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Objective This study aimed to assess Uganda's readiness for implementing a national Point-of-Care (PoC) electronic clinical data capture platform that can function in near real-time. Methods A qualitative, cross-sectional design was adopted to obtain a snapshot of Uganda's eHealth system landscape with an aim to assess the readiness for implementing PoC platform. A purposive sampling strategy was used to select the study districts per region, health facilities per district, and participants per facility or district. Results Nine facilitators were identified, including health worker motivation to serve the community, affirmative action on eHealth financing, improved integrating information and communication technology (ICT) infrastructure, Internet and electricity power connectivity, improved human resource skills and knowledge, the culture of sensitizing and training of stakeholders on eHealth interventions, the perceived value of the platform, health workers' motivation to improve health data quality, interest to improve data use, and continuous improvement in the eHealth regulatory environment. Other suggestions entailed several requirements that must be met, including infrastructure, eHealth governance, human resources, as well as functional and data requirements. Discussion Uganda, like other low-income countries, has adopted ICT to help solve some of its health system challenges. Although several challenges face eHealth implementations in Uganda, this study revealed facilitators that can be leveraged and requirements that, if met, would facilitate the successful implementation of a near real-time data capture platform capable of improving the country's health outcomes. Conclusion Other countries with eHealth implementations similar to those faced in Uganda can also leverage identified facilitators and address the stakeholders' requirements. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) continues to persist with a high disease burden globally. Non-adherence to treatment remains a major problem to TB control. In Uganda, one in every four TB patients does not adhere to their TB medication. The purpose of this study was to design, develop and assess implementation of a voice-text-based mobile application to support TB patients' adherence to medication. Methods: Design science research methodology (DSRM) was utilized to develop a voice-text-based mobile health application. Agile software methodology was used to achieve steps of DSRM that are; design and development. Focus group discussions (FGDs) and Key informant interviews (KIIs) were conducted and data analysed using thematic content analysis. Results: During problem identification, Stigma, transport costs, being asymptomatic, drug side effects, lack of family support were identified as challenges affecting adherence. Technologies identified and used for the development of the voice-text application included; extensible mark-up language (XML) File, Apache server, Ubuntu Server, Hypertext Pre-processor, and jQuery. In the pilot study, 27 voice messages were broadcasted, 85.2% were delivered, 103 text messages were sent and 92.2% were delivered to the intended recipients. Conclusions: Voice-text message mobile health application can be used to reach a wider patient population and it has the capability of addressing some of the challenges affecting TB medication adherence. [ABSTRACT FROM AUTHOR]

More than 80% of the people infected with HIV in low-income countries of sub-Saharan Africa do not know their HIV serostatus. Innovative measures of increasing access to HIV counseling and testing (HCT) are urgently needed so as to improve care and prevention. We implemented a home-based HCT program in Bushenyi District from September 2004 to March 2007, in Uganda where approximately 90% of people aged older than 14 years had never tested for HIV to gauge whether it was acceptable and increased uptake of HCT. Twenty-nine teams comprising a counselor and a laboratory assistant systematically visited homes offering HCT for all people older than 14 years of age and at-risk children (mother deceased or HIV infected) using a rapid HIV testing three-test algorithm. HIV-infected people received cotrimoxazole prophylaxis, were supplied with long-lasting insecticide-treated bed nets and equipment for treatment of drinking water at home, and were referred for assessment for antiretroviral therapy. The program reached 92,984 (63%) of all the homes in the district. Of these, 32,3621 people were eligible for HCT, and 28,2857 (87%) were present at home and were offered pretest counseling. A total of 264,966 (94%) accepted testing and received their results, of whom 11,359 (4.3%) were HIV-infected. Ninety percent of those testing had never tested before. The cost of testing was $7.83 per previously untested client. Ninety-seven percent of HIV-infected people initiated cotrimoxazole prophylaxis, 74% received bed nets, 70% received water treatment equipment, and 11% began antiretroviral therapy. Forty-four percent of people who were in an HIV-discordant relationship were infected. These results demonstrate that home-based HCT was well-accepted, feasible, and effective in identifying HIV-infected individuals who did not know their HIV status in rural Uganda. DOI: 10.1089/apc.2010.0096

Higher education institutions in low- and middle-income countries are increasingly offering post-graduate degree programmes in health informatics. An analysis of accredited Master of Science in Health Informatics (MSc HI) programmes in the East African Community (EAC), a common higher education and labor zone, revealed wide variability in covered courses and competencies. In this paper, we describe the process undertaken to harmonize and establish common benchmarks for MSc HI for the EAC, in collaboration with the Inter-University Council for East Africa (IUCEA). After a multi-step process involving desk-reviews, benchmarking workshop with stakeholders, and quality assurance of benchmarks by IUCEA, the MSc HI benchmarks were finalized. These benchmarks outline the MSc HI degree programme goal, objectives, admission criteria, graduation requirements, and expected Learning Outcomes (ELOs). The ELOs are further translated into courses covering all identified skills and competencies. The benchmarks should facilitate mobility of students, faculty and labor, and improve program quality. [ABSTRACT FROM AUTHOR]

