| 1. |
- Ettarh, Remare, et al.
(författare)
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Spatial analysis of determinants of choice of treatment provider for fever in under-five children in Iganga, Uganda
- 2011
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Ingår i: Health and Place. - : Elsevier BV. - 1353-8292 .- 1873-2054. ; 17:1, s. 320-326
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Tidskriftsartikel (refereegranskat)abstract
- Although health facilities and drug shops are the main alternatives to home management of fever in children in Uganda, the influence of distance on the choice of treatment provider by caretakers is still unclear. We examined the spatial distribution of choice of treatment provider for fever in under-five children and the influence of household and geographical factors. Spatial and regression analysis of choices of treatment provider was done using data from a 2-week recall survey conducted in the Iganga-Mayuge Health and Demographic Surveillance Site. Of 3483 households with febrile children, 45% of caretakers treated the child at home, 33% took the child to a health facility, and 22% obtained treatment at drug shops. The distance to access care outside the home was crucial as seen in the greater preference for treatment at home or at drug shops among caretakers living more than 3km from health facilities. The influence of proximity to health facilities in the choice of treatment provider highlights the need for greater access to health care services. The current Uganda Ministry of Health threshold of 5km for access to health facilities needs to be reviewed for rural areas.
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| 2. |
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| 3. |
- Kalyango, Joan N, et al.
(författare)
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High Adherence to Antimalarials and Antibiotics under Integrated Community Case Management of Illness in Children Less than Five Years in Eastern Uganda
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:3, s. e60481-
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDevelopment of resistance to first line antimalarials led to recommendation of artemisinin based combination therapies (ACTs). High adherence to ACTs provided by community health workers (CHWs) gave reassurance that community based interventions did not increase the risk of drug resistance. Integrated community case management of illnesses (ICCM) is now recommended through which children will access both antibiotics and antimalarials from CHWs. Increased number of medicines has been shown to lower adherence.ObjectiveTo compare adherence to antimalarials alone versus antimalarials combined with antibiotics under ICCM in children less than five years.MethodsA cohort study was nested within a cluster randomized trial that had CHWs treating children less than five years with antimalarials and antibiotics (intervention areas) and CHWs treating children with antimalarials only (control areas). Children were consecutively sampled from the CHWs' registers in the control areas (667 children); and intervention areas (323 taking antimalarials only and 266 taking antimalarials plus antibiotics). The sampled children were visited at home on day one and four of treatment seeking. Adherence was assessed using self reports and pill counts.ResultsAdherence in the intervention arm to antimalarials alone and antimalarials plus antibiotics arm was similar (mean 99% in both groups) but higher than adherence in the control arm (antimalarials only) (mean 96%). Forgetfulness (38%) was the most cited reason for non-adherence. At adjusted analysis: absence of fever (OR = 3.3, 95%CI = 1.6–6.9), seeking care after two or more days (OR = 2.2, 95%CI = 1.3–3.7), not understanding instructions given (OR = 24.5, 95%CI = 2.7–224.5), vomiting (OR = 2.6, 95%CI = 1.2–5.5), and caregivers' perception that the child's illness was not severe (OR = 2.0, 95%CI = 1.1–3.8) were associated with non-adherence.ConclusionsAddition of antibiotics to antimalarials did not lower adherence. However, caregivers should be adequately counseled to understand the dosing regimens; continue with medicines even when the child seems to improve; and re-administer doses that have been vomited.
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| 4. |
- Kalyango, Joan N., et al.
(författare)
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Increased Use of Community Medicine Distributors and Rational Use of Drugs in Children Less than Five Years of Age in Uganda Caused by Integrated Community Case Management of Fever
- 2012
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Ingår i: American Journal of Tropical Medicine and Hygiene. - : American Society of Tropical Medicine and Hygiene. - 0002-9637 .- 1476-1645. ; 87:suppl 5, s. 36-45
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Tidskriftsartikel (refereegranskat)abstract
- We compared use of community medicine distributors (CMDs) and drug use under integrated community case management and home-based management strategies in children 6–59 months of age in eastern Uganda. A cross-sectional study with 1,095 children was nested in a cluster randomized trial with integrated community case management (CMDs treating malaria and pneumonia) as the intervention and home-based management (CMDs treating only malaria) as the control. Care-seeking from CMDs was higher in intervention areas (31%) than in control areas (22%; P = 0.01). Prompt and appropriate treatment of malaria was higher in intervention areas (18%) than in control areas (12%; P = 0.03) and among CMD users (37%) than other health providers (9%). The mean number of drugs among CMD users compared with other health providers was 1.6 versus 2.4 in intervention areas and 1.4 versus 2.3 in control areas. Use of CMDs was low. However, integrated community case management of childhood illnesses increased use of CMDs and rational drug use.Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Swedish International Development Cooperation Agency or the United Nations Children's Fund/ United Nations Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases.
