Health Workers’ Compliance to Implementation of Test, Treat and Track Strategy for Malaria Control in Northern Uganda

Background. Globally, 15 countries, mainly in Sub-Saharan Africa, account for 80% of malaria cases and 78% of malaria related deaths. In Uganda, malaria is endemic and the mortality and morbidity due to malaria cause significant negative impact on the economy. In Gulu district, malaria is the leading killer disease among children <5 years. In 2015, the high intensity of malaria infection in Northern Uganda revealed a possible link between malaria and rainfall. However, available information on the influence of climatic factors on malaria are scarce, conflicting, and highly contextualized and therefore one cannot reference such information to malaria control policy in Northern Uganda, thus the need for this study. Methods and Results. During the 10 year’s retrospective study period a total of 2,304,537 people suffered from malaria in Gulu district. Malaria infection was generally stable with biannual peaks during the months of June-July and September-October but showed a declining trend after introduction of indoor residual spraying. Analysis of the departure of mean monthly malaria cases from the long-term mean monthly malaria cases revealed biannual seasonal outbreaks before and during the first year of introduction of indoor residual spraying. However, there were two major malaria epidemics in 2015 following discontinuation of indoor residual spraying in the late 2014. Children <5 years of age were disproportionally affected by malaria and accounted for 47.6% of the total malaria cases. Both rainfall (P=0.04) and relative humidity (P=0.003) had significant positive correlations with malaria. Meanwhile, maximum temperature had significant negative correlation with malaria (P=0.02) but minimum temperature had no correlation with malaria (P=0.29). Conclusion. Malaria in Gulu disproportionately affects children under 5 years and shows seasonality with a generally stable trend influenced by rainfall and relative humidity. However, indoor residual spraying is a very promising method to achieve a sustained malaria control in this population.

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Are health workers reduced to being drug dispensers of antiretroviral treatment? A randomized cross-sectional assessment of the quality of health care for HIV patients in northern Uganda

Health Policy and Planning ◽

10.1093/heapol/czz074 ◽

2019 ◽

Vol 34 (8) ◽

pp. 559-565

Author(s):

Ulrike G Seeberger ◽

Joseph J Valadez

Keyword(s):

Physical Examination ◽

Health Facility ◽

Antiretroviral Treatment ◽

Treatment Guidelines ◽

Health Workers ◽

Northern Uganda ◽

High Quality ◽

Cross Sectional ◽

Sub Saharan

Abstract High quality of care (QoC) for antiretroviral treatment (ART) is essential to prevent treatment failure. Uganda, as many sub-Saharan African countries, increased access to ART by decentralizing provision to districts. However, little is known whether this rapid scale-up maintained high-quality clinical services. We assess the quality of ART in the Acholi and Lango sub-regions of northern Uganda to identify whether the technical quality of critical ART sub-system needs improvement. We conducted a randomized cross-sectional survey among health facilities (HF) in Acholi (n = 11) and Lango (n = 10). Applying lot quality assurance sampling principles with a rapid health facility assessment tool, we assessed ART services vis-à-vis national treatment guidelines using 37 indicators. We interviewed health workers (n = 21) using structured questionnaires, directly observed clinical consultations (n = 126) and assessed HF infrastructure, human resources, medical supplies and patient records in each health facility (n = 21). The district QoC performance standard was 80% of HF had to comply with each guideline. Neither sub-region complied with treatment guidelines. No HF displayed adequate: patient monitoring, physical examination, training, supervision and regular monitoring of patients’ immunology. The full range of first and second line antiretroviral (ARV) medication was not available in Acholi while Lango had sufficient stocks. Clinicians dispensed available ARVs without benefit of physical examination or immunological monitoring. Patients reported compliance with drug use (>80%). Patients’ knowledge of preventing HIV/AIDS transmission concentrated on condom use; otherwise it was poor. The poor ART QoC in northern Uganda raises major questions about ART quality although ARVs were dispensed. Poor clinical care renders patients’ reports of treatment compliance as insufficient evidence that it takes place. Further studies need to test patients’ immunological status and QoC in more regions of Uganda and elsewhere in sub-Saharan Africa to identify topical and geographical areas which are priorities for improving HIV care.

