions and attributes.ResultsAll health facilities assessed had key surveillance staff; 60% were trained on Integrated Disease Surveillance and Response and most village health teams were trained on disease surveillance. Case detection was at 55%; facilities lacked standard case definitions and were using parallel Implementing Partner driven reporting systems. Recording was at 79% and reporting was at 81%. Data analysis and interpretation was at 49%. Confirmation of outbreaks and events was at 76%. Preparedness was at 72%. Response was at 34%. Feedback was at 82%. Evaluate and improve the system was at 67%. There was low capacity for detection, response and data analysis and interpretation of cases (< 60%).ConclusionThe surveillance system in the refugee settlements was functional with many performing attributes but with many remaining gaps. There was low capacity for detection, response and data analysis and interpretation in all the refugee settlements. There is need for improvement to align surveillance systems in refugee settlements with the mainstream surveillance system in the country. Implementing Partners should be urged to offer support for surveillance and training of surveillance staff on Integrated Disease Surveillance and Response to maintain effective surveillance functions. Functionalization of district teams ensures achievement of surveillance functions and attributes. Regular supervision of and support to health facility surveillance personnel is essential. Harmonization of reporting improves surveillance functions and attributes and appropriation of funds by government to districts to support refugee settlements is complementary to maintain effective surveillance of priority diseases in the northern and central part of Uganda.

Mediating antiretroviral treatment for HIV during COVID-19: lessons from implementation in Gomba District, Uganda

Initial and subsequent waves of COVID-19 in Uganda disrupted the delivery of HIV care. In rural areas, village health teams and organisations on the ground had to develop strategies to ensure that people living with HIV could continue their treatment. It was necessary to take evolving circumstances into account, including dealing with movement restrictions, constrained access to food and stigma due to anonymity being lost as a result of a shift from health facility-based services to community-level support. Uganda has a long history of community-driven response to HIV, although health systems and response programming have become more centralised through government and donors to address political commitments to HIV treatment and other targets. The delivery system for antiretroviral therapy was vulnerable to the impacts of COVID-19 restrictions and related circumstances. To understand the continuum of challenges, and to inform ongoing and future support of treatment for people living with HIV, interviews were conducted with HIV organisation implementers, health workers, village health team members and people living with HIV. It was found that stigma was a central challenge, which led to nuanced adaptations for delivering antiretroviral treatment. There is a need to strengthen support to households of people living with HIV through improving community capacity to manage crises through improving household food gardens and savings, as well as capacity to organise and interact with support systems such as the village health teams. In communities, there is a need to evoke dialogue on stigma and to support community leadership on pressing issues that affect communities as a whole and their vulnerable groups. There are opportunities to reawaken the grassroots civic response systems that were evident in Uganda’s early response to HIV yet were lacking in the COVID-19 context.

Primary care provider notions on instituting community-based geriatric support in Uganda

BackgroundUnderstanding of the most economical and sustainable models of providing geriatric care to Africa’s rising ageing population is critical. In Uganda, the number of old adults (60 years and above) continues to rise against absence of policies and guidelines, and models for providing care to this critical population. Our study explored public primary health care provider views on how best community-based geriatric support (CBGS) could be instituted as an adaptable model for delivering geriatric care in Uganda’s resource-limited primary public health care settings.MethodsWe interviewed 20 key informants from four districts of Bukomansimbi, Kalungu, Rakai, and Lwengo in Southern Central Uganda. Respondents were leads (in-charges) of public primary health units that had spent at least 6 months at the fore said facilities. All interviews were audio-recorded, transcribed verbatim, and analysed based on Hsieh and Shannon’s approach to conventional manifest content analysis.ResultsDuring analysis, four themes emerged: 1) Structures to leverage for CBGS, 2) How to promote CBGS, 3) Who should be involved in CBGS, and 4) What activities need to be leveraged to advance CBGS? The majority of the respondents viewed using the existing village health team and local leadership structures as key to the successful institutionalization of CBGS; leveraging community education and sensitization using radio, television, and engaging health workers, family relatives, and neighbors. Health outreach activities were mentioned as one of the avenues that could be leveraged to provide CBGS.ConclusionProvider notions pointed to CBGS as a viable model for instituting geriatric care in Uganda’s public primary healthcare system. However, this requires policymakers to leverage existing village health team and local governance structures, conduct community education and sensitization about CBGS, and bring onboard health workers, family relatives, and neighbors.

