Geographic location of health facility and immunization program performance in Hoima district, western Uganda: a health facility level assessment

Abstract Background Globally, immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda. Methods We conducted a cross sectional study using a mixed methods approach. The main study unit was a health center and we also interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p < 0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations. Conclusions Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

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Geographic location of health facility and immunization program performance in Hoima district, western Uganda: A health facility level assessment

10.21203/rs.3.rs-25102/v2 ◽

2020 ◽

Author(s):

Nicholas Magambo Kwikiriza ◽

Francis Bajunirwe ◽

Fred Bagenda

Keyword(s):

Health Facility ◽

Urban Areas ◽

Health Workers ◽

Geographic Location ◽

Health Facilities ◽

Urban Setting ◽

World Health ◽

Program Performance ◽

Immunization Program ◽

Western Uganda

Abstract Background: Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of health facility may influence performance of their immunization programs. Therefore, the purpose of this study was to examine whether geographical location of health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.Methods: We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results: We collected data at 49 health facilities. Most of the health units (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations.Conclusions: Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

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Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a Health Facility level assessment

10.21203/rs.3.rs-25102/v4 ◽

2020 ◽

Author(s):

Nicholas Magambo Kwikiriza ◽

Francis Bajunirwe ◽

Fred Bagenda

Keyword(s):

Health Facility ◽

Urban Areas ◽

Health Workers ◽

Geographic Location ◽

Health Facilities ◽

Urban Setting ◽

World Health ◽

Program Performance ◽

Immunization Program ◽

Western Uganda

Abstract Background: Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.Methods: We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results: We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations.Conclusions: Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

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Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a facility level assessment

10.21203/rs.3.rs-25102/v3 ◽

2020 ◽

Author(s):

Nicholas Magambo Kwikiriza ◽

Francis Bajunirwe ◽

Fred Bagenda

Keyword(s):

Health Facility ◽

Urban Areas ◽

Health Workers ◽

Geographic Location ◽

Health Facilities ◽

Urban Setting ◽

World Health ◽

Program Performance ◽

Immunization Program ◽

Western Uganda

Abstract Background Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of health facility may influence performance of their immunization programs. Therefore, the purpose of this study was to examine whether geographical location of health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda. Methods We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results We collected data at 49 health facilities. Most of the health units (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations. Conclusions Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

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Geographic location of health facility and immunization program performance in Hoima district, western Uganda: A health facility level assessment

10.21203/rs.3.rs-25102/v5 ◽

2020 ◽

Author(s):

Nicholas Magambo Kwikiriza ◽

Francis Bajunirwe ◽

Fred Bagenda

Keyword(s):

Health Facility ◽

Urban Areas ◽

Health Workers ◽

Geographic Location ◽

Health Facilities ◽

Urban Setting ◽

World Health ◽

Program Performance ◽

Immunization Program ◽

Western Uganda

Abstract Background: Globally, immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.Methods: We conducted a cross sectional study using a mixed methods approach. The main study unit was a health center and we also interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results: We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations.Conclusions: Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

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Geographic location of health facility and immunization program performance in Hoima district, western Ugandan

10.21203/rs.3.rs-25102/v1 ◽

2020 ◽

Author(s):

Nicholas Magambo Kwikiriza ◽

Francis Bajunirwe ◽

Fred Bagenda

Keyword(s):

Health Facility ◽

Urban Areas ◽

Health Workers ◽

Geographic Location ◽

Health Facilities ◽

Urban Setting ◽

World Health ◽

Health Management Information System ◽

Program Performance ◽

Immunization Program

Abstract Background Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of health facility may influence performance of their immunization programs. Therefore, the purpose of this study was to examine whether geographical location of health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.Methods We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test.Results We collected data at 49 health facilities. Most of the health units (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p < 0.05). Inadequate commitment and competing interests of health workers in the more urban areas were suggested as possible explanations.Conclusions Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

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Factors Influencing Choice of Delivery Place among Mothers in Rukungiri and Kanungu Districts, South Western Uganda: A Cross Sectional Study

10.21203/rs.3.rs-128061/v1 ◽

2020 ◽

Author(s):

Richard Mugambe ◽

Habib Yakubu ◽

Solomon Wafula ◽

Tonny Ssekamatte ◽

Simon Kasasa ◽

...

Keyword(s):