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Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say

Global Health Action ◽

10.1080/16549716.2020.1711618 ◽

2020 ◽

Vol 13 (1) ◽

pp. 1711618

Author(s):

Elizabeth Ayebare ◽

Wibke Jonas ◽

Grace Ndeezi ◽

Jolly Nankunda ◽

Claudia Hanson ◽

...

Keyword(s):

Heart Rate ◽

Fetal Heart Rate ◽

Public Hospital ◽

Fetal Heart ◽

Health Workers ◽

Northern Uganda ◽

Heart Rate Monitoring ◽

Fetal Heart Rate Monitoring

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Use of information and communication technology and retention of health workers in rural post-war conflict Northern Uganda: findings from a qualitative study

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-016-0403-3 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 4

Author(s):

Walter Onen Yagos ◽

Geoffrey Tabo Olok ◽

Emilio Ovuga

Keyword(s):

Qualitative Study ◽

Information And Communication Technology ◽

Communication Technology ◽

Health Workers ◽

Northern Uganda ◽

Information And Communication ◽

Post War

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The 2015–2016 malaria epidemic in Northern Uganda; What are the implications for malaria control interventions?

Acta Tropica ◽

10.1016/j.actatropica.2018.08.023 ◽

2018 ◽

Vol 188 ◽

pp. 27-33 ◽

Cited By ~ 4

Author(s):

Rodney Ogwang ◽

Godfrey Akena ◽

Adoke Yeka ◽

Faith Osier ◽

Richard Idro

Keyword(s):

Malaria Control ◽

Northern Uganda ◽

Malaria Epidemic

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Factors associated with differential community prevalence of hepatitis E in two sub-counties in Kitgum District in Northern Uganda: A comparative cross-sectional study

10.21203/rs.3.rs-1182084/v1 ◽

2021 ◽

Author(s):

Judith Aloyo ◽

Juliet Kiguli ◽

Christopher Orach Garimoi ◽

Eric Nzirakaindi Ikoona ◽

David Lagoro Kitara

Keyword(s):

Health Workers ◽

Internal Validity ◽

Hepatitis E ◽

Hand Washing ◽

Personal Hygiene ◽

P Value ◽

Northern Uganda ◽

Cross Sectional ◽

Factors Associated ◽

Heads Of Household

Abstract Background: Hepatitis E is one of the leading causes of acute viral hepatitis worldwide. During 2009, an epidemic of hepatitis E resulted in 10,437 infections and 167 deaths in Kitgum district.Objective: To investigate factors associated with the differential community prevalence of hepatitis E in two sub-counties in Kitgum District.Methods: We conducted a community survey during the 4th-31st of May 2012 in two Sub Counties in Kitgum District in Northern Uganda. A total of 474 heads of household were recruited using a probability proportional to size through multistage and random sampling methods. Two hundred thirty-four (49.26%) heads of household were from Mucwini, and 241 (50.74%) were from Kitgum Matidi Sub Counties. The questionnaire had an internal validity of Cronbach’s α=0.85. The study was approved by a local IRB. STATA version 10.0 was used for data analysis, and a p-value less than 0.05 was considered significant.Results: The prevalence of hepatitis E was significantly higher in Mucwini Subcountry 97 (41.99%) than in Kitgum Matidi 63 (26.47%); χ2=12.6; p=0.000. Factors associated with differential prevalence were hand washing after latrine use with Adjusted Odds Ratio (AoR)=0.23,95%CI:0.110-0.646; p=0.003; frequency of communal hand washing AoR=0.53,95%CI:0.330-0.860; p=0.01; patients’ handling by health workers AoR=1.91,95%CI:1.410-2.610; p<0.001; frequency of village health meetings held AoR=0.69,95%CI:0.56-0.85; p<0.001 and awareness of the cause of Hepatitis E AoR=1.42, 95%CI:0.710-1.880; p=0.015.Conclusions: Factors associated with the differential community prevalence of hepatitis E in the two communities were poor personal hygiene, poor community practices and a low level of community awareness about the virus. District and health authorities should put in place measures to improve personal and household hygiene and strengthen community health education on hepatitis E.