Comparing quantitative and qualitative verbal and social autopsy tools for under-5 deaths in Uganda: a cross-sectional study

BackgroundUnderstanding biological causes of death and sociocultural factors that influence survival outcomes is crucial to reducing mortality in low-resource settings. Verbal and Social Autopsy instruments (VASAs) query family members about events leading up to an individual's death, resulting in quantitative, categorical data. We aimed to determine the value of a supplemental in-depth interview (known as VASA-QUAL) that generated detailed qualitative data in understanding childhood deaths. MethodsThis cross-sectional study was conducted in Kawaala and Nakulabye in Kampala, Uganda between Feb 6 and March 7, 2020, using 20 village health team members to assist in the identification and recruitment of families within which a children younger than 5 years had died within the preceding 6 months. Family members were interviewed by a trained, local researcher who conducted the quantitative VASA and the VASA-QUAL in-depth interview. Quantitative data were analysed using Stata (v16.0), and qualitative data were transcribed into English and analysed using NVivo (v12.0). Three coders compared quantitative variables from the VASA with qualitative variables from the VASA-QUAL using a rubric of eight key indicators related to symptom recognition, decision making, care seeking, and treatments given, derived from the Pathways to Survival framework. Agreement across sources and new insights from qualitative data were recorded. Findings48 VASAs were conducted, reflecting 48 deaths of children between the ages of 1 month and 3 days to 52 months. Agreement on key indicators ranged from 77% (for illness recognition) to 100% (for following provider referral recommendations). The qualitative component added or clarified information about pediatric illness and care-seeking across all indicators, including information about recognition of illness (96% of cases), care-seeking decisions (81%), whether home care was provided (75%), and choice of outside care (92%). The qualitative interviews frequently included symptoms that were missing or denied in the quantitative VASA, and they often clarified the chronological order of symptoms identified via VASA. Many qualitative interviews described complicated mechanisms of decision making, involving multiple key players, which were not adequately captured in the quantitative survey. InterpretationSupplementing quantitative VASA tools with an in-depth VASA-QUAL interview provided important additional information. Supplemental qualitative interviews are an important tool for understanding the complexity of events leading up to childhood deaths. FundingThe Northern Pacific Global Health Research Training Consortium, Fogarty International Center at the National Institutes of Health.

Treatment-seeking and uptake of malaria prevention strategies among pregnant women and caregivers of children under-five years during COVID-19 pandemic in rural communities in South West Uganda: a qualitative study

BackgroundDespite efforts to avert the negative effects of malaria, there remain barriers to the uptake of prevention measures, and these have hindered its eradication. This study explored the factors that influence uptake of malaria prevention strategies among pregnant women and children under-five years and the impact of COVID-19 in a malaria endemic rural district in Uganda.MethodsThis was a qualitative case study that used focus group discussions, in-depth interviews, and key informant interviews involving pregnant women, caregivers of children under-five years, traditional birth attendants, village health teams, local leaders, and healthcare providers to explore malaria prevention uptake among pregnant women and children under-five years. The interviews were audio-recorded, transcribed and data were analyzed using thematic content approach.ResultsSeventy-two participants were enrolled in the Focus Group Discussions, 12 in the in-depth interviews, and 2 as key informants. Pregnant women and caregivers of children under-five years were able to recognize causes of malaria, transmission, and symptoms. All participants viewed malaria prevention as a high priority, and the use of insecticide-treated mosquito bed nets (ITNs) was upheld. Participants' own experiences indicated adverse effects of malaria to both pregnant women and children under-five. Home medication and the use of local herbs were a common practice. Some participants didn’t use any of the malaria prevention methods due to deliberate refusal, perceived negative effects of the ITNs, and family disparity. The Corona Virus Disease-2019 (COVID-19) control measures did not abate the risk of malaria infection but these were deleterious to healthcare access and the focus of malaria prevention.ConclusionsAlthough pregnant women and caregivers of children under-five years recognized symptoms of malaria infection, healthcare-seeking was not apt as some respondents used alternative approaches and delayed seeking formal healthcare. It is imperative to focus on the promotion of malaria prevention strategies and address drawbacks associated with misconceptions about these interventions, and promotion of health-seeking behaviors. As COVID-19 exacerbated the effect of malaria prevention uptake and healthcare seeking, it’s critical to recommit and integrate COVID-19 prevention measures in normative living and restrict future barriers to healthcare access.

