| 1. |
- Kayemba Nalwadda, Christine, et al.
(författare)
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Community health workers : a resource for identification and referral of sick newborns in rural Uganda
- 2013
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Ingår i: Tropical medicine & international health. - : Wiley. - 1360-2276 .- 1365-3156. ; 18:7, s. 898-906
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine community health workers' (CHWs) competence in identifying and referring sick newborns in Uganda.METHODS: Case-vignettes, observations of role-plays and interviews were employed to collect data using checklists and semistructured questionnaires, from 57 trained CHWs participating in a community health facility-linked cluster randomised trial. Competence to identify and refer sick newborns was measured by knowledge of newborn danger signs, skills to identify sick newborns and effective communication to mothers. Proportions and median scores were computed for each attribute with a pre-defined pass mark of 100% for knowledge and 90% for skill and communication.RESULTS: For knowledge, 68% of the CHWs attained the pass mark. The median percentage score was 100 (IQR 94 100). 74% mentioned the required five newborn danger signs unprompted. 'Red umbilicus/cord with pus' was mentioned by all CHWs (100%), but none mentioned chest in-drawing and grunting as newborn danger signs. 63% attained the pass mark for both skill and communication. The median percentage scores were 91 (IQR 82 100) for skills and 94 (IQR 89, 94) for effective communication. 98% correctly identified the four case-vignettes as sick or not sick newborn. 'Preterm birth' was the least identified danger sign from the case-vignettes, by 51% of the CHWs.CONCLUSION: CHWs trained for a short period but effectively supervised are competent in identifying and referring sick newborns in a poor resource setting.
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| 2. |
- Kiguli, Juliet, et al.
(författare)
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Dietary patterns and practices in rural eastern Uganda : Implications for prevention and management of type 2 diabetes
- 2019
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Ingår i: Appetite. - : Elsevier. - 0195-6663 .- 1095-8304. ; 143
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The burden of type 2 diabetes in Sub-Saharan Africa is projected to double by 2040, partly attributable to rapidly changing diets. In this paper, we analysed how community members in rural Uganda understood the concept of a healthy or unhealthy diet, food preparation and serving practices to inform the process of facilitating knowledge and skill necessary for self-management and care for type 2 diabetes. This was a qualitative study involving 20 focus group discussions and eight in-depth interviews among those at risk, patients with type 2 diabetes and the general community members without diabetes mellitus. Data was coded and entered into Atlas ti version 7.5.12 and interpreted using thematic analysis. We identified three main themes, which revealed, the perceptions on food and diet concerning health; the social dimensions of food and influence on diet practices; and food as a gendered activity. Participants noted that eating and cooking practices resulted in unhealthy diets. Their practices were affected by beliefs, poverty and food insecurity. Women determined which foods to prepare, but men prepared only some of the foods such as delicacies like a rice dish "pilau." New commercial and processed foods were increasingly available and consumed even in rural areas. Participants linked signs and symptoms of illness to diet as they narrated changes from past to current food preparation behaviours. Their view of overweight and obesity was also gendered and linked to social status. Participants' perception of disease influenced by diet was similar among those with and without type 2 diabetes, and those at risk. People described what is a healthy diet was as recommended by the health workers, but stated that their practices differed greatly from their knowledge. There was high awareness about healthy and balanced diets, but food is entrenched within social and gendered paradigms, which are slowly changing. Social and gender dimensions of food will need to be addressed through interventions in communities to promote change on a society level.
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| 3. |
- Kozuki, Naoko, et al.
(författare)
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A systematic review of community-to-facility neonatal referral completion rates in Africa and Asia
- 2015
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15:1, s. 989-
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: An estimated 2.8 million neonatal deaths occur annually worldwide. The vulnerability of newborns makes the timeliness of seeking and receiving care critical for neonatal survival and prevention of long-term sequelae. To better understand the role active referrals by community health workers play in neonatal careseeking, we synthesize data on referral completion rates for neonates with danger signs predictive of mortality or major morbidity in low- and middle-income countries.METHODS: A systematic review was conducted in May 2014 of the following databases: Medline-PubMed, Embase, and WHO databases. We also searched grey literature. In addition, an investigator group was established to identify unpublished data on newborn referral and completion rates. Inquiries were made to the network of research groups supported by Save the Children's Saving Newborn Lives project and other relevant research groups.RESULTS: Three Sub-Saharan African and five South Asian studies reported data on community-to-facility referral completion rates. The studies varied on factors such as referral rates, the assessed danger signs, frequency of home visits in the neonatal period, and what was done to facilitate referrals. Neonatal referral completion rates ranged from 34 to 97 %, with the median rate of 74 %. Four studies reported data on the early neonatal period; early neonatal completion rates ranged from 46 to 97 %, with a median of 70 %. The definition of referral completion differed by studies, in aspects such as where the newborns were referred to and what was considered timely completion.CONCLUSIONS: Existing literature reports a wide range of neonatal referral completion rates in Sub-Saharan Africa and South Asia following active illness surveillance. Interpreting these referral completion rates is challenging due to the great variation in study design and context. Often, what qualifies as referral and/or referral completion is poorly defined, which makes it difficult to aggregate existing data to draw appropriate conclusions that can inform programs. Further research is necessary to continue highlighting ways for programs, governments, and policymakers to best aid families in low-resource settings in protecting their newborns from major health consequences.
