Correction: Caring for children with neurodevelopmental disability: Experiences from caretakers and health workers in rural eastern Uganda

Abstract Background Neurodevelopmental disability (NDD) is increasingly acknowledged as one of the important causes of disease burden in low income countries. None the less, there is a dearth of data on the burden of NDD and its determinants in these settings. We aimed to establish the prevalence and factors associated with NDD among infants in Eastern Uganda. Methods We assessed 487 infants aged 9–12 months within Iganga-Mayuge Health Demographic Surveillance Site in Eastern Uganda using the Malawi Developmental Assessment Tool. The tool has four domains: gross motor, fine motor, language and social domains. An infant failed a domain if she/he failed more than two parameters of the expected at his/her age. We interviewed mothers on factors that could influence the infants’ neurodevelopmental outcomes. Data were analysed using STATA version 14. We used odds ratios and 95% confidence intervals to assess statistical significance of associations. Results Of the 487 infants, 62(12.7%) had an NDD in at least one of the domains. The most affected was social behaviour where 52(10.7%) infants had an NDD. Severe impairment was seen among 9(1.8%) infants with NDD in either three or four domains. Factors associated with NDD at multivariate logistic regression included: parity of more than three children (aOR = 1.8, 95% CI: 1.02–3.18); failure to cry at birth (aOR = 3.6, 95% CI: 1.46–9.17) and post-neonatal complications (aOR = 4.15, 95% CI: 1.22–14.10). Low birth weight, immediate and exclusive breast feeding were not significantly associated with NDD. Conclusion We found a high NDD burden among infants particularly in the social behaviour domain. To optimise the socio-neural development of infants, programs are needed to educate and work with families on how to engage and stimulate infants. Existing immunisation clinics and community health worker strategies provide an excellent opportunity for stemming this burden.

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Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study

Obstetrics and Gynecology International ◽

10.1155/2020/5036260 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Isaac Waniala ◽

Sandra Nakiseka ◽

Winnie Nambi ◽

Isaac Naminya ◽

Margret Osuban Ajeni ◽

...

Keyword(s):

Caesarean Section ◽

Qualitative Data ◽

Health Workers ◽

Maternal Mortality Ratio ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Male Involvement ◽

Community Perceptions ◽

Caesarean Section Delivery ◽

Eastern Uganda

Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. Results. Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion. Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5–15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.

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Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0250421 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250421

Author(s):

Francis Xavier Kasujja ◽

Fred Nuwaha ◽

Meena Daivadanam ◽

Juliet Kiguli ◽

Samuel Etajak ◽

...

Keyword(s):

Health Workers ◽

District Hospital ◽

Diagnostic Delay ◽

Cultural Influences ◽

Traditional Healers ◽

Diagnostic Process ◽

Urban District ◽

Diabetes Clinic ◽

Interview Guide ◽

Eastern Uganda

Background Type 2 diabetes is rapidly becoming a significant challenge in Uganda and other low and middle-income countries. A large proportion of the population remains undiagnosed. To understand diagnostic delay, we explored the diagnostic pathways for diabetes among patients receiving care at a semi-urban district hospital in eastern Uganda. Methods Eligible participants were patients aged 35–70 years receiving care at the diabetes clinic of Iganga district hospital between April and May 2019 and their healthcare providers. Patients were interviewed using an interview guide to collect information on patients’ symptoms and their diagnostic experience. A separate interview guide was used to understand the organisation of the diabetes services and the diabetes diagnostic process at the hospital. Using maximum variation purposive sampling, we selected 17 diabetes patients aged 35–68 years, diagnosed within the previous three years, and the three health workers managing the diabetes clinic at Iganga hospital. The data was analysed using ATLAS.ti version 8 to code, organise and track the data segments. We conducted template analysis using a priori themes derived from the intervals of Walter’s model of Pathways to Treatment to identify the factors influencing diagnostic delay. Results We identified four typologies: a short diagnostic pathway, protracted appraisal pathway, protracted appraisal and diagnostic interval pathway, and delayed treatment pathway. The pathways of patients with protracted appraisal or diagnostic intervals demonstrated strong socio-cultural influences. There was a firm reliance on traditional healers both before and after diagnosis which deferred enrolment into care. Other health system barriers implicated in delayed diagnosis included stock-out of diagnostic supplies, misdiagnosis, and missed diagnosis. Denial of diagnosis was also found to lead to delayed initiation of care. Conclusion Reducing diagnostic delay requires addressing both negative socio-cultural influences and the adoption of system-wide interventions to address barriers to timely diagnosis.