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| 5. |
- Kalyango, Joan N, et al.
(författare)
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Integrated community case management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms in children under five years in Eastern Uganda
- 2013
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Ingår i: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 12, s. 340-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Efforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home management of malaria strategy. However under this strategy, children with other illnesses were often wrongly treated with anti-malarials. Integrated community case management of common childhood illnesses is now recommended but its effect on promptness of appropriate pneumonia treatment is unclear.ObjectivesTo determine the effect of integrated malaria and pneumonia management on receiving prompt and appropriate antibiotics for pneumonia symptoms and treatment outcomes as well as determine associated factors.METHODS: A follow-up study was nested within a cluster-randomized trial that compared under-five mortality in areas where community health workers (CHWs) treated children with malaria and pneumonia (intervention areas) and where they treated children with malaria only (control areas). Children treated by CHWs were enrolled on the day of seeking treatment from CHWs (609 intervention, 667 control) and demographic, illness, and treatment seeking information was collected. Further information on illness and treatment outcomes was collected on day four. The primary outcome was prompt and appropriate antibiotics for pneumonia symptoms and the secondary outcome was treatment outcomes on day four.RESULTS: Children in the intervention areas were more likely to receive prompt and appropriate antibiotics for pneumonia symptoms compared to children in the control areas (RR = 3.51, 95%CI = 1.75-7.03). Children in the intervention areas were also less likely to have temperature >=37.5[degree sign]C on day four (RR = 0.29, 95%CI = 0.11-0.78). The decrease in fast breathing between day one and four was greater in the intervention (9.2%) compared to the control areas (4.2%, p-value = 0.01).CONCLUSIONS: Integrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes. Trial registrationISRCTN: ISRCTN52966230.
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| 6. |
- Kalyango, Joan N, et al.
(författare)
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Performance of community health workers under integrated community case management of childhood illnesses in eastern Uganda
- 2012
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Ingår i: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 11:1, s. 282-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Curative interventions delivered by community health workers (CHWs) were introduced to increase access to health services for children less than five years and have previously targeted single illnesses. However, CHWs in the integrated community case management of childhood illnesses strategy adopted in Uganda in 2010 will manage multiple illnesses. There is little documentation about the performance of CHWs in the management of multiple illnesses. This study compared the performance of CHWs managing malaria and pneumonia with performance of CHWs managing malaria alone in eastern Uganda and the factors influencing performance.METHODS:A mixed methods study was conducted among 125 CHWs providing either dual malaria and pneumonia management or malaria management alone for children aged four to 59 months. Performance was assessed using knowledge tests, case scenarios of sick children, review of CHWs' registers, and observation of CHWs in the dual management arm assessing respiratory symptoms. Four focus group discussions with CHWs were also conducted.RESULTS:CHWs in the dual- and single-illness management arms had similar performance with respect to: overall knowledge of malaria (dual 72 %, single 70 %); eliciting malaria signs and symptoms (50 % in both groups); prescribing anti-malarials based on case scenarios (82 % dual, 80 % single); and correct prescription of anti-malarials from record reviews (dual 99 %, single 100 %). In the dual-illness arm, scores for malaria and pneumonia differed on overall knowledge (72 % vs 40 %, p < 0.001); and correct doses of medicines from records (100 % vs 96 %, p < 0.001). According to records, 82 % of the children with fast breathing had received an antibiotic. From observations 49 % of CHWs counted respiratory rates within five breaths of the physician (gold standard) and 75 % correctly classified the children. The factors perceived to influence CHWs' performance were: community support and confidence, continued training, availability of drugs and other necessary supplies, and cooperation from formal health workers.CONCLUSION:CHWs providing dual-illness management handled malaria cases as well as CHWs providing single-illness management, and also performed reasonably well in the management of pneumonia. With appropriate training that emphasizes pneumonia assessment, adequate supervision, and provision of drugs and necessary supplies, CHWs can provide integrated treatment for malaria and pneumonia.
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| 7. |
- Mayega, Roy William, et al.
