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Segala FV, Ictho J, L'Episcopia M, Onapa E, De Vita E, Novara R, Olung N, Totaro V, Olal L, Patti G, Bingom C, Farina U, Papagni R, Agaro C, Bavaro DF, Amone J, Dall'Oglio G, Ngole B, Marotta C, Okori S, Zarcone M, Ogwang J, Severini C, Lochoro P, Putoto G, Saracino A, Di Gennaro F. Impact of the COVID-19 pandemic on malaria in pregnancy indicators in Northern Uganda: a joinpoint regression analysis. Pathog Glob Health 2023:1-9. [PMID: 37872763 DOI: 10.1080/20477724.2023.2273023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Pregnancy is both a risk factor for P. falciparum infection and development of severe malaria. In low- and middle-income countries, the COVID-19 pandemic severely impacted health systems, including utilization of maternal services. This study aimed to assess trends in delivering malaria in pregnancy-related health-care services before and during COVID-19 in Northern Uganda. METHODS An interrupted time-series study comparing pre-COVID-19 (January 2018 to April 2020) and COVID-19 (May to December 2021) periods, based on the date the first COVID case was detected. The study involved 30 health facilities in Northern Uganda with 22,650 estimated pregnancies per year, 14% of which took place in hospital. Monthly data were sourced from District routinely collected indicators. Trends were analyzed by joinpoint regression models. RESULTS From the onset of the COVID pandemic in Uganda (May 2020), we found a significant reduction in the number of women accessing a fourth antenatal care visit (from APC + 183.5 to + 4.98; p < 0.001) and taking at least three doses of intermittent preventive treatment in pregnancy (IPTp, from APC + 84.28 to -63.12; p < 0.001). However, we found no significant change in the trend of the total number of pregnant women managed as outpatients or hospitalized for malaria, as well as in the number of women attending their first antenatal visit and in the number of institutional deliveries. CONCLUSIONS In our study, the COVID-19 pandemic significantly reduced access to ANC visits and IPTp uptake. However, the healthcare system maintained its capacity for managing malaria cases, first antenatal visits, and institutional deliveries.Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26 April 2022. ClinicalTrials.gov Identifier: NCT05348746.
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Affiliation(s)
- Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Jerry Ictho
- Health Service Management, Doctors with Africa CAUMM, Kampala, Uganda
| | | | - Emmanuel Onapa
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Elda De Vita
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Roberta Novara
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Nelson Olung
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Valentina Totaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Lameck Olal
- Operational Research Unit, African Network for Change, Kampala, Uganda
| | - Giulia Patti
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | | | - Umberto Farina
- Hygiene Unit, Policlinico Riuniti Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Roberta Papagni
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Caroline Agaro
- Health Office, Oyam District Local Government, Loro, Uganda
| | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - James Amone
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | | | - Benedict Ngole
- Operational Research Unit, African Network for Change, Kampala, Uganda
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Samuel Okori
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Maurizio Zarcone
- Unità Operativa Complessa di Epidemiologia Clinica con Registro Tumori, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy
| | - Joseph Ogwang
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Carlo Severini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Peter Lochoro
- Health Service Management, Doctors with Africa CAUMM, Kampala, Uganda
| | - Giovanni Putoto
- Health Service Management, Doctors with Africa CAUMM, Kampala, Uganda
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
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Massavon W, Wilunda C, Nannini M, Agaro C, Amandi S, Orech JB, De Vivo E, Lochoro P, Putoto G. Community perceptions on demand-side incentives to promote institutional delivery in Oyam district, Uganda: a qualitative study. BMJ Open 2019; 9:e026851. [PMID: 31501099 PMCID: PMC6738676 DOI: 10.1136/bmjopen-2018-026851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine the perceptions of community members and other stakeholders on the use of baby kits and transport vouchers to improve the utilisation of childbirth services. DESIGN A qualitative study. SETTING Oyam district, Uganda. PARTICIPANTS We conducted 10 focus group discussions with 59 women and 55 men, and 18 key informant interviews with local leaders, village health team members, health facility staff and district health management team members. We analysed the data using qualitative content analysis. RESULTS Five broad themes emerged: (1) context, (2) community support for the interventions, (3) health-seeking behaviours postintervention, (4) undesirable effects of the interventions and (5) implementation issues and lessons learnt. Context regarded perceived long distances to health facilities and high transport costs. Regarding community support for the interventions, the schemes were perceived to be acceptable and helpful particularly to the most vulnerable. Transport vouchers were preferred over baby kits, although both interventions were perceived to be necessary. Health-seeking behaviours entailed perceived increased utilisation of maternal health services and 'bypassing', promotion of collaboration between traditional birth attendants and formal health workers, stimulation of men's involvement in maternal health, and increased community awareness of maternal health. Undesirable effects of the interventions included increased workload for health workers, sustainability concerns and perceived encouragement to reproduce and dependency. Implementation issues included information gaps leading to confusion, mistrust and discontent, transport voucher scheme design; implementation; and payment problems, poor attitude of some health workers and poor quality of care, insecurity, and a shortage of baby kits. Community involvement was key to solving the challenges. CONCLUSIONS The study provides further insights into the implementation of incentive schemes to improve maternal health services utilisation. The findings are relevant for planning and implementing similar schemes in low-income countries.