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Ten Years of Universal Testing: How the Rapid Diagnostic Test Became a Game Changer for Malaria Case Management and Improved Disease Reporting

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0643 ◽

2021 ◽

Author(s):

Michael Aidoo ◽

Sandra Incardona

Keyword(s):

Case Management ◽

Health System ◽

Malaria Control ◽

Malaria Case ◽

Health Workers ◽

Malaria Diagnosis ◽

World Health ◽

Smear Microscopy ◽

Malaria Case Management ◽

Laboratory Staff

In 2010, the World Health Organization changed its guidance on malaria case management, recommending parasitological confirmation of all suspected cases before treatment with an antimalarial. This recommendation was in large part as a result of the availability of quality assured malaria rapid diagnostic tests (RDTs) that made it possible for malaria diagnosis to be performed by laboratory staff in all health facilities irrespective of the facility’s place in the tiered health system. Community health workers and other non-laboratory health workers who traditionally did not perform malaria testing due to the technical and logistic demands of smear microscopy were now able to test for malaria. The use of RDTs has led to substantial increases in testing rates, improved quality of case management, as well as more accurate reporting of malaria cases. Although current RDTs have limitations, they remain one of the most important tools in contemporary malaria control. Further improvements to existing products, such as increased sensitivity for non-falciparum tests, diversification of Plasmodium falciparum antigen targets, along with strengthened health system support for current RDTs will further enhance their utility in malaria control and prevention.

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Using reproductive health services to address sexual and gender-based violence in post-conflict northern Uganda.

10.21203/rs.2.14293/v1 ◽

2019 ◽

Author(s):

Keneth Opiro ◽

Francis Pebolo Pebalo ◽

Neil Scolding ◽

Charlotte Hardy

Keyword(s):

Reproductive Health ◽

Health Service ◽

Health Workers ◽

Northern Uganda ◽

Gender Based Violence ◽

Reproductive Health Services ◽

Service Workers ◽

Post Conflict ◽

Gender Based ◽

And Gender

Abstract Abstract Background Sexual and gender-based violence (SGBV), including rape and child sexual abuse, remains a significant challenge in post-conflict northern Uganda, including within refugee settlements. Many victims have never sought help from health-related services. Consequently, the scale of the problem is unknown, and SGBV victims’ injuries, both psychological and physical, remain undetected and unaddressed. We hypothesized that health workers in rural Reproductive Health Services could provide a valuable resource for SGBV screening and subsequent referral for support. Methods Our project had three elements. First, Reproductive Health Service workers were trained in the knowledge and skills needed to screen for and identify women who had experienced SGBV, using a questionnaire-based approach. Second, the screening questionnaire was used by reproductive health workers over a 3-month period, and the data analysed to explore the scale and nature of the problem. Third, victims detected were offered referral as appropriate to hospital services and/or the ActionAid SURGE (Strengthening Uganda’s Response to Gender Equality) shelter in Gulu. Results 1656 women were screened. 778 (47%) had a history of SGBV, including 123 victims of rape and 505 victims of non-sexual violence. 1,254 (76%) had been directly or indirectly affected by conflict experiences; 1066 had lived in IDP camps. 145 (9%) were referred at their request to Gulu SGBV Shelter under SURGE. Of these, 25 attended the shelter and received assistance, and a further 20 received telephone counselling. Conclusion Undetected SGBV remains a problem in post-conflict northern Uganda. Reproductive Health Service workers, following specific training, can effectively screen for and identify otherwise unreported and unassisted cases of SGBV. Future work will explore scaling up to include screening in hospital A&E departments, incorporate approaches to screening for male victims, and the impact of taking both screening and support services to rural communities through local clinics with mobile teams.

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