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| 4. |
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| 5. |
- Nalwadda, Christine Kayemba, et al.
(författare)
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High Compliance with Newborn Community-to-Facility Referral in Eastern Uganda : An Opportunity to Improve Newborn Survival
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:11, s. e81610-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Seventy-five percent of newborn deaths happen in the first-week of life, with the highest risk of death in the first 24-hours after birth.WHO and UNICEF recommend home-visits for babies in the first-week of life to assess for danger-signs and counsel caretakers for immediate referral of sick newborns. We assessed timely compliance with newborn referrals made by community-health workers (CHWs), and its determinants in Iganga and Mayuge Districts in rural eastern Uganda.METHODS: A historical cohort study design was used to retrospectively follow up newborns referred to health facilities between September 2009 and August 2011. Timely compliance was defined as caretakers of newborns complying with CHWs' referral advice within 24-hours.RESULTS: A total of 724 newborns were referred by CHWs of whom 700 were successfully traced. Of the 700 newborns, 373 (53%) were referred for immunization and postnatal-care, and 327 (47%) because of a danger-sign. Overall, 439 (63%) complied, and of the 327 sick newborns, 243 (74%) caretakers complied with the referrals. Predictors of referral compliance were; the newborn being sick at the time of referral- Adjusted Odds Ratio (AOR) = 2.3, and 95% Confidence-Interval (CI) of [1.6 - 3.5]), the CHW making a reminder visit to the referred newborn shortly after referral (AOR =1.7; 95% CI: [1.2 -2.7]); and age of mother (25-29) and (30-34) years, (AOR =0.4; 95% CI: [0.2 - 0.8]) and (AOR = 0.4; 95% CI: [0.2 - 0.8]) respectively.CONCLUSION: Caretakers' newborn referral compliance was high in this setting. The newborn being sick, being born to a younger mother and a reminder visit by the CHW to a referred newborn were predictors of newborn referral compliance. Integration of CHWs into maternal and newborn care programs has the potential to increase care seeking for newborns, which may contribute to reduction of newborn mortality.
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| 6. |
- Nalwadda Kayemba, Christine
(författare)
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Seeking referral care for newborns in eastern Uganda : community health workers’ role, caretakers’ compliance and provision of care
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Newborn deaths contribute 44% of all under-five deaths. Community health worker (CHW) during home-visits may identify and refer newborns to health facilities for postnatal care and treatment of danger signs. However, little is known on the care seeking practices and health system capacity to care for healthy and sick newborns in sub Saharan Africa. Objective: The overall objective of the studies was to assess newborn referral care seeking practices, compliance, and associated community and health systems factors in order to inform scale up of newborn care programs in Uganda and other low income countries with high newborn mortality. Methods: Four studies (I-IV) nested within a cluster randomized trial were conducted between 2011 and 2013 at the Iganga-Mayuge Health Demographic Surveillance Site in eastern Uganda. In Study I, focus group discussions (n=12) with men and women and in-depth interviews (n=11) with mothers and traditional birth attendants were used to obtain a deeper understanding of the social and cultural factors that affect caretakers’ compliance with community newborn referrals. Case vignettes, observations through role plays and record reviews were used in a cross sectional study to assess the ability of 57 trained community health workers to identify and refer sick newborns to health facilities (Study II). Study (III) was retrospective cohort of all referred newborns, during which interviews were held with 700 caretakers to determine compliance rate to seek health facility based care within 24-hours of a referral. In a cross sectional study, capacity to provide newborn care was assessed in all the 20 health facilities within the cluster randomized trial, using observations and interviews with of health workers (Study IV). Results: Community members understood the newborn period differently from health workers. A seclusion period observed immediately after birth restricted movement of the mother and newborn until the umbilical cord dropped off, but was not binding in case of illness (Study I). Of the 57 CHWs assessed, 68% were considered knowledgeable with a median knowledge score of 100% (IQR 94%-100%), and 36 (63%) considered skilled in identifying sick newborns (Study II). A total of 724 newborns were referred, of which 700 were successfully