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Walusaga HAG, Atuyambe LM, Muddu M, Mpirirwe R, Nangendo J, Kalibbala D, Semitala FC, Katahoire AR. Perceptions and factors associated with the uptake of the community client-led antiretroviral therapy delivery model (CCLAD) at a large urban clinic in Uganda: a mixed methods study. BMC Health Serv Res 2023; 23:1165. [PMID: 37885014 PMCID: PMC10605330 DOI: 10.1186/s12913-023-10182-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Community Client-Led ART Delivery (CCLAD) is a community HIV care model. In this model, a group of persons living with HIV (PLHIV) in a specific location, take turns going to the HIV clinic to pick up Antiretroviral Treatment refills for members. The uptake of this model, however, remains low despite its improvements in patient retention. In this study, we explored PLHIV's perceptions of this model and identified the factors associated with its low uptake. METHODS This was a mixed methods study based on a retrospective review of records of PLHIV and in-depth interviews. We reviewed the medical records of people receiving ART to determine their current model of ART delivery and conducted in-depth interviews with 30 participants who were eligible to be enrolled in the CCLAD model at the Mulago ISS clinic. We performed logistic regression to identify factors associated with the uptake of the CCLAD model and inductive thematic analysis to explore PLHIV's perceptions of the CCLAD model. RESULTS A total of 776 PLHIV were sampled for the study, 545 (70.2%) of whom were female. The mean age (standard deviation) was 42 (± 9.3) years. Overall, 55 (7.1%) received ART using the CCLAD model. Compared to other ART-delivery models, CCLAD was associated with being on ART for at least eight years (AOR 3.72; 95% CI: 1.35-10.25) and having no prior missed clinic appointments (AOR 10.68; 95% CI: 3.31-34.55). Mixed perceptions were expressed about the CCLAD model. Participants interviewed appreciated CCLAD for its convenience and the opportunities it offered members to talk and support each other. Others however, expressed concerns about the process of group formation, and feeling detached from the health facility with consequences of lack of confidentiality. CONCLUSION The current uptake of the CCLAD model is lower than the national recommended percentage of 15%. Its uptake was associated with those who had been in care for a longer period and who did not miss appointments. Despite CCLAD being perceived as convenient and as promoting support among members, several challenges were expressed. These included complexities of group formation, fear of stigma and feelings of detachment from health facilities among others. So, while CCLAD presents a promising alternative ART delivery model, more attention needs to be paid to the processes of group formation and improved patient monitoring to address the feelings of detachment from the facility and facility staff.
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Affiliation(s)
| | - Lynn M Atuyambe
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Martin Muddu
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Ruth Mpirirwe
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Statistics and Applied Economics, Kampala, Uganda
| | - Joan Nangendo
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dennis Kalibbala
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred C Semitala
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anne R Katahoire
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Child Health Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
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Namale-Matovu J, Kusolo R, Serunjogi R, Barlow-Mosha L, Mumpe-Mwanja D, Niombi N, Kalibbala D, Williamson D, Valencia D, Moore CA, Mwambi K, Nelson LJ, Namukanja-Mayambala PM, Williams JL, Mai CT, Qi YP, Musoke P. Strengthening capacity of health workers to diagnose birth defects in Ugandan hospitals from 2015 to 2021. BMC Med Educ 2023; 23:766. [PMID: 37833686 PMCID: PMC10576368 DOI: 10.1186/s12909-023-04760-w] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Limited diagnostic capabilities, resources and health worker skills have deterred the advancement of birth defects surveillance systems in most low- and middle-income countries (LMICs). Empowering health workers to identify and diagnose major external birth defects (BDs) is crucial to establishing effective hospital-based BD surveillance. Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration BD Surveillance System consists of three diagnostic levels: (1) surveillance midwives, (2) MU-JHU clinical team, and (3) U.S. Centers for Disease Control and Prevention (CDC) birth defects subject matter experts (SMEs) who provide confirmatory diagnosis. The diagnostic concordance of major external BDs by surveillance midwives or MU-JHU clinical team with CDC birth defects SMEs were estimated. METHODS Study staff went through a series of trainings, including birth defects identification and confirmation, before surveillance activities were implemented. To assess the diagnostic concordance, we analyzed surveillance data from 2015 to 2021 for major external BDs: anencephaly, iniencephaly, encephalocele, spina bifida, craniorachischisis, microcephaly, anophthalmia/microphthalmia, anotia/microtia, cleft palate alone, cleft lip alone, cleft lip with cleft palate, imperforate anus, hypospadias, talipes equinovarus, limb reduction, gastroschisis, and omphalocele. Positive predictive value (PPV) as the proportion of BDs diagnosed by surveillance midwives or MU-JHU clinical team that were confirmed by CDC birth defects SMEs was computed. PPVs between 2015 and 2018 and 2019-2021 were compared to assess the accuracy of case diagnosis over time. RESULTS Of the 204,332 infants examined during 2015-2021, 870 infants had a BD. Among the 1,245 BDs identified, 1,232 (99.0%) were confirmed by CDC birth defects SMEs. For surveillance midwives, PPV for 7 of 17 BDs was > 80%. For the MU-JHU clinical team, PPV for 13 of 17 BDs was > 80%. Among surveillance midwives, PPV improved significantly from 2015 to 2018 to 2019-2021, for microcephaly (+ 50.0%), cleft lip with cleft palate (+ 17.0%), imperforate anus (+ 30.0%), and talipes equinovarus (+ 10.8%). Improvements in PPV were also observed among MU-JHU clinical team; however, none were significant. CONCLUSION The diagnostic accuracy of the midwives and clinical team increased, highlighting that BD surveillance, by front-line health care workers (midwives) in LMICs is possible when midwives receive comprehensive training, technical support, funding and continuous professional development.
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Affiliation(s)
- Joyce Namale-Matovu
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda.
| | - Ronald Kusolo
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | - Robert Serunjogi
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | - Linda Barlow-Mosha
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | | | - Dennis Kalibbala
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | - Dhelia Williamson
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | | | | | - Lisa J Nelson
- Division of Global HIV and TB, US CDC, Kampala, Uganda
| | | | - Jennifer L Williams
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Cara T Mai
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Philippa Musoke
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
- Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda
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Nkosi-Gondwe T, Robberstad B, Opoka R, Kalibbala D, Rujumba J, Galileya LT, Akun P, Nambatya W, Ssenkusu J, TerKuile F, Phiri K, Idro R. Dihydroartemisinin-piperaquine or sulphadoxine-pyrimethamine for the chemoprevention of malaria in children with sickle cell anaemia in eastern and southern Africa (CHEMCHA): a protocol for a multi-centre, two-arm, double-blind, randomised, placebo-controlled superiority trial. Trials 2023; 24:257. [PMID: 37016392 PMCID: PMC10074896 DOI: 10.1186/s13063-023-07274-4] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND An estimated 300,000 babies are born with sickle cell anaemia (SCA) annually. Affected children have chronic ill health and suffer premature death. Febrile illnesses such as malaria commonly precipitate acute crises in children with SCA. Thus, chemoprophylaxis for malaria is an important preventive strategy, but current regimes are either sub-optimally effective (e.g. monthly sulphadoxine-pyrimethamine, SP) or difficult to adhere to (e.g. daily proguanil). We propose dihydroartemisinin-piperaquine (DP) as the agent with the most potential to be used across Africa. METHODS This will be a randomised, double-blind, parallel-group superiority trial of weekly single-day courses of DP compared to monthly single-day courses of SP in children with SCA. The study will be conducted in eastern (Uganda) and southern (Malawi) Africa using randomisation stratified by body weight and study centre. Participants will be randomised using an allocation of 1:1 to DP or SP. We will investigate the efficacy, safety, acceptability and uptake and cost-effectiveness of malaria chemoprevention with weekly courses of DP vs monthly SP in 548 to 824 children with SCA followed up for 12-18 months. We will also assess toxicity from cumulative DP dosing and the development of resistance. Participant recruitment commenced on 30 April 2021; follow-up is ongoing. DISCUSSION At the end of this study, findings will be used to inform regional health policy. This manuscript is prepared from protocol version 2.1 dated 1 January 2022. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov, NCT04844099 . Registered on 08 April 2021.
