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Nayiga S, MacPherson EE, Mankhomwa J, Nasuwa F, Pongolani R, Kabuleta R, Kesby M, Dacombe R, Hilton S, Grace D, Feasey N, Chandler CI. "Arming half-baked people with weapons!" Information enclaving among professionals and the need for a care-centred model for antibiotic use information in Uganda, Tanzania and Malawi. Glob Health Action 2024; 17:2322839. [PMID: 38441912 PMCID: PMC10916894 DOI: 10.1080/16549716.2024.2322839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not. OBJECTIVE We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi. METHODS Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting. RESULTS Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred. CONCLUSIONS Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.
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Affiliation(s)
- Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Eleanor E MacPherson
- Research and Innovation Services, University of Glasgow, Glasgow, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - John Mankhomwa
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | | | | | - Rita Kabuleta
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Mike Kesby
- School of Geography & Sustainable Development, University of St Andrews, St Andrews, UK
| | - Russell Dacombe
- Research and Innovation Services, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Delia Grace
- Natural Resources Institute, University of Greenwich, Chatham, UK
- International Livestock Research Institute, Nairobi, Kenya
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- The School of Medicine, University of St Andrews, St Andrews, UK
| | - Clare I.R. Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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van der Hoeven M, van Lettow M, Boonstra P, Hoekstra T, Rutebemberwa E, Tweheyo R, Kok MO. Uptake of community health care provision by community health entrepreneurs for febrile illness and diarrhoea: a cross-sectional survey in rural communities in Bunyangabu district, Uganda. BMJ Open 2024; 14:e074393. [PMID: 38316585 PMCID: PMC10860046 DOI: 10.1136/bmjopen-2023-074393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To assess the uptake of services provided by community health workers who were trained as community health entrepreneurs (CHEs) for febrile illness and diarrhoea. DESIGN A cross-sectional survey among households combined with mapping of all providers of basic medicine and primary health services in the study area. PARTICIPANTS 1265 randomly selected households in 15 rural villages with active CHEs. SETTING Bunyangabu district, Uganda. OUTCOME MEASURES We describe the occurrence and care sought for fever and diarrhoea in the last 3 months by age group in the households. Care provider options included: CHE, health centre or clinic (public or private), pharmacy, drug shop and other. Geographic Information Ssystem (GIS)-based geographical measures were used to map all care providers around the active CHEs. RESULTS Fever and diarrhoea in the last 3 months occurred most frequently in children under 5; 68% and 41.9%, respectively. For those who sought care, CHE services were used for fever among children under 5, children 5-17 and adults over 18 years of age in 34.7%, 29.9% and 25.1%, respectively. For diarrhoea among children under 5, children 5-17 and adults over 18 years of age, CHE services were used in 22.1%, 19.5% and 7.0%, respectively. For those who did not seek care from a CHE (only), drug shops were most frequently used services for both fever and diarrhoea, followed by health centres or private clinics. Many households used a combination of services, which was possible given the high density and diversity of providers found in the study area. CONCLUSIONS CHEs play a considerable role in providing care in rural areas where they are active. The high density of informal drug shops and private clinics highlights the need for clarity on the de facto roles played by different providers in both the public and private sector to improve primary healthcare.
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Affiliation(s)
- Marinka van der Hoeven
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Monique van Lettow
- Department of Implementation and Operational Research, Madiro, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Division of Epidemiology and Centre of Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Pien Boonstra
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Trynke Hoekstra
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Raymond Tweheyo
- School of Public Health, Makerere University, Kampala, Uganda
| | - Maarten Olivier Kok
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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Hossain MS, Ahmed TS, Sultana N, Chowdhury MAB, Uddin MJ. Examining the disparities of anti-malarial drug consumption among children under the age of five: a study of 5 malaria-endemic countries. Malar J 2023; 22:370. [PMID: 38049847 PMCID: PMC10696736 DOI: 10.1186/s12936-023-04805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/23/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Malaria is one of the most prominent illnesses affecting children, ranking as one of the key development concerns for many low- and middle-income countries (LMICs). There is not much information available on the use of anti-malarial drugs in LMICs in children under five. The study aimed to investigate disparities in anti-malarial drug consumption for malaria among children under the age of five in LMICs. METHODS This study used recent available cross-sectional data from the Malaria Indicator Survey (MIS) datasets across five LMICs (Guinea, Kenya, Mali, Nigeria, and Sierra Leone), which covered a portion of sub-Saharan Africa. The study was carried out between January 2, 2023, and April 15, 2023, and included children under the age of five who had taken an anti-malarial drug for malaria 2 weeks before the survey date. The outcome variable was anti-malarial drug consumption, which was classified into two groups: those who had taken anti-malarial drugs and those who had not. RESULTS In the study of LMICs, 32,397 children under five were observed, and among them, 44.1% had received anti-malarial drugs. Of the five LMICs, Kenya had the lowest (9.2%) and Mali had the highest (70.5%) percentages of anti-malarial drug consumption. Children under five with malaria are more likely to receive anti-malarial drugs if they are over 1 year old, live in rural areas, have mothers with higher education levels, and come from wealthier families. CONCLUSION The study emphasizes the importance of developing universal coverage strategies for anti-malarial drug consumption at both the national and local levels. The study also recommends that improving availability and access to anti-malarial drugs may be necessary, as the consumption of these drugs for treating malaria in children under the age of five is shockingly low in some LMICs.
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Affiliation(s)
- Md Sabbir Hossain
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Talha Sheikh Ahmed
- Department of Geography and Environment, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Nahid Sultana
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | | | - Md Jamal Uddin
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh.