Health Facility ◽

Rural Areas ◽

Health Workers ◽

Public Health Facility ◽

Facility Delivery ◽

Health Facilities ◽

Public Facility ◽

Cross Sectional ◽

Western Uganda ◽

Delivery Place

Abstract Background: Child birth in health facilities is generally associated with lower risk of maternal and neonatal mortality. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we examined the determinants of mothers’ decision of the choice of child delivery place in Western Uganda.Methods: Cross-sectional data was collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data was collected on the place of delivery for the most recent child, mothers’ sociodemographic characteristics, health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of mothers’ choice of delivery place as well as determinants for the choice of private versus public facility for delivery at 95% confidence intervals. Results: Majority of mothers (90.2%) delivered in health facilities. Non-facility deliveries were attributed to fast progression of labour (77.3%), lack of transport (31.8%) and high cost of hospital delivery (12.5%). Being engaged in business as an occupation [APR = 1.06, 95% CI (1.01 – 1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02 – 1.17)] favoured facility delivery while higher parity of 3 – 4 [APR = 0.93, 95% CI (0.88 – 0.99)] was inversely associated with facility delivery as compared to parity of 1-2. Choice of private facility over public facility was influenced by how mothers valued factors such as high skilled health workers [APR = 1.15, 95% CI (1.05 – 1.26)], higher quality of WASH services [APR = 1.11, 95% CI (1.04 – 1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78 – 0.92)] and availability of caesarean services [APR = 1.13, 95% CI (1.08 – 1.19)].Conclusion: Utilization of health facility child delivery services was high. Health facility delivery service utilization was influenced by engaging in business, belonging to wealthiest quintile and being multiparous. Choice of private versus public health facility for child delivery was influenced by health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

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Reducing missed opportunities for vaccination in selected provinces of Mozambique: A study protocol

Gates Open Research ◽

10.12688/gatesopenres.12761.1 ◽

2017 ◽

Vol 1 ◽

pp. 5 ◽

Cited By ~ 5

Author(s):

Bvudzai Priscilla Magadzire ◽

Gabriel Joao ◽

Stephanie Shendale ◽

Ikechukwu Udo Ogbuanu

Keyword(s):

Health Workers ◽

Vaccine Coverage ◽

Health Facilities ◽

World Health ◽

Group Discussions ◽

Immunization Program ◽

Missed Opportunities ◽

Target Sample Size ◽

Health Organization ◽

Missed Opportunity

Background: A missed opportunity for vaccination (MOV) refers to any contact with health services by an individual who is eligible for vaccination, which does not result in the person receiving the vaccine doses for which he or she is eligible. A consortium of partners, including VillageReach, the Ministry of Health in Mozambique and the World Health Organization, will implement a strategy to reduce MOV in Mozambique. The strategy involves demonstrating the magnitude of missed opportunities and their causes, and exploring tailored health system interventions to reduce them, with the aim of increasing vaccination coverage and timeliness of vaccinations. Methods: A mixed-methods approach will incorporate both quantitative and qualitative tools. The assessment will target caregivers of children between the ages of 0–23 months who attend a health facility in the selected districts on the day of the assessment. Caregivers who are at least 18 years old will be eligible for inclusion. Another component of the assessment will target all health workers in the selected health facilities on the day of the assessment. A sample of 30 health facilities in different regions of the country will be assessed, with a target sample size of 600 caregiver exit interviews, 300 health worker interviews and focus group discussions with both caregivers and health workers. Data collection will commence late 2017, and the data will be electronically captured, managed and analyzed. Thematic analysis of data from the qualitative aspects of the assessment will be conducted, presenting the scope of interviews, representative verbatim quotes and key conclusions. Conclusions: A concerted effort to reduce or eliminate MOV could increase vaccine coverage by up to 30% and may contribute to wider improvements in efficiencies of service delivery beyond the immunization program. In addition, the findings could contribute to a better understanding of MOV in similar settings.

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Determinants of malaria testing at health facilities: the case of Uganda

Malaria Journal ◽

10.1186/s12936-021-03992-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Ruth N. Kigozi ◽

JohnBaptist Bwanika ◽

Emily Goodwin ◽

Peter Thomas ◽

Patrick Bukoma ◽

...

Keyword(s):

Health Facility ◽

Health Workers ◽

Clinical Symptoms ◽

Malaria Diagnosis ◽

Health Facilities ◽

Sub Saharan Africa ◽

World Health ◽

Supportive Supervision ◽

Care Providers ◽

Cross Sectional Survey

Abstract Background The World Health Organization (WHO) recommends prompt malaria diagnosis with either microscopy or malaria rapid diagnostic tests (RDTs) and treatment with an effective anti-malarial, as key interventions to control malaria. However, in sub-Saharan Africa, malaria diagnosis is still often influenced by clinical symptoms, with patients and care providers often interpreting all fevers as malaria. The Ministry of Health in Uganda defines suspected malaria cases as those with a fever. A target of conducting testing for at least 75% of those suspected to have malaria was established by the National Malaria Reduction Strategic Plan 2014–2020. Methods This study investigated factors that affect malaria testing at health facilities in Uganda using data collected in March/April 2017 in a cross-sectional survey of health facilities from the 52 districts that are supported by the US President’s Malaria Initiative (PMI). The study assessed health facility capacity to provide quality malaria care and treatment. Data were collected from all 1085 public and private health facilities in the 52 districts. Factors assessed included supportive supervision, availability of malaria management guidelines, laboratory infrastructure, and training health workers in the use of malaria rapid diagnostic test (RDT). Survey data were matched with routinely collected health facility malaria data obtained from the district health information system Version-2 (DHIS2). Associations between testing at least 75% of suspect malaria cases with several factors were examined using multivariate logistic regression. Results Key malaria commodities were widely available; 92% and 85% of the health facilities reported availability of RDTs and artemether–lumefantrine, respectively. Overall, 933 (86%) of the facilities tested over 75% of patients suspected to have malaria. Predictors of meeting the testing target were: supervision in the last 6 months (OR: 1.72, 95% CI 1.04–2.85) and a health facility having at least one health worker trained in the use of RDTs (OR: 1.62, 95% CI 1.04–2.55). Conclusion The study findings underscore the need for malaria control programmes to provide regular supportive supervision to health facilities and train health workers in the use of RDTs.

