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Mwine P, Atuhaire I, Ahirirwe SR, Nansikombi HT, Senyange S, Elayeete S, Masanja V, Asio A, Komakech A, Nampeera R, Nsubuga EJ, Nakamya P, Kwiringira A, Migamba SM, Kwesiga B, Kadobera D, Bulage L, Okello PE, Nabatanzi S, Monje F, Kyamwine IB, Ario AR, Harris JR. Readiness of health facilities to manage individuals infected with COVID-19, Uganda, June 2021. BMC Health Serv Res 2023; 23:441. [PMID: 37143093 PMCID: PMC10159667 DOI: 10.1186/s12913-023-09380-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/09/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic overwhelmed the capacity of health facilities globally, emphasizing the need for readiness to respond to rapid increases in cases. The first wave of COVID-19 in Uganda peaked in late 2020 and demonstrated challenges with facility readiness to manage cases. The second wave began in May 2021. In June 2021, we assessed the readiness of health facilities in Uganda to manage the second wave of COVID-19. METHODS Referral hospitals managed severe COVID-19 patients, while lower-level health facilities screened, isolated, and managed mild cases. We assessed 17 of 20 referral hospitals in Uganda and 71 of 3,107 lower-level health facilities, selected using multistage sampling. We interviewed health facility heads in person about case management, coordination and communication and reporting, and preparation for the surge of COVID-19 during first and the start of the second waves of COVID-19, inspected COVID-19 treatment units (CTUs) and other service delivery points. We used an observational checklist to evaluate capacity in infection prevention, medicines, personal protective equipment (PPE), and CTU surge capacity. We used the "ReadyScore" criteria to classify readiness levels as > 80% ('ready'), 40-80% ('work to do'), and < 40% ('not ready') and tailored the assessments to the health facility level. Scores for the lower-level health facilities were weighted to approximate representativeness for their health facility type in Uganda. RESULTS The median (interquartile range (IQR)) readiness scores were: 39% (IQR: 30, 51%) for all health facilities, 63% (IQR: 56, 75%) for referral hospitals, and 32% (IQR: 24, 37%) for lower-level facilities. Of 17 referral facilities, two (12%) were 'ready' and 15 (88%) were in the "work to do" category. Fourteen (82%) had an inadequate supply of medicines, 12 (71%) lacked adequate supply of oxygen, and 11 (65%) lacked space to expand their CTU. Fifty-five (77%) lower-level health facilities were "not ready," and 16 (23%) were in the "work to do" category. Seventy (99%) lower-level health facilities lacked medicines, 65 (92%) lacked PPE, and 53 (73%) lacked an emergency plan for COVID-19. CONCLUSION Few health facilities were ready to manage the second wave of COVID-19 in Uganda during June 2021. Significant gaps existed for essential medicines, PPE, oxygen, and space to expand CTUs. The Uganda Ministry of Health utilized our findings to set up additional COVID-19 wards in hospitals and deliver medicines and PPE to referral hospitals. Adequate readiness for future waves of COVID-19 requires additional support and action in Uganda.
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Affiliation(s)
- Patience Mwine
- Uganda Public Health Fellowship Program, Kampala, Uganda.
