Community overview on the differential prevalence of Hepatitis E in two Sub Counties in Kitgum District: A qualitative study

Background There was an epidemic of Hepatitis E infection in Kitgum District in 2007. More than 10,422 people were infected, and over 166 deaths were registered due to the Hepatitis E virus. Kitgum District Health Management Information Systems (HMIS) showed that Hepatitis E cases continued to occur more in Mucwini than Kitgum Matidi Sub County despite instituting similar epidemic control measures in the two communities. The tenacity of the virus in Mucwini Sub County had remained unclear. Objective To assess communities’ views and perspectives on the differential prevalence of Hepatitis E in the two Sub Counties of Kitgum Matidi and Mucwini in Northern Uganda. Methods A cross-sectional study using qualitative methods was conducted. Four Focus Group discussions and six key informant interviews were conducted with village health teams, local council chairpersons, health workers, and community members. These persons were chosen purposively because of their expertise and experience in community and health services. Face-to-face interview guides were administered to obtain detailed information on factors associated with the differential occurrence of Hepatitis E in the two Sub Counties. This study was approved by a local IRB and Uganda National Council of Science and Technology (UNCS&T). Results The most significant findings from this study were the differences in prevention and control practices in the two communities. Residents of Mucwini were less compliant to infection, prevention, and control guidelines, and disagreements between local councilors and village health teams in Mucwini led to poor implementation and non-adherence to guidelines on community control of Hepatitis E. Conclusion A differentially higher prevalence of Hepatitis E in Mucwini than Kitgum Matidi Sub County resulted from poor personal and community hygiene and non-adherence to behavior change communication among residents Mucwini compared to their counterparts in Kitgum Midi. The authors recommend a more proactive approach in managing the epidemic by securing the willingness of the affected community to adopt appropriate infection prevention and control guidelines. In addition, disagreements among stakeholders should be resolved timely so that all community members adhere to control measures.

“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.

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

Background 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. Methods and principal findings 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. Conclusion and significance 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.

Evaluation of Public Health Surveillance Systems in Refugee Settlements in Uganda, 2016 - 2019: Lessons Learnt

BackgroundCivil wars in the Great Lakes region resulted in massive displacement of people to neighboring countries including Uganda, with associated humanitarian emergencies. Appropriate disease surveillance enables timely detection and response to outbreaks. We describe evaluation of the public health surveillance system in refugee settlements in Uganda and document lessons learnt.MethodsWe conducted a cross-sectional survey using the US CDC Updated Guidelines for Evaluating Public Health Surveillance Systems in four refugee settlements in Uganda i.e., Bidibidi, Adjumani, Kiryandongo and Rhino Camp. Using semi-structured questionnaires, key informant and focus group discussion guides, we interviewed health facility in-charges, key personnel and village health teams from 4 districts, 53 health facilities and 112 villages.ResultsAll health facilities assessed had key surveillance staff; 60% were trained on IDSR and most village health teams were trained on disease surveillance. Case detection was at 55%; facilities lacked standard case definitions (SCDs) and were using parallel Implementing Partner (IP) driven reporting system. 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% and response was at 34%. Feedback was at 82%. Recording, reporting, preparedness, feedback and confirmation of outbreaks and events were highly achieved, and capacity to evaluate and improve the system was moderately achieved. There were low scores in capacity to detect, respond and analyse data.ConclusionPublic health surveillance system had high sensitivity, timeliness and predictive value positive. It was simple, acceptable with fair data quality attributes. It was less flexible, less stable with low representativeness. The system had good recording, reporting, preparedness, feedback and confirmation of outbreaks and events. The capacity for detection, response and data analysis and interpretation was low. Lessons learnt were: IPs offer tremendous support to surveillance; training of surveillance staff on IDSR maintains effective surveillance functions; supplies of tools, personnel etc. should be planned and executed; functionalization of district teams ensures achievement of surveillance functions and attributes; regular support supervision of health facilities necessary; harmonization of reporting improves surveillance functions and attributes; appropriation of funds to districts to support refugee settlements is complementary.