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Affiliation(s)
| | | | - Robert Opoka
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Joseph Rujumba
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Pamela Akun
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Winnie Nambatya
- Makerere University College of Health Sciences, Kampala, Uganda
| | - John Ssenkusu
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Kamija Phiri
- Training and Research Unit of Excellence, Blantyre, Malawi
| | - Richard Idro
- Makerere University College of Health Sciences, Kampala, Uganda.
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Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Lalitha R, Owachi D, Atine E, Nassazi J, Turyahabwe S, Sekadde M. Integration of COVID-19 and TB screening in Kampala, Uganda: healthcare provider perspectives. Implement Sci Commun 2023; 4:8. [PMID: 36650596 PMCID: PMC9844180 DOI: 10.1186/s43058-023-00391-w] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Following the first wave of the COVID-19 outbreak, Uganda experienced a 40% drop in tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCPs) at a National Referral Hospital in Kampala, Uganda. DESIGN/METHODS We conducted a cross-sectional study using in-depth interviews with 12 HCPs involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral Hospital, Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and we denoted the emergent themes as barriers to and facilitators of COVID-19/TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation, and Behavior (COM-B) model. RESULTS The facilitators to integrated COVID-19 and TB screening included the availability of TB focal persons and already existing training forums at the hospital that could be utilized to strengthen the capacity of HCP to integrate COVID-19 and TB screening. The barriers included HCP's inadequate knowledge on how to integrate screening of COVID-19 and TB, the absence of simple easy-to-use standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), understaffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training. CONCLUSIONS These findings provided a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19. Future studies should evaluate the effect of addressing these barriers to the integration of COVID-19 and TB as well as the effect of this on TB case finding in high-burden TB settings.
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Affiliation(s)
- Fred C. Semitala
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rodgers Katwesigye
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Dennis Kalibbala
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Mary Mbuliro
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rejani Lalitha
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Darius Owachi
- grid.513250.0Kiruddu National Referral Hospital, Kampala, Uganda
| | - Edgar Atine
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Josephine Nassazi
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Stavia Turyahabwe
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
| | - Moorine Sekadde
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
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Muzeyi W, Aggrey S, Kalibbala D, Katairo T, Semitala FC, Katamba A, Ayakaka I, Kalema N. Uptake of community antiretroviral group delivery models for persons living with HIV in Arua district, Uganda: A parallel convergent mixed methods study. PLOS Glob Public Health 2023; 3:e0000633. [PMID: 36962948 PMCID: PMC10021482 DOI: 10.1371/journal.pgph.0000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
Community antiretroviral groups (CAGs) is one of the innovative and efficient differentiated service delivery models (DSDM) for reaching persons needing human immunodeficiency virus (HIV) treatment in the community. Since DSDM adoption in Uganda, evidence suggests better care outcomes for patients in DSDM compared to counterparts in routine health facility care. However, uptake of CAG models for eligible community groups of persons living with HIV (PLHIV) has been slow in Arua district, Uganda and stakeholders' perceptions regarding its implementation unexplored. The objective of the study was to determine the uptake, barriers and facilitators influencing CAG model implementation in Arua district, Uganda. We conducted a parallel convergent mixed-methods study from March 2020 to December 2020 at Adumi health centre IV and Kuluva hospital in Arua district. We enrolled and extracted data for every fifth virally suppressed participant on antiretroviral therapy (ART) at the two health facilities. Data were