| | | | | | | | | | - Sarah Elayeete
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | - Alice Asio
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Allan Komakech
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Rose Nampeera
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | | | | | | | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Lillian Bulage
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Paul E Okello
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Sandra Nabatanzi
- United States Centers for Disease Control and Prevention, Kampala, Uganda
| | - Fred Monje
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | - Alex R Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Julie R Harris
- United States Centers for Disease Control and Prevention, Kampala, Uganda
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Kok MO, Terra T, Tweheyo R, van der Hoeven M, Ponce MC, van Furth MT, Rutebemberwa E. Using telehealth to support community health workers in Uganda during COVID-19: a mixed-method study. BMC Health Serv Res 2023; 23:284. [PMID: 36973681 PMCID: PMC10040915 DOI: 10.1186/s12913-023-09217-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/23/2023] [Indexed: 03/28/2023] Open
Abstract
Background At the onset of the COVID-19 pandemic, a local consortium in Uganda set up a telehealth approach that aimed to educate 3,500 Community Health Workers (CHW) in rural areas about COVID-19, help them identify, refer and care for potential COVID-19 cases, and support them in continuing their regular community health work. The aim of this study was to assess the functioning of the telehealth approach that was set up to support CHWs during the COVID-19 pandemic. Methods For this mixed-method study, we combined analysis of routine consultation data from the call-center, 24 interviews with key-informants and two surveys of 150 CHWs. Data were analyzed using constant comparative method of analysis. Results Between March 2020 and June 2021, a total of 35,553 consultations took place via the call center. While the CHWs made extensive use of the call center, they rarely asked for support for potential Covid-19 cases. According to the CHWs, there were no signs that people in their communities were suffering from severe health problems due to COVID-19. People compared the lack of visible symptoms to diseases such as Ebola and were skeptical about the danger of COVID-19. At the same time, people in rural areas were afraid to report relevant symptoms and get tested for fear of being quarantined and stigmatized. The telehealth approach did prove useful for other purposes, such as supporting CHWs with their regular tasks and coordinating the supply of essential products. The health professionals at the call center supported CHWs in diagnosing, referring and treating patients and adhering to infection prevention and control practices. The CHWs felt more informed and less isolated, saying the support from the call center helped them to provide better care and improved the supply of medicine and other essential health products. Conclusions The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. The telehealth approach could be quickly set up and scaled up and offers a low cost strategy for providing useful and flexible support to CHWs in rural communities.
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Affiliation(s)
- Maarten Olivier Kok
- grid.6906.90000000092621349Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Tosca Terra
- Healthy Entrepreneurs Foundation, Kampala, Uganda
| | - Raymond Tweheyo
- grid.11194.3c0000 0004 0620 0548Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
| | - Marinka van der Hoeven
- grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Maiza Campos Ponce
- grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Marceline Tutu van Furth
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Vrije Universiteit Amsterdam Infectious Diseases, Amsterdam, The Netherlands
| | - Elizeus Rutebemberwa
- grid.11194.3c0000 0004 0620 0548Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
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Katusiime J, Tumuhimbise W, Rwambuka Mugyenyi G, Kobutungi P, Mugaba A, Zender R, Pinkwart N, Musiimenta A. The role of mobile health technologies in promoting COVID-19 prevention: A narrative review of intervention effectiveness and adoption. Digit Health 2022; 8:20552076221131146. [PMID: 36276182 PMCID: PMC9585560 DOI: 10.1177/20552076221131146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background Researchers have found innovative ways of using mobile health (mHealth) technologies to prevent the spread of coronavirus disease 2019 (COVID-19). However, fewer studies have been done to determine their adoption and effectiveness. Objective This review summarises the published evidence on the effect of mHealth technologies on the adoption of COVID-19 preventive measures, prevention knowledge acquisition and risk perception as well as technology adoption features for COVID-19 prevention. Methods PubMed, IEEE and Google Scholar databases were searched for peer-reviewed literature from 1 January 2020 to 31 March 2022 for studies that evaluated the effect of mHealth technologies on COVID-19 preventive measures adoption, prevention knowledge acquisition and risk perception. Thirteen studies met the inclusion criteria and were included in this review. All the included studies were checked for quality using the mHealth evidence reporting and assessment (mERA) checklist. Results The review found out that the utilisation of mHealth interventions such as alert text messages, tracing apps and social media platforms was associated with adherence behaviour such as wearing masks, washing hands and using sanitisers, maintaining social distance and avoiding crowded places. The use of contact tracing was linked to low-risk perception as users considered themselves well informed about their status and less likely to pose transmission risks compared to non-users. Privacy and security issues, message personalisation and frequency, technical issues and trust concerns were identified as technology adoption features that influence the use of mHealth technologies for promoting COVID-19 prevention. Conclusion Utilisation of mHealth may be a feasible and effective way to prevent the spread of COVID-19. However, the small study samples and short study periods prevent generalisation of the findings and calls for larger, longitudinal studies that encompass diverse study settings.