Background The global burden of cervical cancer is concentrated in low-and middle-income countries (LMICs), with the greatest burden in Africa. Targeting limited resources to populations with the greatest need to maximize impact is essential. The objectives of this study were to geocode cervical cancer data from a population-based cancer registry in Kampala, Uganda, to create high-resolution disease maps for cervical cancer prevention and control planning, and to share lessons learned to optimize efforts in other low-resource settings. Methods Kampala Cancer Registry records for cervical cancer diagnoses between 2008 and 2015 were updated to include geographies of residence at diagnosis. Population data by age and sex for 2014 was obtained from the Uganda Bureau of Statistics. Indirectly age-standardized incidence ratios were calculated for sub-counties and estimated continuously across the study area using parish level data. Results Overall, among 1873 records, 89.6% included a valid sub-county and 89.2% included a valid parish name. Maps revealed specific areas of high cervical cancer incidence in the region, with significant variation within sub-counties, highlighting the importance of high-resolution spatial detail. Conclusions Population-based cancer registry data and geospatial mapping can be used in low-resource settings to support cancer prevention and control efforts, and to create the potential for research examining geographic factors that influence cancer outcomes. It is essential to support LMIC cancer registries to maximize the benefits of limited cancer control resources. [ABSTRACT FROM AUTHOR]

Background: Globally, Pre-Exposure Prophylaxis (PrEP) is an HIV prevention strategy for high-risk populations including fishing communities. However, some communities have not embraced PrEP. We therefore assessed willingness to take PrEP among high-risk young men and their understanding of PrEP in a fishing community in Uganda. Methods: We conducted a cross-sectional study, between October and November 2020, using quantitative and qualitative data collection methods among young men aged 10-24 years in Masese fishing community, Eastern Uganda. We surveyed 479 young men, who had two or more sexual partners with inconsistent or no condom use. Participants who reported they would take PrEP when provided were categorized as willing. We also conducted four focus group discussions (n=32) among a purposive sample of young men to explore understanding of PrEP. We conducted multivariable modified Poisson regression for the quantitative and thematic analysis for qualitative data. Results: Overall, 86.4% (n=414/479) of the participants were willing to take PrEP. Willingness to take PrEP was significantly lower among single/never married participants compared to the married (adjusted Prevalence Ratio(aPR)=0.92;95%CI:0.87,0.98). Willingness to take PrEP was higher among participants who selfperceived to be high-risk for HIV (aPR=1.11;95%CI:1.03,1.20); perceived less PrEP side-effects (aPR=1.56;95%CI:1.55,2.24) and would obtain PrEP within their community (aPR=1.40;95%CI:1.25,1.57). From the discussions, participants described PrEP as a drug used to prevent HIV, but some could not differentiate PrEP from Post-Exposure Prophylaxis and did not know when it was taken. Some participants feared that PrEP would lead to loss of libido while some feared it would increase sexual activity and expose them to other venereal diseases. Conclusion: There was high willingness to take PrEP among young men in fishing communities. Strategies to improve PrEP interventions may be more effective if they target single men and provision of PrEP within such communities. Health education will also improve understanding of PrEP and promote risk awareness. [ABSTRACT FROM AUTHOR]

Background: Despite the development and enforcement of preventive guidelines by governments, COVID-19 continues to spread across nations, causing unprecedented economic losses and mortality. Public places remain hotspots for COVID-19 transmission due to large numbers of people present; however preventive measures are poorly enforced. Supermarkets are among the high-risk establishments due to the high interactions involved, which makes compliance with the COVID-19 preventive guidelines of paramount importance. However, until now, there has been limited evidence on compliance with the set COVID-19 prevention guidelines. Therefore, this study aimed to measure compliance with the COVID-19 prevention guidelines among supermarkets in Kampala Capital City and Mukono Municipality Uganda. Methods: A cross-sectional study was conducted among selected supermarkets in Kampala Capital City and Mukono Municipality in September 2020. A total of 229 supermarkets (195 in Kampala City and 34 in Mukono Municipality) were randomly selected for the study. Data were collected through structured observations on the status of compliance with COVID-19 prevention guidelines, and entered using the KoboCollect software, which was preinstalled on mobile devices (smart phones and tablets). Descriptive statistics were generated to measure compliance to the set COVID-19 Ministry of Health prevention guidelines using Stata 14 software. Results: Only 16.6% (38/229) of the supermarkets complied with the COVID-19 prevention and control guidelines. In line with the specific measures, almost all supermarkets 95.2% (218/229) had hand washing facilities placed at strategic points such as the entrance, and 59.8% (137/229) of the supermarkets surveyed regularly disinfected commonly touched surfaces. Only 40.6% and 30.6% of the supermarkets enforced mandatory hand washing and use of face masks respectively for all customers accessing the premises. Slightly more than half, 52.4% (120/229) of the supermarkets had someone or a team in charge of enforcing compliance to COVID-19 measures and more than half, 55.5% (127/229) of the supermarkets had not provided their staff with job-specific training/mentorship on infection prevention and control for COVID-19. Less than a third, 26.2% (60/229) of the supermarkets had an infrared temperature gun for screening every customer, and only 5.7% (13/229) of the supermarkets captured details of clients accessing the supermarket as a measure to ease follow-up. Conclusion: This study revealed low compliance with COVID-19 guidelines, which required mandatory preventive measures such as face masking, regular disinfection, social distancing, and hand hygiene. This study suggests the need for health authorities to strengthen enforcement of these guidelines, and to sensitise the supermarket managers on COVID-19 in order to increase the uptake of the different measures. [ABSTRACT FROM AUTHOR]