analysed using STATA 13.0. Uptake was determined as the proportion of eligible PLHIV that were enrolled into a group. We performed logistic regression to determine factors associated with uptake. We conducted one focus group discussion per facility among healthcare workers involved in the management of PLHIV. We also conducted 7 focus group discussions among PLHIV across the two facilities. Thematic analysis was used to describe the data. A total of 399 PLHIV were eligible for CAG, 61.6% were female, and 44.9% were on dolutegravir (DTG) based regimen. Uptake was 6.8%, 95% CI (4.7-9.7) and was found to be significantly associated with being divorced or separated in a marriage (OR; 0.14, 95%CI; 0.02-0.92, P = 0.014). Members picking drugs in turns, comforting and encouraging others to take the drugs, and health workers advising them to join and stay with other group members were perceived as facilitators to uptake of community antiretroviral group delivery model. Having few and distant eligible members in the local area to form a group, lack of transport among the member to pick the drugs when it's their turn, misunderstandings and lack of confidentiality amongst the members, and lack of partner disclosure were perceived as barriers to uptake of community antiretroviral group delivery model. Uptake of community antiretroviral group delivery model in Arua district is very low. There may be a need to support community antiretroviral group delivery models with income- generating activities, transport facilitation, closer community drug pick-up points and improved partner disclosure support mechanisms among married group members.
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Affiliation(s)
- Wani Muzeyi
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Semeere Aggrey
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dennis Kalibbala
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Thomas Katairo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred C Semitala
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Achilles Katamba
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Irene Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Kalema
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Kalibbala D, Kakande A, Serunjogi R, Williamson D, Mumpe-Mwanja D, Namale-Matovu J, Valencia D, Nalwoga B, Namirembe C, Seyionga J, Nanfuka M, Nakimuli S, Achom MO, Mwambi K, Musoke P, Barlow-Mosha L. Mobile tablets for real-time data collection for hospital-based birth defects surveillance in Kampala, Uganda: Lessons learned. PLOS Glob Public Health 2022; 2:e0000662. [PMID: 35910484 PMCID: PMC9335296 DOI: 10.1371/journal.pgph.0000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/01/2022] [Indexed: 11/19/2022]
Abstract
Sustainable birth defects surveillance systems provide countries with estimates of the prevalence of birth defects to guide prevention, care activities, and evaluate interventions. We used free and open-source software (Open Data Kit) to implement an electronic system to collect data for a hospital-based birth defects surveillance system at four major hospitals in Kampala, Uganda. We describe the establishment, successes, challenges, and lessons learned from using mobile tablets to capture data and photographs. After intensive training, surveillance midwives collected data using Android tablets with inbuilt logic checks; another surveillance midwife checked the quality of the data in real-time before data were securely uploaded onto a local server. Paper forms were used when needed as a backup for the electronic system. We experienced several challenges implementing the surveillance system, including forgotten passwords, unstable network, reduced tablet speed and freezing, loss of touch-screen sensitivity, decreased battery strength, and repetitive extensive retraining. We addressed these challenges by backing up and removing all photos from the tablet, uninstalling irrelevant applications to the study to increase storage space and speed, and monitoring and updating the system based mainly on feedback from the midwives. From August 2015 to December 2018, surveillance midwives documented information on 110,752 births at the participating hospitals. Of these, 110,573 (99.8%) were directly entered into the electronic data system and 179 (0.2%) were captured on paper forms. The use of mobile tablets for real-time data collection was successful in a hospital-based birth defects surveillance system in a resource-limited setting. Extensive training and follow-up can overcome challenges and are key to preparing staff for a successful data collection system.