(författare)
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Modifiable Socio-Behavioural Factors Associated with Overweight and Hypertension among Persons Aged 35 to 60 Years in Eastern Uganda
- 2012
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 7:10, s. e47632-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Few studies have examined the behavioural correlates of non-communicable, chronic disease risk in low-income countries. The objective of this study was to identify socio-behavioural characteristics associated with being overweight or being hypertensive in a low-income setting, so as to highlight possible interventions and target groups.METHODS:A population based survey was conducted in a Health and Demographic Surveillance Site (HDSS) in eastern Uganda. 1656 individuals aged 35 to 60 years had their Body Mass Index (BMI) and blood pressure (BP) assessed. Seven lifestyle factors were also assessed, using a validated questionnaire. Logistic regression was used to identify socio-behavioural factors associated with being overweight or being hypertensive.RESULTS:Prevalence of overweight was found to be 18% (25.2% of women; 9.7% of men; p<0.001) while prevalence of obesity was 5.3% (8.3% of women; 2.2% of men). The prevalence of hypertension was 20.5%. Factors associated with being overweight included being female (OR 3.7; 95% CI 2.69-5.08), peri-urban residence (OR 2.5; 95% CI 1.46-3.01), higher socio-economic status (OR 4.1; 95% CI 2.40-6.98), and increasing age (OR 1.8; 95% CI 1.12-2.79). Those who met the recommended minimum physical activity level, and those with moderate dietary diversity were less likely to be overweight (OR 0.5; 95% CI 0.35-0.65 and OR 0.7; 95% CI 0.49-3.01). Factors associated with being hypertensive included peri-urban residence (OR 2.4; 95%CI 1.60-3.66), increasing age (OR 4.5; 95% CI 2.94-6.96) and being over-weight (OR 2.8; 95% CI 1.98-3.98). Overweight persons in rural areas were significantly more likely to be hypertensive than those in peri-urban areas (p = 0.013).CONCLUSIONS:Being overweight in low-income settings is associated with sex, physical activity and dietary diversity and being hypertensive is associated with being overweight; these factors are modifiable. There is need for context-specific health education addressing disparities in lifestyles at community levels in rural Africa.
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| 8. |
- Rutebemberwa, Elizeus, et al.
(författare)
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High prevalence of antibiotic resistance in nasopharyngeal bacterial isolates from healthy children in rural Uganda : A cross-sectional study
- 2015
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 120:4, s. 249-256
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia-often due to delayed diagnosis and treatment. In preparation for a community case management intervention for pneumonia and malaria, the bacterial composition of the nasopharyngeal flora and its in vitro resistance were determined in children aged five or under to establish baseline resistance to commonly used antibiotics.METHODS: In a population-based survey in April 2008, nasopharyngeal specimens were collected from 152 randomly selected healthy children under 5 years of age in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS). Medical history and prior treatment were recorded. Demographic characteristics and risk factors for carriage of resistant strains were obtained from the HDSS census. Bacteria were isolated and analysed for antibiotic susceptibility using disk diffusion and E test.RESULTS: Streptococcus pneumoniae (S. pneumoniae) carriage was 58.6%, and, while most (80.9%) isolates had intermediate resistance to penicillin, none was highly resistant. Whereas no isolate was resistant to erythromycin, 98.9% were resistant to trimethoprim-sulphamethoxazole (co-trimoxazole).CONCLUSIONS: In vitro resistance in S. pneumoniae to co-trimoxazole treatment was high, and the majority of isolates had intermediate resistance to penicillin. To inform treatment policies on the clinical efficacy of current treatment protocols for pneumonia in health facilities and at the community level, routine surveillance of resistance in pneumonia pathogens is needed as well as research on treatment efficacy in cases with resistant strains. Improved clinical algorithms and diagnostics for pneumonia should be developed.