Abstract Background Use of diagnostics in integrated community case management (iCCM) of fever is recognized as an important step in improving rational use of drugs and quality of care for febrile under-five children. This study assessed household access, acceptability and utilization of community health workers (CHWs) trained and provided with malaria rapid diagnostic tests (RDTs) and respiratory rate timers (RRTs) to practice iCCM. Methods A total of 423 households with under-five children were enrolled into the study in Iganga district, Uganda. Households were selected from seven villages in Namungalwe sub-county using probability proportionate to size sampling. A semi-structured questionnaire was administered to caregivers in selected households. Data were entered into Epidata statistical software, and analysed using SPSS Statistics 17.0, and STATA version 10. Results Most (86%, 365/423) households resided within a kilometre of a CHW’s home, compared to 26% (111/423) residing within 1 km of a health facility (p Fifty-seven percent (243/423) of caregivers took their febrile children to a CHW at least once in the three month period preceding the survey. Households located 1–3 km from a health facility were 72% (AOR 1.72; 95% CI 1.11–2.68) more likely to utilize CHW services compared to households within 1 km of a health facility. Households located 1–3 km from a CHW were 81% (AOR 0.19; 95% CI 0.10–0.36) less likely to utilize CHW services compared to those households residing within 1 km of a CHW. A majority (79%, 336/423) of respondents thought CHWs services were better with RDTs, and 89% (375/423) approved CHWs’ continued use of RDTs. Eighty-six percent (209/243) of respondents who visited a CHW thought RRTs were useful. Conclusion ICCM with diagnostics is acceptable, increases access, and is the first choice for caregivers of febrile children. More than half of caregivers of febrile children utilized CHW services over a three-month period. However, one-third of caregivers used drug shops in spite of the presence of CHWs.

Background: Birth registration is a child's first right. Registration of live births, stillbirths and deaths is foundational for national planning. Completeness of birth registration for live births in low- and middle-income countries is measured through population-based surveys which do not currently include completeness of stillbirth or death registration. Methods: The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). In four African sites, we included new/modified questions regarding registration for 1177 stillbirths and 11,881 livebirths (1333 neonatal deaths and 10,548 surviving the neonatal period). Questions were evaluated for completeness of responses, data quality, time to administer and estimates of registration completeness using descriptive statistics. Timing of birth registration, factors associated with non-registration and reported barriers were assessed using descriptive statistics and logistic regression. Results: Almost all women, irrespective of their baby's survival, responded to registration questions, taking an average of < 1 min. Reported completeness of birth registration was 30.7% (6.1-53.5%) for babies surviving the neonatal period, compared to 1.7% for neonatal deaths (0.4–5.7%). Women were able to report age at birth registration for 93.6% of babies. Non-registration of babies surviving the neonatal period was significantly higher for home-born children (aOR 1.43 (95% CI 1.27–1.60)) and in Dabat (Ethiopia) (aOR 4.11 (95% CI 3.37–5.01)). Other socio-demographic factors associated with non-registration included younger age of mother, more prior births, little or no education, and lower socio-economic status. Neonatal death registration questions were feasible (100% women responded; only 1% did not know), revealing extremely low completeness with only 1.2% of neonatal deaths reported as registered. Despite > 70% of stillbirths occurring in facilities, only 2.5% were reported as registered. Conclusions: Questions on birth, stillbirth and death registration were feasible in a household survey. Completeness of birth registration is low in all four sites, but stillbirth and neonatal death registration was very low. Closing the registration gap amongst facility births could increase registration of both livebirths and facility deaths, including stillbirths, but will require co-ordination between civil registration systems and the often over-stretched health sector. Investment and innovation is required to capture birth and especially deaths in both facility and community systems. [ABSTRACT FROM AUTHOR]

Background: Termination of pregnancy (TOP) is a common cause of maternal morbidity and mortality in low- and middle-income countries. Population-based surveys are the major data source for TOP data in LMICs but are known to have shortcomings that require improving. The EN-INDEPTH multi-country survey employed a full pregnancy history approach with roster and new questions on TOP and Menstrual Restoration. This mixed methods paper assesses the completeness of responses to questions eliciting TOP information from respondents and reports on practices, barriers, and facilitators to TOP reporting. Methods: The EN-INDEPTH study was a population-based cross-sectional study. The Full Pregnancy History arm of the study surveyed 34,371 women of reproductive age between 2017 and 2018 in five Health and Demographic Surveillance System (HDSS) sites of the INDEPTH network: Bandim, Guinea-Bissau; Dabat, Ethiopia; IgangaMayuge, Uganda; Kintampo, Ghana; and Matlab, Bangladesh. Completeness and time spent in answering TOP questions were evaluated using simple tabulations and summary statistics. Exact binomial 95% confidence intervals were computed for TOP rates and ratios. Twenty-eight (28) focus group discussions were undertaken and analysed thematically. Results: Completeness of responses regarding TOP was between 90.3 and 100.0% for all question types. The new questions elicited between 2.0% (1.0–3.4), 15.5% (13.9–17.3), and 11.5% (8.8–14.7) lifetime TOP cases over the roster questions from Dabat, Ethiopia; Matlab, Bangladesh; and Kintampo, Ghana, respectively. The median response time on the roster TOP questions was below 1.3 minutes in all sites. Qualitative results revealed that TOP was frequently stigmatised and perceived as immoral, inhumane, and shameful. Hence, it was kept secret rendering it difficult and uncomfortable to report. Miscarriages were perceived to be natural, being easier to report than TOP. Interviewer techniques, which were perceived to facilitate TOP disclosure, included cultural competence, knowledge of contextually appropriate terms for TOP, adaptation to interviewee's individual circumstances, being non-judgmental, speaking a common language, and providing detailed informed consent. Conclusions: Survey roster questions may under-represent true TOP rates, since the new questions elicited responses from women who had not disclosed TOP in the roster questions. Further research is recommended particularly into standardised training and approaches to improving interview context and techniques to facilitate TOP reporting in surveys. [ABSTRACT FROM AUTHOR]