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Affiliation(s)
- Dennis Kalibbala
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Ayoub Kakande
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Robert Serunjogi
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Dhelia Williamson
- US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Daniel Mumpe-Mwanja
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Joyce Namale-Matovu
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Diana Valencia
- US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Beatrice Nalwoga
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Christine Namirembe
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Joan Seyionga
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Margaret Nanfuka
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Sophia Nakimuli
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | | | - Kenneth Mwambi
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Philippa Musoke
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Linda Barlow-Mosha
- Makerere University–Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
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Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Opio R, Owachi D, Atine E, Nassazi J, Turyahabwe S, Sekadde M. Integration of COVID-19 and TB screening in Kampala, Uganda - Healthcare provider perspectives. Res Sq 2022:rs.3.rs-1448831. [PMID: 35702151 PMCID: PMC9196119 DOI: 10.21203/rs.3.rs-1448831/v1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Following the first wave of COVID-19 outbreak, Uganda experienced a 40% drop in Tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCP) at a National Referral Hospital in Kampala, Uganda. Design/Methods: We conducted a cross sectional study using in-depth interviews with 12 HCP involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral hospital Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the Hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and the emergent themes were denoted as barriers to and facilitators of COVID-19-TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation and Behavior (COM-B) model. Results: The facilitators to integrated COVID-19 and TB screening included; HCP knowledge of how to separately screen for TB and COVID-19, availability of TB focal persons and interest in learning how to provide integrated screening for TB and COVID-19. The barriers included; HCP inadequate knowledge on how to integrate screening of TB and COVID-19, absence of simple standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), under staffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training. Conclusions: These findings provide a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19.
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Affiliation(s)
| | | | | | | | - Rejani Opio
- Makerere University Faculty of Medicine: Makerere University College of Health Sciences
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8
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Wani M, Nakigudde J, Nansikombi HT, Orishaba P, Kalibbala D, Kalyango JN, Kiwuwa SM. Contraceptive acceptability and associated factors among young women (15-24) living with HIV/AIDS: a hospital-based study in Kampala, Uganda. Afr Health Sci 2022; 22:21-27. [PMID: 36032466 PMCID: PMC9382528 DOI: 10.4314/ahs.v22i1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: In Uganda, over 43% of all pregnancies among young women (15-24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics inKampala.
Methods: Between February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive.Data were analyzed using STATA 13.0. Statistical significance was determined at a P values < 0.05.
Results: Contraceptive acceptability was 40.7% (95% CI: 27.6%-53.6%). Older age group (20-24 years) (aPR; 2.42, 95%CI; 1.06-5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13-1.38, P<0.001), having friend on contraceptives (aPR; 1.90, 95%CI; 1.10 - 3.26; P =0.021) and being married (aPR; 1.20, 95%CI; 1.09 - 1.32, P<0.001) were significantly associated with acceptability of contraceptives.
Conclusion: There is a low acceptability for contraceptives. Younger age group who are not yet married need to be targeted.
Keywords: Contraceptive acceptability; young women; HIV/AIDS; Kampala; Uganda.
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Affiliation(s)
- Muzeyi Wani
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Janet Nakigudde
- Department of psychiatry, School of medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hildah Tendo Nansikombi
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philip Orishaba
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dennis Kalibbala
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Steven M Kiwuwa
- Child Health Development Center, College of Health Sciences, Makerere University, Kampala, Uganda
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9