Perceptions of long-term impact and change following a midwife-led biomass smoke education program for mothers in rural Uganda: a qualitative study.

Women and children in Uganda and other low- and middle-income countries are exposed to disproportionately high levels of household air pollution from biomass smoke generated by smoke-producing cookstoves, especially in rural areas. This population is therefore particularly vulnerable to the negative health effects caused by household air pollution, including negative pregnancy outcomes and other health issues throughout life. The Midwife Project, a collaboration between research and health teams in the UK and Uganda, began in 2016 to implement an education program on lung health for mothers in Uganda, to reduce the health risks to women and children. Education materials were produced to guide midwives in the delivery of health messages across four rural health centres, and mixed-methods results of knowledge questionnaires and interviews demonstrated knowledge acquisition, acceptability and feasibility. This qualitative follow-up study aimed to improve understanding of the longer term impact of this education program from the perspective of midwives, village health team members and mothers, in consideration of rolling the program out more widely in rural Uganda. Purposive sampling was carried out to recruit consenting antenatal or postnatal women, midwives and village health team members who had been involved in an education session. Individual interviews were conducted with 12 mothers and four village health team members, and four focus groups were conducted with 10 midwives in total. Interviews and focus groups were conducted across all four health centres by two researchers and six translators as appropriate depending on language spoken (English or Lusoga). These were semi-structured and directed by topic guides. Reflective and observational notes were also made. A thematic analysis was carried out by two researchers, along with production of a narrative for each mother, to enrich understanding of each individual story. Midwives and village health teams had continued with the program well past the project end date and all mothers expressed making, or intending to make, changes, suggesting long-term feasibility and acceptability. Main themes generated were ability to change and changes made, ability to change dictated by money, importance of practical education, perceived health improvements, and passing on knowledge. Additional findings were that some education topics seemed to be overlooked, and there was a lack of clarity about the village health team role for the purposes of this program. Some mothers had been motivated to overcome financial barriers, for example by reconstructing cooking areas cheaply themselves. However, information given in the program about building advice and potential financial gains was inconsistent. Recommendations for future biomass smoke education should include explicit building advice, emphasis on financial gains, encouragement to share the knowledge acquired and clarification of the village health team role. These program changes will improve focus and relevancy, optimise impact and, with behaviour change and implementation strategy in mind, could be used for widespread rollout in rural Uganda. Future research should include quantitative data collection to objectively examine surprising perceived health benefits, including reduction in malaria and burns, and further qualitative work on why some education content appears neglected.

Access to HIV/AIDS or TB care among refugees in Kampala, Uganda: exploring the enablers and barriers during the COVID-19 pandemic

The rapid spread of COVID-19 has overwhelmed the existing health care systems, finding it challenging to provide essential health services besides the COVID-19 response interventions. Refugees are disproportionately affected by the COVID-19 pandemic because of the barriers they face to access health care. However, there is limited research that investigates how access to HIV/AIDS or TB care services by urban refugees is affected during pandemics such as the COVID-19. This study adopted a cross-sectional survey utilizing quantitative (N=229) and qualitative data (26 in-depth interviews and 8 key informant interviews) held among urban refugees living in Kampala, Uganda. Results revealed that more females (75%) than males (25%) were able to access TB or HIV/AIDS services during COVID-19 related lockdowns. A decrease in queues, delivery of drugs through Village Health Teams (VHTs), proximity to health facilities, supply of necessities like food and the reception at the health facilities facilitated access to TB or HIV/AIDS services. On the other hand, restrictions on public transport, high transport costs, unemployment and subsequent poverty were barriers to access to TB or HIV/AIDS services. Results offer major insights into the effect of COVID-19 control measures on disruption of access to services particularly in relation to being able to access service points. The findings suggest that recognizing structural barriers to uninterrupted or continued access to HIV/AIDS or TB services during pandemics such as COVID-19 can go a long way in helping stakeholders to design measures that make it possible for more urban refugees to access HIV/AIDS or TB services.