Background: Low birthweight (< 2500 g) is an important marker of maternal health and is associated with neonatal mortality, long-term development and chronic diseases. Household surveys remain an important source of population-based birthweight information, notably Demographic and Health Surveys (DHS) and UNICEF's Multiple Indicator Cluster Surveys (MICS); however, data quality concerns remain. Few studies have addressed how to close these gaps in surveys. Methods: The EN-INDEPTH population-based survey of 69,176 women was undertaken in five Health and Demographic Surveillance System sites (Matlab-Bangladesh, Dabat-Ethiopia, Kintampo-Ghana, Bandim-Guinea-Bissau, IgangaMayuge-Uganda). Responses to existing DHS/MICS birthweight questions on 14,411 livebirths were analysed and estimated adjusted odds ratios (aORs) associated with reporting weighing, birthweight and heaping reported. Twenty-eight focus group discussions with women and interviewers explored barriers and enablers to reporting birthweight. Results: Almost all women provided responses to birthweight survey questions, taking on average 0.2 min to answer. Of all babies, 62.4% were weighed at birth, 53.8% reported birthweight and 21.1% provided health cards with recorded birthweight. High levels of heterogeneity were observed between sites. Home births and neonatal deaths were less likely to be weighed at birth (home births aOR 0.03(95%CI 0.02–0.03), neonatal deaths (aOR 0.19(95%CI 0.16–0.24)), and when weighed, actual birthweight was less likely to be known (aOR 0.44(95%CI 0.33–0.58), aOR 0.30(95%CI 0.22–0.41)) compared to facility births and post-neonatal survivors. Increased levels of maternal education were associated with increases in reporting weighing and knowing birthweight. Half of recorded birthweights were heaped on multiples of 500 g. Heaping was more common in IgangaMayuge (aOR 14.91(95%CI 11.37–19.55) and Dabat (aOR 14.25(95%CI 10.13–20.3) compared to Bandim. Recalled birthweights were more heaped than those recorded by card (aOR 2.59(95%CI 2.11–3.19)). A gap analysis showed large missed opportunity between facility birth and known birthweight, especially for neonatal deaths. Qualitative data suggested that knowing their baby's weight was perceived as valuable by women in all sites, but lack of measurement and poor communication, alongside social perceptions and spiritual beliefs surrounding birthweight, impacted women's ability to report birthweight. Conclusions: Substantial data gaps remain for birthweight data in household surveys, even amongst facility births. Improving the accuracy and recording of birthweights, and better communication with women, for example using health cards, could improve survey birthweight data availability and quality. [ABSTRACT FROM AUTHOR]

Background: A large, district‐wide, home‐based HIV counselling and testing (HBHCT) programme was implemented in Bushenyi district of Uganda from 2004 to 2007. This programme provided free HBHCT services to all consenting adults of Bushenyi district and had a very high uptake and acceptability. We measured population‐level changes in knowledge of HIV status, stigma and HIV‐risk behaviours before and after HBHCT to assess whether widespread HBHCT had an effect on trends of risky sexual behaviours and on stigma and discrimination towards HIV. Methods: Serial cross‐sectional surveys were carried out before and after the implementation of HBHCT programme in Bushenyi district of Uganda. A total of 1402 randomly selected adults (18 to 49 years) were interviewed in the baseline survey. After the implementation, a different set of randomly selected 1562 adults was interviewed using the same questionnaire. Data was collected on socio‐demographic characteristics, sexual behaviour, whether respondents had ever tested for HIV and stigma and discrimination towards HIV/AIDS. Results: The proportion of people who had ever tested for HIV increased from 18.6% to 62% (p Conclusion: These data suggest that HBHCT rapidly increased the uptake of HCT and may have led to reduction in high‐risk behaviours at population level as well as reduction in stigma and discrimination. Because HBCT programmes are cost‐effective, they should be considered for implementation in delivery of HIV services especially in areas where access to HCT is low., Background Recent studies have highlighted the importance of massively increasing knowledge of HIV serostatus and providing anti‐retroviral therapy (ART) in order to significantly reduce HIV transmission [1–3]. Realization of the [...]