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Ssuna B, Katahoire A, Armstrong-Hough M, Kalibbala D, Kalyango JN, Kiweewa FM. Factors associated with willingness to use oral pre-exposure prophylaxis (PrEP) in a fisher-folk community in peri-urban Kampala, Uganda. BMC Public Health 2022; 22:468. [PMID: 35264123 PMCID: PMC8905810 DOI: 10.1186/s12889-022-12859-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/24/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends the use of pre-exposure prophylaxis (PrEP) in key populations at elevated risk for exposure to HIV. If used effectively, PrEP can reduce annual HIV incidence to below 0.05%. However, PrEP is not acceptable among all communities that might benefit from it. There is, therefore, a need to understand perceptions of PrEP and factors associated with willingness to use PrEP among key populations at risk of HIV, such as members of communities with exceptionally high HIV prevalence. OBJECTIVE To examine the perceptions and factors associated with willingness to use oral PrEP among members of fishing communities in Uganda, a key population at risk of HIV. METHODS We conducted an explanatory sequential mixed-methods study at Ggaba fishing community from February to June 2019. Survey data were collected from a systematic random sample of 283 community members in which PrEP had not been rolled out yet by the time of we conducted the study. We carried out bivariate tests of association of willingness to use PrEP with demographic characteristics, HIV risk perception, HIV testing history. We estimated prevalence ratios for willingness to use PrEP. We used backward elimination to build a multivariable modified Poisson regression model to describe factors associated with willingness to use PrEP. We purposively selected 16 participants for focus group discussions to contextualize survey findings, analysing data inductively and identifying emergent themes related to perceptions of PrEP. KEY RESULTS We enrolled 283 participants with a mean age of 31 ± 8 years. Most (80.9%) were male. The majority of participants had tested for HIV in their lifetime, but 64% had not tested in the past 6 months. Self-reported HIV prevalence was 6.4%. Most (80.6, 95%CI 75.5-85.0) were willing in principle to use PrEP. Willingness to use PrEP was associated with perceiving oneself to be at high risk of HIV (aPR 1.99, 95%CI 1.31-3.02, P = 0.001), having tested for HIV in the past 6-months (aPR 1.13, 95%CI 1.03-1.24, P = 0.007), and completion of tertiary education (aPR 1.97, 95%CI 1.39-2.81, P < 0.001). In focus group discussions, participants described pill burden, side-effects and drug safety as potential barriers to PrEP use. CONCLUSIONS AND RECOMMENDATIONS Oral PrEP was widely acceptable among members of fishing communities in peri-urban Kampala. Programs for scaling-up PrEP for fisherfolk should merge HIV testing services with sensitization about PrEP and also increase means of awareness of PrEP as an HIV preventive strategy .
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Affiliation(s)
- Bashir Ssuna
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences, P.O. Box 21696, Kampala, Uganda. .,Uganda Tuberculosis Implementation Research Collaboration (U-TIRC), P.O. Box 21696, Kampala, Uganda.
| | - Anne Katahoire
- Makerere College of Health Sciences, Child Health and Development Centre, Kampala, Uganda
| | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Collaboration (U-TIRC), P.O. Box 21696, Kampala, Uganda.,Department of Social and Behavioral Sciences, Department of Epidemiology, New York University School of Global Public Health, New York, USA
| | - Dennis Kalibbala
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences, P.O. Box 21696, Kampala, Uganda.,Makerere University-John Hopkins University Research Collaboration (MU-JHU), Kampala, Uganda
| | - Joan N Kalyango
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences, P.O. Box 21696, Kampala, Uganda
| | - Flavia Matovu Kiweewa
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences, P.O. Box 21696, Kampala, Uganda.,Makerere University-John Hopkins University Research Collaboration (MU-JHU), Kampala, Uganda
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10
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Kalibbala D, Mpungu SK, Ssuna B, Muzeyi W, Mberesero H, Semitala FC, Katahoire A, Armstrong-Hough M, Kalyango JN, Musiime V. Determinants of testing for HIV among young people in Uganda. A nested, explanatory-sequential study. PLOS Glob Public Health 2022; 2:e0000870. [PMID: 36962841 PMCID: PMC10022384 DOI: 10.1371/journal.pgph.0000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
Awareness of HIV serostatus helps individuals calibrate behaviour or link to care. Globally, young people (15-24years) contribute over 30% of new HIV infections. Despite progress in enhancing access to HIV services, HIV testing among young people in Uganda is below target. We determined the prevalence and factors influencing HIV testing among young people in a peri-urban district with the highest proportion of young people. We conducted a nested explanatory sequential mixed-methods study from March to May 2019 in Wakiso district. We used stratified cluster random sampling to select 397 rural and 253 urban young people from eight parishes. We collected data using questionnaires and subsequently conducted in-depth interviews with 16 purposively selected survey participants. The prevalence of testing for HIV was 80.2%. Young people related their decisions about HIV testing to self-evaluation of their risk and perceived ability to manage the consequences of a positive result. Participants reported high levels of support for HIV testing from peers, partners, and family members. They perceived health facilities as confusing, distant, expensive, and staffed by judgmental, older health workers as barriers. They felt that mobile testing points solved some of these problems, but introduced less privacy and greater confidentiality concerns. The prevalence of HIV testing among young people in Wakiso district was low compared to the UNAIDS 2030 target but among the highest in sub-Saharan Africa. Community-based programs resolve many concerns about testing at health facilities. However, there is a need to make these programs more comfortable and private.