- Faculty of Graduate Studies, Daffodil International University, Savar, Dhaka, 1216, Bangladesh.
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Brunner NC, Karim A, Athieno P, Kimera J, Tumukunde G, Angiro I, Signorell A, Delvento G, Lee TT, Lambiris M, Ogwal A, Nakiganda J, Mpanga F, Kagwire F, Amutuhaire M, Burri C, Lengeler C, Awor P, Hetzel MW. Starting at the community: Treatment-seeking pathways of children with suspected severe malaria in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001949. [PMID: 37405978 DOI: 10.1371/journal.pgph.0001949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
Community health workers (CHW) usually refer children with suspected severe malaria to the nearest public health facility or a designated public referral health facility (RHF). Caregivers do not always follow this recommendation. This study aimed at identifying post-referral treatment-seeking pathways that lead to appropriate antimalarial treatment for children less than five years with suspected severe malaria. An observational study in Uganda enrolled children below five years presenting to CHWs with signs of severe malaria. Children were followed up 28 days after enrolment to assess their condition and treatment-seeking history, including referral advice and provision of antimalarial treatment from visited providers. Of 2211 children included in the analysis, 96% visited a second provider after attending a CHW. The majority of CHWs recommended caregivers to take their child to a designated RHF (65%); however, only 59% followed this recommendation. Many children were brought to a private clinic (33%), even though CHWs rarely recommended this type of provider (3%). Children who were brought to a private clinic were more likely to receive an injection than children brought to a RHF (78% vs 51%, p<0.001) and more likely to receive the second or third-line injectable antimalarial (artemether: 22% vs. 2%, p<0.001, quinine: 12% vs. 3%, p<0.001). Children who only went to non-RHF providers were less likely to receive an artemisinin-based combination therapy (ACT) than children who attended a RHF (odds ratio [OR] = 0.64, 95% CI 0.51-0.79, p<0.001). Children who did not go to any provider after seeing a CHW were the least likely to receive an ACT (OR = 0.21, 95% CI 0.14-0.34, p<0.001). Health policies should recognise local treatment-seeking practices and ensure adequate quality of care at the various public and private sector providers where caregivers of children with suspected severe malaria actually seek care.
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Affiliation(s)
- Nina C Brunner
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Aliya Karim
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Proscovia Athieno
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Kimera
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Gloria Tumukunde
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Irene Angiro
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Aita Signorell
- University of Basel, Basel, Switzerland
- Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Giulia Delvento
- University of Basel, Basel, Switzerland
- Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Tristan T Lee
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Mark Lambiris
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Alex Ogwal
- Malaria Programme, Clinton Health Access Initiative, Kampala, Uganda
| | - Juliet Nakiganda
- Malaria Programme, Clinton Health Access Initiative, Kampala, Uganda
| | - Flavia Mpanga
- Child Survival and Development, UNICEF, Kampala, Uganda
| | - Fred Kagwire
- Child Survival and Development, UNICEF, Kampala, Uganda
| | - Maureen Amutuhaire
- National Malaria Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Christian Burri
- University of Basel, Basel, Switzerland
- Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Christian Lengeler
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Phyllis Awor
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Manuel W Hetzel
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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DMPA-SC stock: Cross-site trends by facility type. Contracept X 2022; 4:100075. [PMID: 35493973 PMCID: PMC9046645 DOI: 10.1016/j.conx.2022.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives To measure trends in the supply of DMPA-SC in public and private health facilities and compare with other prominent modern methods. Study design We used repeated cross-sectional data from service-delivery-point surveys in six settings: Burkina Faso, Democratic Republic of Congo (Kinshasa and Kongo Central), Nigeria (Kano and Lagos), and Uganda, each with 3-5 rounds of data collected between 2016 and 2020. We analyzed trends in DMPA-SC availability using percent of service delivery points offering the method and percent experiencing stockouts; trends were compared with those for DMPA-IM, IUD, implants, and other short-acting methods, by facility type. Results All settings showed increased offering of DMPA-SC over time for both private and public facilities. Larger proportions of public facilities provided DMPA-SC compared to private facilities (66%–97% vs 16%–50% by 2019–2020). DMPA-SC was provided by fewer facilities than DMPA-IM (90%–100% public, 34%–69% private by 2019–2020), but comparable to implants (83%–100% public, 15%–52% private by 2019–2020) and IUDs (55%–91% public, 0%–44% private by 2019–2020). Trends of DMPA-SC stock varied by setting, with more consistent stock available in private facilities in the DRC and in public facilities in Burkina Faso and Nigeria. Uganda showed decreasing stock in public facilities but increasing stock in private facilities. Conclusion DMPA-SC availability has been increasing since its introduction in sub-Saharan Africa, yet significant gaps in stock exist. Countries should consider alternative distribution models to address these issues. Implications Our findings may help inform countries about the need to monitor DMPA-SC availability and to consider solutions that ensure contraceptive options are available to women who need them and disruptions to contraceptive use are minimized.