Background: Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths.Methods: This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken.Conclusions: This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Besides use of insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS), other complimentary measures including suitable housing structures, and environmental management that reduce breeding of malaria vectors, can be implemented at households to prevent the disease. However, most studies on malaria prevention have focused mainly on ITNs and IRS. The aim of this study was therefore to assess malaria prevention practices beyond ITNs and IRS, and associated environmental risk factors including housing structure in rural Wakiso district, Uganda. Methods: A clustered cross-sectional survey was conducted among 727 households in Wakiso district. Data were collected using an interviewer-administered questionnaire and observational checklist. The questionnaire assessed participants’ household practices on malaria prevention, whereas the checklist recorded environmental risk factors for malaria transmission, and structural condition of houses. Poisson regression modeling was used to identify factors associated with use of mosquito nets by households. Results: Of the 727 households, 471 (64.8%) owned at least one mosquito net. Use of mosquito nets by households was higher with increasing education level of participants—primary (aPR = 1.27 [95% CI: 1.00–1.60]), secondary (ordinary level) (aPR = 1.47 [95% CI: 1.16–1.85]) and advanced level / tertiary (aPR = 1.55 [95% CI: 1.19–2.01]), and higher household income (aPR = 1.09 [95% CI: 1.00–1.20]). Additionally, participants who were not employed were less likely to have mosquito nets used in their households (aPR = 0.83 [95% CI: 0.70–0.98]). Houses that had undergone IRS in the previous 12 months were 42 (5.8%), while 220 (43.2%) households closed their windows before 6.00 pm. Environmental risk factors found at households included presence of vessels that could potentially hold water for mosquito breeding 414 (56.9%), and stagnant water in compounds 144 (19.8%). Several structural deficiencies on houses that could promote entry of mosquitoes were found such as lack of screening in ventilators 645 (94.7%), and external doors not fitting perfectly into walls hence potential for mosquito entry 305 (42.0%). Conclusion: There is need to increase coverage and utilisation of ITNs and IRS for malaria prevention in Wakiso district, Uganda. In addition, other malaria prevention strategies such as environmental management, and improving structural condition of houses are required to strengthen existing malaria prevention approaches. [ABSTRACT FROM AUTHOR]

Introduction: Reliable and timely immunization data is vital at all levels of health care to inform decisions and improve program performance. Inadequate data quality may impair our understanding of the true vaccination coverage and also hinder our capability to meet the program objectives. It’s therefore important to regularly assess immunization data quality to ensure good performance, sound decision making and efficient use of resources. Methods: We conducted an immunization data quality audit between July and August 2016. The verification factor was estimated by dividing the recounted diphtheria, pertussis and tetanus third dose vaccination for children under 1 year (DPT3<1 year) by reported DPT3<1 year. The quality of data collection processes was measured using quality indices for the 3 different components: recording practices, storage/reporting, monitoring and evaluation. These indices were applied to the different levels of the health care service delivery system. Quality index score was estimated by dividing the total question or observation correctly answered by the total number of answers/ observations for a particular component. Results: The mean health center verification factor was 87%. Sixty five percent (32/49) of the health centers had consistent data, 27% (13/49) over reported and 4% (2/49) under-reported. Health center 11s and 111s contributed to over-reporting and under-reporting. All the health centers’ reports were complete and timely between January and June and from November to December. The mean quality indices for the 3 different componets assessed were; recording practices 66%, storing/reporting 75%, monitoring and evaluation 43%. There was a weak positive correlation between the health center verifaction factor and quality index though this was not statistically significant (r = 0.014; p = 0.92). Conclusion: Lower level health centers contributed significantly to the inconsistencies in immunization data; there were wide variation between the quality indices of recording practices, storage/reporting, monitoring and evaluation. We recommended that District Local Governments and Ministry of Health focus on improving data quality at lower levels of health service delivery. [ABSTRACT FROM AUTHOR]

Poor water, sanitation, and hygiene (WASH) continue to contribute to the high prevalence of diarrhoeal diseases in low-income countries such as Uganda particularly in slums. We implemented a 3-year WASH project in two urban slums in Uganda with a focus on safe drinking water and improvement in sanitation. The project implemented community and school interventions in addition to capacity building initiatives. Community interventions included home improvement campaigns, clean-up exercises, water quality assessment, promotion of drinking safe water through household point-of-use chlorination, promotion of hand washing, and support towards solid waste management. In schools, the project supported health clubs and provided them with "talking compound" messages. The capacity building initiatives undertaken included training of youth and community health workers. Project evaluation revealed several improvements in WASH status of the slums including increase in piped water usage from 38% to 86%, reduction in use of unprotected water sources from 30% to 2%, reduction in indiscriminate disposal of solid waste from 18% to 2%, and increase in satisfaction with solid waste management services from 40% to 92%. Such proactive and sustainable community interventions have the potential to not only improve lives of slum inhabitants in developing countries but also create lasting impact. [ABSTRACT FROM AUTHOR]

Background: In April 2015, Kamwenge District, western Uganda reported a measles outbreak. We investigated the outbreak to identify potential exposures that facilitated measles transmission, assess vaccine effectiveness (VE) and vaccination coverage (VC), and recommend prevention and control measures.Methods: For this investigation, a probable case was defined as onset of fever and generalized maculopapular rash, plus ≥1 of the following symptoms: Coryza, conjunctivitis, or cough. A confirmed case was defined as a probable case plus identification of measles-specific IgM in serum. For case-finding, we reviewed patients' medical records and conducted in-home patient examination. In a case-control study, we compared exposures of case-patients and controls matched by age and village of residence. For children aged 9 m-5y, we estimated VC using the percent of children among the controls who had been vaccinated against measles, and calculated VE using the formula, VE = 1 - ORM-H, where ORM-H was the Mantel-Haenszel odds ratio associated with having a measles vaccination history.Results: We identified 213 probable cases with onset between April and August, 2015. Of 23 blood specimens collected, 78% were positive for measles-specific IgM. Measles attack rate was highest in the youngest age-group, 0-5y (13/10,000), and decreased as age increased. The epidemic curve indicated sustained propagation in the community. Of the 50 case-patients and 200 controls, 42% of case-patients and 12% of controls visited health centers during their likely exposure period (ORM-H = 6.1; 95% CI = 2.7-14). Among children aged 9 m-5y, VE was estimated at 70% (95% CI: 24-88%), and VC at 75% (95% CI: 67-83%). Excessive crowding was observed at all health centers; no patient triage-system existed.Conclusions: The spread of measles during this outbreak was facilitated by patient mixing at crowded health centers, suboptimal VE and inadequate VC. We recommended emergency immunization campaign targeting children <5y in the affected sub-counties, as well as triaging and isolation of febrile or rash patients visiting health centers. [ABSTRACT FROM AUTHOR]