"We shall have gone to a higher standard": Training village heath teams (VHTs) to use a smartphone-guided intervention to link older Ugandans with hypertension and diabetes to care.

Background: It is not clear whether village health teams (VHTs) can be empowered to participate in interventions to prevent and control hypertension and diabetes in older adults in Uganda. We conducted this study in rural Uganda to establish if VHTs could be effectively trained to use a smart phone guided intervention to link older people with hypertension and diabetes to care. We also explored the experiences of VHTs in managing older adults with health problems, their knowledge of hypertension and diabetes and their understanding of referral systems. We also explored their experiences with smartphones. Methods: We conducted in-depth interviews (IDIs) with and trained 20 VHTs randomly selected from Bukulula sub-county in Kalungu district from October 2017-December 2018. We used interview guides to explore topics relevant to our study objectives. VHTs were trained to measure blood sugar and blood pressure using digital machines. VHTs were trained on identifying symptoms of diabetes mellitus. Data from IDIs were analysed using thematic content analysis. Competence tests were used to evaluate the training. Results: Most of the VHTs were female (75%). All VHTs had some knowledge on hypertension and diabetes and other chronic diseases. They did not have any experience in treating older adults since they had been trained to deal mainly with children. Half of the VHTs owned smartphones. All were willing to participate in an intervention using a smartphone to link older adults with hypertension and diabetes mellitus to care. By the end of the training, all but three participants could comprehend the symptoms of diabetes and measure blood sugar and blood pressure. Conclusion: Village health teams in the study setting need training in managing the health needs of older adults before engaging with an intervention using smartphones to link older adults with diabetes mellitus and hypertension to care.

Using Population-Based Structures to Actively Monitor AEFIs during a Mass Immunization Campaign—A Case of Measles–Rubella and Polio Vaccines

Active vaccine pharmacovigilance complements the standard passive or spontaneous surveillance system, which suffers from low reporting rates. This study aimed at utilizing population-based structures to report and profile adverse events following immunization (AEFI) with the measles and rubella vaccine (MR), or MR in combination with the bivalent oral polio vaccine (bOPV 1&3) (MR & bOPV), during mass vaccination in Uganda. Caretakers of children at home (less than 5 years) and schoolgoing children were followed up on and encouraged to report any AEFIs on day one, 2–3 days, 10 days, and 14 days after vaccination at school by their teachers and at-home, community-based village health teams. Out of 9798 children followed up on, 382 (3.9%) reported at least one AEFI, and in total, 517 AEFIs were reported. For MR, high temperature (21%), general feeling of weakness (19.3%), and headache (13%) were the most reported AEFIs, though there were variations on the days when they were reported. For the combination dose of MR & bOPV, high temperature (44%), rash (17%), general feeling of weakness (13%), and diarrhoea (8%) were the most common adverse events following immunization reported by caretakers. All 382 children cleared the AEFIs within 2 days, with 343 (90%) children reporting mild or moderate AEFIs and only 39 (10%) reporting severe AEFIs. The reported AEFIs are known and are mentioned in the vaccine leaflets with similar severity classification. Rates of AEFIs differed with the number of days after receiving the immunization. Conclusion: Active surveillance for AEFIs provides additional important information to national vaccine regulatory bodies. It reassures the public that vaccines are safe and that their safety is being taken seriously in Uganda, which would improve vaccine acceptability and confidence in the health system. Piggybacking on existing structures such as village health team members (for children at home) and teachers (for schoolgoing children) facilitates reaching vaccine recipients and increases reporting rates. Therefore, studies using active reporting of AEFIs should be conducted at regular intervals to report the overall incidence of AEs and to monitor trends and changes.

Schistosomiasis messaging in endemic communities: Lessons and implications for interventions from rural Uganda, a rapid ethnographic assessment study.

