| 1. |
- Bergström, Anna, 1983-, et al.
(författare)
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Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework
- 2012
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Ingår i: Implementation Science. - : BioMed Central (BMC). - 1748-5908. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting.METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data.RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT.CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.
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| 2. |
- Hanson, Claudia, et al.
(författare)
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Expanded Quality Management Using Information Power (EQUIP) : protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.
- 2014
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Ingår i: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda.METHODS: In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys.DISCUSSION: EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings.TRIAL REGISTRATION: PACTR201311000681314.
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| 3. |
- 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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| 4. |
- Mukanga, David, et al.
(författare)
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Access, acceptability and utilization of community health workers using diagnostics for case management of fever in Ugandan children : a cross-sectional study
- 2012
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Ingår i: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875 .- 1475-2875. ; 11, s. 121-
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Tidskriftsartikel (refereegranskat)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<0.001). The median walking time by caregivers to a CHW was 10 minutes (IQR 5-20). The first option for care for febrile children in the month preceding the survey was CHWs (40%, 242/601), followed by drug shops (33%, 196/601). 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.
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| 5. |
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| 6. |
- 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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| 7. |
- Waiswa, Peter, et al.
(författare)
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'I never thought that this baby would survive; I thought that it would die any time' : perceptions and care for preterm babies in eastern Uganda
- 2010
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Ingår i: Tropical medicine & international health. - : Wiley. - 1360-2276 .- 1365-3156. ; 15:10, s. 1140-1147
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To explore the current care for and perceptions about preterm babies among community members in eastern Uganda. METHODS A neonatal midwife observed care of preterm babies in one general hospital and 15 health centres using a checklist and a field diary. In-depth interviews were conducted with 11 community health workers (CHWs) and also with 10 mothers, six fathers and three grandmothers of preterm babies. Three focus group discussions were conducted with midwives and women and men in the community. Content analysis of data was performed. RESULTS Community members mentioned many features which may correctly be used to identify preterm babies. Care practices for preterm babies at health facilities and community level were inadequate and potentially harmful. Health facilities lacked capacity for care of preterm babies in terms of protocols, health workers' skills, basic equipment, drugs and other supplies. However, community members and CHWs stated that they accepted the introduction of preterm care practices such as skin-to-skin and kangaroo mother care. CONCLUSION In this setting, care for preterm babies is inadequate at both health facility and community level. However, acceptance of the recommended newborn care practices indicated by the community is a window of opportunity for introducing programmes for preterm babies. In doing so, consideration needs to be given to the care provided at health facilities as well as to the gaps in community care that are largely influenced by beliefs, perceptions and lack of awareness.
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| 8. |
- Waiswa, Peter, et al.
(författare)
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Poor newborn care practices : a population based survey in eastern Uganda
- 2010
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Four million neonatal deaths are estimated to occur each year and almost all in low income countries, especially among the poorest. There is a paucity of data on newborn health from sub-Saharan Africa and few studies have assessed inequity in uptake of newborn care practices. We assessed socioeconomic differences in use of newborn care practices in order to inform policy and programming in Uganda.METHODS:All mothers with infants aged 1-4 months (n = 414) in a Demographic Surveillance Site were interviewed. Households were stratified into quintiles of socioeconomic status (SES). Three composite outcomes (good neonatal feeding, good cord care, and optimal thermal care) were created by combining related individual practices from a list of twelve antenatal/essential newborn care practices. Multiple logistic regression analysis was used to identify determinants of each dichotomised composite outcome.RESULTS:There were low levels of coverage of newborn care practices among both the poorest and the least poor. SES and place of birth were not associated with any of the composite newborn care practices. Of newborns, 46% had a facility delivery and only 38% were judged to have had good cord care, 42% optimal thermal care, and 57% were considered to have had adequate neonatal feeding. Mothers were putting powder on the cord; using a bottle to feed the baby; and mixing/replacing breast milk with various substitutes. Multiparous mothers were less likely to have safe cord practices (OR 0.5, CI 0.3 - 0.9) as were mothers whose labour began at night (OR 0.6, CI 0.4 - 0.9).CONCLUSION:Newborn care practices in this setting are low and do not differ much by socioeconomic group. Despite being established policy, most neonatal interventions are not reaching newborns, suggesting a "policy-to-practice gap". To improve newborn survival, newborn care should be integrated into the current maternal and child interventions, and should be implemented at both community and health facility level as part of a universal coverage strategy.
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| 9. |
- Waiswa, Peter, et al.