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| 9. |
- Rutebemberwa, Elizeus Kabareebe
(författare)
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Access to health care for febrile children in Uganda : symptom recognition, care seeking practices and provider choice
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Febrile illnesses including malaria and pneumonia are leading causes of death among children under five in Uganda. The survival of a sick child depends on access to prompt and appropriate care. Despite government efforts to increase health care access by offering free services at government facilities, the majority of the sick children receive care after 24 hours, often with less efficacious drugs. One of the strategies suggested for increasing access is the distribution of antimalarials and antibiotics at community level. However, determinants on access to health care for febrile children are not sufficiently understood. Main aim: The aim of this study was to assess the factors associated with access to treatment for febrile children under five in order to inform the implementation of child survival interventions at community level. Methods: Four studies were conducted in the Iganga Mayuge Demographic Surveillance Site in eastern Uganda (I IV). Study I used key informant interviews (KIIs) with eight health workers and eight traditional healers and five focus group discussions (FGDs) with mothers of children under five. Study II was a cross sectional survey of 9,176 children under five. Study III was a survey of a random sample of 1078 households with children under five. Study IV used four FGDs with fathers and mothers of children under five and eight KIIs with health workers in government and Non-Governmental Organization facilities, community medicine distributors (CMDs), and attendants in drug shops and private clinics. Content analysis was used for qualitative data. Quantitative data was analysed at univariate, bivariate and multivariate levels to determine the independent predictors of delayed care or choice of provider. Results: There is general lack of knowledge on antibiotics as first treatment for fever with pneumonia symptoms (I) and use of less efficacious drugs for malaria acquired from the open market (IV). Caretakers prefer health care providers with a variety of drugs and able to do diagnostic investigations (IV). Two thirds of the caretakers consult the private sector and 27% of them among other things because they can get treatment on credit (III).There are diverse perceptions on drug efficacy among caretakers (IV). Being of low socio-economic status (OR 1.45; 95% CI 1.06 1.97) and presenting with pallor (OR 1.58; 95% CI 1.10 2.25) are associated with delay in care seeking >24 hours after onset. Children seeking care outside the home <24 hours had fast breathing (OR 0.75; 95% CI 0.60 0.87), had had tepid sponging (OR 0.43; 95% CI 0.27 0.68), had provider proximity (OR 0.72; 95% CI 0.60 0.87) and went to drug shops (OR 0.70; 95% CI 0.59 0.84) or CMDs (OR 0.33; 95% CI 0.15 0.74) (II). Caretakers more likely went to government facilities when children had vomiting (OR 2.07; 95% CI 1.10 3.89), or when expecting qualified (OR 10.32; 95% CI 5.84 18.26) or experienced workers (OR 1.93; 95% CI 1.07 3.48). Caretakers went to private providers when seeking treatment as first aid (OR 0.20; 95% CI 0.08 0.52) (III). Discussion: Caretakers should be sensitized on recognition of symptoms for pneumonia, prompt care seeking and use of efficacious drugs. CMDs should be able to do some diagnostic investigations and have constant drug supply. Using drug shops and private clinics in community interventions could complement government efforts to deliver timely treatment.
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| 10. |
- Rutebemberwa, Elizeus, et al.
(författare)
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Use of drugs, perceived drug efficacy and preferred providers for febrile children : implications for home management of fever
- 2009
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Ingår i: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 8:1, s. 131-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Community distribution of anti-malarials and antibiotics has been recommended as a strategy to reduce the under-five mortality due to febrile illnesses in sub-Saharan Africa. However, drugs distributed in these interventions have been considered weak by some caretakers and utilization of community medicine distributors has been low. The aim of the study was to explore caretakers' use of drugs, perceptions of drug efficacy and preferred providers for febrile children in order to make suggestions for community management of pneumonia and malaria. METHODS: The study was conducted in eastern Uganda using four focus group discussions with fathers and mothers of children under five; and eight key informant interviews with health workers in government and non-governmental organization facilities, community medicine distributors, and attendants in drug shops and private clinics. Caretakers were asked the drugs they use for treatment of fever, why they considered them efficacious, and the providers they go to and why they go there. Health providers were interviewed on their opinions of caretakers' perceptions of drugs and providers. Analysis was done using content analysis. RESULTS: Drugs that have been phased out as first-line treatment for malaria, such as chloroquine and sulphadoxine/pyrimethamine, are still perceived as efficacious. Use of drugs depended on perception of the disease, cost and drug availability. There were divergent views about drug efficacy concerning drug combinations, side effects, packaging, or using drugs over time. Bitter taste and high cost signified high efficacy for anti-malarials. Government facilities were preferred for conducting diagnostic investigations and attending to serious illnesses, but often lacked drugs and did not treat people fast. Drug shops were preferred for having a variety of drugs, attending to clients promptly and offering treatment on credit. However, drug shops were considered disadvantageous since they lacked diagnostic capability and had unqualified providers. CONCLUSION: Community views about drug efficacy are divergent and some may divert caretakers from obtaining efficacious drugs for febrile illness. Interventions should address these perceptions, equip community medicine distributors with capacity to do diagnostic investigations and provide a constant supply of drugs. Subsidized efficacious drugs could be made available in the private sector.