Background: In Uganda, malaria vector control interventions and case management with Artemisinin Combination Therapies (ACTs) have been scaled up over the last few years as a result of increased funding. Data on parasitaemia prevalence among children less than 5 years old and coverage of interventions was collected during the first two Malaria Indicator Surveys (MIS) conducted in 2009 and 2014, respectively. In this study, we quantify the effects of control interventions on parasitaemia risk changes between the two MIS in a spatio-temporal analysis. Methods: Bayesian geostatistical and temporal models were fitted on the MIS data of 2009 and 2014. The models took into account geographical misalignment in the locations of the two surveys and adjusted for climatic changes and socio-economic differentials. Parasitaemia risk was predicted over a 2 × 2 km² grid and the number of infected children less than 5 years old was estimated. Geostatistical variable selection was applied to identify the most important ITN coverage indicators. A spatially varying coefficient model was used to estimate intervention effects at sub-national level. Results: The coverage of Insecticide Treated Nets (ITNs) and ACTs more than doubled at country and sub-national levels during the period 2009-2014. The coverage of Indoor Residual Spraying (IRS) remained static at all levels. ITNs, IRS, and ACTs were associated with a reduction in parasitaemia odds of 19% (95% BCI: 18-29%), 78% (95% BCI: 67-84%), and 34% (95% BCI: 28-66%), respectively. Intervention effects varied with region. Higher socio-economic status and living in urban areas were associated with parasitaemia odds reduction of 46% (95% BCI: 0.51-0.57) and 57% (95% BCI: 0.40-0.53), respectively. The probability of parasitaemia risk decline in the country was 85% and varied from 70% in the North-East region to 100% in Kampala region. The estimated number of children infected with malaria declined from 2,480,373 in 2009 to 825,636 in 2014. Conclusions: Interventions have had a strong effect on the decline of parasitaemia risk in Uganda during 2009-2014, albeit with varying magnitude in the regions. This success should be sustained by optimizing ITN coverage to achieve universal coverage. [ABSTRACT FROM AUTHOR]

Introduction: Disease surveillance is a critical component in the control and elimination of vaccine preventable diseases. The Uganda National Expanded Program on Immunization strives to have a sensitive surveillance system within the Integrated Disease Surveillance and Response (IDSR) framework. We analyzed measles surveillance data to determine the effectiveness of the measles case-based surveillance system and estimate its positive predictive value in order to inform policy and practice. Methods: An IDSR alert was defined as ≥1 suspected measles case reported by a district in a week, through the electronic Health Management Information System. We defined an alert in the measles case-based surveillance system (CBS) as ≥1 suspected measles case with a blood sample collected for confirmation during the corresponding week in a particular district. Effectiveness of CBS was defined as having ≥80% of IDSR alerts with a blood sample collected for laboratory confirmation. Positive predictive value was defined as the proportion of measles case-patients who also had a positive measles serological result (IgM +). We reviewed case-based surveillance data with laboratory confirmation and measles surveillance data from the electronic Health Management Information System from 2012–2015. Results: A total of 6,974 suspected measles case-persons were investigated by the measles case-based surveillance between 2012 and 2015. Of these, 943 (14%) were measles specific IgM positive. The median age of measles case-persons between 2013 and 2015 was 4.0 years. Between 2013 and 2015, 72% of the IDSR alerts reported in the electronic Health Management Information System, had blood samples collected for laboratory confirmation. This was however less than the WHO recommended standard of ≥80%. The PPV of CBS between 2013 and 2015 was 8.6%. Conclusion: In conclusion, the effectiveness of measles case-based surveillance was sub-optimal, while the PPV showed that true measles cases have significantly reduced in Uganda. We recommended strengthening of case-based surveillance to ensure that all suspected measles cases have blood samples collected for laboratory confirmation to improve detection and ensure elimination by 2020. [ABSTRACT FROM AUTHOR]