Can the Timed and Targeted Counseling Model Improve the Quality of Maternal and Newborn Health Care? A Process Analysis in the Rural Hoima District in Uganda

Each year, more than half a million women die worldwide from causes related to pregnancy and childbirth, and nearly 4 million newborns die within 28 days of birth. In Uganda, 15 women die every single day from pregnancy and childbirth-related causes, 94 babies are stillborn, and 81 newborn babies die. Cost-effective solutions for the continuum of care can be achieved through Village Health Teams to improve home care practices and health care-seeking behavior. This study aims at examining the implementation of the timed and targeted counseling (ttC) model, as well as improving maternal and newborn health care practices. We conducted a quantitative longitudinal study on pregnant mothers who were recruited on suspicion of the pregnancy and followed-up until six weeks post-delivery. The household register was the primary data source, which was collected through a secondary review of the ttC registers. All outcome and process variables were analyzed using descriptive statistics. The study enrolled 616 households from 64 villages across seven sub-counties in Hoima district with a 98.5% successful follow-up rate. Over the course of the implementation period of ttC, there was an increase of 29.6% in timely 1st antenatal care, 28.7% in essential newborn care, 25.5% in exclusive breastfeeding, and 17.5% in quality of antenatal care. All these improvements were statistically significant. The findings from this study show that the application of the ttC model through Village Health Teams has great potential to improve the quality of antenatal and newborn care and the health-seeking practices of pregnant and breastfeeding mothers in rural communities.

Illness representations of chronic obstructive pulmonary disease (COPD) to inform health education strategies and research design—learning from rural Uganda

More than 90% of chronic obstructive pulmonary disease (COPD)-related deaths occur in low- and middle-income countries; however, few studies have examined the illness experiences of individuals living with and providing treatment for COPD in these settings. This study characterizes illness representations for COPD in Nakaseke, Uganda from the perspectives of health care providers, village health teams and community members (CMs) with COPD. We conducted 40 in-depth, semi-structured interviews (16 health care providers, 12 village health teams and 12 CMs, aged 25–80 years). Interviews were analyzed using inductive coding, and the Illness Representations Model guided our analysis. Stakeholder groups showed concordance in identifying causal mechanisms of COPD, but showed disagreement in reasons for care seeking behaviors and treatment preferences. CMs did not use a distinct label to differentiate COPD from other respiratory illnesses, and described both the physical and social consequences of COPD. Local representations can inform development of adapted educational and self-management tools for COPD.

“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 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 and whether VHTs could be effectively trained to use a smartphone-guided intervention to link older adults with hypertension and diabetes mellitus to care. 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.

Community-based management and care of people with dementia: A training needs assessment among village health teams in Uganda based on WHO guidelines

Background Dementia is a public health problem worldwide with approximately 47 million people living with the disease. Although the symptoms are known and named, dementia remains a hidden problem in low and middle income countries (LMICs) as most people perceive it be a normal aging process. In a bid to improve healthcare, the Uganda government adopted a model of recruiting community-based health assistants known as village health teams (VHTs). These individuals helped in linking the community health units with community members with a goal of promoting health services. However, there is paucity of information about how the VHTs provide community-based management and care for people with dementia and their ability to perform the task. The purpose of this study was to identify the training needs of the VHTs in caring for people with dementia in rural communities of southwestern Uganda.Methods This study utilized a cross-sectional qualitative design conducted with the help of semi-structured interview guide. The WHO guide was adopted in developing interviews on dementia care and management in LMICs.Results From the study, VHTs reported the need for training with specific to dementia care to equip them with knowledge and skills on early detection and management, care and referral system. Results also show that VHTs were not able to detect dementia early since they perceive it as normal aging process. There was no community engagement in helping people with dementia since most people in the community do not take dementia to be a medical condition. Also there was little support for dementia in these areas as VHTs only referred people with dementia to health facilities in an event of physical ailment. Other organisations like churches only offered prayers only to the aged persons who are very close to the church.Conclusions The study found that there is an urgent need for training VHTs on caring for individuals with dementia in rural communities of southwestern Uganda. The identified gaps helped in designing the strategies for capacity building through training of VHTs on dementia care in rural communities of southwestern Uganda.