(författare)
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The Uganda Newborn Study (UNEST) : an effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities - study protocol for a cluster randomized controlled trial
- 2012
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 13, s. 213-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reducing neonatal-related deaths is one of the major bottlenecks to achieving Millennium Development Goal 4. Studies in Asia and South America have shown that neonatal mortality can be reduced through community-based interventions, but these have not been adapted to scalable intervention packages for sub-Saharan Africa where the culture, health system and policy environment is different. In Uganda, health outcomes are poor for both mothers and newborn babies. Policy opportunities for neonatal health include the new national Health Sector Strategic Plan, which now prioritizes newborn health including use of a community model through Village Health Teams (VHT). The aim of the present study is to adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and to evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda. Methods/Design: Through formative research around evidence-based practices, and dialogue with policy and technical advisers, we constructed a home-based neonatal care package implemented by the responsible VHT member, effectively a Community Health Worker (CHW). This CHW was trained to identify pregnant women and make five home visits - two before and three just after birth - so that linkages will be made to facility care and targeted messages for home-care and care-seeking delivered. The project is improving care in health units to provide standardized care for the mother and the newborn in both intervention and comparison areas. The study is taking place in a new Demographic Surveillance Site in two rural districts, Iganga and Mayuge, in Uganda. It is a two-arm cluster randomized controlled design with 31 intervention and 32 control areas (villages). The comparison parishes receive the standard care already being provided by the district, but to the intervention villages are added a system for CHWs to visit the mother five times in her home during pregnancy and the neonatal period. Both areas benefit from a standardized strengthening of facility care for mothers and neonates. (Continued on next page) Discussion: UNEST is designed to directly feed into the operationalization of maternal and newborn care in the national VHT strategy, thereby helping to inform scale-up in rural Uganda. The study is registered as a randomized controlled trial, number ISRCTN50321130.
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| 10. |
- Waiswa, Peter
(författare)
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Understanding newborn care in Uganda : towards future interventions
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The highest rates of newborn deaths are in Africa. Existing evidence-based interventions could reduce up to 72% of the 3.8 million newborn deaths which occur every year worldwide, but are yet to be operationalised at scale in sub-Saharan health systems. Aim: To explore community perceptions, determine uptake of evidence-based newborn care practices, and identity delays leading to newborn deaths in Uganda. Methods: Studies were conducted from 2007 to 2009 in Iganga and Mayuge districts in eastern Uganda, and in an embedded Health Demographic Surveillance Site (HDSS) as follows: Qualitative methods with focus group discussions and in-depth interviews (I and IV); a population based cross-sectional study (II) and a case series approach of newborn deaths in the HDSS (III); and a health facility survey (III and IV). A wealth index was generated using principal component analysis of household assets, and was used as a proxy for socio-economic status (II and III). Verbal and social autopsy and a modified maternal mortality delay model were used to code causes and care-seeking delays of newborn deaths (III). Standard descriptive analysis (III) and content analysis were done (I and IV). Newborn care practices were coded as binary composite outcomes (optimal thermal care, good cord care, and good neonatal feeding) and multiple logistic regression analysis was done (II). Results: Most of the evidence-based newborn care practices were acceptable to community members but not promoted by health providers (I and IV). There was poor uptake of newborn care practices among both the poorest and least poor (II). Some practices like putting nothing on the umbilical cord and delaying bathing were less acceptable to caregivers (I). Only 42%, 38%, and 57% of newborns were judged to have had optimal thermal care, good cord care, and good neonatal feeding, respectively (II). Some mothers were putting powder on the cord; using a bottle to feed the baby and mixing/replacing breast milk with various substitutes (I, II and IV). Multiparous mothers were less likely to have safe cord practices (OR 0.5, CI 0.3 0.9), and so were mothers whose labour began at night (OR 0.6, CI 0.4 0.9) (II). 33% of 64 newborn babies had died in a hospital/health centre, 13% in private clinics and 54% died elsewhere (III). The median time to seeking care was 3 days from illness onset (IQR 1-6) (III). Major delays related to deaths of newborn babies were Delay 1 (delay in problem recognition and deciding to seek outside care) (50%) and Delay 3 (delay in receiving treatment at a health facility) (30%) (III). Health facilities lacked equipment, drugs, supplies and protocols for newborn care, and health workers had correct knowledge on only 31% of the survey questions related to newborn care (III). Care practices for preterm babies at home and at health facilities were of poor quality and potentially harmful (IV). Discussion: Implementation of evidence-based newborn care practices needs to be tailored to the local context. In order to reduce newborn deaths, a universal strategy targeting the entire population is needed and should utilise the many missed opportunities in current programmes. Capacity to manage newborns should be built at health facilities, including private clinics and those at the lower level. Community health workers in health facilitylinked preventive and curative newborn programmes may assist in underserved areas.
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