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| 11. |
- Rutebemberwa, Elizeus, et al.
(författare)
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Utilization of public or private health care providers by febrile children after user fee removal in Uganda
- 2009
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Ingår i: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 8, s. 45-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Despite investments in providing free government health services in Uganda, many caretakers still seek treatment from the drug shops/private clinics. The study aimed to assess determinants for use of government facilities or drug shops/private clinics for febrile illnesses in children under five. METHODS: Structured questionnaires were administered to caretakers in 1078 randomly selected households in the Iganga - Mayuge Demographic Surveillance site. Those with children who had had fever in the previous two weeks and who had sought care from outside the home were interviewed on presenting symptoms and why they chose the provider they went to. Symptoms children presented with and reasons for seeking care from government facilities were compared with those of drug shops/private clinics. RESULTS: Of those who sought care outside the home, 62.7% (286/456) had first gone to drug shops/private clinics and 33.1% (151/456) first went to government facilities. Predictors of having gone to government facilities with a febrile child were child presenting with vomiting (OR 2.07; 95% CI 1.10 - 3.89) and perceiving that the health providers were qualified (OR 10.32; 95% CI 5.84 - 18.26) or experienced (OR 1.93; 95% CI 1.07 - 3.48). Those who took the febrile child to drug shops/private clinics did so because they were going there to get first aid (OR 0.20; 95% CI 0.08 - 0.52). CONCLUSION: Private providers offer 'first aid' to caretakers with febrile children. Government financial assistance to health care providers should not stop at government facilities. Multi-faceted interventions in the private sector and implementation of community case management of febrile children through community medicine distributors could increase the proportion of children who access quality care promptly.
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| 12. |
- Wanduru, Phillip, et al.
(författare)
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The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda : a mixed methods cross-sectional study
- 2016
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Community health workers (CHWs) have the potential to reduce child mortality by improving access to care, especially in remote areas. Uganda has one of the highest child mortality rates globally. Moreover, rural areas bear the highest proportion of this burden. The optimal performance of CHWs is critical. In this study, we assess the performance of CHWs in managing malaria, pneumonia, and diarrhea in the rural district of Lira, in northern Uganda.Designs: A cross-sectional mixed methods study was undertaken to investigate the performance of 393 eligible CHWs in the Lira district of Uganda. Case scenarios were conducted with a medical officer observing CHWs in their management of children suspected of having malaria, pneumonia, or diarrhea. Performance data were collected using a pretested questionnaire with a checklist used by the medical officer to score the CHWs. The primary outcome, CHW performance, is defined as the ability to diagnose and treat malaria, diarrhea, and pneumonia appropriately. Participants were described using a three group performance score (good vs. moderate vs. poor). A binary measure of performance (good vs. poor) was used in multivariable logistic regression to show an association between good performance and a range of independent variables. The qualitative component comprised seven key informant interviews with experts who had informed knowledge with regard to the functionality of CHWs in Lira district.Results: Overall, 347 CHWs (88.3%) had poor scores in managing malaria, diarrhea, and pneumonia, 26 (6.6%) had moderate scores, and 20 (5.1%) had good scores. The factors that were positively associated with performance were secondary-level education (adjusted odds ratio [AOR] 2.72; 95% confidence interval [CI] 1.50-4.92) and meeting with supervisors in the previous month (AOR 2.52; 95% CI 1.12-5.70). Those factors negatively associated with CHW performance included: serving 100-200 households (AOR 0.24; 95% CI 0.12-0.50), serving more than 200 households (AOR 0.22; 95% CI 0.10-0.48), and an initial training duration lasting 2-3 days (AOR 0.13; 95% CI 0.04-0.41). The qualitative findings reinforced the quantitative results by indicating that refresher training, workload, and in-kind incentives were important determinants of performance.Conclusions: The performance of CHWs in Lira was inadequate. There is a need to consider pre-qualification testing before CHWs are appointed. Providing ongoing support and supervision, and ensuring that CHWs have at least secondary education can be helpful in improving their performance. Health system managers also need to ensure that the CHWs' workload is moderated as work overload will reduce performance. Finally, although short training programs are beneficial to some degree, they are not sufficient and should be followed up with regular refresher training.
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