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A health worker knowledge, attitudes and practices survey of SARS-CoV-2 infection prevention and control in South Africa

BMC Infectious Diseases ◽

10.1186/s12879-021-05812-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Saiendhra Vasudevan Moodley ◽

Muzimkhulu Zungu ◽

Molebogeng Malotle ◽

Kuku Voyi ◽

Nico Claassen ◽

...

Keyword(s):

South Africa ◽

Health Worker ◽

Prevention And Control ◽

Infection Prevention ◽

Health Workers ◽

Health Facilities ◽

World Health ◽

Infection Prevention And Control ◽

Successful Implementation ◽

And Control

Abstract Background Health workers are crucial to the successful implementation of infection prevention and control strategies to limit the transmission of SARS-CoV-2 at healthcare facilities. The aim of our study was to determine SARS-CoV-2 infection prevention and control knowledge and attitudes of frontline health workers in four provinces of South Africa as well as explore some elements of health worker and health facility infection prevention and control practices. Methods A cross-sectional study design was utilised. The study population comprised both clinical and non-clinical staff working in casualty departments, outpatient departments, and entrance points of health facilities. A structured self-administered questionnaire was developed using the World Health Organization guidance as the basis for the knowledge questions. COVID-19 protocols were observed during data collection. Results A total of 286 health workers from 47 health facilities at different levels of care participated in the survey. The mean score on the 10 knowledge items was 6.3 (SD = 1.6). Approximately two-thirds of participants (67.4%) answered six or more questions correctly while less than a quarter of all participants (24.1%) managed to score eight or more. A knowledge score of 8 or more was significantly associated with occupational category (being either a medical doctor or nurse), age (< 40 years) and level of hospital (tertiary level). Only half of participants (50.7%) felt adequately prepared to deal with patients with COVD-19 at the time of the survey. The health workers displaying attitudes that would put themselves or others at risk were in the minority. Only 55.6% of participants had received infection prevention and control training. Some participants indicated they did not have access to medical masks (11.8%) and gloves (9.9%) in their departments. Conclusions The attitudes of participants reflected a willingness to engage in appropriate SARS-CoV-2 infection prevention and control practices as well as a commitment to be involved in COVID-19 patient care. Ensuring adequate infection prevention and control training for all staff and universal access to appropriate PPE were identified as key areas that needed to be addressed. Interim and final reports which identified key shortcomings that needed to be addressed were provided to the relevant provincial departments of health.

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Evaluation of Infection, Prevention and Control Program in Goromonzi District, Zimbabwe, 2018: A process outcome evaluation

10.21203/rs.2.18251/v1 ◽

2019 ◽

Author(s):

Govha Emmanuel ◽

Zizhou Simukai Tirivanhu ◽

Shambira Gerald ◽

Gombe Tafara Notion ◽

Tsitsi Juru ◽

...

Keyword(s):

Health Facility ◽

Prevention And Control ◽

Infection Prevention ◽

Health Workers ◽

Outcome Evaluation ◽

Hazard Identification ◽

Health Facilities ◽

Infection Prevention And Control ◽

Hiv Test ◽

And Control

Abstract Background A healthcare-associated infection (HAI) is defined as an infection originating in the environment of a health facility that was not present or incubating at the time of patient admission. HAIs can be prevented through infection, prevention and control (IPC) measures. No hazard identification and risk assessment IPC rounds and monthly meetings were conducted in Goromonzi district since 1st of January to 30th of June 2018. No trainings nor orientation for the new employees was conducted. We therefore evaluated Goromonzi District IPC program. Methods A process-outcome evaluation using the logic model was conducted in Goromonzi district’s 15 health facilities. Checklists, interviewer administered questionnaires and key informant guides were used to collect data on availability of inputs, knowledge of health workers, processes performed, outputs and outcomes achieved. Data were entered into Epi Info 7TM, which was used to generate frequencies and proportions. Qualitative data from checklists and key informants interviews was sorted manually into themes and analysed. Results All 15 health facilities had adequate stocks of HIV test kits and PEP kits. Adequate bins and detergents were found in only 3/15 (20%) of health facilities. All facilities failed to hold a single IPC meeting and none had specific budget for IPC in 2018. No IPC mentorship activities were carried out in the district. Only 7/13 (54%) health workers who had needle pricks received PEP with 2/7 (29%) of them finishing the course. No health facility had a functional HAI surveillance system. The overall knowledge rating was fair. Conclusion The IPC program inputs in Goromonzi district were inadequate hence its failure to achieve the intended outputs and outcomes. Inadequate knowledge, unavailability of health worker training plans, specific budgets and absence of IPC committees reflected non prioritisation of the program.

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