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Affiliation(s)
| | - Calistus Wilunda
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
- Division of Epidemiology and Prevention, National Cancer Center Japan, Chuo-ku, Japan
| | - Maria Nannini
- School of Economics and Development, University of Florence, Florence, Italy
| | - Caroline Agaro
- District Health Office, Oyam District Local Government, Loro, Uganda
| | - Simon Amandi
- District Health Office, Oyam District Local Government, Loro, Uganda
| | - John Bosco Orech
- District Health Office, Oyam District Local Government, Loro, Uganda
| | | | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
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Massavon W, Wilunda C, Nannini M, Majwala RK, Agaro C, De Vivo E, Lochoro P, Putoto G, Criel B. Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study. BMC Pregnancy Childbirth 2017; 17:431. [PMID: 29258475 PMCID: PMC5737523 DOI: 10.1186/s12884-017-1623-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated the effects and financial costs of two interventions with respect to utilisation of institutional deliveries and other maternal health services in Oyam District in Uganda. METHODS We conducted a quasi-experimental study involving intervention and comparable/control sub-counties in Oyam District for 12 months (January-December 2014). Participants were women receiving antenatal care, delivery and postnatal care services. We evaluated two interventions: the provision of (1) transport vouchers to women receiving antenatal care and delivering at two health centres (level II) in Acaba sub-county, and (2) baby kits to women who delivered at Ngai Health Centre (level III) in Ngai sub-county. The study outcomes included service coverage of institutional deliveries, four antenatal care visits, postnatal care, and the percentage of women 'bypassing' maternal health services inside their resident sub-counties. We calculated the effect of each intervention on study outcomes using the difference in differences analysis. We calculated the cost per institutional delivery and the cost per unit increment in institutional deliveries for each intervention. RESULTS Overall, transport vouchers had greater effects on all four outcomes, whereas baby kits mainly influenced institutional deliveries. The absolute increase in institutional deliveries attributable to vouchers was 42.9%; the equivalent for baby kits was 30.0%. Additionally, transport vouchers increased the coverage of four antenatal care visits and postnatal care service coverage by 60.0% and 49.2%, respectively. 'Bypassing' was mainly related to transport vouchers and ranged from 7.2% for postnatal care to 11.9% for deliveries. The financial cost of institutional delivery was US$9.4 per transport voucher provided, and US$10.5 per baby kit. The incremental cost per unit increment in institutional deliveries in the transport-voucher system was US$15.9; the equivalent for the baby kit was US$30.6. CONCLUSION The transport voucher scheme effectively increased utilisation of maternal health services whereas the baby-kit scheme was only effective in increasing institutional deliveries. The transport vouchers were less costly than the baby kits in the promotion of institutional deliveries. Such incentives can be sustainable if the Ministry of Health integrates them in the health system.