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A Qualitative Exploration of the Referral Process of Children with Common Infections from Private Low-Level Health Facilities in Western Uganda. CHILDREN 2021; 8:children8110996. [PMID: 34828709 PMCID: PMC8618635 DOI: 10.3390/children8110996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022]
Abstract
Over 50% of sick children are treated by private primary-level facilities, but data on patient referral processes from such facilities are limited. We explored the perspectives of healthcare providers and child caretakers on the referral process of children with common childhood infections from private low-level health facilities in Mbarara District. We carried out 43 in-depth interviews with health workers and caretakers of sick children, purposively selected from 30 facilities, until data saturation was achieved. The issues discussed included the process of referral, challenges in referral completion and ways to improve the process. We used thematic analysis, using a combined deductive/inductive approach. The reasons for where and how to refer were shaped by the patients’ clinical characteristics, the caretakers’ ability to pay and health workers’ perceptions. Caretaker non-adherence to referral and inadequate communication between health facilities were the major challenges to the referral process. Suggestions for improving referrals were hinged on procedures to promote caretaker adherence to referral, including reducing waiting time and minimising the expenses incurred by caretakers. We recommend that triage at referral facilities should be improved and that health workers in low-level private health facilities (LLPHFs) should routinely be included in the capacity-building trainings organised by the Ministry of Health (MoH) and in workshops to disseminate health policies and national healthcare guidelines. Further research should be done on the effect of improving communication between LLPHFs and referral health facilities by affordable means, such as telephone, and the impact of community initiatives, such as transport vouchers, on promoting adherence to referral for sick children.
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Mwanga-Amumpaire J, Ndeezi G, Källander K, Obua C, Migisha R, Nkeramahame J, Stålsby Lundborg C, Kalyango JN, Alfvén T. Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda. PLoS One 2021; 16:e0257851. [PMID: 34669729 PMCID: PMC8528317 DOI: 10.1371/journal.pone.0257851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds. METHODS We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections. RESULTS Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in >90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses/midwives and (26% diploma nurses/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed. CONCLUSION Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.
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Affiliation(s)
- Juliet Mwanga-Amumpaire
- Mbarara University of Science and Technology, Mbarara, Uganda
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Grace Ndeezi
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Karin Källander
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Programme Division, Health Section, UNICEF, New York, New York, United States of America
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Richard Migisha
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Juvenal Nkeramahame
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Joan Nakayaga Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pharmacy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
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Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157742. [PMID: 34360041 PMCID: PMC8345429 DOI: 10.3390/ijerph18157742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
In Uganda, >50% of sick children receive treatment from primary level-private health facilities (HF). We assessed the appropriateness of care for common infections in under-five-year-old children and explored perspectives of healthcare workers (HCW) and policymakers on the quality of healthcare at low-level private health facilities (LLPHF) in western Uganda. This was a mixed-methods parallel convergent study. Employing multistage consecutive sampling, we selected 110 HF and observed HCW conduct 777 consultations of children with pneumonia, malaria, diarrhea or neonatal infections. We purposively selected 30 HCW and 8 policymakers for in-depth interviews. Care was considered appropriate if assessment, diagnosis, and treatment were correct. We used univariable and multivariable logistic regression analyses for quantitative data and deductive thematic analysis for qualitative data. The proportion of appropriate care was 11% for pneumonia, 14% for malaria, 8% for diarrhea, and 0% for neonatal infections. Children with danger signs were more likely to receive appropriate care. Children with diarrhea or ability to feed orally were likely to receive inappropriate care. Qualitative data confirmed care given as often inappropriate, due to failure to follow guidelines. Overall, sick children with common infections were inappropriately managed at LLPHF. Technical support and provision of clinical guidelines should be increased to LLPHF.
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Mwanga-Amumpaire J, Kalyango JN, Källander K, Sundararajan R, Owokuhaisa J, Rujumba J, Obua C, Alfvén T, Ndeezi G. A qualitative study of the perspectives of health workers and policy makers on external support provided to low-level private health facilities in a Ugandan rural district, in management of childhood infections. Glob Health Action 2021; 14:1961398. [PMID: 34482794 PMCID: PMC8425752 DOI: 10.1080/16549716.2021.1961398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND With the under-five child mortality rate of 46.4 deaths per 1000 live births, Uganda should accelerate measures to reduce child deaths to achieve the Sustainable Development Goal 3. While 60-70% of frontline health services are provided by the private sector, many low-level private health facilities (LLPHF) are unregistered, unregulated, and often miss innovative and quality improvement strategies rolled out by the Ministry of Health. LLPHF need support in order to provide quality health care. OBJECTIVE To explore the perspectives of health workers and policy makers on external support given to LLPHF providing health care for children in Mbarara District, Uganda. METHODS We carried out a qualitative study, in which 43 purposively selected health workers and policy makers were interviewed. The issues discussed included their views on the quantity, quality, factors determining support received and preferred modalities of support to LLPHF. We used thematic analysis, employing an inductive approach to code interview transcripts and to identify subthemes and themes. RESULTS The support currently provided to LLPHF to manage childhood illnesses is inadequate. Health providers emphasised a need for technical capacity building, provision of policies, guidelines and critical supplies as well as adopting a more supportive supervisory approach instead of the current supervision model characterised by policing, fault finding and apportioning blame. Registration of the health facilities and regular submission of reports as well as multi-stakeholder involvement are potential strategies to improve external support. CONCLUSION The current support received by LLPHF is inadequate in quantity and quality. Capacity building with emphasis on training, provision of critical guidelines and supplies as well as and supportive supervision are key strategies for delivering appropriate external support to LLPHF.