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Lack of Trust, Insufficient knowledge and Risk denial; an in-depth Understanding of Health worker Barriers to uptake of the Covid-19 vaccine at Iganga Hospital Eastern Uganda, and Mengo Hospital Kampala Uganda

10.1101/2021.10.13.21264920 ◽

2021 ◽

Author(s):

Lubega Muhamadi ◽

Namulema Edith ◽

Waako James ◽

Nazarius mbona tumwesigye ◽

Safinah Kisu Museene ◽

...

Keyword(s):

Peer Influence ◽

Health Workers ◽

Vaccine Hesitancy ◽

Specific Information ◽

Dissemination Strategy ◽

Vaccine Acceptance ◽

Levels Of Care ◽

Negative Publicity ◽

Eastern Uganda ◽

Risk Denial

Covid 19 Vaccine hesitancy among health workers remains a major hindrance to the governments vaccine roll out plan among health workers and other target populations in Uganda. We conducted 12 focus group discussions and 20 in-depth interviews with health workers (vaccinated and un vaccinated) to understand barriers to vaccine acceptance in their own perspective and context in central and eastern Uganda. Reported barriers to vaccine acceptance included: gross lack of trust, fear of side effects, risk denial and insufficient information about the vaccine amidst negative publicity about the vaccine from the internet and social media platforms. Others were health system inhibition factors and religious beliefs against the vaccine. We recommend a health work context specific information, education and dissemination strategy to create awareness, information and more knowledge about the vaccine to health workers. We also recommend a sustained government media campaign to give more information about the vaccine and also dispel the negative publicity and misinformation about the vaccine. Dialogue with health workers at all levels of care, positive peer influence, use of religious and opinion leaders as well as government ensuring accessibly to various Covid 19 vaccines and putting vaccine posts outside hospital settings to limit exposure to Covid patients could also increase uptake of the vaccine among health workers.

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Maternal and newborn health priority setting partnership in rural Uganda in association with the James Lind Alliance: a study protocol

Research Involvement and Engagement ◽

10.1186/s40900-020-00231-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

James Ditai ◽

Monicah Nakyazze ◽

Deborah Andrinar Namutebi ◽

Proscovia Auma ◽

Martin Chebet ◽

...

Keyword(s):