Background: Malaria burden in Uganda has declined disproportionately among regions despite overall high intervention coverage across all regions. The Uganda Malaria Indicator Survey (MIS) 2014–15 was the second nationally representative survey conducted to provide estimates of malaria prevalence among children less than 5 years, and to track the progress of control interventions in the country. In this present study, 2014–15 MIS data were analysed to assess intervention effects on malaria prevalence in Uganda among children less than 5 years, assess intervention effects at regional level, and estimate geographical distribution of malaria prevalence in the country. Methods: Bayesian geostatistical models with spatially varying coefficients were used to determine the effect of interventions on malaria prevalence at national and regional levels. Spike-and-slab variable selection was used to identify the most important predictors and forms. Bayesian kriging was used to predict malaria prevalence at unsampled locations. Results: Indoor Residual Spraying (IRS) and Insecticide Treated Nets (ITN) ownership had a significant but varying protective effect on malaria prevalence. However, no effect was observed for Artemisinin Combination-based Therapies (ACTs). Environmental factors, namely, land cover, rainfall, day and night land surface temperature, and area type were significantly associated with malaria prevalence. Malaria prevalence was higher in rural areas, increased with the child’s age, and decreased with higher household socioeconomic status and higher level of mother’s education. The highest prevalence of malaria in children less than 5 years was predicted for regions of East Central, North East and West Nile, whereas the lowest was predicted in Kampala and South Western regions, and in the mountainous areas in Mid-Western and Mid-Eastern regions. Conclusions: IRS and ITN ownership are important interventions against malaria prevalence in children less than 5 years in Uganda. The varying effects of the interventions calls for selective implementation of control tools suitable to regional ecological settings. To further reduce malaria burden and sustain malaria control in Uganda, current tools should be supplemented by health system strengthening, and socio-economic development. [ABSTRACT FROM AUTHOR]

Background: Most tuberculosis (TB) case management guidelines emphasize microbiological cure as treatment goal without highlighting quality of life outcomes. This study assessed health-related quality of life (HRQoL) and related factors in the pre-treatment, intensive and continuation phases of anti-TB therapy among sputum smear positive pulmonary TB patients in Mbale region, Eastern Uganda. Methods: In this cross-sectional study, questionnaires and 36-Item Short-Form Health Survey Version 2.0 (UK English SF36v2) forms were administered to 210 participants of whom 64.8 % were males. The mean age was 35.48 ± 12.21 years. For each of the three treatment phases, different patients were studied. Responses were translated into the standard 00–100 scale. Means and standard deviations were used to express HRQoL as physical composite scores (PCS) and mental composite scores (MCS). Analysis of variance was used to compare scores across phases. Multiple linear regression methods were used to model relationships between predictor variables and HRQoL for each treatment phase. Results: HRQoL scores were different across treatment phases. General health (38.8 ± 17.5) and mental health (52.7 ± 18.6) had the lowest and highest sub-scale scores respectively. Mean PCS scores in pretreatment, intensive and continuation phases were 29.9 ± 19.4, 41.9 ± 14.2 and 62.2 ± 18.8 respectively. Mean MCS scores in the pretreatment, intensive and continuation phases were 38.8 ± 18.3, 49.4 ± 13.1 and 60.6 ± 18.8 respectively. Prior to treatment initiation, having an informal occupation (ß = -28.66 (<0.001) was associated with poor HRQoL. Being unmarried (ß = 11.94, p = 0.028) and belonging to the highest tertile of socioeconomic status (SES) (ß = 14.56, p = 0.007) were associated with good HRQoL in the intensive phase. In the continuation phase, SES (ß = 10.83, p = 0.021 for MCS and ß = 13.14, p = 0.004 for PCS) predicted good HRQoL. Older age (ß = -0.43 p = 0.013 for PCS and ß = -0.36 p = 0.040 for MCS) was associated with poor HRQoL. Conclusions: TB treatment improved patients’ perceived health and having means of income was particularly associated with high HRQoL. Strategies to strengthen treatment support that include income generation and specific close monitoring of older patients may help improve overall TB treatment experience, by sustaining acceptable levels of physical, social and emotional functioning. [ABSTRACT FROM AUTHOR]