Over 240 million people are infected with schistosomiasis, the majority in sub-Saharan Africa. In Uganda, high infection rates exist in communities on the shores of Lake Victoria. Praziquantel mass drug administration (MDA) delivered by village health teams is the mainstay of schistosomiasis control. However, treatment uptake remains suboptimal, with many people unaware of treatment or thinking it is only for children. Furthermore, people are often rapidly reinfected post-treatment due to continued exposure. In three Schistosoma mansoni high endemicity lake-shore communities in Mayuge district, Eastern Uganda, we investigated the sources of schistosomiasis information, remembered content of information, and the perception of information and related practices towards the control of schistosomiasis. Data were collected from September 2017 to March 2018 using a rapid ethnographic assessment that included transect walks, observations, individual in-depth interviews and focus group discussions. Data were analysed thematically using iterative categorisation. We found that the main sources of schistosomiasis information included health workers at government facilities, village health teams, teachers, and radio programmes produced by the Ministry of Health. These messages described the symptoms of schistosomiasis, but did not mention the side effects of praziquantel treatment. Despite this messaging, the main cause of the disease and transmission was unclear to most participants. The translation of schistosomiasis on the radio into the local language 'ekidada'-meaning swollen stomach-increased, rather than reduced, confusion about the cause(s) of schistosomiasis, due to believed links between ekidada and witchcraft, and prompted a reluctance to engage with treatment or preventative efforts. This study highlights gaps in schistosomiasis messaging. We recommend MDA is complemented by effective, evidence-based messaging on schistosomiasis transmission, prevention, and treatment, that is sensitive to local language and context issues, resulting in clear, concise, and consistent messages, to increase effectiveness.

Influence of Information Sharing on Availability of Contraceptives: A Case of Uganda’s Public Health Sector

There is shortage of literature that links information sharing and availability of contraceptives and specifically focusing on the public health sector. This paper examines the influence of information sharing on the availability of contraceptives in Uganda’s public health sector. Drawing from the resource dependence theory (RDT), this study adopts a deductive approach to address the issue at hand. Using stratified sampling, quantitative data was collected from 165 self – administered questionnaires from public health facilities in South Western Uganda. PLS-SEM approach was used for data analysis. The findings of the study reveal a positive and significant influence between logistics management information systems (LMIS) and training on the availability of contraceptives in the public health sector. At the same time, the findings also reveal a positive but non-significant influence between sensitization and availability of contraceptives. The government is advised to increase resources to implement more logistics management information systems (LMIS) in public health facilities, improve on capacity building more especially with village health teams (VHTs) and implementing adolescent clinics.

Prevalence and socio-economic factors affecting the use of traditional medicine among adults of Katikekile Subcounty, Moroto District, Uganda.

In Uganda generally and in rural areas in particular, use of traditional medicine is a common practice, yet there remains lack of evidence on the overall utilization of traditional medicine and there are many aspects that remain unclear. To determine the use of traditional medicine and factors associated with this among the adults of Katikekile Subcounty in Moroto district. A descriptive cross-sectional study using quantitative and qualitative methods. Interviews among 323 respondents, and focus group discussions were carried out among village traditional birth attendants, village health team members, and traditional health providers. Use of traditional medicine among the adults of Katikekile Subcounty was 68%. Usage was more prevalent among older people, and the majority of the adults used traditional medicine often as their first line-treatment for any illness. Herbs used for traditional medicines are usually locally available and free-of-charge. Long distance to health-facility based health care services, and medical fees contributed to the use of traditional medicine. Use of traditional medicine among adults of Katikekile Subcounty in Moroto in the Karamoja region in Uganda was high, and majority of the adults often used traditional medicine as first line-treatment. Both socioeconomic and health sector factors were associated with use of traditional medicine.