Health Workers ◽

Newborn Health ◽

Adverse Outcomes ◽

Maternal And Newborn Health ◽

Face To Face ◽

The Public ◽

James Lind Alliance ◽

Research Questions ◽

Eastern Uganda ◽

Maternal And Newborn

Abstract Background Maternal and newborn deaths and ill health are relatively common in low income countries, but can adequately be addressed through locally, collaboratively designed, and responsive research. This has the potential to enable the affected women, their families and health workers themselves to explore ‘why maternal and newborn adverse outcomes continue to occur. The objectives of the study include; To work with seldom heard groups of mothers, their families, and health workers to identify unanswered research questions for maternal and newborn health in villages and health facilities in rural Uganda To establish locally responsive research questions for maternal and newborn health that could be prioritised together with the public in Uganda To support the case for locally responsive research in maternal and newborn health by the ministry of health, academic researchers and funding bodies in Uganda. Methods The present study will follow the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology. The project was initiated by an academic research group and will be managed by a research team at the Sanyu Africa Research Institute on a day to day basis. A steering group with a separate lay mothers’ group and partners’ group (individuals or organisations with interest in maternal and newborn health) will be recruited. The PSP will be initiated by launch meetings, then a face-to-face initial survey for the collection of raw unanswered questions; followed by data collation. A face-to-face interim prioritisation survey will then be performed to choose questions before the three separate final prioritisation workshops. The PSP will involve many participants from an illiterate, non-internet population in rural eastern Uganda, but all with an interest in strategies to avert maternal and newborn deaths or morbidities in rural eastern Uganda. This includes local rural women, their families, health and social workers, and relevant local groups or organisations. We will generate a top 10 list of maternal and newborn health research priorities from a group with no prior experience in setting a research agenda in rural eastern Uganda. Discussion The current protocol elaborates the JLA methods for application with a new topic and in a new setting translating the JLA principles not just into the local language, but into a rural, vulnerable, illiterate, and non-internet population in Uganda. The face-to-face human interaction is powerful in eliciting what exactly matters to individuals in this particular context as opposed to online surveys. This will be the first time that mothers and lay public with current or previous experience of maternal or neonatal adverse outcomes will have the opportunity to identify and prioritise research questions that matter to them in Uganda. We will be able to compare how the public would prioritise maternal health research questions over newborn health in this setting.

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Engaging community health workers in maternal and newborn care in eastern Uganda

Global Health Action ◽

10.3402/gha.v8.23968 ◽

2015 ◽

Vol 8 (1) ◽

pp. 23968 ◽

Cited By ~ 15

Author(s):

Monica Okuga ◽

Margaret Kemigisa ◽

Sarah Namutamba ◽

Gertrude Namazzi ◽

Peter Waiswa

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Newborn Care ◽

Maternal And Newborn Care ◽

Eastern Uganda ◽

Maternal And Newborn

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Exploring knowledge and attitudes toward non-communicable diseases among Village Health Teams in Eastern Uganda: a cross-sectional mixed methods study

10.7287/peerj.preprints.3196 ◽

2017 ◽

Author(s):

Temitope Ojo ◽

Nicola Hawley ◽

Mayur Desai ◽

Ann Akiteng ◽

David Guwatudde ◽

...

Keyword(s):

Health Workers ◽

Medical Personnel ◽

Communicable Diseases ◽

Maternal Child Health ◽

Major Barrier ◽

Non Communicable Diseases ◽

Attitudes And Practices ◽

Eastern Uganda ◽

Village Health ◽

Village Health Teams

Background: Community health workers are essential personnel in resource-limited settings. In Uganda, they are organized into Village Health Teams (VHTs) and are focused on infectious diseases and maternal-child health; however, their skills could potentially be utilized in national efforts to reduce the growing burden of non-communicable diseases (NCDs). We sought to assess the knowledge of, and attitudes toward NCDs and NCD care among VHTs in Uganda as a step toward identifying their potential role in community NCD prevention and management. Methods: We administered a knowledge, attitudes and practices questionnaire to 68 VHT members from Iganga and Mayuge districts in Eastern Uganda. In addition, we conducted four focus group discussions with 33 VHT members. Discussions focused on NCD knowledge and facilitators of and barriers to incorporating NCD prevention and care into their role. A thematic qualitative analysis was conducted to identify salient themes in the data. Results: VHT members possessed some knowledge and awareness of NCDs but identified a lack of knowledge about NCDs in the communities they served. They were enthusiastic about incorporating NCD care into their role and thought that they could serve as effective conduits of knowledge about NCDs to their communities if empowered through NCD education, the availability of proper reporting and referral tools, and visible collaborations with medical personnel. The lack of financial remuneration for their role did not emerge as a major barrier to providing NCD services. Conclusions: Ugandan VHTs saw themselves as having the potential to play an important role in improving community awareness of NCDs as well as monitoring and referral of community members for NCD-related health issues. In order to accomplish this, they anticipated requiring context-specific and culturally adapted training as well as strong partnerships with facility-based medical personnel. A lack of financial incentivization was not identified to be a major a barrier to such role expansion. Developing a role for VHTs in NCD prevention and management should be a key consideration as local and national NCD initiatives are developed.

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