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Affiliation(s)
- Juliet Mwanga-Amumpaire
- Department of Paediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda.,Clinical Epidemiology Unit, College of Health Sciences, Makerere University Kampala, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University Kampala, Uganda.,Department of Pharmacy, College of Health Sciences, Makerere University Kampala, Uganda
| | - Karin Källander
- Department of Global Public Health, Karolinska Institutet, Sweden
| | | | - Judith Owokuhaisa
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Rujumba
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University Kampala, Uganda
| | - Celestino Obua
- Department of Paediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Sweden.,Department of Emergency Medicine, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Grace Ndeezi
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University Kampala, Uganda
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Coverage of isoniazid preventive therapy among people living with HIV; A retrospective cohort study in Tanzania (2012-2016). Int J Infect Dis 2020; 103:562-567. [PMID: 33276111 PMCID: PMC7862080 DOI: 10.1016/j.ijid.2020.11.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 01/25/2023] Open
Abstract
There was low IPT initiation among those who were eligible. Female sex, ART, obesity and WHO clinical stage II, enrolment in Njombe region and being in public hospitals were associated with increased IPT initiation. Strategies are needed to work on barriers and to sustain enabling factors to improve IPT initiation.
Background Isoniazid Preventive Therapy (IPT) is a proven public health tool to reduce Tuberculosis (TB) among people living with HIV. However, its implementation in most countries is suboptimal. This retrospective study was conducted to determine the coverage and factors associated with IPT initiation to inform program scale up and improve quality of service in Tanzania and elsewhere. Methods Retrospective cohort study design involving HIV clinics in Dar es Salaam, Iringa and Njombe regions from January 2012 to December 2016. Results A total of 171,743 PLHIV were in the cohort from 2012 to 2016. Of these, 166,709 were involved in the analysis. Of those analyzed, 23,970 (14.38%) were ever initiated on IPT. Female sex (aOR = 1.72, 95% CI: 1.13, P < 0.001), obesity (aOR = 1.29, 95% CI:1.20−1.39, P < 0.001), WHO clinical stage II (aOR = 1.48, 95% CI: 1.42−1.55, P < 0.001), enrolment in hospitals (aOR = 1.98, 95% CI: 1.89−2.06, P < 0.001), enrolment in Njombe region (aOR = 1.25: 95% CI: 1.18−1.33, P < 0.001) and enrolment in public health facilities (aOR = 1.93: 95% CI: 1.82−2.04, P < 0.001) were associated with increased IPT uptake. Being on ART (aOR = 0.67, 95% CI: 0.65−0.70, P < 0.001) and severe nutritional status (aOR = 0.72, 95% CI: 0.60−0.88, P < 0.001) were associated with decreased IPT initiation. Conclusions Our study documented low IPT initiation in the study area as well as documented factors which enable IPT initiation and those which impair IPT initiation. Strategies are needed to work on barriers and sustain enabling factors to improve IPT coverage.
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Macarayan E, Papanicolas I, Jha A. The quality of malaria care in 25 low-income and middle-income countries. BMJ Glob Health 2020; 5:e002023. [PMID: 32133188 PMCID: PMC7042579 DOI: 10.1136/bmjgh-2019-002023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Even with accessible and effective diagnostic tests and treatment, malaria remains a leading cause of death among children under five. Malaria case management requires prompt diagnosis and correct treatment but the degree to which this happens in low-income and middle-income countries (LMICs) remains largely unknown. Methods Cross-sectional study of 132 566 children under five, of which 25% reported fever in the last 2 weeks from 2006 to 2017 using the latest Malaria Indicators Survey data across 25 malaria-endemic countries. We calculated the per cent of patient encounters of febrile children under five that received poor quality of care (no blood testing, less or more than two antimalarial drugs and delayed treatment provision) across each treatment cascade and region. Results Across the study countries, 48 316 (58%) of patient encounters of febrile children under five received poor quality of care for suspected malaria. When comparing by treatment cascade, 62% of cases were not blood tested despite reporting fever in the last 2 weeks, 82% did not receive any antimalarial drug, 17% received one drug and 72% received treatment more than 24 hours after onset of fever. Of the four countries where we had more detailed malaria testing data, we found that 35% of patients were incorrectly managed (26% were undertreated, while 9% were overtreated). Poor malaria care quality varies widely within and between countries. Conclusion Quality of malaria care remains poor and varies widely in endemic LMICs. Treatments are often prescribed regardless of malaria test results, suggesting that presumptive diagnosis is still commonly practiced among cases of suspected malaria, rather than the WHO recommendation of 'test and treat'. To reach the 2030 global malaria goal of reducing mortality rates by at least 90%, focussing on improving the quality of malaria care is needed.
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Affiliation(s)
- Erlyn Macarayan
- Harvard Global Health Institute, Harvard University, Cambridge, Massachusetts, USA.,Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Irene Papanicolas
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Ashish Jha
- Harvard Global Health Institute, Harvard University, Cambridge, Massachusetts, USA.,Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Rahimi A, Kassam R, Dang Z, Sekiwunga R. Challenges with accessing health care for young children presumed to have malaria in the rural district of Butaleja, Uganda: a qualitative study. Pharm Pract (Granada) 2019; 17:1622. [PMID: 31897260 PMCID: PMC6935545 DOI: 10.18549/pharmpract.2019.4.1622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/27/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: A qualitative study was conducted to gain insight into challenges reported by
Butaleja households during a previous household survey. Specifically, this
paper discusses heads of households’ and caregivers’
perceptions of challenges they face when seeking care for their very young
children with fever presumed to be malaria. Methods: Eleven focus groups (FGs) were carried out with household members (five with
heads of households and six with household caregivers) residing in five
sub-counties located across the district. Purposive sampling was used to
ensure the sample represented the religious diversity and geographical
distance from the peri-urban center of the district. Each FG consisted of
five to six participants. The FGs were conducted at a community centre by
two pairs of researchers residing in the district and who were fluent in
both English and the local dialect of Lunyole. The discussions were
recorded, translated, and transcribed. Transcripts were reviewed and coded
with the assistance of QDA Miner (version 4.0) qualitative data management
software, and analyzed using thematic content analysis. Results: The FG discussions identified four major areas of challenges when managing
acute febrile illness in their child under the age of five with presumed
malaria (1) difficulties with getting to public health facilities due to
long geographical distances and lack of affordable transportation; (2) poor
service once at a public health facility, including denial of care, delay in
treatment, and negative experiences with the staff; (3) difficulties with
managing the child’s illness at home, including challenges with
keeping home-stock medicines and administering medicines as prescribed; and
(4) constrained to use private outlets despite their shortcomings. Conclusions: Future interventions may need to look beyond the public health system to
improve case management of childhood malaria at the community level in rural
districts such as Butaleja. Given the difficulties with accessing quality
private health outlets, there is a need to partner with the private sector
to explore feasible models of community-based health insurance programs and
expand the role of informal private providers.