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Affiliation(s)
- William Massavon
- Doctors with Africa CUAMM, Aber Hospital, P. O. Box 130, Lira, Uganda
| | - Calistus Wilunda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, Kyoto, 606-8501 Japan
- Doctors with Africa CUAMM, Via San Francisco 126, 35121 Padua, Italy
| | - Maria Nannini
- School of Economics and Development, University of Florence, Via delle Pandette, 32, (50127) Florence, Italy
| | - Robert Kaos Majwala
- Doctors with Africa CUAMM, Aber Hospital, P. O. Box 130, Lira, Uganda
- Kampala Capital City Authority, Plot 1-3 Kyagwe Road, P.O. Box 7010, Kampala, Uganda
| | - Caroline Agaro
- District Health Office, Oyam District Local Government, P. O. Box 30 Loro, Oyam Town Council, Oyam, Uganda
| | - Emanuela De Vivo
- Doctors with Africa CUAMM, Aber Hospital, P. O. Box 130, Lira, Uganda
| | - Peter Lochoro
- Doctors with Africa CUAMM, Plot 3297 Church Road, P.O. Box 7214, Kampala, Uganda
| | - Giovanni Putoto
- Doctors with Africa CUAMM, Via San Francisco 126, 35121 Padua, Italy
| | - Bart Criel
- Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Agaro C, Beyeza-Kashesya J, Waiswa P, Sekandi JN, Tusiime S, Anguzu R, Kiracho EE. The conduct of maternal and perinatal death reviews in Oyam District, Uganda: a descriptive cross-sectional study. BMC Womens Health 2016; 16:38. [PMID: 27418127 PMCID: PMC4944522 DOI: 10.1186/s12905-016-0315-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/07/2016] [Indexed: 11/18/2022]
Abstract
Background Uganda like many developing countries still experiences high levels of maternal and perinatal deaths despite a decade of maternal and perinatal death review (MPDR) program. Oyam district has been implementing MPDR since 2008 with varying successes among the health facilities. This paper presents the factors that influence the conduct of maternal and perinatal death reviews in Oyam District, Uganda. Methods This was a cross-sectional study where both qualitative and quantitative data were collected. Semi-structured interviews were administered to 66 health workers and ten key informants (KIs) to assess the factors influencing the conduct of MPDR. Univariate and Bivariate analysis of quantitative data was done using SPSS version 17.0. A Pearson Chi-Square test was done to determine factors associated with conduct of MPDR. Factors with a p-value < 0.05 were considered statistically significant. Qualitative data was analyzed using content analysis. Results Only 34.8 % of the health workers had ever participated in MPDR. The factors that influenced conduct of MPDR were existence of MPDR committees (p < 0.001), attendance of review meetings (p < 0.001) and knowledge of objectives of MPDR (p < 0.001), implementation of MPDR recommendations (p < 0.001), observed improvement in maternal and newborn care (p < 0.001) and provision of feedback (p < 0.001). Hindrance to conduct of MPDR was obtained from KIs: the health workers were not made aware of the MPDR process, committee formation and training of MPDR committee members was not effectively done, inadequate support supervision, and lack of financial motivation of MPDR committee members. Challenges to MPDR included: heavy workload to health workers, high number of perinatal deaths, and non-implementation of recommendations. Conclusion The proportion of maternal and perinatal death reviews conducted in Oyam was low. This was due to poor initiation of the review process and a lack of support supervision. The district and Ministry of Health needs to put more emphasis on monitoring the conduct of maternal and perinatal death reviews by: forming and training MPDR committees and ensuring they are financially supported, providing overall coordination, and ensuring effective support supervision. Electronic supplementary material The online version of this article (doi:10.1186/s12905-016-0315-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline Agaro
- Makerere University School of Public Health, Kampala, Uganda
| | - Jolly Beyeza-Kashesya
- Department of Obstetrics and Gynaecology, Makerere University, College of Health Sciences, Kampala, Uganda.
| | - Peter Waiswa
- Depertment of Health Policy, Planning and Management Makerere University School of Public Health, Kampala, Uganda
| | - Juliet N Sekandi
- Department of Epidemiology & Biostatistics Makerere University School of Public Health, Kampala, Uganda
| | - Suzan Tusiime
- Makerere University School of Public Health, Kampala, Uganda
| | - Ronald Anguzu
- Makerere University School of Public Health, Kampala, Uganda
| | - Elizabeth Ekirapa Kiracho
- Depertment of Health Policy, Planning and Management Makerere University School of Public Health, Kampala, Uganda
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