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Affiliation(s)
- Jane Katusiime
- Department of Computer Science, Humboldt Universität zu Berlin, Berlin, Germany,Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda,Jane Katusiime, Department of Computer Science, Humboldt Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany.
| | - Wilson Tumuhimbise
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Phionah Kobutungi
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Aaron Mugaba
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raphael Zender
- Department of Computer Science, Humboldt Universität zu Berlin, Berlin, Germany
| | - Niels Pinkwart
- Department of Computer Science, Humboldt Universität zu Berlin, Berlin, Germany
| | - Angella Musiimenta
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda
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Seruwagi G, Nakidde C, Otieno F, Kayiwa J, Luswata B, Lugada E, Ochen EA, Muhangi D, Okot B, Ddamulira D, Masaba A, Lawoko S. Healthworker preparedness for COVID-19 management and implementation experiences: a mixed methods study in Uganda's refugee-hosting districts. Confl Health 2021; 15:79. [PMID: 34732235 PMCID: PMC8564594 DOI: 10.1186/s13031-021-00415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background The negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for COVID-19 management and implementation experiences in Uganda’s refugee-hosting districts. Methods A cross sectional, mixed-method descriptive study in 17 health facilities in 7 districts from 4 major regions. Total sample size was 485 including > 370 health care workers (HCWs). HCW knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. The quantitative data was processed and analysed using SPSS 26, and statistical significance assumed at p < 0.05 for all statistical tests. Bloom's cutoff of 80% was used to determine threshold for sufficient knowledge level and practices with scores classified as high (80.0–100.0%), average (60.0–79.0%) and low (≤ 59.0%). HCW implementation experiences and key stakeholder opinions were further explored qualitatively using interviews which were audio-recorded, coded and thematically analysed. Results On average 71% of HCWs were knowledgeable on the various aspects of COVID-19, although there is a wide variation in knowledge. Awareness of symptoms ranked highest among 95% (p value < 0.0001) of HCWs while awareness of the criteria for intubation for COVID-19 patients ranked lowest with only 35% (p value < 0.0001). Variations were noted on falsehoods about COVID-19 causes, prevention and treatment across Central (p value < 0.0356) and West Nile (p value < 0.0161) regions. Protective practices include adequate ventilation, virtual meetings and HCW training. Deficient practices were around psychosocial and lifestyle support, remote working and contingency plans for HCW safety. The work environment has immensely changed with increased demands on the amount of work, skills and variation in nature of work. HCWs reported moderate control over their work environment but with a high level of support from supervisors (88%) and colleagues (93%). Conclusions HCWs preparedness is inadequate in some aspects. Implementation of healthcare interventions is constrained by the complexity of Uganda’s health system design, top-down approach of the national response to COVID-19 and longstanding health system bottlenecks. We recommend continuous information sharing on COVID-19, a design review with capacity strengthening at all health facility levels and investing in community-facing strategies.
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Affiliation(s)
- Gloria Seruwagi
- Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda. .,Department of Health Policy Planning and Management (HPPM), Makerere University School of Public Health (MakSPH), Kampala, Uganda.
| | - Catherine Nakidde
- Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda
| | - Felix Otieno
- Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda.,Infotrak Research Consulting, Nairobi, Kenya
| | - Joshua Kayiwa
- Public Health Emergency Operations Centre (PHEOC), Ministry of Health, Kampala, Uganda
| | - Brian Luswata
- Directorate of Health Governance and Regulation, Ministry of Health, Kampala, Uganda
| | - Eric Lugada
- Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda
| | - Eric Awich Ochen
- Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda
| | - Denis Muhangi
- Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda
| | - Betty Okot
- Centre for Health and Social Economic Improvement (CHASE-i) - Department of Social Work and Social Administration (SWSA), Makerere University, Kampala, Uganda
| | - Dunstan Ddamulira
- Agency for Cooperation in Research and Development (ACORD), Nairobi, Kenya
| | - Andrew Masaba
- The Lutheran World Federation (LWF), LWF, Kampala, Uganda
| | - Stephen Lawoko
- Department of Public Health - Faculty of Medicine, Gulu University, Gulu, Uganda
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