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Affiliation(s)
- Asa Rahimi
- BSc (Hons). Faculty of Medicine, University of British Columbia. Vancouver, BC (Canada).
| | - Rosemin Kassam
- BSc Pharm, ACPR, PharmD, PhD. Professor. School of Population and Public Health, Faculty of Medicine, University of British Columbia. Vancouver, BC (Canada).
| | - Zhong Dang
- BSc MBIM. Research Assistant. School of Population and Public Health, Faculty of Medicine, University of British Columbia. Vancouver, BC (Canada).
| | - Richard Sekiwunga
- MSc PRH. Scientist. Child Health and Development Centre, School of Medicine, Makerere University, Kampala (Uganda).
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Opio D, Semitala FC, Kakeeto A, Sendaula E, Okimat P, Nakafeero B, Nankabirwa JI, Karamagi C, Kalyango JN. Loss to follow-up and associated factors among adult people living with HIV at public health facilities in Wakiso district, Uganda: a retrospective cohort study. BMC Health Serv Res 2019; 19:628. [PMID: 31484571 PMCID: PMC6727328 DOI: 10.1186/s12913-019-4474-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Loss to follow-up (LTFU) from care among people living with HIV (PLHIV) is thought to be more common in the public setting compared to the private health care. It is anticipated that the problem may become worse with the current "test and treat" policy in Uganda due to the likely increases in patient loads and its attendant pressure on health care providers to support patient counseling. This study determined the incidence and factors associated with LTFU from HIV care among adult PLHIV in public health facilities in Wakiso district, Uganda. METHODS This was a retrospective cohort study that involved the review of 646 records of patients initiated on antiretroviral therapy (ART) between January 1st, 2015 and December 31st, 2017 at 13 randomly selected public health facilities in Wakiso district. The cox proportional hazards regression was used to determine the factors associated with LTFU. The results were supported by sequential in-depth and key informant interviews to explore reasons for LTFU. RESULTS Of the 646 patients enrolled, 391 were female (60.5%), 282 were below 30 years (43.6%) and 207 were married (50.1%). A total of 216 patients (33.4%) had no documented outcomes and were considered LTFU. The incidence of LTFU was 21 per 1000 person months (95% confidence interval (CI): 18-25 per 1000 person months). Factors associated with LTFU included having normal weight compared to underweight (adjusted hazard ratio (aHR) 0.64, 95% CI: 0.45-0.90, p = 0.011), receiving HIV care from hospitals compared to lower level facilities (aHR 0.22, 95% CI: 0.12-0.41, p < 0.001), and no telephone contact compared to those with a telephone contact (aHR 2.16, 95% CI: 1.33-3.51, p = 0.002). Stigmatization and long waiting times were the prominent reasons for LTFU reported from the in-depth and key informant interviews. CONCLUSIONS The incidence of LTFU in public health facilities in Uganda is quite high and is associated with being underweight, not having a telephone contact to receive reminders and receiving care at lower level facilities. Early diagnosis, routine use of patient address locator forms and improved quality of HIV care at lower level health facilities may reduce LTFU among PLHIV.
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Affiliation(s)
- Denis Opio
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
- Makerere University- Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | - Fred C. Semitala
- Department of Internal Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
- Makerere University Joint AIDS Program (MJAP), P.O. Box 7072, Kampala, Uganda
- Infectious Diseases Research Collaboration (IDRC), P.O. Box 7475, Kampala, Uganda
| | - Alex Kakeeto
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Emmanuel Sendaula
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Paul Okimat
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
- Institute of Public Health and Management, Clarke International University, P.O. Box 7782, Kampala, Uganda
| | - Brenda Nakafeero
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Joaniter I. Nankabirwa
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
- Infectious Diseases Research Collaboration (IDRC), P.O. Box 7475, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Joan N. Kalyango
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
- Department of Pharmacy, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Buchner DL, Kitutu FE, Cross DE, Nakamoga E, Awor P. A cross-sectional study to identify the distribution and characteristics of licensed and unlicensed private drug shops in rural Eastern Uganda to inform an iCCM intervention to improve health outcomes for children under five years. PLoS One 2019; 14:e0209641. [PMID: 30625187 PMCID: PMC6326429 DOI: 10.1371/journal.pone.0209641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/10/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Malaria, pneumonia and diarrhea are leading causes of death in young children in Uganda. Between 50–60% of sick children receive treatment from the private sector, especially drug shops. There is an urgent need to improve quality of care and regulation of private drug shops in Uganda. This study was conducted to determine the distribution, the licensing status and characteristics of drug shops in four sub-districts of Kamuli district. Methods This study was part of a pre-post cross sectional study that examined the implementation of an integrated Community Case Management (iCCM) intervention for common childhood illness in rural private drug shops in Kamuli District in Eastern Uganda. This mapping exercise used a snowball sampling technique to identify licensed and unlicensed drug shops and collect information about their characteristics. Data were collected using a questionnaire. GPS data were collected for all drug shops. Analysis Quantitative data were analyzed using SPSS for descriptive statistics. Open ended questions were entered into NVivo 10 and analyzed using thematic analysis strategies. Results In total, 215 drug shops in 284 villages were located. Of these, 123 (57%) were open and consented to an interview. Only 12 (10%) drug shops were licensed, 93 (76%) were unlicensed, and the licensing status of 18 (15%) was unknown. Most respondents were the owner of the drug shop (88%); most drug sellers reported their qualification as nursing assistants (70%). Drug sellers reported licensing fees and costs of contracting an “in-charge” as barriers to licensing. Nearly all drug shops sold drugs for malaria (91%) and antibiotics (79%).