traced. Fifty three percent (373/700) were referred for postnatal care/immunization and 47% because they had at least one danger sign (Study III). Overall, 63% of the caretakers of referred newborns complied within less than24 hours, but more caretakers of sick newborns (243/327, 74%) complied, compared with 196/373 (53%) of those referred for immunization and postnatal care (p<0.001). A majority, (493, 77%) sought care from lower level health facilities. The determinants of compliance were: referred for danger signs Adjusted Odds Ratio (AOR) = 2.3, (95% CI: 1.6-3.5); CHW making a reminder visit to the referred newborn shortly after referral (AOR =1.7; 95% CI: 1.2 –2.7); and age of mother being 25-29 or 30-34 years, (AOR =0.4; 95% CI: 0.2 - 0.8) and (AOR = 0.4; 95% CI: 0.2 - 0.8) respectively; compared to the age group of less than 20 years (Study III). Fifteen of the 20 health facilities offered newborn care but level II facilities had the lowest availability score for resuscitation equipment (31%,) or newborn sepsis drugs (8%), and none offered kangaroo mother care. Two-thirds (33/50, 66%) of the health facility workers were considered knowledgeable in newborn care, but less than a half (17/42, 41%) skilled in newborn resuscitation (Study IV). Conclusion: Trained community health workers when engaged in maternal-newborn programs can assist caretakers to recognize sick newborns, change long held norms like the ‘seclusion’ and achieve good referral care seeking for newborns. There was high compliance with referrals, and caretakers mainly sought care from first level facilities which lacked capacity to care for sick newborns. Health workers had good knowledge about newborn care but unsatisfactory skills for resuscitation of newborns. Wherever deliveries are conducted there must also be health service readiness to care for newborn asphyxia and low-birth weight/prematurity. Policy and practice needs to change to enable lowest level health centres (HCII) to care for newborns with possible septicemia.
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| 7. |
- Ssekamatte, Tonny, et al.
(författare)
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Do sexual expectancies and inhibitions predict high-risk sexual behaviours? Evidence from a cross-sectional survey among young psychoactive substance users in informal settlements in Kampala, Uganda
- 2021
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Psychoactive substance use is a public health challenge among young people in informal settlements. Though rarely examined, psychoactive substance use is linked to sexual expectancies and inhibitions, and consequently high-risk sexual behaviours. This study examined the association between sexual expectancies and inhibitions, and high-risk sexual behaviours among young psychoactive substance users (PSUs) in informal settlements in Kampala, Uganda.Methods: This cross-sectional study recruited 744 young PSUs from informal settlements in Kampala. Respondent driven sampling was used to recruit respondents. A ‘modified’ Poisson regression model was used for inferential statistics. Data were analysed using the Stata 14 software.Results: Of the 744 study participants, 45.6% believed that psychoactive substance use improves sexual performance; 43.3% believed that psychoactive substances make sex more pleasurable, and 53.3% believed that psychoactive substances give courage or confidence to approach a partner for sex. The belief that psychoactive substance use improves sexual performance (PR 1.14, 95% CI: 1.01–1.30), increases the likelihood of engaging in sex (PR 1.20, 95% CI: 1.04–1.40) or gives courage or confidence to approach a sexual partner (PR 1.21, 95% CI: 1.05–1.39) were associated with having sex while under the influence of psychoactive substances. The belief that a psychoactive substance user under the influence of psychoactive substances is more likely to engage in sex (PR 1.48, 95% CI: 1.15–1.90), and likely to find it difficult to refuse sex (PR 1.28, 95% CI: 1.06–1.55) were positively associated with engaging in multiple sexual partnerships. The belief that one easily forgets to use a condom when under the influence of psychoactive substances was positively associated with inconsistent condom use (PR 1.26, 95% CI: 1.09–1.45).Conclusion: Psychoactive substance use expectancies associated with high-risk sexual behaviours included the belief that psychoactive substances improve sexual performance and improve confidence in approaching a sexual partner. Psychoactive substance use inhibitions associated with high-risk sexual behaviours included an increased likelihood of engaging in sexual intercourse, difficulties in refusing to engage in sexual intercourse, and forgetting to use condoms while intoxicated. Interventions targeting a reduction in high-risk sexual behaviour should integrate the impact of psychoactive substance use on sexual behaviour.
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