Introduction: Influenza surveillance was conducted in Uganda from October 2008 to December 2014 to identify and understand the epidemiology of circulating influenza strains in out-patient clinic attendees with influenza-like illness and inform control strategies. Methodology: Surveillance was conducted at five hospital-based sentinel sites. Nasopharyngeal and/or oropharyngeal samples, epidemiological and clinical data were collected from enrolled patients. Real-time reverse transcription polymerase chain reaction (RT-PCR) was performed to identify and subtype influenza strains. Data were double-entered into an Epi Info 3.5.3 database and exported to STATA 13.0 software for analysis. Results: Of the 6,628 patient samples tested, influenza virus infection was detected in 10.4% (n = 687/6,628) of the specimens. Several trends were observed: influenza circulates throughout the year with two peaks; the major one from September to November and a minor one from March to June. The predominant strains of influenza varied over the years: Seasonal Influenza A(H3) virus was predominant from 2008 to 2009 and from 2012 to 2014; Influenza A(H1N1)pdm01 was dominant in 2010; and Influenza B virus was dominant in 2011. The peaks generally coincided with times of higher humidity, lower temperature, and higher rainfall. Conclusion: Influenza circulated throughout the year in Uganda with two major peaks of outbreaks with similar strains circulating elsewhere in the region. Data on the circulating strains of influenza and its patterns of occurrence provided critical insights to informing the design and timing of influenza vaccines for influenza prevention in tropical regions of sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Routine immunisation (RI) contributes immensely to reduction in mortality from vaccine preventable diseases (VPD) among children. The Nigerian Demographic and Health Survey, 2008 revealed that only 58 % of children in Osun State had received all recommended vaccines, which is far below World Health Organization (WHO) target of 80 %. We therefore, assessed RI uptake and its determinants among children in Atakumosa-west district of Osun State.Methods: Atakumosa-west district has an estimated population of 90,525 inhabitants. We enrolled 750 mothers of children aged 12-23 months in this cross-sectional study. Semi-structured questionnaires were used to obtain data on socio-demographic characteristics, knowledge of mothers on RI, history of RI in children and factors associated with full RI uptake. A fully-immunised child was defined as a child who had received one dose of Bacillus-Calmette-Guerin, three doses of Oral-Polio-Vaccine, three doses of Diptheria-Pertusis-Tetanus vaccine and one dose of measles vaccine by 12 months of age. We tested for the association between immunisation uptake and its likely determinants using multivariable logistic regression at 0.05 level of significance and 95 % confidence Interval (CI).Results: Mean ± (SD) age of the mothers and children were 27.9 ± 6.1 years and 17.2 ± 4.0 months, respectively. About 94 % (703/750) of mothers had received antenatal care (ANC) and 63.3 % (475) of the children possessed vaccination cards. Seventy-six percent (571/750) had good knowledge of RI and VPD. About 58 % (275/475) of children who possessed vaccination card were fully-immunised. Mothers antenatal care attendance (aOR = 3.3, 95 % CI = 1.1-8.3), maternal tetanus toxoid immunisation (aOR = 3.2, 95 % CI = 1.1-10.0) access to immunisation information (aOR = 1.8, 95 % CI = 1.1-2.5) and mothers having good knowledge of immunisation (aOR = 2.4, 95 % CI = 1.6-3.8) were significant determinants of full immunisation.Conclusions: Routine immunisation uptake was still below WHO target in the study area. Encouraging mothers to attend antenatal care and educational interventions targeted at rural mothers are recommended to improve vaccination status of children in the rural communities. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends TB infection control (TBIC) in health care facilities. In 2008, the Ministry of Health Uganda initiated efforts to implement TBIC by training of health care workers (HCWs). This study was carried out to assess knowledge and attitudes towards TBIC among HCWs.Methods: We conducted a cross-sectional study among HCWs in health facilities in the districts of Mukono and Wakiso in Uganda, from October 2010 to February 2011. We assessed HCWs' knowledge of basic standards of TB diagnosis, treatment and TBIC and attitudes towards TBIC measures.Results: Twenty four percent of the participants answered correctly all the basic TB knowledge questions. Overall, 62 % of the HCWs were judged to have adequate basic TB knowledge. At multivariable analysis, non-clinical cadres, were more likely to have poor basic TB knowledge, [adjusted odds ratio (aOR) 0.43; 95 % confidence interval (CI) 0.27-0.68)]. Only 7 % of the respondents answered all the questions on TBIC correctly. Almost all the respondents (98 %; 529/541) knew that TB was transmitted through droplet nuclei, while only a third (34 %; 174/532) knew that masks do not protect the wearer from getting TB. Overall, 69 % (355/512) of the HCWs were judged to have adequate TBIC knowledge. At multivariable analysis, non-clinical cadres (aOR 0.61; 95 % CI 0.38-0.98) and having not attended TBIC training, (aOR 0.65; 95 % CI 0.42-0.99), were more likely to have poor TBIC knowledge. More than three quarters (77 %; 410/530) and 63 % (329/522) of the respondents had a high self-efficacy and perceived threat of acquiring TB at work, respectively. Having not attended a TBIC training was significantly associated with a low self-efficacy (aOR 0.52; 95 % CI 0.33-0.81) and low perceived threat of acquiring TB infection at work, (aOR 0.54; 95 % CI 0.36-0.81).Conclusions: Our study finds moderate number of HCWs with correct knowledge and attitudes towards TBIC. Efforts should be put in place to train all HCWs in TBIC, with particular emphasis on the non-clinical staff due to their limited grasp of TBIC measures. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends use of multiple approaches to control malaria. The integrated approach to malaria prevention advocates the use of several malaria prevention methods in a holistic manner. This study assessed perceptions and practices on integrated malaria prevention in Wakiso district, Uganda. Methods: A clustered cross-sectional survey was conducted among 727 households from 29 villages using both quantitative and qualitative methods. Assessment was done on awareness of various malaria prevention methods, potential for use of the methods in a holistic manner, and reasons for dislike of certain methods. Households were classified as using integrated malaria prevention if they used at least two methods. Logistic regression was used to test for factors associated with the use of integrated malaria prevention while adjusting for clustering within villages. Results: Participants knew of the various malaria prevention methods in the integrated approach including use of insecticide treated nets (97.5%), removing mosquito breeding sites (89.1%), clearing overgrown vegetation near houses (97.9%), and closing windows and doors early in the evenings (96.4%). If trained, most participants (68.6%) would use all the suggested malaria prevention methods of the integrated approach. Among those who would not use all methods, the main reasons given were there being too many (70.2%) and cost (32.0%). Only 33.0% households were using the integrated approach to prevent malaria. Use of integrated malaria prevention by households was associated with reading newspapers (AOR 0.34; 95% CI 0.22 –0.53) and ownership of a motorcycle/car (AOR 1.75; 95% CI 1.03 – 2.98). Conclusion: Although knowledge of malaria prevention methods was high and perceptions on the integrated approach promising, practices on integrated malaria prevention was relatively low. The use of the integrated approach can be improved by promoting use of multiple malaria prevention methods through various communication channels such as mass media. [ABSTRACT FROM AUTHOR]