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Affiliation(s)
- Denise Lynn Buchner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Freddy Eric Kitutu
- Pharmacy Department, Makerere University, Kampala, Uganda
- Department of Woman’s and Children’s Health, Upsala University, Uppsala, Sweden
| | - Dónall Eoin Cross
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Wales, United Kingdom
| | - Esther Nakamoga
- School of Public Health, Makerere University, Kampala, Uganda
| | - Phyllis Awor
- School of Public Health, Makerere University, Kampala, Uganda
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Mpimbaza A, Katahoire A, Rosenthal PJ, Karamagi C, Ndeezi G. Caregiver responses and association with delayed care-seeking in children with uncomplicated and severe malaria. Malar J 2018; 17:476. [PMID: 30563514 PMCID: PMC6299589 DOI: 10.1186/s12936-018-2630-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 12/14/2018] [Indexed: 12/23/2022] Open
Abstract
Background Gaps remain in understanding the role of caregiver responses on time to seek appropriate care. The objective of this study was to describe caregiver responses to illness and the impact of these responses on time to seek appropriate care among children with malaria. Methods A case–control study of 325 children with severe (cases) and 325 children with uncomplicated (controls) malaria was conducted in Jinja, Uganda. Caregivers’ responses to their children’s illnesses and time to seek appropriate care were documented. Responses included staying at home, seeking care at drug shops, and seeking care at public health facilities classified into two types: (1) health facilities where caregiver initially sought care before enrollment, and (2) health facilities where children were provided appropriate care and enrolled in the study. Weighted Cox regression was used to determine risk factors for delays in time to seek appropriate care within 24 h of illness onset. Results Children staying home on self-medication was the most common initial response to illness among caregivers of controls (57.5%) and cases (42.4%, p < 0.001), followed by staying at home without medication (25.2%) and seeking care at drug shops (32.0%) for caregivers of controls and cases, respectively. Seeking care at drug shops was more common among caregivers of cases than of controls (32.0% vs. 12.3%; p < 0.001). However, compared to public health facilities, drug shops offered sub-optimal services with children less likely to have been examined (50.0% vs. 82.9%; p < 0.001) or referred to another facility (12.5% vs. 61.4%; p < 0.001). Upon adjustment for known risk factors for delay, initially seeking care at a drug shop (HR 0.37, p = 0.036) was associated with delay in seeking care at a health facility where appropriate care was provided. In contrast, those initially seeking care at public health facility before enrollment were more likely to subsequently seek care at another public health facility where appropriate care was provided (HR 5.55, p < 0.001). Conclusion Caregivers should be educated on the importance of promptly seeking care at a health facility where appropriate care can be provided. The role of drug shops in providing appropriate care to children with malaria needs to be reviewed. Electronic supplementary material The online version of this article (10.1186/s12936-018-2630-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arthur Mpimbaza
- Child Health and Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda.
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
| | | | - Charles Karamagi
- Department of Pediatrics and Child Health, Makerere University, College of Health Sciences, Kampala, Uganda.,Clinical Epidemiology Unit, Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Pediatrics and Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
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Soremekun S, Kasteng F, Lingam R, Vassall A, Kertho E, Settumba S, Etou PL, Nanyonjo A, ten Asbroek G, Kallander K, Kirkwood B. Variation in the quality and out-of-pocket cost of treatment for childhood malaria, diarrhoea, and pneumonia: Community and facility based care in rural Uganda. PLoS One 2018; 13:e0200543. [PMID: 30475808 PMCID: PMC6261061 DOI: 10.1371/journal.pone.0200543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A key barrier to appropriate treatment for malaria, diarrhoea, and pneumonia (MDP) in children under 5 years of age in low income rural settings is the lack of access to quality health care. The WHO and UNICEF have therefore called for the scale-up of integrated community case management (iCCM) using community health workers (CHWs). The current study assessed access to treatment, out-of-pocket expenditure and the quality of treatment provided in the public and private sectors compared to national guidelines, using data collected in a large representative survey of caregivers of children in 205 villages with iCCM-trained CHWs in mid-Western Uganda. RESULTS The prevalence of suspected malaria, diarrhoea and suspected pneumonia in the preceding two weeks in 6501 children in the study sample were 45%, 11% and 24% respectively. Twenty percent of children were first taken to a CHW, 56% to a health facility, 14% to other providers and no care was sought for 11%. The CHW was more likely to provide appropriate treatment compared to any other provider or to those not seeking care for children with MDP (RR 1.51, 95% CI 1.42-1.61, p<0.001). Seeking care from a CHW had the lowest cost outlay (median $0.00, IQR $0.00-$1.80), whilst seeking care to a private doctor or clinic the highest (median $2.80, IQR $1.20-$6.00). We modelled the expected increase in overall treatment coverage if children currently treated in the private sector or not seeking care were taken to the CHW instead. In this scenario, coverage of appropriate treatment for MDP could increase in total from the current rate of 47% up to 64%. CONCLUSION Scale-up of iCCM-trained CHW programmes is key to the provision of affordable, high quality treatment for sick children, and can thus significantly contribute to closing the gap in coverage of appropriate treatment.