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Affiliation(s)
- Dennis Kalibbala
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Steven Kiwuwa Mpungu
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bashir Ssuna
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Wani Muzeyi
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Happiness Mberesero
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred C Semitala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mari Armstrong-Hough
- Department of Epidemiology and Department of Social and Behavioral Sciences, New York University, New York, New York, United States of America
| | - Joan N Kalyango
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Victor Musiime
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
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11
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Barlow-Mosha L, Serunjogi R, Kalibbala D, Mumpe-Mwanja D, Williamson D, Valencia D, Tinker SC, Matovu JN, Moore CA, Adler MR, Nelson L, Nankunda J, Nabunya E, Birabwa-Male D, Musoke P. Prevalence of neural tube defects, maternal HIV status, and antiretroviral therapy from a hospital-based birth defect surveillance in Kampala, Uganda. Birth Defects Res 2021; 114:95-104. [PMID: 34766465 PMCID: PMC8828660 DOI: 10.1002/bdr2.1964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The estimated prevalence of neural tube defects (NTDs) in Africa is 11.7 per 10,000 live births; however, data on the impact of antiretroviral therapy (ART) during pregnancy and the risk for birth defects in Africa are limited. METHODS Data from a hospital-based surveillance program at four hospitals in Kampala, Uganda were used to estimate the baseline prevalence of NTDs and assess potential associations with HIV status and ART use. All live births, stillbirths, and spontaneous abortions delivered at the participating hospitals affected with selected birth defects between August 2015 and December 2018 were included. Trained midwives collected data from hospital records, maternal interviews, photographs, and narrative descriptions of birth defects. We estimated NTD prevalence per 10,000 births (live, stillbirths, spontaneous abortions), prevalence ratios, and 95% confidence intervals (CIs). RESULTS A total of 110,752 births from 107,133 women were included in the analysis; 9,394 (8.8%) women were HIV-infected and among those with HIV infection, 95.6% (n = 8,977) were on ART at delivery. Overall, 109 births were affected with NTDs, giving a prevalence of 9.8 (95% CI [8.2, 11.9]). Spina bifida (n = 63) was the most common type of NTD, with a prevalence of 5.7 (95% CI [4.4, 7.3]), followed by anencephaly (n = 31), with a prevalence of 2.8 (95% CI [2.0, 4.0]). CONCLUSION The prevalence of NTDs among births in Kampala, Uganda is consistent with current estimates for Africa. With the continued introduction of new medications that may be taken during pregnancy, sustainable birth defect surveillance systems and pharmacovigilance are indicated.