“We shall have gone to a higher standard”: Training village heath teams (VHTs) to use a smartphone-guided intervention to link older Ugandans with hypertension and diabetes to care

Background: It is not clear whether village health teams (VHTs) can be empowered to participate in interventions to prevent and control hypertension and diabetes in older adults in Uganda. We conducted this study in rural Uganda to establish if VHTs could be effectively trained to use a smart phone guided intervention to link older people with hypertension and diabetes to care. We also explored the experiences of VHTs in managing older adults with health problems, their knowledge of hypertension and diabetes and their understanding of referral systems. We also explored their experiences with smartphones. Methods: We conducted in-depth interviews (IDIs) with and trained 20 VHTs randomly selected from Bukulula sub-county in Kalungu district from October 2017-December 2018. We used interview guides to explore topics relevant to our study objectives. VHTs were trained to measure blood sugar and blood pressure using digital machines. VHTs were trained on identifying symptoms of diabetes mellitus. Data from IDIs were analysed using thematic content analysis. Competence tests were used to evaluate the training. Results: Most of the VHTs were female (75%). All VHTs had some knowledge on hypertension and diabetes and other chronic diseases. They did not have any experience in treating older adults since they had been trained to deal mainly with children. Half of the VHTs owned smartphones. All were willing to participate in an intervention using a smartphone to link older adults with hypertension and diabetes mellitus to care. By the end of the training, all but three participants could comprehend the symptoms of diabetes and measure blood sugar and blood pressure. Conclusion: Village health teams in the study setting need training in managing the health needs of older adults before engaging with an intervention using smartphones to link older adults with diabetes mellitus and hypertension to care.

Uganda Mountain Community Health System-Perspectives and Capacities towards Emerging Infectious Disease Surveillance.

In mountain communities like Sebei, Uganda, which are highly vulnerable to emerging and re-emerging infectious diseases, community-based surveillance plays an important role in the monitoring of public health hazards. In this survey, we explored capacities of village health teams (VHTs) in Sebei communities of Mount Elgon in undertaking surveillance tasks for emerging and re-emerging infectious diseases in the context of a changing climate. We used participatory epidemiology techniques to elucidate VHTs’ perceptions on climate change and public health and assessed their capacities to conduct surveillance for emerging and re-emerging infectious diseases. Overall, VHTs perceived climate change to be occurring with wider impacts on public health. However, they had inadequate capacities in collecting surveillance data. The VHTs lacked transport to navigate through their communities and had insufficient capacities in using mobile phones for sending alerts. They did not engage in reporting other hazards related to the environment, wildlife, and domestic livestock that would accelerate infectious disease outbreaks. Records were not maintained for disease surveillance activities and the abilities of VHTs to analyze data were also limited. However, VHTs had access to platforms that could enable them to disseminate public health information. The VHTs thus need to be retooled to conduct their work effectively and efficiently through equipping them with adequate logistics and knowledge on collecting, storing, analyzing, and relaying data, which will improve infectious disease response and mitigation efforts.

Mitigating Impacts of the COVID-19 Pandemic on Gorilla Conservation: Lessons From Bwindi Impenetrable Forest, Uganda.

The COVID-19 pandemic, affecting all countries, with millions of cases and deaths, and economic disruptions due to lockdowns, also threatens the health and conservation of endangered mountain gorillas. For example, increased poaching due to absence of tourism income, led to the killing on 1st June 2020 of a gorilla by a hungry community member hunting duiker and bush pigs. Conservation Through Public Health (CTPH), a grassroots NGO and non-profit founded in 2003 promotes biodiversity conservation by enabling people to co-exist with wildlife through integrated programs that improve animal health, community health, and livelihoods in and around Africa's protected areas and wildlife rich habitats. Through these programs, we have helped to mitigate these impacts. CTPH worked with Uganda Wildlife Authority and other NGOs to improve great ape viewing guidelines and prevent transmission of COVID-19 between people and gorillas. Park staff, Gorilla Guardians herding gorillas from community land to the park and Village Health and Conservation Teams were trained to put on protective face masks, enforce hand hygiene and a 10-meter great ape viewing distance. To reduce the communities' need to poach, CTPH found a UK-based distributor, for its Gorilla Conservation Coffee social enterprise enabling coffee farmers to earn revenue in the absence of tourism and provided fast growing seedlings to reduce hunger in vulnerable community members. Lessons learned show the need to support non-tourism dependent community livelihoods, and more responsible tourism to the great apes, which CTPH is advocating to governments, donors and tour companies through an Africa CSO Biodiversity Alliance policy brief.