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Affiliation(s)
- Seyi Soremekun
- Department of Population Health, London School of Hygiene and Tropical Medicine, London United Kingdom
| | - Frida Kasteng
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London United Kingdom
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Raghu Lingam
- Department of Population Health, London School of Hygiene and Tropical Medicine, London United Kingdom
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London United Kingdom
| | | | - Stella Settumba
- The Malaria Consortium, Kampala, Uganda
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sidney, Australia
| | - Patrick L. Etou
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Agnes Nanyonjo
- The Malaria Consortium, Kampala, Uganda
- African Population Health Research Centre, Nairobi, Kenya
| | - Guus ten Asbroek
- Department of Population Health, London School of Hygiene and Tropical Medicine, London United Kingdom
- Department of Global Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - Karin Kallander
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- The Malaria Consortium, London, United Kingdom
| | - Betty Kirkwood
- Department of Population Health, London School of Hygiene and Tropical Medicine, London United Kingdom
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Wang LT, Bwambale R, Keeler C, Reyes R, Muhindo R, Matte M, Ntaro M, Mulogo E, Sundararajan R, Boyce RM. Private sector drug shops frequently dispense parenteral anti-malarials in a rural region of Western Uganda. Malar J 2018; 17:305. [PMID: 30134987 PMCID: PMC6106765 DOI: 10.1186/s12936-018-2454-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/10/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Malaria is a leading cause of paediatric morbidity and mortality in Uganda. More than half of febrile children in rural areas initially seek care at private clinics and drug shops. These shops are generally unregulated and the quality of clinical care is variable, with the potential for misdiagnosis and the development of drug resistance. There is thus an urgent need to identify rural drug shops and coordinate their malaria treatment efforts with those of the public sector. The objective of the study was to identify all drug shops in the Bugoye sub-county of Western Uganda and assess their anti-malarial dispensing practices. METHODS This study is a cross-sectional survey of drug shops in a rural sub-county of Western Uganda. In the first phase, shop locations, licensing and shopkeeper's qualifications, and supply and pricing of anti-malarials were characterized. In the second phase, the proportion of anti-malarials dispensed by private drug shops was compared to public health facilities. RESULTS A total of 48 drug shops were identified. Only one drug shop (1 of 48, 2%) was licensed with the sub-county's records office. The drug shops stocked a variety of anti-malarials, including first-line therapies and less effective agents (e.g., sulfadoxine/pyrimethamine). Almost all drug shops (45 of 48, 94%) provided parenteral anti-malarials. Of the 3900 individuals who received anti-malarials during the study, 2080 (53.3%) purchased anti-malarials through the private sector compared to 1820 (46.7%) who obtained anti-malarials through the public sector. Drug shops were the primary source of parenteral anti-malarials. Inadequate dosing of anti-malarials was more common in drug shops. CONCLUSIONS Drug shops are major sources of parenteral anti-malarials, which should be reserved for cases of severe malaria. Strengthening malaria case management and incorporating drug shops in future interventions is necessary to optimize malaria control efforts in the sub-county, and in similarly endemic regions.
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Affiliation(s)
- Lawrence T Wang
- School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Robert Bwambale
- Bugoye Level III Health Centre, Uganda Ministry of Health, Bugoye, Kasese District, Western Region, Uganda
| | - Corinna Keeler
- Department of Geography, University of North Carolina at Chapel Hill, Campus Box 3220, Chapel Hill, NC, 27599, USA
| | - Raquel Reyes
- Division of General Medicine & Clinical Epidemiology, University of North Carolina at Chapel Hill, 5039 Old Clinic Building, CB 7110, Chapel Hill, 27599, USA
| | - Rabbison Muhindo
- Department of Community Health, Mbarara University of Science & Technology, P.O. Box 1410, Mbarara, Uganda
| | - Michael Matte
- Department of Community Health, Mbarara University of Science & Technology, P.O. Box 1410, Mbarara, Uganda
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science & Technology, P.O. Box 1410, Mbarara, Uganda
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science & Technology, P.O. Box 1410, Mbarara, Uganda
| | - Radhika Sundararajan
- Department of Emergency Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10065, USA
| | - Ross M Boyce
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
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Frickmann H, Hinz R, Rojak S, Bonow I, Ruben S, Wegner C, Zielke I, Hagen RM, Tannich E. Evaluation of automated loop-mediated amplification (LAMP) for routine malaria detection in blood samples of German travelers - A cross-sectional study. Travel Med Infect Dis 2018; 24:25-30. [PMID: 29763668 DOI: 10.1016/j.tmaid.2018.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/30/2018] [Accepted: 05/11/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND We assessed a commercial loop-mediated amplification (LAMP) platform for its reliability as a screening tool for malaria parasite detection. METHODS A total of 1000 blood samples from patients with suspected or confirmed malaria submitted to the German National Reference Center for Tropical Pathogens were subjected to LAMP using the Meridian illumigene Malaria platform. Results were compared with microscopy from thick and thin blood films in all cases. In case of discordant results between LAMP and microscopy (n = 60), confirmation testing was performed with real-time PCR. Persistence of circulating parasite DNA was analyzed by serial assessments of blood samples following malaria treatment. RESULTS Out of 1000 blood samples analyzed, 238 were positive for malaria parasites according to microscopy (n = 181/1000) or PCR (additional n = 57/60). LAMP demonstrated sensitivity of 98.7% (235/238), specificity of 99.6% (759/762), positive predictive value (PPV) of 98.7% (235/238) and negative predictive value (NPV) of 99.6% (759/762), respectively. For first slides of patients with malaria and for follow-up slides, sensitivity values were 99.1% (106/107) and 98.5% (129/131), respectively. CONCLUSIONS The performance of the Meridian illumigene Malaria platform is suitable for initial screening of patients suspected of clinical malaria.