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Affiliation(s)
- Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Robert Serunjogi
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Dennis Kalibbala
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Dhelia Williamson
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Joyce Namale Matovu
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Michelle R Adler
- U.S. Centers for Disease Control and Prevention (CDC), Kampala, Uganda
| | - Lisa Nelson
- U.S. Centers for Disease Control and Prevention (CDC), Kampala, Uganda
| | - Jolly Nankunda
- Department of Paediatrics, Makerere University College of Health Sciences, Kampala, Uganda.,Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | - Evelyn Nabunya
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda.,Department of Paediatrics, Makerere University College of Health Sciences, Kampala, Uganda
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12
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Serunjogi R, Barlow-Mosha L, Mumpe-Mwanja D, Williamson D, Valencia D, Tinker SC, Adler MR, Namale-Matovu J, Kalibbala D, Nankunda J, Nabunya E, Birabwa-Male D, Byamugisha J, Musoke P. Comparative analysis of perinatal outcomes and birth defects amongst adolescent and older Ugandan mothers: evidence from a hospital-based surveillance database. Reprod Health 2021; 18:56. [PMID: 33663555 PMCID: PMC7934544 DOI: 10.1186/s12978-021-01115-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
Background Uganda has one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes between adolescents (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals. Methods Maternal demographics, HIV status, and birth outcomes of all live births, stillbirths, and spontaneous abortions delivered from August 2015 to December 2018 were extracted from a hospital-based birth defects surveillance database. Differences in the distributions of maternal and infant characteristics by maternal age groups were tested with Pearson’s chi-square. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated using logistic regression to compare the prevalence of adverse birth outcomes among adolescents to mothers 20–34 years. Results A total of 100,189 births were analyzed, with 11.1% among adolescent mothers and 89.0% among older mothers. Adolescent mothers had an increased risk of preterm delivery (aOR: 1.14; CI 1.06–1.23), low birth weight (aOR: 1.46; CI 1.34–1.59), and early neonatal deaths (aOR: 1.58; CI 1.23–2.02). Newborns of adolescent mothers had an increased risk of major external birth defects (aOR: 1.33; CI 1.02–1.76), specifically, gastroschisis (aOR: 3.20; CI 1.12–9.13) compared to mothers 20–34 years. The difference between the prevalence of gastroschisis among adolescent mothers (7.3 per 10,000 births; 95% CI 3.7–14.3) was statistically significant when compared to mothers 20–34 years (1.6 per 10,000 births; 95% CI 0.9–2.6). Conclusions This study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years, similar to findings in the region and globally. Interventions are needed to improve birth outcomes in this vulnerable population. Adolescent pregnancies are a global problem occurring in high-, middle-, and low-income countries with Uganda having one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes, including major external birth defects, between adolescents, (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals. All informative births, including live births, stillbirths, and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2018 were examined. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes. Of the 100,189 births, 11.0% were among adolescent mothers and 89.0% among mothers (20–34 years). Adolescent mothers were more likely than mothers (20–34 years) to have an infant with preterm delivery, low birth weight, early neonatal death, and major external birth defects. Adolescent pregnancies were also associated with an increased risk of gastroschisis when compared to mothers (20–34 years). In conclusion, this study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years. Research on the potential underlying causes or mechanisms for these adverse outcomes among adolescent births is necessary to identify possible interventions.
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Affiliation(s)
- Robert Serunjogi
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda.
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda
| | - Dhelia Williamson
- US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Diana Valencia
- US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sarah C Tinker
- US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Michelle R Adler
- US Centers for Disease Control and Prevention (CDC), Kampala, Uganda
| | - Joyce Namale-Matovu
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda
| | - Dennis Kalibbala
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda
| | - Jolly Nankunda
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Evelyn Nabunya
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Doreen Birabwa-Male
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda.,Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Namale-Matovu J, Barlow-Mosha L, Mumpe-Mwanja D, Kalibbala D, Serunjogi R, Nankunda J, Valencia D, Nabunya E, Byamugishat J, Birabwa-Male D, Okwero MA, Nolan M, Williamson D, Musoke P. Overcoming staffing challenges when implementing a birth defects surveillance system: a Ugandan experience. J Glob Health Rep 2020; 4. [PMID: 33851034 PMCID: PMC8040481 DOI: 10.29392/001c.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Joyce Namale-Matovu
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Linda Barlow-Mosha
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Dennis Kalibbala
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Robert Serunjogi
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jolly Nankunda
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Diana Valencia
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Evelyn Nabunya
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Josaphat Byamugishat
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Margaret A Okwero
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Uganda
| | - Monica Nolan
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Dhelia Williamson
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Philippa Musoke
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda; Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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