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Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Tropical Microbiology and Entomology Unit, Bundeswehr Hospital Hamburg, Bernhard Nocht Str. 74, 20359 Hamburg, Germany; Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057 Rostock, Germany.
| | - Rebecca Hinz
- Department of Microbiology and Hospital Hygiene, Tropical Microbiology and Entomology Unit, Bundeswehr Hospital Hamburg, Bernhard Nocht Str. 74, 20359 Hamburg, Germany.
| | - Sandra Rojak
- Department of Microbiology and Hospital Hygiene, Tropical Microbiology and Entomology Unit, Bundeswehr Hospital Hamburg, Bernhard Nocht Str. 74, 20359 Hamburg, Germany; Department of Infectious Diseases and Tropical Medicine, Bundeswehr Hospital Hamburg, Bernhard Nocht Str. 74, 20359 Hamburg, Germany.
| | - Insa Bonow
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359 Hamburg, Germany.
| | - Stefanie Ruben
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359 Hamburg, Germany.
| | - Christine Wegner
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359 Hamburg, Germany.
| | - Iris Zielke
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359 Hamburg, Germany.
| | - Ralf Matthias Hagen
- Department of Preventive Medicine, Bundeswehr Medical Academy, Neuherbergstr. 11, 80937 Munich, Germany.
| | - Egbert Tannich
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359 Hamburg, Germany.
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Wadunde I, Mpimbaza A, Musoke D, Ssempebwa JC, Ediau M, Tuhebwe D, Adoke Y, Wanyenze RK. Factors associated with willingness to take up indoor residual spraying to prevent malaria in Tororo district, Uganda: a cross-sectional study. Malar J 2018; 17:5. [PMID: 29304803 PMCID: PMC5755310 DOI: 10.1186/s12936-017-2163-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 12/23/2017] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Indoor residual spraying (IRS) is an efficient method of preventing malaria in homes, and community willingness to take up IRS is critical to its success. The first phase of IRS was conducted in Tororo district, Uganda between December 2014 and January 2015. High coverage rates (90%) were attained in the district. However, Mulanda sub-county had the lowest coverage of 78%, in the first round. This study assessed willingness and associated factors of IRS uptake among household heads for the next IRS campaign in Mulanda sub-county, Tororo district. METHODS A household survey was conducted in all three parishes of Mulanda sub-county. A multistage sampling technique involving the village and household as the first and second sampling levels, respectively, was used to identify 640 households Household heads were interviewed using standard questionnaire. Seven key informants were also conducted to explore the impact of community IRS-perceptions on uptake. Bi-variable and multi-variable logistic regression analyses were used to identify factors associated with willingness to take up IRS. Qualitative data was analysed by thematic content analysis method. RESULTS Most (79.9%) respondents were willing to take up repeat IRS. However this was below the target of 85%. Fear of insecticide adverse effects (62%) was the most common reason mentioned by 134 (21%) household heads who were not willing to take up IRS. Factors associated with to take up IRS were; age ≥ 35 years (AOR 1.9; 95% CI 1.08-3.51), higher socio-economic status (AOR 0.4; 95% CI 0.27-0.98), not taking IRS in previous round (AOR 0.1; 95% CI 0.06-0.23), not knowing reason for conducting IRS (AOR 0.4; 95% CI 0.24-0.78) and having an iron sheet roof (AOR 2.2; 95% CI 1.03-4.73). Community and religious leaders were the preferred sources of IRS information. CONCLUSIONS The level of willingness to take up IRS was low (79%) compared to the targeted 85%. Involvement of community and religious leaders in community sensitization on the efficacy and safety of the chemicals could increase uptake of IRS.
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Affiliation(s)
- Ignatius Wadunde
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Arthur Mpimbaza
- Child Health and Development Centre, School of Medicine, Makerere University College of Health Sciences, P.O. Box 6717, Kampala, Uganda.,Infectious Diseases Research Collaboration, P.O. Box 7475, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Infectious Diseases Research Collaboration, P.O. Box 7475, Kampala, Uganda
| | - John C Ssempebwa
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Infectious Diseases Research Collaboration, P.O. Box 7475, Kampala, Uganda
| | - Michael Ediau
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Doreen Tuhebwe
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Yeka Adoke
- Child Health and Development Centre, School of Medicine, Makerere University College of Health Sciences, P.O. Box 6717, Kampala, Uganda.,Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Infectious Diseases Research Collaboration, P.O. Box 7475, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Infectious Diseases Research Collaboration, P.O. Box 7475, Kampala, Uganda
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